The cost of health insurance

[BigMoneyJim]

Quote:

Heh heh, actually that was a sloppy * edit. *I meant to say thingy Armey but I guess you got my drift.

This looks like a message board profanity filter edit to me. It makes for interesting converstaions sometimes, especially when talking about people with names like Dick Armey and John Hancock. (Spelled correctly at posting time as the recently retired House majority leader and a prominent signer of the Declaration of Independence.)

Limbaugh a liberal? Ouch.

Edited 2-23-2003: Dory36 changed the profanity filter; for the benefit of future readers, before this any mention of Dick Armey showed as "thingy Armey" and my example of John Hancock came out as "John Hanthingy".

[area52]

This looks like a message board profanity filter edit to me

It is. I just noticed that I made the EXACT same mistake TWICE! Not possible since I had it proofed.

I am glad to see no one is in phoney baloney high dudgeon about CENSORSHIP!

[1HappyFool]

This looks like a message board profanity filter edit to me


Does this mean that people from northern New England can't use their favorite expression for people who move up from MA and screw up the local politics. I'll try it:

massholes

That should come out something like Massachusetts holes.

[1HappyFool]

Quote:

Well, I too have roots in Michigan, as does my wife. However, the winters are not what I had envisioned for my twilight years. *Still, the prospect has some appeal. *I am quite conflicted at present. To be continued.........................................

When we decided to retire to MI, we didn't let the cold winters deter us. If they get bad enough, you can always take a trip during the worst part to someplace warm. This gives you something to look forward to, some relief from the cold, and when you get back, spring is on it's way. This winter has been the toughest of the three so far. Many days where the high didn't get above 20. We still haven't felt the need to become snowbirds. We both like spring and fall and cooler summers. You probably already know about the Great Lakes being climate moderators. Think hard about whether baking in the summer sun is better than snowbirding or cabin fever. We lived in VA and found it hard to do anything strenuous outdoors between 10 AM and 5 PM for about four months of the year.

1HF

[MRGALT2U]

Fist of all, I wish to clarify my comment about Rush Limbaugh
being to my left politically. There was a bit of hyperbole
there, but not much.

As far as Happy Fool's Michigan remarks, I lived and worked there (all over the state) from 1976 to 1993.
It is my favorite northern state and I have been in all of them. Plus, my wife lived there her whole life until she
hooked up with me. I'm tempted to return, but most
reluctant to give up the "dream" (Margaritaville on the
Gulf). I lived in Texas from 1994 to 1998 and loved it.
I believe this is the most difficult decision I've faced
since I retired. As Gilda Radner said "It's always something!"

[dory36]

Quote:

This looks like a message board profanity filter edit to me

Heh -- the filter comes with the software that operates the forum. It's configurable, but I'd never bothered until now.

I took out "dick" -- not sure why the authors felt it needed to be in there, as all the rest were clearly unusable at the dinner table.

So now you can talk about thingy Armey as Dick Armey.

However, I did notice that there were a couple of words omitted that, when uttered, caused me some concern. I added them. Now, an early-retiree who must earn wages again might be said to go back to w*rk, or get a j*b.

(Just joking. If you want to talk about - gulp - getting a job, go ahead!)

D*ry36

[Michael]

area52 wrote:

If I were suddenly relived of taxes but I know you still have the same
amount of money to pay me I would have no incentive to lower prices.

Mike replies:

Competition is what keeps providers from charging more than cost plus a reasonable profit. Food is also necessary, but quite inexpensive, because machines do most of the work today. Farmers do not charge exhorbitant prices, despite food's absolute necessity, because people can simply buy from another farmer. Labor intensive services by contrast cost a lot. No labor intensive provider can charge less, because all labor is heavily taxed. Insurance companies would aggressively negotiate lower fees if medical workers no longer had to pay income tax, etc... We can agree to disagree on this topic if you like, since the tax on medicine will never be removed in this country to test our theories.

[area52]

Yes food is a necessity but it's underlying mode of production is different than seeing a practitioner so it's not a clean comparison to medical care.

Also, the biggest reason why food production is so copious and inexpensive is because of massive federal subsidies (Farmers are businessmen) directl;y and indirectly PLUS.. all the inovations in techniques, sciencs and machienry over the last 100 yrs has been paid for totally or partially by the government. The costs were socialized.The ensuing money to be made was privatized. The Holy Grail of the Business Class.

(By the way this is also true of medical advancements. And most electronics and nearly all computer technology)

No labor intensive provider can charge less, because all labor is heavily taxed. Insurance companies would aggressively negotiate lower fees if medical workers no longer had to pay income ,

Well, I agree with that. Why labour is taxed to death but the sources of wealthy for people who already have most of the money is taxed less IS something we need to work on! I don't see why they need to invent :classes of wealth or income" Tax labour like free pickens but hold off on the dividends and cap gains. what's so magical about that? The way it ought to work is, as Jefferson and Adam Smith concluded, don't tax anything below a certain limit. THEN tax in graduated proportions, anything above that.

