"The nation’s largest insurers, which include giant for-profit companies like Anthem, CVS Health and UnitedHealth, reported billions of dollars in profits last year, and analysts say these companies have abundant capital to absorb any losses because of the pandemic"
". Lee warned that insurers are likely to seek rates that are double their additional costs from the virus. If their costs go up 20 percent, Mr. Lee says rates could jump as much as 40 percent in 2021."
I don't get the impression that paying medical staff for working even registers in this equation.
This’ll kill more people and likely hurt the economy more than 9/11 did. How much money did we spend on wars and security junk after that? Seems like a reasonable amount to ask for over the next couple decades to help fix our healthcare system and support people.
Makes sense, stock buybacks should be illegal for companies that required bailouts. Better yet, they should be made illegal for certain essential industries like healthcare.
This assumes that nothing in the medical field will change.
In most professions, an increase in demand would cause wages to increase, which would cause more people to flock to the profession.
Medicine has intentionally put barriers up to prevent more people from entering the field. But then, when the shortages are pointed out, they throw up their hands.
You can't tell me that everyone needs to go $100K's in debt and devote 10 years of medical school/residency to be able to practice family medicine. But the people who are benefitting from this system (the doctors who already went through the training and loans) aren't willing to change it.
Or, and I’m just saying maybe, we could use this crisis as an opportunity to create a Federal-level reinsurance program. This isn’t quite Medicare for all but it would guarantee costs higher than some reasonable number are spread across the entire population.
My impression is that medicare for all covers people, and reinsurance covers insurance companies. A huge danger would be that the premiums would be insufficient, and it would become a taxpayer bailout program. Spreading a cost over the population doesn't necessarily mean it's a reasonable cost.
Perhaps a middle ground is to have it like the FDIC, which covers depositors not banks. As I understand it, if a bank goes under, the FDIC takes it over and runs it until a suitable buyer can be found.
That isn’t true though. Switzerland has a much better predecessor version of the ACA: everyone is required to buy insurance (with subsidies for those that can’t). They got rid of the group market so everyone is in the same risk pool, which is an improvement over our system. However, Switzerland has the second highest healthcare costs when comparing developed countries in a per capita basis.
AFAIK every other rich country regulates some or all medical costs per procedure or what have you (that is, they have price controls). Some do it directly and others by establishing a monopsony on buying healthcare, but that and a good fall-back insurance provider (or a system set up such that one isn’t needed as everyone’s basically already on it) seem to be the common necessary ingredients in keeping costs sane and everyone covered, as far as I can tell.
Sure, I can agree with that. But many countries have hybrid systems that mix public and private insurance (Netherlands?) and then add it in a bunch of regulation and control to keep things sane.
I’m not really sure what health insurer roles are in Switzerland, since the cantons heavily regulate premiums and care. Maybe a Swiss could make light of the situation.
When you actually look at any of these systems, you find there is such great government control of these nominally "private" insurers that it's effectively Medicare-for-All.
All insurance offered at a standard price, subsidized by government, that covers the exact same things by law for every single person and can't be cancelled... who cares whether you're nominally dealing with the government or a private entity?
"Quality Federal Health Insurance for all" = yes
"Medicare for all" = Terrible idea
Medicare is insufficient coverage. Almost all folks on Medicare need supplemental insurance, or a state plan to actually get the care they need. Medicare under pays on claims, typically under the costs of providing care. Every industry group, union, medical association, who has looked at all the various plans has said it would lead to more hospital bankruptcies, particularly in rural areas.
Now, if you want to break the current system and force a government take over of the whole system it's not a bad idea, but selling it as something that would give folks the care they need is very disingenuous.
Medicare for All isn’t an extension of existing Medicare benefits to everyone, it’s an expansion of those benefits,
for everyone, under a single-payer system.
You didn't understand what the person you replied to said, and he's right.
Medicare is NOT good insurance. Its reimbursement rates for hospitals is lower than their costs, and it doesn't fully cover people, it only covers 80%.
Like the person you replied to said: Most people on Medicare need to buy supplemental private insurance - it's called Medicare Advantage, and it may be government funded.
We need good insurance, and Medicare is NOT good insurance.
They clearly did understand what they said. The "Medicare for All" proposals do not simply extend existing Medicare benefits to everyone, they also expand what Medicare covers for the people it covers.
