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#1 May 12 2016 at 6:18 PM Rating: Good
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At work, our health insurance premiums have been relatively low for a long time. In the 10 years I've worked here, They haven't budged at all. I haven't looked up relative costs, but I think it's really cheap. For my single coverage, it's $10.50 per week. Compared to what my parents pay (not thru an employer), I know it's a huge savings.

But they have taken steps to reduce costs to avoid increasing premiums. No smoking anywhere in the shop. And last year they did a "Health Risk Assessment". Where you could voluntarily sign up to get blood tests and some other stuff at a Clinic, and recommendations on how to improve.

Apparently that did not work well, and this year they are making it less voluntary. Kind of.

Get a Risk Assessment, and see a doctor about it (don't have to do anything about it, but you have to at least talk to a doctor) and you are flagged as "Compliant" and you won't see a premium increase. If you don't get the Assessment, or you don't consult a doctor about the Assessment, you are flagged as "Non Compliant" and your premiums will increase 75-100%.

Now, ya, ok, bound to happen. But the issue was with the way that the HR presented the idea in their presentation.

They basically said "Here is the Health Risk Assessment system *details*. If you don't do this, your insurance premiums will increase."

But what they should have said is "Your insurance premiums are going to be increasing. But here is a system you can participate in to stop that."

It's a minor change, but it changes how people feel about the setup drastically. The Former presents premium increases as a penalty for non compliance. But the latter presents a premium discount as a reward for compliance. HR really dropped the ball with their presentations, and now a large portion of the work force is pissed off. As one person put it, "They want me to pay 100 dollars per month or let them poke and prod me."

Most of use knew a premium increase was coming. I mean, 10 years without any change, and all the new factories we had opened, the employees paid higher premiums.

I know though, that this is just the first step toward risk based scaled premiums. Seems only the next logical step. First it was voluntary risk assessments. Now it's "mandatory" risk assessments, but you don't have to do anything about them. And I'm sure as they realize people really still aren't doing anything, they will make it so the number of risks flagged will cause an increase in premiums.
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#2 May 12 2016 at 7:09 PM Rating: Default
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How exactly did you think the focus on "preventative care" in the ACA would shake out at the business level? I get that your main beef appears to be not about what they're doing, but how they are dressing the windows around it, but it's still the same thing. Would wording it differently really have changed that much? I get that a good percentage of the population are dumb as rocks, but this is the sort of thing even most dumb people see right through.

Welcome to the brave new world of mandated health care. And yeah, for the record, my company also implemented a voluntary risk assessment thingie about 6 months ago or so too. They approached it slightly differently. Basically, you get like $500 into your health account if you participate, but nothing if you don't. What's interesting is that the organization that handles the tests isn't your primary care source, or even technically a "health care" organization. Which means that they aren't actually bound by doctor patient rules and while they promise not to share details about your specific health to your employer, there's nothing legally preventing them from doing things like selling the data they collect to medical research organizations (and in fact, they directly stated that the data would be consolidated and sent to some such org that I can't remember the name of now). I declined.

I suspect we'll see more of these kinds of things going on as a means of defraying the costs lumped into the health care system by the ACA. Insurers will provide kickbacks to companies based on how many of their employees they can get to participate in these sorts of things. Meanwhile the organizations that do the testing can sell the data to other groups, and pass some of that back to the insurers for doing their part in the whole scheme. And I suppose as long as they actually keep their promises not to release individuals specific data to anyone (or their records aren't compromised at some point in the future), there's no harm.

But I wouldn't count on that over any sort of long term. The value, as you say, of targeted health care based on that data (for your own good, of course!) is just too great. I'm quite sure that people who already decided that forcing people to buy health insurance even if they don't want or need it on the grounds that it'll make it cheaper to provide health care to other people wont even blink at using the data collected by these risk assessments to help make each individual healthier and thus cost less (in theory) over their lifetime. If that means forcing overweight people to participate in diet plans, and forcing smokers to sit through anti-smoking seminars (or even mandate that they take smoking cessation products), then that's what they'll do. It's all for the "common good", right?

