# Do teabaggers and town hellers not realize that the insurance industry already rations healthcare? **URL:** \ **Category:** Great Debates\ **Created:** [September 30, 2009, 4:55pm UTC](https://boards.straightdope.com/t/do-teabaggers-and-town-hellers-not-realize-that-the-insurance-industry-already-rations-healthcare/512120 "2009-09-30T16:55:01Z")\ **Posts on this page:** 8\ **Page:** 2
**Author:** ![Beadalin](https://avatars.discourse-cdn.com/v4/letter/b/3be4f8/32.png) [@Beadalin](https://boards.straightdope.com/u/Beadalin)\ **Post date:** [September 30, 2009, 9:55pm UTC](https://boards.straightdope.com/t/do-teabaggers-and-town-hellers-not-realize-that-the-insurance-industry-already-rations-healthcare/512120/21 "2009-09-30T21:55:29Z")
> [@theR](#): > > What definition of “sickest” are you using? I think you’re equating the amount of dollars spent with the sickness of the person? In other words, the sickest person in the U.S. is the one that has spent the most health care dollars? If so, you should just drop the words “sickest” and “healthiest” from the comparison, because it’s not accurate. This strikes me a a weird thing to get hung up on. The numbers are accurate and make sense, and using “sick” and “healthy” is a nice shorthand for how people consume healthcare. The “sickest” 1% of the population are people with chronic conditions (as in, something that can be treated but not cured) and those involved in catastrophic cases, where a single episode of care costs more than $50,000 – generally, ICU is involved in such cases, be it for organ transplants or reconstructive surgery. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [September 30, 2009, 10:03pm UTC](https://boards.straightdope.com/t/do-teabaggers-and-town-hellers-not-realize-that-the-insurance-industry-already-rations-healthcare/512120/22 "2009-09-30T22:03:14Z")
> [@joebuck20](#): > > Do teabaggers and town hellers not realize that the insurance industry already rations healthcare? No, they don’t realize it. And if you tell them, they still won’t realize it. Teh Stupid, it burns. ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [September 30, 2009, 10:04pm UTC](https://boards.straightdope.com/t/do-teabaggers-and-town-hellers-not-realize-that-the-insurance-industry-already-rations-healthcare/512120/23 "2009-09-30T22:04:41Z")
> [@yorick73](#): > > Yeah…that sentence was worded horribly. What I meant to convey is that doctors make up for their losses on Medicare patients by increasing the prices for those with insurance and those who pay cash. So, in effect, insurance companies and cash customers subsidize Medicare treatment to some degree. And? We all subsidize uninsured people’s health care right now. Anytime someone walks into the ER and can’t pay those costs are distributed through the system. In fact I’d say private health insurance costs also pay low. Note my cite above that some MA payments are below FFS (MA is private insurance). Can I then say Medicare is footing the bill for private insurance? ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [September 30, 2009, 10:47pm UTC](https://boards.straightdope.com/t/do-teabaggers-and-town-hellers-not-realize-that-the-insurance-industry-already-rations-healthcare/512120/24 "2009-09-30T22:47:53Z")
> [@theR](#): > > What definition of “sickest” are you using? I think you’re equating the amount of dollars spent with the sickness of the person? In other words, the sickest person in the U.S. is the one that has spent the most health care dollars? If so, you should just drop the words “sickest” and “healthiest” from the comparison, because it’s not accurate. By sickest, I meant people who required the most expensive medical care. It may have been worded badly. I got the stats from a government website, but am not sure where to find it. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [September 30, 2009, 11:00pm UTC](https://boards.straightdope.com/t/do-teabaggers-and-town-hellers-not-realize-that-the-insurance-industry-already-rations-healthcare/512120/25 "2009-09-30T23:00:14Z")
> [@Rhythmdvl](#): > > Well duh it involves rationing. Don’t confuse me with a teabagger or a staunch free marketer who things [Gwen](http://boardstest.straightdope.com/sdmb/showthread.php?t=534101) is a great idea for a toy. > > But also please don’t wrap intelligent and thoughtful right-wingers up in the same fishwrapper that one should use for the Beckians. That undercuts debate (in hand with their dictatorial tactics) and misses some valid points. > > Furthering the argument, it’s not that the market is perfect _now_. Of course not. Nor is it the case that advocating for free market solutions over single payers (again, for lack of a better term) means that the poor and less well off can go suck it. But for the majority of Americans (er, I _think_ the majority of Americans) who can afford ten to fifteen thousand a year on insurance, the preference for market-based healthcare rationing/decisions is rational. > > As for who is shopping or educated, there are two responses. First, the market shouldn’t be that opaque, and proper information should be available. It’s not FDA-like in which a good amount of information and background is required to make informed decisions. Rather basic math and research/comparison ability should lead to the understanding of differences. > > Second there are a _lot_ of trained and informed people making these decisions. At companies across the country, every HR person or committee has to make a choice between healthcare plans. Of course it’s not _every_ company and sure, lots of HR staff members are morans or don’t really put in the effort, but the point raised above about the market needing informed consumers is a good one; but there are informed consumers making decisions every day. > > I can’t say I’m doing the best job defending the rationale–given my personal preferences I couldnt’ be said to have standing on this side. But I do have an appreciation for the non-shouty side of the debate, one that is unfortunately lost to the Beckian bleating. In the stimulus bill $1.1 billion was devoted to comparative effectiveness research in health care. According to budget director Peter Orszag, about $700 billion in health costs go to treatment that doesn’t make