Study: When Counting Premiums, US Workers Heavily Taxed

[PetraG]

But as you likely recall, it died as soon as critics started screaming about “socialism.”

I do not get people who decry a common health care system as “socialism” when they don’t feel that way about nationwide postal delivery, interstate freeways and other public works projects such as running electricity out into rural areas where it is not “cost effective.” There are times when private enterprise is the most sensible way to deliver goods and services and there are instances where having a nationwide public infrastructure to take care of common problems is just the most sensible way.

Honestly, I think a nationwide network of public infrastructure for people who don’t have shelter falls into that category. The courts will not allow criminalization of destitution in the form of outlawing public camping by people who have no other place to go. It is in the public interest to have places for the destitute to exist in safety so that having them camping in the street can be eliminated. Even forgetting that it is a disgrace to have the poor treated that way, public camping by the destitute is unsafe, it is unsanitary, and it is a drag on businesses in areas with high numbers of destitute people. I think the solution needs to be national because every locality has the reasonable fear that if they solve their local problem they’ll attract the destitute citizenry from across the country.

As I’m sure you’ll acknowledge, sometimes they deserve the lawsuit. I’ll have to dig it up, but I remember seeing a 2006 study showing that only a tiny fraction of malpractice lawsuits met the definition of “frivolous.” Given that medical incompetence is killing 100K-400K Americans annually, this shouldn’t surprise any of us.

That doesn’t change the fact that a lot of tests and procedures are done primarily in anticipation of a lawsuit that will claim that their absence was negligent when in fact their inclusion is almost always overkill. That’s not a good use of medical resources.
And by the way, since when have we gotten to the point that when someone who makes a mistake, it is incompetence? Fear of litigation really isn’t the best way to deliver the most low-fault medical care possible. (As an example: fear of litigation leads people to fear open admission of mistakes and near misses.)

My husband now needs a root canal for a once-minor filling that his dentist botched. We could sue, but why? And how? Only the rich can afford that sort of legal counsel. A root canal is a lot cheaper.

I’m suggesting a system where mistakes like that are tracked in order to improve care, but the cost of necessary care is not astronomical. Why should the rest of us pay for your husband’s dental care? Because people with healthy teeth and gums have fewer health problems and the fewer of those problems in the population, the higher the productivity and the less of a person’s life needs to be covered by very expensive end-of-life care.

 

[blackforest]

That doesn’t change the fact that a lot of tests and procedures are done primarily in anticipation of a lawsuit that will claim that their absence was negligent when in fact their inclusion is almost always overkill. That’s not a good use of medical resources.

Agreed. Defensive medicine isn’t helping any of us. Fear of lawsuits is one thing. Reality is quite another.

 

[DarkLight]

Patent evergreening is a big problem. Companies can effectively hold on to a patent forever and keep necessary care incredibly expensive.

The big issue with medical care too is that often we don’t have another option. With food, for example, there are many different things I can eat. If the price of beef goes up too much I’ll eat chicken or beans.

I’m suggesting a system where mistakes like that are tracked in order to improve care, but the cost of necessary care is not astronomical. Why should the rest of us pay for your husband’s dental care? Because people with healthy teeth and gums have fewer health problems and the fewer of those problems in the population, the higher the productivity and the less of a person’s life needs to be covered by very expensive end-of-life care.

I’ve pointed out cases like my own too. I was very young when serious health problems hit. Not offering medical care wouldn’t just have caused personal issues, but quite likely put me on long-term disability, or some other form of welfare or charity. I’d be willing to bet over my lifetime the government’s going to get back more in taxes from me than was spent on my medical care.

 

[Theo520]

Actually… why not improve the ACA Exchanges,

Nothing is stopping progressive states from pouring more money into their ACA Exchanges. Suggest you ponder why they are not doing so.

I guess this is a case where we’ll need to stand up to special interest

Yes, we agree on this point. They are the reason ACA ended up being such a train wreck, they wrote the law for Obama.

 

[PetraG]

Agreed. Defensive medicine isn’t helping any of us. Fear of lawsuits is one thing. Reality is quite another.

