Thread: What do you think will happen when...

Originally Posted by thebigspendur

We pay to much, we get too little, our outcomes are worse than most other countries, health Insurance Companies are some of the wealthiest Companies in the U.S even during hard times, eventually few will be able to afford insurance at all. Is that enough?

You say we pay too much and get too little, but I don't know if this is true in every case, or even in most cases. I'm not exactly sure what you mean by "too little."

Outcomes are worse than most countries? What countries and what outcomes exactly? Personally I've never experienced a less than expected medical outcome. Mistakes do happen, but once again, is this the exception? If our system were that bad wouldn't Americans flock to other countries for care? If they are, is it a big secret?

Health insurance companies could only be wealthy if they are doing something right. A company doesn't become wealthy by making mistakes, does it? No one forces individuals to pay health insurance companies. So if people are paying voluntarily, there must be some perceived benefit. Unless we are to believe that all those people, including all of us, are just plain stupid with money. I prefer to give people more credit than that. And insurance companies are not going to price themselves out of the range that people can pay for their services. That would be suicidal and stupid.

Besides that, what do you think all of those wealthy insurance companies do with all that wealth? Don't they pay employee salaries which pays for living expenses? They purchase business supplies, computers, software, etc. Possibly invest. What's wrong with all of that? I don't begrudge any business or individual for using their ingenuity and guts to become successful and wealthy. Who, with the same abilities, wouldn't want to do the same?

The more people who join a health plan, the lower the premiums, correct? Add to that more health plans competing for the same group(s) of people, should bring about even lower premiums. Am I wrong?

Is it true that health plans in one State can not sell policies to individuals in another?

And is it true that one reason for increased cost is due to out of control malpractice and tort litigation?

I still think that any form of national health care is just a quick band aid fix and will end up creating more long term problems than it will seem to cure in the short term.

Originally Posted by honedright

You say we pay too much and get too little, but I don't know if this is true in every case, or even in most cases. I'm not exactly sure what you mean by "too little."

Outcomes are worse than most countries? What countries and what outcomes exactly? Personally I've never experienced a less than expected medical outcome. Mistakes do happen, but once again, is this the exception? If our system were that bad wouldn't Americans flock to other countries for care? If they are, is it a big secret?

Health insurance companies could only be wealthy if they are doing something right. A company doesn't become wealthy by making mistakes, does it? No one forces individuals to pay health insurance companies. So if people are paying voluntarily, there must be some perceived benefit. Unless we are to believe that all those people, including all of us, are just plain stupid with money. I prefer to give people more credit than that. And insurance companies are not going to price themselves out of the range that people can pay for their services. That would be suicidal and stupid.

Besides that, what do you think all of those wealthy insurance companies do with all that wealth? Don't they pay employee salaries which pays for living expenses? They purchase business supplies, computers, software, etc. Possibly invest. What's wrong with all of that? I don't begrudge any business or individual for using their ingenuity and guts to become successful and wealthy. Who, with the same abilities, wouldn't want to do the same?

Excessive corporate greed in any type of industry is a shame and IMO ends up causing more damage than good for most. However, placing blame with insurance companies and viewing them as reaping endless profit is not correct. I'm in agreement with you there. It's a long established game between health insurance companies and their contracted providers; providers increase their R&C charges (Reasonable and Customary) on services and insurance companies set a lower contracted rate. The contracted rate increases each time the R&C increases. If the R&C for a doctor visit in a certain area is $150 today the insurance company may pay $100. Next year the R&C may be $300. The insurance company may then pay $200, etc.

One thing no one talks about is the dramatic change, skyrocketing overall health costs that started in the early to mid nineties and I believe in large part due to drug companies being allowed to advertise in the media. I believe the rise in health care costs if viewed on a chart would climb like the Matterhorn in correlation with the change in drug laws.

There are a lot of players contributing to this mess. Group health offered by ANY employer other than large corporations? That will simply be an impossibility for the average employer very soon and already has been for many small businesses.

Chris L

Originally Posted by matt321

I think the existing system is caught in a death spiral.

This is the spiral:
Costs go up to cover medical services for the uninsured.
Since costs are rising insurance premiums must go up as well.
As premiums rise fewer folks can afford insurance coverage.
The number of uninsured families rises.
Therefore costs go up to cover medical services for the uninsured.

I found this quote on the first google hit I opened:
The cumulative increase in employer-sponsored health insurance premiums have raised at four times the rate of inflation and wage increases during last decade. This increase has made it much more difficult for businesses to continue to provide coverage to their employees and for those workers to afford coverage themselves.

The Congressional Budget Office has estimated that job-based health insurance could increase 100 percent over the next decade. Employer-based family insurance costs for a family of four will reach nearly $25,000 per year by 2018 absent health care reform

I agree, reform is needed, NOT socialism.

Maybe it's off topic, but what exactly is excessive corporate greed?

Originally Posted by ChrisL

It's a long established game between health insurance companies and their contracted providers; providers increase their R&C charges (Reasonable and Customary) on services and insurance companies set a lower contracted rate. The contracted rate increases each time the R&C increases. If the R&C for a doctor visit in a certain area is $150 today the insurance company may pay $100. Next year the R&C may be $300. The insurance company may then pay $200, etc.

