# Basic problem of for-profit medical care **URL:** \ **Category:** The BBQ Pit\ **Created:** [April 17, 2012, 3:03pm UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045 "2012-04-17T15:03:46Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![MsRobyn](https://avatars.discourse-cdn.com/v4/letter/m/90ced4/32.png) [@MsRobyn](https://boards.straightdope.com/u/MsRobyn)\ **Post date:** [April 20, 2012, 1:17am UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/41 "2012-04-20T01:17:49Z")
> [@curlcoat](#): > > It is not a “line”. Social Security is not “government aid”. I’m not going to touch this, except to wonder out loud what Social Security is if it’s not “government aid.” 😕 > [@](#): > > I’m not sure what your quote has to do with what I said, especially since you seem to think it somehow proves that the state hasn’t gotten into financial trouble largely because the government expects those with money to support those who are here illegally, or who cannot be bothered to support themselves. Your cite shows they haven’t learned from that and are considering making even more of those who still have some money to pay in even more. As for numbers out of my ass, I have no idea what you are talking about, unless it’s that 11 million? That is a quote from a post by **JohnBckWLD**. I personally have no idea how many illegals there are here. I don’t doubt that the State of California is in deep and dire shit, at least as far as its budget is concerned. However, you apparently missed the part in the article where, under California’s version of RomneyCare, people would be required to _purchase_ health insurance. I don’t recall anything about the state giving it to them for free. > [@](#): > > You want to provide a cite that all smokers are charged more for insurance? My husband has smoked for decades and in the 20 years I’ve been married to him, he has never paid more for coverage. Just as the people in his office who have four kids don’t pay any more than those with two. Unless things have radically changed in the group insurance industry since I left in 2007, providing lower premiums for non-smokers is rare. Just because individual employees aren’t charged more for their insurance doesn’t mean that the increased cost isn’t spread out to all of them. In other words, the people who don’t smoke absorb part of the cost of those who do. Indeed, if this weren’t the case, why would so many [employers complain about smoking being part of the problem in the increase in premiums](http://www.reuters.com/article/2011/10/31/us-penalties-newspro-idUSTRE79U3CB20111031)? (There’s a nifty infographic [here](http://graphics.thomsonreuters.com/11/10/US_HEALTHCOSTS1011_VT.html).) Besides, your husband’s company is one of many. Other companies, such as Wal-Mart, are actively thinking about penalizing smokers and the obese directly with higher individual premiums and rewarding people who quit smoking and lose weight with by not charging those higher premiums. > [@](#): > > Higher premiums for those who _already have children_, and as I said above, generally no more (or not significantly more) for many children than for a few. That is all based on how many people the policy needs to cover - the costs to take care of a pregnancy, birth the child and any issues arising from child birth are not part of that. They are just lumped into the coverage of any female of child bearing age, because the assumption is that any such female will start having kids as soon as she gets coverage (no I don’t have a cite for that, it is just what was said during my 25 years in insurance). Addressing your last claim first, I call bullshit. It may be the assumption, but it’s far from the truth. That said, people with kids already pay higher premiums. Some companies offer two prices, one for individuals and one for families. Others charge per individual person, so a family of four would pay for the employee, the spouse, and two children, while a family of five would pay for three children. Either way, people who have kids pay more for insurance. > [@](#): > > You seriously think that it is trolling to expect people to pay the freight for those who are selfish enough to roll the genetic dice and hope that their child won’t get whatever expensive health problem they have? Shit, it’s bad enough for the child itself, but then these folks turn around and look to others to pay for that bad genetic roll. I do. Suggesting that people not give birth because it’s so expensive for the rest of us is trolling, and if it’s not, it’s inhumane and hateful. Of course, I’ve come to expect this from you. > [@](#): > > Just because I don’t think that children are the be all and end all of existence doesn’t mean that I am trolling. And if you could think without all those baby booties in your way, you would realize that a basic policy would cover all things that are not brought about by choice. You know, like how plastic surgery is covered under almost all policies if it is the result of an injury or accident, but not if it is being done because the person doesn’t like their nose or whatever? How most (all?) insurance that covers Lapbands only do so if you are X overweight and regular weight loss has already been attempted? A basic policy would cover accidents (not covered by other coverage), illnesses, essentially any breakdown of the human body that come about thru the course of living life, but nothing that comes about because someone chose to do drugs, smoke, create life, race cars or anything else that folks