Rekna

We have heard about many plans that are out there and we all have opinions on what we would do to reform health care. Let's start out a simple discussion of what is wrong with our current health care system and what we could do to reform it (or leave it as is).

This discussion was initially restricted to what was wrong with the system. It has now been expanded to include how to fix what is wrong.



I'll start with some things that I see as wrong (in no particular order):

1) People needing treatment can't always get it because they can't afford it or the insurance company says sorry we won't pay.
2) Costs are so high that a single medical emergency can put a family in massive debt for their entire life.
3) People are afraid of these costs that many times they won't get help for something minor which escalates into something major.
4) Doctors and institutions who are honestly working twoard helping individuals have to fear getting sued.

Derwood

5) Lobbyists for Insurance and Pharmaceutical companies have far too much influence on legislation in Washington, DC

Rekna

I would definitely agree with that.

rahl

I'm an insurance agent so some may consider my opinions slightly biases. That being said, Most of my sales are from supplemental products, namely a gap plan that is designed to fill the gap between rising deductables. From my 6 years of experience, the number one reason health insurance premiums rise is due to the risk factors of the groups employee's. And that makes sense, it works the same way with car insurance or homeowners insurance...if you don't live within so many feet of a fire hydrant then your premiums will be higher than someone who does. If you have several speeding tickets on your record your premiums will be higher. The same goes for health insurance. The higher the risk the higher the premiums. People need to take an initiative and start living healthier lifestyles. Some will say that the govn'thas no right to tell you how to live, and their right they don't. But it isn't fair for everyone to pay the same premiums when people are intentionally making themselves sick by not excercising or smoking or eating mcdonalds 3 times a day

Rekna

That is interesting information rahl. I would agree that people have varying risk factors and some people intentionally make themselves higher risk. The question I have for you is right now risk is risk it isn't divided into risk that is caused by ones own behaviors (not eating well or staying in shape, wild outdoors enthusiast, etc) and risks that just are (consecutive abnormal pap-smears, previous cancer victim, birth defects, etc).

Is it fair to take people who are high risk due to no fault of their own and treat them the same as people who choose to live a risky lifestyle? I do think there should be intensives for people to live healthy but we need to be careful that those incentives do not become punishments for people who are sick.

Derwood

How does one assess the collective risk of several thousand employees of a major corporation?

rahl

Risk levels for large sized groups are calculated differently than smaller groups. The larger groups acutally have cheaper rates because there are so many people generating premiums that the premium to payout ratio is more in favor for insurance companies. Smaller groups are rated based on applications each employee fills out and based on prior medical history(pre-existing conditions).

---------- Post added at 08:13 PM ---------- Previous post was at 08:09 PM ----------

Is it fair to take people who are high risk due to no fault of their own and treat them the same as people who choose to live a risky lifestyle? I do think there should be intensives for people to live healthy but we need to be careful that those incentives do not become punishments for people who are sick.[/QUOTE]

It is fair from a free market standpoint. If the govn't passes a single payer plan then things will obviously change. But keep in mind it is extremely expensive to take care of sick people, so the costs are going to be spread out to all tax paying americans in some form or another.

Derwood

It's expensive to take care of sick people, so the answer is to deny coverage to customers who have been paying into the system for years and years?

rahl

No one is being denied coverage. People are denied affordable coverage. If you can afford $3,000 a month then your covered, if not then too bad. Thats the way the system is set up now, and it makes sense in a free market. If you have a car with engine trouble and problems with the frame, how is it fair that you would pay the same as me for coverage when my car is in pristine condition? I'm not saying that it is fair for everyone, just that this is how it works currently. And i can't see any way of fixing it without seriously long term initiatives. The cost of care from hospitals and doctors needs to be way down from the current prices. How to do that I don't know, but if all we do is adopt a government plan then that plan will be just as expesive as the current system so whats the point. I understand something needs to be done but it's going to take decades to implement, otherwise the economy will get even worse.

Derwood

part of the reason the doctors/hospitals charge so much is because the insurance companies aren't reimbursing them for everything that they're "covering" for the patient

rahl

Thats the least of the reasons. The number one reason is that doctors are sued like crazy for malpractice, which lead to over testing and needlessly testing. Which insurance companies rightly don't want to pay for.

