As we've discussed elsewhere, single payer systems are not a "wash." They are actually significantly cheaper to run due to reduced overhead costs, which are right now about a third of all medical costs in the US.

As for reducing costs, being healthier is not an independent variable. Good access to preventive care, for example, greatly reduces those needless ER trips.

And there is no comparison to auto insurance. Auto insurance is for exceptional circumstances (theft, accidents, etc.) and doesn't deal with preventive care and the inevitable issues related to aging. Some people never get involved in a car accident. Everyone gets sick, needs preventive care, and eventually die. A system where it is more efficient to compete by excluding certain conditions and age groups is, on the macro level, less efficient than one that pools everyone.

By the way, the majority of the uninsured are not high risk. They are mostly under or unemployed 19 to 34 year olds.

I haven't said anything about socialism or government take over of health care so don't don't go there. It may surprise you I'm all for a government option but I'm opposed to these bills for numerous reasons neither of which is socialism or government takeover. I do feel it is a payoff to the insurance companies and the millions spent by the insurance companies worked as one only needs to look at the two bills to figure that out.

Auto insurance, home owners insurance, health insurance...all operate the exact same way.

No, they do not and you should know that. Some abstract principles ("risk") are the same, but other than that they are very different. There's the fact that it's employer based for the most part, that it covers routine procedures and "maintenance," and as such private insurers have set up strict rules to reduce excessive use, and that people, through no fault of their own, will, as a virtual certainty, become uninsurable.

In a perfect world, with perfect information about each individual person and how their health will be through the course of their lifetime, the pooling of risk would be along one's own lifetime distribution. I.e., the young person is paying for coverage he will need as an old person. The exclusion of preexisting conditions (for which there is no analogous exclusion in auto or home owners) means that that pooling of risk over the individual's lifetime is impossible, and generates a situation where it is more profitable to exclude those in old age and sick than it is to compete on price or services alone.

I have to agree with you, it isn't the health insurance companies that are the major evil here. They are part of the big 3 but they are the smallest part of the triad that is the Healthcare beast.

First and foremost, we have malpractice insurance and lawsuits that feed the beast, probably moreso than all other reasons combined. Somewhere, in this great country's journey we became an extremely litigious country. We sue for ANYTHING, we believe it is our right to, we deserve it and we look at lawsuits as ways to "get rich quick" without thinking of what the end will bring.

Doctors of certain areas (such as OB/GYN Dr. here in Ohio) in some states can't afford the malpractice insurance. Doctors that do stay in business, then have to see more people, cover themselves better by issuing tests that they know are not needed but due to liability have to authorize to cover their asses. If they miss anything, they run the risk of getting sued into oblivion.

Hospitals are the same way. Their #1 cost (for most hospitals) is not equipment, people who can't pay or staff but insurance. Then it's the equipment that they have to have. They have to cover their asses for malpractice in far more ways than any doctor. So they tack those prices onto the services.

Pharmaceutical companies, as much as I hate them are also in the same boat. They spend years developing a med that helps. FDA tests and approves it (this is where the Pharms fucked themselves). Med comes out... starts affecting a percentage of people adversely and a class action comes up... they lose millions. They have to raise prices on meds to cover any potential litigation.

(I say the Pharm companies fucked themselves because they lobbied the FDA to be more lax in the regulations and testing... the FDA did. However, in doing so, meds come out that show bad long term effects or even short term because they were allowed to rush testing.)

So we have side one of the Triad. Malpractice and liability insurance.

Part 2 of the triad is the uninsured and those that cannot pay. This causes prices for those that can pay to go up. Again, when someone comes in and complains of chest pains, the hospital needs to perform all kinds of expensive tests to cover their ass from a wrongful death lawsuit. (Trust me, even that homeless bum on the corner has family that will come out of the woodwork if he dies and they think they can get money for a wrongful death suit.)

Again, the hospital runs these tests and no one pays. So that cost has to be passed on to those that do.

Finally, we have the insurance companies and government (medicare/medicaid). They get the brunt of everything because they do pay. Thus, they get all these tests, meds, everything thrown at them, because the money is prime for the taking. The insurance companies try to protect themselves a little but in the end they really can't because the doctors and hospitals know ways around all the loopholes. So things like "Tonail Fungus" become big money. Which feeds into the "we have a cure for everything"... erectile dysfunction... we have a cure.

Regulating the whole industry and throwing tax money at it, giving government control over you life.... is NOT going to end any of the Triad. If anything the Triad will get worse and the beast become even more of a financial drain to the GDP.