choose to do that tend to end up costing an insurance company a bunch of money. I’m not sure why you seem to think I’ve got baby booties in my way, nor do I see what that has to do with the rest of your point. There are such policies, and they are relatively expensive, but they don’t work for everyone. > [@](#): > > At least I’m not creating a significant ongoing expense (children) that I cannot afford. Really, if you cannot save $400 in five years (time from when baby is born until it enters school) what are you doing with a child? That’s less than $7 a month. You shouldn’t be having children unless you can afford to save for their college, never mind school vaccinations. My child’s education costs are taken care of, thanks. In terms of vaccinations, I wish they only cost $400. But that’s just for one set. Each child requires several doses of several vaccines starting at birth. In any event, making sure that every child is fully vaccinated is definitely to the benefit of the public at large because of herd immunity. Making sure that cost isn’t a barrier is a big part of that benefit. > [@](#): > > I fail to see how you can consider me an idiot for expecting that others should show some amount of personal responsibility. I still haven’t figured out how we ended up with the idea that people should not be held responsible for the decision to reproduce without having the money to pay for it as long as there are other around who can be forced to cover the costs. Neither do I understand how anyone can look at what is happening here and not see the devastating results of those policies. There’s personal responsibility, and then there’s the hateful, selfish bullshit that you spew. I’m not thrilled about paying for someone’s open-heart surgery after a lifetime of smoking and/or obesity. But I accept it and move on because we, as a society, have decided that that’s what we should do. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [April 20, 2012, 4:32am UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/42 "2012-04-20T04:32:06Z")
> [@MsRobyn](#): > > I’m not going to touch this, except to wonder out loud what Social Security is if it’s not “government aid.” 😕 Really? You honestly don’t know that Social Security is a pension plan the government forces you to pay into? > [@](#): > > I don’t doubt that the State of California is in deep and dire shit, at least as far as its budget is concerned. However, you apparently missed the part in the article where, under California’s version of RomneyCare, people would be required to _purchase_ health insurance. I don’t recall anything about the state giving it to them for free. And I don’t recall saying anything about the state giving it to them for free either. However, I also have to hope that even our government is not so stupid that they will think that all the folks on Medi-Cal will suddenly be able to buy insurance? And if they are actually going to require everyone with some money to buy insurance, do you honestly think there isn’t going to be a sliding scale based on income? We have a _lot_ of people here making more or less minimum wage with three or four kids - do you really think they are going to pay as much for their insurance as a middle class couple? > [@](#): > > Just because individual employees aren’t charged more for their insurance doesn’t mean that the increased cost isn’t spread out to all of them. And that is exactly what I was speaking to. There is no reason why others should have to pay extra to cover those who make choices that will end up costing the insurance company a pile of money. > [@](#): > > Other companies, such as Wal-Mart, are actively thinking about penalizing smokers and the obese directly with higher individual premiums and rewarding people who quit smoking and lose weight with by not charging those higher premiums. “Actively thinking about” is not the same thing as “smokers are charged more for insurance”, which is what you claimed earlier. However, it would be nice if more companies actually did that, as well as carving out other expensive choices. > [@](#): > > Addressing your last claim first, I call bullshit. It may be the assumption, but it’s far from the truth. Shrug. I’m the one with the decades in the insurance industry. And assumptions made by actuaries tend to turn into policy premium costs. However, back then it was probably any married female of child bearing age, not just any female as I said before. > [@](#): > > That said, people with kids already pay higher premiums. Some companies offer two prices, one for individuals and one for families. Others charge per individual person, so a family of four would pay for the employee, the spouse, and two children, while a family of five would pay for three children. Either way, people who have kids pay more for insurance. For starters, there are also policies where there is a price for the employee, a lesser add on for a spouse, and an even less add on price for each kid. Or it can be a just two or three prices - employee only, employee and spouse or family. In all of these, the more people that are covered, the less each one costs. People with kids may be paying more money, but they are generally paying less per person than those without. You also completely ignored how the birth of each child isn’t covered by a new payment to the insurance company. > [@](#): > > I do. Suggesting that people not give birth because it’s so expensive for the rest of us is trolling, and if it’s not, it’s inhumane and hateful. Of