Another reason that prices are so high, especially in ER's is that people go there for every little thing. People need to be better educated in that ER's are for EMERGENCIES only. Not colds or back pain. that's what family doctors are for and urgent care facilities. Also every ER in the country has to accept people whether or not they have insurance. The people who don't have insurance, for what ever reason, almost never pay their bills. Granted it may be expensive but they can easily work out a payment plan with the hospital. My wife is an ER nurse and 2/3rds of the people who go there are either drug seeking or bringing their kid in for a runny nose

Derwood

Isn't malpractice's share of total health care costs pretty minuscule? Low single digit % if I remember correctly

EDIT: Malpractice payouts account for less than 1% of total health care expenditures

rahl

it's around 1% per hospital. but those suits cost the hospital itselft millions of dollars. Driving up the cost of malpractice insurance which is then passed on to patients in the form of over testing, which in turn the insurance companies often deny because they are unneccessary. Again there is no easy answer or quick fix that I can see. Lots of people can have opinions on the best course to take but I seriously doubt any one person, even experts in the are, have any clue how to fix the problem without bankrupting the country

Derwood

not-for-profit insurance is the only way to go, IMO, but that's something I doubt you'll agre with (ha ha ha)

Willravel

What's wrong? A for-profit health care industry. It puts health care out of the price range of 1 in 6 Americans and treats the other 5 out of 6 like they're money bags. They'll use basically any excuse that's legally defensible to deny care, they refuse to treat people that have "preexisting conditions" (most people do), and they allow people under their care to die more often than most people think. Put simply, the health of an individual is too important to entrust to a for-profit entity.

How would I reform health care? I'd create a universal single payer system and make it compulsory, paying for it through an immediate progressive tax increase.

rahl

and that tax increase is what scares the majority of americans. Like I stated earlier, the cost of healthcare isn't going to go down if we have a universal healthcare system. The government plan may cover everyone but they will most definately put a limit on how much they will be willing to pay for any given procedure, they have to otherwise they will be in the same boat as the insurance companies are now. Medicaid is a perfect example. Most Primary care physicians will not accept medicaid patients because they only pay a fraction of what an hmo or ppo will pay them. There's no way the government will be able to totally get rid of insurance companies, because the vast majority of people can afford them, and most doctors will only accept private insurance. The government should not be able to tell doctors that they have to accept their plan over private insurance. A state funded hospital is a different story but not a privately owned medical practice

Willravel

The cost of health care will go down if we have a universal health care system. It won't happen overnight, but just as we can see in every other industrialized nation in the world, universal health care is ultimately cheaper.

If most Americans were to understand that instead of paying $5,000 a year to an insurance company they could pay $2600 a year in taxes, they're not going to be scared anymore. They're going to be livid that they've been giving in to scare tactics for like 70 years.

rahl

Those other countries didn't have a runaway healthcare system like we do. Why would hospitals and doctors offices reduce how much they charge for procedures or visits just because there is a government plan? Do you think they would do it out of the goodness of their hearts? if you do you are incredibly nieve

Willravel

Do you think that they'd quit? What happens when you're a free market doctor in a universal world? You die or you adapt.

rahl

why would they adapt? The government can't outlaw private insurance, or the right that doctors have to run their business how they see fit. The problem I have with Healthcare Reform is that yes while costs are climbing, only a very small fraction of the population aren't covered for various reasons(unemployed, can't afford it, etc.) so the current system can work if we can find a way to drive down the cost of treatments. The easiest way to do that imo is to limit malpractice suits, and for americans to live healthier lifestyles. As i said earlier a person who drives recklessly has higher car insurance rates than someone who has a perfect record.

Willravel

The government won't have to outlaw private insurance, it will die because it can't compete with government health care. Very quickly.

BTW, since when is 1 in 6 "a very small fraction"?

Derwood

and how is curbing malpractice (0.36% of total health care costs) going to make a scratch (much less a dent) in rising health care costs?

how about CEO salaries for the Insurance companies? I'm guessing those account for more

rahl

1 in 6 is a false number. All it means is they don't have private insurance, it groups together all the people who are currently on medicaid/s-chip, people who are eligible for said programs who have not yet signed up and illegal aliens. Again I ask you why would a doctors office accept a government plan that pays only a fraction of what a private insurance carrier does? They wouldn't, so the government plan would never overtake private insurance companies. So without outlawing private insurance companies(wich will never happen) how would the government plan hope to compete with private insurance?

Derwood

private insurers already pay a fraction of what the doctors bill. Can you cite an article or government plan that states the government plan would pay less than the private insurers please?

rahl

Malpractice causes Hospital to do unneccessary tests in order to cover their asses so they won't get sued. Insurance companies rightfully don't want to pay for things that are unneccessary, and neither will the government. If the government gets involved they will most likely pass an immunity clause like most municipalities for liability. Meaning if the hospital or doctor screws up, oh well, they have immunity.

