I despise Trump but would vote for him over someone who wants to take my family's insurance away

Politics & Elections
282

I hate it, too. Speaking as an American, I’m appalled that we (en masse) can’t seem to understand that health care should be included in:

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

We’re far too focused on pulling the ladder up after ourselves. I’m embarrassed for us all. We continue to be a nation of selfish hypocrites (as a group).

283

Those estimates are VERY relevant to your point. You are making an assumption about the costs incurred in our healthcare system in your originally flawed question, and I’m telling you that people who know much much more about US healthcare than you or me don’t agree with you, or at best have a mixed opinion.

You can throw out the F word. But those estimates are relevant whether you like it or not, because those estimates are about the US. And they are much more relevant than anything about the healthcare system of a country that has less population than Metro Atlanta.

284

I don’t care what the reason is. Talk to the cost estimates:

These people know more about healthcare in the US than you, me, Wolfpup, Banquet Bear, and Bernie put together.

285

You are citing one article which belabors the obvious point that giving people with little to no access to coverage/care in the current system greater access to care in a revised system will make overall costs go up.

So… yeah. So what?

286

Would like to note the article completely ignored savings brought about by:

  1. Reduced staff on the part of doctors and hospitals, especially those dealing with insurance issues (compliance, billing, claims, accounting, more)
  2. Greatly reduced complexity in billing
  3. Lack of commissions being paid to insurance sales people ($25 per month per insured here in the TX small business market. 4.7 million employed by small bus, assume 30% are covered, this would be a $423 million savings in the TX small business health insurance market alone.)

… more.

287

I don’t think they fully account for the savings to employees & employers from not needing to buy insurance either. It seems to be looking mainly at costs to the government.

288

Why is the Urban Institute analysis in that article the gold standard, or are you just illustrating the worst case? Friedman shows a substantial savings while Mercatus and RAND show very little change in costs compared to the current.

Bottom line, nobody really knows what will ultimately happen, but it’s pretty clear that the status quo is untenable for the reasons listed by Horatius. More, the things that this money is actually spent on would be more directly related to health care, and not to support the bureaucracy and profits of the health insurance industry.

289

I’m still interested in your plan design, btw.

Insurance Company:
Plan Name:
Deductible:
Max Out of Pocket:
Per-Paycheck Cost to You:
Number of times paid per year:
Cost to your employer (express per check, annually, whatever - just let me know the period the number refers to):
Employer Size (# of employees):
ACA plan (Y/N):
Do you have out of network benefits?:

Really, if you could just link to me your summary of benefits (it will look like this), that would be cool. It won’t have the cost info, but it will have all the rest. Then I can do a financial analysis of your policy (I already have the spreadsheets set up) to see when you get 1st-dollar benefits beyond copays. I’ll even find out how much you have to incur in medical expenses before you receive more in benefits than you paid out.

Thanks!

290

No, they include premiums, that’s stated earlier. But the composition of those premiums includes such things as commissions and the SG&A (Selling, General, and Administrative) expenses related to having a sales team.

In short: Remove the sales team and you’re probably removing $500 of cost, per month, per enrollee, from the health care system.

So, using Texas figures (which I know best)…

28.7 million people

23.7 million enrolled

23,700,000 X 25 X 12 = $7,110,000,000

Assume health insurance will be $400 per person per month (look at my Delores Clairborne example above)…

$400x12=$4,800

$7,110,000,000/4,800 = 1,481,250

Just by removing commissions alone, an additional 1.5 million people can gain health insurance in the state of Texas.

Now that we’ve removed the S, let’s look at the G&A side…

I’m not going into detail, but let’s be assured that in my experience G&A should take about 14-18% of revenue, which is buttressed on page 14 of this PDF.

So… 14% of revenue. Let’s see how that shakes out:

28.7 million people

23.7 million enrolled

Assume health insurance will be $400 per person per month (look at my Delores Clairborne example above)…

23,700,000 X 400 X 12 = $113,760,000,000

$113.76 billion X 14% = $15,926,400,000 (That’s $672 in sales overhead, per person, per year!)

$15,926,400,000/$4,800 = 3,318,000 additional insured

insured because no commissions: 1,481,250

+# insured because no G&A caused by sales overhead: 3,318,000
=# insured because health insurance was socialized, eliminating sales agents and the support staff needed for them: 4,799,250

of people in Texas uninsured: 5,000,000

But, obviously, somebody writing for the New York Times knows more about this than me.

291

One thing about the above I didn’t explain: In small group health insurance in the State of Texas, commissions are a flat $25 per insured per month, no negotiation. When you get larger groups (50+) you can negotiate, but things tend towards the mean here, guys.

292

The Urban Institute isn’t the gold standard. But people on this board take it as gospel that single-payer will save money. And I think that type of groupthink needs to be challenged, because the opposite could very well be true. What is often cited are savings in admin & claims adjusters. But we don’t know what M4A will be forced to pay doctors, pharmaceutical companies, hospitals, & surgery/outpatient centers. Nor do we know what will occur with patient behavior. Others, including me, have pointed out corruption and politics, which could make the design of an M4A system as expensive, inefficient, and kludgy as anything else. So, we shouldn’t be making these grand assumptions about cost savings & single payer. It might evaporate before our eyes.

