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Old 08-29-2010, 10:11 AM   #41
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Because if we wanted to be like those countries we would have joined those countries or patterned our government after those countries. From the very beginning of this country we have had a desire to forge our own destiny and make something entirely our own. Some still believe in those principles and will do just about anything to keep our country it's own independent idea and not join the idea of other countries. Objectively, it doesn't make our country any better or worse than other countries, just different. Personally, I don't think any other country has done any better than this one. If I did, I would move there in a heartbeat.
Health care does not make a country
but it could financially break it

I would not move somewhere just to get better health care- if other aspects of life- like quality of life- did not exist, why live there?

For example if Antartica had the best health care on the planet, would you move there?
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Old 08-29-2010, 10:33 AM   #42
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Originally Posted by nun View Post
With double digit health insurance costs each year we are obviously in a bubble. The increases are unsustainable and when it bursts there will be a lot of real and financial pain for everyone.

In the US the UK approach to health care is derided as being "socialized medicine". However, the British love it, live longer that Americans, and it costs them far less. So at what point would you move to the UK, if you could, and use their system....
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With US permiums going up so fast my question remains: At what point (cost, %age insured) would you be more comfortable with a UK type system that is funded through taxation, but is free at the point of delivery and covers everyone.
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If I ER I can get a $350/mth plan with big deductibles and co-pays. If the cost of that plan continues to increase at 10% per year I'll be unable to afford it. I just see spiraling costs and reduced services in the US with nothing being done about it. At least in the UK they are realistic that there is a finite pool of money and that needs to be spent wisely so everyone can be well cared for.
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Obviously a 10% per year increase is unsustainable, what are the hospitals, doctors and insurance companies going to do to control costs? Where are the cost saving mechanisms in the US system or will the price and deductibles just keep going up until we can't afford them any more?
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The US spends about 2x as much per capita on health care as European countries, yet we live shorter lives. Obviously the US system isn't working and it hasn't been copied by any other country. The thing that stops us from getting a better system in arrogance. Surely we could learn from other countries and come up with a better system. Some day soon we'll have to.
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US health companies are constantly changing coverages. They ration coverage already, we just don't acknowledge that.

So I'm still waiting for constructive ways we can change the system to make it cost less. Would they be further rationing, cutting doctors salaries, cutting drug company profits, limiting the number of tests per year, making insurance companies and hospitals non-profits. I like the idea of increasing the insurance base by requiring insurance, but that will run into political opposition in the US....so what's to be done?
What is your and criteria for cost cutting?
For example:
-Must everyone be covered?
- Would you be OK with eliminating the law(?) that anyone that enters an emergency room, must be treated regardless of their ability to pay, or their nationality?
-What kind of system - individual pay, government pay, combination?
-What about increasing the national debt; is that OK?
-Can services be cut as in the UK? What are examples that you would approve?
- How would you describe an acceptably level of cost to the consumer?

It appears, that you are OK with the UK system and their cuts, so why is not an answer for you?
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Old 08-29-2010, 10:35 AM   #43
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Health care does not make a country
but it could financially break it

I would not move somewhere just to get better health care- if other aspects of life- like quality of life- did not exist, why live there?

For example if Antartica had the best health care on the planet, would you move there?
My comments were meant as an overall comparison, not just health care. Sorry I wasn't more clear.
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Old 08-29-2010, 10:49 AM   #44
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I agree, people have a natural bias in favor of their own country. It is home. It is our tribe. So it is natural for us to say what we have is the best.

Plus, it isn't so easy to move. Canada doesn't want me. Even within the US it is tough for many to move to a new area. There is a cost, both economic and emotional.

Just because the US likes to make its own way does not mean that we can't learn something from other countries. It is incredibly egotistical for us if we believed we always come up with the best solutions. I think that it is wise to see what works and what doesn't work elsewhere and pick and chose ideas that might work for us.

From the reading I have done I have come to the conclusion that the primary reason health care costs are so much higher in the US than just about anywhere else is simply because they can be.
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Old 08-29-2010, 11:00 AM   #45
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From the reading I have done I have come to the conclusion that the primary reason health care costs are so much higher in the US than just about anywhere else is simply because they can be.
If the numbers below are correct, the health ins. business in not very profitable compared to others - see second link. Eliminating their profit from the insurance premium equation would not reduce the premium very much.


