Socialize Medicine

[The Fool]

Honestly...I find this whole US health insurance thing quite amazing....That the US would not only lag behind the developed world but would seemingly find it desirable to do so.

 

[Francesca R]

I am a proponent of making the American health care system universal [ . . . ] Quality of health results should be the #1 priority,followed then by costs.

There are a lotta lotta people who believe that universal access ranks higher than both of those.

 

[AvalonXQ]

Honestly...I find this whole US health insurance thing quite amazing....That the US would not only lag behind the developed world but would seemingly find it desirable to do so.

I find it quite desirable not to give control of healthcare over to the government.

 

[Francesca R]

Its just wrong to suggest that health care is accessible to "relatively few".

When you consider the gap between the proportion who can access it in the United States and the proportion who can access it in every other country in the OECD, it is quite accurate to use "relatively few".

 

[Francesca R]

Both.

The benefit of insurance (risk pooling) is that you have healthy people and unhealthy people, and lucky people and unlucky people, and by collectively underwriting future liabilities, the healthy and lucky end up compensating the unhealthy and unlucky. That's a benefit since--ex ante--individuals don't know which of these they will be, and to individually insure your own risk would require massive personal savings.

What benefit do we get by allowing a middle man to siphon off resources from those actually providing care???

It doesn't matter to those who provide care, if your insurer pays them or if you do. They are happy either way. It does matter if someone pays them, and (ex ERs) if they don't know they are going to get paid they are not going to provide anything to you.

Therefore you get a significant benefit from having the known ability to pay for care up front.

Whether it is tax funded, or privately funded, or publicly or privately managed, it is still insurance. To not want insurance is to undertake the risk-bearing of future medical liability fully by yourself--which is not a great idea.

Therefore your complaint is against ethical malpractice by US insurance firms, and the fact that the state does not underwrite claims (both reasonable complaints to which you will hear few arguments from anybody outside the US). But it is not a complaint against insurance itself.

 

[Francesca R]

The title IS "Socialize Medicine."

Yes, well non-Americans give Americans who say "socialised medical care" the benefit of the doubt that what they usually mean is universal access medical care. Every OECD country bar the US has this, and few of them would be considered "socialist" except by far right-wing conservatives. None of them are Marxist. Marx' theories are resolutely out of favour in the developed world and have been for a long time.

 

[Francesca R]

First, profits would be a HUGE difference between private vs. non-profit providers.

Not sure if you mean insurers or health service providers here. Under universal systems, health service providers mostly still do operate for profit. And under many of them (excluding the UK), so do the insurers.

You do not need to eliminate profit to fix the busted flush that is the US system. You do (IMO) need compulsory enrollment, statutory entitlements, and the public purse underwriting the system in extremis.

What recourse do you have against the health care industry? "If you don't process this claim, I am gonna go get denied by another insurance provider!"

Very little; you only have recourse to the law, which doesn't apparently always save you in the US unless you can visit an ER.

The private, profit seeking insurers in Switzerland, Germany, Holland and Denmark (and others) can not refuse to pay out a statutorily entitled claim just because it costs too much. Nor can they void your policy, because there is no such thing as an uneligible citizen in the realm of government protected entitlements. They still seek, and earn profits.

 

[King of the Americas]

No, they're not.

According to Yahoo. the average profit margin for health insurance providers is 3.4%.

http://biz.yahoo.com/p/sum_qpmd.html

Actually, not its not.

The private sector may offer high wages (plus things like stock options) to its top executives, but the fact is, those people make up only a small portion of a company's pay structure. (I once worked out that for Canada's largest business, the Royal Bank, executive pay amounted to less than 5% of the total. Even a small increase in the average salary would easily beat out the combined pay of all of the top executives.)

http://www.usatoday.com/news/washington/2007-06-24-fedpay_N.htm
http://www.cfib-fcei.ca/cfib-documents/WW_MB.pdf


Ummm... Why exactly are you assuming this?

After all, in the public sector (where there is a certain amount of job security), what would be the incentive to seek out cases of fraud? You don't get paid for each and every case of fraud, and its probably easier to just let questionable cases slide.

On the other hand, in the private sector, any employee that is lax in their job (including insurance adjusters) may find themselves unemployed.



First of all, I find that rather ironic that you'd give me that advice, considering all the assumptions you make (not to mention faulty information)... that government insurers would be better at finding fraud (no evidence of that), that profits make up a big part of the cost of insurance (it doesn't), etc.

Secondly, I never actually assumed anything. I know that average government wages are higher for government workers than private sector workers. I know that profits make up a very small amount of the cost of insurance. The only reason why I didn't come right out and say "you're wrong" because I recognize that there are many factors involved.


Yes, insurance in the U.S. can be rather expensive.

But hey, look at Canada... The average cost of health care is roughly $5,000/year. Most of that is paid for by our taxes. If I had the choice of paying $300 or whatever taxes are deducted from my paycheck to pay for health care, I'd probably be better off to pay the $300.


