What we’ve done to ourselves doesn’t address the problem you claim it does. Just look at my real world example. Let’s assume that the premium is subsidized at 66% by a company. So out-of-pocket costs have gone from $2,000 to $5,000. If you’re self-employed or your employer doesn’t chip in, the number went from $6,000 to $9,000. I’ve been through my policy, there’s not a single benefit in there that I didn’t already have - I’m just out almost $3,000 more.
If you couldn’t afford health insurance before, you definitely can’t now (hence 5+ million more people on Medicaid as of April).
Of course it will be quite simple to gauge this wealth transfer. At some point in the future we should be able to point to some statistic - life span perhaps - and see a dramatic shift to some new plateau. I predict not. This is simply a mechanism for the government to shift social program spending to the private sector.
As an aside, the example of women in their 50’s more than doubling the number of births in a decade is perfect. Among the many explanation possible could be the number of women over 50 has doubled, menopause onset has moved dramatically, or medical intervention. I’m going with medical intervention. Why should I or anyone else subsidize or enable that (or any of the other countless medical procedures people undergo simply because they can)?
No it doesn’t. If it did, our medical expenses would be on a par with the MANY other countries that do better for less. But it was the step we could take given the fucking idiocy about health care and the multitude of entrenched interests in this country.
The you are IME the luckiest effing SOB on the planet. I’ve had years where the insurance company got no claims exactly right, and averaged more than one error per claim. We run through a lot of claims in my family - easily 100 a year between health, pharmacy, dental, and mental health. I do not know of anyone else who’s gotten a refund from an audit. I don’t think you know how incredibly lucky you are in that aspect. You fantastic luck in your dealings with the insurance companies may have colored your view of reform. I know my average luck in dealing with the scumbags has colored my view a lot.
Why assume that? What’s the basis for these numbers?
If there is not a single benefit in the new policy that you did not already have, then your old policy was ACA-compliant anyway and did not have to be cancelled. In other words, your insurance company jacked your rate for no good reason, and got you to blame somebody else, which is a win-win for them.
The Medicaid expansion is exactly that: lots of people who were not previously eligible for Medicaid are now eligible under the expanded criteria, so your ‘hence’ does not follow from the first part. Newly-eligible people are signing up–that’s a good thing, and part of the what the law was supposed to accomplish.
Except you ignore that the spending was happening anyway: the U.S. spends more per capita and a greater percentage of GDP on health care than any other nation, with mediocre results.
Look at Medicaid. Being poor did not (and in much of the U.S., still does not) automatically make you eligible for Medicaid. Here in Kansas, e.g., a working-age adult who is not disabled and is not the parent of small children is not eligible for Medicaid, period, no matter how small their income. There is no “social program spending” on adults like that; if they have medical bills they can’t pay, it simply goes down as uncompensated care, so the doctors and hospitals and other providers have to make up that cost by charging other people more. The private sector is already paying.
Beyond that, you keep focusing on medical interventions while ignoring the question I’m actually asking, and have posed several times now: the “oops” factor. What do you propose to do about women who have an UNPLANNED late-in-life pregnancy, or for that matter any other expensive, unplanned, uncovered, unbudgeted-for medical condition?
What do you want to do about people who thought they only needed coverages X, Y, and Z, so that’s all they bought, when it turns out they really needed coverage W too?
The premium I quoted is what I personally pay and I used 66% because that’s how much I subsidize of my employees’ premiums.
My premium didn’t move much but my deductible went through the roof. Rather than come to the conclusion that my carrier is out to get my little small business, I’m going with I am sitting in a risk pool that includes guaranteed claims that are measured in thousands of dollars, maybe even tens of thousands. And everyone else with one of these policies is too. My policy also includes coverages I can’t possibly ever use and/or don’t want.
So you do agree then - we will pay for the ‘uninsured’ anyway and we’ll know exactly how much it costs.
Doesn’t bother me.
I stopped reading at non-disabled, working-age adult with no dependents.
So you’re going with they’re eating better - didn’t see that coming.