I understood perfectly and they and you are both incorrect. Medicare for All is not Medicare, it expands and closes the gaps in coverage under the current regime using a single payer system (which is not even really a form of “insurance” to begin with).
This doesn't sound hard to achieve in a bipartisan manner. Why didn't this get created with the Affordable Care Act? This also seems much more in line with traditional insurance (big, occasional claims) and would probably be easier to audit due to the lower volume of cases.
> The goal of the ACA’s temporary reinsurance program was to stabilize individual market premiums during the early years of new market reforms (e.g. guaranteed issue). The temporary program is in place from 2014 through 2016. The program transfers funds to individual market insurance plans with higher-cost enrollees in order to reduce the incentive for insurers to charge higher premiums due to new market reforms that guarantee the availability of coverage regardless of health status.
I believe it also ended up tragically underfunded. I believe the co-op started in Illinois was still in a lawsuit over underpayments when it became insolvent and was shut down.
So, keep the idiotic bargaining wars between insurance companies and hospitals that don't reduce costs but do increase administrative overhead, keep the profit pipeline, keep the cherry picking / lemon dropping, but get rid of the ability of insurance companies to lose money?
That's so cynically "privatize the gains, socialize the losses" that I'm sure the lizards will love it!
Actually you're right, it would get rid of the worst of the lemon dropping, which is when they find excuses to dump cancer patients with the least ability to retaliate (least family, least social media, whatever).
The example that was at the top of my mind when I made that claim was the cherry picking, because at this point in my life I'm a cherry, so that's what I have experience with. It's the situation where insurance companies all provide first year discounts, encouraging companies to switch every year, and then make getting set up a hassle so that relatively healthy people forego interaction with the medical system entirely.
Reinsurance wouldn't fix that problem, but that problem is much less pressing than the "dump cancer patients" problem.
This mixes elegantly with the upcoming recession. Less people being able to afford health care compounded with even less people being able to afford health care. Like the article states, either government steps up or this whole system collapses financially.
It’s the ideal storm to push the US to universal healthcare. It would’ve happened eventually, COVID simply pushed up the timeline by rapidly overextending an already failing system.
And already, US healthcare spending is at least twice that of other developed countries, at arguably much reduced availability to the average American.
as an outsider, the inability of the USA to change its healthcare system is baffling.
If you’re baffled you can start with the concept that all that extra money being spent is going to specific people and organizations, who will work to preserve it.
Can you elaborate more on your point about tragedy of the commons?
Maybe I'm dense but it sounds a lot less like many commoners taking advantage of a common shared resource to the point of destruction. More like "corporate socialism", "regulatory capture", or "corruption"
tragedy of the commons is not the best way of describing it. a large fraction of the US workforce works in healthcare (doctors, nurses) and related fields (insurance, pharma, etc.). they may have their gripes with the current system, but ultimately it pays their bills so they don't want to see too much of a change to the status quo.
then you have most fulltime employees getting insurance through their employer. even the ones on shitty plans are somewhat protected from seeing the full costs because the employer doesn't usually disclose their share of premiums. I have a decent high-deductible plan that I pay zero premiums for; I have literally no idea how much it costs and no real way to find out (short of harassing our benefits manager).
on top of this, you have the powerful institutions/individuals who are making real money of the situation and lobby to perpetuate it. the small subset of the population that isn't more or less apathetic faces an uphill battle to change anything.
My analogy was that the pool of money available to fund health care was a “commons” and without being rationed by a government it would be exploited.
Perhaps the better public policy jargon to use would be logic of collective action, in the sense that the profiteers are the special interest group and the rest of us are the diffuse group, but the concepts are pretty conceptually related in my opinion.
There are a number of problems with the US health care system (insurers and providers).
But on the insurance side, it has come to more closely resemble a legalized protection racket. You never know what it's going to actually cost you, you and your family members can be "hung out over a bridge" by the system, and when you really need the protection, the system decides what is protection and how much you can have. It needs to end. It's hollowing out the vitality of the country in its increasing conflict-of-mission.
I don't think it's entirely fair to just look at overall spending. For instance, nearly half of new drugs were produced in the US, so presumably you pay a premium to get access to the newest stuff. Second, other countries have price controls set by the government. This means that US is likely subsidizing for other countries to have cheaper meds. Due to the price controls, if a life saving drug is too expensive it may not even be available at all.