course, I’ve come to expect this from you. Well, if I’d said that people shouldn’t have kids because it’s so expensive for the rest of us, yeah that might be trolling but of course that isn’t what I said. What I said was I don’t think that if those who know they carry for a serious genetic problem decide to have children, they should not expect the rest of the world to pay for it. I’d see this back when I was paying medical claims - family with four children and there would be at least one kid born after the one with CF or juvenile diabetes or whatever. When I was paying claims for people living in Alaska, there were women who would have child after child with fetal alcohol syndrome. These days I imagine it’s more an issue of crack babies, but everyone still has the right to have children no matter what, right? > [@](#): > > I’m not sure why you seem to think I’ve got baby booties in my way, nor do I see what that has to do with the rest of your point. That’s because you ignored the point, which is you cannot address the subject in anything approaching rational because it’s about children. You don’t get that there are a lot of us out here who are tired of paying for your lifestyle choice, because you think it is the obvious and natural one. And somehow over the decades, it has also become common? natural? to assume that the choice to have children will be subsidized by others. > [@](#): > > There are such policies, and they are relatively expensive, but they don’t work for everyone. Of course they don’t, because then those who chose to have children, smoke or become obese wouldn’t be able to afford to do it/pay the medical bills. > [@](#): > > My child’s education costs are taken care of, thanks. Congratulations for going from not being able to cover vaccinations to being able to cover the cost of a college education. > [@](#): > > In terms of vaccinations, I wish they only cost $400. But that’s just for one set. Each child requires several doses of several vaccines starting at birth. In any event, making sure that every child is fully vaccinated is definitely to the benefit of the public at large because of herd immunity. Making sure that cost isn’t a barrier is a big part of that benefit. What is even better for the public at large is fewer people stressing our resources. > [@](#): > > There’s personal responsibility, and then there’s the hateful, selfish bullshit that you spew. I’m not thrilled about paying for someone’s open-heart surgery after a lifetime of smoking and/or obesity. But I accept it and move on because we, as a society, have decided that that’s what we should do. See, there you are with your bigotry. You call it hateful, selfish bullshit because you don’t agree with me that children are merely a lifestyle choice. As for society deciding we should pay for all of those open-heart surgeries - _that is my whole point_. We cannot afford to keep doing that. There are simply too many people taking hundreds of thousands of dollars out of the system due to having made irresponsible choices, and we are running out of people who can afford to pay back in. As medical science makes more and more advances, we have the ability to treat and keep alive more people, at a huge financial cost. Everyone wants to say that a human life is worth more than money, but nobody wants to face the fact that money is finite. Yet society goes merrily along insisting that everyone “deserves” whatever they want, right now, just do it. I just hope I die before the whole thing goes into the bucket because I really don’t want to have to live thru that. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [April 20, 2012, 8:13pm UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/43 "2012-04-20T20:13:40Z")
> [@curlcoat](#): > > I’m not sure what your quote has to do with what I said, especially since you seem to think it somehow proves that the state hasn’t gotten into financial trouble largely because the government expects those with money to support those who are here illegally, or who cannot be bothered to support themselves. Your cite shows they haven’t learned from that and are considering making even more of those who still have some money to pay in even more. As for numbers out of my ass, I have no idea what you are talking about, unless it’s that 11 million? That is a quote from a post by **JohnBckWLD**. I personally have no idea how many illegals there are here. [This chart](http://www.indexmundi.com/facts/united-states/state-taxes/california/all-tax-types/tax-revenue#graph) shows how we got into trouble - a significant dip in revenue from the recession, made even worse because here in California too much of the revenue comes from income and sales taxes, which fluctuate with the economic condition, and too little from property taxes, which don’t. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [April 21, 2012, 6:09am UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/44 "2012-04-21T06:09:29Z")
