# Dispelling US Health Care Myths: Part 2 Profit **URL:** \ **Category:** Great Debates\ **Created:** [January 26, 2010, 9:47pm UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573 "2010-01-26T21:47:50Z")\ **Posts on this page:** 17\ **Page:** 3
**Author:** ![Algher](https://avatars.discourse-cdn.com/v4/letter/a/3d9bf3/32.png) [@Algher](https://boards.straightdope.com/u/Algher)\ **Post date:** [February 2, 2010, 7:40pm UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/41 "2010-02-02T19:40:35Z")
> [@gonzomax](#): > > It is called creative accounting. Money can be hidden in lots of semi-legal ways. > I have a doctor in my racketball group. he has like 6 women handling insurance claims. They spend their whole day squabbling with insurance companies over billing, and rejected claims. With Medicare he submits a claim. Job done. There is one billing number and they know how much every thing costs in advance. How much money is wasted by doctors and hospitals fighting with insurance companies? It is just too stupid and wasteful to justify. Fighting with Medicare and Medicaid can be just as fun. They reject as well, you have to know how to code, they can come back YEARS later and ask for their money back, and you are guilty until proven innocent with the government. There are more regulations with Medicare patients, different record keeping rules as well. Oh yeah, and it pays so poorly that Obama’s poster child of the Mayo Clinic has stopped taking Medicare patients in Arizona. ---
**Author:** ![emacknight](https://avatars.discourse-cdn.com/v4/letter/e/3ec8ea/32.png) [@emacknight](https://boards.straightdope.com/u/emacknight)\ **Post date:** [February 2, 2010, 7:43pm UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/42 "2010-02-02T19:43:44Z")
> [@Ludovic](#): > > I just realized this: shouldn’t it really be “Dispelling US Health Care Myths: Part 3: Profit!” I was thinking that too, but worried what would happen if I started a thread with Part 1: Steal Underpants. I was also worried that if I started a thread with “Part 3” in the title the first 8 posts would be about “where is part 2” and then back and forth postings of “Republicans drive like this, but Democrats drive like this…” ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [February 2, 2010, 8:30pm UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/43 "2010-02-02T20:30:52Z")
> [@Algher](#): > > Fighting with Medicare and Medicaid can be just as fun. They reject as well, you have to know how to code, they can come back YEARS later and ask for their money back, and you are guilty until proven innocent with the government. > > There are more regulations with Medicare patients, different record keeping rules as well. > > Oh yeah, and it pays so poorly that Obama’s poster child of the Mayo Clinic has stopped taking Medicare patients in Arizona. [Mayo Clinic - Wikipedia](http://en.wikipedia.org/wiki/Mayo_Clinic) Mayo,the Clinic that puts it’s doctors on a fixed salary. They reduce the incentive to crank out patients to increase profits. They do understand part of what is wrong with our medical system. In Japan , doctors make a lot less and actually compete for patients. They are inventing ways to make medicine cheaper. We are coming up with ways to make the health care industry richer. that .of course, makes it more and more expensive. It is fundamentally wrong to make profit off the illnesses of the people. ---
**Author:** ![Critical1](https://avatars.discourse-cdn.com/v4/letter/c/3e96dc/32.png) [@Critical1](https://boards.straightdope.com/u/Critical1)\ **Post date:** [February 2, 2010, 9:14pm UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/44 "2010-02-02T21:14:38Z")
> [@Magiver](#): > > [From your own cite](http://www.albertahealthservices.ca/761.asp)from the other thread the government benchmark for hip replacements was 26 weeks and none of the hospitals met that goal. 6 months waiting in pain for what amounts to a common operation in the US. Same thing for knee replacements. None of the hospitals met that pathetic benchmark. then you have the American system, where you can wait 15 YEARS for the same surgery, definitely a step up. ---
**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:** [February 2, 2010, 9:43pm UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/45 "2010-02-02T21:43:28Z")
> [@emacknight](#): > > I’ve been thinking about this for a couple of days, and the conclusion I’ve come to is that the health insurance industry isn’t to blame at all. They are behaving exactly the way an insurance company should behave. Just like auto insurance, they are going to charge more for high risk clients, and they are going to drop clients that failed to disclose _relevant_ information. > > If you have a history for crashes while intoxicated, your premiums are going to go up until the insurance company balances the level of risk they are undertaking. And if you fail to tell them about previous DUIs, then get in another accident while drunk, they aren’t going to cover you, despite how many years of premiums you paid. And they aren’t going to cover you AFTER you’ve had an accident, why would they? The difference is, people choose to drive drunk. Most people