people healthier, and actually can backfire. Medicare costs in some parts of the nation are twice those in others (15k per beneficiary vs 7.5k, despite similar demographics and health outcomes). He claims the reason is a lack of transparency in some aspects of medicine. [http://www.nytimes.com/2009/02/16/health/policy/16health.html](http://www.nytimes.com/2009/02/16/health/policy/16health.html) So we did pass something in the stimulus to study comparative effectiveness, and to try to understand ways to cut money out of that $700 billion a year. There are times a rational consumer approach can work. If you have a prescription, you can shop around. I know a woman who was getting her psych meds via a government grant program that was charging the state over $200 a month for them. After the state cut the budget and her grant was eliminated, she shopped around and found the same meds at a different pharmacy for $35. Generic meds, meds from overseas (where governments bargain) or buying large doses where you only take half or a quarter of a pill a day can result in decent cuts to pharmacy costs for many consumers. But aside from issues where the consumer has a strong knowledge of what kind of treatment he needs, I don’t see cost shopping working. The average citizen should be able to shop among transparent price lists of domestic and international providers after they know for a fact what treatment or medication they need. I’m all for people considering going overseas or shopping various doctors for surgery after they know for a fact what kind of surgery they need. But I don’t think we can really can’t decide from a list of which treatment or medication we need. But shopping to determine the cheapest (out of a list of) interventions for a blocked aorta or epilepsy probably isn’t going to work well. Many of us will probably pick the cheapest option rather than the one that will result in the highest benefits to health. However if you know for a fact that you need medication X, and you know that you can get your medicine for 60% cheaper by finding the cheapest pharmacy you can, getting a double dose and taking half a pill a day, then I think that could help cut costs, at least for those willing to do the work. ---
**Author:** ![yorick73](https://avatars.discourse-cdn.com/v4/letter/y/b5a626/32.png) [@yorick73](https://boards.straightdope.com/u/yorick73)\ **Post date:** [September 30, 2009, 11:14pm UTC](https://boards.straightdope.com/t/do-teabaggers-and-town-hellers-not-realize-that-the-insurance-industry-already-rations-healthcare/512120/26 "2009-09-30T23:14:32Z")
> [@Whack-a-Mole](#): > > And? > > We all subsidize uninsured people’s health care right now. Anytime someone walks into the ER and can’t pay those costs are distributed through the system. > > In fact I’d say private health insurance costs also pay low. Note my cite above that some MA payments are below FFS (MA is private insurance). Can I then say Medicare is footing the bill for private insurance? Did you read the rest of my first post? Of course Medicare patients are happy with the system. But, the fees paid to docs by the government doesn’t pay for their care. This is unsustainable if scaled up to the levels the current administration would like to see. ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [October 1, 2009, 2:25am UTC](https://boards.straightdope.com/t/do-teabaggers-and-town-hellers-not-realize-that-the-insurance-industry-already-rations-healthcare/512120/27 "2009-10-01T02:25:06Z")
> [@yorick73](#): > > Did you read the rest of my first post? Of course Medicare patients are happy with the system. But, the fees paid to docs by the government doesn’t pay for their care. This is unsustainable if scaled up to the levels the current administration would like to see. Fine. Did you note above where the AMA said Medicare Advantage (note that is private insurance massively subsidized by the government) often paid less than straight Medicare? Add in MA wanting more paperwork. Add in MA denying a lot more claims. Not sure how it all pans out yet clearly private insurance is nowhere near better in this case. This from the AMA which is hardly a fan of screwing doctors. ---
**Author:** ![yorick73](https://avatars.discourse-cdn.com/v4/letter/y/b5a626/32.png) [@yorick73](https://boards.straightdope.com/u/yorick73)\ **Post date:** [October 1, 2009, 4:20pm UTC](https://boards.straightdope.com/t/do-teabaggers-and-town-hellers-not-realize-that-the-insurance-industry-already-rations-healthcare/512120/28 "2009-10-01T16:20:30Z")
> [@Whack-a-Mole](#): > > Fine. > > Did you note above where the AMA said Medicare Advantage (note that is private insurance massively subsidized by the government) often paid less than straight Medicare? Add in MA wanting more paperwork. Add in MA denying a lot more claims. > > Not sure how it all pans out yet clearly private insurance is nowhere near better in this case. This from the AMA which is hardly a fan of screwing doctors. This is private insurance subsidized by the government. I’m willing to bet that this is a different animal than private insurance that most of us have through the workplace. For instance, I doubt the companies can raise rates as needed. Plus, the pool they are working with are MUCH more likely to be receiving medical care. My guess is the payout has to be lower for the companies to profit. Remember, companies cannot run a deficit over an extended period. But this is neither here nor there. I would not call MA private insurance since the goverment is paying such a large chunk of the premiums. In my opinion this also illustrates the problems with a public option or single payer. Companies cannot compete with a government plan that can and will operate at a net loss. The end result will be for-profit companies going out of business. Also, the government plans (medicare and medicaid) currently get away with paying so little because doctors are charging those of us with private insurance and cash payers more. What will happen when the doctors and hospitals do not have these groups to subsidize patients on government plans? [Previous page](https://boards.straightdope.com/t/do-teabaggers-and-town-hellers-not-realize-that-the-insurance-industry-already-rations-healthcare/512120.md?page=1)