Exactly. We don’t have the airline safety we have because the airlines were afraid of being sued. We have the safety we have because research into how things go wrong have lead to protocols that prevent accidents even though it is a given that human beings are prone to certain errors. That requires people being able to open about when they had near-misses or less-than-optimal performance, for instance.

 

[PetraG]

Yes, we agree on this point. They are the reason ACA ended up being such a train wreck, they wrote the law for Obama.

Honestly, I think Obama was willing to push for a law that even he knew was not a long-term answer in the belief that once people had something, they’d push for better but not want to lose what they got. Presidents since Nixon have tried to improve our system of delivering and paying for health care. A lot of times, the pursuit of the perfect has been the enemy of achieving even the good.

I didn’t believe President Trump as a candidate when he said that he had a beautiful plan for a health care system that would cover everybody better and cost less than Obamacare, but that doesn’t mean that I don’t believe it can be done. I do believe it can be done. Honestly, I think everybody in Congress does, too. I just didn’t believe Mr. Trump because if he’d have really had something, he would have been more specific by no later than the week after election. When he starts waving his hands and making generalizations about what he can accomplish, I take that with a big grain of salt because the chances are that he’s not nearly as far along in his project as he implies that he is. Maybe he has something but doesn’t see an advantage in revealing specifics, but maybe there is a big nothing behind the red curtain. It happens.

Bill Clinton was a lawyer, Reagan was an actor and Donald Trump is a salesman. You just have to know that going in and adjust your interpretation of what they say accordingly.

 

[Theo520]

f we lived in a world where we didn’t know what percentage private health insurance companies spend on administration and profit and what our current government-run insurance plans spend on administration

This statement shows gross ignorance on how the world operates. (it’s a Bernie talking point )

Medicare piggybacks off Social Security, so administrative costs such as enrollment, payment and keeping track of patients are still being incurred, but not counted. There are many reasons it’s an apples and oranges discussion to compare admin costs.

Private insurers also do more than pay claims and occasionally go after fraud (a hidden expense in medicare). They check its appropriateness, whether it is medically necessary and if it can be done is a cheaper way) outpatient vs (name removed by moderator)atient). The right kind of admin expenses actually sames costs and improves outcomes.

I’d say the only real savings would come from reduced marketing costs.

I could go on, but I’ve not seen you want a serious discussion. You prefer talking points.

 

[Sarcelle]

They check its appropriateness, whether it is medically necessary and if it can be done is a cheaper way) outpatient vs (name removed by moderator)atient).

Who are the ones checking for the appropriateness of a medical procedure? Are they medically trained or are they bean counters with no medical training?

I suspect the latter.

 

[Theo520]

Who are the ones checking for the appropriateness of a medical procedure? Are they medically trained or are they bean counters with no medical training?

I don’t know, but I’m confident there are some Govt regulations in place covering this.

Do you imagine Govt healthcare wouldn’t need to perform a similar administrative oversight?

 

[Pattylt]

Do you imagine Govt healthcare wouldn’t need to perform a similar administrative oversight?

Since WE are the government and vote for our representation, I would trust a government entity devoted to healthcare to represent my interests much better than a profit motivated business with shareholders to please. Whoever winds up running our healthcare, I would hope that the motivation was improved health as the priority rather than an entity that must prove profitability first and foremost!

 

[Theo520]

Since WE are the government and vote for our representation, I would trust a government entity devoted to healthcare to represent my interests much better than a profit motivated business with shareholders to please.

I’m guessing you know nothing about how the VA has operated for decades.

I would hope that the motivation was improved health as the priority rather than an entity that must prove profitability first and foremost!

Costs will always be contained, it happens in socialized medicine as well. They refuse treatment due to the perceived cost/benefit, orchestrate long wait times, and don’t offer cutting edge treatments.

 

[whatistrue]

I’m confident there are some Govt regulations in place covering this.

Why? I am not at all confident of that for the simple reason that insurance companies tend to get what they want from “our” representatives. As my father said long ago, “The banks may own almost everything, but the insurance companies own the banks”. No, I don’t have references and I am not prepared to prove it; it was just a world-weary working man giving his view of how things were.