Medical insurance should cover the unexpected. If you find a company (in the world I’m imagining) that sells individual riders for specific diseases I suggest you not consider that company’s policy. Given how highly regulated this industry is by the states and now the Feds, write regulations that define that disease pool if it’s that large a concern.
I’ve already described what I think should happen to unplanned pregnancies (or any other self-inflicted condition or routine care) - join a price club. Insurance should insure you against unforeseen losses. If you want to achieve some sort of social goal - tax us. Using insurance to achieve these goals is just a way for politicians to hide the costs.
You are making an assumption. It may or may not be a warranted assumption, but I see no reason I should make the same assumptions without data.
In the pre-ACA system, we were paying for the uninsured to get the most expensive sort of care available: care provided in the emergency room once their medical problems rose to that level. We received mediocre results (since by the time their illnesses were that serious, treatment is less effective), but we were still paying far more than any other western nation. How is that practical?
It ought to bother you. As a business owner, would you consider it fiscally prudent to pay more than your competitors for lesser product? In essence, that’s what we as a nation were doing, and that is an incredible drain on the resources of the nation and everyone in it.
Why? Do you think people in that demographic don’t get cancer, don’t have devastating accidents, don’t develop diabetes or heart disease or other ailments?
Remember, we’re not just talking about unemployed. Most of the uninsured working-age non-disabled adults with no dependents in my state have jobs. They are in low-wage, low-benefit industries such as retail and meatpacking and call centers, but they have jobs. They just have no fallback plan if they get sick, except “dump the bills on other people.”
That’s what the evidence shows. Average age of menopause is increasing in most of the developed world, coincident with better nutrition and better health generally.
Unplanned pregnancy, by definition, is unexpected. Therefore, by your own assertion, medical insurance should cover it.
If you want to define medical insurance as covering only those conditions that could not possibly be self-inflicted, then what would it cover? Many cancers, e.g., are linked to behavior (diet, occupational exposure, obesity, etc.); so are diabetes and heart disease. You couldn’t be in a devastating road accident if you never went out on the road; if you made sure you never fell, a broken hip is far less likely. What, exactly, would insurance cover in your view?
Sorry, I’m missing your point here. Are you objecting to my premium costs, how much I’m subsidizing, my deductible - what assumption don’t you like? Or do you think my premiums aren’t representative?
I’ve never seen any of this data that attempts to adjust for differences in how other countries report and measure this information. I doubt I ever will. But I also don’t see how burying these costs in insurance premiums will have any effect. How will it drive down costs? Are you assuming a behavior change?
Just not interested in building health care systems around the needs of under/un-employed, non-disabled, working-age adults with no dependents.
[QUOTE=Josephine Quintavalle of Comment on Reproductive Ethics]
The older the mother, the higher the risk of complications. Having a child at such an old age also has implications on the time these mothers will have to enjoying being a grandparent.
This doubling of births to over-fifties isn’t something which would have happened naturally, as there’s no way there has been that significant a change in natural menopause in the past five years.
[/QUOTE]
An unplanned pregnancy is simply lack of responsibility. If you didn’t join the price club, you’re going to be out some money. If you have complications during pregnancy or delivery and you have insurance, I think your insurance should cover that (and you should reject riders that attempt to exclude them if you’re female or have females in your household).
I don’t have a problem with insurance carriers taking behaviors into account when setting premium levels.
I’m objecting to the assumption that your premiums, deductibles, and subsidies, and the changes therein since the adoption of the ACA, are typical.
Try reading about the Health Accounts Country Platform and the System of Health Accounts developed by the World Health Organization; one of the primary goals is the production of data comparable across time and across countries, and they’ve written extensive documentation.
What part of ‘delivering health care in the most expensive way possible’ escapes you?
The Emergency Room is THE most expensive and least efficient way to deliver routine care, but it’s the default for most of the uninsured, because it’s the one available delivery option that won’t refuse service due to lack of insurance.