Edited, May 12th 2016 6:16pm by gbaji
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#3 May 12 2016 at 7:50 PM Rating: Excellent
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gbaji wrote:
If that means forcing overweight people to participate in diet plans, and forcing smokers to sit through anti-smoking seminars (or even mandate that they take smoking cessation products), then that's what they'll do. It's all for the "common good", right?

Maybe. But we're well behind the rest of the world when it comes to health coverage so maybe you can point to some nations where this happens as a cautionary tale. I mean, they've been doing this for years and years so it should be easy to find this logical conclusion and tell me which countries force you into a diet plan or require you to wear nicotine patches.
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#4 May 13 2016 at 2:31 AM Rating: Excellent
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Are there other countries out there with such a convoluted way of making sure everyone has health coverage? Don't the ones that make sure everyone has health coverage use a universal health care model and not ******* health insurance?


Also, did you relocate to Mexico or some other "3rd" worldlike country? Who the **** still allows smoking on the shop floor?



Edited, May 13th 2016 5:36am by Uglysasquatch
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#5 May 13 2016 at 6:55 AM Rating: Excellent
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Uglysasquatch wrote:
Are there other countries out there with such a convoluted way of making sure everyone has health coverage?

I hope not.
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#6 May 13 2016 at 8:02 AM Rating: Good
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Those other countries where it's working despite it being impossible to do so don't really have people going out of their way to sabotage it, too.
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#7 May 13 2016 at 9:41 AM Rating: Decent
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Uglysasquatch wrote:
Also, did you relocate to Mexico or some other "3rd" worldlike country? Who the **** still allows smoking on the shop floor?


I remember when they stopped allowing smoking in bars. Lots of people were pissed because who doesn't smoke when they drink. Then they did it, and I'll tell you, I wouldn't go to a bar where people are allowed to smoke now, or even 5 years ago when I was still smoking. You don't realize how bad it is until it's gone. Allowing smoking in a work place is just stupid, shop or not.
#8 May 13 2016 at 9:58 AM Rating: Excellent
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TirithRR wrote:
I know though, that this is just the first step toward risk based scaled premiums. Seems only the next logical step. First it was voluntary risk assessments. Now it's "mandatory" risk assessments, but you don't have to do anything about them. And I'm sure as they realize people really still aren't doing anything, they will make it so the number of risks flagged will cause an increase in premiums.
They went with exercise requirements here. Basically you could avoid the premium increase if you exercised 20min 3x a week, logged it in online, and filled out a health assessment survey. Then they started increasing the amount of time required for exercise every year. Eventually it was a minimum of 40 minutes, happening more often. Kids and whatnot being what they are I had to bow out of the program at that point. Hard to find 40 minutes of uninterrupted free time several times a week.

gbaji wrote:
The value, as you say, of targeted health care based on that data (for your own good, of course!) is just too great.
It's where the money is for better or for worse. Nothing like having a marker that's a trigger for a condition in 35% of cases, along with an insurance system that will subsidize the test. Smiley: rolleyes

Uglysasquatch wrote:
Are there other countries out there with such a convoluted way of making sure everyone has health coverage? Don't the ones that make sure everyone has health coverage use a universal health care model and not ******* health insurance?
This is what happens when you're desperate enough to get legislation passed that you agree to let the people who will be making money from the system write the rules. Handing over your health care system to a oligopoly is a mistake most countries aren't dumb enough to make. Alas we're special... Smiley: frown
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#9 May 13 2016 at 4:47 PM Rating: Decent
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someproteinguy wrote:
They went with exercise requirements here. Basically you could avoid the premium increase if you exercised 20min 3x a week, logged it in online, and filled out a health assessment survey. Then they started increasing the amount of time required for exercise every year. Eventually it was a minimum of 40 minutes, happening more often. Kids and whatnot being what they are I had to bow out of the program at that point. Hard to find 40 minutes of uninterrupted free time several times a week.


