Dirty Tricks of the Private Healthcare Industry

[Rolfe]

OK, sense of humour failure today. I didn't read the block of text carefully enough.

Rolfe.

 

[GreNME]

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%.

Care to try that again without the hand-wavy stuff? In other words, can you qualitatively and/or quantitatively support that assertion? You see, what you originally seemed to say was that the Medicare costs were way, way lower than they actually are, which was an incorrect assertion. So, since you're now saying that under some type of criteria that has yet to be laid out in a manner that can be tested (at least, not in this thread and not in any explanation I've yet heard of) that the actual cost would be far lower than the actual cost right now, then it would be helpful to the credibility of your assertion to provide at least some type of evidence to qualify it.

ETA: And I don't mean to be rude about it. I am seriously asking for real numbers and equations instead of the normal right/left hyperbole that tends to gunk up the healthcare discussions. What you're suggesting is quite significantly different than the numbers tend to show, both for Medicare and Medicaid, so I'd really like to see where this assertion is based.

 

[Eskarina]

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?

That number refers to the average overhead costs of the public HC insurance providers in Germany, which are called "sickness funds". That means roughly 95% of their income go into providing health care compared to the 78% the private US HC providers spend according to the video in the OP.

And as they can use their combined power to haggle each year with the HC providers, prices are comparatively low. And to be fair, so is the satisfaction of quite a few HC providers with their income.

Only a few hospitals (like university teaching hospitals) are state-owned - I don't like the term "government-owned" -, doctors usually are self-employed as are physiotherapists and the likes.

 

[Skeptic Ginger]

..."healthcare provided to patients outside the NHS". ...

This shows your thread title is even more confusing. Among other remedies, adding "in the UK" to the title would fix the problem.

 

[Rolfe]

Did you watch the documentary linked to in the OP? It's an interview with an executive who left a well-paid job in the health insurance industry in the USA because he couldn't stand the hypocrisy (the "dirty tricks") any more.

Rolfe.

 

[Eskarina]

The Daily Show on HC:

Drag me to health Pt. 1

Drag me to health Pt. 2

 

[jimbob]

I don't think anyone is suggesting that the only alternative for the USA is to copy the NHS exactly. There are many different ways of delivering healthcare throughout the developed world, and mostly they seem to work. Given where the USA is starting from, something like the Swiss or German systems would probably be a better road to go down.

I don't think, either, that in Britain we can do nothing apart from either revert to a private system or "sit back and watch the NHS as it implodes". I don't think the NHS is as close to implosion as all that, and I think there are a great deal that can be done without compromising the principle of healthcare "free at the point of need". However, that's not what this thread is about. This is about the protectionist beghaviour of the US health insurance companies. If you want to start a thread about the problems in the NHS, do so, but that's a different subject.

In this context, I strongly suggest watching the documentary linked from this page - Sick Around the World. It's a look at about six different systems in operation in different countries, how well they work, and how satisfied the citizens are with each one. The main problem noted is insufficient funding, when countries are spending only 6% to 7% of GDP on comprehensive healthcare for their citizens. Since the USA currently spends about 16% of GDP on healthcare, then that shouldn't be a problem faced by that country.

Rolfe.

And of course in 2004, the US spent a greater proportion of its greater GDP on publicly-funded healthcare than the UK:

And I am not arguing for an US NHS, there are plenty of other universal models out there, but the NHS is pretty cheap...

I think the point is that the US could be getting far more value for the money it spends, or spend less money and redistribute good-quality care to everyone (while ensuring that people are still free to buy excess care if they want). The only thing holding them back seems to be ideology, and that ideology seems to be based on misunderstanding and misinformation.

Linda

Yup: some further evidence from an earlier thread:

The US state alone spends more of its GDP on healthcare than the UK: for as system that is far form universal.

Here is where I got the 6.6% figure (for 2004)

Medicaid costs a larger percentage of GDP than the NHS does the British taxpayer.
(44.7% of 14.7%=6.6%) was public, as opposed to the UK's (83.4% of 7.7%=6.3%) of GDP Source:

OECD Health Data 2007 - Frequently Requested Data

The death rate is higher in the US too, and not all can be explained by higher gun ownership:

I have found one estimation, in what seems like an appropriate journal.

Thank for for your research.

"The United States thus suffers from a life expectancy gap of 1.7 years."

Now add 1.7 years to your previous stats and tell me were we are.



Keep in mind that this is only one factor to be considered.

"These deaths account for 26.86 percent of the U.S. males' excess mortality when compared to peer nations, and 8.7 percent of the racial gap between black and white males in the United States."

So, yes Jerome, it is significant, but only explains about a quarter of the difference between the US and the other thirty-four other richest countries.


In fact I am surprised at the magnitude of the effect, but it still leaves 74% unexplained by gun-deaths.

In answer to the assertion that the rest of the world is freeloading on the US medical research, which is lowering death rates, a lot of the mortality and morbidity is preventable with better primary healthcare.