I'm not saying the US is perfect, but it does have some benefits other countries do not.
What are you talking about? We’re subsidizing every other nations healthcare system. Not just the medications.
The US in finances provides 60% of the worlds medical research. We produce 40% of the worlds medical journals, and research.
People bitch about the United States healthcare being this or that. But what they’re really saying is our healthcare is too expensive, bloated in cost, and inaccessible to lower income and at risk individuals. Which I would agree.
Fantastical notions of universal healthcare aside..
This was to be expected, and it won’t be well received. It’s also not necessary, and shouldn’t happen. Much of the US Healthcare expense when insurance companies are involved is fake.
For example, last week I got a medical statement from my insurance. The total cost was a couple grand. I paid 20$ co-pay, and insurance paid a couple hundred. The remainder was “negotiated down, look at this great value your insurance provided!”
If I were to pay out of pocket the 220$ instead of my health insurance premium that month I could have easily paid it. The same is true for emergency surgeries, the actual medical cost of things like brain surgery is around 10-15k. Atleast at some providers, and not hospitals that gouge.
My point here is - Insurance companies have spend decades rewriting the healthcare system to their advantage. They’ve spent years boosting the cost of healthcare, while paying only a fraction and making the remainder of the money disappear. Hospitals have spent years reducing costs while charging 100k for some surgeries in hopes they’ll get even 20k. And have 80k “negotiated”.
There’s plenty of money in the system between insurance companies and healthcare systems. The resolution here isn’t single-payer. The resolution is to force insurance companies to pay their fair share instead of hoarding money.
There’s no reason they should increase their rates right now. They should be breaking into their reserves to handle this.
Back when I took health care policy class in college, we did a cost breakdown / comparison tree between the US health care system and others. One striking result was that each head of the hydra -- hospitals, insurance companies, drug companies -- did a remarkable job of evenly sharing the ~2x cost inflation factor vs other countries.
Of course, each head of the hydra points at the other two and claims it isn't the problem.
I’d replace “hospitals” with “care and testing providers generally” but yeah, I reached the same conclusion looking into this on my own. Each is screwing us a ton, which adds up to 3x a ton, but they can always say “don’t look at me, I’m not most of the problem!”
This difference here is it’s not about the cost. Those are fake.
Its about what is paid. The United States has non-discriminatory laws in place where healthcare providers can’t charge two groups different pricing. So what happens is hospitals and such charge insurance 100k for a service, and then discount it down to 20k. The cost of the service is reported as 100k, but the paid amount is 20k.
Because of this individuals are forced to pay 100k if they don’t have insurance. Or if they don’t negotiate a rate on healthcare. This creates an environment where individuals feel they MUST have health insurance. Because of that health insurance companies are treated like they’re essential and can’t fail.
It’s all a fake fucking sham. None of this is necessary.
No, those numbers were real, post-negotiation, money-changing-hands numbers. US hospitals are actually 2x more expensive. If you looked at hospital pre-negotiation asking prices, I'd expect them to be worse still.
The insurance company side of this pissing contest is "nobody forces hospitals to list insane prices, certainly not us, but we can give you the leverage to make sure they don't stick -- good luck managing that on your own!"
I blame the insurance companies based on the simple calculus that they are the ones in your list that add the least value. Drug companies and providers make things and do things. Insurance companies push paper. By your argument we could dispense with them, save 1/3, and lose nothing.
Insurance in the form of risk pooling is an extremely valuable service.
The issue is that in the US the health insurers do way more than risk pooling. They also do gatekeeping, discounting, & provisioning. Plus there is an asinine indirection layer where their customers are employers instead of the covered.
In a properly functioning health market there would be a very important role for insurance, our current market is just so insane it’s hard to see it.
Insurance only risk-pools by accident. In a world where they had perfect information, they would risk-smooth over your life, but not risk-pool between people.
Collective plans, like those provided by your employer, would risk-pool, but then should we really attribute the pooling to insurance companies?
When I was asking "should we really give them credit," I was referring specifically to the imaginary world in which they had perfect information.
I agree that we should give insurance companies credit for the value they accidentally create in the world that we live in -- so long as we keep in mind that the value creation was predicated on their inability to find & leverage information.