The claim that malpractice suits are the main culprit for the US's poor healthcare system is simply a red herring from those who want to avoid change at any cost. It ignores that several states have already implemented tort reform without all the supposedly wonderful cost reductions. In fact, 23 states have limits on non-economic damages and 34 have limits on punitive damages.

The sum of all malpractice payouts and all malpractice insurance is less than 2% of all healthcare spending in the US.

correct. malpractice suits rarely get paid out, and the amount that IS paid out is very small in comparison to the total healthcare expenditures each year. It's a compelte red herring

for the purposes of this discussion they are the same as it relates to pre exs.

No, they are not, no matter how many times you say they are.

First of all, there are no "preexisting conditions" in auto and home insurance. You have previous behavior that indicates current and future risk, but you don't have a condition or a risk that is completely excluded from coverage. And that is because the nature of the insurance is different. The risk distribution is different. And in statistics, distribution is everything. That is why a true health insurance would pool the risk across a person's lifetime.

yes they are no matter how many times u say they're not. if u have damage to your automobile before u have coverage u can't expect them to cover it. if they are forced to cover it that creates an adverse selection sotuation. premiums will have to rise to compensate for the increased exposure that the insurance company will face. that is reality...ignore it all u want but that doesn't change what is

Except that you are comparing apples and oranges. Exclusion from preexisting conditions is not refusing to pay retroactive coverage of existing damages, but additional charges stemming from a known problem. And it is not the same because the risk distribution is not the same. Everybody will get sick and die. Not everyone will get their car stolen or be involved in an accident.

Because EVERYONE will get sick or die, the issue of risk segmentation is completely different, especially when you figure in employer based health insurance.

Really??? That's why there are certain types of doctors that because of malpractice insurance are unable to practice because of the economic reality in some states. (Like OB/GYNs)?

High Cost Of Malpractice Insurance - CBS Evening News - CBS News

Taken from a professional medical magazine website

Do You Have the Right Malpractice Insurance Policy? - Nov-Dec, 2004 - Family Practice Management

http://www.freerepublic.com/focus/f-news/2374999/posts

(Yes, the above was taken from the Free Republic posting boards... however, I do not have a subscription to Investors.com or IBD to get the article.)

For people to ignore the high cost and severity of Malpractice lawsuits and insurance is fucking ignorant.

It's not the only cause of out of control expensive healthcare but it is an integral part of it.

Those who want to claim it is the insurance industry and HMO's and the medical profession just raping the people are not seeing the whole picture.

The plan that is being put forth is not going to make the triad I put forth any cheaper at all. In fact it will make it far worse, far more expensive and services far more ineffective.

I am all for healthcare reform.... have been for many many moons and I have argued for it here since I have joined TFP. But what is being passed is bullshit and in no way a healthy, beneficial plan. What Congress is pushing through is destructive. There were and are far, far better, more efficient, economically sound ways to get reform and protect the people uninsured and keep government out of our lives.

The saddest part of all this is some of you are more than willing to sacrifice freedoms for what YOU believe everyone else needs.

"Fucking ignorant" is picking a couple of cases portrayed by the media and turning them somehow into the norm.

You can use all the expletives in the world, but it doesn't change the fact that malpractice insurance is actually an incredibly minor portion of the costs associated with healthcare.

http://www.rwjf.org/files/research/no8primer.pdf


Medical Malpractice Reform and Employer-Sponsored Health Insurance - RWJF

I'm comparing apples to apples when it comes to insurance principles. I'm sorry you refuse to see how ALL insurance works. When you have a certainty for risk(claims payout, pre-ex, retroactive coverage) isnurance companies(auto coverage, homeowner, health) all operate the EXACT SAME WAY, they will deny the claim. With the current legislation that will change with health insurance only, the result will be increased premiums to cover the increased payouts.

Except you still refuse to understand that the risk distribution is different in health insurance. By making it a impossibility to do certain types of risk segmentation, at the same time you make insurance mandatory, you force companies and people to pool risk along a person's lifetime.

That is at least "less bad" than the current system, with its perverse incentives for adverse selection .

Of course, in the end it still means that private, for profit basic health insurance is still worse than most public systems.

I'm not sure there's anything left to discuss here. You refuse to see how basic insurance principles work, I assume because you are not in the industry. When you force a company to take on people with pre-ex's premiums will rise. When you force a company to put maximums on how much a covered person is responsible to pay premiums will rise. Don't believe me, doesn't matter.

Is your claim to being right here solely that you "work" on the industry?