293

“Remove the sales team and you’re probably removing $500 of cost, per month, per enrollee, from the health care system.”

Uh… no idea where that 500 figure came from. **The actual is $80.** I think I originally guessed “50” when I wrote it and typed in an extra 0, never going back to modify it when I was done with the math.

294

But “making grand assumptions” is the entirety of your argument up to the sentence about not “making grand assumptions.”

I asked for… and provided… numbers. Can you do the same, or are you going to let the NY Times do your math for you?

295

The NYT isn’t doing the math for anyone. They’re just summarizing 5 separate studies, of which 3 think we will have higher healthcare costs post-single-payer. I think that carries more weight to the general public than anything posted on this board by you, me, or people in Canada and New Zealand.

296

This is a much more nuanced response than I have been seeing upthread, underscoring the uncertainty of these analyses. You have been harping on the most pessimistic analysis. Most of your interlocutors, it seems to me, have been struggling to emphasize the uncertainty and point out that ultimately, the shift in costs, good or bad, will happen regardless, because the current situation is unacceptable.

Will I ultimately pay more in a National Health Tax than I and my employer are currently paying to United Health Insurance? Will my doctor have to take a pay cut, or can she recover that through a lower overhead burden by not needing to employ as many office staff? The reply is hazy; please try again after a formal plan is introduced. I’m just going to figure that there will be growing pains and unintended consequences regardless of the actual plan, but also that ultimately, the majority of the country will be more secure in not having to worry about a loved one’s illness destroying their household, not just the body.

297

Yes, we know your beliefs. I want to know your math.

Give me the numbers. Let me figure this out for you, then you can make an educated decision based upon your numbers and not what some rando quoted by a single newspaper said.

298

I think I’ve been consistent in what I’m saying. And even if you don’t think so, just look at the groups doing these estimates in the NYT. They are not a bunch of CATO or Heritage think tank types. This isn’t Fox News. I think the NY Times is more than fair to candidates like Bernie, Warren, or any other democrat who wants Single-Payer. In the face of these estimates, I take with a grain of salt the dominant position on this board about how M4A will “save money”.

299

This argument seems to pit math, logic and factual analysis against a belief system. Some folks here believe that costs would not go down in a UHC system, because… reasons. Because they believe they might not.

And the belief system will win every time. Because it’s impossible to get someone to change a belief system using math, logic and factual analysis.

300

What is going to “force” M4A to pay a particular fee for those services when one of its major features is that it sets those fees? To be sure, there will be providers caterwauling about losing their sacred right to set their own fees, but as I said earlier, all health care systems have cost controls; you either control provider costs up front through a negotiated uniform fee structure, impacting the providers’ economic autonomy, or you do it by meddling in the doctor-patient relationship, impacting the providers’ clinical autonomy which ought to be recognized as much more important, and which insurance companies are constantly violating in the course of normal business. Furthermore, the fees are not set unilaterally by the single payer program, but are negotiated with the physicians’ professional association, and they would surely accept lower fees knowing that their net income will remain about the same and that they will be relieved of massive amounts of paperwork and costs while being guaranteed prompt full payment.

You keep alluding to how smart the folks are who costed out M4A, but another group that’s pretty smart is the group of folks who run all the UHC programs all over the world, and specifically in the industrialized OECD countries, and every single one of them without exception costs far less than the US system, averaging less than half as much per capita. It’s absurd to claim without evidence that the US is somehow fundamentally different because it’s inherently more corrupt, or bigger, or can’t manage anything properly or something.

I’m not sure what you mean by “patient behavior”, but I assume it’s a reference to potential over-utilization if individuals have no cost constraints to utilizing medical services. This is just silly, because it doesn’t happen in other countries, including places where there is no co-pay for anything. It doesn’t happen because no one considers a visit to the doctor or to the hospital to be a form of entertainment. They do it because they have to, because they need medical attention. What does happen is that people don’t unduly put off doctor’s visits or surgical procedures for financial reasons, causing their conditions to worsen and making treatment more difficult and expensive, so it actually promotes a healthier population while helping to reduce costs.

We’ve been going round and round on this forever. I’ll just say that the underlying factor here that we’re all subject to, including me, is that we have a natural reluctance to change a system that we feel we’re generally pretty happy with, especially when it’s an important benefit like health care. But ISTM that my reluctance – and that of my fellow posters in other single-payer type UHC countries – is far more objectively justified than Americans’ reluctance to part with private insurance. Why on earth would I give up a health care system that pays for all the health care I need, never costs me anything out of pocket, never requires me to do any paperwork, never denies a claim, allows me to see any health care provider I choose, and overall costs half as much per capita as the US private insurance system? And why on earth would anyone prefer and cling to the latter?

301

And, it’s not like fee-setting isn’t going on today in the U.S. Not only does CMS set the fees for treatment for people who are currently covered by Medicare, but private health insurance companies are setting fees with providers who are “in network” for them.

Undoubtedly, in both cases, it’s some manner of a collaborative process between the providers and the insurers, but in the end, I suspect that it’s the insurers who hold most of the power in that fee-setting – meaning that, even today, the providers don’t necessarily have a great deal of control over their fees, while, at the same time, the providers’ billing systems need to be able to cope with multiple insurance company systems.