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Old 06-13-2014, 12:22 PM   #41
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And I must respectfully disagree with your disagreement.

I will make this brief in the hope that I don't bring out the bacon nor derail the thread.

Focusing on health insurer profits completely misses the point when discussing health care cost. It's like saying your car doesn't go fast enough because it has a bad paint job. See the attached article, Table 3-1 in particular. That's where the "pony" is; all the rest is...well you know.

http://economix.blogs.nytimes.com/20...n-health-care/
So where's the disagreement? Overall HC costs are too high but this is not mainly due to HI companies. If you go to the IOM source material, most of the "Excess Administrative Costs" are NOT due to the insurance co's but are spread throughout the system. Much of it is at the provider/hospital level (e.g. too many supervisors per doc/nurse/tech actually delivering care), much is due to gov't mandates/unnec regulations, and much is due to just plain silliness (e.g. spending $25 in billing costs to recoup a $2 payment...duh!). And big insurers are on the front lines in the fight against the 3 of the 4 biggest sources of excess costs-"Unnecessary Services", "Inefficiently Delivered Care", and "Excessively High Prices". It's very hard for individual patients to impact these directly, but big insurance (warts and all) has the clout to push back. BTW- I think IOM's definition of "Excessively High Prices" seriously UNDERestimates this factor- particularly with Big Pharma and the medical device makers.

FWIW- I've followed Reinhardt's work for years. Some is "pony" and some is....well you know . But IMHO this is a good synopsis of factors in excess US HC costs. I would love to see a similar analysis of HC overhead in other developed nations.
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Old 06-13-2014, 12:37 PM   #42
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Originally Posted by Totoro View Post
How the US manages to spend double or more of what most other countries spend, and with worse outcomes on average, is a very sad achievement.

One example of worse outcomes: infant mortality is at 5.4 out of 1.000 in the US. Japan is at 2.6, Germany at 3.7
Unfortunately, Comparisons of this sort are fallacious. This is a confusion of HEALTH and healthCARE. Non-healthcare determinants like motor vehicle accidents, drug addiction, violence, and socioeconomic issues like teenage and unwed pregnancy have strong impacts on indicators like infant mortality and have nothing to do with Healthcare. If one actually examines Healthcare, the USA is outstanding. It should also be noted that the US subsidizes healthcare around the globe by being the center of research in healthcare: the rest of the world takes a free ride.
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Old 06-13-2014, 01:12 PM   #43
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If one actually examines Healthcare, the USA is outstanding.
It depends on what metrics you are looking at. If you are looking at costs compared to other countries for the same procedures and number of uninsured, I agree, those statistics show we are outstanding in these two areas.

In 2013 we had more uninsured than the entire population of Canada.
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Old 06-13-2014, 01:12 PM   #44
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If one actually examines Healthcare, the USA is outstanding. It should also be noted that the US subsidizes healthcare around the globe by being the center of research in healthcare: the rest of the world takes a free ride.
Do you have a source that marks the USA as outstanding in overall healthcare?

Here is one study of many describing it's not
MMS: Error

I won't dispute that the best healthcare in the world for many ailments can be found in the USA, if you can afford it. Most (99%) of its citizens however, can't. They are getting a bad deal, paying twice as much for poorer outcomes vs. other developed countries. That said, don't underestimate countries like Singapore. I'd much rather have a medical emergency there than in any US city.

In terms of research the USA also have the edge overall, although certainly not in all areas. More importantly however, the total amount spent on research in the US is nowhere near 3.500 USD per person (or >1 Trillion USD, yes with a "T"), which is what you are spending more than the average OECD country (adjusted for purchasing power) annually.

List of countries by total health expenditure (PPP) per capita - Wikipedia, the free encyclopedia

All the facts i've seen point to a system that's too expensive for what it delivers. Would love to find out if my perspective should change though!
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Old 06-13-2014, 01:26 PM   #45
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Wow, I'm really not understanding why folks have a hard time staying under 2-300% FPL to get the generous ACA subsidies (and cost-sharing). If you're living off savings and investments as I plan to do, where is the high income that would take you past the subsidy range? Are y'all just living in high expense areas and declaring a lot more income than we are planning?