I would hope you find that ridiculously intrusive.

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It's where the money is for better or for worse. Nothing like having a marker that's a trigger for a condition in 35% of cases, along with an insurance system that will subsidize the test. Smiley: rolleyes


Yup. Now follow this to the next logical step.

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This is what happens when you're desperate enough to get legislation passed that you agree to let the people who will be making money from the system write the rules. Handing over your health care system to a oligopoly is a mistake most countries aren't dumb enough to make. Alas we're special... Smiley: frown


Yes. This is the problem. Although I don't agree with the broad oligarchy term, the point here is that the worst system is one that is run privately but funded/mandated publicly. You need to pick one "side" and use that, not try to do something in the middle. One of the major complaints from us crazy conservatives was that all the "problems" the Left raised about our existing health care system was the result of this sort of frankencare process we've build up over the decades, with government regulations and mandates fueling private health care systems profit motives, resulting in rising costs. The problem is that the ACA simply doubles down on the same broken parts of the system, making it even less free market than it was before, but still including profit motives. Thus guaranteeing a poor result.

The theory being that the objective wasn't really to make a "better" health care system, but to make the one we have so broken that in another 20 years or so the public will demand that we move to a 100% government funded system. So yeah, it's about intentional sabotage, but not in the manner many think. And yeah, when we talk about the problems and abuses, they are the result of this half-way system. Saying "but it works great in systems with 100% socialized medicine" fails to address the point. That's not what we have, and it's not what most people want (today). We could have a great health care system without the problems of the ACA (or even those prior to it), and *also* without the liberty loss issue of a public system, but we'd need to go in the opposite direction and move towards a completely privatized health care system, and get the government out of the industry entirely.

Get rid of mandates. Get rid of insurance requirements. Make it a free market industry. Do that and the industry will be forced to lower its prices to a level that people can afford. Decrease the number of steps between the buyer of the product and the seller and the cost will go down. Every time. Will that solve every problem and provide everyone perfect health care? No. But no system will do that. What it will do is make it actually more affordable for everyone. You hate the fact that pharma companies charge hundreds of dollars per pill for new medicine? Imagine if insurance didn't cover it. What would the cost be if everyone using it had to pay out of their own pockets. Would this still possibly price things out of range of the most poor among us? Sure. But it would make it affordable for everyone else. I think that the government controlled system throws the baby out with the bathwater. Out of a desire to make health care "affordable" for the poor (via subsidies and transfer payments), it actually makes it less affordable in real terms for everyone, thus requiring that everyone get subsidies and transfer payments to obtain health care.

That's an insane system IMO. And yes, it's made doubly insane when the folks running the health care system have a profit incentive to mile the public funds as much as possible. The left has done the same thing to the health care industry now that they did to the housing industry back in the late 90s. And we're already seeing that bubble forming. We're going to make health care "affordable" to people who can't actually afford it, and in the process the real costs will artificially rise. Until the market can't really sustain it anymore. Then it will collapse, and the government will step in and take over.


Which, I suspect, was the plan all along. When your strategy is to never let a crisis go to waste, it kinda helps you out to do what you can to ensure that as many crises occur as possible.
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#10 May 16 2016 at 11:08 AM Rating: Excellent
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gbaji wrote:
I would hope you find that ridiculously intrusive.
It was annoying at the very least. I can't argue that it wasn't effective though, it definitely did get me exercising more, up until the point it wasn't practical of course.

gbaji wrote:
the point here is that the worst system is one that is run privately but funded/mandated publicly. You need to pick one "side" and use that, not try to do something in the middle.
Aye, yes that's my biggest thought on the matter as well. The oligopoly comment is just, frankly, I don't think there's sufficient competition in the health care industry for a free market economy to work in the present state (for the record it's not just me thinking this, if you google 'health care oligopoly' you'll see several articles written on this over the last 5-10 years addressing the problem). This is beyond the problem of something like a small town having a single hospital, even in the large cities you're in a position where a handful of companies control the vast majority of the market. Obamacare has only made this worse by driving consolidation as doctors and other care providers have been increasingly forced to "choose sides" in these insurance wars or be left outside everyone's network and not be able to have patients afford their care at all. The health care 'markets' have ironically likely done more to help with price-fixing than anything else.

