I'm freaking out over health insurance

[Fedup]

The healthcare equation in the United States is seriously screwed up. And from what I can tell no politician is truly focused on the real issue.

Indeed, the current Healthcare debate, like much debate in this country, is akin to discussing the placement of the deck chairs aboard the Titanic.

The US spends approximately 17% of GDP annually on healthcare. According to data from the World Bank other industrialized high income nations (like Canada, France, Finland, Germany, Australia, etc.) spend approximately 12%.

If we could reduce the difference by half (or approximately 2.5% which would still leave the US spending 20% more than the average) that would equate to a savings of $500 billion annually. The CBO estimates the cost of ACA at $136 billion a year as a referendum point.

The real discussion ought to be how to increase efficiency, and eliminate waste, in the Healthcare delivery system. We, as a nation, need to understand the reasons why the US spends 42% more on healthcare compared to comparable countries. And using average life expectancy as a proxy suggests the US is not getting its money's worth.

We are a fatter and richer country, that's how in a nut shell.

 

[explanade]

The real discussion ought to be how to increase efficiency, and eliminate waste, in the Healthcare delivery system. We, as a nation, need to understand the reasons why the US spends 42% more on healthcare compared to comparable countries. And using average life expectancy as a proxy suggests the US is not getting its money's worth.

What you call waste or inefficiency may be the profit motive of a lot of different players in the system.

In the past year, we've heard several cases about drug companies gouging patients and insurers with drug pricing, not just of state of the art drugs but old drugs as well.

 

[explanade]

I guess I can say I am worried, but not freaking out...

There does seem to be some steam on SOME kind of bill so they can say they 'repealed and replaced' even if it does not...

And nobody knows what will be in it since there is no clear consensus and they are just throwing stuff on the wall to see what sticks.... trying to get enough votes... still, it has to pass the Senate where I think anything that is much worse than what we have will die in filibuster....


I am not saying that what we have is great as our plans keep getting worse and much more expensive... but at least right now I know what is going on... now, if we have a number of plans drop off for next year.... well, who knows what to do...

Some of the more recent proposals being tossed around would be to cause even more people to lose coverage than the first AHCA incarnation.

Or some of the proposals, like discarding community rating, could cause premiums to go up a lot for some people.

The push for repeal and replace isn't just about keeping a campaign promise. The AHCA would have clawed back a $1 trillion over 10 years from the Medicaid expansion so that they could reset the budget baseline for greater tax cuts.

Because the tax reform they're talking about would be done by reconciliation, so that they don't have to get 60 votes in the Senate.

So they have to find "savings" from health care in order to enable the steep tax cuts they want to do.

 

[LARS]

What you call waste or inefficiency may be the profit motive of a lot of different players in the system.



In the past year, we've heard several cases about drug companies gouging patients and insurers with drug pricing, not just of state of the art drugs but old drugs as well.

Agreed. Broadly speaking "price gouging" falls under waste/inefficiency.

 

[travelover]

........... We, as a nation, need to understand the reasons why the US spends 42% more on healthcare compared to comparable countries. ............

I have to chuckle at this. At MegaMotors, we knew not only how much every part of every car costs, but how much it cost to paint vs plate that part, how much it cost to install it, to ship it, to replace it, to stock it as a spare. Yet here we have an industry consuming 17% of the largest economy on Earth and we act like understanding where the money goes is an impossibly complex task. Given that we are not stupid, it is obvious that there are forces basically sabotaging any effort for a comprehensive understanding leading to meaningful reform. And, if I had to guess, sniffing backwards on the money trail would lead one straight to the culprits.

 

[LARS]

I have to chuckle at this. At MegaMotors, we knew not only how much every part of every car costs, but how much it cost to paint vs plate that part, how much it cost to install it, to ship it, to replace it, to stock it as a spare. Yet here we have an industry consuming 17% of the largest economy on Earth and we act like understanding where the money goes is an impossibly complex task. Given that we are not stupid, it is obvious that there are forces basically sabotaging any effort for a comprehensive understanding leading to meaningful reform. And, if I had to guess, sniffing backwards on the money trail would lead one straight to the culprits.

