That seems more of a matter of opinion than anything. If the US does have the best & brightest physicians it is probably because our population is 2-10x larger than most other developed nations and as a result there are more opportunities for physicians to prove themselves at medicine. Plus in the US alot more money is spent on medical researcy by the government.
I hear this argument alot but virtually every Canadian I’ve talked to prefers his system over ours.
Huh?
That’s my point! For “customer,” read “you and your employees”! Even if you use less healthcare, you don’t use *zero *healthcare – and for that which you do use, you’re paying higher prices than you would otherwise, because your medical providers are relying on you to make up for their losses on uninsured, and underinsured patients.
http://www.mass.gov/hrsa/pages/pdf/selffund.pdf
When we went self-funded in 2002 my research said that 60% of companies of over 250 employees self-fund. The cite here has 37% of companies of 50 employees self-funding three years ago. I’m sure you’d agree the % goes higher with bigger employees. I cited this article because it does a pretty good job as well explaining why companies self-fund.
Private insurance companies make money by assuming and spreading risk. We have advantageous demographics. I had insurance companies fall all over themselves with incentives when I shopped our plan, that tipped me off to how good our demographics must be, made self-funding a no-brainer.
What is the average age, gender make up of your medical staff? That may have made self-funding a problem for your company.
Nope, in UHC I would not be self-funding…I would be paying much closer to $6,300 a head rather than $4,200 a head.
You just don’t get the difference between a usage issue and a rate issue. Our companies savings are largely based on a usage advantage, which would substantially reduced under UHC.
You know, I didn’t think what I was contending was so difficult to understand. Maybe I can get the judgment of a disinterested third party on whether my posts are that incomprehensible. Anyone?
Your posts are not hard to understand. You contend that most business would pay less under UHC is just simply wrong.
You don’t have to believe me, but you’d have to consider that there must be some reason that business doesn’t come out in support of UHC. Do you really believe the reason would be anything other than money?
I defer to your experience swissmtndog, but it does seem that you state quite specifically -
Are you making a distinction between the paying uninsured and the non-paying uninsured here, because the non-paying uninsured are (in a macro sense) being paid for by the increased fees hospitals charge to the insured paying clients (and counted among them would surely members of self insured groups that get services from a hospital)
There is obviously some subtle point I’m missing here.
Actually, with regards to the Massachusetts law, I’m making a distinction between the ‘non-paying uninsured’ and the ‘non-paying insured’… a young male who doesn’t not have insurance who will now have to pay for it will be incentivized to gain employment where the company provides insurance. If that company is self-funded, the amount of money actually spent on behalf for health costs will change very little, and probably much less than this plan projects. You need money to subsidize, where is it coming from? It needs to come from those who use to system less to cover those who use the system more.
This will actually make company benefits even more attractive to both employer and employee than they are. The young male would rather take benefits that save him say $400 a month, not taxed to either employee or employer rather than equal pay of $400, which is taxed to both.
I haven’t contended that, I’ve contended that you’re paying for the uninsured now, even though you think you aren’t.
But now let me ask: what’s your evidence that business would pay more under universal health care? Just because you pay relatively less now, under the current system, is evidence of nothing, except that the current system is skewed slightly in your favor. “Universal healthcare” means lots of things – it could even mean a system where your business paid nothing (at least not directly).
The fact is, discussions over who pays I think are actually fairly meaningless. If you expect government to pay, it comes out of taxes, whether paid for by business or the individual. If paid by business, individual employees will see their wages decrease slightly, if the levy should be more than businesses are currently paying in health benefits; if paid by employees, individuals will see their wages rise slightly, presumably out of the savings businesses realize from not paying health benefits.
It’s the same pot of money in the end, and we’re deluding ourselves when we say that it’s *somebody else *who’s paying for the unnecessarily complicated cost-shifting system of today. By coincidence, I just got in my email inbox the following bit of industry news: “Yale-New Haven Hospital notified consumer credit bureaus that it canceled the bills of about 3,500 patients whose ratings may have been hurt by their delinquent accounts.” We’re crazy if we think that those costs are somehow not being passed along to us. And we’re even crazier if we think that’s a cost-efficient way to proceed.
If this were even remotely true, we would have UHC today.
The purpose of the unnecessarily complicated cost-shifting system is to, surprise, shift costs to ‘somebody else’. I shifted $600k by being self-funded, nothing else I spent money on wen’t up nearly as much as a conseqence. It make very well be the same big pot, but how it is divided up is exactly the rub.
Multiply my company be the thousands of companies that self-fund.
These costs will largely get shifted to those who use the system more until something is done to get those who pay less because of lower usage rate to pay more.
And you are at least part of the “somebody else.” It seems to me like you’re pretending that none of the costs of the uninsured were shifted onto you, just because you saved $600,000 by, in effect, switching insurance plans. Do you at least acknowledge that in the prices you pay for medical services, some of the cost of the uninsured/underinsured has been passed on to you?
sure, but it’s a fraction, which means net—we are still paying for much less of the pie, is it really that hard to believe that under UHC we would pay more?
most of the money saved isn’t from switching insurance plans, it is from assuming much more of the risk, which is where insurance company profits lie, so the real insurance companies cost shift by charging more for insurance to organzations who cannot assume more of the risk by self funding (i.e. people with higher usage rates)
Think about it, why do some individuals not pay for health insurance? because it is too high and getting higher because the actual insured pool has higher risk, because anyone who can opt out is opting out, because they believe the odds are in their favor. Even within a small group, they are probably right, why would companies who offer benefits not take advantage of this?