As far as insurance companies aggressively negotiating lower fees. Well, maybe. Or maybe Drs will extort the people (running to the government first) by going "on strike" for more take-home pay like they're doing now in several states. I guess it's only good when people who make a lo of money and have "professional status" do it. But when Ralph Kramden throws his weight around for more take-home pay he's a *----ing communist.

Competition? People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices" Adam Smith

[MRGALT2U]

Well, I don't begrudge the rich their money, regardless
of how they made it, and I am in full support of striking doctors. Their insurance premiums are ridiculous.
This is America and I think "every man for himself" and
"the less government the better" is the way it oughta
be". We need a little more rugged individualism and a little less "some one needs to take care of me."

BTW, Ralph Kramden probably was a f--king commie!

[area52]

I don't begrudge anybody their wealth no matter how it was derived. But the middle class has their wealth begrudged all the time. Speacial treatment for everything exept teh fruits of going to work every day And the wealth of the wealthy was created by other people. I dont confuse working people who do something with "The Rich"

I have no inherent problem with teh doctor thing. The real problem is insurance. And it IS an insurance problem. But when lesser folk cant afford it it gets a big yawn. When dr's and now businesses in general are complaining about the cost, it's a cause celebre.
And of course they run to the first refuge of any "American Capitalist Businessman": The Government

Business buys the Gov and Dr's feel free to extort. And it IS because of take home pay. The patients pay the bills and the dr's go on strike. Or maybe they need to find different work? No, they LIKE being Dr's and making shtloads of bread. Or hey, here's one. When the middle class cant afford medical insuarnce the trendy thing for the econo-kooks and Limbovian ecomists is to say :Life ain't fair. (Implied: Do your civic duty and just die for me)

Hey, doc. Life ain't fair? Upgrade your skills so you can earn more money (nobody can afford them now)

There's no moral or economic consistency. It's all justified on whose ox is being gored or whose ox you can gore. That was my point

As far as Ralph Kramden.... not a commie circa 1956. Now...I'd say it's debatable

But he makes a living driving that bus creating wealth for Mr Marshall who inherited and million dollar (1956 dollars) operation. If I had to begrudge anybody it'd be Marshall. He's not creating anything or assuming any risk at all except on the links to his rotator cuff

[MRGALT2U]

Well, area52, I think we are mostly in agreement with
how things are functioning now. Our areas of
disagreement appear to be in how it should work and how to fix it. My politics are quite radical (closest
label would be Libertarian) and I have no confidence in
either major party to slow our slippery slope to socialism. I have watched it my whole life and it was
a significant factor in my decision to retire. If you are
familiar with my fictional doppelganger (John Galt),
you will have a solid grasp of my views. Anyway,
read some Orwell or Ayn Rand. They saw it coming.

[Michael]

area 52 quoted Adam Smith:

"People of the same trade...raise prices."

Mike replies:

You have a point about the limited competition in medicine. Adam Smith also wrote, "The monopolists, by keeping the market constantly understocked, by never fully supplying the effectual demand, sell their commodities much above the natural price..."

The AMA has convinced Congress to give MDs a de jure monopoly on myriad medical practices, and virtually all prescription drugs. The AMA et al then limits the number of doctors by limiting medical school enrollments, and driving the cost of medical education past the point where many can afford it. There is no true competition under these circumstances. Even the few trades, such as pharmacist or psychologist, that permit the practitioner to prescribe real medicine require a Ph.D. as a minimum entry point to prescribe. This forces people to go to the high priced few people who meet the legal requirements for even the most minor condition. If they cannot afford the prices, they simply have to do without under this system. They resort to herbs and folk medicine in desperation.

Removing the income tax on these professionals would lower their costs, some of which insurance companies would demand be passed on to them. To make medicine really affordable, however, we would have to introduce genuine unlimited competition in the field. This is about as unlikely as the removal of the taxes on medicine, because the special interest groups are far too powerful. Plan on increasingly expensive health insurance premiums in the future.

[1HappyFool]

Quote:

The AMA has convinced Congress to give MDs a de jure monopoly on myriad medical practices, and virtually all prescription drugs. *The AMA et al then limits the number of doctors by limiting medical school enrollments, and driving the cost of medical education past the point where many can afford it. *There is no true competition under these circumstances. *Even the few trades, such as pharmacist or psychologist, that permit the practitioner to prescribe real medicine require a Ph.D. as a minimum entry point to prescribe. *This forces people to go to the high priced few people who meet the legal requirements for even the most minor condition. *If they cannot afford the prices, they simply have to do without under this system. *They resort to herbs and folk medicine in desperation.