 

[Darth Rotor]

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

In theory, yes, in practice, I am skeptical. Spoke last night with a male nurse who works at local hospital. It's something sorta simple here. Based on the reductions, arbitrarily arrived at, in medicaid co pay, in the next six months, due to cash flow, that hospital will reduce its capacity by about one third. The operating funds to keep it at present size will simply not flow into the system, based on historical patient flow stats, and the net decrease in available care is the most reliable prediction of outcome so far seen. What keeps the system afloat at present is that a higher percentage of the patients there rely on private health insurance than on public programs. Reducing that income costs you cash flow that pays for labor and facilities, and mundane operating costs.

Where does that get made up, and more importantly, when?

The rest of your post does not seem to address my remarks on the transition period. For x years, and I'll guess five at least due to how long it takes to change things in large systems into a new, roughly steady state condition, what happens is that the inefficiencies that crop up due to the activities of transition (a bit of cheapo organizational change theory at work here) create a net loss of care events.

Once the change period is over, the new system is either a beneficiary of cost savings, due to the efficiencies you perceive as accruing, or it all turns out to be a flawed analysis and costs are not contained. I have not confidence, given the approach as I understand it to date, that the former will be the case.

Edit to add for jimbob:

The United States thus suffers from a life expectancy gap of 1.7 years."

This may be, but when you multiply that "L.E.G." by the population ratio, it's 1.7 years better times the ratio _of zero carbon footprint_ for that entire population of flower fertilizing folks, or the complete ashes. Not all bad news, eh?


DR

 

[casebro]

I thought that the 1.7 year LEG was explained by the fact that each country counts child mortality differently. In the U.S., every live-born child who then dies is considered a fatality, while in other countries they are not counted in mortality figures unless they lived a specified time period first. A week or a month? sort of considered still-born?

 

[casebro]

But let me do some math here, right in front of of FSM and everybody:

Since many of the un-insured are so healthy they don't need healthcare, their cost to universal healthcare will be ZERO. Pulling a figure of 50% out of a place where the sun seldom shines, that leaves us with a total of 25M sickos. I believe Medicare pays about $6,000 per year for old, sick, disabled people. That gives me $150B, per year. Or, using the Kaiser Foundation figure of 12M total, 50% @$6K= $36B. It sounds like the $1.5 trillion is an exaggeration.

 

[Darth Rotor]

But let me do some math here, right in front of of FSM and everybody:

Since many of the un-insured are so healthy they don't need healthcare, their cost to universal healthcare will be ZERO.

For how long? We all age.

Pulling a figure of 50% out of a place where the sun seldom shines, that leaves us with a total of 25M sickos. I believe Medicare pays about $6,000 per year for old, sick, disabled people. That gives me $150B, per year. Or, using the Kaiser Foundation figure of 12M total, 50% @$6K= $36B. It sounds like the $1.5 trillion is an exaggeration.

"the uninsured" simply don't get some care or maintenance inspections/check ups that, in the long term, risk significantly more expense as bits aren't nipped in the bud.

Of course, some insured folks don't either.

 

[shadron]

fugeddit.

 

[Skeptic Ginger]

Did you watch the documentary linked to in the OP? It's an interview with an executive who left a well-paid job in the health insurance industry in the USA because he couldn't stand the hypocrisy (the "dirty tricks") any more.

Rolfe.

I have seen the man interviewed more than once.

I never said anything about this not applying to the US. It most certainly does. Probably more so than in Britain. My complaint is only that volatile's thread title implies the entire private health care industry is involved. In the US that is not the case.

In the US, it is mainly the insurance industry, the right wing Republican leadership, and the Libertarians who are using lies to distort the actual health care reforms being proposed. It's my understanding the AMA, the AHA (hospital association) and the largest nursing union have all endorsed the proposed changes, at least in general.

As for the insurers denying care as a means of maximizing profits, that scandal has been exposed by whistle blowers repeatedly for years. The Bush administration ignored it. The current changed in health care are intended to fix the problem. The insurers are pouring millions into fighting the proposed changes.

According to volatile, everyone knows he was referring to the PHI in the UK. I'm objecting to the fact the thread title implies I and my colleagues are in on the dirty tricks. It is insulting and a false charge.

 

[Skeptic Ginger]

I thought that the 1.7 year LEG was explained by the fact that each country counts child mortality differently. In the U.S., every live-born child who then dies is considered a fatality, while in other countries they are not counted in mortality figures unless they lived a specified time period first. A week or a month? sort of considered still-born?

While there is some truth to that when comparing the US to many third world countries, the US and the European countries have adopted the WHO definition of infant mortality and for the last 2 decades the numbers are fairly comparable even if not perfectly so.