The Massachusetts law does attempt to address this, but unless you get everyone in the pool, it’ll just be a new round of cost-shifting.
All right, at least I got you to admit you’re carrying some of the load for the uninsured. Phew! The next challenge is to quantify it. I’ll tell you what I’ll do – you said earlier your wife had a knee operation for three grand. If you don’t mind telling me what the operation was, I’ll try to figure out what the actual cost of the operation is, so you can see how much is tacked on to support everything else the hospital is doing, including covering the uninsured. I can’t promise it till next week, though.
No reason to waste both of our times, since you don’t clearly don’t get that the increasing gaps involved have has much less to do with cost of services than it does rate of usage, based on statements like ‘it doesn’t matter who pays’.
If I’m paying $4,200 a head, how will UBC cost me less? It won’t.
The reason we don’t have UBC is because for most people, it does matter who pays.
Are the uninsured subsidized, sure, if they we’re subsidized nearly enough we wouldn’t even be having this dialogue.
My company is self insured, but it is managed by a standard company, and I don’t think there is any way for a practice to know that we’re self insured or not.
Don’t take this wrong, but from the view of society as a whole your company is contributing to the problem by cherry picking, based on the age of your workforce. Unless you have a lot of turnover, in 10 or 20 years you’re going to be singing a different tune as your premiums increase as your workforce ages. Your company is analogous to the young male who self insures by not buying coverage, and thus effectively raising the rates for everyone else. This might be fair if he stayed young, but he will soon be needing coverage, where he will be subsidized by those younger who don’t remove themselves from the pool.
This is different from giving non-smokers a break, since they will never, as a population, require the same level of services on the average as smokers.
In a single payer system your company won’t benefit as much as other companies. (You may or may not save money absolutely from efficiency improvements.) But, society as a whole will benefit a lot. In any case like this some groups get more than others.
You’re acting here like prices don’t matter. You seem to be suggesting that so long as you pay less than everybody else, you’re happy. But prices – “cost of services” – do matter. Of course they matter. That’s why I proposed an experiment using your wife’s knee operation, as a way of inquiring into the price you paid versus the actual costs of providing the service. It’s a fact of our health system that the oldest, sickest patients – those suffering from diabetes, or congestive heart failure, or chronic obstructive pulmonary disease – tend to be the ones who cost hospitals the most in underreimbursed services. So how do hospitals stay afloat? Through their big profit centers, such as surgical services and imaging – the same services your wife got. Result? You likely paid inflated prices for your wife’s knee operation. That’s cost-shifting for you. You’re fixating on the $3000 you did pay, versus the $6000 you could have paid – but if the actual cost to the hospital for providing that service was $1500, you still overpaid by 100%.
There is also a whole other aspect to this, which is that the $4200 per employee is not the total cost to your business of providing healthcare. Whatever taxes you pay also pay for healthcare, even if it’s somebody else’s. You mentioned Medicare taxes. You and your employees probably pay copays, and maybe deductibles. There is a cost to managing the benefit program – you probably have one or more FTEs to do it. You’d probably be hard put to say how much you actually pay for healthcare, considered globally.
The bottom line is this: we in the States pay 16% of our GDP for healthcare, while the U.K. spends half that, and manages to cover everyone. That amounts to about a trillion dollars that we’re potentially wasting every year. That’s over $4,000 per worker – your workers among them. So when you ask how you could possibly spend less than $4200 a year for universal coverage – that’s how you could spend less.
I completely agree with the notion that our company is contributing the overall problem. As is nearly every business that provides insurance to employees. Unless you get everyone in the same pool, there will be incentive to cost-shift. As I’ve said, the trend to self-fund is definately fragmenting the pools, to believe this isn’t reducing the amount of subsidization, and a big factor in increasing rates is just not paying attention.
The nature of our workforce is unlikely to change, we have a lot of relatively low paying, physically demanding jobs. These will likely alway be held by not only young males, but people who are in pretty good physical condition who will have better than average health cost results.
Some companies who are self-funded are firing smokers. I’m sure you can understand why.
How do you know that?
I’m fixating on the $4,200 per person instead of the $6,300 per person I did pay when we we’re not self-funded. Our medicare taxes did not go up. My personnel (less than one FTE involved in signing people up for our benefits) did not change.
I’m am paying for the average medical costs for our employees, instead of paying the average medical cost for a larger, less favorably demographic pool, plus insurance company profits.
The amount of care provided to our employees, nor anyone elses did not change because we went self funded, so figuratively someone else paid the $600,000 I saved, that would be cost shifting. That someone else would be insurance companies and other users of the health-care system. Insurance companies cost-shifted by charging their other customers more. End result, real insurance for those in less advantageous groups goes up.
The only real solution is to get everyone in the same pool.