Now I'm no expert in how we get that to happen, of course. I'd love to see things without so much interference, but I'm afraid without action to break up the existing larger companies, or lower the barriers to entry into the market any "free market" alternative isn't going to get itself to an efficient or otherwise desirable outcome. You could mandate that both in-network and out-of-network providers be applied the same insurance rate, but that feels way to heavy handed, and there's probably a mile-long list of downsides to it.
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#11 May 16 2016 at 12:04 PM Rating: Good
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Gbaji wrote:
Do that and the industry will be forced to lower its prices to a level that people can afford


Huh? No they won't. Not even a little bit.

The problem with health care being a private industry is you can't not get health care. It's a necessity and laws prevent you from getting your own medications without using that industry to get a prescription. If I can't afford to go to the doctor I'm going anyway because I have to. Then, because I can't pay the bill, your taxes are going to end up paying for my visit and everyone else's costs are going to go up because I'm a deadbeat.

There is NOTHING good about a private health care system. Money should not be the primary motivator in keeping people alive.
#12 May 16 2016 at 12:19 PM Rating: Good
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Yodabunny wrote:
Not even a little bit.
Even though that's not what happens anywhere else in the world, it just would here.
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#13 May 16 2016 at 12:29 PM Rating: Excellent
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Yodabunny wrote:
Then, because I can't pay the bill, your taxes are going to end up paying for my visit and everyone else's costs are going to go up because I'm a deadbeat.
Probably not so much. Even if we're being un-humanitarian about it, and assuming you aren't nearing the end of your natural life, it's probably worthwhile to treat you even if you show up and have no way to pay. You'll likely contribute more a good amount more to society than your hospital bill or prescription or whatever will cost. Ironically if we provide full universal "free" coverage to everyone under 60, then simply cut you loose and made you pay your own way after that we could lower healthcare costs. End of life costs and elder care are the vast majority of the costs in our society.

Pretty picture.

Edited, May 16th 2016 12:16pm by someproteinguy
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#14 May 17 2016 at 9:20 AM Rating: Decent
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When I first got my job in 2003 my monthly premium was $80 per month. A doctors visit cost me $10 and I had no out of pocket for any in-network treatment all the way from blood tests to surgery for my family and I.

Now It cost me $200 a month. My doctor visits cost me $20, my family is 80/20 until a 2000 dollar deductible is met. Every time my wife has blood work done it costs us over $100. IT cost us close to $3000 to have our son back in 2013 and it was a standard childbirth. That doesn't include all the deductibles we had to pay for Ultrasounds, blood work, etc leading up to childbirth.

In 2010 our railroad union tried to strike when the company announced the medical changes to our dependents going from 100% to 80/20 but Obama, using the power given to him by Reagan involving transportation unions, forbid us from going on strike saying we would work it out with the employer. Yea we worked it out all right... we get 80 20 just like they said we would.

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#15 May 17 2016 at 11:59 AM Rating: Decent
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It cost me nothing for all of our children. 2 were C-sections, 1 emergency. I don't pay to go to the doctors, so when I'm old I'll have fewer issues because I don't hesitate to get things checked out when something isn't right, the cost of my care will be cheaper overall because of this.

I pay $6.50 a week for prescription and dental coverage through work.

Your complaints about your health care premiums wouldn't exist if your country would just take the health care system in house and treat everyone properly. You'd pay 10% in taxes what you spend on your health care for less restricted service.
#16 May 20 2016 at 6:04 PM Rating: Good
Insurance is personal here, not connected with your employment, but with your income.