However, going forward in a world of increasingly available information, do you think it is a good idea to rely on their inability to find & leverage information? I sure don't.
I don’t agree with the idea that this is accidental. It’s the specific thing they do, they do it with rigor and engineering. If they get it wrong they go out of business.
They are the central agents of information discovery and we all reap the benefits of the massive amount effort they put into those activities.
If anything I think we should be endeavoring to make health insurance more like traditional insurance to provide those efficiencies more broadly
Do you know of sources/research that shows this "get-as-much-money-as-possible" and hoard it? I'm interested how insurance companies' financials show this.
Key point of conflict in the Democratic primaries, ACA under serious threat in the courts, insurance companies paying hand over fist to tank single payer, millions of newly uninsured...but not part of the conversation?
Your personal Overton window is smaller than the current political reality.
Nor does conversation mean your own suppositions, limits, or dictates. And of course, again, you began by referring to single payer in the US as “fantastical” at the top of the thread.
That's like tying your shoelaces together, complaining that you can't run, and pointing at the variety in other peoples' footwear when someone suggests that the tied shoelaces might be the problem.
The solution is definitely single-payer. Otherwise you can't hope to eliminate the administrative bloat that is a Hallmark of the system and is responsible for so much of the extra cost.
Germany, Japan, Singapore and others seem to do it. If getting everyone covered at reasonable cost is the goal, single-payer is factually not the only solution.
Germany has a public option that covers a lot of people and the insurance industry is regulated to a degree that would make CEOs in the US scream, Japan has a draconian price schedule under a single payer system, and Singapore is more or less a managed economy dictatorship. These examples aren’t like each other nor evidence of the impracticality of a single payer system in the US.
Arguing that these are too extreme actually weakens the case for single-payer because that would require more regulation and more draconian pricing. Meanwhile we could look at even more countries like The Netherlands, Switzerland, or even Denmark, Bernie Sanders’ favorite country to cite, managed without single-payer.
I never argued that they were too extreme, only that referencing disparate systems in contrast to the US’ amounts to little more than a vague, incoherent gesture. I personally think we should have a nationalized health service.
They weren’t referenced in contrast to the US system. They were referenced as countries without single-payer healthcare that still manage universal healthcare. It’s neither vague or incoherent to point out how many different ways exist to solve a problem, only someone with an agenda could think so.
$72k estimate for a hospital case. That is above the median yearly income, it is absolutely time for the government to nationalize healthcare and provide Medicare for all. I’m not worried about paying a few hundred for a premium for Medicare per month, it’s the Monopoly money hospital bill that is the problem.
It may be premature to evaluate performance of different systems in the current crisis, but I would like to point out that the Netherlands, Germany and Switzerland do not have nationalized healthcare.
I fully understand that, but NL/DE/CH do not allow their healthcare providers to pull the shenanigans that we do in the United States.
It is incredibly frustrating to need to go to the urgent care for strep throat or something and then not have any idea how much it will cost afterwards, and also have a health plan with a $2000 deductible and $4000 out of pocket max. This is literally the garbage that we in the USA have to deal with all the time.
> It is incredibly frustrating to need to go to the urgent care for strep throat or something and then not have any idea how much it will cost afterwards
Isn't that stuff all defined though? I just looked at my insurance, and it clearly states Urgent Care visit is $65 and a Strep Lab test is $28 (both out of pocket, after insurance costs).
Granted, getting costs on something more complicated is more difficult, but there's still the defined deductible and out of pocket maximums that can be useful.
Much of it is defined in their policies and imo Kalifesque reality, however if the strep test accidentally goes to an out of network lab, then you will have to pay their imaginary rate or argue with your insurance provider. Another example would be using an out of network anesthesiologist, which one would not be informed of and then receive a surprise bill three moths later.
No, that’s 72k that’s what’s charged. The actual paid price is MUCH lower. Some hospitals have cash based pricing where brain surgery is 15-20k out the door.
The spending is almost entirely on the elderly. Cuts that matter mean less for them. They've already got Medicare so there's no "wasteful" insurance company to save on eliminating.
Of course this will largely be a cynical maneuver by insurance companies to make more money, who now, because of this pandemic, are seeing huge reductions in non-COVID claims.
