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We need to get rid of health insurance companies. They are the reason all of our costs are massively inflated. The same thing is happening in education: unive
by jimrhods23 8y ago
We need to get rid of health insurance companies. They are the reason all of our costs are massively inflated.
The same thing is happening in education: universities know that a large percentage of students are getting financial aid, so the true costs are buried in a layer of bureaucracy.
Fees and administrative fees continue to go up and the universities will always get their money.
The students are then on the hook to pay the loan back. If the Universities actually had to worry about students defaulting, they would be forced to reduce costs or they would go under.
- badfrog 8y agoEven if all the bureaucracy of insurance went away, major operations would still likely be tens of thousands of dollars. How do you suggest people pay for that?
- thanatos_dem 8y agoWe all do! Something something single payer. Edit: not sure why the downvotes, that’s the reality of things. If you want a more fully fleshed out thought, here you go: We would all contribute to the payment of expensive operations via taxes in a single payer system. In the current system we have insurance payments. It’s effectively the same, paying a small fee regularly, to subsidize the costs for expensive procedures for yourself and (surprise) others. What do you think happens if you pay into insurance your whole life and never need an expensive operation? You’re subsidizing others. Otherwise the insurance companies would be out of business. But with single payer, we cut out companies in the middle pulling a heafty profit for effectively the same system as we could get via taxes. Better?
- conanbatt 8y ago> We would all contribute to the payment of expensive operations via taxes in a single payer system. That's just insurance, managed by the state. > But with single payer, we cut out companies in the middle pulling a heafty profit Oh boy. Lets say I concede, for the sake of argument, that government can run a private business with the same efficiency, and that the profits it would make as private are given back to its consumers (healthcare.gov cost almost 2 billion dollars to make, remember that. Or Blue shield is actually a non-profit, and its not gobbling up the space by reinvesting its supposed profits). To add to that, the profits of healthcare insurances companies are not that large: they have a 6% operating margin, lower than other insurance companies. Cumulatively, the big companies must have around 20~30 billion dollars a year in profits. It's a staggering number, but in the healthspace thats nothing: only the subsidy of tax-exemption for insurance benefits is estimated to be 260 billion a year. You could eliminate that benefit and expand medicaid: but that would help the poor, and wreck the rich and the middle class together, which is often politically unfeasible. https://www.axios.com/profits-are-booming-at-health-insurance-companies-1513302495-18f3710a-c0b4-4ce3-8b7f-894a755e6679.html https://www.axios.com/profits-are-booming-at-health-insuranc... https://www.verywellhealth.com/health-insurance-companies-unreasonable-profits-1738941 https://www.verywellhealth.com/health-insurance-companies-un...
- toomuchtodo 8y agoI’d still prefer the state over private insurance companies (Medicare is well run and popular). As Steve Jobs said about Dropbox, you’re a feature (insurance companies) not a product.
- conanbatt 8y ago> I’d still prefer the state over private insurance companies (Medicare is well run and popular). And I vote accordingly. Thats perfectly reasonable, but no need to make a single payer system for that. Just allow medicare to compete in the open market. Thats a much smaller program with a lot less risk. Unfortunately the chances of such a plan to succeed are nil. Thats why big healthcare reform proposals want to strong-arm the position, with single-payer proposals. Its true medicare is popular, but remember it's free insurance for its patients today. If you eliminated the medicare payroll tax and made it a monthly payment, I assure you old people will not have the same opinion on the topic.
- deleted 8y ago[deleted]
- vertex-four 8y agoThe NHS “competes in the open market”, so to speak - you pay taxes to get free healthcare for everyone, then you can get private insurance which picks and chooses what it wants to treat and dumps complex cases back on the NHS. Routine treatment is also dealt with by some combination of the NHS and private pharmacies (for flu jabs etc), generally speaking. Unsurprisingly, private health insurance is not very popular here. It’s mostly just something people get through work. And I’ll remind you that we spend less per capita on our healthcare than the US does. I’m sure that if there was actually demand to meet that spending, private insurance here would happily eat it up - but there just doesn’t seem to be.
- conanbatt 8y agoIf you get private health insurance, do you get your NHS contribution back? Thats what would make it "competing" in the open market. If you have to pay for it no matter what, there is no competition, there is double charging.
- dkashbfldls 8y agoMutual aid, same as any other problem. Presumably if there aren’t the resources or people or they deserve not having kids they won’t. Anything else is hard to justify at all.
- badfrog 8y agoWhat is mutual aid? I haven't heard that phrase before.
- obrisintor 8y agoCare to explain your logic? Cat repair isn't so expensive even though everyone with a car has car insurance.
- jimrhods23 8y agoYou don't need to take a gigantic loan from the government and pay the repair companies for their work.
- AnIdiotOnTheNet 8y agoCompetitive pressure. If your can't be fixed or you don't want to fix it you have alternative forms of transportation or you can purchase another one (either at full price or used). Also, many of us only carry liability.
- Sir_Vival 8y agoAnd it's well known that disreputable repair shops will ask you up front how much your insurance is paying you so they can get the full amount.
