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Fantastical notions of universal healthcare aside.. This was to be expected, and it won’t be well received. It’s also not necessary, and shouldn’t happen. Much
by digi59404 7y ago
Fantastical notions of universal healthcare aside..
This was to be expected, and it won’t be well received. It’s also not necessary, and shouldn’t happen. Much of the US Healthcare expense when insurance companies are involved is fake.
For example, last week I got a medical statement from my insurance. The total cost was a couple grand. I paid 20$ co-pay, and insurance paid a couple hundred. The remainder was “negotiated down, look at this great value your insurance provided!”
If I were to pay out of pocket the 220$ instead of my health insurance premium that month I could have easily paid it. The same is true for emergency surgeries, the actual medical cost of things like brain surgery is around 10-15k. Atleast at some providers, and not hospitals that gouge.
My point here is - Insurance companies have spend decades rewriting the healthcare system to their advantage. They’ve spent years boosting the cost of healthcare, while paying only a fraction and making the remainder of the money disappear. Hospitals have spent years reducing costs while charging 100k for some surgeries in hopes they’ll get even 20k. And have 80k “negotiated”.
There’s plenty of money in the system between insurance companies and healthcare systems. The resolution here isn’t single-payer. The resolution is to force insurance companies to pay their fair share instead of hoarding money.
There’s no reason they should increase their rates right now. They should be breaking into their reserves to handle this.
- jjoonathan 7y agoBack when I took health care policy class in college, we did a cost breakdown / comparison tree between the US health care system and others. One striking result was that each head of the hydra -- hospitals, insurance companies, drug companies -- did a remarkable job of evenly sharing the ~2x cost inflation factor vs other countries. Of course, each head of the hydra points at the other two and claims it isn't the problem.
- karatestomp 7y agoI’d replace “hospitals” with “care and testing providers generally” but yeah, I reached the same conclusion looking into this on my own. Each is screwing us a ton, which adds up to 3x a ton, but they can always say “don’t look at me, I’m not most of the problem!”
- jjoonathan 7y agoI'd accept that pull request.
- digi59404 7y agoThis difference here is it’s not about the cost. Those are fake. Its about what is paid. The United States has non-discriminatory laws in place where healthcare providers can’t charge two groups different pricing. So what happens is hospitals and such charge insurance 100k for a service, and then discount it down to 20k. The cost of the service is reported as 100k, but the paid amount is 20k. Because of this individuals are forced to pay 100k if they don’t have insurance. Or if they don’t negotiate a rate on healthcare. This creates an environment where individuals feel they MUST have health insurance. Because of that health insurance companies are treated like they’re essential and can’t fail. It’s all a fake fucking sham. None of this is necessary.
- jjoonathan 7y agoNo, those numbers were real, post-negotiation, money-changing-hands numbers. US hospitals are actually 2x more expensive. If you looked at hospital pre-negotiation asking prices, I'd expect them to be worse still. The insurance company side of this pissing contest is "nobody forces hospitals to list insane prices, certainly not us, but we can give you the leverage to make sure they don't stick -- good luck managing that on your own!"
- api 7y agoI blame the insurance companies based on the simple calculus that they are the ones in your list that add the least value. Drug companies and providers make things and do things. Insurance companies push paper. By your argument we could dispense with them, save 1/3, and lose nothing.
- kasey_junk 7y agoInsurance in the form of risk pooling is an extremely valuable service. The issue is that in the US the health insurers do way more than risk pooling. They also do gatekeeping, discounting, & provisioning. Plus there is an asinine indirection layer where their customers are employers instead of the covered. In a properly functioning health market there would be a very important role for insurance, our current market is just so insane it’s hard to see it.
- jjoonathan 7y agoInsurance only risk-pools by accident. In a world where they had perfect information, they would risk-smooth over your life, but not risk-pool between people. Collective plans, like those provided by your employer, would risk-pool, but then should we really attribute the pooling to insurance companies?
- kasey_junk 7y agoWe don’t live in a world with perfect information which is what makes all insurance valuable. So yes? We should give credit to insurance for providing value in the real world.
- jjoonathan 7y agoWhen I was asking "should we really give them credit," I was referring specifically to the imaginary world in which they had perfect information. I agree that we should give insurance companies credit for the value they accidentally create in the world that we live in -- so long as we keep in mind that the value creation was predicated on their inability to find & leverage information. However, going forward in a world of increasingly available information, do you think it is a good idea to rely on their inability to find & leverage information? I sure don't.
- dpflan 7y agoDo you know of sources/research that shows this "get-as-much-money-as-possible" and hoard it? I'm interested how insurance companies' financials show this.
- digi59404 7y agoQuick google reveals this might be of help. https://naic.org/documents/topic_insurance_industry_snapshots_2018_health_ins_ind_report.pdf https://naic.org/documents/topic_insurance_industry_snapshot...
- airza 7y agoAre you saying "fantastical" about a system that every other industrial nation has?
- throwaway_pdp09 7y agoDo you really need /S
- digi59404 7y agoWe’re not every other industrialized nation. There are major differences between the US and say Norway. Cultural, Geographical, Political, Legal, etc. Universal Healthcare isn’t part of this conversation, or this issue. So I’m not even going to waste time on it.
- claudeganon 7y agoKey point of conflict in the Democratic primaries, ACA under serious threat in the courts, insurance companies paying hand over fist to tank single payer, millions of newly uninsured...but not part of the conversation? Your personal Overton window is smaller than the current political reality.
- digi59404 7y agoI’m sorry, we’re any of those part of this article or my reply? No, they were not. Conversation does not mean “oh anything that involves health insurance anywhere in the world at any time”.
- claudeganon 7y agoNor does conversation mean your own suppositions, limits, or dictates. And of course, again, you began by referring to single payer in the US as “fantastical” at the top of the thread.
- intopieces 7y agoIt's the implementation in the United States that's a fantasy, not the system it self.
- defterGoose 7y agoThe solution is definitely single-payer. Otherwise you can't hope to eliminate the administrative bloat that is a Hallmark of the system and is responsible for so much of the extra cost.
- take_a_breath 7y agoGermany, Japan, Singapore and others seem to do it. If getting everyone covered at reasonable cost is the goal, single-payer is factually not the only solution.
- masklinn 7y agoTaiwan built up their universal healthcare system from scratch in 1995.
- claudeganon 7y agoGermany has a public option that covers a lot of people and the insurance industry is regulated to a degree that would make CEOs in the US scream, Japan has a draconian price schedule under a single payer system, and Singapore is more or less a managed economy dictatorship. These examples aren’t like each other nor evidence of the impracticality of a single payer system in the US.
- take_a_breath 7y agoArguing that these are too extreme actually weakens the case for single-payer because that would require more regulation and more draconian pricing. Meanwhile we could look at even more countries like The Netherlands, Switzerland, or even Denmark, Bernie Sanders’ favorite country to cite, managed without single-payer.
- claudeganon 7y agoI never argued that they were too extreme, only that referencing disparate systems in contrast to the US’ amounts to little more than a vague, incoherent gesture. I personally think we should have a nationalized health service.
- BurningFrog 7y ago> There’s no reason they should increase their rates right now. They should be breaking into their reserves to handle this. Last I heard health insurers weren't particularly profitable, and I'd be surprised if they have reserves of that magnitude. Very happy to be shown wrong with facts though!
- theshadowknows 7y agoYou’re correct! Insurance in America is a surprisingly low margin business!