If you have insurance, though, you have other options, frequently more convenient options, and certainly more cost-effective options. A behavior change that involves going to the doctor’s office or the urgent care clinic instead of the ER for ear infections and the flu and suspicious moles and all of the other non-emergencies that now clog the ER offers substantial opportunities to reduce costs.
That’s merely one small part of the law; the ACA includes entire sections devoted entirely to cost containment measures separate and apart from the insurance mandate or subsidies. (See, e.g., the funding for evidence-based medicine and comparative effectiveness research, or the limitations on non-medical expenses of insurance companies.)
What demographic are you interested in providing for? Every state sets its own requirements for Medicaid; in other states, non-disabled, working-age adults WITH dependents aren’t eligible either. (In my state, a parent with children at home is eligible for Medicaid, but only if the family’s countable income does not exceed $471/month (family of four)). Moreover, the percentage of jobs offering insurance has been declining for a number of years; do you really believe that fully a third of American employees are under-employed? (In 2010, only 67% of American workers [people who had jobs] held jobs that offered insurance.) If you do believe this, what conclusions do you draw about the state of the American economy?
Failure of birth control, rape . . .
This discussion started precisely because some were advocating for policies that let you pick and choose coverages instead of having something comprehensive. (See, e.g., adaher’s posts from #3038 on.) The argument as presented is: I don’t think I can get pregnant, so I should not be forced to buy insurance that covers maternity/childbirth.
This is a bad deal, for the individual AND for society at large, precisely because individuals are bad at judging risk. Suppose I’m 52, think I can’t get pregnant, decline maternity coverage, and “oops.” Change the condition: posit someone who has no family history of cancer, has no risk factors for cancer, and declines cancer coverage because it’s cheaper. “oops.” If you don’t like pregnancy or cancer, pick something else where there are known risk factors and people who think they aren’t at risk. “oops”
You are changing your argument then, because your previous argument was that insurance should not cover “any other self-inflicted condition” period. You choose to have a kid, so all of the costs (including complications) come from this “price club.” You choose to smoke, so all of the costs of lung cancer or emphysema treatment come from the price club. etc.
Sorry, this is just another collection tool by yet another agency (with a somewhat checkered past that has failed spectacularly at every opportunity for several decades). It doesn’t address the differences in how societies evaluate outcomes or even how they measure them.
So you do believe there will be a behavior change.
Pardon me if I decide not to take you up on your kind offer of that fine bridge you have for sale.
I’m interested in a true insurance product that allows me to decide what level of risk I’m willing to accept and living with the consequences of those decisions. We, through programs at the state and/or federal level, should provide assistance to those without the income or assets to use these products or develop alternatives to the products. It’s a program - I can measure its effectiveness and gauge whether the return is worth it.
I’ve already addressed the specific example of pregnancy/birth as a result of rape, incest, … here.
Your condom broke and you decided yesterday to stop participating in the pregnancy/birth price club - tough, no new car for a few years.
The odds, if you will, of conditions, diseases, accidents, etc, are easily projected. Developing products to provide coverage for these is something the industry can do quite effectively. I think we should not be restricting the industry from evaluating your individual risk factors to determine a specific premium for your coverage. Obviously a subset of the population will not be able to afford the coverage at that point. The federal and state governments should provide assistance or alternative products to meet that need or, alternatively, we as a society decide we’re not going to address that particular need or service it at a reduced level.
Additionally, if some behavior should always result in a certain outcome (driving drunk for example) then the consequences of that behavior should it result in a claim could be non-payment (if the underwriter desires). I would probably start with some sort of fund that supports the expenses resulting (and a non-dischargeable debt). I understand that some people are judgement proof.
I’ll address some of your other points later when I have more time, but this is such a biggie that I’ll make time now.
Exactly how do you think this could possibly work?
Somebody shows up at the ER or other medical facility. STOP!! DO NOT TREAT!! CALL HIS INSURANCE COMPANY FIRST!! We must conduct a thorough and in-depth examination of his policy. Have our lawyers call their lawyers, and negotiate what kinds of treatments he will be permitted before our staff begin any sort of care.
Seriously?!?