Health Insurance Industry's Profit Margins Rank #86 -- Seeking Alpha

As the table above of Profit Margins by Industry shows (click to enlarge, data here for the most recent quarter), the industry "Health Care Plans" ranks #86 by profit margin (profits/revenue) at 3.3%. Measured by profit margin, there are 85 industries more profitable than Health Care Plans (included Cigna (CI), Aetna (AET), WellPoint (WLP), HealthSpring (HS), etc.).


Just How Profitable are Healthcare Insurers? ę Thinking About Thinking

Here is some info for Hospitals.
http://www.usatoday.com/news/health/...its-usat_x.htm

Median operating margins, which don't include investment income, were 2% in 2004, according to Lisa Goldstein, a senior vice president at Moody's in New York. The median overall margin for the same year was 4.5%.
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Old 08-29-2010, 12:51 PM   #46
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Nope, it definitely works the way I described. Here's a link to a subsidy calculator from the Kaiser Foundation:

Health Reform Subsidy Calculator

Try plugging in $93,000 in "2014 dollars" for a family of 4, age 55, in a high cost area. Subsidy is $14,865 and cost of coverage to the family is $8,835 (9.5% of income). Then try plugging in $94,000 as the income (equal to 401% of poverty level, just over the limit) and there is $0 subsidy and cost of coverage to the family is $23,700, or 25.21% of income. Where will these numbers be in 2020 when the cost of insurance has tripled and the limit on out-of-pocket for subsidized people is 9.5%? Family A still paying $8800 and Family B paying $60k? Not only is family B paying $52k more, they're also footing the bill for Family A's $52k subsidy! That'll go over well...

I'll bet you just got a whole lot angrier, didn't you?
dgoldenz is correct, the law is worded in such a way that if your income is under the threshold, your cost to buy health insurance is capped at a % of that income. But make $1 over the threshold, and you pay full freight.

It leads to a huge singularity in marginal tax rates. We've discussed this on the forum before, it creates an enormous incentive for early retirement, living in low COL areas, paying off debt to avoid needing high incomes to service debt, etc.
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Old 08-29-2010, 01:17 PM   #47
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dgoldenz is correct, the law is worded in such a way that if your income is under the threshold, your cost to buy health insurance is capped at a % of that income. But make $1 over the threshold, and you pay full freight.
I don't understand the plan very well at all and I really can not anything about it, so I can wait until 2015 to plug in the number into a 1040.

I am getting the sense I will not be paying Federal income taxes for quite some time.
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Old 08-29-2010, 01:30 PM   #48
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Just because the US likes to make its own way does not mean that we can't learn something from other countries. It is incredibly egotistical for us if we believed we always come up with the best solutions. I think that it is wise to see what works and what doesn't work elsewhere and pick and chose ideas that might work for us.
Getting back to the health care debate...Since costs are comparable across different countries, why make huge changes to our system to favor another system, which really isn't that much better? I can see and understand tweaking our system to make it better, but that is not what our congress critters seem to be doing. It seems the majority in Congress want to make huge changes to health insurance that does little to control costs, which was one of the primary reasons to make the changes in the first place.
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Old 08-29-2010, 03:10 PM   #49
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Dex, health insurance is just one piece and I know about the profit margins. We do little to contain costs. One piece of this problem of doing nothing is shown by huge regional cost differences. I've linked to a couple of studies on this issue before. This letter from a couple of the researchers summaries the issue:

There are marked variations in spending observed across hospitals and regions that are largely due to how much time similar patients spend in the hospital, how many specialists they see and how many diagnostic tests they receive. On average, health systems that spend more on these services are less likely to deliver safe and effective care.
The key point: Itís not how much you spend. Itís what you spend it on. And all thoughtful scholars agree that the United States has tremendous room to improve the quality and costs of care.

http://www.nytimes.com/2010/06/11/op...l11health.html
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Old 08-29-2010, 04:54 PM   #50
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Some commonly accepted drivers of cost and some differing opinions.