Basic insurance is mandatory and if you're unable to work or without work you will be compensated up to the full amount.
#17 May 24 2016 at 5:48 PM Rating: Good
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So I guess this thread is about Health Insurance.

I learned something last weekend. I get my insurance through my employer. And it's paid with pre-tax dollars. My dad does not, and his premiums are paid with after-tax dollars. It also costs him much more. Easily 10x. And at the end of the year, my paid premiums are deducted from my gross income. His are not. Of course there are a bunch of rules and limits and various ways that he could get some deducted, based on actual expenses, and whether or not he itemizes or takes the standard deduction. Etc, Etc. But in the end, my paid premiums are deducted outside of this Standard v Itemized stuff.

So I'm sitting there talking with him, and just thinking... "Why?"

If they really wanted to make Health Insurance more affordable to lower income brackets, wouldn't a very simple step to take just be making paid premiums deductible from gross incomes even if you get your insurance outside of an employer policy? I mean, for someone like me, my premiums are such a small part of my overall income that the deduction actually makes little to no difference. But for someone like my father, premium costs could approach 10% of their income.

In the end the whole "pre-tax" and "after-tax" stuff just seems like BS to me. I mean, to me, it doesn't really matter when the money is actually taxed. At the end of the year I deduct the premiums from my income and they are no longer considered "taxed". Seems like it'd be pretty simple to let another person do that. I'm aware that there would likely need to be a cap on how much could be deducted, but simplifying it into it's own straight forward deduction just seems like a simple step to me.
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#18 May 25 2016 at 7:48 PM Rating: Decent
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Yodabunny wrote:
Gbaji wrote:
Do that and the industry will be forced to lower its prices to a level that people can afford


Huh? No they won't. Not even a little bit.


Yes, they would. It's just hard to see this because we already exist in a system where health care costs are massively inflated due to government mandates (which existed pre-ACA, just to a lesser degree).

Quote:
The problem with health care being a private industry is you can't not get health care. It's a necessity and laws prevent you from getting your own medications without using that industry to get a prescription. If I can't afford to go to the doctor I'm going anyway because I have to. Then, because I can't pay the bill, your taxes are going to end up paying for my visit and everyone else's costs are going to go up because I'm a deadbeat.


Health care is a necessity. But health insurance is what we pay. The problem is that you pay for the cost of insurance based on the entirety of what that insurance covers, not necessarily what your actual direct health care costs are. And since it's being paid in one big bucket, there's little incentive for anyone to keep costs down. I just don't think you realize how much of your costs have nothing to do with the actual cost of your care, and have a lot to do with those costs being spread around to pay for super expensive medical devices and pharmaceuticals. A company marketing an MRI machine has zero need to decrease their cost (and will in fact crank it up) because they know the hospital will just spread the cost for that MRI machine into the bills every patient has to pay. And the patient doesn't care because his insurance is paying it. And the insurance company doesn't care because they just pass that on to the purchaser. And the purchaser doesn't care because he's just taking that out of his labor costs for his employees and they don't see it, unless they're paying attention to their wages being flatter over time than they should be.

Of course, this screws over the self insured, or direct payers. But they're in the minority. But that's why those costs are so high. If *everyone* self payed, it would be vastly less expensive. You'd pay just for the care you received.

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There is NOTHING good about a private health care system. Money should not be the primary motivator in keeping people alive.


That has nothing at all to do with this though. Money is already involved. The difference is that we've created a system that effectively grants free money to folks who are 4+ steps removed from the patient seeking care. That's what drives up prices. Again, it's not about health care, but health insurance, what it must provide, and thus how that creates a cost inflating effect. Obamacare mandates that everyone must purchase health insurance. That's a doubling down on the problem, and not in any way a solution (much less anything that could possibly be expected to make healthcare more affordable).

TirithRR wrote:
If they really wanted to make Health Insurance more affordable to lower income brackets, wouldn't a very simple step to take just be making paid premiums deductible from gross incomes even if you get your insurance outside of an employer policy? I mean, for someone like me, my premiums are such a small part of my overall income that the deduction actually makes little to no difference. But for someone like my father, premium costs could approach 10% of their income.