> [@Voyager](#): > > [This chart](http://www.indexmundi.com/facts/united-states/state-taxes/california/all-tax-types/tax-revenue#graph) shows how we got into trouble - a significant dip in revenue from the recession, made even worse because here in California too much of the revenue comes from income and sales taxes, which fluctuate with the economic condition, and too little from property taxes, which don’t. I’m on dial up and that thing didn’t want to load - if it says only what you recapped that isn’t my point. Yes, I know that the recession meant less income from taxes, but what I am talking about is the decades of more and more social services paid out while ignoring the slip in the tax base (which started before the latest recession). California has also, at least recently, had a history of being unfriendly to business, so there is more money lost. So now we have all these people depending on all these social programs, not enough money coming in AND now they want to force us to pay for some plan to get everyone insured? And they keep wanting to repeal Prop 13 to jack up our property taxes, as if our mortgages aren’t high enough. Something is going to break here. ---
**Author:** ![Isamu](https://avatars.discourse-cdn.com/v4/letter/i/7c8e57/32.png) [@Isamu](https://boards.straightdope.com/u/Isamu)\ **Post date:** [April 21, 2012, 6:59am UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/45 "2012-04-21T06:59:59Z")
I don’t know of any country that has a non ‘for-profit’ healthcare system. Even in a communist system, people make a profit. Doctors make money by treating people. So I’m not exactly sure what the OP’s ‘for profit’ system means. Perhaps someone can explain. Apart from the healthcare insurance companies leeching off the public, and having healthcare tied to employment, there’s one other factor in the US that, as an outsider, I think contributes to the problem you have, and that’s the purported cost of medical procedures. If your insurance company lists the cost of an MRI as $10,500 (my made-up example), well, fuck, who are you to argue? But I think that cost is vastly inflated (from my reading of people’s HC expenses in the US). I’d like to know how this $10,500 figure is arrived at. If anyone knows the breakdown of such costs, please post it here. ---
**Author:** ![Isamu](https://avatars.discourse-cdn.com/v4/letter/i/7c8e57/32.png) [@Isamu](https://boards.straightdope.com/u/Isamu)\ **Post date:** [April 21, 2012, 8:06am UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/46 "2012-04-21T08:06:55Z")
Coda: I have a favorite GP one block away who I go to for coughs and colds, and one medical clinic I to go to for mandatory yearly check-ups. Other than that, I have no general contact with medical care. Exceptionally, I had an MRI two years ago, as a result of a yearly medical checkup ultrasound which found a shadow somewhere in my abdomen. It cost me about $100 out of pocket (I’m in the national insurance plan, like most people in full-time employment in Japan, and also in a private insurance system, that is reserved for serious hospital stays and surgery so it wasn’t used in this case.) The MRI section of the hospital seemed like it was being continuously used throughout the day - I had 3 or 4 people waiting in front of me and 3 or 4 people joining behind me in the waiting room. I could have chosen other places to go, but that hospital was the closest to where I live, about 5 mins by car and it had a good reputation on the net. Four days after that I had a 30 minute private consultation with the doctor at the same hospital to explain the results. It was a doctor I hadn’t met before, but it was clear he’d read my record, and the MRI results. Out of pocket, $100. Result - all clear. How much would you expect to pay? ---
**Author:** ![gamerunknown](https://avatars.discourse-cdn.com/v4/letter/g/6bbea6/32.png) [@gamerunknown](https://boards.straightdope.com/u/gamerunknown)\ **Post date:** [April 21, 2012, 8:55am UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/47 "2012-04-21T08:55:17Z")
> [@Isamu](#): > > So I’m not exactly sure what the OP’s ‘for profit’ system means. Perhaps someone can explain. Privatised healthcare, where the primary concern is to make profit, rather than to cure, treat or immunise people. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [April 21, 2012, 4:37pm UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/48 "2012-04-21T16:37:17Z")
> [@Isamu](#): > > How much would you expect to pay? That would depend on your insurance co-pay and deductible rules. If you have no insurance, you pay the full retail price (from several hundred to several thousand dollars). Here is a discussion of [prices](http://health.costhelper.com/mri.html). US prices are probably higher than in Japan because you have more machines than the US and MRI’s are more popular. ---
**Author:** ![Euphonious\_Polemic](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/euphonious_polemic/32/3002_2.png) [@Euphonious\_Polemic](https://boards.straightdope.com/u/Euphonious_Polemic)\ **Post date:** [April 21, 2012, 4:57pm UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/49 "2012-04-21T16:57:25Z")
> [@jasg](#): > > That would depend on your insurance co-pay and deductible rules. If you have no insurance, you pay the full retail price (from several hundred to several thousand dollars). > > Here is a discussion of [prices](http://health.costhelper.com/mri.html). US prices are probably higher than in Japan because you have more machines than the US and MRI’s are more popular. US prices are also higher than in Japan because in the US, the hospitals must recoup the costs from patients who have no insurance and no means of paying. It’s similar (although larger in scope) to a store charging more to cover their losses due to loss or spoilage in their stock. Imagine a produce company that has poor refrigeration, so that 20% of their stock is lost due to spoilage. They must charge more to recoup these losses. Also in the US, the cost of an MRI must include the increased administration costs of having someone bill the various insurance companies, and chase up after unpaid accounts. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [April 21, 2012, 6:50pm UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/50 "2012-04-21T18:50:39Z")