Health Care Costs: the Biggest Drivers - ABC News

BCBS has some interesting info on what they think drives cost.

http://www.bluecrossmn.com/bc/wcs/gr...st_drivers.pdf

http://www.mass.gov/Cago/docs/health...on_HCCT&CD.pdf
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Old 08-29-2010, 08:00 PM   #51
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Dex, health insurance is just one piece and I know about the profit margins. We do little to contain costs. One piece of this problem of doing nothing is shown by huge regional cost differences. I've linked to a couple of studies on this issue before. This letter from a couple of the researchers summaries the issue:

There are marked variations in spending observed across hospitals and regions that are largely due to how much time similar patients spend in the hospital, how many specialists they see and how many diagnostic tests they receive. On average, health systems that spend more on these services are less likely to deliver safe and effective care.
The key point: It’s not how much you spend. It’s what you spend it on. And all thoughtful scholars agree that the United States has tremendous room to improve the quality and costs of care.

http://www.nytimes.com/2010/06/11/op...l11health.html
That is an interesting point. The question is if all the thing were done would it offset the trends that increase cost and decrease revenues. I think they would be a speed bump.

Right now, one reason health ins. premiums are increasing is because fewer people have ins either due to layoffs or companies no longer giving it as a benefit. Costs are spread among fewer ins. payees. This trend will continue after the recession.

How about others -
Aging baby boomers - w/ins using more services
Aging baby boomers w/o ins using more services*
Poor w/o ins. using services that the hospital must provide*
Workers & families w/o ins. using services that the hospital must provide*
Politically mandated services that must be covered for 'new ins. policies' under Obamacare.
Expansion of Obamacare - similar to how other gov't programs have expanded.

In short - cost cutting can not offset revenue decreases and political mandated cost increases.

Increased premiums or government plan with higher taxes or increased debt is the only way to pay for health ins at this point.

*hospitals will have to recoup their costs someplace

The mistake most make int the health ins. question is that they focus on cost. How to increase health ins. participation and revenues would go further to addressing the issue for everyone.
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Old 08-30-2010, 08:47 AM   #52
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What is your and criteria for cost cutting?
For example:
-Must everyone be covered?
- Would you be OK with eliminating the law(?) that anyone that enters an emergency room, must be treated regardless of their ability to pay, or their nationality?
-What kind of system - individual pay, government pay, combination?
-What about increasing the national debt; is that OK?
-Can services be cut as in the UK? What are examples that you would approve?
- How would you describe an acceptably level of cost to the consumer?

It appears, that you are OK with the UK system and their cuts, so why is not an answer for you?
Right now the US system has rationing as insurance companies regularly refuse procedures for cost or pre existing conditions, so to hold the US system up as in some way superior to those in Europe is obviously wrong.
I am amazed at the reaction to the thought of adopting some proven ideas that provide universal coverage and better health care at a lower cost.

Personally I would like to see a single payer system similar to that of Canada. However, that would be too radical for the US. So the Japanese model of private insurance companies regulated by the government might work. It should be done on a State to State basis to accommodate regional differences. Coverage should be Universal to keep costs down. More should be invested in public health and preventative medicine. I believe that part of the higher cost of US health care compared to the rest of the world is that many people don't go to the doctor regularly becasue they don't have insurance or are frightened of the deductible. lack of ealy treatment makes the resulting acute care expensive. The multiple levels of administration and duplication of effort in the US system is also an area for cost savings.
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Old 08-30-2010, 09:42 AM   #53
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I went to the doctor this morning and was prescribed two medications - since I have an HSA plan, I specifically asked if there was a generic available that would work. Just went and picked them up and the cost was a total of $5.17 for both. One was free and the other was $5.15. The free one had a brand name equivalent that costs $305 and the one that was $5.15 has a brand name that costs $110. How many people with a co-pay plan would have just taken the brand name and not bothered to ask about a generic? And people wonder why health insurance is so expensive...
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Old 08-30-2010, 10:00 AM   #54
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I went to the doctor this morning and was prescribed two medications - since I have an HSA plan, I specifically asked if there was a generic available that would work. Just went and picked them up and the cost was a total of $5.17 for both. One was free and the other was $5.15. The free one had a brand name equivalent that costs $305 and the one that was $5.15 has a brand name that costs $110. How many people with a co-pay plan would have just taken the brand name and not bothered to ask about a generic? And people wonder why health insurance is so expensive...
Too bad you didn't have coupons from the brand name drug manufacturer. Then your out of pocket cost would have been zero and the insurance company would have been billed $415.
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Old 08-30-2010, 10:18 AM   #55
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Right now the US system has rationing as insurance companies regularly refuse procedures for cost
I don't think that is correct, if it is a covered procedure they pay for it - they can refuse to pay for it if is an experimental procedure.

