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Old 02-18-2012, 08:12 AM   #161
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See below. And BTW, I'd hope for your recommendation after such a lengthy critique.
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I'll be the first to say our U.S. system needs to be changed. It needs a dramatic overhaul. Agreed.

I am not in favor of a single-payer (i.e. government) system. I personally know people in Canada and in the U.K. Yes, they like the system in general but they also think there are significant problems that need to be addressed. But they certainly don't want the US system, so what does this mean? And of course they'd like to see improvements, that's going to be a given with any affordable system, there are inevitable trade offs.

I'll gladly deal with some paperwork and added premiums for more input in the system. Even a 40-100% premium, or an average of about $3,000-$4,000 per person per year? We're not talking some nominal "premium." We collectively can't afford that, and the costs are growing much faster than inflation overall.
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Old 02-18-2012, 09:18 AM   #162
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What if the US gov't provided only Universal Catastrophic Health Coverage for huge expenses (cancer, heart attack etc) and you had your own insurance to cover yourself (or not) for general, smaller expenses (broken arm, routine Dr visits etc).

Wouldn't the cost of your personal insurance go down and the gov't could cover the big stuff with a smaller tax hit?

Seems like everybody --including the insurance co's--win. Or, as is often the case, am I missing something?
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Old 02-18-2012, 09:33 AM   #163
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What if the US gov't provided only Universal Catastrophic Health Coverage for huge expenses (cancer, heart attack etc) and you had your own insurance to cover yourself (or not) for general, smaller expenses (broken arm, routine Dr visits etc).

Wouldn't the cost of your personal insurance go down and the gov't could cover the big stuff with a smaller tax hit?

Seems like everybody --including the insurance co's--win. Or, as is often the case, am I missing something?
I think that would just kick the can down the road. A version of that is happening now. There has been an explosion of small outpatient surgery and treatment centers that has taken a lot of the inexpensive stuff away away from hospitals so they are increasingly left with the very sick, most expensive and least profitable patients. Increasing numbers of doctors are owners or part owners of the outpatient centers making more and more money, and reducing the numbers of injuries that could be treated without surgery and increasing the numbers of scans and tests.
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Old 02-18-2012, 10:10 AM   #164
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I actually think that the HSA and high deductible policies work pretty well and are consistent with the notion that in the US health care is a personal responsibility. Having periodic physicals covered results in people using it rather than not going to the doc for a physicals because they don't want to spend the $200 and health problems being identified earlier.

The problem is that too many people have a warped view that health insurance should pay for every little thing, but at the same time they wouldn't think that car insurance should pay for oil changes or tires or brakes.

I sometimes wonder if it would make sense to centralize medical records to reduce chasing information and duplicative medical tests and centralize claims processing. But then allow each individual (or family) to insure the economic risk with health insurers who would compete for their business. Somewhat similar to the way Medicare works but without the government on the hook for the economic risk. Perhaps have a number of different options (sort of like is done for Medigap) where people could make their own decisions on the risk/reward tradeoff. That way, those who want brakes and oil changes covered can do so but pay for it in their premiums and those who would prefer to self-insure that routine stuff can do so and save on their premiums.

You would still have the problem of freeloaders who don't participate and expect society to pay for them if they get sick. It seems to me there are only true possible options: leave them to their own devices and if charity can take care of them fine, otherwise they are s-o-l, have a government funded program for catastrophic health care or require every individual buy a high deductible health care policy (say >$50k) unless they can prove that they can self-insure (like the very rich, etc.)

Just thinking how it could be better without having the government totally takeover.
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Old 02-18-2012, 10:20 AM   #165
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I wonder how much the increased ease and availability in joint replacements will effect health care costs down the road. I read this week that one out of 20 people over the age of 50 now has had some joint replaced already. The article said that older people used to just adjust their lifestyle to fit their pain cmfort level.
I won't try and predict the future, but I do know that my MIL had a hip replacement in her 70's. Without it she would have been in a wheel chair for most of the last 20 years of her life. Though she complained about the pain and the fact the the replacement hip was not perfect, she managed to stay in her own apartment for over 15 years and only needed special care in the last year of her life. Compare the cost of the hip replacement to the cost of special care needed for 15 years. Which might be cheaper?n Older people live longer these days, so adjusting one's lifestyle may not be as easy as it was when people died at an earlier age.
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Old 02-18-2012, 10:26 AM   #166
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I hear the high deductible plans are considered like icing on the cake to the insurers. More profitable than their other products.