Also, Japanese health insurance companies are non-profit. ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [April 21, 2012, 7:23pm UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/51 "2012-04-21T19:23:18Z")
> [@MsRobyn](#): > > It doesn’t work all that well when you’re talking about care that is either mandatory (e.g., vaccinations for kids to be able to enter school) or where not doing it will impair function or possibly cause loss of life. I don’t have the $400 that a set of vaccinations costs, even though I know about it well in advance. The pure capitalist will argue that I have sufficient notice that I should be able to save up to pay for them, but let’s crunch some numbers. If I save $20 a month toward the cost of the shots, which is a nice, comfortable amount, it’ll take me 20 months before I have the $400. This also assumes that the cost doesn’t increase, or that I don’t need that $20 a month for something else. So that’s why I have health insurance. In a pure private market with little regulation, do you think vaccinations would cost $400? Or would competition drive down the prices? I contend that the reason that sticker price is $400 is because most people pay their $20 copay and go about their business not giving a whit what the doctor charges the insurance company (which sure as hell isn’t $400). The number of people self-paying for vaccinations is so small that there is no market for them to negotiate. Now, if you had a truly free market, there would be clinics charging a small fraction of that for routine vaccinations that have been around for many years. The comparison to food is apt. We all need food, but we don’t pay $40/lb for bacon. It is sufficiently free market to where competing stores keep the prices down. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [April 21, 2012, 8:36pm UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/52 "2012-04-21T20:36:40Z")
I would be much more confident of free market healthcare if there were a industrialized nation that had adopted that model - and achieved universal, cost efficient, high quality care that matched results from countries like Germany, Japan, France or Canada (among many). Have I missed the country that has achieved that? ---
**Author:** ![brickbacon](https://avatars.discourse-cdn.com/v4/letter/b/898d66/32.png) [@brickbacon](https://boards.straightdope.com/u/brickbacon)\ **Post date:** [April 21, 2012, 8:42pm UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/53 "2012-04-21T20:42:20Z")
> [@jtgain](#): > > Now, if you had a truly free market, there would be clinics charging a small fraction of that for routine vaccinations that have been around for many years. There are clinics that provide routine vaccinations. Here is CVS’s [price list](http://www.minuteclinic.com/services/vaccination/). Still seems pretty expensive to me. Second, it seems as if you have a complete misunderstanding of the vaccine market. It is generally a free-market. The regulations mostly serve to attempt to convince people to actually bother making vaccines. Vaccine makers are usually exempt from civil lawsuits, and they often get government subsidies. Even so, few people want to make them. The reason vaccines cost so much is because the barriers of entry are high, making them comes with a significant opportunity cost, and there are a few companies in a “[cartel](http://blogs.webmd.com/all-ears/2006/10/why-do-vaccines-cost-so-much.html)” that produce them. That is (largely) the free-market at work. > [@](#): > > Everything goes up in price, but vaccines have climbed astronomically in cost to the consumer or insurance company. Twenty years ago, the full array of childhood vaccines used to cost about $84. Now, those same vaccines, along with the increasing number of newer vaccines costs, about $1,200 or more — a 14-fold increase. Since the cost of medical care and hospitalization has also skyrocketed, vaccines are still a good deal. This year, we added RotaShield for the infants and Gardasil for the young girls — they are not cheap. Gardasil alone will cost someone about $360 for the series. > > There used to be about two dozen companies producing vaccines. We are now down to five major players that account for 80% of the vaccine market. Perhaps we should call them the Vaccine Cartel, since the free-market allows them to set their own fees. In the overall scope of revenue, vaccines still account for only a few percent of pharmaceutical company profits. The sale of drugs is still the cash cow. > > Vaccines are inherently safe, but when rare adverse events happen, some people head for an attorney. However, winning a suit against a large pharmaceutical company is not that simple. The cost of liability may be an underlying factor in the cost of vaccines, but it is a small one, since companies are aided by liability protection enacted by Congress. Manufacturing costs have also increased over the last twenty years, but biotechnology has made vaccine production even easier. Actual production and marketing costs do not drive this market — we do, by our desire to prevent more and more diseases. When you see lines forming to get the annual influenza vaccine, you know you have a good product. In fact, many drug makers got out of the vaccine game because there was not a lot of money to be made. This [article](http://content.healthaffairs.org/content/24/3/622.full) elaborates the reasons for the dearth of manufacturers, and the constant shortages. The reasons they outlined were as follows: 1. Small market for vaccines compared with drugs. 