Except for one problem (one that I thought I explained well enough, but you didn't quite catch)... A politician does not have to make everyone happy. They only need to make enough people happy in order to get elected. And there are more issues than just health care. For example, a politician might find himself more likely to be re-elected if he campaigns on a cost-cutting platform if that is the issue that bothers more voters.


Somebody else already explained that to you...

If an insurance company has a habit of always denying claims, they will likely find people leaving their company to buy insurance from their competitors.

3.4%...?

So for every $100 they take in, in premiums, they only keep $3.40...?

They pay out the other $96.60 in claims...???

I am sorry, but I just don't believe that. Where's that number within your link?

---

I am going to concede to your second point, about government pay vs private sector pay. However, I am going to argue now, that there is a bigger 'difference' between private sector profit margins vs non-profit cost operations. Everybody has to pay employees, and a certain number of them. But at the end of the day, the corporation has to show 'profit', at the end of the day. Enough not only to pay the general middle management paper filer, keyboard puncher, or phone response person, but enough to pay a well funded CEO & Board. Our Congressmen make less than $200,000 a year...

Question: "Does the average government job require certification or a degree of some kind, or are most government officials 'unlicensed'?"

---

Well, I'll make my point in this manner, since we are going to pay out "more" claims for all "valid medically ordered" ones, we are going to HAVE to increase our fraud and abuse wing. Today's medical insurance has a much easier time denying a claim, than my system would. I am sure in my system there'd be lots of "fly-by night" clinics pop up, and attempt to de-fraud the taxpayers. The law enforcement wings have never had to be profitable, to be justified. I may well concede that this would cost more in a government model than in a private sector model.

---

But I CAN'T afford $300 a month PLUS the huge deductible that came with that price...THAT's my point. If I didn't have my present coverage, I'd end up at the Emergency Room, in pain with something gone too far. Then cost of treatment is HUGE.

I don't spend $300 'every' month on my health care plus whatever deductible is added. MOST people don't, and that's how the insurance companies are profitable. That $300 was back in '94. I am looking for some specific numbers, on what they'd be for me today.

...

more later...

 

[King of the Americas]

The benefit of insurance (risk pooling) is that you have healthy people and unhealthy people, and lucky people and unlucky people, and by collectively underwriting future liabilities, the healthy and lucky end up compensating the unhealthy and unlucky. That's a benefit since--ex ante--individuals don't know which of these they will be, and to individually insure your own risk would require massive personal savings.

It doesn't matter to those who provide care, if your insurer pays them or if you do. They are happy either way. It does matter if someone pays them, and (ex ERs) if they don't know they are going to get paid they are not going to provide anything to you.

Therefore you get a significant benefit from having the known ability to pay for care up front.

Whether it is tax funded, or privately funded, or publicly or privately managed, it is still insurance. To not want insurance is to undertake the risk-bearing of future medical liability fully by yourself--which is not a great idea.

Therefore your complaint is against ethical malpractice by US insurance firms, and the fact that the state does not underwrite claims (both reasonable complaints to which you will hear few arguments from anybody outside the US). But it is not a complaint against insurance itself.

EXACTLY.

My complaint is the over billing that has to occur to keep Medical Insurers in business.

I have no problem with hospitals operating for-profit. They are providing a real service. The insurer, is merely 'holding' our collective money, there's no nee for them to be profitable.

 

[Francesca R]

The insurer, is merely 'holding' our collective money, there's no nee for them to be profitable.

Well you said "EXACTLY" but then you undid it again with this. No that is not what an insurer (who is actually insuring) does, and this has been explained to you already.

 

[JoeTheJuggler]

I find it quite desirable not to give control of healthcare over to the government.

What type of "control" are you talking about? The government already regulates the industry to some extent. Are you talking about medical decisions made by non-medical people? If that's the case, are you happy with the "control" private insurers have over healthcare under the status quo?

 

[Darth Rotor]

Why not make Medical Insurance Companies 'illegal'...?

Why indeed? Look how successful making things illegal has been in the War on Drugs.

They don't provide any real service, do they? They are literally the middle man, between you and your medical care provider. They literally make profits, by denying claims...

Is that all they do? Actually, their function is a lot like a car insurance company as well as the above.

Piggy back a strong fraud and oversight authority, and start paying for yearly screenings and 'optional' preventative treatments.

Look at what oversight has done for us in other areas. What utopian state do you live in?

Medical Insurance Companies are consuming money that you should be paying your doctors, nurses, and hospitals.

Or not paying at all.

Can someone explain to me why insurance companies are so important?

They are a good tool for dealing with collective risk.

Why do we feel so married to the 'private' health insurance model?

Because labor wanted management to pay for it, and insuring was a cost effective way to deal with that.

Did you know that the health insurance sector is one of the top 5 earners, all for 'doing' nothing more than denying you a test, a procedure, or a treatment...