who get into a lot of accidents are not driving properly. Someone who gets cancer is not doing it on purpose. Health insurance companies do charge more for people who elect dangerous behavior, like smoking, and I haven’t heard anyone objecting to that. > [@](#): > > Think about what has been proposed: we want to force them to take high risk clients without due compensation (high premiums), we want them to take clients with current problems (like taking an auto policy after an accident), and prevent them from dropping clients (paying for clients that lied). > > If we end up agreeing that we need fixed, low cost premiums; that everyone has to buy coverage; that high risk clients can’t be dropped; that there can’t be excessive profit; you’ve simply created a very complicated and expensive version of UHC. If we let them not take those with pre-existing conditions, who will. Two choices - let them die, or have the taxpayers (all of us) pay for them. Is that really more efficient? The idea is that if all insurance companies are forced to take everyone, none have an advantage from excluding high risk clients. Premiums may go up, but taxes we pay now to take care of these people, inefficiently, will go down more. With that savings we can let the companies raise their rates to an acceptable level - or pay the additional premiums out of the savings from not having staff whose job it is to exclude people. BTW, that many (perhaps) most Americans don’t understand margins doesn’t mean anyone is lying to you. The margins of a casino are pretty low also, but they can make a lot of money by funneling lots of money through. Health or any insurance is a bet on probability, like a casino, and when the numbers are big enough the bet is pretty much a sure thing. ---
**Author:** ![emacknight](https://avatars.discourse-cdn.com/v4/letter/e/3ec8ea/32.png) [@emacknight](https://boards.straightdope.com/u/emacknight)\ **Post date:** [February 2, 2010, 10:02pm UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/46 "2010-02-02T22:02:07Z")
> [@Voyager](#): > > The difference is, people choose to drive drunk. Most people who get into a lot of accidents are not driving properly. Someone who gets cancer is not doing it on purpose. Health insurance companies do charge more for people who elect dangerous behavior, like smoking, and I haven’t heard anyone objecting to that. I have, I’ll try to dig up the quote. It’s also not entirely true that people don’t choose cancer. Look at the resistance to the vaccine that prevents certain forms of HPV that cause cervical cancer. A car warranty can require regular oil changes, can a health insurance company require you to eat a cancer fighting diet? Most health problems Americans have are the result of poor diet and lack of exercise. Except for the health problems caused directly by exercise and diet. > [@Voyager](#): > > If we let them not take those with pre-existing conditions, who will. Two choices - let them die, or have the taxpayers (all of us) pay for them. Is that really more efficient? The idea is that if all insurance companies are forced to take everyone, none have an advantage from excluding high risk clients. Premiums may go up, but taxes we pay now to take care of these people, inefficiently, will go down more. With that savings we can let the companies raise their rates to an acceptable level - or pay the additional premiums out of the savings from not having staff whose job it is to exclude people. Okay, so you require them to accept everyone. But the premiums go up to match the increased risk. That means the people who are sick (and not earning income) are the exact people that need coverage. So then what? Subsidize the cost of their premiums using what? Tax dollars? Then you have UHC. And you certainly can’t offset it using [other people’s premiums](http://boards.straightdope.com/sdmb/showthread.php?t=549963). ---
**Author:** ![dropzone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dropzone/32/7515_2.png) [@dropzone](https://boards.straightdope.com/u/dropzone)\ **Post date:** [February 3, 2010, 3:36am UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/47 "2010-02-03T03:36:01Z")
> [@Lobohan](#): > > But as better pointed out by DD above, the profit is \*after \*they spend a huge amount on overhead and highly paid staff. Noting how many hospitals are ostensibly “non-profit” it behooves them to not make a profit. :rolleyes: They do this by continually plowing what would be profit into building beautiful expansions and new outpatient clinics. ---
**Author:** ![Magiver](https://avatars.discourse-cdn.com/v4/letter/m/4491bb/32.png) [@Magiver](https://boards.straightdope.com/u/Magiver)\ **Post date:** [February 3, 2010, 4:43am UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/48 "2010-02-03T04:43:08Z")
> [@Critical1](#): > > then you have the American system, where you can wait 15 YEARS for the same surgery, definitely a step up. Is that the same American system that the [Newfoundland Premier](http://www.nationalpost.com/news/story.html?id=2510700) is using for his heart surgery? ---
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [February 3, 2010, 4:45am UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/49 "2010-02-03T04:45:36Z")
