Which political party wants you dead?

[TragicMonkey]

Wrong. The average is 4.5% with margins raging from 5.7% for Aetna to 2.4% for Humana.

And what is the math behind those numbers? Remember, according to the studio accountants, "Titanic" didn't make a dime. I wouldn't trust the numbers without knowing how they were arrived at.

But even if they are honestly got at, what do these numbers represent? Millions (and in some cases, billions) of dollars that people have paid for healthcare, but do not actually go into the provision of healthcare. Sally pays her insurance $4000 a year, and gets $600 worth of healthcare expenses paid (the rest came out of her pocket due to copays and deductibles). Her doctor, in exchange for providing $1000 worth of services to Sally, got $400 from Sally and $300 from the insurance company. The other $300 never got paid, because the insurance company's contract with the provider only allows for 80% of the actual charges for those services, and gets a discount in exchange for letting that provider see their customers.

The numbers for the profits of insurers, whatever they are, represent waste. Money paid "for healthcare" that didn't go towards medicine, or doctor visits, or operations, or even administrative costs and paperwork and appointment setters. That money didn't even go to the man who mops the floor in the clinic. It's money that went to enrich a third party that provided what service, exactly? What value did the insurer add?

I don't need to ask myself that since I already know that the larger the pool the greater the risk is collectively shared. You seemed to have missed this with your previous comment as to simply equating insurance to middlemen. BTW, universal health care still involves a middleman.

As I've repeatedly pointed out, it's nothing but simple. But I still maintain that private health insurance companies add no value to the supply and consumption of healthcare. I think healthcare should be like education--a publicly funded service for all members of the public for the public's own good. Without needing to turn a profit. Insurance has no place in that model.

 

[TragicMonkey]

Hold on, we're still on this topic:
So back to your original assertion... that the GOP simply doesn't care if you die or not. If you were being honest, you would admit that the real reason is that the GOP does not want to force people to pay for other people's health insurance. For one thing, (and I predict we will soon get confirmation from the Supreme Court), it's unconstitutional. And another, this precedent could be used by the government in the future to require the public to buy other things as well.

I'm confused. Under what provision of "Obamacare", enacted already or proposed, is someone being "forced to pay for someone else's healthcare"? The issue before the Supreme Court is the constitutionality of the "individual mandate", isn't it? Which is attempting to require people to pay for their own insurance. The controversy is over whether the government can require people to purchase a product.

 

[Neally]

And what is the math behind those numbers? Remember, according to the studio accountants, "Titanic" didn't make a dime. I wouldn't trust the numbers without knowing how they were arrived at.

GAAP. Looks like the onus is on you now to show that the books have been cooked.

But even if they are honestly got at, what do these numbers represent? Millions (and in some cases, billions) of dollars that people have paid for healthcare, but do not actually go into the provision of healthcare.

Again, you seem to miss the point of the concept of "insurance" and risk mitigation. ALL forms of insurance end up taking in more than they pay out. Their purpose isn't to buy stuff. It's to mitigate risk. You are paying for risk mitigation, not health care.

It's money that went to enrich a third party that provided what service, exactly? What value did the insurer add?

Risk mitigation. You still don't understand the concept of insurance, do you?

As I've repeatedly pointed out, it's nothing but simple.

Yet you ignorantly liken insurance to a middleman, which it is not.

 

[DrBaltar]

Actually, if your claim was indeed the case, then the GOP would also be trying to eliminate Medicare/Medicade. Right now, people are forced to pay for others health care via taxes, that those people do not have access to, and must pay again for their own insurance.

So I reject your proposition that the GOP is trying to prevent people from paying for others health care/insurance. Because it is happening right now.

The GOP (i.e. Paul Ryan) is at least looking into options to reduce the cost of Medicare/Medicade. Why doesn't the GOP simply get rid of it? Because they actually do care if people die. I know... what a shock.

 

[DrBaltar]

I'm confused. Under what provision of "Obamacare", enacted already or proposed, is someone being "forced to pay for someone else's healthcare"? The issue before the Supreme Court is the constitutionality of the "individual mandate", isn't it? Which is attempting to require people to pay for their own insurance. The controversy is over whether the government can require people to purchase a product.

I don't know all the provisions, but Justice Alito said that it "forces young, healthy people to subsidize services that will be received by somebody else”. So apparently that part of it is being looked at.

 

[mike3]

Insurance is about pooling risk for affordable premiums and affordable payouts.

Travis's problem is that his risk is so high that no affordable premium exists, and no affordable payout is possible. He doesn't need health insurance, he needs health care. Which is, of course, expensive. Living in a depressed region and not having an Engineering degree probably don't help matters.