For example, our current expenses are around $36k a year. If I draw that much from savings/investments (or less, since wife is earning around $15k doing a little part time work and we'll have cap gains and dividend distros anyway), I can easily see us staying below 200% FPL and getting very generous subsidies and cost sharing for Silver plans. I did a quick look recently and we can get plans for $150/mo. or so with $4500 max family out of pocket for the year.
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Old 06-13-2014, 01:32 PM   #46
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Wow, I'm really not understanding why folks have a hard time staying under 2-300% FPL to get the generous ACA subsidies (and cost-sharing). If you're living off savings and investments as I plan to do, where is the high income that would take you past the subsidy range? Are y'all all just living in high expense areas and declaring a lot more income than we are planning?
.
Lots of us dinosaurs and retired government employees with pensions can't manage our incomes down to subsidy levels.
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Old 06-13-2014, 01:38 PM   #47
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Can the government afford to continue such large ACA subsidies? Can I really count on them throughout early retirement until reading Medicare age? Maybe in a decade or two out-of-pocket costs for Medicare will be just as high as current ACA plans. Also, maybe it makes more sense to forego the ACA subsidies now and instead do Roth conversions from traditional IRA accounts?
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Old 06-13-2014, 01:47 PM   #48
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Wow, I'm really not understanding why folks have a hard time staying under 2-300% FPL to get the generous ACA subsidies (and cost-sharing). If you're living off savings and investments as I plan to do, where is the high income that would take you past the subsidy range? Are y'all just living in high expense areas and declaring a lot more income than we are planning?.
Under current law, with current spending, assuming most from post-tax account we will be under 400% FPL (and prob below 300% FPL). BUT I don't feel it is prudent (for me) to count on the subsidies because I don't know how the laws will change until we are eligible for Medicare in 15 years. I'm the type that hopes for the best but plans for the worst. If I get the subsidy I can always figure out a pleasant way to spend it.
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Old 06-13-2014, 01:54 PM   #49
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The law isn't going to change anytime soon especially with the intransigent crowd we have running the place now. You go with what you have, not what might happen in 5-10 years. What if Medicare and SS get whacked? Same deal, you just don't know. But I've got to plan on them being there just like you do.
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Old 06-13-2014, 02:05 PM   #50
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CBO projects total gross spending for Medicaid, CHIP and all ACA exchange related subsidies and exchange based assistance to cost around $2T between 2015-2024. (here) The tax break given to employer provided health care over the same timeframe will be around $3T, or 50% more (here). Of the total $5T in tax breaks and subsidies, around $4T was already in place before the ACA.
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Old 06-13-2014, 02:11 PM   #51
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Since DH left the megacorp job our insurance premiums have varied by plus or minus $2.1K a month between COBRA, COBRA conversion and ACA policies.

I think all you can do is hope for the best and plan for the worst. One change in legislation and we could be back to over $2K a month in premiums alone for less than stellar coverage.
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Old 06-13-2014, 02:19 PM   #52
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I'll be amazed if there is any meaningful reduction in entitlements given the history of Medicare and SS 'reform'. I don't see the ACA being any different, regardless of the blowharding about repeal. The ship has sailed.
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Old 06-13-2014, 02:23 PM   #53
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Huston, I'm not sure what your point is. I think ERHoosier is correct in that health insurer profits are not a significant contributing cause to the escalation of health insurance premiums, particularly since medical claims cost ratio limits were put in place a couple years ago. Health care costs, which ultimately become health insurance claims are the major cause for the reasons described in the article and summarized in Table 3-1.
Sorry, maybe I was trying to be too clever. I'll try to be more direct.

It's not just the insurance companies (which I actually never mentioned or inferred), it's not just the hospitals, and it's not just the govt. It's the whole design of our healthcare delivery system. It's broken. It doesn't deliver effectively. It wastes valuable resources.

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So where's the disagreement? Overall HC costs are too high but this is not mainly due to HI companies. If you go to the IOM source material, most of the "Excess Administrative Costs" are NOT due to the insurance co's but are spread throughout the system. Much of it is at the provider/hospital level (e.g. too many supervisors per doc/nurse/tech actually delivering care), much is due to gov't mandates/unnec regulations, and much is due to just plain silliness (e.g. spending $25 in billing costs to recoup a $2 payment...duh!). And big insurers are on the front lines in the fight against the 3 of the 4 biggest sources of excess costs-"Unnecessary Services", "Inefficiently Delivered Care", and "Excessively High Prices". It's very hard for individual patients to impact these directly, but big insurance (warts and all) has the clout to push back. BTW- I think IOM's definition of "Excessively High Prices" seriously UNDERestimates this factor- particularly with Big Pharma and the medical device makers.

