3 ms·

I think you misunderstand my question. In a perfect world, you'd keep 100% of the premiums and never pay a cent to a healthcare provider because everyone is he

by Nrsolis 10y ago

I think you misunderstand my question. In a perfect world, you'd keep 100% of the premiums and never pay a cent to a healthcare provider because everyone is healthy, right? In a terrible world, every single one of your insured has a chronic, long-term expensive to treat condition that requires you to pay tons of money to providers. In the first/perfect case, premiums are zero, right? In the second/terrible/worst case, you're not making zero money because your (collected premiums - minimum payout) > 0. See where I'm going with this? In a world with healthy people, there is little need for health insurance and spending trends towards zero. There isn't a need for an insurer. Your company can only exist in a world with sick people.

tunesmith 10y ago
I don't see how that point has any value. It's kind of like calling Social Security a ponzi/pyramid scheme. It's only true if children cease to exist. Similarly here, your point only has value if sickness and accidents cease to exist. But that won't happen. The market for health insurance naturally exists already. And the incentives for increasing health care costs are very much what the ACA is about - those incentives are being affected by things like the ACA rewarding quality-of-care instead of fee-for-service, etc.
- Nrsolis 10y ago
  I'm for aligning incentives. Quality of care is a good direction but doesn't go far enough. We need to get real price transparency into the market so people understand what it costs to treat lung cancer and what the probabilities are that they'll actually get better. Do you think the average person on the street really knows what it costs to undergo a round of chemotherapy? Does the EXACT SAME procedure performed in different hospitals across town cost the same? These are important questions and there doesn't seem to be any political will to actually answer them. And my suspicion for this state of affairs is that the interests of the players in this game is for nobody to really know what things cost because if they did the game would change. And we can't have that, now, can we.
  - ubernostrum 10y ago
    Interestingly, Medicare is a slight counterexample to your comments, because you can -- given motivation to sit down and collate the necessary public data sources and understand the rules -- calculate what rate Medicare allows for a given procedure. And since providers who accept Medicare have agreed to those rates, it means that for Medicare, at least, you can find out the price (or the ceiling of the price, which is what people often want to know anyway). Note that this doesn't mean the same procedure costs the same at every provider, though; Medicare rates include a geographic adjustment, among quite a few other factors, but it does mean you can work it all out for yourself.
  - Nrsolis 10y ago
    Interesting that you should bring up Medicare. I'd encourage you to read pages 23-28 of the following paper from the Mercatus Center. You'll find that prices for Medicare reimbursement are set by a committee largely stacked by the AMA, a de-facto lobbying group for doctors. They aren't likely to support any schema that cuts reimbursement rates for their members. https://www.mercatus.org/system/files/Feldman-Medicare-Role-Prices-oct.pdf https://www.mercatus.org/system/files/Feldman-Medicare-Role-...

by Nrsolis 10y ago

tunesmith 10y ago

I don't see how that point has any value. It's kind of like calling Social Security a ponzi/pyramid scheme. It's only true if children cease to exist. Similarly here, your point only has value if sickness and accidents cease to exist. But that won't happen. The market for health insurance naturally exists already. And the incentives for increasing health care costs are very much what the ACA is about - those incentives are being affected by things like the ACA rewarding quality-of-care instead of fee-for-service, etc.

Nrsolis 10y ago
I'm for aligning incentives. Quality of care is a good direction but doesn't go far enough. We need to get real price transparency into the market so people understand what it costs to treat lung cancer and what the probabilities are that they'll actually get better. Do you think the average person on the street really knows what it costs to undergo a round of chemotherapy? Does the EXACT SAME procedure performed in different hospitals across town cost the same? These are important questions and there doesn't seem to be any political will to actually answer them. And my suspicion for this state of affairs is that the interests of the players in this game is for nobody to really know what things cost because if they did the game would change. And we can't have that, now, can we.
- ubernostrum 10y ago
  Interestingly, Medicare is a slight counterexample to your comments, because you can -- given motivation to sit down and collate the necessary public data sources and understand the rules -- calculate what rate Medicare allows for a given procedure. And since providers who accept Medicare have agreed to those rates, it means that for Medicare, at least, you can find out the price (or the ceiling of the price, which is what people often want to know anyway). Note that this doesn't mean the same procedure costs the same at every provider, though; Medicare rates include a geographic adjustment, among quite a few other factors, but it does mean you can work it all out for yourself.
- Nrsolis 10y ago
  Interesting that you should bring up Medicare. I'd encourage you to read pages 23-28 of the following paper from the Mercatus Center. You'll find that prices for Medicare reimbursement are set by a committee largely stacked by the AMA, a de-facto lobbying group for doctors. They aren't likely to support any schema that cuts reimbursement rates for their members. https://www.mercatus.org/system/files/Feldman-Medicare-Role-Prices-oct.pdf https://www.mercatus.org/system/files/Feldman-Medicare-Role-...