Socialize Medicine

[King of the Americas]

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

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...

It's your money, that you pool, so that when the

Edited by Locknar: 

Edited, re breach of Rule 10.

your arse is covered.

Why not let a government, or other non-profit entity 'hold' our collective premiums, and pay out ALL claims, period. Piggy back a strong fraud and oversight authority, and start paying for yearly screenings and 'optional' preventative treatments.

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

Can someone explain to me why insurance companies are so important? Why do we feel so married to the 'private' health insurance model? 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...

WHY???

'I' am in favor of 'socializing' or 'non-profitting' medical premium(s) holding. I'd like to pass laws that make it 'illegal' to deny a valid medical claim.

Make Medicine a Right, not a privilege.

 

[Francesca R]

They don't provide any real service, do they?

Yes they do. Every kind of insurance does. The service is pooling risk, and pooling risk diversifies some of it away, which makes it cheaper to fund. That is basic maths.

In some types of risk, it doesn't work and becomes so inefficient that--unless the incentives can be rigged correctly--it is not worth doing.

With any type of risk, insurance may or may not be priced effectively. Insurers can waste money. They also have the incentive to lie and cheat against the interest of those insured.

But this does not make your statement correct, and does not warrant criminalising medical insurance.

They are literally the middle man, between you and your medical care provider. They literally make profits, by denying claims...

The legal way to make money in insurance is to price policies above your cost of capital without deceiving people.

It's your money, that you pool, so that when the

Edited by Locknar: 

Moderated content removed

, your arse is covered.

Yes but a payout of a claim is not your money--it comes from others who have not claimed.

Why not let a government, or other non-profit entity 'hold' our collective premiums, and pay out ALL claims, period.

Because insurance doesn't work that way. If all claims are paid out, then the premium has to rise simultaneously in order to fund the rate of payouts. If you make a claim and the money in the kitty ran out five minutes before you called (because of eveyone else "beating you to it") then how does this proposed system pay you?

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

The diversification benefit of a risk pool, as above

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

It does not have to be privately managed. (In the UK it is not). But some people trust the civil service to act in the interests of "customers" even less than they trust ACME Insurance Inc. Others trust them more.

I'd like to pass laws that make it 'illegal' to deny a valid medical claim.

How do you fund excess liability? Sudden unanticipated tax rises? Do you realise you would create a raft of different incentives that would undermine this system?

 

[King of the Americas]

Yes they do. Every kind of insurance does. The service is pooling risk, and pooling risk diversifies some of it away, which makes it cheaper to fund. That is basic maths.
...

The diversification benefit of a risk pool, as above

It does not have to be privately managed. (In the UK it is not). But some people trust the civil service to act in the interests of "customers" even less than they trust ACME Insurance Inc. Others trust them more.
How do you fund excess liability? Sudden unanticipated tax rises? Do you realise you would create a raft of different incentives that would undermine this system?

But there's no need to 'risk' anything anymore, since there'd be no need to seek huge profits from the premiums collected... Each year the rates would be reset to refill what was used in last year's payout.

Savings occur because of mandatory screenings that will catch diseases before they become financially untreatable. We FUND claims rather than pay insurance employees.

We take OUT the middle man, and our monthly premiums will DROP.

What is being argued today is that "We don't want the government making health care decisions." But what the difference between a private health insurance provider, and a non-profit holder of premiums...claim denials that fund people to deny claims...

I still don't understand what 'service' is being offered.

 

[Professor Yaffle]

So you think that just because nobody is making a profit, there is suddenly unlimited money to go round? Sorry, it doesn't work out like that, or the NHS wouldn't need NICE to decide what treatments are cost effective. And we would just employ more doctors and build more hospitals etc to eliminate waiting lists.

 

[Francesca R]

I still don't understand what 'service' is being offered.

You don't understand the benefit of pooling offsetting risks?

Or you don't understand why an intermediary should be a private profit-seeking institution?

 

[Francesca R]

But there's no need to 'risk' anything anymore, since there'd be no need to seek huge profits from the premiums collected

The risk that is being insured is the uncertainty of the future medical liabilities of those who are covered. That can't be eliminated.

Savings occur because of mandatory screenings that will catch diseases before they become financially untreatable.

I don't see why a government insurer has any more incentive to arrange this type of thing than a private one. Some would say it has less, because it does not have to compete for business.

 

[GStan]

<snip>

Savings occur because of mandatory screenings that will catch diseases before they become financially untreatable. We FUND claims rather than pay insurance employees.

I certainly can't speak for all health insurers, but the one I work for does this already, aggressively. They aren't "mandatory", but financial incentives (reduced premiums/copays/deductibles) are offered to all members to go get check-ups, mamagrams and other well-checks. For members on Medicaid, who do not pay anything out of pocket that could be reduced for incentive purposes, we pay cash to them to go have these done.