Any insurance company that accepted high-risk members without charging commensurately high (unaffordable) premiums would promptly go bankrupt. Obviously Travis is not entitled to compel the bankruptcy of any insurance company.

One possible way to mitigate this would be to compel a large number of extremely low-risk individuals to pool their risk with Travis, so as to keep the premiums affordable and guarantee the high-cost healthcare that Travis will almost certainly require.

Of course, this is not really "insurance" anymore: It's really just "health care for Travis, faked up to look like insurance, and relying for success on government compulsion and artificially-capped premiums".

I can't speak for the GOP: For all I know, they really do want Travis dead. That's probably the most rational explanation, right?

But all I want is to know if Travis is any more entitled to compel low-risk people to pool their risk with his and pay for his health care, than he is to bankrupt insurance companies?

What do you think the best thing for Travis would be?

 

[DrBaltar]

I can't speak for the GOP: For all I know, they really do want Travis dead.

Ohhhh I thought this thread was about the public in general. Yeah, I can see that they would want Travis dead.

 

[Random]

The GOP (i.e. Paul Ryan) is at least looking into options to reduce the cost of Medicare/Medicade.

Not Really. Ryancare doesn't really do anything to reduce the cost of healthcare, just what Medicare would spend on healthcare.

Why doesn't the GOP simply get rid of it? Because they actually do care if people die. I know... what a shock.

The fact that Medicare is a ridiculously popular program among the over-65 crowd that gives the GOP a good portion of its votes might also have something to do with it.

 

[TragicMonkey]

GAAP. Looks like the onus is on you now to show that the books have been cooked.

Meh. It's not a question of cooking books, necessarily, as that denotes illegality. But there are a lot of ways to work the math so you get the numbers you like.

Again, you seem to miss the point of the concept of "insurance" and risk mitigation. ALL forms of insurance end up taking in more than they pay out. Their purpose isn't to buy stuff. It's to mitigate risk. You are paying for risk mitigation, not health care.

Sigh. I've worked in insurance as well. I've worked for huge health insurance companies. I've worked for huge healthcare providers. I understand the concepts of insurance and risk mitigations very well. I just don't agree that healthcare is a proper arena for insurance at all. It would be cheaper to pay the actual costs of provided healthcare than to pay for the potential costs. In other words, get rid of medical insurance entirely. Instead have all medical costs paid directly to the providers by the government, which in turns funds these through taxes. Everybody pays, everybody will get their treatments if and when they need them. Nobody needs to worry about potential financial risks to themselves because there won't be any; the only risks will be the risk of getting ill, not the risks of paying for it.

Risk mitigation. You still don't understand the concept of insurance, do you?

Again, I'm saying eliminate risk by simply paying for actual costs, not potential future ones. If everybody's bills get paid, there is no risk. If there's no profit being made, there's nothing to lose. I'm saying stop running healthcare as a for-profit industry, instead run it like a service. The healthcare provided is the goal, not dividends for the shareholders.

Yet you ignorantly liken insurance to a middleman, which it is not.

I don't know how many times you want to go in circles here. You have patients, you have doctors, you have insurers. The patient gets sick. The doctor treats the sick. The insurer takes money from one party and gives money to the other party. The insurer wasn't sick. The insurer didn't treat any sickness. Where is the insurer? In the middle.

Final time: I reject the necessity of having insurance mitigate risk. If we had true universal healthcare, there would be no need for insurance. Nobody pays for "coverage" of potential illnesses. Everybody's taxes pay for everybody's illnesses. No risk pools. No margins. No profits. Service provided to all who need it.

I realize that's very confusing because when most Americans talk about healthcare reform they are thinking of a bigger government-run insurance program. I am not in favor of replacing a bunch of insurance companies with another insurance company, government or not.

 

[TragicMonkey]

I don't know all the provisions, but Justice Alito said that it "forces young, healthy people to subsidize services that will be received by somebody else”. So apparently that part of it is being looked at.

Sounds like Medicare to me.

 

[AlBell]

Meh. It's not a question of cooking books, necessarily, as that denotes illegality. But there are a lot of ways to work the math so you get the numbers you like.

GAAP can be whipped like a rented mule, and too often is.

Sigh. I've worked in insurance as well. I've worked for huge health insurance companies. I've worked for huge healthcare providers. I understand the concepts of insurance and risk mitigations very well. I just don't agree that healthcare is a proper arena for insurance at all. It would be cheaper to pay the actual costs of provided healthcare than to pay for the potential costs. In other words, get rid of medical insurance entirely. Instead have all medical costs paid directly to the providers by the government, which in turns funds these through taxes. Everybody pays, everybody will get their treatments if and when they need them. Nobody needs to worry about potential financial risks to themselves because there won't be any; the only risks will be the risk of getting ill, not the risks of paying for it.