“XYZ Insurance would like us to fax his blood tests to see if he had any undisclosed conditions that would void his coverage so they can make a determination. Oh, the patient died two weeks ago? Well, too bad, so sad.”
In health care, what you are asking for is impossible. In any emergency situation, the hospitals treat first and ask for payment second. That means a heck of a lot of people would never have to face the consequences of their decision to be uninsured for any particular problem, which means a product like this could not work as you envision.
Works now. Somebody shows up at the ER and they get taken care of. According to the American College of Emergency Physicians, ER costs are 2% of health care costs.
What if in my country I spend enormous amounts of money trying to save every live birth and in your country it’s too bad, so sad and it doesn’t even show up in the infant mortality numbers? What if in my country I use every trick in my medical playbook to keep dear old dad alive and in your country dear old dad goes straight to hospice?
What country do you think it wouldn’t show up in the infant mortality numbers?
All of the major OECD nations standardized on the same definition of live birth (born with a heartbeat or breathing) some decades ago. You’ll find some older definitions for older statistics (e.g., in Czechoslovakia prior to 1965 an infant born before 28 weeks gestation had to survive at least 24 hours to count, but they adopted the standardized international definition of “breathing or a heartbeat” fifty years back).
We’re not comparing the U.S. infant mortality rate to some third-world nation that hasn’t gotten around to standardizing; we are comparing it to nations using exactly the same definition as we do, and we don’t compare favorably.
What “works now” is the very antithesis of what you are advocating.
Under your proposal, if you show up at the ER with the wrong kind of insurance, you DON’T get taken care of. You get treatment for exactly what your insurance will cover or you have cash in hand to pay for. Anything else, too bad, so sad.
The consequences would be lack of medical treatment (which could mean death). Nobody showing up in an American emergency room today faces those consequences.
If I can show up at the ER and get treatment for whatever ails me, then what is the mechanism of “a true insurance product that allows me to decide what level of risk I’m willing to accept and living with the consequences of those decisions”?
The consequences of living with a given level of risk are that I won’t be able to get treatment for something, that I might die or be permanently injured by something not covered by the insurance I bought. If treatment’s available at the ER to everyone, then there are no consequences to a bad decision. If there are consequences, then that means that people who show up at the emergency room do NOT get treated for uncovered conditions.
And the Bulletin of WHO article cited is discussing neonatal death statistics over several centuries (the Swedish statistics cited begin in the 1750s). The U.S. CDCnotes that almost all of Europe adopted the standard definition (any sign of life) at various dates in the later 20th century. Under CURRENT law, Austria, Denmark, Finland, Germany, Hungary, Italy, Portugal, Slovak Republic, Spain, Sweden, the United Kingdom, and the United States all require any birth in which the infant draws a single breath to be reported as a live birth; Norway and France require any birth after 12 and 22 weeks respectively (the world record for earliest surviving birth is 21 weeks, 5 days).
Among those nations, the United States has a lower infant mortality rate than Hungary. Everybody else does better.
That can be a set of consequences for insufficient coverage (and I don’t hear anyone advocating that position).
Among the many other consequences are higher costs for you (the person receiving the care) and financial liability for you (and I understand there’s a segment of the population that just doesn’t care about that liability). And I’ve pointed out several times some of the ways I would handle it.
But in the end - it’s not even a significant driver of the spending discrepancies that seem to bother you and others so much.
The report doesn’t say that (it’s even listed as a key finding). The WHO report (among other things - it’s quite long) points out that despite reporting requirements, countries are (as of 2006) not reporting births they should. The authors of the CDC report acknowledge that and point it out. They posit the differences in the way other countries reports births doesn’t account for most of the disparity but do acknowledge it has an effect (and they make no rigorous demonstration of this - and I wouldn’t expect them to, it’s a report, not a study). This just confirms that you can’t look at the data as reported (which was my point). And those are just health results - it doesn’t even touch on accounting of spending.
Their conclusion is reduce the number of preterm births (the infant mortality of preterm births is much lower in the US).