Regarding this, medicare and medicaid aren’t the only insurers who “bargain down” prices. I recently had an outpatient surgery for which I was insured by my employer’s private coverage. The assistant surgeon wanted to charge about $7000. He got $314. The primary surgeon also wanted to charge $7000. He got $2100. The anestesiologist wanted $1,600. He got $400. The hospital wanted to charge $25,000. The insurance paid them $6,421. So, you were saying about “bargaining down prices” if the government takes over?
That is sort of my point. It is quite foreseeable that insurance that covers people not currently covered is going to cost more.
So, given that these costs are foreseeable, if you cannot be expected to come up with the money, how are we as a society going to come up with the money?
As you (very correctly) assert, the healthy have to pay for the sick. OK, assuming that we include people like your wife* as “the sick”, then pretty much by definition we have to ask the healthy to pay more to cover her.
Assume that there are a lot of folks in your same situation - they cannot get coverage, because it would cost too much. Okay, now we have UHC, and all those folks are covered. It seems to me inescapable that we need to charge the healthy as much to cover them as will cover their (very expensive) cost. Thus the cost of health care under UHC goes up.
How then do we pay for that? We can try the foolsguinea method and soak the rich, but, as has been pointed out, the rich don’t have enough money to make that feasible. Even assuming they will sit still and take it, which they won’t.
There is not going to be a pain-free method to implement UHC. That’s just how the universe works. Any UHC scheme means that those currently covered will have to be satisfied with worse health care at more cost.
Regards,
Shodan
*It is not my intention to sound like I am making this personal, so please don’t take it that way. My best wishes for your wife, no matter what.
You are right, I am limited by what my employer offers. We cannot purchase additional insurance, no one will sell it to us (well possibly at a ridiculous sum).
I understand, thank you.
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Well, from my experience, the larger the negotiating group, the more power over health costs it has. My current employer is small, and does not have much negotiating power, our premiums are high, and the coverage is average. My previous employer was large, and had great negotiating power, my premiums were lower and the coverage was above average.
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If I were to be laid off, start my own company or go to another firm, my wife may or may not be covered under a new health care plan for a “prior condition”.
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I am “indentured” to my current employer, not because I cannot find another job possibly even a higher paying job, but because my wifes healthcare is tied to that insurance.
This is all true, a comment on number 5. In the U.S. insurance providers negotiate with drug companies, it is critical for the success of a new drug to be on the insurance providers formulary. This is all negotiated, and the formulary is usually tiered. If a drug is not on the insurance providers formulary, it is not covered by patient insurance, and the patient will complain to the doctor, who will write another prescription. I believe the U.S. through medicare/medicaid does negotiate with drug companies.
Shodan, for a right-winger, you sure seem uninterested in market forces. There are two known methods to lower prices: increase supply (which is slow but looks to me like it’s necessary with an aging population); or use monospony power through larger pools of patients being covered by the same insurer.
As it stands now, some Americans are insured by the government: the very old & the very very poor. Other Americans are insured by their labor unions. But the self-employed, the small businesses, even management of companies that have amazing insurance for their labor, get worse deals. (A factory in my hometown has the floor workers unionized through the Teamsters; they get very good benefits. An acquaintance with an engineering degree got promoted into management; more freedom, better pay, good perks–except his benefits went down. But he was doing the job he wanted, so it was good.)
We have socialized medicine now, but without equal protection. And those in smaller groups of buyers get a worse deal. Sometimes twice. First in the number of persons you can bring to an insurer; then in the number of accounts the insurance company has versus other insurers.
Let me add: Decreasing supply does not decrease price.
And how do we make sure that everyone who needs insurance can get it? I’ve been advocating this for years, that my entire family (some ~200 of us) or the membership of my credit union or hell, the people who live in my zip code, should be able to qualify as a group, for the purposes of insurance, but unless we start a company, we don’t. This is another one of the means of opening up the insurance market, but once more, unless we tell insurers "covering everyone means covering everyone people like me are still going to be screwed.
Well then it’s a good, good thing that no one is suggesting that “we” pay for “every citizen’s” health care.
OK, none of your three sentences is true of the USA.
We have a screwy economy because we went from a high-domestic-production high-domestic-consumption economy to a high-domestic-consumption economy with outsourced production. But we still have the engineers & the intellectual property.
Making it easier to start a business might help, as might the gradual correction in wages & prices to get us where we ought to be as a country (rich but not as dominant as in 1960). Leaving in place the 20th-Century employer health care regime does not accomplish those things at all.
Currently the US pays more than anyone and gets less coverage and lower quality than comparable nations. So the argument that you can’t afford anything different makes no sense. I would think you can’t afford NOT to change the system.
Under the current system you have to pay profits for the insurance companies, the pharmaceptical companies, retaliers and hospitals. You also have to pay for litigation, and due to the convoluted system, for excessive administration. A private business has to make a profit.
At the same time, the insurance companies and others of course are encouraged to not give treatment. Pre-existing conditions etc, after all a companies responsibility is with the stock holders, maximising profits, not maximising care or quality. If it will cost the company $50.000 to deny a service and $100.000 to provide it, they will of course deny it.
