When your job covers part of your health insurance ,you are paying for it. It is part of your salary package. You work for it and earn it. It is not a gift from your employer.
I know of no one who goes to the doctor for kicks. There are people who are hypochondriacs. I do not know any. But most people avoid going to the doc. You wait all day and the cost is huge. Even with insurance the copays and extra uncovered costs are formidable.
This sounds good in theory, but how does one logistically shop around for the best cardiac surgeons for the best buck? Medicine is not like dropping the car off at the mechanic to have them take a gander at the fender and rattle you off a good faith estimate. When someone’s health is on the line, they’re more concerned about getting the best care irrespective of money, as soon as possible. I don’t see why that’s so unreasonable. Would you want to select a urosurgeon based on how cheap his services are, or would you choose to go to the best place that accepts your insurance.
Most healthcare isn’t emergency care, you’re right. But if the issue was mainly about people having yearly checkups and the like, we wouldn’t need healthcare reform. Paying for annual physicals is not what is putting people in the poorhouse. It’s the unforseen medical crises that pop up and are insufficiently covered by insurance, if they are covered at all.
Just like you shop for anything else. Most people have no way of knowing what the best refrigerator is or what the best car is, so they rely on sources that are trained to know these things. Right now there really isn’t a need for such gatekeepers but if consumers were actually in control of their money they would arise just as they have for every other product.
And there is where you misunderstand the whole situation. Actually, buying health care is just like any other decision you make. The same economics apply.
Yes, today they are, because money doesn’t matter to them. Someone else is paying. But every decision is based on getting the best deal for the amount of money you are willing to pay. Health care is no different.
Of course I’ll go to the best place that accepts my insurance, since the cost to me for this care is likely to be, at most, a couple hundred dollars. But if I actually had to pay for the service with money I control, then there would be a different set of trade-offs I’d have to make compared to the situation that exists today.
Really? I’d like to see a cite for this.
No shit. However, when your employer purchases it they get a tax deduction that isn’t available to you, so it’s cheaper to have employer-purchased insurance rather than individually-purchased insurance. Furthermore, they are the ones who determine what range of plans you have and the design of the plans offered. They are in control of your insurance, you aren’t.
That’s not what I’m saying. But it is an indisputable fact that people get unecessary health care in this country. Since the cost to them is essentially zero, they get as much as they can, even if they don’t really need it.
There are already gatekeepers. They’re called “primary care physicians.” There are also entities called “insurance companies” and “hospitals” both of which vet physicians for qualifications and malpractice history, among other things.
Those trade-offs may involve diagnostic tests that are reimbursed as a matter of course, but which some people can’t afford or don’t see the need for. I’m not a doctor. I don’t understand why certain tests are needed, and if I had to pay for it myself, I may not do it, even if it means the doctor won’t have a clear understanding of my problem. That may extend to any number of costs, including second-opinion consultations, that can make the difference in diagnosis and treatment.
I don’t see anyone forcing you to take your employer’s insurance. You could just as easily take that money and find your own insurance, or you can invest that money, buy your own care and take your own tax write-offs. If you genuinely believe you can make appropriate spending decisions over your health care, put your money where your mouth is and prove it.
Robin
The “someone else” is them. You’re portraying insurance as if it’s free money, when that’s hardly the case today. The same money that goes to pay for people’s cancer treatments is the same money that comes from people’s premiums.
I’d be interested in seeing how broad the spread is on prices for medical services. Certainly the insurance companies have direct influence on healthcare costs simply by restricting coverage to providers that meet their price criteria, right? Insurance companies aren’t forced to pay for million dollar heart surgeries just because a patient shows up a at fancy hospital. They already control where patients are allowed to get services. So I’m failing to see why it’s necessary that patients do even more penny pinching. The penny pinching is built into the system.
You need a cite for what? That preventative care isn’t what is causing the medical bill burden, but rather illnesses and injuries? I can’t believe you’d need a cite for that, but see here: Uninsured and Underinsured Adults Estimated at 61 Million | Physicians for a National Health Program.
I haven’t seen any evidence that people are getting unnecessary healthcare in this country. Can you pin any numbers down on this phenomenon? Since this is indisputable, there should be some hard facts to point to.
Yes, there are a few gatekeepers, although insurance companies, hospitals, and doctors seem to have a clear conflict-of-interest in getting you to buy more services and doing it from them. I’m talking about truly indepdendent organizations that evaluate goods and services like we have with Consumer Reports for things like appliances and cars. There are some rudimentary places doing that now, but if there were more consumer control of health care we’d see more.