It’s always just an excuse to screw more people and these companies should be abolished.
COVID-19 is going to have severe economic impacts on many different transactions. Renters versus landowners. Patients versus insurance providers. Insurance providers versus care providers. Oil producers versus refiners. Refiners versus retailers.
In each case, both sides are going to try as hard as they can to isolate the losses to the other party. In situations where their bargaining power and leverage are balanced, both parties will bear some of the loss. In cases where one side has much more economic power, well, you can see where this is going.
In the insurance and health care markets, barring radical restructuring, it will come down to state regulators to ensure that the costs come out well-balanced. Some state boards are going to find this easier to do than others, but I don't think it will trend out on left-right political lines.
The uniquely terrible US healthcare system succeeds in privatizing profits during most years but socializing losses, just like the finance industry in 2008-09.
From the linked report("new analysis") referenced in the first paragraph:
>"The potential impacts detailed in this report reflect
what could happen absent decisive federal action.
If these impacts are not mitigated, the public
health and economic consequences to consumers,
small and large employers and health insurers are
potentially staggering, including:
• Consumers and employees not getting needed
testing or treatments due to cost barriers,
both for COVID-19 but also for other health
conditions.
• Employers no longer being able to offer
affordable coverage, or dramatically shifting
costs to employees.
• Consumers and employers no longer being able
to afford coverage, leading to employer groups
dropping coverage or individuals deciding to go
uninsured.
• Even more unsubsidized marketplace enrollees
being priced out of individual markets.
• Small insurers risk insolvency, and if they
close, put covered consumers at financial risk,
damaging competition that benefits consumers
and the employers that purchase on behalf of
millions of Americans.
• Dramatic cost increases, many of which will be
borne by the federal government in the form of
higher Advanced Premium Tax Credits (APTC),
or by both federal and state governments paying
for increased Medicaid enrollment as individuals
and employers drop coverage"
Aren't almost all of these things not only already true but have also been true for years now?
Healthcare can be the difference between life and death. It is very much unlike any other market good. It is also somewhat unique in that failure to seek early care often leads to much more extensive need of care later, and any imparement is a deadweight loss in human capital terms (unless you're a sociopath who thinks we need to clear out "surplus" population)
A free market requires price discrimination to establish prices. By definition some people must be priced out of the market. There is no free market in healthcare that will deliver anything close to the correct care for the people who need it, and as mentioned delaying the purchase of care or substituting the wrong care is often the worst of both worlds.
Health insurance is uniquely terrible: denying care is the quickest way to increase profits, and unlike fire insurance healthcare is needed by everyone at some point (most people never have their house burn down).
There are some things the free market is bad at. Natural monopolies are one. Healthcare is another.
rising health insurance premiums will drag down any notion of economic recovery once the pandemic recedes, much like rising health insurance premiums led to the middle class being hard-pressed in the aftermath of the great recession.
quite simply, there is no economy without consumer demand for services. and consumers who pay higher rents to their health insurance company have less money to spend. the money doesn't ever trickle back down into the economy once it is lost inside of the insurance system.
nevermind that millions of people have lost their employer-provided health insurance after being laid off. for them, these discussions of health insurance premiums rising are a bit academic; there is no chance of care being accessible or affordable, even if the monthly toll of maintaining expensive insurance is rising astronomically.
it's clear the the US healthcare system cannot continue in its current form. it is my hope that people will no longer entertain delusions of perseverating the present system. it's decidedly non-serious to consider that the ACA might be reformed further to keep the current system.
the only true debates remaining are about how much of the healthcare system should be under the public's control, which we can boil down to two camps: above 70% public ownership, or above 40% but less than 70%. the former camp includes ideas like single payer and medicare for all, whereas the latter camp includes hybrid systems which are closer to switerland's or germany's systems.
This is unbelievably absurd. Insurance companies don't want to do their one and only job, paying healthcare costs, so they want a bailout from the government too. How much money are we going to pour into these useless entities before we just get rid of them altogether? How backwards does America need to be on this issue before there's a will to fix it? How many people need to die and go bankrupt over medical bills while insurance companies make 100% profit off of any premium raises? Is being the new epicenter of the global pandemic of the century not enough? The greed and cruelty is just unbelievable. So much for helping others when it really matters.