"Nothing" is an inaccurate way of describing what they do, and we can agree that the expense may be too high (I think it is) and the ability to cut people off a foul, which IMO it is, but to claim that they do nothing is wrong.

One thing mine does is negotiate the costs down somewhat: our group pays doctors slightly less than Blue Cross blue Shield, and we thus have some doctors here who don't take our plan, but that function is of some, if small, utility.

DR

 

[Random]

3.4%...?

So for every $100 they take in, in premiums, they only keep $3.40...?

They pay out the other $96.60 in claims...???

I am sorry, but I just don't believe that. Where's that number within your link?

That's 3.4% profit margin remember. Lavish salary packages to their CEOs counts as "overhead".

 

[lomiller]

The benefit of insurance (risk pooling) is that you have healthy people and unhealthy people, and lucky people and unlucky people, and by collectively underwriting future liabilities, the healthy and lucky end up compensating the unhealthy and unlucky. That's a benefit since--ex ante--individuals don't know which of these they will be, and to individually insure your own risk would require massive personal savings.

This, IMO, is getting close to the root cause of why the US system ends up being so much more expensive then any other despite offering at best similar quality care.

When health insurance companies get to select who they will insure and for how much they have a strong incentive to only insure the people who won’t get sick and let someone else absorb the costs for the people who do get sick. This motive is so strong it outweighs anything they can do on the cost/quality of care side of the equation. Worse, while dumping their own high risk clients they also need to make sure they don’t get saddled with the high risk people dumped by someone else, or the ones who choose to self insure until there is a real possibility of costs involved.


The end result is that they have to build a massive administrative structure to manage risks that don’t even exist in most other countries. At the same time, there is little or no completive pressure one the medical communities to provide cost effect care because that only a secondary hit the insurance companies bottom line.

 

[AvalonXQ]

This, IMO, is getting close to the root cause of why the US system ends up being so much more expensive then any other despite offering at best similar quality care.

Emphasis added. Can you provide evidence for the "at best similar quality" claim? I thought the consensus was that U.S. healthcare is better quality, just at prohibitive expense.

 

[Francesca R]

When health insurance companies get to select who they will insure and for how much they have a strong incentive to only insure the people who won’t get sick and let someone else absorb the costs for the people who do get sick [ . . . ]

. . . And then people who might get sick have an incentive to withold info, and people who think they will be healthy have an incentive to opt out, and insurers thus have an incentive to find reasons to cancel policies retrospectively and never accept anyone who was cancelled elsewhere, etc. It is several successive iterations of the "lemons problem" which won its author a Nobel.

 

[IchabodPlain]

There are a lotta lotta people who believe that universal access ranks higher than both of those.

I was actually starting off with universal access being a given. Of course universality could lower quality of results, but I quite think it silly that cost gets thrown about without regard to quality.

Sure, we could lower our average cost expenditure - disallow everyone from purchasing health care. Or alternatively, we could mandate everyone have access but hire car mechanics to preform the surgeries.

When you consider the gap between the proportion who can access it in the United States and the proportion who can access it in every other country in the OECD, it is quite accurate to use "relatively few".

No, it isn't. The proportion of Americans is still far and away above half to 3/4 of the population who have access to health care. 100% to 75% does not "relatively few" make.

 

[IchabodPlain]

Yes, well non-Americans give Americans who say "socialised medical care" the benefit of the doubt that what they usually mean is universal access medical care. Every OECD country bar the US has this, and few of them would be considered "socialist" except by far right-wing conservatives. None of them are Marxist. Marx' theories are resolutely out of favour in the developed world and have been for a long time.

I had always thought Americans viewed "socialized medicine" as a single-payer system. Or one where government-run insurance systems were mandatory and facilities were publically owned and operated.

Thank you 1950s America.

 

[JoeTheJuggler]

Of course universality could lower quality of results, but I quite think it silly that cost gets thrown about without regard to quality.

I think we're dealing with extremely divergent meanings for words like "quality of results". To me, doing a million dollar high-tech surgery to save or improve one life while not treating and allowing unnecessary suffering and loss of hundreds of other lives to occur is not preferable to giving everyone access to some minimum level of healthcare.

Note, such a minimum standard for everyone does not preclude the "haves" or people who inspire donations of large sums of money through charity from getting that whiz-bang high tech stuff.

That some people have extremely limited (or even no) access while others can get an MRI for every joint pain isn't a very high quality of result. That's why the WHO wisely considered accessibility to be one criterion of overall quality of healthcare.

 

[Francesca R]

No, it isn't. The proportion of Americans is still far and away above half to 3/4 of the population who have access to health care. 100% to 75% does not "relatively few" make.

It doesn't "absolutely few" make, it does make 75%, or even 90%, relatively few if all the comparators are at 99.5%.

This is why people from UHS nations are quite frequently shocked, shocked, to hear that "one person in ten (or whatever) is without a great deal of health provision".