View Full Forums : Wait... I thought free enterprise was more efficient than government?


Panamah
05-10-2009, 10:03 PM
So, I can't quite reconcile this with the usual Republobabble. Health Insurance companies don't want the government to offer a health care option because they're afraid they can't compete.

Ummm... if they can't compete with the government then why the hell should they be kept around?

http://www.chicagotribune.com/news/nationworld/chi-tc-nw-health-care-0510may10,0,6617021.story

Tudamorf
05-10-2009, 10:30 PM
They're not afraid they can't compete.

They're afraid the government will offer a sensible, low-cost health care plan, as every other first world nation has.

And that will mean that they will no longer be able to price gouge and rape the consumer financially, as they're doing now, charging us several times more than they should just because they can.

Obama (with his Democratic Congress) has them scared shîtless because he has shown the political will to actually succeed in reforming health care, and because he isn't on their payroll.

That's why they're ready to surrender before he even makes a move. I suspect the $2 trillion they've offered is just the tip of the iceberg, and I hope he soaks those greedy evil bastards for every penny they've got.

Kamion
05-10-2009, 11:59 PM
The government can tax people and can run debts for decades at a time, the private sector can't. That's the difference. The government isn't actually saving money, it just can lay the costs on other people and on future generations.

But government run insurance programs are (generally) ran worse than private sector ones. I don't hear about the private insurance sector bleeding $60 billion a year to fraudulent claims. It's simple. If a private company pays out off of the insurance pool to fradulent claims, they go out ot business. If the government does that, Medicare employees still get their bonuses/promotions and just tell congress to give them more money (which btw, comes from us.)

Many countries with universal health coverage opt to have private companies provide/manage the actual insurance, the government just sets the guidelines (and fyi, those guidelines often include what the company is allowed to profit off of and what they're not.)

Panamah
05-11-2009, 12:27 AM
Well no, at some point (and I think we're close to being there) the government gets so far into debt that no one will lend anymore money. The US spends a larger percentage of GDP on health care than any other first-world country, and we're the only ones without guaranteed access.
Many countries with universal health coverage opt to have private companies provide/manage the actual insurance, the government just sets the guidelines (and fyi, those guidelines often include what the company is allowed to profit off of and what they're not.)
Right they're guaranteed a small profit and very, very regulated. And they have to insure everyone, not cherry pick like they do now.

AbyssalMage
05-11-2009, 04:33 AM
But government run insurance programs are (generally) ran worse than private sector ones. I don't hear about the private insurance sector bleeding $60 billion a year to fraudulent claims. It's simple. If a private company pays out off of the insurance pool to fradulent claims, they go out ot business. If the government does that, Medicare employees still get their bonuses/promotions and just tell congress to give them more money (which btw, comes from us.)


1) Insurance companies pay billions in fradulant claims every year, they pass the loss off to the rest of their client base in higher premiums or they simply cut services that are "high" in fraudulant claims. Goverment passes it off to tax payers, Insurerer pass it off to members. Not really seeing a difference.

2) Private companies refuse service to their own customers. Why? Often its too expensive and its easier to stick the customer with the bill. Unless you have government insureance or really great private insurance, the chances of you playing the phone game with human resources is really high. And your usually forced to go to a mediator to resolve the problem to force them to pay your bill if they don't stick it to you with fine print.

3) Insurance companies are in it to make a profit. Pure and simple. The more claims they deny, the more money they make. And being forced to use a mediator insures they keep their profits high. When All State (mabye it was State Farm, I get them mixed up) almost went bankrupt in 2005 (When all the flooding was happening), you watched on the news as they denied claims to everyone using fine print and loopholes in State Law to deny paying benefits. It wasn't until the public outcry that they changed course and put all the PR commercials on the TV.

4) The only run government run health program thats a shambles is in the US. Every other country has figured out how to run it correctly. Or at least so that it is self sufficient. None of the countries with universal health care have a problem running it. And they even have private health care to compete.


Many countries with universal health coverage opt to have private companies provide/manage the actual insurance, the government just sets the guidelines (and fyi, those guidelines often include what the company is allowed to profit off of and what they're not.)

And thats the way it should be ran. They are the professionals in the matter. The only thing the government should do/say is putting price caps on services and medicine and preventing the insurance companies from denying claims even if its a pre-existing injury.

Kamion
05-11-2009, 07:56 AM
we're the only ones without guaranteed access.
The only reason why there's guaranteed access is because they mandate you to buy health insurance even if you don't want it.

In countries like Switzerland and Holland, there's not "free" health care for all. If you're poor, government picks up the tab, if you're not poor, you have to buy your own. If you're poor in America, the government picks up the tab (medicaid), but unlike Switzerland and Holland, you don't have to buy insurance if you're not poor.

The only run government run health program thats a shambles is in the US. Every other country has figured out how to run it correctly. Or at least so that it is self sufficient. None of the countries with universal health care have a problem running it.
Japan.