This has been somewhat mitigated by the introduction of Physician's Assistants and the immigration of foreign doctors and US graduates of foreign medical schools. Immigrants from English speaking countries are obviously favored on the exams rightly required for accreditation, but it has the effect of draining the best and brightest from around the world.

A doctor who posts on TMF/REHP by the screen name of JLC claims the greatest deterrent to more US graduates is both the high cost and the insane hours required in residency programs. IOW, there is no suitable slow track for getting an MD while financing the education by working in the field.

It seems to me that there are opportunities for the school of engineering to add some competition to the school of medicine, but it would require some serious federal money to produce an AI that could prescribe drugs. Picture using PA's to input symptoms and recommendations to an AI and the AI could approve treatment and issue prescriptions. Military and VA doctors could fill the knowledge base and federally funded medicare centers using "autodocs" could be the kind of solution required to light a fire under the AMA to become more competitive. Depriving doctors of medicare and medicaid patients might be an acceptable level of socialized medicine, if only the feds could be trusted to do it efficiently.

1HF

[Ted]

The restrictions on becoming licensed as a physician have the advantage of insuring a certain minimum level of skill, even though they drive up the price of those services. As in the case of occupations that are "unionized," the consumer gets a generally better product, but at a higher price. Despite this, one hears plenty of people complain about alleged mistakes by their doctors, so I'd be cautious about lowering the standards for M.D.'s to the extent that more people, who would presumably be less intelligent and/or motivated, could also practice medicine at the highest level.

The best prospect for controlling the cost of medical care, while continuing to improve its quality, is through greater use of healthcare personnel with lower levels of training/skill than M.D.s. In fact, that is the function that nurses have long performed. Changing their title to something like "medical practitioners" would help to dispel the streotype that this field is limited to women (who are the only ones who can "nurse" according to the original meaning of the word.)

There is, of course, inevitible controversy as to the appropriate "dividing line" between the responsibilities of M.D.s and nurses. Some of this is legitimate concern for insuring appropriate skill levels, and some is protection of market (monopoly) power.

My wife is an administrator in a hospital, and has observed the same sort of behavior on the part of nurses (who are unionized there) resisting efforts to transfer some of their traditional functions (like helping patients to the toilet) to lower skilled, lower paid personnel. Hospitals keep very extensive statistical records regarding patient outcomes, and many changes to traditional healthcare procedures can be monitored to determine whether any statistically significant change in patient outcomes occurs.

Another aspect to this issue is that many of the lower skilled people who could potentially be used more extensively (and who would eventually become more highly skilled and more highly paid as the result) are minorities. So it is in their interest as well as in the economic interest of patients/taxpayers that their skills be developed and utilized, in a way short of sending them all to nursing or medical school.

[MRGALT2U]

What I would really like is some affordable
catasthropic health insurance with a large
(up to $20,000) annual deductible. Can't locate so far,
although I am pretty sure someone must be in this
business. Vicki Terhorst told me she had heard of an
English company that was into underwriting something
like this. Alas, she had no details. Can anyone out there help ?? Thanks.

[MRGALT2U]

Does anyone know someone who has arranged their
finances (offshore?) in order to put their assets out of reach of creditors?? I do not refer to scams or any kind of fraud.
However, if you knew that in a worst case scenario
your base would be protected, it could alter your
whole view of how to manage risk.

Thanks.

[Michael]

I may be mistaken, but it is my understanding that the type of overseas policy that you are talking about covers you anywhere in the world, except the United States. For the most part, we are pretty much limited to purchasing health insurance that covers us in the US from companies licenced to sell insurance by the state that we live in.

[dory36]

I used a company for a while when I first retired, at http://www.escapees.com/website/support/escape.html -- they offer catastropic coverage.

Dory36

[MRGALT2U]

How about the health insurance offered through AARP?
Has anyone tried that? Results?

Thanks!

[Telly]

Has the AARP added real health insurance? I checked their web site some time ago, and only saw Medicare Supplementary, etc.

About a year or so ago Consumer Reports had an article on private health insurance, with rates for different companies in many states. They had various subject scenarios that they insured. Rates in Florida were real high for some of the companies. Probably too many old people there...

One of CR conclusions was to consider BCBS in your state. But BCBS can get very restrictive on who they will accept, they have been rigid on BMI (Body Mass Index) as a pre-filter. If you or a covered family member has a BMI of 30 or over, forget it. It is an automatic dump from their consideration.

A common practice of insurers is also to not cover any pre-existing condition. And their definition of pre-existing can be anything they see in a person's past, whether it is an active problem, or something well past and done with. They will say no coverage for any X problem for the next Y years. It is the choice of their underwriters to accept or opt out of anything they want. The more they opt out of for X years, the lower their $ risk is. Of course, the insured does not get any break on the premium amounts for anything the underwriters put on pre-existing opt out.