I don’t know where you grew up, but my father was in an early HMO when I was born, in 1951. I got out of grad school in 1980 and health insurance was neither new nor rare. 80 years ago things were different, but costs were a lot less and you more or less got better or died. No expensive machines to amortize.
This is a marketing ploy - just like the supermarket giving the list price and the club card price. The insurance company wants you to know how big a discount they got you. Which is the reason for the public option - people on their own get screwed.
Are you going to interpret that EKG by yourself? I know manufacturing some, and the capital costs of equipment are bigger than you might think. I’ve never had expensive tests done as a default - I never had an EKG until I started having heart problems, and I’ve never been near an MRI. I would not be surprised if they get over-used in order to get money for the doctor/hospital, and I do think we need some guidelines and best practices to cut down on waste, as mentioned in the New Yorker article.
I don’t know the stats. But it seems to me, and this is just a WAG, folks like to come out with stats that the US has more EKG machines per capita than country X and so forth. But how do we know if it is optimal. The total capital cost on EKG machines is divided by the number of times it is used to get a “capital cost” per patient, well if there is too many then too much capital is being put into them and those higher costs are being transferred on to the consumer. If it was a perfect marketplace, the market would decide the proper number of machines, but this is far from a perfect marketplace.
Do I know the answer, but I am always intereested when I see those stats about how great our health care system is because we have all these wonderful devices. Those devices weren’t free.
It’s my impression that the health insurance industry (HMOs, “comprehensive” coverage, etc) started to change in the 80s – before then it seemed to be a “oh, yeah, I’ve got insurance” instead of the receptionist saying “give me your insurance info before I book an appt”. I could be entirely wrong on that, but the point remains, it used to be that people got the care they needed, then they worried about the bill(s) for it, now it seems that if you don’t have insurance, or a ton of money up front, you can’t get in to see many doctors, etc.
Even with insurance, many providors require hefty up front payments before services are rendered.
It’s not a marketing ploy - If I didnt have the insurance, I’d have to pay the original amount. While the insurance company might want me to feel good about that discount, it still shows that there is a tremendous room for reduction of overall expenses.
FTR - I detest those discount cards too - quit playing games and sell stuff to me at the lowest price you want to - I can do my own comparisons. I’ll take advantage of your ‘gimicks’ - but fully recognize them for what they are.
Last time I went and got an EKG - the interpetation by the Dr - in the room with me - including comparisons to the prior 3 - took all of 5 minutes. While I value his expertise and am willing to pay for it, I still doubt that the test should COST hundreds/thousands of dollars.
Obviously, technology is expensive to keep updated/maintained, etc… especially new equipment, etc… but that doesnt mean there isnt room for improvement in controlling the costs there-of, and overall reducing the cost of operation.
So, we have to decide where the problem lies - and I go back to my original comment -
We would not be debating mandatory “insurance” if cost was better controlled such that “routine” care was more widely available.
I haven’t noticed very many changes in this kind of thing in the 30 years I’ve been working, but I may go to ritzy places. Given the increase in the number of uninsured, I can’t say I’d blame them for acting as you say. It is not the position of a private practice to give unlimited charity care. If we think that each person deserves decent medical care by right of being alive, we need to get together as a nation and provide it, and not expect the medical community to eat the costs for us without any impact.
I say this because 10 years ago your insurance statements just said what they paid, and didn’t give their discounts in large, friendly letters. But people with bargaining power do get better prices, no doubt about it, which as I said is why the public option is needed.
I just had a stress test, which is a lot more involved than a simple EKG, and a lot longer. I’ll have to look up the bill. If the whole thing was much more than $1,000 I’d be surprised, so $1,000 for an EKG seems high. On the other hand, I get my INR tested every month. It involves putting a drop of blood into a desktop machine, takes about a minute, and costs $19. That probably would have been a lab test and cost more 10 years ago. Some things are getting more efficient.
