I mispoke - I meant to say consumer of services. I made this mistake earlier too.
The main point was that it is a given that the insurance company is involved in the transaction between the patient and doctor - and that their involvement is not an intrusion. The patient has voluntarily engaged the insurance company.
This ignores the fact that there is a market for health insurance not through employers - though the proportion is much smaller.
In what way is there coercion? In what way is the cost of a service an indicator of coerciveness?
In the field of Health Care Economics, the patient is considered the consumer (among other things) of health care.
One of the many structural economic problems with insurance as a method for health care delivery is that externality.
Neither the consumer (of health care) nor the provider (the physician) of it bears the cost. That is borne by an external third party, the insurance company. Classic externality. And one of the major drivers of excess costs in the US.
The insurance company AND the employer is involved in the transaction between doctor and patient - because it’s the EMPLOYER who chooses the insurance company and policy and not the patient.
No, the patient does not “engage” the insurance company. The patient MIGHT have a choice of insurance policies IF the employer feels like making a choice available… or might just have one “option” and it’s take it or leave it.
Yes, the patient is the “consumer of service”, but the patient is NOT the chooser of insurance.
Let’s look at someone like my spouse. He has multiple chronic medical conditions. He can either take an insurance policy a hypothetical employer offers OR he can go bare… except the out-of-pocket cost of his chronic health care conditions exceeds our monthly gross income. Without that maintenance care he’d probably be hospitalized within months and very likely looking at either amputation, blindness, kidney failure, or death within a year or three after that.
You don’t see anything coercive in that relationship, none at all? You either take this one offer here or you go blind/loose your feet/die? Is that really a viable “choice”? That’s more like having a loaded gun pointed at your head from my viewpoint.
(As it happens, he’s in the state high-risk pool and we were able to obtain insurance for him through a state program, but if we lived across the border in, say, Illinois, we’d be up shit creek. He could have emergency care, including things like emergency amputations should that be necessary, but he would not able to obtain the services to prevent such an occurrence)
That’s the thing - you can’t be denied insurance anymore, but you can be priced out of the market. Most places, until the ACA came in, you either took whatever your employer offered if your employer offered insurance at all or you went without. If you had a chronic condition requiring something daily you were SOL. For decades I couldn’t get private insurance first because I was denied due to a history of allergies and asthma, then they hiked up the prices beyond my reach due to allergies and asthma.
I took jobs I loathed just to get insurance for us.
Now that my health insurance is uncoupled from my workplace I’m much more free to change jobs, and no longer have to worry about losing our insurance if I’m laid off. It would have been easy to say, living in this state, I don’t need ACA because my state already took care of my needs but I’d like to see everyone else in our position having the same option we do - the ability to get basic coverage at a price that doesn’t leave us homeless or my spouse dying.
Yes, but the patient is NOT the chooser of insurance coverage or policies, the employer is… at least until ACA was rolled out.
I believe it, and not because I’m naive. I believe it because I’m fortunate enough to live under a single-payer health care system.
There is every way to characterize the insurance company as an intrusion because that’s exactly what it is – an intrusion, in fact, so egregious that it often results in treatments being entirely denied or drastically altered. This is flagrant and unethical clinical interference for monetary gain, plain and simple.
There is not, however, any way to characterize the relationship as “voluntary” unless one has such vast financial means that health insurance itself is optional. As has been pointed out to you several times, very few people are in that position, so your labored rationalizations are just so much ideological fluff.
I believe about six hundred thousand people work in health care insurance in the US. Mostly at very good salaries. The majority of developed nations do not see the point in this layer, and do without it.
The number of different entities covering medical expenses in the US, along with the many different billing systems and other related tasks leads to a vast amount of administrative work and duplication of effort.
This is the other big contributor to US medical costs. Administrative excess and overprovision together are estimated to be responsible for two-thirds of the US excess medical spending. (Not two-thirds of total medical spending)
I did back-of-envelope calculations in an old thread that suggested the US spends more per capita on healthcare administration as the NHS and BUPA (the dominant private supplementary insurer in the UK) spend on everything. And that was using BUPA’s global revenue figure because I couldn’t find a number for their UK-only operations.
The patient engages the insurance company by choosing to elect coverage under their employer’s plan. You recognize this above. There is no way the insurance company is involved in the doctor/patient relationship without that engagement.