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[ 2.4 ms ] story [ 152 ms ] thread". Lee warned that insurers are likely to seek rates that are double their additional costs from the virus. If their costs go up 20 percent, Mr. Lee says rates could jump as much as 40 percent in 2021."
I don't get the impression that paying medical staff for working even registers in this equation.
Universal healthcare wouldn't force doctors to work overtime for free.
In most professions, an increase in demand would cause wages to increase, which would cause more people to flock to the profession.
Medicine has intentionally put barriers up to prevent more people from entering the field. But then, when the shortages are pointed out, they throw up their hands.
You can't tell me that everyone needs to go $100K's in debt and devote 10 years of medical school/residency to be able to practice family medicine. But the people who are benefitting from this system (the doctors who already went through the training and loans) aren't willing to change it.
Why not have "Medicare for all"?
Like every other Western country.
Perhaps a middle ground is to have it like the FDIC, which covers depositors not banks. As I understand it, if a bank goes under, the FDIC takes it over and runs it until a suitable buyer can be found.
I’m not really sure what health insurer roles are in Switzerland, since the cantons heavily regulate premiums and care. Maybe a Swiss could make light of the situation.
All insurance offered at a standard price, subsidized by government, that covers the exact same things by law for every single person and can't be cancelled... who cares whether you're nominally dealing with the government or a private entity?
Medicare is insufficient coverage. Almost all folks on Medicare need supplemental insurance, or a state plan to actually get the care they need. Medicare under pays on claims, typically under the costs of providing care. Every industry group, union, medical association, who has looked at all the various plans has said it would lead to more hospital bankruptcies, particularly in rural areas.
Now, if you want to break the current system and force a government take over of the whole system it's not a bad idea, but selling it as something that would give folks the care they need is very disingenuous.
https://www.vox.com/2019/4/10/18304448/bernie-sanders-medica...
Medicare is NOT good insurance. Its reimbursement rates for hospitals is lower than their costs, and it doesn't fully cover people, it only covers 80%.
Like the person you replied to said: Most people on Medicare need to buy supplemental private insurance - it's called Medicare Advantage, and it may be government funded.
We need good insurance, and Medicare is NOT good insurance.
Public option is a fine transition.
So Medicare for all will solve nothing.
> The goal of the ACA’s temporary reinsurance program was to stabilize individual market premiums during the early years of new market reforms (e.g. guaranteed issue). The temporary program is in place from 2014 through 2016. The program transfers funds to individual market insurance plans with higher-cost enrollees in order to reduce the incentive for insurers to charge higher premiums due to new market reforms that guarantee the availability of coverage regardless of health status.
https://www.kff.org/health-reform/issue-brief/explaining-hea...
That's so cynically "privatize the gains, socialize the losses" that I'm sure the lizards will love it!
The example that was at the top of my mind when I made that claim was the cherry picking, because at this point in my life I'm a cherry, so that's what I have experience with. It's the situation where insurance companies all provide first year discounts, encouraging companies to switch every year, and then make getting set up a hassle so that relatively healthy people forego interaction with the medical system entirely.
Reinsurance wouldn't fix that problem, but that problem is much less pressing than the "dump cancer patients" problem.
And already, US healthcare spending is at least twice that of other developed countries, at arguably much reduced availability to the average American.
as an outsider, the inability of the USA to change its healthcare system is baffling.
It’s a textbook tragedy of the commons example.
Maybe I'm dense but it sounds a lot less like many commoners taking advantage of a common shared resource to the point of destruction. More like "corporate socialism", "regulatory capture", or "corruption"
then you have most fulltime employees getting insurance through their employer. even the ones on shitty plans are somewhat protected from seeing the full costs because the employer doesn't usually disclose their share of premiums. I have a decent high-deductible plan that I pay zero premiums for; I have literally no idea how much it costs and no real way to find out (short of harassing our benefits manager).
on top of this, you have the powerful institutions/individuals who are making real money of the situation and lobby to perpetuate it. the small subset of the population that isn't more or less apathetic faces an uphill battle to change anything.
It's not tragedy of the commons. https://en.wikipedia.org/wiki/Tragedy_of_the_commons
This is an example of an inefficient system with powerful stakeholders working to preserve the gravy train that's developed around it.