> [@Magiver](#): > > Is that the same American system that the [Newfoundland Premier](http://www.nationalpost.com/news/story.html?id=2510700) is using for his heart surgery? Yes. Rich people can afford to not wait. What’s so hard to understand about that? ---
**Author:** ![Magiver](https://avatars.discourse-cdn.com/v4/letter/m/4491bb/32.png) [@Magiver](https://boards.straightdope.com/u/Magiver)\ **Post date:** [February 3, 2010, 5:11am UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/50 "2010-02-03T05:11:51Z")
> [@Lobohan](#): > > Yes. Rich people can afford to not wait. What’s so hard to understand about that? I’m not remotely rich and I get that kind of care. What’s so hard to understand about that? All Canada managed to do was shift middle class health care down. We have a good health care system for the rich, the elderly, the middle class and the poor. what we’re working on is bringing insurance to those with pre-existing conditions, the near poor, and those who refuse to buy insurance but can afford it. The difference is that given a choice, people will pick an insurance policy that fits their needs instead of being forced into a national system that makes the choice for them. ---
**Author:** ![Delayed\_Reflex](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/delayed_reflex/32/3172_2.png) [@Delayed\_Reflex](https://boards.straightdope.com/u/Delayed_Reflex)\ **Post date:** [February 3, 2010, 5:20am UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/51 "2010-02-03T05:20:19Z")
I’ve always wondered why the profit motive doesn’t act as a stronger incentive to _reduce_ administrative costs. A company that could deliver the same health services with less bureaucracy would be more profitable then one with tons of administrative costs, no? I am wondering though if the high administration costs in the US is a function of insurance companies and health care providers of being at odds - health care providers just want to provide their services as long as they get paid; insurers best interest is to pay out as little as possible. Hence, there is an “arms race” of administrators fighting for their side, and any one health care provider or insurance company with inadequate administration may end up being less profitable than a competitor with more bureaucrats. This is really just a WAG though. For a future myth, are we going to look at whether Americans spend a lot on health mainly because they are unhealthy? I honestly don’t know whether this is true or false (or somewhere in between) - I’m not even sure if there is a right answer, but I think it would be a good discussion. ---
**Author:** ![emacknight](https://avatars.discourse-cdn.com/v4/letter/e/3ec8ea/32.png) [@emacknight](https://boards.straightdope.com/u/emacknight)\ **Post date:** [February 3, 2010, 2:16pm UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/52 "2010-02-03T14:16:59Z")
> [@Magiver](#): > > Is that the same American system that the [Newfoundland Premier](http://www.nationalpost.com/news/story.html?id=2510700) is using for his heart surgery? Hahaha, I read that two days ago and new you’d pop in here with it. I am now waiting for a horror story about crappy US health care to counter with. That will set everything even again. [Here are 12, does that mean I win?](http://www.billshrink.com/blog/health-care/) ---
**Author:** ![The\_Tooth](https://avatars.discourse-cdn.com/v4/letter/t/c67d28/32.png) [@The\_Tooth](https://boards.straightdope.com/u/The_Tooth)\ **Post date:** [February 3, 2010, 5:10pm UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/53 "2010-02-03T17:10:59Z")
> [@emacknight](#): > > [Here are 12, does that mean I win?](http://www.billshrink.com/blog/health-care/) Since you don’t have to live under the American insurance racket, yes. ---
**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:** [February 3, 2010, 6:36pm UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/54 "2010-02-03T18:36:48Z")
> [@emacknight](#): > > I have, I’ll try to dig up the quote. It’s also not entirely true that people don’t choose cancer. Look at the resistance to the vaccine that prevents certain forms of HPV that cause cervical cancer. A car warranty can require regular oil changes, can a health insurance company require you to eat a cancer fighting diet? Most health problems Americans have are the result of poor diet and lack of exercise. Except for the health problems caused directly by exercise and diet. For cervical cancer, it is mostly parents who are the problem, and they aren’t refusing the treatment because they are choosing cancer, but because they have odd moral views. (Which are even worse, IMO). However the point stands, especially because many people are born with conditions. > [@](#): > > Okay, so you require them to accept everyone. But the premiums go up to match the increased risk. That means the people who are sick (and not earning income) are the exact people that need coverage. So then what? Subsidize the cost of their premiums using what? Tax dollars? Then you have UHC. And you certainly can’t offset it using [other people’s premiums](http://boards.straightdope.com/sdmb/showthread.php?t=549963). How much would premiums go up? Not much, I expect. All corporate funded or subsidized insurance programs, like most people are on, don’t allow exclusion for pre-existing conditions today. If you work for the company, you are in the pool. The issue here is for people buying individual insurance, who get screwed in our current system. The reason is that individuals are in pools of one, which allow providers to be selective. Include them in a giant pool, like with employees, and there is no problem. ---