So you get less coverage and less quality at a higher cost. Which makes sense considering how the system is constructed.
In the socialised systems taxes pay for the healthcare directly, usually with nominal fees for seeing a doctor. There is no need to pay out profits, and since only one administrative body is involved the cost for beauracracy is very limited. The doctors will be paid less since there will be less competition for them, but they still make a handsome living (a doctor will still make more than twice as much as an average wirker).
So it’s mainly a philosophical question. Would you rather pay twice as much in premiums to have the freedom to be exploited, or would you rather pay much less, but in taxes instead of insurance fees and not have the freedom to go without medical care? Of course there is also the side effect that everyone will have access to the healthcare, which some seem to see as a bad thing.
You’re just restating your position in the OP. As many have noted, the price difference isn’t only nor probably principally due to the universal health issue. We could get to the same cost of health care via other means just as well without sacrificing the quality of health care we have now.
No, I have a better understanding than someone who assumes we can get a trillion dollars by taxing Warren Buffet out of existence.
This is certainly true.
The way to increase prices is to increase demand. Adding 47 million people will increase demand. Supply is held constant, or nearly so. Therefore, prices will go up.
Actually, almost half. This is a much larger group than any single private insurer; therefore, by your logic government should pay less for services but maintain the same access for its beneficiaries. Unfortunately, this is hardly the case.
Add to that the unfortunate fact that, calculated on a per-person basis, administrative costs for Medicare are higher than for private insurers and we can see that adding more beneficiaries to taxpayer-funded health plans will make it cost more.
Regards,
Shodan
Is the current healthcare cost to taxpayers/society of those 47 million people now $0?
If not is it more or less than the cost to taxpayers/society if UHC* is implemented?
Is this cost even currently quantifiable?
- I’m not a UHC proponent, but I do think our current system is broken.
It is less than the cost to taxpayers under UHC. People without insurance tend to use the health care system less. This is based on the idea that preventative care does not, overall, save money. Which is certainly a little cold-blooded. It is rather like the idea that cigarette smoking saves money on health care, since lung cancer is rarely treatable and smokers die young and fast and therefore do not incur the high costs of dying.
Regards,
Shodan
Which is why I don’t want to throw more money & more people into the present Medicare structure without massive investment in the supply side. You can argue with the idiot Democrats in Congress, but you’re not answering me.
I didn’t say, “maintain the same access for its beneficiaries,” that’s your interpolation. Of course if the demand is sufficiently greater than supply, doctors can choose to only take those who will pay more. The widespread refusal to treat Medicare patients only proves my point. Thank you for your cites, you’re helping me make my case.
My point was that your quality of healthcare seems low, and you’re paying more than twice as much as everyone else. So “same cost” and “without sacrificing the quality of health care” isn’t really the proposition. Raising quality as well as lowering the cost is. Which, to me, would need a very strong principal reason to oppose (but I admit that I am not very principled in these matters but rather pragmatic/opportunistic).
It sounds to me like opportunism is your primary motive. But basically, the principal of the thing is, if I have the choice between supporting Duke, the alcoholic high-school dropout, and my daughter at equal levels of health care, or telling Duke to piss off until he’s dying and give my own daughter the best level of care and preventative care that I can, I would choose the latter. Expanding the example to the entire populace of the United States rather than a three-person mini-scenario doesn’t magically change the dynamic. 8 million Dukes aren’t more worthy of my money than 1. I don’t mean to sentence him to death or anything, but at the same time, I just don’t care to give him any attention until I’m pretty much forced to.
Health care should be on a gradient. The bottom of the gradient should suck, and the top should be wonderful. Everybody doesn’t get a free iPod even though it would make the national average of happiness higher, and there’s no reason to expect it.
Ah, but what if the options are:
Pay $100 and your daughter gets adequate healthcare, Duke the drunken bozo gets none.
Pay $50 and your daughter gets adequate healthcare, but so does Duke.
Then you’d really have to carry a grudge against Duke not to pick the second option.
So how are we going to pay for that? I think you have already bankrupted Warren Buffett, so don’t expect to spend his money again.
Then, as I said, people are going to have to get used to less health care for more money.
Regards,
Shodan
Again, the dollar values is a bogeyman. Your insistence that it’s purely or mostly the lack of universal healthcare driving up the cost doesn’t become true the more you repeat it.
But to answer your question: Yeah, sure, I’d pay less to give my daughter the same care. If you can show that preventative care for poor people is easier on my pocket in the long run than telling them to piss of until they’re dying, then fine let’s go with preventative care. But I’m personally dubious that the math is that clearcut on that issue. Certainly there are examples of it being true, but there are likely examples where it isn’t true that just happen to never be brought up.
I, for one, would really like to see some solution to this nonsense. One of the things that makes being uninsured so untenable is the ridiculous prices uninsured people are charged in comparison to what insurance companies paid.
I couple of years back I had routine ankle surgery. It would have been financially painful, but I could have paid off the $6000 my insurance company paid for the whole procedure. I could not have afforded the $22,000 original bill.