And I’m not a mechanic, so I don’t know how to fix my car. But I took it in this morning and everything seemed to work out OK. I’m also not a nutritionist, so I don’t know exactly what food my body needs. Guess what? I haven’t died yet from eating something bad or not eating enough of the right thing. You aren’t an expert in pretty much every area of your life. We have a system where you pay experts to advise you to help you make the right choices. With medical care we can have the same thing.
Well, my wife does actually force me to take her employer’s insurance. She’s the boss of me.
No, actually we can’t. Her job doesn’t allow employees to take the employer share of the insurance premiums and shop around for other insurance. If they did we’d do it in an instant.
I can, sure, because I’m self-employed. If you are employed by someone else and buy your own insurance, however, you pay for the premiums with after-tax dollars (unless those premiums plus your other medical care equal 7% of your income).
I’d love to do so, but it makes no economic sense for me. Why give up $11,000 in essentially free money (my wife’s employer’s share of our premiums)?
Since employers still pay for the vast majority of health care premiums for most Americans, and since the government pays for 50% of the health care in this country, consumers spend very little of their own money on health care.
Not really. When you have a third party paying for a fourth party to cover the medical expenses of someone, the price system gets very messed up. Prices for medical care are essentially meaningless today. They don’t reflect the reality of the value of services offered. Doctors say they have one price, the insurance companies only pay up to another price, and Medicaid and Medicare do the same.
No, I need a cite that “unforseen” crises are burdening the system. If you smoke for forty years, it’s pretty likely you’ll get cancer. If your father has Alzheimer’s, you have a good chance of getting it, too. Many diseases do crop up out of nowhere. Many others, however, seem fairly predictable. Long-term care costs a huge amount of money, for instance. It’s also fairly predictable that you’ll need it.
Again, this is pretty much an indisputable fact. There may be some difference of opinion as to how large this phenomenon is, but I doubt you’d find a credible economist of the left or right who would deny that the phenomenon exists.
Here’s a quick quote from the head of the nonpartisan Congressional Budget Office:
“High-spending regions do not generate better health outcomes, on average, than the lower-spending ones. When health care at some of the nation’s leading medical facilities costs half as much as care at other top-rated facilities for the same types of patients, something must be wrong with the system. Some academic research suggests that national costs for health care can be reduced by perhaps 30% without harming quality.”
That’s not true. From here:
There’s no free money here. Employers pay premiums at the expense of reduced wages. Even with those premiums, there are out-of-pocket expenses.
Yeah, the insurance only pays as much as its willing to pay, nothing more. As I said, the penny pinching is built in the system.
Okay, lung cancer as a result may not be exactly “unforseen”. But using that rational you could say the same thing for almost all diseases since most are associated with risk factors. I fail to see how that changes anything. Preventing the onset of these “forseeable” diseases inevitably will require some preventative care (screenings, tests, checkups), but you say Americans do too much of that already. So, it’s like, what do you want? Do you want people to stay home and wait for the breast cancer to set in, and do you want them to go get annual mammographies and checkups whether they “need” one or not?
That stuff you posted after this doesn’t support your assertion that people are overusing healthcare.
Actually, it is true. Your cite doesn’t address the fact that government pays for around 50% of the health care, insurance companies pay for about 30%, and consumers directly pay around 20% (those are the figures for Maryland, at least).
True, but so what? A third party pays for the vast majority of the average consumer’s health care in the U.S. That’s my only point.
True, but the prices don’t reflect the value to the consumer. Insurance companies may pinch pennies, but they have no real way of knowing which pennies to pinch and how much to pinch. If someone else is paying for my medical care I have a huge incentive to use as much of it as possible. I know what is valuable for me; the third party does not. It can try and contain costs but there will always be that tension.
I want them to have control over their health care dollars so they can make a rational choice. If they think a mammography is truly needed, then they can get one. If they don’t, then they don’t. I want people to have control. That’s it.
It in fact does. I’d urge you to read it more closely if you can’t see that.
But we already have that kind of control and we already have the ability to make rational choices like that. Last time I checked, no one is forcing anyone to get a mammography that they don’t need.
You’re being pretty damned charitable to McCain there. The reporter is putting words into his mouth because McCain doesn’t have a fucking clue. Unless he time-traveled here from the early '80s, having to ask his advisers whether or not condoms stop the spread of HIV is ignorance on a stunning level. I read that whole exchange and my jaw pretty much dropped to the floor.
The only thing he knows how to say is “abstinence, abstinence, abstinence” to the point where he doesn’t even seem know the most absolutely basic facts about STDs. That’s downright scary.
