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Stossel Solves the Health Crisis with Capitalism

Toke said:
What are they adding to the system?
Apart from cost.
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Insurance companies have an incentive to not pay for treatment unless it is cost-effective (from their point of view). Some of the time this coincides with patients' interests.

For example, an insurance company may fund routine check-ups to avoid expensive emergency treatment.

On the other hand, if an individual is likely to pay less in premiums in the future than some costly (but life-saving) treatment, then it is in the interests of the insurance company to let them die.
 
Earthborn said:
It makes no sense at all for an insurance company to allow people to "just grab what they want".
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How is an insurance company supposed to tell the difference between neccecary and not?

Do they have a parallel healthcare system to evaluate the first?
Or is it left to some office type to determine it that bypass is really neccecary or if someone is trying to get it because they think they can get away with it.

How many people without cancer commit insurance fraud to get some of that expensive chemoterapy?
 
Ok, my starting point is that everyone should get what treatment they need*.

That makes an insurance company an unneccerary cost.


*Yes there will be rationing, the state buget is not unlimited.
 
Unfortunately, at this point I'm out of my depth, relying as I am on information gleaned from other Americans on this forum. My understanding is that a person with a serious pre-existing condition can't buy insurance directly because no insurance company will write him a policy. So he has to get it indirectly by finding employment at a company that offers a health plan. Said company is then obligated to add him to their plan.

Of course, lying about a pre-existing condition on a job application is a sackable offense.

It's an outrageous way to run a health system. And then Americans wonder why other people shake their heads and sigh.

I see Dan's taken a bit of a breather from this discussion. I hope he returns to confirm or dispute my take on things.
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I'm not 100% on this, but I used to work with a guy who had all kinds of medical problems from a car crash he was in. He was able to get insurance through our employer even with all of the ongoing medical care he would need throughout his life. I'm not sure if this is how it works for every employer though.

We also have SSI, which another friend of mine has, that gives him about 600 bucks a month and free medical because he has a rare syndrome that requires major surgery every 3 or 4 years. Just another way to stop the dyin' n the streets.

I'll be back later for my weekly kick in the nuts.
 
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Francesca R said:
It doesn't seem to be a part of your knowledge that this is exactly what insurance companies do. Ideology I guess . . . .
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And they are better at it than the doctors seeing the patient?
And it does not cost anything to have that second evaluation?

Can you see the difference between fraud on a burnt out car and someone trying to get chemo they don´t need.

Or just explain what you think the insurance companies are supposet to contribute with.

Ideology I guess . . .
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Comming from you.....
 
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Toke said:
How is an insurance company supposed to tell the difference between neccecary and not?
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It really isn't that hard.

First you make it illegal for pharmaceutical companies and manufacturers of medical devices to give bonuses and gifts to doctors who prescribe their products to their patients.

Second, insurance companies will need to accept that anything prescribed by a doctor is a necessity, and they will have to pay for it. If they are not sure why a patient needs the $40 insulin meter instead of the $15 one, they can call the doctor to explain it. If the patient wants a $80 their doctor can tell them "you don't need it. I'm not going to prescribe it, so your insurance won't cover it."
 
Earthborn said:
It really isn't that hard.

First you make it illegal for pharmaceutical companies and manufacturers of medical devices to give bonuses and gifts to doctors who prescribe their products to their patients.

Second, insurance companies will need to accept that anything prescribed by a doctor is a necessity, and they will have to pay for it. If they are not sure why a patient needs the $40 insulin meter instead of the $15 one, they can call the doctor to explain it. If the patient wants a $80 their doctor can tell them "you don't need it. I'm not going to prescribe it, so your insurance won't cover it."
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My bolding.

It sounds sensible enough.
There is just one problem, what purpose does the insurance company then serve?
 
Francesca R said:
I agree. This is why Rolfe's suggestion to get rid of them ("parasite middlemen") is pretty flawed IMO.
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It doesn't matter to the insurance company so long as it takes in more in premiums than it pays out. For as long as they turn a profit the cost (or inflated cost) don't matter to them, they're not paying the premiums.

Steve
 
Toke said:
Cool, does that mean that with full deductibles you would have free insurance?:D
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When I was working for an insurance company, a running joke was that you´d get free insurance if you opted for the "Five Minutes Clause":

Insurance coverage always ends five minutes before an insured loss occurs.
 
