Universal Health Coverage

[analog]

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Why should someone non-insured pay more to cover the *below cost payment by the insurance co?
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*IMO, the lab cant afford to provide the test results for the amount the insurance company paid them. Speaking as one who makes and sells clinical tests for a living.

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I used to have an HMO. For my first heart attack they paid the hospital ten percent of their bill, the rest was "discounted". My share was $500 out of about 150K, the hospital wrote off over $100K. I later rode down the hospital elevator with two fellows, one of whom had just quit the hospital to go to work for the HMO and doubled his salary. Crime pays.

We've been racheted into compulsory roulette by the insurance industry, first with automobiles now medical. If they keep rebuilding on the beaches, windstorm will be the next national lottery.

Don't get me started on NFIP (National Flood insurance Program) which was created to 'promote development in high risk areas'. Barbara Tuchman was right - there IS a lemming genome that switches on when government gets big.

oops - my pessimistic streak is showing...

There's indications of sentiment toward an insurance revolt - last week the jury put it to State Farm on some Katrina claims.

[OperaTenor]

To me, it goes back to the fundamnetal question: What are insurance companies in business for?

[Selma in Sandy Eggo]

To me, it goes back to the fundamnetal question: What are insurance companies in business for?

To make as much money as they can get away with. Have you noticed how many construction projects are funded by insurance companies? They seem to be doing well.

I still think it's both stupid and uneconomical to permit the health care dollars to be so deeply skimmed by insurance carriers. There has got to be a better way than the current setup.

[BigJon]

Companies." Hmm, to hear BJ tell it, there's no one else to do it, but Haggis infers there are multiple companies who provide these kinds of services.

If that's the case, then why was Hallburton given no-bid, cost-plus contracts? And no time constraint excuses, either. Since this was all an act of aggression on our part, the bidding could have taken place in the run-up.

There is now only one service company of the size that could handle the Iraq war. There are smaller companies that could handle smaller conflicts.

You're going to have to prove that "they can do it cheaper" claim. From the amount of taxpayer money that's been pissed away with little or no infrastructure to show for it, and from the size of salaries paid to private contractors' employees, I don't see how that can be the case.

And how about the quality of service? How about the contaminated water served up, or the expired or low-grade food supplied?

Untreated water at U.S. base in Iraq

Democrats seek inquiry on expired food in Iraq

Halliburton Hearing Unearths New Abuse

How about their total lack of accountability corporate and personal, until only very recently(which is still too little, too late, IMO)?[/url]

Now on this part, we are in agreement. Halliburton has been incredibly inefficient, wasteful, and unaccountable. That is what happens when you have a monopoly. It sickens me how poorly the "after we topple Sadam" portion of the endeavor was thought out.

Bad government spending is bad government spending. It doesn't matter to me whether it happens in Iraq or on government supported health care. I'll fight it all to my dying day.

[BigJon]

You all know I'm a free-market type of guy. The problem with health care and its insurance, is that so many people have no way of knowing what is best for them, due to the complexity of medicine and treatment options. Therefore the free market operates inefficiently in the health care business because decisions are ceded to the doctors and the insurance companies by the ultimate consumers.

I'll throw the question out to all my fellow free marketers out there. What is the free-market solution to the spiraling costs of healthcare?

[dai bread]

Theoretically I should be able to go from surgeon to surgeon saying "I have a XXX. What will you charge to fix it"? and get a range of competing quotes.

Do I hear

[Selma in Sandy Eggo]

[Selma in Sandy Eggo]

BigJon, free-market or not, medically you'd end up exactly where you are now. You have to talk to a doctor whose advice you trust, consider the options for your particular situation, and decide what you can live with. The financial aspect of the health care you receive is one of the factors you consider, whether you have a HMO, full-coverage, 80% reimbursement, or one of those pretax savings account thingies, or no coverage whatsoever.

One of the reasons that the free-market price for services that no insurance covers (like my frankenteeth, or cosmetic surgery) is so reasonable is that doctors who do that work simply don't accept patients who can't pay. They don't have to recoup losses, because they don't have any.

[piqaboo]

TM, clinical labs, at least in the US, operate on a very thin margin. Nationwide labs do better, because they can negotiate better prices from the sellers of the tests.
For example, we want LabCorp happy, so we bend a little. Not a lot, but a little. And that little makes a difference. And the labs stretch, a lot.
They develop a "home brew" test, and market it because its cheaper than using an FDA approved test. They charge a bit more here and there to make up for expensive tests with smaller margins. They sell a FDA-approved test, and stretch reagent use to the max*.
The test I was referring to is skill-intensive. Pregnancy tests arent especially, and I suspect the mark-up is significant.


*Ex: we sell a test kit with ~6 different components. Each is slightly over-filled to allow the lab to get all the advertized results despite loss of fluid in transfer (stickign to the walls of the vials etc). One of the 6 is overfilled a bit more than the others. The customers do not view this as getting extra. They view it as being shorted in the other 5 vials.

Shapley, by overcharging the uninsured, the hospitals etc drive us all to buy insurance if at all possible, and then the insurance cuts the payments down, so the hospitals overcharge the uninsured even more..... Im not seeing how the hospital comes out ahead in this scenario. It seems they'd have a better business model to determine a fair/reasonable and profitable price for each procedure, and bill that to everyone - HMO, insurance company, and the self-employed uninsured folks.