In the end the whole "pre-tax" and "after-tax" stuff just seems like BS to me. I mean, to me, it doesn't really matter when the money is actually taxed. At the end of the year I deduct the premiums from my income and they are no longer considered "taxed". Seems like it'd be pretty simple to let another person do that. I'm aware that there would likely need to be a cap on how much could be deducted, but simplifying it into it's own straight forward deduction just seems like a simple step to me.


Ironically, that's exactly the issue that the GOP proposed as a counter to Obama's plan. Mccain had an whole plan back in 2008 to replace the existing pre-tax/post-tax inequity with a tax credit that everyone received equally. So whether your employer paid for your insurance on your behalf, or you purchased it directly, you got the same credit. The thinking was that this would reduce costs because people would seek out insurance plans that provided them just with what the actually needed, rather than the so called "cadillac" plans.

The GOP also pushed for things like allowing people to buy insurance out of state, thus increasing competition (so many more options for consumers which always tend to lower prices), and tort reform to prevent silly high malpractice insurance (which would also decrease costs for consumers of health care). But hey, we all know that the GOP didn't actually have any alternative ideas to Obamacare because that's what we were told repeatedly, right? Right?


Instead, what did we get? Um... The same broken system we already had, only now we're required to buy into it, even if we don't want or need to. That helps how exactly? The ACA doesn't change how costs are spread through the system. It doesn't remove the profit incentive for third party vendors to crank up their prices and profits at the expense of the patients wallets. If anything, it increases those problems since now even the healthy have no choice by to pay for it. All it does is increase the size of the pool of free money for those looking to enrich themselves from it.

It's a terrible law. So horribly flawed. Oh, and the kicker is that along the way, out of a desire to appear to be caring about the health of the people (or whatever) the law resulted in a horrible ruling by the SCOTUS, which has firmly established the precedent that the government can force you to do something you don't want to do, just because it'll benefit someone else. Um... Which is basically the opposite of individual liberty. So yeah, bad on so many levels that it's not even remotely funny.

Edited, May 26th 2016 6:10pm by gbaji
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#19 May 25 2016 at 10:04 PM Rating: Good
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gbaji wrote:
The difference is that we've created had and continue to have a system that effectively grants free money to folks who are 4+ steps removed from the patient seeking care.


Yes. They are called insurance companies. Do you have any idea of the breakdown of where the premium dollars go? Because the vast majority of those dollars are held by the companies (it's called "gross profit") and not to paying medical bills. The insurance company profit should be ~15-20%, not 66%+.


Romney was right about at least one thing, and that was a single payer system.
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#20 May 26 2016 at 7:44 AM Rating: Good
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gbaji wrote:
So yeah, bad on so many levels that it's not even remotely funny.
Well, the part where you play innocent is kind of funny.
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#21 May 26 2016 at 12:25 PM Rating: Excellent
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Friar Bijou wrote:
gbaji wrote:
The difference is that we've created had and continue to have a system that effectively grants free money to folks who are 4+ steps removed from the patient seeking care.


Yes. They are called insurance companies. Do you have any idea of the breakdown of where the premium dollars go? Because the vast majority of those dollars are held by the companies (it's called "gross profit") and not to paying medical bills. The insurance company profit should be ~15-20%, not 66%+.
Insurance companies, hospitals, health care networks, pharmacies, etc. TBH they're so intertwined at this point with various networks and alliances that it's not worth separating out different entities. The reduction in competition mixed with various means to hide the true cost from people makes it difficult for prices to go anywhere but up. You'll never get anyone undercutting you on price because of the "out-of-network" pricing structure that's rampant in today's system. You'd have to build the entire pipeline from doctors, to medical centers, to pharmacies, to patents, to insurance, and the rest just to get your foot in the door.
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#22 May 26 2016 at 4:03 PM Rating: Good
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someproteinguy wrote:
Friar Bijou wrote:
gbaji wrote:
The difference is that we've created had and continue to have a system that effectively grants free money to folks who are 4+ steps removed from the patient seeking care.