2. The Effects of Mergers 3. Dramatic reduction in the private vaccine market. 4. Low or inconsistent insurance reimbursements. 5. Lack of infrastructure support. Reason 5 is very important as the article includes the following stats: > [@](#): > > Lack of infrastructure support. > > In 1955 doctors bought the polio vaccine for $1.50 per dose and sold it to their patients for $5. In the late 1970s doctors bought the combination measles-mumps-rubella vaccines for $25 per dose and sold them for $75. Because people paid for vaccines out of their own pockets, doctors could depend on reimbursements that offset the enormous infrastructure required to purchase, store, administer, and record vaccines. > > Reimbursements for the polio vaccine fifty years ago are at variance with reimbursements for the influenza vaccine today. In 2004 the CDC changed its recommendation for the influenza vaccine; it recommended that all children ages 6–23 months, and all family members living in the home of children less than two years of age, receive a flu vaccine.12 The CDC’s recommendation was difficult to implement. Doctors had to create an infrastructure within their practices that included hiring receptionists to schedule appointments and hiring nurses to administer a yearly, seasonal vaccine. **But reimbursements by insurance companies for vaccines, including “administration fees,” were about 5–10 percent above the cost of the vaccine, compared with a 300 percent markup for vaccines when the private market consisted of direct out-of-pocket payments.** By refusing to pay for the infrastructure required to administer vaccines, the federal government and insurance companies are asking doctors to pay for the infrastructure themselves. As a consequence, doctors often view new vaccines, or expanded recommendations for existing vaccines, as yet another burden to be borne by their practices. So your theory is largely incorrect. 1. Public buy-in versus public buy-out. 2. Regulatory issues: moving from relative to absolute safety. 3. Product liability. Also note that one of their main suggestions for increasing the use of vaccines is: > [@](#): > > Increase payments for vaccines. > > Pharmaceutical companies could be encouraged to make vaccines if the federal government provided more assurances that the VFC entitlement program was robust, allowed for a mechanism to increase the fixed price of certain vaccines, offered tax breaks to companies that chose to make vaccines, and supported more testing centers (such as the Vaccine Evaluation and Testing Units [VETUs]) for commercial vaccines prior to licensure. Further, the burden of assuming the cost of creating and maintaining an infrastructure for vaccines by health care professionals could be supported by adequate administration fees through both the VFC program and private insurers. If you had a completely free-market for vaccine, nobody would bother making them. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [April 22, 2012, 12:59am UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/54 "2012-04-22T00:59:57Z")
> [@curlcoat](#): > > I’m on dial up and that thing didn’t want to load - if it says only what you recapped that isn’t my point. Yes, I know that the recession meant less income from taxes, but what I am talking about is the decades of more and more social services paid out while ignoring the slip in the tax base (which started before the latest recession). California has also, at least recently, had a history of being unfriendly to business, so there is more money lost. So now we have all these people depending on all these social programs, not enough money coming in AND now they want to force us to pay for some plan to get everyone insured? And they keep wanting to repeal Prop 13 to jack up our property taxes, as if our mortgages aren’t high enough. > > Something is going to break here. What slip in the tax base? The chart I linked to shows a pretty steady gain in revenuse since 2001, when there was a decline due to the end of the Bubble, which hit us particularly hard. Our social programs these days are not so great. Our UCs are a mess, and have been for some time. If you want to complain about pensions, I’d be a lot more sympathetic. But we are now cutting stuff which is going to cost more in the end. As for Prop 13 - I’m a beneficiary of it. I’ve been in my house 15 years, and my property taxes have gone up less than 20%, though the house is worth twice what I paid for it and I make a ton more also. And it is unfair. My neighbor two doors down pays almost nothing, and the guy who just moved into the house between us pays a ton more than me. It also disrupts the market. Someone just called asking if I was interested in selling my house. (Our market is hot again.) Even if we decided to sell our house for a smaller one, now that the kids are gone, we couldn’t afford to because our taxes would skyrocket. And then there are businesses, which are covered also, which also holds down the revenue. Even if the tax burden was constant, it could be fairer, and I’m all for breaks for the retired. ---