Agreed. (I had to bite my tongue with original comment to not point fingers, but I certainly can think of a few, 535 of them to be exact.)

 

[Alan]

My husband said it's from the Economist. But I don't know if I can find the link. I found it, but there are other links out there for the same article, so it's not far fetching idea.
http://www.economist.com/news/brita...ocial-care-paid-order-bolster-national-health

Thanks for the link.

the most radical idea is to change how it is paid for, either to a form of social insurance or to a levy on inherited wealth, says Andrew Haldenby of Reform, a think-tank.

So it is a radical idea from a think tank which is why I hadn't heard of it. It is currently funded from general taxation and runs about £120B/year To fund it from inherited wealth means increasing the existing income from inherited wealth by a factor of 25 and hoping that the wealthy don't start donating heavily to charities or finding more innovative ways to avoid their estates being taxed at extremely high levels.

 

[broadway]

Agreed. (I had to bite my tongue with original comment to not point fingers, but I certainly can think of a few, 535 of them to be exact.)

The same forces that lead to waste and efficiency are in other countries as well, so why is it that other countries are doing a better job at this?
Are Americans in general greedier than people in other countries?
That is what I can't figure out.

 

[daylatedollarshort]

Given the amount involved, unless you think you can make a lot of progress on your own it may be worth getting one of those medical billing advocates involved to make sure that the bill is correct and you are paying the least amount possible.

https://www.nerdwallet.com/blog/hea.../patient-advocates-medical-billing-advocates/

I have not yet used one, but I wonder if any others on the forum have and would be willing to share their experiences.

I think that is a good idea. First I'm going to check with the insurance and make sure they know what test I really had and find out the negotiated rate for that. I had an X-ray at the same hospital network and the insurance negotiated charges seemed quite reasonable, as did the doctors charges.

 

[LARS]

The same forces that lead to waste and efficiency are in other countries as well, so why is it that other countries are doing a better job at this?

Are Americans in general greedier than people in other countries?

That is what I can't figure out.

I simply point out the elephant in the room and recognize where we should be focusing. I am certain there are a myriad of reasons that "explain" why the US spends so much more per GDP than our counterparts (some may be legitimate, but those alone cannot explain the wide gulf). What those specific reasons are I can hazard guesses, but the answers are there to be found if we'd only seriously ask the questions.

 

[Meadbh]

Interesting article in the New York Times:

https://www.nytimes.com/2017/04/22/...ol-top-region&WT.nav=opinion-c-col-top-region

"For every doctor, there are 16 other health care workers. And half of those 16 are in administrative and other nonclinical roles...."

 

[Winemaker]

I have to chuckle at this. At MegaMotors, we knew not only how much every part of every car costs, but how much it cost to paint vs plate that part, how much it cost to install it, to ship it, to replace it, to stock it as a spare. Yet here we have an industry consuming 17% of the largest economy on Earth and we act like understanding where the money goes is an impossibly complex task. Given that we are not stupid, it is obvious that there are forces basically sabotaging any effort for a comprehensive understanding leading to meaningful reform. And, if I had to guess, sniffing backwards on the money trail would lead one straight to the culprits.

I remember years ago reading about the state of US automakers. Opinion was that upper management was a bunch of healthcare experts and not car manufacturing experts.

 

[travelover]

I remember years ago reading about the state of US automakers. Opinion was that upper management was a bunch of healthcare experts and not car manufacturing experts.

The industry is complex and can't be summarized into an sound bite, but my point is that complicated systems that involve huge amounts of money can be broken down, analyzed and optimized. When the analysis doesn't happen, it is fair to ask why.

 

[ShokWaveRider]

The US spends approximately 17% of GDP annually on healthcare. According to data from the World Bank other industrialized high income nations (like Canada, France, Finland, Germany, Australia, etc.) spend approximately 12%.

If we could reduce the difference by half (or approximately 2.5% which would still leave the US spending 20% more than the average) that would equate to a savings of $500 billion annually. The CBO estimates the cost of ACA at $136 billion a year as a referendum point.