Again, I'm saying eliminate risk by simply paying for actual costs, not potential future ones. If everybody's bills get paid, there is no risk. If there's no profit being made, there's nothing to lose. I'm saying stop running healthcare as a for-profit industry, instead run it like a service. The healthcare provided is the goal, not dividends for the shareholders.



I don't know how many times you want to go in circles here. You have patients, you have doctors, you have insurers. The patient gets sick. The doctor treats the sick. The insurer takes money from one party and gives money to the other party. The insurer wasn't sick. The insurer didn't treat any sickness. Where is the insurer? In the middle.

Final time: I reject the necessity of having insurance mitigate risk. If we had true universal healthcare, there would be no need for insurance. Nobody pays for "coverage" of potential illnesses. Everybody's taxes pay for everybody's illnesses. No risk pools. No margins. No profits. Service provided to all who need it.

I realize that's very confusing because when most Americans talk about healthcare reform they are thinking of a bigger government-run insurance program. I am not in favor of replacing a bunch of insurance companies with another insurance company, government or not.

Do you (or anyone else here) consider Medicare insurance? Medicaid?

Single-payer, everyone either medicare or medicaid, funded by taxes collected, seems to me the only way to go.

 

[Neally]

Instead have all medical costs paid directly to the providers by the government, which in turns funds these through taxes.

Oh you mean make the government the middleman. I thought you didn't like middlemen. You think the government taking in money and paying it back out incurs no costs?

I'm saying stop running healthcare as a for-profit industry, instead run it like a service. The healthcare provided is the goal, not dividends for the shareholders.

Doctors won't make a profit on their services? Hospitals won't profit on their services? Drug companies won't make a profit?

I don't know how many times you want to go in circles here. You have patients, you have doctors, you have insurers. The patient gets sick. The doctor treats the sick. The insurer takes money from one party and gives money to the other party. The insurer wasn't sick. The insurer didn't treat any sickness. Where is the insurer? In the middle.

And your scenario puts the government in the middle. The only way you avoid the middle is for a patient to pay the provider directly. Unless of course private doctors, drug companies and hospitals are outlawed, and everything is nationalized. The doctors are government employees, drug companies are nationalized, etc.

Final time: I reject the necessity of having insurance mitigate risk. If we had true universal healthcare, there would be no need for insurance. Nobody pays for "coverage" of potential illnesses. Everybody's taxes pay for everybody's illnesses. No risk pools. No margins. No profits. Service provided to all who need it.

I guess the government could take over all insurance, life, fire, auto, everything. That way the evil insurance companies wouldn't be needed and be sucking up all the profits.

 

[Tatyana]

I find these threads so bizarre.

So many odd arguments, like drug companies being privatised.

It isn't as if numerous models of universal health care exist already in countries that still have drug companies and various combinations of private and public health care.

 

[TragicMonkey]

Do you (or anyone else here) consider Medicare insurance? Medicaid?

Single-payer, everyone either medicare or medicaid, funded by taxes collected, seems to me the only way to go.

Medicare and Medicaid act like insurance in some ways, but aren't. Their eligibility rules are geared toward serving particular populations, rather than trying to game actuarial tables to turn a profit. Expanding Medicare to cover everybody would be a form of UHC, but certainly there is room for reform in Medicare operations. Medicaid is a different animal, it's mostly fee-for-service, which is undesirable for everybody. Not only does it cost more to provide that way, but it results in worse overall health. Ideally, we would have what's called "managed care", which focuses on preventative care by getting everybody in to see the doctor regularly rather than just when they feel sick. This cuts costs enormously, as well as giving patients better health. But with a fee-for-service model like (most of) Medicaid is, there's no incentive to push regular routine checkups. Ditto private insurance--how many people visit the doctor regularly unless they feel sick? Deductibles and copays discourage that.

 

[TragicMonkey]

Oh you mean make the government the middleman. I thought you didn't like middlemen. You think the government taking in money and paying it back out incurs no costs?

I never said there would be zero costs. I said that removing the need to make a profit would reduce costs. And again, I have nothing against middlemen as long as they are adding some value to the process. In the case of the UHC scheme I suggested, a government agency would be adding value by managing the thing. Even the most hardnosed of costcutters agree that paying the bills is rather a necessary function.

Doctors won't make a profit on their services? Hospitals won't profit on their services? Drug companies won't make a profit?

I can't see why you conflate "get rid of insurance" with "privatize doctors, hospitals, and drug companies". I'm suggesting removing insurance, and leaving the rest as is. Costs for providers will go down without competiting insurers because they won't have to fight to negotiate so many radically different contracts--contracts that require steep discounts for the insurer to keep profitable.