FWIW- I've followed Reinhardt's work for years. Some is "pony" and some is....well you know . But IMHO this is a good synopsis of factors in excess US HC costs. I would love to see a similar analysis of HC overhead in other developed nations.
Hoosier: As noted above, I didn't mention health insurance companies. So, your defending a group that has not yet been accused of anything. Seems to me, thou protesteth too much. And, honestly, insurance companies on the front lines fighting for more efficiency; really?

On the final point, "excess US HC costs", we do agree. So, we got that goin' for us.

So, my comments are about the inefficiency of our system, as is simply and clearly noted by Totoro below:

All the facts i've seen point to a system that's too expensive for what it delivers.

PS: this is all kind of off point from the OP's post so, I suggest someone start another thread if he desires this discussion to continue.
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Old 06-13-2014, 02:27 PM   #54
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I'll be amazed if there is any meaningful reduction in entitlements given the history of Medicare and SS 'reform'. I don't see the ACA being any different, regardless of the blowharding about repeal. The ship has sailed.
I think total repeal is unlikely but asset testing could be added or income limits lowered. Hopefully we would never be back to the $2K+ a month days, but who knows the way health care costs keep rising.

With health care costs rising at a faster rate than SS benefits, there are predictions that health care for retirees will cost more in the future than people receive in SS benefits. I think the peasants will revolt before that happens, but it does make how much to budget for retiree health costs pretty much a wild card.
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Old 06-13-2014, 02:32 PM   #55
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Do you have a source that marks the USA as outstanding in overall healthcare?

Here is one study of many describing it's not
MMS: Error

I won't dispute that the best healthcare in the world for many ailments can be found in the USA, if you can afford it. Most (99%) of its citizens however, can't. They are getting a bad deal, paying twice as much for poorer outcomes vs. other developed countries. That said, don't underestimate countries like Singapore. I'd much rather have a medical emergency there than in any US city.

In terms of research the USA also have the edge overall, although certainly not in all areas. More importantly however, the total amount spent on research in the US is nowhere near 3.500 USD per person (or >1 Trillion USD, yes with a "T"), which is what you are spending more than the average OECD country (adjusted for purchasing power) annually.

List of countries by total health expenditure (PPP) per capita - Wikipedia, the free encyclopedia

All the facts i've seen point to a system that's too expensive for what it delivers. Would love to find out if my perspective should change though!

I don't want to high jack this thread to any greater extent; but the report you linked refers to a study that has been repeated discussed to be flawed by it's very design. It doesn't compare apples to apples. the American Enterprise review here will give you some insight.
US health care: A reality check on cross-country comparisons - Health - AEI

The US certainly has substantially higher costs and the healthcare system is plagued by those who are uninsured, those who choose life styles that are unhealthy, and those who choose not to receive preventative services. (i.e. our relatively low pertussis immunization rates are commonly cited despite being available for free. People CHOOSE to not receive the all sorts of immunizations).

These aren't issues of the quality of our healthcare. Whether the value per unit cost is acceptable is a different story.
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Old 06-13-2014, 02:47 PM   #56
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With health care costs rising at a faster rate than SS benefits, there are predictions that health care for retirees will cost more in the future than people receive in SS benefits.
That's not a future situation. It's happening to some Medicare recipients now. Their entire SS monthly benefit is applied to their Medicare Part B premium and they are then billed for the amount their Medicare premium exceeds their SS benefit.
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Old 06-13-2014, 02:49 PM   #57
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the healthcare system is plagued by those who are uninsured
The health care system is plagued by the uninsured? The 47 million are a plague?
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Old 06-13-2014, 02:49 PM   #58
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The law isn't going to change anytime soon especially with the intransigent crowd we have running the place now. You go with what you have, not what might happen in 5-10 years. What if Medicare and SS get whacked? Same deal, you just don't know. But I've got to plan on them being there just like you do.
Medicare plus a supplemental plan plus Part D for prescriptions currently runs approx $4.5k / per person / year. My budget is 7.5k / per person / year.

I only count on 65% of what the SSI calculators says I will get.

How we fudge our numbers is our individual choice. I'm more risk adverse, hence my pessimistic financial data.
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Old 06-13-2014, 02:53 PM   #59
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I won't dispute that the best healthcare in the world for many ailments can be found in the USA, if you can afford it. Most (99%) of its citizens however, can't.
I think your 99% is BS. More than 1% of our citizens can afford (primarily through insurance) access to our "best healthcare in the world for many ailments."
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Old 06-13-2014, 03:02 PM   #60
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The health care system is plagued by the uninsured? The 47 million are a plague?
Exactly! The decision to not take insurance or to not cover certain classes of people in our communities is a personal decision or a political one. It has NOTHING to do with the quality of our healthcare.
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