OK, YWTF, I’m going to show you how this works, it’s quite simple, and then you tell me what you think of it:
Consumer Driven Health Care:
For all non-emergency procedures*, your insurance company gives you a price list of approved medical procedures: This is what we will pay for each procedure**. They also give you a list of doctors and facilities in your area that have agreed to provide those services for the stated price, along with a third party evaluation of those providers (Consumer Reports for Docs, say). Now, you can got to ANY doctor or facility you want. If you go to one of the ones on the list, you pay nothing out of pocket. If you go to one not on the list, the insurance company pays exactly what they said they would pay for the procedure, not a penny more, and you are responsible for the rest. There are some wrinkles like deductibles and such that would need to be factored in in practice, but that’s the basic idea. Would you find such a plan to be unduly complex and unworkable? It’s basically what happens after the fact and behind the scenes now, just brought out in the open, up front and placed under the patient’s control. It’s a fantastic idea that brings market forces back into the equation to control costs while putting the patient in charge, rather than corporations or medical and/or governmental bureaucracies.
*For emergency procedures nothing changes, you just go to the nearest emergency room/hospital.
**Such things do already exist, they are called usual and customary rate charts, and they even have different ones by percentages: This chart shows the rates that 30% of all doctors in a given area would accept, this cart 50%, this chart 80%, etc… You could pay a higher premium to have a CDHP based upon 80% charts verses one based upon 50% charts, for example.
Well, I’ve said as much already so I’m honestly not sure what point you’re trying to make. Insurance companies already put so many limits on the number and scope of services that they’ll pay for. So expecting patients to do further “comparison shopping” for their medical treatments on top of this rigamorole is unnecessary and unreasonable.
True, but you’re missing the fact that with the cost to the consumer of essentially zero, there is no incentive for the consumer to use medical care wisely or shop around for the best deal. Having control of your health care dollars means that you have incentives to make better decisions than if you are using someone else’s money.
Christ. For the second time, that’s not what McCain says at all. I know that it interferes with the narrative you’ve created to admit that, but it’s true. The issue is the Coburn report, in which the first preventative measure is abstinence, but, as McCain specifically says, "Where that doesn’t succeed, than he thinks that we should employ contraceptives as well. But I agree with him that the first priority is on abstinence. I look to people like Dr. Coburn. I’m not very wise on it.” Again, the word condom isn’t brought up at all. Now, whether you agree or disagree with abstinence, there is no way you can read that and say, “McCain doesn’t believe condoms prevent HIV.” No way. When pressed on the government’s specific policy of providing contraceptives, he defers back to the report. He is never ever asked if he believes that condoms don’t prevent transmission. He is asked that, knowing that they do prevent transmission, does he support distributing them. He defers to the report.
Now, I’ll ask you, do you think that contraceptives prevent the spread of HIV? Note that I didn’t say condoms. I said contraceptives.
I dispute this fact.
The point that you are missing is that CDHP would replace this rigamarole entirely with something simpler and completely under the patient’s control. You didn’t answer my question though: Would you find such a plan to be unduly complex and unworkable?
Okay, let’s ignore the pie-in-the-sky fantasy of convincing a group of any size whatsoever to be abstinent and concentrate on that question.
Say you’re a presidential candidate who wants to sound, you know, the least bit intelligent. Which of these two ways would you respond?
A.) (really long pause) “Durrr, ya stumped me!”
or
B.) “Not all contraceptives, but properly used condoms certainly do.”
Think hard about that one. It’s a real noggin scratcher. :rolleyes:
Maybe I’m missing something big and obvious, but what you wrote doesn’t seem substantially different than what’s in place now. Can you explain how this really represents a real change? The basic facts still remain that:
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Insurance companies aren’t paying any more than they’re willing to for services. We agree on this?
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It’s not exactly a secret that if you go to a provider that doesn’t accept your insurance, you’re gonna have to pay out of pocket. Likewise, it’s also not a secret that if you go to a provider that does accept your insurance but has prices that aren’t fully covered by your insurance, that you’re gonna have to pay of pocket. We agree on this?
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Currently, if you find yourself in a situation where you need a particular service (i.e. double bypass surgery) and the place you go to charges more than the insurance is willing to pay, then you’ll probably be getting on the phone to speak to an agent who will either direct you to a cheap teaching hospital 100 miles away or will inform you that you are SOL and have to pay the shit yourself. Do we agree on this?
So how is the Consumer Health Driven Plan different from the Shit We Already Got Plan? I’m being glib, yes. But my question is an honest one. Then I’ll tell you whether it’s “unworkable”. Because if what we have in place now is “unworkable” then this sounds equally “unworkable”.