Alas, let''s break it down:

You force insurance companies to cover pre-existing conditions. All else being constant, premiums should rise. But all else is NOT constant. By prohibiting companies from risk segmentation like that, you essentially end the practice of competition through coverage of only low risk individuals. Then, of course, you have the other side of the coin: mandatory coverage. With that, you end the adverse selection effects on the other side of the coin: young people not having insurance because they are very low risk. As such, you move towards the ideal of pooling risk across one's lifetime. Premiums would only go up if those currently uninsured were those uninsurable, but that is simply not true. The currently uninsured are mostly low risk young people who are under or unemployed.

With the current system you get closer to the risk pooling ideal of considering the entire lifetime, because EVERYONE will die.

Of course, this is still suboptimal, but in a private insurance for basic healthcare setting it is actually an improvement.

If out of pocket maximums weren't being capped then they would only marginally rise. But since this legislation also caps out of pocket maximums as well as removes the cap for lifetime benefits premiums will rise. So taken as a whole insurance companies have no choice but to raise premiums to cover their exposure.

this thread really makes me wish that insurance was 100% not-for-profit.

This is all speculation without taking into account the numerous factors that apply here, such as the risk distribution of the uninsured being included in the risk pool, increased access to maintenance and preventive care, and so on.

And again, if that is the outcome, it will be simply another reason for why single payer universal health care is far superior to for profit basic health insurance.

Why does everyone insist on blaming insurnace companies for the outrageously high costs of treatment in this country?

Saying a single payer system is better is not the same as blaming insurance companies. It is a mere recognition of the fact that healthcare is a right that private markets will often fail to provide.

As for who is to blame for increasing healthcare costs in the US, part of it is this insane system that is employment based and driven by risk segmentation. But a major part of it, beyond any doubt, is significantly higher overhead costs.

Ok, i can atleast see your point of view on this.

I have a serious question now that isn't meant to be condescending or glib or anything like that. In my opinion, Medicare, Medicaid, Social Security, all of which are govn't run programs, though well intentioned, are a complete disaster. They are all broke and they are all being severly abused. How does the govn't think it can run something as massive as Single Payor in this country(I understand it may work in other countries, but I'm talking about this one) when all the other social programs they currently run are seriously flawed?

based on what are you saying that medicare, medicaid, and social security are any more flawed than their counterparts?

For starters, the President, when outlining his plans for paying for this bill, stated that He wanted to fix the inefficiencies and wasteful spending in medicare in order to pay for this latest govn't plan. Both medicaid and social security are abused on a daily basis.

I didn't dispute that there is waste and abuse. I am asking based on what do you think that they are any worse than their private counterparts (nevermind the fact that many of these programs exist precisely because the market didn't want to provide those services).

My point is that you want to blame insurance companies for the rediculously high costs of treatment. By having the govn't pay for these treatments instead of insurance companies, all you would be doing is changing the method of payment, not the cost of payment. It is at best a lateral move

We've talked about this before: every single payer system in the world has lower overhead costs than the US's current system. And all it takes is a stroll through the HR department of any company to see how many people are there simply to deal with the health insurance part of it, or through the billing department of any hospital, and it's clear why.

And as I said, it is a lot less about the health insurance companies being "evil" and a lot more about a competition model that is driven by cost segmentation and a market that is employer based.

I pay close to $100 every pay (it would be $300 if I included my son and wife), now because of that I would love to find a market open for individuals and be able to pay a lower premium. But that is not available.

Instead of government coming in and taking over, entering my life and soon making decisions because they have to now worry about medical costs.... why not subsidize a market for individuals. IT takes the burden off the employer, allows the individual to decide how much coverage how much he/she wants to pay.

Why should a 25 year old pay the same amount as me for health insurance? I admit, I'm older and more of a risk, especially with a known condition (Sarcoidosis). Maybe the employer can have several programs through different companies to choose from and you pick what is best for you.

There are so many other options government could have gone and taken that would have been far cheaper and better fo ALL PEOPLE. The one they chose to jam down our throats is wrong, plain and simple.

I'm sorry but now your doing the very thing you accuse me of doing, speculating. Other countries aren't this one. Now let's say your right for a moment, wouldn't you then be eliminating a large number of jobs from just about every company in this country, specifically HR departments?

So you are saying that an inefficient system should be sustained because of the jobs involved?

And other countries aren't this one, some basic economic principles still apply. It is simple logic. You eliminate overhead costs associated with maintaining and providing several different types of insurance, and costs go down. There is no hidden variable that would counterbalance this here.

But if you need evidence from this country, medicare is significantly more cost effective than private insurance:

Assessing the Viability of Medicare: Testimony for The Joint Economic Committee Hearing

http://content.healthaffairs.org/cgi...t/22/2/230.pdf

By the way, overhead costs associated with medicare are estimated as being between 2 and 5% of all costs. Private insurance has 16 to 31%....