Chris L

Maybe the problem is that the patient/ consumer is not the one participating in deciding the Usual and Customary (that's what it was called when I was in practice) rate.

Originally Posted by honedright

Maybe it's off topic, but what exactly is excessive corporate greed?

That's a good question. I think there are two perspectives one can view commerce from.

There's the camp: "If laws are inadequate or the law allows for "unethical" behavior, piracy, suppression, collusion, etc, it's no fault of the oil companies, pharmaceutical companies, etc to behave in ways that most would view as unethical. If it isn't illegal, it isn't wrong.

Then there's the camp that believes that "ethical business practices" have an inherent factor which fosters healthy balanced commerce and "unethical" practices create an atmosphere which is detrimental to commerce and ultimately set the stage for the failure of capitalism.

You've heard the term "robber baron"? Fascinating stuff if you read about J.P. Morgan, Carnegie, Rockefeller, etc. I'm in the camp that believes that individuals such as they could not have amassed such staggeringly disproportionate wealth for their time without employing tactics that were, well, wrong.

Others view "robber baron" as an inaccurate term arguing that, again, the laws at the time either allowed or were changed or written to allow for their businesses to act in all the manners they saw fit so, what's the harm?

Chris L

Originally Posted by honedright

Maybe the problem is that the patient/ consumer is not the one participating in deciding the Usual and Customary (that's what it was called when I was in practice) rate.

In the Midwest, "R&C" was and I assume is the term used interchangeably with "U&C". I worked for several health plans in Minnesota in the early and mid nineties much of that time as a claims processor than as a data analyst.

Chris L

I just found out that under the bill that is expected to be voted on in the next few weeks will mandate that everyone buy U.S. Government approved insurance or be fined up to $25,000 and up to a year in jail. This is on page 49 of the bill that was written in the House.

Also, states with more than 12% unemployment will be excused from paying for the cost of increases in Medicaid caused by the Universal Health Care. Originally, there were three states that qualified: Oregon, Michigan, and New Hampshire (IIRC). Harry Reed got Nevada added (his state). The cost of the free passes by these four states will be covered by Florida, California, and Illinois. Florida does not have personal income taxes, yet, and California is in terrible financial mess. I don't know about Illinois, but you can bet these three states will have to increase personal income taxes or enact personal income taxes.

Per the Congressional Budget Office, 21% of the cost of the Obama Health Care will be covered by families with family incomes less than $40,000 and 80% will be borne by families with family incomes less than $100,000.

Originally Posted by honedright

Outcomes are worse than most countries? What countries and what outcomes exactly?

Worse than the vast majority of industrialized countries. #1 in cost and #37 in quality of healthcare. Yes, I know you are #1 in survival rate for a specific cancer... read the original paper in its entirety, you'll see that's almost the only sample survival rate in which America looks good amongst industrialized countries.

Before you repeat the media-fed "long waiting lines, bureaucrat between the patient and the doctor, dieing in the waiting room", what your media is spouting flies in the face of the first-hand experience of every single person I know in Europe... and I have been working all over Europe in the last 17 years.

Up to date, the only time I had to wait in a European hospital is when a soldier got his legs crushed in an accident on the closest military ground. The hospital stabilized my injury and treated that guy first, I had no issue with that... his condition was more life-threatening than mine. If they hadn't done it automatically, I'd have volunteered to give him priority.

Originally Posted by honedright

If our system were that bad wouldn't Americans flock to other countries for care? If they are, is it a big secret?

I don't know if it is still the case, but a few years back there was a lot of specialized medical tourism... Dental work in Mexico being one example.

Yes, I know that people from many other countries do flock to America for treatment. It would be interesting to see the split on treatment type, a non-random guess: cosmetic surgery, cosmetic surgery on minors (forbidden in Europe), experimental treatments.

Originally Posted by ChrisL

That's a good question. I think there are two perspectives one can view commerce from.

There's the camp: "If laws are inadequate or the law allows for "unethical" behavior, piracy, suppression, collusion, etc, it's no fault of the oil companies, pharmaceutical companies, etc to behave in ways that most would view as unethical. If it isn't illegal, it isn't wrong.

Then there's the camp that believes that "ethical business practices" have an inherent factor which fosters healthy balanced commerce and "unethical" practices create an atmosphere which is detrimental to commerce and ultimately set the stage for the failure of capitalism.

You've heard the term "robber baron"? Fascinating stuff if you read about J.P. Morgan, Carnegie, Rockefeller, etc. I'm in the camp that believes that individuals such as they could not have amassed such staggeringly disproportionate wealth for their time without employing tactics that were, well, wrong.

Others view "robber baron" as an inaccurate term arguing that, again, the laws at the time either allowed or were changed or written to allow for their businesses to act in all the manners they saw fit so, what's the harm?

Chris L

What comes to mind is "buyer beware." Why not let the well informed public pocketbook deal with unethical private business rather than government? When government gets involved, even ethical businesses are affected.