Perhaps the better public policy jargon to use would be logic of collective action, in the sense that the profiteers are the special interest group and the rest of us are the diffuse group, but the concepts are pretty conceptually related in my opinion.
But on the insurance side, it has come to more closely resemble a legalized protection racket. You never know what it's going to actually cost you, you and your family members can be "hung out over a bridge" by the system, and when you really need the protection, the system decides what is protection and how much you can have. It needs to end. It's hollowing out the vitality of the country in its increasing conflict-of-mission.
I'm not saying the US is perfect, but it does have some benefits other countries do not.
The US in finances provides 60% of the worlds medical research. We produce 40% of the worlds medical journals, and research.
People bitch about the United States healthcare being this or that. But what they’re really saying is our healthcare is too expensive, bloated in cost, and inaccessible to lower income and at risk individuals. Which I would agree.
The more things change, the more they stay the same...
Don't they every year? Not even kidding.
Diversity in this case is on healthiness and age axes rather than gender or racial axes.
I checked mine, and the past 3 annual increases were 7.7%, 13.3% and 6.9%.
edit: I should add I'm on an individual plan purchased directly from an insurer, not a group or employer plan.
This was to be expected, and it won’t be well received. It’s also not necessary, and shouldn’t happen. Much of the US Healthcare expense when insurance companies are involved is fake.
For example, last week I got a medical statement from my insurance. The total cost was a couple grand. I paid 20$ co-pay, and insurance paid a couple hundred. The remainder was “negotiated down, look at this great value your insurance provided!”
If I were to pay out of pocket the 220$ instead of my health insurance premium that month I could have easily paid it. The same is true for emergency surgeries, the actual medical cost of things like brain surgery is around 10-15k. Atleast at some providers, and not hospitals that gouge.
My point here is - Insurance companies have spend decades rewriting the healthcare system to their advantage. They’ve spent years boosting the cost of healthcare, while paying only a fraction and making the remainder of the money disappear. Hospitals have spent years reducing costs while charging 100k for some surgeries in hopes they’ll get even 20k. And have 80k “negotiated”.
There’s plenty of money in the system between insurance companies and healthcare systems. The resolution here isn’t single-payer. The resolution is to force insurance companies to pay their fair share instead of hoarding money.
There’s no reason they should increase their rates right now. They should be breaking into their reserves to handle this.
Of course, each head of the hydra points at the other two and claims it isn't the problem.
Its about what is paid. The United States has non-discriminatory laws in place where healthcare providers can’t charge two groups different pricing. So what happens is hospitals and such charge insurance 100k for a service, and then discount it down to 20k. The cost of the service is reported as 100k, but the paid amount is 20k.
Because of this individuals are forced to pay 100k if they don’t have insurance. Or if they don’t negotiate a rate on healthcare. This creates an environment where individuals feel they MUST have health insurance. Because of that health insurance companies are treated like they’re essential and can’t fail.
It’s all a fake fucking sham. None of this is necessary.
The insurance company side of this pissing contest is "nobody forces hospitals to list insane prices, certainly not us, but we can give you the leverage to make sure they don't stick -- good luck managing that on your own!"
The issue is that in the US the health insurers do way more than risk pooling. They also do gatekeeping, discounting, & provisioning. Plus there is an asinine indirection layer where their customers are employers instead of the covered.
In a properly functioning health market there would be a very important role for insurance, our current market is just so insane it’s hard to see it.
Collective plans, like those provided by your employer, would risk-pool, but then should we really attribute the pooling to insurance companies?
So yes? We should give credit to insurance for providing value in the real world.
I agree that we should give insurance companies credit for the value they accidentally create in the world that we live in -- so long as we keep in mind that the value creation was predicated on their inability to find & leverage information.
However, going forward in a world of increasingly available information, do you think it is a good idea to rely on their inability to find & leverage information? I sure don't.
They are the central agents of information discovery and we all reap the benefits of the massive amount effort they put into those activities.
If anything I think we should be endeavoring to make health insurance more like traditional insurance to provide those efficiencies more broadly
Universal Healthcare isn’t part of this conversation, or this issue. So I’m not even going to waste time on it.
Your personal Overton window is smaller than the current political reality.
No, they were not. Conversation does not mean “oh anything that involves health insurance anywhere in the world at any time”.
Saying they're all the same is a bit like saying all foreigners speak the same language.