It’s an unfortunate situation with what seems to be very little choices to be made. I don’t see that as coercive at all, unless somehow the insurance company was the cause of the health conditions described. In what way is the health insurance company coercing your spouse? Compare that to an alternative insurance company that you are not involved with - is that company somehow coercing activty as well? That’s just not the meaning of the word.
Just because there are limited or no alternative choices, that is not coercive. Coercion generally requires force or threats of force.
Agreed, but there’s another and more fundamental underlying cause of excessive medical costs, and it’s directly pertinent to point I’ve been making about insurance company intrusion into the doctor-patient relationship. And that is the inability of the fragmented, competitive and uncoordinated private insurance system to control provider costs, an ability that is a core strength of single-payer systems. And that has two side effects. One is overprovision, because it can be so damn profitable, but that’s really just a symptom. The big one is that, unable to control costs in a centralized systemic way, insurance companies control costs at the individual patient level case by case. Hence the clinical intrusion. Bone likes to claim that this is intrinsic and inseparable from having health insurance. Bullshit. It’s intrinsic and inseparable from having health insurance treated as a commercial product and provided by private for-profit corporations.
I’ve never made this claim, that insurance companies controling costs at the individual patient level case by case is intrinsic and inseparable from having health insurance. Are you confusing me for someone else?
Your solution to avoid this problem was to pay all medical costs out of pocket. Obviously there’s a better solution since I don’t have any of these problems and I don’t pay a cent in medical costs.
Your interpretation of that statment is not congruous with your paraphrase. I made no comment on what is better, what is intrisic, or what is inseparable. Your assertion that I made that claim is false. I await your acknoledgment and retraction.
Protip: try and understand what message is actually being conveyed rather than the one you want to rally against.
I’m always happy to retract a false claim with due apologies if I’ve made one. But I don’t see anything at all incongruous here. You stated that the insurance company is involved between the doctor and the patient because the consumer/patient has “elected to pay them to do so”. Did I get any of that wrong? And it’s quite a reasonable explanation for how a corporate business, accountable only to Wall Street shareholders, would have to operate. And your solution to this problem is to have the patient pay the medical costs out of pocket if he doesn’t like it, which as Septimus noted, is equivalent to suggesting that if you don’t like the service on an airline, buy your own jet.
But let’s go with your latest version. You say you never suggested that insurance company meddling between the patient and his doctor is intrinsic or inseparable from the insurance itself. Perhaps you’d like to tell us how the system of private for-profit insurance would function without adjudicating each and every case and each and every claim that came before it, which necessitates exactly the patient-doctor interference I was referring to, and which if you think about it is the basis of how every traditional insurance company has ever functioned in the history of insurance. I await your response.
That’s correct. This discussion was primarily about care within the US, but my statement applies generally as well. Insurance companies do not involve themselves with patients or their health coverage claims if the patient has not opted for service through that insurance company.
But just as I am describing the configuration as it exists, does not mean that all other configurations are precluded. Do you see where you went wrong? You made that leap, unsupported. That I suggested one alternative does not follow that no other is possible.
Correct - this is something you concocted on your own.
This is relevant how? It’s nothing that I’ve commented on nor are my musings on how this could be accomplished related to the fact that you are asserting something that is false.
Again, this is your statement:
No where have I made this claim. I await your acknowledgment and retraction.
Right, we’ve been down this wacky road before, remember? And if you don’t like the service on commercial airlines, then just try flapping your arms really hard and get there all on your own.
The only alternative you’ve suggested is ludicrous. So I ask again: tell us how the system of private for-profit insurance would function without adjudicating each and every case and each and every claim that came before it, which necessitates exactly the patient-doctor interference I was referring to, and which is the basis of how every traditional insurance company has ever functioned in the history of insurance.
If you can’t do this, as an apologist for the private insurance system, then we’d have to conclude that such a system is indeed intrinsically and inseparably linked to meddling between the patient and the doctor.
The question is of course rhetorical. Health care economists have long concluded that this is precisely the problem with commercial risk-based health insurance.
Someone should tell the Republicans that Obama has finally fixed that nasty unemployment problem.
Are there any other laws that you feel would be best handled by private corporations? Speed limits, perhaps? Or maybe laws against murder?
Like it or not, there are some things that the free market can do better than government, and there are some things that the government does better than the free market. The free market had its chance with healthcare, and blew it. It’s time to try something else.