Sounds like a raw deal for consumers.
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Old 02-18-2012, 10:30 AM   #167
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The problem is that too many people have a warped view that health insurance should pay for every little thing,
Very true! We all need to make some payments so as to keep some 'skin in the game' as they say.
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Old 02-18-2012, 10:37 AM   #168
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Reason why insurance has to pay for every little thing is that prices are completely out of whack. A 10-minute visit to the doctor (where you're waiting maybe an hour for the session, taking a couple of hours off work for the appt.) is billed to the insurer at like $200.

Often, the providers charge non-insured patients more for the same services.

Oh and if people had to pay out of pocket for "every little thing" they will start avoiding doctor visits when they should be seeing a doctor and conditions become more acute and treatment becomes more expensive.

Imagine how many people would skip annual physicals if they had to pay out of pocket.
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Old 02-18-2012, 10:42 AM   #169
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I hear the high deductible plans are considered like icing on the cake to the insurers. More profitable than their other products.

Sounds like a raw deal for consumers.
And what support do you have for the opinion?
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Old 02-18-2012, 10:48 AM   #170
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Reason why insurance has to pay for every little thing is that prices are completely out of whack. A 10-minute visit to the doctor (where you're waiting maybe an hour for the session, taking a couple of hours off work for the appt.) is billed to the insurer at like $200.

Often, the providers charge non-insured patients more for the same services.

Oh and if people had to pay out of pocket for "every little thing" they will start avoiding doctor visits when they should be seeing a doctor and conditions become more acute and treatment becomes more expensive.

Imagine how many people would skip annual physicals if they had to pay out of pocket.
I agree tht prices are out of whack, but there are a few things that you need to consider.

First, preventative care is typically covered but high deductible health plans.

Second, those who have a high deductible health plans pay negotiated rates and not the rack rates that non-insured patients are charged. From my experience the negotiated rates are 30-50% less than the rack rates.

Finally, if a person isn't willing to spend the money needed to preserve their health, why should I give a damn about their health and pay for it?
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Old 02-18-2012, 11:12 AM   #171
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I hear the high deductible plans are considered like icing on the cake to the insurers. More profitable than their other products.

Sounds like a raw deal for consumers.
What sort of premiums, deductibles, maxes and co-pays are we talking about with these policies?

The US will never adopt a system like the NHS and the patchwork of the states will produce a variety of solutions. I have no idea what they will, but they must produce universal coverage for everyone at a price they can afford. Having health insurance linked to work without long term affordable alternatives if you loose your job is an enormous issue. COBRA is simply too expensive and short lived.
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Old 02-18-2012, 11:12 AM   #172
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What if the US gov't provided only Universal Catastrophic Health Coverage for huge expenses (cancer, heart attack etc) and you had your own insurance to cover yourself (or not) for general, smaller expenses (broken arm, routine Dr visits etc).

Wouldn't the cost of your personal insurance go down and the gov't could cover the big stuff with a smaller tax hit?

Seems like everybody --including the insurance co's--win. Or, as is often the case, am I missing something?
My guess is that scenario might only add to the administrative cost.
Of course, I agree it would be better than what we have now. But then almost anything is better than we have now.

The other side of that coin in controlling costs is individuals having some skin in the game. I see myself - people on medicare and private insurance (paid for by their employer), not being at all concerned with costs and therefore either agreeing or opting for things they might not if they had to pay a portion of it themselves.

My GP, who I know well was complaining about the excessive appointments his medicare patients were making when there was really nothing wrong with them. He said he would like to see a $25 copay instituted and he thinks these frivolous visits would decrease dramatically.

There of course would probably have to be a reduced fee for people very low income patients (say $10), or the doctor could have the option to waive it if he so chose.