**Author:** ![Isamu](https://avatars.discourse-cdn.com/v4/letter/i/7c8e57/32.png) [@Isamu](https://boards.straightdope.com/u/Isamu)\ **Post date:** [April 22, 2012, 4:14am UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/55 "2012-04-22T04:14:03Z")
> [@jasg](#): > > That would depend on your insurance co-pay and deductible rules. If you have no insurance, you pay the full retail price (from several hundred to several thousand dollars). > > Here is a discussion of [prices](http://health.costhelper.com/mri.html). US prices are probably higher than in Japan because you have more machines than the US and MRI’s are more popular. Thanks for that. It’s not exactly a breakdown of the cost, but it does show that out of pocket costs are roughly comparable (I could have sworn I saw some doper post about their insurance company listing a huge cost for an MRI, but maybe I was mistaken). I’d have to crunch some numbers of what I pay for national health insurance p/a as compared to what the average US citizen pays. ---
**Author:** ![Normal\_Phase](https://avatars.discourse-cdn.com/v4/letter/n/5f9b8f/32.png) [@Normal\_Phase](https://boards.straightdope.com/u/Normal_Phase)\ **Post date:** [April 22, 2012, 11:37am UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/56 "2012-04-22T11:37:15Z")
> [@Isamu](#): > > Out of pocket, $100. Result - all clear. > > How much would you expect to pay? Based on the experiences of myself (insured) and my mother-in-law (not insured), something like $200-$500 if insured, from co-pays and 20%/80% splits on all the various fees. It wouldn’t be a single bill most likely; you’d have to pay the lab or hospital for the use of the MRI, plus each individual doctor separately. If not insured, more like $1000-$2000. But we have the bestest health care system in the world. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [April 24, 2012, 4:09am UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/57 "2012-04-24T04:09:28Z")
> [@gamerunknown](#): > > Privatised healthcare, where the primary concern is to make profit, rather than to cure, treat or immunise people. Sounds like you need to change doctors! > [@Voyager](#): > > What slip in the tax base? The chart I linked to shows a pretty steady gain in revenuse since 2001, when there was a decline due to the end of the Bubble, which hit us particularly hard. Gain in revenue isn’t the same thing as a gain in tax base. What I am remembering (trying to remember) is an article talking about how fewer people are paying more in taxes, either because people are leaving the state or because they have less income. This may have been specific to S Cal tho, since the article was in the OC Register. > [@](#): > > Our social programs these days are not so great. Our UCs are a mess, and have been for some time. If you want to complain about pensions, I’d be a lot more sympathetic. But we are now cutting stuff which is going to cost more in the end. I am not of the opinion that our social programs are all that great but like our schools, they are costing a fortune every year and never seem to improve. > [@](#): > > As for Prop 13 - I’m a beneficiary of it. I’ve been in my house 15 years, and my property taxes have gone up less than 20%, though the house is worth twice what I paid for it and I make a ton more also. And it is unfair. My neighbor two doors down pays almost nothing, and the guy who just moved into the house between us pays a ton more than me. OTOH, the house we live in my husband bought for about half what it is worth now, but a couple of years ago it was worth five times the original price. Without Prop 13, there is no way we could have afforded five times the property taxes. Not all of us are making “a ton more” than we were 15 years ago. There seem to be enough people losing their houses without hitting them with a huge property tax bill. > [@](#): > > It also disrupts the market. Someone just called asking if I was interested in selling my house. (Our market is hot again.) Even if we decided to sell our house for a smaller one, now that the kids are gone, we couldn’t afford to because our taxes would skyrocket. If you are over 55 (or whatever the age is) you can buy one time and hold onto your current tax base. There is a law that allows retirees to sell and buy another house without getting hit with a huge increase in property taxes. > [@](#): > > And then there are businesses, which are covered also, which also holds down the revenue. > Even if the tax burden was constant, it could be fairer, and I’m all for breaks for the retired. 😕 How would having high property taxes be a break for the retired? ---
**Author:** ![BigAppleBucky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bigapplebucky/32/178_2.png) [@BigAppleBucky](https://boards.straightdope.com/u/BigAppleBucky)\ **Post date:** [April 25, 2012, 3:40pm UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/58 "2012-04-25T15:40:40Z")
> [@Euphonious\_Polemic](#): > > US prices are also higher than in Japan because in the US, the hospitals must recoup the costs from patients who have no insurance and no means of paying. It’s similar (although larger in scope) to a store charging more to cover their losses due to loss or spoilage in their stock. Imagine a produce company that has poor refrigeration, so that 20% of their stock is lost due to spoilage. They must charge more to recoup these losses. > > Also in the US, the cost of an MRI must include the increased administration costs of having someone bill the various insurance companies, and chase up after unpaid accounts. > **[Debt Collector Is Faulted for Tough Tactics in Hospitals (Published 2012)](https://www.nytimes.com/2012/04/25/business/debt-collector-is-faulted-for-tough-tactics-in-hospitals.html?ref=us)** > > One of the United States’ largest medical debt-collection companies is under fire in Minnesota for placing employees in hospitals and demanding patients pay before receiving treatment, documents show. **Debt Collector Is Faulted for Tough Tactics in Hospitals** > [@](#): > > The tactics, like embedding debt collectors as employees in emergency rooms and demanding that patients pay before receiving treatment . . . ---