Yes. They are called insurance companies. Do you have any idea of the breakdown of where the premium dollars go? Because the vast majority of those dollars are held by the companies (it's called "gross profit") and not to paying medical bills. The insurance company profit should be ~15-20%, not 66%+.
Insurance companies, hospitals, health care networks, pharmacies, etc. TBH they're so intertwined at this point with various networks and alliances that it's not worth separating out different entities. The reduction in competition mixed with various means to hide the true cost from people makes it difficult for prices to go anywhere but up. You'll never get anyone undercutting you on price because of the "out-of-network" pricing structure that's rampant in today's system. You'd have to build the entire pipeline from doctors, to medical centers, to pharmacies, to patents, to insurance, and the rest just to get your foot in the door.


There are a lot of middlemen in the system. Single payer would solve this.
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#23 May 26 2016 at 4:46 PM Rating: Excellent
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Timelordwho wrote:
someproteinguy wrote:
Friar Bijou wrote:
gbaji wrote:
The difference is that we've created had and continue to have a system that effectively grants free money to folks who are 4+ steps removed from the patient seeking care.


Yes. They are called insurance companies. Do you have any idea of the breakdown of where the premium dollars go? Because the vast majority of those dollars are held by the companies (it's called "gross profit") and not to paying medical bills. The insurance company profit should be ~15-20%, not 66%+.
Insurance companies, hospitals, health care networks, pharmacies, etc. TBH they're so intertwined at this point with various networks and alliances that it's not worth separating out different entities. The reduction in competition mixed with various means to hide the true cost from people makes it difficult for prices to go anywhere but up. You'll never get anyone undercutting you on price because of the "out-of-network" pricing structure that's rampant in today's system. You'd have to build the entire pipeline from doctors, to medical centers, to pharmacies, to patents, to insurance, and the rest just to get your foot in the door.


There are a lot of middlemen in the system. Single payer would solve this.
To be fair there's a lot of things that would be better. Problem is basically anything that would fix the system would result in less money for the medical industry.

The only reason we had the momentum necessary to get a pseudo-fix in the form of Obamacare in the first place was because it had the support of the medical community (I mean why would you oppose someone trying to give you more money?). It's unlikely we can get change without the various groups on board. Beyond the political sway the industry has, people in general aren't usually inclined to give doctors and hospitals less money (I mean people rarely ask for less treatments or less tests if they have the money to afford them), and it wouldn't take long to hear "Sorry your relative died, we used to use 'x' treatment in 'y' situation but it's not on the government approved list" or something similar. Breaking Americans addiction to overpriced healthcare will probably require cultural changes revolving around end-of-life decision making that we just aren't ready to swallow right now.

Edited, May 26th 2016 3:49pm by someproteinguy
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#24 May 26 2016 at 7:12 PM Rating: Decent
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Friar Bijou wrote:
gbaji wrote:
The difference is that we've created had and continue to have a system that effectively grants free money to folks who are 4+ steps removed from the patient seeking care.


Yes. They are called insurance companies. Do you have any idea of the breakdown of where the premium dollars go? Because the vast majority of those dollars are held by the companies (it's called "gross profit") and not to paying medical bills. The insurance company profit should be ~15-20%, not 66%+.


Sure. And the solution to that problem is to require everyone to buy health insurance? How the heck does that make any sense? So the insurance companies are cranking up costs, so we reward them by mandating that everyone must purchase insurance from them. Really? You get that aside from a couple window dressing changes, this is more or less all that Obamacare does.
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#25 May 26 2016 at 7:30 PM Rating: Decent
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Timelordwho wrote:
someproteinguy wrote:
Friar Bijou wrote:
gbaji wrote:
The difference is that we've created had and continue to have a system that effectively grants free money to folks who are 4+ steps removed from the patient seeking care.