Doctors are of the same mentality sometimes. When I saw a specialist a couple of years ago, he suggested I have an expensive test to see if my condition had worsened. I asked him, if it has, is there anything he can do to make it better? He said, "not really". So I said, "then why go through the expense of the test?" His answer to me was: "What do you care, medicare will pay for it." So, I politely told him, I did care because someone was paying for it. That is a true story.

It is a real Catch 22 if there ever was one - when it comes to medicine. We know that making people incur some costs might greatly reduce unnecessary procedures and tests. On the other hand, it might discourage people from seeing a doctor and getting treatment they need. We know that some doctors are quick to recommend operations and procedures that patients might not need and would not really improve their condition enough if at all to warrant such an expense.

I'd love to see physicians compensation be based on performance. They could have different grade pays. The better your overall patient outcome is, the higher your pay grade. It would be the same as lawyers with good track records (wins to loses) charging higher hourly rates or company executives competing for higher positions based on how well they do.
Maybe I'm dreaming, but more pay for good performance seems like a real incentive to do good and the American way.

I do want to see doctors receive adequate pay, especially with the high cost of education and time involved. They deserve it.

Untangling the current system will be very challenging. But if it has been done in so many other countries. It can be done here. There are people who are very knowledgeable in this area such as the doctor Midpack mentioned earlier, who has helped other countries into the transition.
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Old 02-18-2012, 11:24 AM   #173
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The other side of that coin in controlling costs is individuals having some skin in the game. I see myself - people on medicare and private insurance (paid for by their employer), not being at all concerned with costs and therefore either agreeing or opting for things they might not if they had to pay a portion of it themselves.
In the UK the patient doesn't have any "skin in the game" as they never see a bill. The only paper work might be a prescription or a letter from your doctor. Costs are controlled by Local Health Trusts that must run on tight budgets and there is also control of accepted procedures so that only ones with proven efficacy are allowed on the NHS. UK doctors are also far less lightly to do expensive diagnostic tests that their US counterparts. Finally I think the psychology of UK vs US citizens also plays a part. The UK patient is a lot less pro-active than their US counterpart. They will take the treatment given by their doctor and don't ask for lots of new drugs or tests. They accept the standard of care and just get on with things. I don't really like that, but deference to authority runs deep in the UK and as far as health care is concerned it actually works pretty well........on average.
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Old 02-18-2012, 11:29 AM   #174
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And what support do you have for the opinion?
Quick search turned up a bunch of articles:

High Deductible Health Insurance Plays Russian Roulette With Our Health As Insurers Rack Up Record Profits - Forbes


I remember when the Cigna executive turned whistleblower first started doing interviews, he mentioned these kinds of plans as manna for the insurers. Found this just now:

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Insurers and employers, in the US, are forcing more and more Americans into consumer driven plans, with high dollar deductibles, ceilings under which no benefits will be paid out, and this is increasing out of pocket expenses, and causing people to delay or forgo care. Potter writes of a "forced 'migration' of workers [in]to managed care," from traditional indemnity plans, during the 1990s, due to provisions of the Nixon era HMO Act. In 1998, a PR campaign was undertaken to help improve the image of managed care; companies hired Goddard Clausen, the creators of the 'Harry and Louise' commercial, aimed at the Clinton plan, and the Hawthorn Group, both of which operated behind a front group called Coalition for Affordable Quality Healthcare. Rather than owning up to their failures, health insurance companies "pointed the finger of blame at their customers," and their CEOs embarked on personal responsibility crusades, which Potter describes as a ploy "for pushing risks, and costs, formerly borne by institutions onto individual Americans." Potter writes that the shift from "failed" managed care to "consumerism" was all about meeting the expectations of Wall Street, finding ways to "avoid paying for healthcare," and shifting "costs to policy holders." Big insurance companies like CIGNA, and United Health Group, began forcing their employees into "high-deductible plans," a process that was called "'going full replacement.'" A 2005 survey of employers "showed that more than three quarters of all US companies planned to shift costs to their employees." Potter then mentions the sale of the "illusion of coverage" and what he calls "limited-benefit plans." These are the "ultimate in cost shifting" and are marketed to chains with high employee turnover. He calls them "fake insurance." Finally, it is through premium increases, and the shifting of costs, that insurers are able to "manipulate" their "medical-loss ratio" (MLR). This ratio is followed closely by Wall Street, and CEOs concerned about their stock options, and it says much that having to pay for care is seen as a loss. Potter writes that from 1993 to the present "the average MLR in America has dropped from 95 percent to around 80 percent."
Insurance industry whistleblower predicted new front group "Vermonters For Healthcare Freedom" | Facebook
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Old 02-18-2012, 11:31 AM   #175
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And what support do you have for the opinion?