**Author:** ![BigAppleBucky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bigapplebucky/32/178_2.png) [@BigAppleBucky](https://boards.straightdope.com/u/BigAppleBucky)\ **Post date:** [April 25, 2012, 6:18pm UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/59 "2012-04-25T18:18:17Z")
> [@Isamu](#): > > I don’t know of any country that has a non ‘for-profit’ healthcare system. Even in a communist system, people make a profit. Doctors make money by treating people. So I’m not exactly sure what the OP’s ‘for profit’ system means. Perhaps someone can explain. Salaries and recovery of costs are not profit. A doctor on salary is not as likely to order an unnecessary medical test as one who owns a lab and makes beaucoup bucks whenever his lab is used. Giant medical corporations are taking over hospitals and even medical practices. They make more money by offering less care at higher prices. * * * A completely free and unregulated market? Right. So the one remaining hospital conglomerate starts charging $1million for a routine appendix removal? Pay or die. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [April 25, 2012, 7:22pm UTC](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045/60 "2012-04-25T19:22:04Z")
> [@curlcoat](#): > > Gain in revenue isn’t the same thing as a gain in tax base. What I am remembering (trying to remember) is an article talking about how fewer people are paying more in taxes, either because people are leaving the state or because they have less income. This may have been specific to S Cal tho, since the article was in the OC Register. Well, if the people who are moving use more resources than they pay in taxes, we win, right? And if the people who are staying are the ones making lots of money, then they can’t be driven out by high taxes, right? > [@](#): > > I am not of the opinion that our social programs are all that great but like our schools, they are costing a fortune every year and never seem to improve. If you keep cutting them, you can hardly expect them to get better, can you? I sent both my kids out of state, and the older one had been admitted to Berkeley in high school, but didn’t want to go. The younger one went to a state school in the East, in a state where they still care about education, and got a lot from programs that don’t exist in California, For instance, they had a person working full time on helping students apply for things like Fulbrights. > [@](#): > > OTOH, the house we live in my husband bought for about half what it is worth now, but a couple of years ago it was worth five times the original price. Without Prop 13, there is no way we could have afforded five times the property taxes. Not all of us are making “a ton more” than we were 15 years ago. There seem to be enough people losing their houses without hitting them with a huge property tax bill. Here is the way it worked in NJ, at least. Every five or ten years they reassess all the properties, and rebalance property tax bills accordingly. It is usually done to keep the tax revenue more or less constant, so if the houses of all your neighbors also went up five-fold you wouldn’t actually be paying more. A little bit more to make up for the people who just bought and are paying at a higher rate. The value of my house in NJ went up significantly while we were there, but the taxes did not. If values go down, so do taxes. That’s fair. Of course it is no good if your much reduced home value is still way above your Prop 13 value. But this should have been done before the crash. The unfairness is still there. After all, the ones hit the worst are those who suffered real, not paper losses, and they are the ones paying taxes on the inflated value. > [@](#): > > If you are over 55 (or whatever the age is) you can buy one time and hold onto your current tax base. There is a law that allows retirees to sell and buy another house without getting hit with a huge increase in property taxes. I’ve heard this and finally decided to look it up. Prop 50 covers this inside a county and Prop 90 covers it outside a county. However most counties don’t give the break to inter-county transfers. [Here is a list.](http://www.car.org/tools/smart/archive/prop90/) So if I wanted to sell my house and move to Sonoma county, I’m still screwed. I live in one of the older, more stable neighborhoods in our town (our houses were built in the early 1950s) and I know lots of older people who stay out in their big houses. > [@](#): > > 😕 How would having high property taxes be a break for the retired? Some states have specific tax breaks for the retired which don’t involve them leaving their homes. The retired, with a reduced income and the same tax burden, do deserve a break. Let’s pay for it by raising taxes on business property. Businesses who are over 65 are not retired. [Previous page](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045.md?page=2) [Next page](https://boards.straightdope.com/t/basic-problem-of-for-profit-medical-care/619045.md?page=4)