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Dirty Tricks of the Private Healthcare Industry

Ivor the Engineer said:
http://www.law.virginia.edu/html/news/2005_spr/healthinsure.htm
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But that speaks nothing about people's satisfaction, it speaks about the trouble people have with getting appointments and treatment at clinics (which are basically the convenience store of health care treatment to begin with). Perhaps I had no problems with my treatment because I was treated in a hospital and trauma care center, and was having follow-ups at doctors' offices (including specialist care) instead of clinics.

Regardless, what I said still stands: private healthcare is best when you are healthy, subsidized healthcare when you are not.
 
Ivor the Engineer said:
A free market approach has never worked well for the provision of health care. It's been tried in the past and has always failed to provide adequate care for large segments of the population. Economists can even explain why a free market in health care is doomed to failure.
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Economists can explain anything. One of the easiest things is to find the 'right' economist to back up one's particular viewpoint!

Ivor the Engineer said:
What is fascinating is the number of otherwise intelligent people who cannot get past their irrational fears and ideological biases to understand this.
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I also find this absolutely fascinating. And one of my primary reasons for being here is to be somewhere where my own world view is challenged so that I'm forced to reassess in the light of critical responses to my posts.

One interesting tendency I'm finding is where I'm more confident, I'm happier taking a back seat, maybe calmly adding a little something where I think it might help bring the 'mistaken party' to 'see the errors of their ways'. And on the flip side, such as with this thread, where I'm less certain that all the premises are sound I tend to write more strongly and more defensively. This I think I should learn to notice and take as a cue to question the assumptions on which my argument is based.

It's a slow process, this learning business, but someone's got to do it!!

Thanks all for the part you're playing :)

BDd

Ivor the Engineer said:
A free market approach has never worked well for the provision of health care. It's been tried in the past and has always failed to provide adequate care for large segments of the population. Economists can even explain why a free market in health care is doomed to failure.

What is fascinating is the number of otherwise intelligent people who cannot get past their irrational fears and ideological biases to understand this.
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BartiDdu said:
Do I relaise?! I thought this kind of rhetoric had gone out with the death of Communism in the 20th century. Don't see it peddled that often any more so thanks for reminding me this kind of talk used to be commonplace!

BDd
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Glad to be of service, I am sure you have a handwave practiced for anti trust laws.:)
 
Rolfe said:
I don't imagine there's any logic or reason that can get past Beerina on this one. Maybe he has shares in health insurance companies.
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I need a ruling on this: ad hom or poisoning the well? I vote well poisoning.
However, taking the argument on a little for the more open-minded around here, is it really all fine and dandy for US insurance companies to spend only 78% of the money they receive on providing healthcare, when experience in other countries shows that a spend of 95% is possible?
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Depends on the overhead (to include advertising) costs.

Good question, however.

Here is a thought to chew on: the 1990's tech boom, and to a lesser extent the 1980's tech boom, created what I saw as an unrealistic demand on a lot of corporations in terms of return margins. This is a coarse analysis, but attracting captial and investors with older earnings expectations seemed to run afould of double digit payouts (or the prospect of that). Not sure if that is over, but I suspect that Health Insurance Companies ran into this as well as other sectors of the economy.

Not to belittle greed, by any means, but it may have factored in as, during the same period, the "company insurance policy/union leveraged benefit package" changed and the system evolved, for better and worse.

The "95%" seems extraordinary.

Are overhead expenses really that low? :confused:

DR
 
Ivor the Engineer said:
Given the huge sums of money flowing and no output other than shuffled papers, I'm not surprised it doesn't cost much to administer.
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Ivor, respectfully, I am curious as to the cost accounting that arrives at that figure.

Since manpower costs are not trivial in any undertaking, private or public, and the infrastructure and operating costs of administration (other than payroll) are opaque to me, (takes money to house and heat and electrify all the places the administrative side works in) we are looking at a bit more than "paper shuffling" here.

DR
 
Eskarina said:
According to this German wikipedia link overhead costs in 2007 - including advertising - for all German sickness funds (i.e. "public" - not "eeeevil gubmint" or private) was 5.3 %.
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Well, if that system includes the manpower, operating and infrastructure cost, it's a pretty nice expense to benefit ratio. I wonder at how long it took to fine tune the system to become that cost effective.

One of Senator McCain's points in his (failed) attempt at being elected president is that cost control was the key to reforming health care, be it public, private, or a mix of the two. I tend to agree with the ovearching principle.

It is the fear, a reasonable fear, that costs won't be contained (and thus further drive the US Treasury into entitlement debt) that has skeptics of public health worried. The transition to a new system alone will have a signficant, and most likely unrecoverable, cost. If we had a budget surplus, fine, but we aren't quite in that sunny position at the moment.

DR
 
It seems to me that the problems of transition will focus mainly on diverting resources from unproductive ends to productive ends.

Excessive overheads/profits of insurance companies, excessive administration costs in chasing money round the system and deciding what gets paid for and what doesn't, spending on procedures that have no demonstrable clinical benefit and overspending on procedures that do have benefit (remember the contrasting prices of MRI scans in Japan and the USA) all have to be addressed.

However, at the moment there are people making a living out of facilitating all these unproductive uses of healthcare money. You can't just throw a switch and convert an accounts clerk in a doctor's office into a diabetic nurse. It's all part of the problem.

Deciding where you go is the first step. But even that is informed by the difficulty or otherwise of getting there. Everest may be very desirable, but if the Jungfrau is also serviceable and it just happens to have this dinky train that'll take you to the top, well, it may be sensible to choose the Jungfrau. The solution is inevitably path dependent.