Insurance coverage always ends five minutes before an insured loss occurs.
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:dl:

Like the used cardealers "OK" garantie (or OC in english)

We garantie that it can drive over the curb, if not we will help push.
 
You would think there is an incentive for insurance companies -- because they are the ones paying for it -- to shop for a cheaper product. Or at the very least not fully cover ridiculously overpriced stuff. You haven't explained why there isn't.
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Because it is all ridiculously overpriced – and stays that way because of the lack of real competition. The only thing an insurance company could do now would be refuse to pay – they don't have cheaper strips to pick from.
 
Medical treatment is not pleasant, most sensible people avoid it whenever possible. Patients do not want simply to receive unnecessary treatment. At the same time providing medical treatment that isn’t necessary has potentially devastating implications for the physician. While you may find occasional occurrences where unneeded treatment is provided, it will never be common.

What may happen if you leave decision on care to be made by the patient and physician based only on what is best for the patient, is that more expensive but slightly effective treatments will be chosen. Of course it you truly want to have “the best medical care in the world” it seems like you would be doing this anyway.
 
DaN K. StAnLeY said:
Plus, I mostly left because you guys/girls are [rule 10]-holes. I still don't agree that we need to switch to UHC to have better HC. The more I'm reading, the more I find out how crappy systems like Canada's are. I don't see people dying in the streets here yet, so I still have time to ponder.
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They don't die in the streets. They die in ER's and you and I, the insurance purchasing customers, end up footing the bill.

http://www.ucpress.edu/books/pages/10379/10379.intro.php


This book was born at a Harvard health care symposium when Rushika, a physician specializing in health policy, met Susan, an anthropologist who recently had returned to the United States after living for two decades in Israel and Japan, countries that have national health care programs. With the fresh eyes that an outsider sometimes can bring to a situation most of us take for granted, Susan asked Rushika: "Where are the bodies? If forty million Americans don't have health insurance, there must be a lot of bodies. I would think that American cities would look like Delhi or Calcutta, where trucks collect corpses from the streets each morning. Where is America hiding its uninsured sick and dying citizens?"
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How the Death Spiral Works
In insurance lingo, a death spiral occurs when a health plan starts attracting sicker patients, which causes the price of premiums to go up, which causes more healthy people (who have other options) to leave the plan, which causes the remaining pool to be proportionately sicker, which causes the price of premiums to increase even more, eventually resulting in the company going bankruptÑin other words, dying.
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Where Are the Bodies?
Many portals lead into the death spiral, but few lead out. The sick and dying bodies that Susan asked Rushika about are hidden inside the death spiral, in three primary locations.

Where do we hide the bodies? In emergency rooms and end-stage hospital wards across the country.

America's hospitals are legally obligated to stabilize the condition of emergency patients and to treat any life-threatening condition regardless of the patient's ability to pay. Emergency rooms are not, however, required to provide any definitive treatment or any therapy to prevent the condition from recurring. For those who are pronounced terminally ill, the Social Security disability program provides health care services through Medicare. Thus, we do not provide care to prevent emergencies or to stave off terminal illness, but we do offer a place to land at the bottom of the spiral.
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DaN K. StAnLeY said:
KellyB, what was really scary for me was seeing a Canadian man who was having a heart attack waiting for an available bed. It was also pretty scary for the woman on the show who's doctors told here she had to wait months for "elective" surgery that ended up almost killing her. Luckily she made it to the doctors in the US who were able to treat her and BTW said if she would have waited any longer she'd be dead. She wasn't upset at the cost though. She was just fine with being alive.
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aah single examples, how was the name of the ladys that died in Hospital while she was waiting there? and nobody didnt even care........
 
Ivor the Engineer said:
Insurance companies have an incentive to not pay for treatment unless it is cost-effective (from their point of view). Some of the time this coincides with patients' interests.
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Insurance companies have an incentive to not pay for treatment regardless of effect. They also have an incentive to pay for popular ineffective treatments like acupuncture.
 
Francesca R said:
Why, what nonsense :D
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Nope, the business of the insurance company is to make money. For as long it gets it's premiums and pays out less to the insured it's fine. At the point when people won't pay the premiums THEN they have to worry. If the insurance companies were really after best value for the customer then perhaps prices would come down, at the moment the only way premiums seem to be moving is up.

Steve
 
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