We do have to do a better job on cost control, and this has to be one of the legs of any UHC system. However some procedures are just going to cost a fortune, so the need for insurance will never go away.
The question is: how much of the cost of insurance is used for basic services, and how much comes from expensive procedures? I’m probably close to break even now, even though I’m getting on and have a heart condition. I’m sure that for most of my life I lost on the deal. Except, of course, for the year my wife had $50K in retinal surgery.
I’m not debating that insurance is a good deal when its needed, helping with the un-expected - what I’m debating is our current focus on “mandating” insurance.
It seems that everyone thinks the problem is that folks can’t afford insurance, and therefore cant afford basic medical services. That somehow once they have insurance, medical services suddenly become affordable - we all know that that really isnt the case.
I’m asking the question - why aren’t basic medical services more affordable to begin with? - what can be done to resolve that? Once we solve that, we can then work to challenge the insurance industry to provide more coverage where appropriate (pre-existing, low-income, etc).
Mandating insurance is not likely to control costs - it seems to be focused on the wrong aspect of the problem.
We don’t allow monopolies because they can operate in a vacuum with no care to cost. The same applies to government run agencies. They are run by people whose only qualification (literally) is that they were elected or appointed by elected officials. In a political climate of vote buying it’s safe to say the Democratic party will cater to union votes by padding the industry with unnecessary jobs which will jack up the cost of healthcare.
If the Government creates an insurance company for people to buy into then there is nothing stopping it from being regulated into an HMO style system which charges standard (non-HMO) rates. It would destroy the insurance industry and we are back to a national health care system run by bureaucrats with the ability to use tax money to buy votes (more insurance).
The problem with health care is not a national one. We’re talking about 15% of the population at most. Of that 15% probably half of them can and would be forced to pay for insurance (the focus of this thread). It doesn’t make sense to involve the government directly in health insurance. If the government creates it’s own program for part of the population it will likely morph into a national quagmire like social security did. This was a program for a very small portion of the population and it is now mandatory for everyone except government workers (sound familiar). It allows for private retirement investment but the money taken in the process represents a huge loss of personal investment. Social Security is a total loss of control of the money withheld.
We all already pay a 1.5% Medicare levy which is our contribution - the government uses this additional 1% levy as an incentive to push us into private healthcare - it is considered a ‘fine’ here.
People who don’t have insurance raise the price of services so mandatory insurance would be one of many pieces of the puzzle. There are many ways medical costs can be reduced and they have been discussed at length in other threads. I pay my doctor in cash which knocks about 40% off the bill. I buy generic drugs. I adjusted my deductible to match my needs and bank the difference as hedge.
From a regulatory standpoint we can reduce medical lawsuits, work with drug companies to cover research costs with longer patents in return for lower prices. Legislators can regulate State and Federal insurance laws so that uniform policies exist for roll-over clauses. Pre-existing premium costs can be deductible for low-income families etc… there are many ways to keep costs down.
There are two orthogonal issues, each of them vital. The first is cost control, since both a public plan or the status quo are going to lead to disaster if costs are not brought under control. The second part is access to health care. I agree that the cost issue makes this a worse problem than it would be otherwise, but even if basic procedures get cheaper it is going to be an issue. No one went bankrupt because of EKGs or doctors visits, after all.
The reason that the public option is a good idea is that it works in both dimensions. Subsidization gives everyone access to it without having to buy single policies with no power. By adding competition, and by pushing down prices, it will force the medical establishment to become more efficient. It has to come from within them, no government agency is going to be able to mandate efficiencies. For example, just the discussion of this seems to be getting the insurance companies to start to standardize on forms at long last, which should save tons of overhead. The public option should really get the capitalist juices flowing in the insurance companies at long last - except those involved in ripping off the customer, which have been flowing for some time.
The problem isn’t only with the uninsured it is also with the underinsured; underinsured due to cost reasons. Those who go bankrupt from medical costs often have insurance, lost because losing a job means losing insurance, or the uncovered costs means they can no longer keep it up.