The real discussion ought to be how to increase efficiency, and eliminate waste, in the Healthcare delivery system. We, as a nation, need to understand the reasons why the US spends 42% more on healthcare compared to comparable countries. And using average life expectancy as a proxy suggests the US is not getting its money's worth.

My opinion about healthcare in the USA (It is JMHO), is simply the lawmakers just do not get it. They measure healthcare in costs (to them, the government coffers) instead of citizen coverage. Again IMHO the healthcare model is completely wrong.

Insurance is in business to make a profit, and by design is obliged to avoid paying anything it can, whenever it can and for as long as possible, regardless off the consequences. Their ideal situation for any insurance application is to take a premium and never have to pay out (of course this is the extreme).

Instead we should measure the success of healthcare to how many citizens it covers, NOT how much money can be saved in covering less. In Canada, Australia & Europe, (whatever you wish to call each system), they are all successful BECAUSE they cover ALL their citizens. the US is a failure because it does not. Personal income aside, a governing body has no business deciding who will get healthcare and who will not.

We brandish numbers around as if they are poker chips. 24m people will lose their healthcare if..... 24m people will be covered if we do that. Instead of saying "What do we have to do to ensure ALL our citizens are covered!"

Medicare attempts to achieve that for folks over 65. That is a great start. But still a large percentages of US CITIZENS do not have coverage.

I am trying to avoid using the word insurance as I do not believe healthcare funding should be a For Profit industry.

Costs are important and of course should be controlled, but are costs more important than your life? Of course not. Then why should they be more important for someone else's, the answer is also they are not.

So getting 100% of a countries citizens healthcare coverage should be priority number 1 and costs a close second.

Unfortunately when we seem to be prepared to fund and do anything OTHER than provide decent healthcare for ALL our citizens, this is just a pipe dream for me.

 

[Fedup]

My opinion about healthcare in the USA (It is JMHO), is simply the lawmakers just do not get it. They measure healthcare in costs (to them, the government coffers) instead of citizen coverage. Again IMHO the healthcare model is completely wrong.

Insurance is in business to make a profit, and by design is obliged to avoid paying anything it can, whenever it can and for as long as possible, regardless off the consequences. Their ideal situation for any insurance application is to take a premium and never have to pay out (of course this is the extreme).

Instead we should measure the success of healthcare to how many citizens it covers, NOT how much money can be saved. In Canada, Australia & Europe whatever you wish to call each system, are successful BECAUSE, they cover ALL their citizens. the US is a failure because it does not. Personal income aside, a governing body has no business deciding who will get healthcare and who will not.

We brandish numbers around as if they are poker chips. 24m people will lose their healthcare if..... 24m people will be covered if we do that. Instead of saying "What do we have to do to ensure ALL our citizens are covered!"

Medicare attempts to achieve that for folks over 65. That is a great start. But still a large percentages of US CITIZENS do not have coverage.

I am trying to avoid using the word insurance as I do not believe healthcare funding should be a For Profit industry.

Costs are important and of course should be controlled, but are costs more important than your life? Of course not, then why should they be more important for someone else's. The answer is also they are not.

So getting 100% of a countries citizens healthcare coverage should be priority number 1 and costs a close second.

Unfortunately when we seem to be prepared to anything OTHER than provide decent healthcare for ALL our citizens, this is just a pipe dream for me.

You are getting in dangerous territory. Posting political comments here. Maybe it's time for porky pig.

 

[travelover]

You are getting in dangerous territory. Posting political comments here. Maybe it's time for porky pig.

I don't see this as overtly political.

 

[ShokWaveRider]

You are getting in dangerous territory. Posting political comments here. Maybe it's time for porky pig.

Which part? Please tell me. It is NOT intended to be political at all. I do not mention anything about politics, only my opinions on healthcare. I do not think it is at all. Seems mentioning anything to do with healthcare gets labeled political.

 

[MichaelB]

No worries, the discussion is fine so far. Hopefully it will stay on track...