---------- Post added at 12:00 AM ---------- Previous post was Yesterday at 11:57 PM ----------


This is a pub discussion so no citations, but if a doctor bills an insurance company, and the procedure/test was neccessary, then the company will pay. The vast majority of doctors offices will not accept medicaid because they only pay doctors a fraction of what he normally charges. Thats why people with medicaid just go to the ER because they are forced to accept medicaid, driving up the cost of ER visits for everyone else.

Willravel

I was rounding, but yeah 46.6 million out of 300 million as of 2005 is something to be deeply ashamed of as a civilization.
This is where PUB discussions fail. I can verify that this isn't true through citations, but we don't allow those. All I can do is say, "You're wrong," and get stuck in a stalemate.
Universal health care would completely decimate private insurance in savings (private health care has administrative costs of about $300 billion annually). Private insurers would start going belly up left and right, and the few stubborn conservatives and ultra rich wouldn't be able to support the huge number of physicians that would want to work privately. Some might get lucky, but a vast majority would have to either enter a new profession, which means a waste of 8 years of schooling and god knows how much tuition, or they'd be absorbed into the public system. If they're anything like every other time that a private system has become a public system, most will join the public health care system and do just fine.

Not only that, but over half of US doctors support universal healthcare according to that Reuters newspaper on the bar beside you.

I'm afraid you're not on the right side of this one.

Rekna

Isn't the point of insurance to mitigate risk over a large group? You yourself have said large group plans are cheaper because the risk is averaged over everyone. So why not put anyone that wants on the same group plan?

Also wouldn't eliminating insurance remove a middle man in the health care process there bye reducing the cost of health care? I think what really scares the insurance agency is that they are a middleman and if the government were to assume all risk by being a single payer there would be no need for the health insurance industry. In a single payer system what role do insurance companies play?

Fotzlid

I worked with a doctor once who would put patients in for admissions based on what the chief complaint was in triage, long before he even saw the patient. He got sued once and was determined to never let it happen again. Worked with many a doctor who would order CAT scans or MRIs even though they knew it wasn't going to tell them anything.

Part of that problem lies in the fact there are too few primary care physicians. The general practitioner has gone the way of the dodo bird. Everyone is a specialist these days. Most people don't have one doctor, they have 2 or 3 depending on the number of medical conditions they have. The ones that do see patients as a primary care are horribly overbooked and can't see the back pains/colds for weeks if not months. They always tell their patients that call in to be seen to go to the ER if they want treatment that day. Then there is the instant satisfaction group that want to be treated immediately and will return in 24 hours if they still feel bad.
I won't even go into the drug seekers (either the street bred variety or the ones created by physicians) and the drunk homeless that local police will no longer hold in the cells but instead send to the ER where they tie up beds and staff till they are sober enough to walk out and do it all over again in a few hours.
Lets not forget the abuse of the EMS system which in my area is looked at as a form of taxi service. You'd be amazed what people will call 911 for.
Then there is the problem of an appalling lack of psychiatric services. Too many mentally ill people that need long term care and no where to put them.
Substandard nursing homes and rehabs.
Nursing shortages.
Patients on 10 or 20 different medications.

These are just some of the problems facing ERs. There is an entirely different list of things wrong from the hospital wards perspective, or just about any other department for that matter.

People actually think the government is going to be able to fix things? The same people who rely on polls and lobbyists to tell them what to do. The same ones that want to build bridges to nowhere and can't seem to pass anything without a healthy doses of pork included. Do you really want the government mandating your health care?

rahl

well you must be reading something i'm not because I can verify it's true. Like I said 45 millions americans don't have PRIVATE insurance, some are covered under current govn't plans or are eligible. The real number is closer to 10-15 million, which is still alot i'm not saying it isn't.

The govn't plan would have just as many admin costs as private insurance. Doctors will not accept the government plan unless they pay what the doctor charges period. They can't be fased out, they won't simply put up their hands and surrender.

You assume I'm not on the right side of this issue. I agree that something needs to be done to stop run away costs, a complete government take over of medicine isn't the answer. I don't know what the CORRECT answer is, but I'm able to admit it. I've been in the insurance industry for 6 years, my wife has been in the ER for 5 years, most of you have absoulutely no idea what you are talking about when it comes to this issue you just have opinions, not realistic solutions

dc_dux

The figures I have seen are that about 25% (10-12 milion) are eligible for Medicaid or S-CHIP.

A large majority of those w/o insurance are small business employees making more than the threshold for those programs, but faced with paying the full cost of insurance w/o employer contributions, which could easily approach or exceed a third of their take home pay.