We take OUT the middle man, and our monthly premiums will DROP.

<snip>

You are not taking out the middle man. You are just replacing private middle men with public ones.

 

[Beerina]

I have to ask: if (doctors' cost) + (insurance overhead) is so outrageous, where are all the doctors or hospital systems offering basically just (doctors' cost). I find it hard to believe there's this much business just laying on the ground out there and nobody wants to pick it up.

If things are as the OP suggests, this should be happening -- hell, it should have long since already happened. So why not?

 

[AvalonXQ]

I have to ask: if (doctors' cost) + (insurance overhead) is so outrageous, where are all the doctors or hospital systems offering basically just (doctors' cost). I find it hard to believe there's this much business just laying on the ground out there and nobody wants to pick it up.

This is speculation, but it could have something to do with medical licenses which allow for a de facto monopoly on medical practice. Barriers to entry are large in this industry.

 

[JoeTheJuggler]

So you think that just because nobody is making a profit, there is suddenly unlimited money to go round?

I don't think that's the theory at all. I think the idea is that if you don't take profits out, there is more money available for healthcare goods and services--not unlimited money.

 

[Professor Yaffle]

I don't think that's the theory at all. I think the idea is that if you don't take profits out, there is more money available for healthcare goods and services--not unlimited money.

But he said no medical claim should ever be rejected.

 

[Francesca R]

I think the idea is that if you don't take profits out, there is more money available for healthcare goods and services--not unlimited money.

Whose theory is that? Marx?

 

[Professor Yaffle]

Anyway, if you look at Europe, which uses a variety of different systems, there is no vast cost difference between insurance based systems and non insurance based ones.

 

[JoeTheJuggler]

Whose theory is that? Marx?

I'm not sure health insurance as we know it existed in Marx's day. I'm talking about the idea put forth by the OP of this thread, and the response to the strawman argument that if going to a single-payer system doesn't provide unlimited money for healthcare, it's not a good idea.

Nobody claims that getting rid of profit centers not connected to the delivery of healthcare goods and services will provide unlimited money.

 

[JoeTheJuggler]

But he said no medical claim should ever be rejected.

You mean this:

I'd like to pass laws that make it 'illegal' to deny a valid medical claim.

I think that sort of law is going to pass no matter what. (Rescission was the subject of a House investigation, and the stuff that came to light was pretty shocking.)


I don't see this as a claim of unlimited money.

 

[Professor Yaffle]

It was this part of the OP I was specifically objecting to:

Why not let a government, or other non-profit entity 'hold' our collective premiums, and pay out ALL claims, period.

Since this isn't what happens in the UK (which is often called a single payer system by people in the US), I didn't think he was advocating a system like ours. I have no particular preference as to which model you adopt in the US, insurance based or not, but I think you have to realise that it is the set up of the system that counts, not whether it is insurance based or not. I think you should look at European models and figure out which one would be easiest to get to from where you are now.

 

[Francesca R]

Well the government (UK) does hold the premiums since they are taken from direct tax. It also sets the budget for the NHS, which is the fund from which "claims" are settled. It further allows the budget to be overshot or undershot, which is loosely how it works to have all* entitlements met free.

So it is not a million miles off.

*all eligible ones

 

[Professor Yaffle]

That's the whole point - eligible claims - there is always going to be some mechanism by which a decision is made as to what treatment is funded, and what isn't. It was that fact hat I don't think the OP was recognising.

 

[JoeTheJuggler]

It was this part of the OP I was specifically objecting to:

Again, I think he was talking about this nasty business of rescission (which isn't the same as denying a claim for valid reasons). But I shouldn't speak for K. of A.

I think you should look at European models and figure out which one would be easiest to get to from where you are now.

I agree (though why limit it to Europe only--just look at all systems in practice and work toward achieving a system that seems to work best).

However, almost any system in the industrial world works better than the status quo in the U.S.

And, unfortunately, politics is the art of the possible. Since we can't even get a public option through with this health insurance reform bill (thanks to Lieberman and possibly the Blue Dogs), and this is likely to be the best Congress make-up for achieving any reform, I think what we're going to get is going to be at best a minor improvement on perhaps the worst system in the developed world.

 

[JoeTheJuggler]

That's the whole point - eligible claims - there is always going to be some mechanism by which a decision is made as to what treatment is funded, and what isn't. It was that fact hat I don't think the OP was recognising.

Again, I can't speak for K of A, but I don't think that's a fair reading of his post. I think it was about denying valid claims to increase profits, which is a big problem in the current system here.

ETA: link to the House subcommittee investigations

link to PBS story on rescission