[Shapley]

Ethically, the provider should charge everyone the same for a given service. The private-practice doctor in my hometown always did just that. There was a government-funded clinic in the same town that charged a 'sliding fee' - those with the ability to pay payed more than those who didn't. That included, presumably, the insurance companies. However, the government was supposed to reimburse them for the cost of treating the poor, with the result that the overall cost of treatment was supposed to have been the same. Word is that that didn't happen correctly, and the government and insurance paid more than the paying customers. But this was in the bad old days before Medicare, Medicade, and insurance payments went under the microscope. Supposedly, the fees are set and charged in accordance with a set standard. However, since HIPPA forbids most of us from seeing the bills of others, I have no way of knowing if this fairness was ever achieved or maintained.

Having said that the bill should be the same, however, I do not oppose the concept of discounting services to insurance companies - specifically because the risk of non-pay is greatly reduced when dealing with insurance companies. If the average cash-paying customer pays only 60% of his bill, it is understandable that providers will raise their rates so that they make a profit at that payment percentage. On the the other hand, if insurance companies default only 15% of the time, they should be rewarded for their dilligence in paying.

I know of people with good insurance who nevertheless owe great deals of money to their health-care providers, simply because they refuse to pay their co-payments and deductibles. It hardly seems fair to overbill the insurance to cover the costs to these dead-beats, since the insurance has met its part of the obligation. The providers can pursue payment from the dead-beats through collection agencies, garnishments, etc., but there is a cost to that as well, which must also be made up.

I'm not saying it's a fair system, but I'm saying it is as fair a system as can be devised under the circumstances. In an ideal world, the non-pays would be forced to pay both the amounts owed and the costs associated with obtaining the amount owed, but we know that ain't gonna happen. So, they structure the system in a way that is least offensive to their best paying customers (the insurance companies), and meets the legal test of their fall-back source (the government). The cash customer is lowest on the totem pole, so that's who gets stuck with the excess. After all, the cash customer has no bargaining union or collective to negotiate for him. It's one man against the system, and they can shut the door in his face if they don't want to deal. The insurance and the government have all the bargaining power, and they aren't afraid to use it.

V/R
Shapley

[piqaboo]

Shap, your argument and conclusion confound me utterly.
And completely ignore the total cost to the system.

[shostakovich]

You all know I'm a free-market type of guy. The problem with health care and its insurance, is that so many people have no way of knowing what is best for them, due to the complexity of medicine and treatment options. Therefore the free market operates inefficiently in the health care business because decisions are ceded to the doctors and the insurance companies by the ultimate consumers.

I'll throw the question out to all my fellow free marketers out there. What is the free-market solution to the spiraling costs of healthcare?

Hi BigJon. I think the free market is a large part of the problem, so there can't be a free market solution, IMO.
Not a Free Market Fan

[BigJon]

BigJon, free-market or not, medically you'd end up exactly where you are now. You have to talk to a doctor whose advice you trust, consider the options for your particular situation, and decide what you can live with. The financial aspect of the health care you receive is one of the factors you consider, whether you have a HMO, full-coverage, 80% reimbursement, or one of those pretax savings account thingies, or no coverage whatsoever.

One of the reasons that the free-market price for services that no insurance covers (like my frankenteeth, or cosmetic surgery) is so reasonable is that doctors who do that work simply don't accept patients who can't pay. They don't have to recoup losses, because they don't have any.

What if there were an independent certification organization that would review and certify doctor decisions, then rank outcomes as well as providing the consumer with all alternate paths to treatment? Would that improve the breed and keep the costs lower?

[BigJon]

Hi BigJon. I think the free market is a large part of the problem, so there can't be a free market solution, IMO.
Not a Free Market Fan

Which problem would that be?

[analog]

........

I'll throw the question out to all my fellow free marketers out there. What is the free-market solution to the spiraling costs of healthcare?

For starters, decouple it from the tort system. Our family doctor in S Florida paid more for malpractice insurance than I made as an engineer. I cannot imagine what a hospital must pay.

[Selma in Sandy Eggo]

For starters, decouple it from the tort system.

Yup. And I'd seriously consider denying suits against pharmaceutical companies because their drugs have side effects.

A sensible public health system should include pediatric and family practice care (including obstetrics), immunizations and contraception, and really aggressive infectious disease treatment. Chronic disease management also needs to be easily available and screening for developing chronic conditions should be routine.

Those things would probably come out budget-neutral or better, simply because you can treat a lot of fairly healthy people for cholesterol and blood pressure, for the price of one quadruple bypass surgery plus rehab. (Don't look now, but your tax dollars are filtered through Medicare and state Medicaid to pay for that bypass. The public already pays for this stuff.)

[shostakovich]

Hi BigJon. I think the free market is a large part of the problem, so there can't be a free market solution, IMO.
Not a Free Market Fan

Which problem would that be?

The problem of spiraling costs. If costs were capped, they couldn't climb with no ceiling.
Shos

[BigJon]

That's the point I'm trying to make. The free market has not be allowed to operate due to the lack of quality information to the ultimate consumer. I'm trying to figure out how we fix that.

[Selma in Sandy Eggo]

That's the point I'm trying to make. The free market has not be allowed to operate due to the lack of quality information to the ultimate consumer. I'm trying to figure out how we fix that.

There's no lack of quality information. I can find anything I look for. The problem is that the "ultimate consumer" is not usually capable of searching for, finding, and comprehending said information.

I have a huge vocabulary, decent librarian skills, and sufficient biology, chemistry, and pharmacology knowledge to let me do detailed study on my diagnosis. Do you? Does the 19-year-old mother of the Phenylketonuric infant? And how much time should be allowed for this activity? That baby is going to be brain damaged by this time next month if not treated appropriately TODAY!

You are, in practice, assuming that each "consumer" has the theoretical knowledge of a physician and research biologist.

[Haggis@wk]

The problem of spiraling costs. If costs were capped, they couldn't climb with no ceiling.
Shos

here's an "easy" challenge.

Find one example of price caps that has ever worked.