The other problem? The patchwork nature of state regulations where there is no incentive for private insurers to control costs. In many states, profits (and admin expenses) are tied to a fixed percentage of premiums...so, in fact, if as an insurer, my profits are based directly on a fixed rate of 15% of premiums, there is a built in disincentive to lower premiums....lower premium means less profit....higher premiums means more profit.

It seems to me an insurance exchange of public and private that would encourage greater competition would likely reverse, at least to some degree, those current incentives to keep premiums rising.

IMO, there is no reason to abandon our current employer-based system. The issue is containing costs of those employer-based plans and expanding affordable coverage to those w/o ....and generally, greater competition not only accomplishes that, but it also stimulates greater innovation.

__________________
"The perfect is the enemy of the good."
~ Voltaire

rahl

The other problem? The patchwork nature of state regulations where there is no incentive for private insurers to control costs. In many states, profits (and admin expenses) are tied to a fixed percentage of premiums...so, in fact, if as an insurer, my profits are based directly on a fixed rate of 15% of premiums, there is a built in disincentive to lower premiums....lower premium means less profit....higher premiums means more profit.

It seems to me an insurance exchange of public and private that would encourage greater competition would likely reverse, at least to some degree, those current incentives to keep premiums rising.

IMO, there is no reason to abandon our current employer-based system. The issue is containing costs of those employer-based plans and expanding affordable coverage to those w/o ....and generally, greater competition not only accomplishes that, but it also stimulates greater innovation.[/QUOTE]


Profits for insurance companies are based on a premium to payout ratio, so if the cost of care went down then the insurance companies would be more willing to reduce premiums. so competition by itself will not bring down the cost to insureds.

SirSeymour

As un-American as it sounds, I am slowly coming to this same mindset. I know in my own case my family's deductible and premium's both went up by half this year, my co-pay doubled and our coverage was reduced (we paid nearly over twice as much to have our second child in March when compared to the first one back in 2006) all while my insurance carrier posted record profits.

Although, having said this I think any real reform to the medical industry has to start with tort reform to reduce the cost of malpractice and all that is associated with it. From there, we need real reform in Washington to reduce the influence of the insurance and pharmaceutical lobby on Congress. Once these two things are under control, we can start to see what things look like.

The problem is that even once those two things are fixed (assuming they could be fixed, that is) I doubt prices would come down. After all, why charge less than you have been charging?

__________________
SQL query
SELECT * FROM users WHERE clue > 0
Zero rows returned....

rahl

Not for profit sounds great to everyone who proposes it because it's not their job they will be loosing. What if whatever your job happens to be, suddenly there is a public outcry to have the government take it over and make it not for profit, you'd be pretty pissed. The economy is already hurting my sales and if a single payer system is passed I will be totally out of work, and so will millions of other americans, but hey atleast everyone will be covered under the new plan

Derwood

not-for-profit doesn't mean no one gets paid. it means at the end of your fiscal year, your balance sheet should read $0.00. This means you lower premiums in order for your payouts/salaries/etc. to balance out, or you reinvest any "profits" back into the company. I've worked for many not-for-profit groups (in various industries) and I always drew a paycheck

rahl

I'm not willing to take a pay cut, would you be?

Derwood

Why would you take a pay cut?

rahl

If my company were to turn non profit I would be paid less commissions. But if there is a single payer system implemented I would loose my job outright. I don't want either of those things

Derwood

right, so you're arguing from a personal point of view rather than a national one. completely understandable considering your job. somehow I doubt that every work in the private insurance industry would lose their jobs

SirSeymour

Find me another way for insurance companies to act ethically and I will listen but right now I don't see it. The drive to post a bigger profit is killing heathcare in this nation, in my humble opinion.

__________________
SQL query
SELECT * FROM users WHERE clue > 0
Zero rows returned....

ratbastid

I'm coming to this thread late, but this quote:

...speaks to precisely what's wrong with our current system. You know who else talks in terms of payout ratios being in their favor? Casinos.

Insurance Companies are basically big gambling operations, where people bet against the house that they'll get sick some day, and gamble that on that day the house will honor its agreement to pay out.

Lots of people would be better off putting their premiums into a slot machine.


ALSO: I think it's very strange that people get their insurance through where they work. Really... If that wasn't "how it is", and somebody came along and proposed that, I think we'd all look at them funny. These days, anyway--back when you got a job and it was your job for life, and your pension and retirement came from there, it made more sense. These days, not so much. Why not get insurance through your church? Or your neighborhood watch association? That would be about as strange. The two things that make ANY real sense, logistically speaking, are private insurance, and government insurance.