Yes. They are called insurance companies. Do you have any idea of the breakdown of where the premium dollars go? Because the vast majority of those dollars are held by the companies (it's called "gross profit") and not to paying medical bills. The insurance company profit should be ~15-20%, not 66%+.
Insurance companies, hospitals, health care networks, pharmacies, etc. TBH they're so intertwined at this point with various networks and alliances that it's not worth separating out different entities. The reduction in competition mixed with various means to hide the true cost from people makes it difficult for prices to go anywhere but up. You'll never get anyone undercutting you on price because of the "out-of-network" pricing structure that's rampant in today's system. You'd have to build the entire pipeline from doctors, to medical centers, to pharmacies, to patents, to insurance, and the rest just to get your foot in the door.


There are a lot of middlemen in the system. Single payer would solve this.


Single payer would not solve this. Single provider, might, but that's an entirely different concept, with a huge amount of additional changes required. All a single payer system does is say that the government pays on your behalf (and you fund that cost via taxes rather than via insurance premiums). The problem is that this just adds another middleman to the equation. And frankly, a middleman that has even less desire or need to keep costs low than the insurance companies do now.

Insurance companies can spread the costs among their customers, but they still have to have customers willing to pay for the insurance. The government has no such limitation. You have to pay taxes. Period. They can hide the costs of the health care in the budget. So while today you can at least look at the dollar amount you are paying for insurance (or your employer is paying per person for their group policy) and get at least some clue as to how badly you're being boned. With the government as single payer? You have no clue. Because *you* aren't directly paying for health care at all. A percentage of your taxes are, and those taxes are not calculated based on your health risk factors and choices you make, but your income level alone.

So instead of today where there's a weak link between the buyer of health care and the providers of health care, in single payer there is zero link at all. Assuming you accept the logic that costs increases occur because of that disconnect, then you must conclude that it'll get worse with a single payer system. The only way it gets less expensive is if you socialize the health care provider industry. So the hospitals become government run facilities, and the doctors government employees. You have to go 100% to government control over the entire industry to have any chance of reining in costs, and even then there are potential problems. The government still isn't likely to directly run and control all the medical device manufacturers or pharma companies. So you still have the potential for a "free money" scenario going on. Right now, for a medical device manufacturer to sell units at an exorbitant price they have to wine and dine the money folks at the hospitals, and convince doctors of the necessity of their equipment and kinda hope for the best. If the government runs things, then campaign donations and hosting of events and fundraisers for politicians gets them in the door, and can become very corrupt very very fast. The right handful of government folks, with no knowledge of the actual value of some device in the health field, can wield enormous power over what devices get purchased (think "the machine that goes ping!").

As I mentioned earlier, costs can be managed best at the extreme ends of the scale. The closer you get to a free market privately run health care system, the lower the costs will be. The closer you get to a fully government run system at the other end, the lower the costs will be. Anything in the middle range will be more expensive, to the degree that the two are equally mixed. Prior to the ACA passage, we were maybe at the 30% mark (if you were to range from 0% government run to 100%). With the ACA we're floating right around the 50% mark now (ie: least efficient and most expensive location to be). That's why it was a bad law. It took everything that was broken about our health care system and instead of fixing those things, instead required everyone to use them even more. Terrible terrible law.
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King Nobby wrote:
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#26 May 26 2016 at 11:48 PM Rating: Good
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Quote:
Single payer would not solve this. Single provider, might, but that's an entirely different concept, with a huge amount of additional changes required. All a single payer system does is say that the government pays on your behalf (and you fund that cost via taxes rather than via insurance premiums). The problem is that this just adds another middleman to the equation. And frankly, a middleman that has even less desire or need to keep costs low than the insurance companies do now.


Single payer is not in addition to the various middlemen/billers, it is in lieu of.

It replaces the general health insurance system for routine & cato, but does not replace EoL, elective, and ultra premium care.
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