My point is more that there is no single other well thought out system that works in every other country.
Those 30+ systems are very different from each other. Most of them are also in some kind of crisis, if you ask local public opinion.
I'm arguing against the simplistic "let's just convert to the other system" idea. This isn't like going metric.
Despite what you say, it can be fixed, and can be resolved.
Last I heard health insurers weren't particularly profitable, and I'd be surprised if they have reserves of that magnitude.
Very happy to be shown wrong with facts though!
Italy, on the other hand...
It is incredibly frustrating to need to go to the urgent care for strep throat or something and then not have any idea how much it will cost afterwards, and also have a health plan with a $2000 deductible and $4000 out of pocket max. This is literally the garbage that we in the USA have to deal with all the time.
Isn't that stuff all defined though? I just looked at my insurance, and it clearly states Urgent Care visit is $65 and a Strep Lab test is $28 (both out of pocket, after insurance costs).
Granted, getting costs on something more complicated is more difficult, but there's still the defined deductible and out of pocket maximums that can be useful.
Some states have passed legislation which somewhat protects against this however here is a good example of it https://www.google.com/amp/s/khn.org/news/even-with-insuranc...
https://www.politifact.com/article/2013/jan/28/federal-spend...
The spending is almost entirely on the elderly. Cuts that matter mean less for them. They've already got Medicare so there's no "wasteful" insurance company to save on eliminating.
It’s always just an excuse to screw more people and these companies should be abolished.
In each case, both sides are going to try as hard as they can to isolate the losses to the other party. In situations where their bargaining power and leverage are balanced, both parties will bear some of the loss. In cases where one side has much more economic power, well, you can see where this is going.
In the insurance and health care markets, barring radical restructuring, it will come down to state regulators to ensure that the costs come out well-balanced. Some state boards are going to find this easier to do than others, but I don't think it will trend out on left-right political lines.
>"The potential impacts detailed in this report reflect what could happen absent decisive federal action. If these impacts are not mitigated, the public health and economic consequences to consumers, small and large employers and health insurers are potentially staggering, including:
• Consumers and employees not getting needed testing or treatments due to cost barriers, both for COVID-19 but also for other health conditions.
• Employers no longer being able to offer affordable coverage, or dramatically shifting costs to employees.
• Consumers and employers no longer being able to afford coverage, leading to employer groups dropping coverage or individuals deciding to go uninsured.
• Even more unsubsidized marketplace enrollees being priced out of individual markets.
• Small insurers risk insolvency, and if they close, put covered consumers at financial risk, damaging competition that benefits consumers and the employers that purchase on behalf of millions of Americans.
• Dramatic cost increases, many of which will be borne by the federal government in the form of higher Advanced Premium Tax Credits (APTC), or by both federal and state governments paying for increased Medicaid enrollment as individuals and employers drop coverage"
Aren't almost all of these things not only already true but have also been true for years now?
A free market requires price discrimination to establish prices. By definition some people must be priced out of the market. There is no free market in healthcare that will deliver anything close to the correct care for the people who need it, and as mentioned delaying the purchase of care or substituting the wrong care is often the worst of both worlds.
Health insurance is uniquely terrible: denying care is the quickest way to increase profits, and unlike fire insurance healthcare is needed by everyone at some point (most people never have their house burn down).
There are some things the free market is bad at. Natural monopolies are one. Healthcare is another.
quite simply, there is no economy without consumer demand for services. and consumers who pay higher rents to their health insurance company have less money to spend. the money doesn't ever trickle back down into the economy once it is lost inside of the insurance system.
nevermind that millions of people have lost their employer-provided health insurance after being laid off. for them, these discussions of health insurance premiums rising are a bit academic; there is no chance of care being accessible or affordable, even if the monthly toll of maintaining expensive insurance is rising astronomically.
it's clear the the US healthcare system cannot continue in its current form. it is my hope that people will no longer entertain delusions of perseverating the present system. it's decidedly non-serious to consider that the ACA might be reformed further to keep the current system.
the only true debates remaining are about how much of the healthcare system should be under the public's control, which we can boil down to two camps: above 70% public ownership, or above 40% but less than 70%. the former camp includes ideas like single payer and medicare for all, whereas the latter camp includes hybrid systems which are closer to switerland's or germany's systems.