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or pre existing conditions
Pre existing conditions are an issue when you get the policy - either not covered or pay a higher premium.

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so to hold the US system up as in some way superior to those in Europe is obviously wrong.
Which poster/post said the above?
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Old 08-30-2010, 10:57 AM   #56
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I went to the doctor this morning and was prescribed two medications - since I have an HSA plan, I specifically asked if there was a generic available that would work. Just went and picked them up and the cost was a total of $5.17 for both. One was free and the other was $5.15. The free one had a brand name equivalent that costs $305 and the one that was $5.15 has a brand name that costs $110. How many people with a co-pay plan would have just taken the brand name and not bothered to ask about a generic? And people wonder why health insurance is so expensive...

It does seem like more and more insurance plans have much lower copays for generic drugs so using generics is reinforced more often than it used to be.

But on the other hand, some drugs never go generic. There is no generic insulin available as it is a biologic and subject to different rules than other drugs. The FDA has to put out guidelines for approval of generic insulin. It hasn't and there is little indication that it is going to do so.

Complexity has a cost.
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Old 08-30-2010, 11:27 AM   #57
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Right now the US system has rationing as insurance companies regularly refuse procedures for cost or pre existing conditions, so to hold the US system up as in some way superior to those in Europe is obviously wrong.
Rationing is another now-meaningless buzzword. In the US system, you can obtain any amount of care you like, AS LONG AS YOUR RESOURCES CAN PAY FOR IT. Now, your insurance company may not pay for some things, but if you're Warren Buffett, or one of the Koch brothers, you can still get pretty much whatever care you want.

The argument that you can't get care your resources don't cover constitutes rationing might just as well apply to buying groceries. You can't buy more groceries than your resources (cash, credit, WIC card, etc) will cover. Does the US system ration food? Similarly, you can't buy cars that your resources won't extend to cover. Does the US system ration cars? If your answer to these is yes, congratulations! You've just rendered another word meaningless, or at best, neatly shoved it through the looking-glass.

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`When I use a word,' Humpty Dumpty said in rather a scornful tone, `it means just what I choose it to mean -- neither more nor less.'
This is why we won't see any meaningful action on health care issues in the US. Idiot America is in charge of the debate, busily creating soundbites as a substitute for reasoned thought. "Rationed healthcare" "Death panels" "Socialism!" Truthiness takes precedence over facts. Rationality went thataway...

US healthcare is expensive for the results it delivers. That makes the insurance, which represents the averaged cost of healthcare over a covered group, plus the cost of administration and perhaps profits, expensive. Whether you buy a low deductible policy, or a high deductible, when you add the premiums and deductibles up for a year's coverage the price comes out roughly the same, representing very roughly the average cost of care for the slice of the population that has that policy.

Shopping for lower costs, bringing market forces into play, would be a wonderful thing. Alas, there is a certain amount of 'fixing' in the marketplace. There are a fixed number of positions available for internships and residencies for med school grads (National Residency Matching Program), which serves to limit the number of doctors in practice. (The AMA has recently moved from projecting a surplus of doctors to projecting a shortage, so perhaps they'll stop working to limit the supply of doctors.) Large hospital chains, such as Sutter Health, have come to dominate services in some regions. Sutter is notorious for it's arrangements to ban disclosure of its prices for various services.

Where supply is deliberately held back, and pricing is concealed, don't expect a free market behavior to emerge. A free market would be nice, but would go against the interests of current participants in the existing market.
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