And your scenario puts the government in the middle. The only way you avoid the middle is for a patient to pay the provider directly. Unless of course private doctors, drug companies and hospitals are outlawed, and everything is nationalized. The doctors are government employees, drug companies are nationalized, etc.

Again, eliminating insurance says nothing about nationalizing anything else. Insurance <> drug companies. Insurance <> hospitals. Insurance <> doctors.

I guess the government could take over all insurance, life, fire, auto, everything. That way the evil insurance companies wouldn't be needed and be sucking up all the profits.

I guess you missed where I said I didn't think healthcare was an appropriate arena for insurance. I said nothing about other arenas, such as property and life insurance.

And finally, did I ever say insurance companies were "evil"? I've worked for them. They're not evil, but they are holding back healthcare. I am not, as you seem to think, some caricature of a communist bogeyman, wanting government to seize control of everything. I am a reasonable person who has seen the inside of the industry from provider and insurer perspectives, and have reached the opinion that the quality of care in America could be improved and the costs decreased by reforming the industry through removing insurance companies from the equation. You may certainly disagree with me. But it is ridiculous of you (and does your argument no good) that you persistently indulge in hyperbole and attribute hysterical strawmen to me.

 

[Caper]

I would like to interject a moment of sanity by reminding people that healthcare, reform or not, is not a partisan issue. Everyone stands to benefit. Even those who like the current system recognize that it has flaws that need to be corrected. Nobody wants "people to die", not really. They just disagree on what the best solutions are. Because it's complicated. It's life, death, sickness, health, and an enormous amount of money at stake. Naturally this gives rise to passionate feelings on the subject.

+1

 

[Francesca R]

Yeah, right. Middlemen can be necessary when it comes to distribution, marketing, getting the products to the consumers. But what exactly does the insurance middleman add to healthcare? It receives money from one source, and pays a smaller amount to another. What value has been added? What benefit does the patient and the provider receive from having this intermediary?

There are a ton of good reasons for the superiority of universal health insurance cover.

Shame you picked a bogus one.

(I wish it did not get referred to as universal health care. That gives the wrong impression that the health care industry is run by the state, and that it is unlimited)

 

[Francesca R]

It isn't as if numerous models of universal health care exist already in countries that still have drug companies and various combinations of private and public health care.

. . . And that still have for-profit private insurers providing the universal mandatory cover. This is the case in most of Europe (but not the UK. And I have often argued in UHS threads that most of Europe's systems are better than the NHS).

US health insurers might be able to get away with murder, due to incentives so warped you couldn't really design them worse. Doesn't mean that has to be the case, or that insurers can't add value (= do a better job than single-payer)

 

[Francesca R]

I know at least 3 people that would start their own business or switch jobs if they could retain their health insurance.

Professions where add-on private health cover is provided as one of the benefits suffer from the same problem in the UK. The difference is that it isn't necessary to have it, IE it's a benefit in the proper sense of the word. I've spent most of my career working for financial institutions where add-on private health is part of the standard employee package* (I don't think it is in may sectors), and therefore the firm is a bulk buyer, but if you leave the firm you leave the policy.

I moved jobs twice before quitting to co-found a startup three years back, and each time I moved the list of exclusions from the health policy increased. While I was a partner in my own firm I didn't bother with add-on private cover. Last year we were bought out by a larger partnership which, again, does have private health firm-wide so I'm back in a group policy. But by now it's so limiting it's not really worth having.

Of course, to repeat, none of this is the same order of magnitude of problem where there is a universal system anyway.

*I suspect this is the case with banks dating back to the influx of US banks in the 1980s. I think the Americans thought that they obviously had to provide private health cover in England to get anyone to work for them there, Dunno though.

 

[Neally]

I never said there would be zero costs. I said that removing the need to make a profit would reduce costs.

And there are plenty of non-profit health insurance companies as I mentioned. And There is no significant difference in their premiums from the for profit companies.

I can't see why you conflate "get rid of insurance" with "privatize doctors, hospitals, and drug companies".

Because you keep harping on getting rid of the middleman. The only way to do that is to pay the person that delivers your services directly.

I'm suggesting removing insurance, and leaving the rest as is.

Fine. Don't buy insurance. Insurance isn't supposed to be a way of delivering health care anyway. You'll pay out more for insurance on average than you consume in health care. Pay for everything out of pocket if you want to. You've eliminated the middleman!

I guess you missed where I said I didn't think healthcare was an appropriate arena for insurance. I said nothing about other arenas, such as property and life insurance.

I didn't miss it. Your solution though means that governmental take over of insurance in one field should be an equally good solution to governmental takeover in all aspects of insurance.