- jjordan 8y agoMaybe it's naive, but I always thought that Medicare played a big role in our inflated healthcare costs. Think about it: the number one demographic using the system has most/all their expenses covered by an entity that doesn't care how much things cost. Doctors and hospitals then price accordingly, and everyone else paying out of pocket gets screwed because the system is priced to favor its biggest users, who never see the bill.
- conanbatt 8y agoThis concept of "Cost shifting" exists, but there is some academic debate if its actually whats happening. Medicare also does something invisible to the patients: it pays the least and has the highest stringent requirements for providers. You need to be up to code to the last detail, you will be under scrutiny for your documentation, you have no bargaining power and medicare pays 20-50% less to providers than private insurance. It is also not the same as PPO's (which most employees in HN must have) you will have a lot fewer options for care. (remember, you can only get a doctor that collects a much smaller fee, so forget about swanky offices and convenient locations)
- yardie 8y agoMedicare is very cost conscious. So much so that some care providers would rather not accept it.
- conanbatt 8y ago> We need to get rid of health insurance companies. They are the reason all of our costs are massively inflated This is not correct. Insurance is a very valuable service to prevent high-risk events, and applying insurance is a very hard problem. You need to do economics, operations, fight fraud, etc. What does create price insensitivity (and thus doesnt allow for the competition that drives down prices and increases value to happen naturally) is that you use healthcare for menial transactions like annual checkups or sick visits. I find it incredible when people complain about the 150U$S annual fee on OneMedical, when a basic check-up visit is billed between 300 and 500 dollars. Or when people get surprised that a cancellation fee for a primary care visit is 100 dollars, when "their copay is only 20 bucks". In addition, another thing is that its tied to the employer, which means that you dont get to choose the insurance you want. If people had to choose their own insurance, insurances would cater to patients not to companies. This is probably the single most important change to do on healthcare reform, and one thing both Bernie Sanders and Republicans could agree with.
- jniedrauer 8y agoYou're misunderstanding the problem. Americans are not being bankrupted by annual checkups. Americans are being bankrupted by cancer and other serious health problems. And this is in spite of being insured. In practice, private insurance turns out not to be, as you put it "a very valuable service." Given a choice between death and bankruptcy, most people will choose bankruptcy. There is no downward pressure on the cost of medical care because there is no alternative. It's a situation that capitalist market dynamics are just not equipped to address. A state-run apparatus is the only thing that seems to work.
- conanbatt 8y agoThere are multiple reasons why healthcare is expensive in the US. Life ending or multimillion dollar diseases exist everywhere and the reasonable solution to that is insurance: that doesnt make healthcare expensive or cheap, or care good or bad. If you have a cancer that is estimated cost of care is 5 million dollars, neither private nor public insurance will make it cost less, and someone somewhere still has to decide if its covered or not. You cant have unlimited health care, because it requires human beings to deliver it. (at least today). > Given a choice between death and bankruptcy, most people will choose bankruptcy. There is no downward pressure on the cost of medical care because there is no alternative This is a common trope in this debate, but its not an economically sound argument. First of all, people choose this all the time: a european person does not sell their home and get indebted to pay for a trip to the us to get bleeding-edge 1% rate of success medical care for his unique condition. Second, its not medically sound. Medicine is absolutely practiced with economic considerations in mind. Care is not the same in the U.S. than say, an African country with hospital shortages. The doctors recommendation changes based on the patients sensibility to prices (for example, a doctor will not recommend highly expensive vitamins to the unemployed, or wont indulge in expensive out-of-coverage procedures for people who would find great economic suffering for the test alone). This latter part is a key missing education link that for some reason the public seems to misunderstand. Its strange because in actual education people understand that prices give different qualities, but someone reject the idea that healthcare doesnt behave that way. I have other counter-arguments to this notion of downward pressure, but fundamentally what makes prices low is competition. Any one would prefer bankrupcy to starvation, but thats not a problem with food isn't it.
- hippich 8y agoI agree, that in a form current insurance companies exists - i.e. perpaid medical discounts plan, they should be removed. People should be getting insurance from insurable events - i.e. accident, heart attack, etc. Not from routine vaccination, annual checkup, seasonal cold. High-deductible plans are a hack to get people to pay for more of routine stuff and I think it moves into the right direction.
- ams6110 8y agoExcept even on a high-deductible plan, the provider bills the insurer, they play their games with the price, and eventually you get a bill. There is no up-front price. There is no market pressure. You still don't know what you will need to pay until weeks or months later.
- hippich 8y agoThat's why I called it a hack and not proper implementation. While what you described is true - patients are hit with "real costs" instead of $10 co-pays and rising premiums. ideally - yes, most minor stuff would be paid out of pocket - market forces would immediately put things in a right place. And for emergencies - leave that to insurances.
- snovv_crash 8y agoSwitzerland does this right: there is an annual excess (which patients can choose, typically between $500 and $2500, and which is reflected in reduced premiums if you choose a higher excess) which is paid entirely by the patient, and after that the insurance kicks in for 90% of costs up to another threshold, after which the insurer covers everything. In this way the insurance is actually an insurance like a car insurance, and not some bastardized medical payment plan where incentives of different parties aren't aligned.
- hippich 8y agoThis sounds pretty much what high deductible plans are in the USA. Are there some other differences? Perhaps patients file insurance claims themselves?