Read Wendell Potters book. He was a CEO at Cigna, I believe. He explains this new trend by insurance companies and explains how they are pushing these policies because they make a lot of money on them. They are high deductible (lower costing) policies that have lots of exclusions in them. He explains how insurance companies are relieving themselves of cost obligations in these policies and giving it to the policy holder, rendering them highly under insured. He has testified in Congress as to the current practices of insurance companies.

My sister has one of these high deductible policies, because she can't afford anything else.
She has a problem with her foot and is in constant pain walking on it. She finally did go to a doctor, who said he needed her to get a MRI. As she would be a private payer of this scan, it was double what an insurance company would pay. She can not afford this, so she lives with the pain and remains in the dark as to the cause. This is wrong on so many levels.
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Old 02-18-2012, 11:40 AM   #176
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That's interesting, that the insurers hired a PR firm to push the idea that patients should be consumers for choosing health care, when to have it, when not to, in order to reduce costs.

IOW, don't seek care for medical reasons, do it for how much costs one is willing to bear. Of course, that leads to conditions turning more acute and care becoming more expensive later. But they tout this as "personal responsibility" and making the "free market" work in health care. That all this reduces the payouts of the insurers while they still increase premiums every year (if they're paying less, their costs should not be rising) is supposedly incidental.
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Old 02-18-2012, 11:52 AM   #177
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and I suppose that you believe everything that you read on the internet.

There is pretty good competition in this sector that prevents consumers from the "raw deal". Also, the returns of healthcare companies have been in the mid-teens, good but not outrageous.

The reason for the push towards high deductible plans is because the HMO, PPO etc plans were costing employers too much and were unsustainable. The HDHP puts some of the responsibility for the cost of health care back on the individual, which is the way it has historically been in this country.

So the "raw deal" may have been referring to moving from plans that were proving to be economically unsustainable to plans with more personal responsibility.

If you really believe consumers are getting a raw deal and the insurers are making out, then perhaps you should skew your investments towards health insurers.
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Old 02-18-2012, 12:00 PM   #178
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You asked for support but you really didn't want to see information contradicting your beliefs.

That's fine, you don't have to change your mind. Some people won't be open to changing their opinions because of pesky little things like facts.

Millions of people still smoke (including parents raising young children) despite clear evidence that smoking is harmful. So it shouldn't be surprising that facts alone won't change the mindsets of people in health care policy.
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Old 02-18-2012, 12:02 PM   #179
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Read Wendell Potters book. He was a CEO at Cigna, I believe. He explains this new trend by insurance companies and explains how they are pushing these policies because they make a lot of money on them. They are high deductible (lower costing) policies that have lots of exclusions in them. He explains how insurance companies are relieving themselves of cost obligations in these policies and giving it to the policy holder, rendering them highly under insured. He has testified in Congress as to the current practices of insurance companies.
Actually, you are wrong. Wendell Potter was the Media Relations contact at CIGNA, not the CEO. In my experience these folks are good at PR and dealing with the media but do not have the depth of understanding of the business to be as expert as you think he is.
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Old 02-18-2012, 12:04 PM   #180
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You asked for support but you really didn't want to see information contradicting your beliefs.

That's fine, you don't have to change your mind. Some people won't be open to changing their opinions because of pesky little things like facts.

Millions of people still smoke (including parents raising young children) despite clear evidence that smoking is harmful. So it shouldn't be surprising that facts alone won't change the mindsets of people in health care policy.
An opinion layered on top of an opinion does not equal a fact.
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