Just to be clear, the health care/health insurance system pre-Obamacare cannot, by any reasonable measure, be called “free market”. It was highly regulated, controlled, subsidized and embedded in the tax code.
Now, if you think the government can distribute contraception better than the free market, then propose legislation where the government does this. Don’t have the government engage a third party to do so.
It’s amusing that you think I’m an apologist for the private insurance system. It’s indicative of your continual reading things and thinking they say something that you want them to rather than the plain text of what is written.
I doubt how ever hard you flap you’d be able to fly. But building your own airline is certainly an available option. You say it as if it makes some fundamental point, but it is true. If you do not like it, you have the option of not flying, among many other available options. But saying that you can build your own airline does not mean everything else is foreclosed.
Do you understand that?
Do you conclude from that suggestion that I somehow believe that is the ONLY other option? If you do, your reading comprehension has failed you.
And I say again, I need not provide insight into any musings I may have to refute your claim. Your claim was false. The intellectually honest thing to do would be to admit error. Are you always this quick to judgment even in the face of the person whom your communicating with telling you otherwise? When I make a mistake in that fashion, I simply say that I misinterpreted and concluded in error. Of course, I usually attempt to clarify to avoid these things.
When the choice is “take what someone else has decided you should have” vs. “have nothing and possibly die for lack of medical care” that is little to no choice at all.
It’s like saying “eat this dogshit pie” or “starve to death”.
Since so many nations have discovered that having a private insurance company involved is completely unnecessary WHY do we have this at all? Why are so many Americans de facto forced to “engage” a private company that is not an actual medical provide in order to obtain medical care?
The only reason that’s not laughably stupid to the average American is because they’ve never known anything other than the jacked-up mess imposed on them.
The coercion comes from the fact that if you do not have a benevolent employer you cannot access medical care in the US. That means taking crap jobs are you unsuited for instead of other employment where you might contribute more to society. Or it might make you into the poster Desert Nomad who talked about leaving the US because he could no longer get medical care here but he could get it abroad. Or it might mean just dying because, since no one cares to employ a particular cripple that person simply can’t raise enough money via spaghetti dinners and other charitable means to maintain his/her own existence.
The situation is morally repugnant and disgusting. America can not continue to claim to be the “greatest” if it continues to abandon the sick and handicapped in such a manner. We do NOT have the “greatest” medical care in the world if 1/6 of our citizens can’t access it or face great obstacles to even basic medical care. From child mortality to average lifespan and for many points in between the US lags shamefully among dozens of other nations. We’re the “land of the free” but for all too many all that freedom means is the freedom to die bankrupt from diseases and conditions that are cared for as a matter of course in every other first world nation.
This IS a different way to do things, and experience shows it also gives better results.
Continuing to deny this is valuing ideology over the lives of actual people.
There ARE alternatives… but all too many in the US stupidly refuses to even consider them. Preserving the parasitic health insurance industry is more important than actually helping sick people.
The insurance companies themselves are not directly involved in the coercion, it is the system. With health care being as expensive as it is, individuals cannot avoid doing business with a health insurance company. Unless you’re hideously wealthy, a significant illness is financial disaster.
Even routine medical care is a financial quagmire, filled with ridiculous list prices, and a poor negotiating position. I had a procedure done, and after multiple phone calls to understand the price, it still came out 20% higher than expected because I had to pay for this shot, and that test, that I didn’t know were separate charges, and I HAVE insurance that pre-negotiated prices with the surgeon.
Our country should simply be embarrassed at the sorry state of our system, it’s more difficult, more stressful AND more expensive, without providing better care.
Ok, so it’s not the insurance companies that are coercing individuals, it’s the system? Can you describe in what way ‘the system’ is coercing anyone?
There are many many things that I want that I cannot afford. Some of these are luxuries and others would marginally improve my health. Am I being coerced by the system because I cannot afford these things? That is an odd twisting of the word.
It’s not that you cannot access medical care, it’s that you cannot afford it. That’s not coercive.
I am all for decoupling health insurance from employers. I’m certainly against forcing businesses to operate in a way they would not otherwise operate to support some healthcare scheme. Hell, I might even be able to support single payer depending on the details. The system we have now certainly does suck in many many ways. But misrepresenting what it actually is now adds no value.
Insurance companies aren’t intruding between patients and doctors, they are part of that relationship. Something being very expensive and at the same time in very high demand does not make it coercive if it’s not provided.