 

[PetraG]

Who are the ones checking for the appropriateness of a medical procedure? Are they medically trained or are they bean counters with no medical training?

I suspect the latter.

Just having physicians “checking for the appropriateness” will still lead to vastly different opinions on standard of care. Look at what is allowed by different state medical boards.

I’m guessing you know nothing about how the VA has operated for decades.

The VA is a non-typical system-within-a-system. For better and for worse, I’d expect a national health care system to be quite different in how would operate than the VA. (For instance, if a veteran decides that he or she prefers to use the private health care they can get through their jobs, that is a cost savings for the VA.

The problem I see in our health care system is that (a) it is mandated that everybody be treated for serious issues but not mandated that everybody have health coverage and (b) those with some money but no health insurer get taken to the cleaners when they are forced to go in for care.

It is a really absurd system, when you think about it. The more one learns about it, the more Alice in Wonderland it gets.

 

[DarkLight]

Just having physicians “checking for the appropriateness” will still lead to vastly different opinions on standard of care. Look at what is allowed by different state medical boards.

Yeah, there’s a limit to what can be done by someone who hasn’t hands on examined the patient, honestly. I know it can be a pain for any of us who have non-standard reactions to certain treatments. Insurance will really push what should work with a given patient, even if it doesn’t actually work.

 

[Theo520]

Why? I am not at all confident of that for the simple reason that insurance companies tend to get what they want from “our” representatives. As my father said long ago, “The banks may own almost everything, but the insurance companies own the banks”. No, I don’t have references and I am not prepared to prove it; it was just a world-weary working man giving his view of how things were.

Naturally there is significant state oversight. The conflict between insured and insurer is hardly a new thing.

 

[PetraG]

Yeah, there’s a limit to what can be done by someone who hasn’t hands on examined the patient, honestly. I know it can be a pain for any of us who have non-standard reactions to certain treatments. Insurance will really push what should work with a given patient, even if it doesn’t actually work.

Well, and there are physicians out there who want to put themselves “above” evidence-based medicine. (I won’t name names, but there are states this kind of doctor will move to in order to do what they want whether there is evidence for the efficacy of their treatments or not.)

 

[DarkLight]

Well, and there are physicians out there who want to put themselves “above” evidence-based medicine. (I won’t name names, but there are states this kind of doctor will move to in order to do what they want whether there is evidence for the efficacy of their treatments or not.)

That’s sort of the hard balance here, honestly, to strike with regulation. What do you do for people who are kind of at the edge of evidence-based medicine? I know I’m one of those people where many treatments - mostly drugs - don’t work the way the evidence says they’re supposed to work. There’s some very experimental genetic testing that might help, but really not much solid. Too much regulation runs the risk of not being able to figure out ways to treat people when we don’t have solid evidence. Not enough allows practices to flourish that may be hurting rather than helping.

 

[blackforest]

It’s a super fine line to walk. Some physicians, especially those who are hospital employees, are bound and gagged by protocol and insurance demands. I’m all for evidence-based care so long as there’s wiggle room to listen to each patient and treat each one as an individual.

In my experience, the best physicians are gifted with sharp listening skills and a strong intuition, and sometimes those Dr. House-types can successfully defy protocol with successful results. I’m not advocating for every Tom-Dick-Harry quack out there who marches to their own beat. I just think it’s important to strike a balance between the science of medicine and the art of medicine.

 

[Sarcelle]

Just having physicians “checking for the appropriateness” will still lead to vastly different opinions on standard of care. Look at what is allowed by different state medical boards.

Are bean counters whose priority is profitability in any business to make decisions on medical care with no training? These decisions can be life or death.

Is a person’s life of less importance than the profits of an insurance company?

First they have no training, second their priority is profit over lives.

I see a problem here.

 

[whatistrue]

Naturally there is significant state oversight

Most US states do have an Insurance Commissioner or equivalent that is supposed to oversee the insurance companies doing business in that state. The problem is that not all of them (some would claim very few of them) actually provide real oversight and control.