However, once the where is reasonably decided, detailed attention has to be paid to the how. How do you get from here to there. Not necessarily easy. But if "here" is the Maldives and the tide is coming in, it's something best tackled sooner rather than later.

Rolfe.
 
Darth Rotor said:
Well, if that system includes the manpower, operating and infrastructure cost, it's a pretty nice expense to benefit ratio. I wonder at how long it took to fine tune the system to become that cost effective.
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That very much depends on how you define "manpower, operating and infrastructure costs." Basically, it's the part of my monthly (income-related) premium that I pay the paper-pushers to make sure everything runs fairly smoothly (sic?). ;) And 5.3% just for administration alone isn't half-bad. (I'm a paper-pusher myself, albeit in a different sector.)

The German health care system has been in effect (with modifications, naturally) since 1883, so we've had quite some time to test it.

http://en.wikipedia.org/wiki/Otto_von_Bismarck#Health_Insurance_Bill_of_1883

Darth Rotor said:
It is the fear, a reasonable fear, that costs won't be contained (and thus further drive the US Treasury into entitlement debt) that has skeptics of public health worried. The transition to a new system alone will have a signficant, and most likely unrecoverable, cost. If we had a budget surplus, fine, but we aren't quite in that sunny position at the moment.

DR
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Which is a very reasonable fear. There is no guarantee that a change means a change for the better for the majority even in the long run. No UHC system is perfect, but if we use perfection as a standard, we might just as well give up on democracy. And the human kind.

FWIW, I just naively wish that everyone on this planet has easy access to UHC. After all, what's the alternative?

ETA: This has been pointed out before: If the US really wants to introduce UHC, they have the almost unique possibilty to pick and choose from all the other UHC systems around the world and/or reject them all to come up with their own solution if they want to.
 
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I believe the U.S. medicare overhead runs about 6% too.

But Medicare is actually dispensed through private HMO corporations, on a contract basis. Low bidders, I assume, get more business? But that does add an extra layer of administration to the 6% figure. Does the German system use outside providers? Or are the care givers actual employees of the govt? Hospitals govt owned too?
 
casebro said:
I believe the U.S. medicare overhead runs about 6% too.

But Medicare is actually dispensed through private HMO corporations, on a contract basis. Low bidders, I assume, get more business? But that does add an extra layer of administration to the 6% figure. Does the German system use outside providers? Or are the care givers actual employees of the govt? Hospitals govt owned too?
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I believe you mean Medicaid, not Medicare, and (according to WP) Medicaid overhead often runs well above 6% (though it is state-level with federal matching, not a direct comparison). For the record, WP also shows that Medicare was 16% of the federal budget in 2007.
 
No, I did mean Medicare, coverage for the retired and disabled. I believe it is covering 60% of our retirees.

Other than figuring out a per-person cost, the 16% is not relevent.

If you do want to attempt to figure a per-person cost from the 16%, remember that the medicare recipient is older and sicker than average. So our average medical cost is bound to be substantially lower then 16%.
 
If we had an actual free market, then most of these problems would disappear. First of all, in a free market there are no barriers to entry, and this assumption holds up particularly well in the case of health-care where anyone can start a local business. All of this competition means lower prices for you (and lower profits for business). Second, consumers are informed (no asymmetries); they're not swayed by silly superstitions and they don't need something like ten years of training. Moreover, bad decisions are perfectly reversible and consumers have lots of time to shop around. Third, indivisible benefits and costs: not happenin' here. When other people get sick and die, it's on them. Some people -- yes, I'm talking about communists -- like those two old white guys in the video -- will complain about how much is lost in "worker productivity" on account of days missed due to tooth aches and chest pains. Well, boohoo. Fourth: the children. It's actually better if fewer kids see doctors because it toughens them up. It's like my doctor says, "what doesn't kill you can only make you stronger." This may sound counter-intuitive to you. If it does sound counter-intuitive, then you're stupid, and you need to get your "duh-face" checked out... if you can. Fif: no government bureaucrats. Instead of decisions made by some poindexter in Washington who thinks he knows more than your doctor, under a free market they'll be made by some business major in Connecticut who doesn't care if he knows better than your doctor.
 
skeptigirl said:
First, how about clarifying your title. Perhaps you can get a mod to edit it for you. It isn't the health care industry, it's the third party payer system or health care INSURANCE industry. As a health care provider, it is insulting to treat the two as one.
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Bingo
 
Cain said:
If we had an actual free market, then most of these problems would disappear. First of all, in a free market there are no barriers to entry, and this assumption holds up particularly well in the case of health-care where anyone can start a local business. All of this competition means lower prices for you (and lower profits for business). Second, consumers are informed (no asymmetries); they're not swayed by silly superstitions and they don't need something like ten years of training. Moreover, bad decisions are perfectly reversible and consumers have lots of time to shop around. Third, indivisible benefits and costs: not happenin' here. When other people get sick and die, it's on them. Some people -- yes, I'm talking about communists -- like those two old white guys in the video -- will complain about how much is lost in "worker productivity" on account of days missed due to tooth aches and chest pains. Well, boohoo. Fourth: the children. It's actually better if fewer kids see doctors because it toughens them up. It's like my doctor says, "what doesn't kill you can only make you stronger." This may sound counter-intuitive to you. If it does sound counter-intuitive, then you're stupid, and you need to get your "duh-face" checked out... if you can. Fif: no government bureaucrats. Instead of decisions made by some poindexter in Washington who thinks he knows more than your doctor, under a free market they'll be made by some business major in Connecticut who doesn't care if he knows better than your doctor.
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Nice one :dl:
 
I'm sure that has been tried. Snake-oil salesmen are clearly Cain's preferred method of healthcare delivery....

Rolfe.
 
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