**Author:** ![Magiver](https://avatars.discourse-cdn.com/v4/letter/m/4491bb/32.png) [@Magiver](https://boards.straightdope.com/u/Magiver)\ **Post date:** [February 3, 2010, 7:56pm UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/55 "2010-02-03T19:56:20Z")
> [@emacknight](#): > > Hahaha, I read that two days ago and new you’d pop in here with it. I am now waiting for a horror story about crappy US health care to counter with. That will set everything even again. > > [Here are 12, does that mean I win?](http://www.billshrink.com/blog/health-care/) No, it means only the wealthy in your country have access to the insurance most Americans take for granted and you have no choice in the matter. But we can discuss your examples. Just looking at the first six: 1 - The person had a choice to pay the $7 or go to another facility. 2 – Copaxone Costs $1395 in generic form in Canada for a month’s supply which is $1000 more than the American woman was paying through insurance. [http://www.canada-pharmacy.com/drug-prices/copaxone.html](http://www.canada-pharmacy.com/drug-prices/copaxone.html) 3 – The person in probation as a new hire had the choice to buy private insurance to cover the gap. 4 – The person wishing to take Sprycel as a substitute for chemotherapy had the choice of chemotherapy or paying extra for the expensive drug. In Canada it is only [approved if other treatments fail or are not tolerated](http://www.bmscanada.ca/bms/news/archives/?news_id=2284). You are not given the choice up front. It’s [$8,505 for a 90 day supply in Canada](http://www.canadadrugsonline.com/DrugMoreInfo6660.aspx?gclid=CLv-t9Ly1p8CFQsMDQodty2Scg) versus the $4,000 quoted in the article. 5 – I can’t compare the Canadian cost but the American insurance picked up 2/3 of the cost of the medicine. 6 – was the result of government backed medical insurance and a great reason to avoid it if possible. We have better health care for the majority of Americans and we have chosen to fix the gap for those who don’t have insurance rather than downgrade care for those who have it. ---
**Author:** ![emacknight](https://avatars.discourse-cdn.com/v4/letter/e/3ec8ea/32.png) [@emacknight](https://boards.straightdope.com/u/emacknight)\ **Post date:** [February 3, 2010, 9:24pm UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/56 "2010-02-03T21:24:49Z")
> [@Magiver](#): > > No, it means only the wealthy in your country have access to the insurance most Americans take for granted and you have no choice in the matter. But we can discuss your examples. Just looking at the first six: > > We have better health care for the **majority** of Americans and we have chosen to fix the \*\*gap \*\*for those who don’t have insurance rather than downgrade care for those who have it. (bolding mine) I’m still not sure why you have such a hard-on for the Canadian Health Care System. Are you not aware of the [Tu quoque](http://en.wikipedia.org/wiki/Tu_quoque) fallacy? There are [36](http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy) other countries with a higher life expectancy. And [31](http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate) other countries with better infant mortality rates. You’ve found an article about one Canadian going to the US for specialized treatment. Did you notice that it was after a consultation with his doctors? Did you know that if it is a treatment he wouldn’t be able to receive in Nfld (a province of 510,000 people) the health care system will pay for it to be done some where else? And that if it makes sense to do so, it will get done in the US (population 320million). I’m also pretty sure what he’s doing is political suicide, so there is a lot more to this story than has been reported. [Here](http://boards.straightdope.com/sdmb/showthread.php?t=545309) is a very similar story in the US where they COULDN’T get specialized care in the US. I’m not sure if you noticed the title of this, and the previous, thread, but it’s not actually about Canadian health care. So I’m not even going to bother with a rebuttal to your use of “majority” and “gap” in describing the American system. ---
**Author:** ![Magiver](https://avatars.discourse-cdn.com/v4/letter/m/4491bb/32.png) [@Magiver](https://boards.straightdope.com/u/Magiver)\ **Post date:** [February 3, 2010, 9:42pm UTC](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573/57 "2010-02-03T21:42:13Z")
> [@emacknight](#): > > (bolding mine) > > I’m still not sure why you have such a hard-on for the Canadian Health Care System. I’m not the one trying to sell it and I assure you I do not have a hard-on for it. [Previous page](https://boards.straightdope.com/t/dispelling-us-health-care-myths-part-2-profit/526573.md?page=2)