Notes re Cause-of-death classification (warning, lg pdf file and it is only these notes I quote here that matter from the link:

Mortality statistics are compiled in accordance with the World Health Organization regulations that specify that member nations classify and code causes of death in accordance with the current revision of the International Statistical Classification of Diseases, and Related Health Problems (ICD). The ICD provides the basic guidance used in virtually all countries to code and classify causes of death. It provides not only disease, injury, and poisoning categories but also the rules used to select the single underlying cause of death for tabulation from the several diagnoses that may be reported on a single death certificate, as well as definitions, tabulation lists, the format of the death certificate, and regulations on the use of the classification. Effective with deaths occurring in 1999, the United States began use of the Tenth Revision of this classification, (ICD-10) (24). During the period 1979–98 causes were coded and classified according to the Ninth Revision (ICD-9) (25).
The change from ICD-9 to ICD-10 resulted in discontinuities for selected cause-of-death trends. These discontinuities are measured using comparability ratios from a comparability study described in the ‘‘Technical Notes’’ of the preliminary report for 1999 (26) under the section ‘‘Comparability between ICD-9 and ICD-10 for mortality.’’ Causes of death for data presented in this report were coded by procedures described in annual issues of part 2a of the NCHS Instruction Manual (27).
Beginning with data for 2001, NCHS introduced categories *U01–*U03 for classifying and coding deaths due to acts of terrorism. The asterisks before the category codes indicate that they are not part of the International Classification of Diseases, Tenth Revision (ICD-10). Deaths classified to the terrorism categories are included in the categories Assault (homicide) and Intentional self-harm (suicide) for the 113 causes-of-death list (table 2) and for Assault (homicide) in the 130 causes-of-infant death list (table 5).

ICD 9 has a list of when revisions were made.
ICD 10 is the latest revision.


Still, one can't assume access to health care is the cause of the different infant mortality. But the point is, having an national health care system does not produce the poor care the right wingers are claiming.

 

[jimbob]

Whistleblower tells of America's hidden nightmare for its sick poor

From the guardian:

Such sentiments are rare in an industry that has given America a healthcare system that can be cripplingly expensive for patients, but that does not produce a healthier population. The industry is often accused of wriggling out of claims. Firms comb medical records for any technicality that will allow them to refuse to pay. In one recently publicised example, a retired nurse from Texas discovered she had breast cancer. Yet her policy was cancelled because her insurers found she had previously had treatment for acne, which the dermatologist had mistakenly noted as pre-cancerous. They decreed she had misinformed them about her medical history and her double mastectomy was cancelled just three days before the operation.

Last month three healthcare executives were grilled about such "rescinding" tactics by a congressional subcommittee. When asked if they would abandon them except in cases of deliberately proven fraud, each executive replied simply: "No."

 

[volatile]

"Yet her policy was cancelled because her insurers found she had previously had treatment for acne, which the dermatologist had mistakenly noted as pre-cancerous. They decreed she had misinformed them about her medical history and her double mastectomy was cancelled just three days before the operation."

:-O

 

[jimbob]

But at least you are free to choose in the US....

 

[Beerina]

"High-ranking insurance PR flack defects, explains dirty tricks"




Thoughts? Comments?

That people should be more concerned with the dirty tricks politicians use to gain power, including using rhetoric to pound the heads of "those who oppress us"?











By the way, that article gets down on its knees to sympathize with the guy "watching the industry slam Sicko". Even some health care nationalization supporters around here acknowledge it's a hack piece. So the (note, not "my") answer to "thoughts?" is "another hack piece."

 

[jimbob]

That people should be more concerned with the dirty tricks politicians use to gain power, including using rhetoric to pound the heads of "those who oppress us"?
<snip>
By the way, that article gets down on its knees to sympathize with the guy "watching the industry slam Sicko". Even some health care nationalization supporters around here acknowledge it's a hack piece. So the (note, not "my") answer to "thoughts?" is "another hack piece."

Beerina,

The guardian article is a print version of the same story, (Wendel Potter again).

Was the example I quoted [EDIT: post#97] factually untrue?

I consider it ethically "dubious" to refuse to pay on technicalities. Which the executives stated that they would continue to do so.

 

[ARubberChickenWithAPulley]

In the US, it is mainly the insurance industry, the right wing Republican leadership, and the Libertarians who are using lies to distort the actual health care reforms being proposed. It's my understanding the AMA, the AHA (hospital association) and the largest nursing union have all endorsed the proposed changes, at least in general.

AHIP (the health insurance trade group) has supported broad reform this time around. Heck, they've even aired advertisements supporting it -- including supporting the idea of getting rid of pre-existing exclusion clauses and the like. They've opposed a government run option.

The AMA is also, at best, skeptical of a government run option as well, though they are willing to consider some form of it:

"The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program, or pays Medicare rates, but the AMA is willing to consider other variations of a public plan that are currently under discussion in Congress," Dr. Nielsen said.

Ditto the AHA:

Sources said that during negotiations with the Senate committee and its chairman, Max Baucus (D-Mont.), the hospital associations made clear their opposition to a new public insurance plan that would pay at Medicare and Medicaid rates, which they have long complained are too low.

The most fervent anti-reform ads have been led by Rick Scott, who is a former CEO of Columbia/HCA, a hospital company.