Oh, throw me into the briers Br’er Fox! Most Americans would love to have their health insurance as awful as their Social Security. Remember that Bush at the height of his power got zapped when he tried to play with it, and that was before all the people got to see their 401Ks sink out of sight.
The government worker plan is a red herring. The real differentiator is defined benefits vs defined contributions, and the government worker pension plan is defined benefits, like the good old company pension plans.
You are making the classical economics mistake of assuming that all players will act according to their best interests, which behavioral economists has shown to be false. Hasn’t the meltdown amply demonstrated that higher returns mean higher risk? Given the importance of money for retirement, isn’t it good to allow this only after a base of a very safe investment is kept? Those who don’t have the surplus income to let them invest in an IRA or 401K have no business making risky investments, since if they lose it they are screwed, and wind up on the dole or starving.
An article in the Times last week showed how 401Ks inadvertently have hurt the economy. People dependent on them have put off retirement, which makes the jobs they might have left open for the now unemployed unavailable. Since they wouldn’t be looking for work if they were retired, this drives up the unemployment rate. In Europe, where they get defined benefits, they are retiring at normal rates.
I find it incredibly offense that in a free country, that I should be “allow[ed]” to do or not do something with my own money for retirement. That’s where the whole comparison about socialism starts to creep into these discussions. Is it my money, or do we collectively own the money so that we get to make decisions about what each person should be “allowed” to do when planning his finances?
While I agree with your statement about making risky investments, shouldn’t individuals have that right to decide? Oh, but since I might be on the dole, then it is acceptable to take away this freedom? To me, that’s the best reason ever for not having a public welfare system.
we already have a system in place for rolling insurance over after losing a job and that can be adjusted to cover the people who need it. Currently most people with company insurance have an HMO . The post employment COBRA elective is tied to the same expensive policy. If that could be converted to a free INSURANCE policy with a low deductable then companies would save money, laid off workers would have a reduced insurance cost and any deductable involved would limit long term financial hardship.
As it stands now, if I want to save money by opting out of COBRA then I pay a much reduced premium and the company/State pays nothing. We can split the difference and everybody wins. These are the things that can be done without a another government sponsored social security debacle. You asked for solutions to save money and I’ve given you a serious, win/win solution.
No they wouldn’t. Most Americans would like the gold plated retirement program that Congress gets and the Federal workers USED to get and many State and City employees still get. These people get to keep their money. It’s invested and it grows which allows people to care for themselves. The alternative is a welfare system with no investment that relies on the transfer of wealth from one generation to the next. This doesn’t account for increased tax burdens on each new generation nor does it take into affect any population swings which we are about to experience when the baby boomers retire.
It’s always, always, always better to operate under the principle of letting people control their own money because it takes the bureaucratic middleman out of the equation. When you vote and pay politicians to fleece someone else on your behalf it only works if you’re never the “someone else”.
I am self-employed, and have no health insurance due to pre-existing conditions. If I’m forced to buy health insurance, I’ll refuse. If they fine me I won’t pay. Hopefully, they’ll throw me into jail . . . where I’ll get free healthcare.
The general idea of reform is that your situation will be addressed in some form. If you can survive without insurance that means You should be able to be worked into the insurance pool without destroying life as we know it on the planet.
I don’t know what your specific situation is but if you get gored by a a bull named Al it would be nice if you were already part of the insurance pool. Just off the top of my head I think it’s possible to make insurance risk transferable and the premium differential for pre-existing conditions tax deductable. That’s a start.
I guess it confuses me that (as is) conservatives don’t seem to address the problem of people with pre-existing conditions being required to go broke before being eligible for government paid treatment at unchecked prices.
Wait. So even if there ends up being a affordable policy for you and providers are required to accept your pre-exiting conditions , you’re still going to refuse and instead leech off the rest of us?