 

[ivinsfan]

Which part? Please tell me. It is NOT intended to be political at all. I do not mention anything about politics, only my opinions on healthcare. I do not think it is at all. Seems mentioning anything to do with healthcare gets labeled political.

Well insurance companies sell you insurance and the government regulates it so any intense discussion is going to go off in the ditch, it's the nature of beast and the biggest problem we face today re health insurance.

 

[Fedup]

Interesting enough, I think comment like a government body has no business in deciding who gets health care or not is political comment.

I would prefer it to stay out, no ACA, nothing. Will see how that goes. I believe you choose to not think it's political but I think it is. How about giving back all those millions that you made from working in USA so you can get free healthcare.
My husband's uncle is in his 80s and still working in UK. I don't want a system like that either. Somebody has to pay for the tax. While you don't think government has anything to do with it but who pays for them.

Healthcare works fine for my family and other immediate family members. But nobody, emphasis is on nobody demands to have cheap health care so they can retire early. In fact none will retire early. Most will retire in their 70s and only two will retire when he gets Medicare. Not because he needs Medicare but his wife has retiree's insurance.

 

[ShokWaveRider]

Interesting enough, I think comment like a government body has no business in deciding who gets health care or not is political comment.

It would have been if the comment was referring to a specific faction, but it was not. (See Michael & Alan, I am learning)

 

[Fedup]

It would have been if the comment was referring to a specific faction, but it was not. (See Michael & Alan, I am learning)

How could it not be? It's a political charge topic even within one party.

 

[explanade]

Well the main thing now that people worried about relying on the ACA for ER has to think about is that the administration may yet again try to pass a repeal and replace law.

But some of the ideas floated would lead to more uninsured people than the first incarnation of the AHCA and there's talk about giving states the right to revoke community rating, which could lead to higher premiums for older people and those with preexisting conditions.

Meanwhile, it seems the main thrust for health care is to recover a lot of money used for Medicaid expansion, so that that money could be used for tax cuts. The reason they have to pay for tax cuts this way is the budget reconciliation rules, which allow them to pass laws without having to get 60 votes in the Senate.

The president has threatened not to fund some of the cost sharing provisions in the ACA. Specifically, there's something like $7 billion which were allocated to help insurers defray any losses in the exchanges. That deadline is looming soon because by May, insurers will have to commit to staying in the exchanges for 2018.

Refusal to fund these cost-sharing reductions could cause more insurers to leave the exchanges:

Trump, Democrats negotiate on Obamacare cost-sharing payments - Business Insider

 

[Winemaker]

The industry is complex and can't be summarized into an sound bite, but my point is that complicated systems that involve huge amounts of money can be broken down, analyzed and optimized. When the analysis doesn't happen, it is fair to ask why.

Oh I agree, we engineers tend to add, subtract, multiply and divide everything to death. I also tend to believe that healthcare costs, although variable for a specified demographic, are also analyzed and optimized. That is why some patients are charged more for a procedure than others; someone has to pay the difference somewhere up or down the money trail.

 

[ivinsfan]

Well the main thing now that people worried about relying on the ACA for ER has to think about is that the administration may yet again try to pass a repeal and replace law.

But some of the ideas floated would lead to more uninsured people than the first incarnation of the AHCA and there's talk about giving states the right to revoke community rating, which could lead to higher premiums for older people and those with preexisting conditions.

Meanwhile, it seems the main thrust for health care is to recover a lot of money used for Medicaid expansion, so that that money could be used for tax cuts. The reason they have to pay for tax cuts this way is the budget reconciliation rules, which allow them to pass laws without having to get 60 votes in the Senate.

The president has threatened not to fund some of the cost sharing provisions in the ACA. Specifically, there's something like $7 billion which were allocated to help insurers defray any losses in the exchanges. That deadline is looming soon because by May, insurers will have to commit to staying in the exchanges for 2018.

Refusal to fund these cost-sharing reductions could cause more insurers to leave the exchanges:

Trump, Democrats negotiate on Obamacare cost-sharing payments - Business Insider

Here comes the padlock..come on you guys please quit the politics...