And they even have private health care to compete.
In some countries, yes, in some countries, no. But it doesn't mean it's more efficient.

I like cola. I drink cola sweeten with corn syrup. Is it more efficient to sweeten cola with corn syrup than sugar? no, without government intervention, sugar is far cheaper. But government puts quotas and tariffs on sugar and subsidizes corn production; they make it in my self interest to drink cola with corn syrup, and I do.

In Germany, the only country with a true private vs public plan competition, it's essentially the same economic logic occurring. Even though people with private plans still need to pay some into the public plan, 10% of the population opts to use private plans.

=============================

Every country has vastly different health care plans. Don't think you know how every single country works just because you saw Sicko, which focuses on single-payer models, and even the countries featured in that have very different models.

Fyyr
05-11-2009, 12:03 PM
The US spends a larger percentage of GDP on health care than any other first-world country, and we're the only ones without guaranteed access.


Anyone in the US, citizen or illegal alien, has guaranteed access to healthcare.

Anyone can go into any hospital and be treated for any ailment, from splinter or blister to DM/DKA/HHNK, COPD, ACS, Stroke, or hangover.

And every hospital(that has an ED, or receives a dime of government money) is required to treat you, by law. And you don't have to have insurance or Medicare to do it(though the hospital will try and bill Medicare). It is free. And you can go back as many times as you like. Of course they will try and collect it from you, but if you are poor and don't have anything, then they certainly can't get anything from you.

Why is that so hard to understand?

You and everyone you have met has guaranteed access to healthcare in the US.


Caveat; there are like, last time I looked into it a few years ago, 5 hospitals in the whole US which are not covered by EMTALA.

Tudamorf
05-11-2009, 01:05 PM
Why is that so hard to understand?

You and everyone you have met has guaranteed access to healthcare in the US.People are so brainwashed by the media's sound bites of "XX million without health care" that they have trouble grasping this.

It's not that we don't have universal health care. It's that we have a horribly dysfunctional, inefficient, and costly universal health care system that is in desperate need of an overhaul.

For that matter, we already have a better working model, Medicare, that covers the most expensive patients. Surely we can at least extend this model to cover the least expensive ones.

Fyyr
05-11-2009, 02:08 PM
People are so brainwashed by the media's sound bites of "XX million without health care" that they have trouble grasping this.

It's not that we don't have universal health care. It's that we have a horribly dysfunctional, inefficient, and costly universal health care system that is in desperate need of an overhaul.

For that matter, we already have a better working model, Medicare, that covers the most expensive patients. Surely we can at least extend this model to cover the least expensive ones. Absolutely true, except for the last paragraph. Unless I misunderstand it.

Medicare is what hospitals bill for(to) all uninsured, and poor people who don't pay their bills.

Medicare is the uninsured insurance. That the uninsured don't pay into. But the uninsured get coverage from. And all poor people qualify for Medicare. And all people making a paycheck pay for.

Honestly, it is the KP model, which is the best model for healthcare. Of course everyone hates HMOs, and KP invented them.

Tudamorf
05-11-2009, 04:37 PM
Absolutely true, except for the last paragraph. Unless I misunderstand it.

Medicare is what hospitals bill for(to) all uninsured, and poor people who don't pay their bills.

Medicare is the uninsured insurance. That the uninsured don't pay into. But the uninsured get coverage from. And all poor people qualify for Medicare. And all people making a paycheck pay for.I think you're confusing Medicare with Medicaid.

Medicare is the standard universal health insurance for people age 65+. It is mostly funded by a flat 2.9% tax on all adjusted gross income (there's no limit, so rich people really help prop this system up), and if you've worked in the United States for several years you hardly need to pay anything extra to use it.

Medicare does not work like regular insurance, in that hospitals can bill whatever they want. Rather, Medicare pays a predetermined fixed rate per procedure or unit of hospital work, which is why some doctors don't accept it.

While it has its issues, it has been a working single-payer model for decades, and it covers the highest risk, most expensive patients. Surely if we can do that, we can cover the least expensive patients too.Honestly, it is the KP model, which is the best model for healthcare. Of course everyone hates HMOs, and KP invented them.That model was based on the underlying principle that you should provide people with the least health care possible, so you can make the most money off of them -- hardly a model I'd want our government to officially adopt.

Besides, today Kaiser Permanente is one of the more expensive health care plans out there. For example, for me, it's nearly triple the cost of my own plan, plus I'd be stuck with their hospitals, their doctors, and their silly rules.

Panamah
05-11-2009, 05:30 PM
You only have access to medicaid if you're essentially broke or probably an illegal immigrant. The rest of us have to sell off all our assets or go bankrupt first. That might as well be no health care because if it comes down to meeting the monthly rent/mortgage payment or getting meds or a doctor's visit, the living expenses will come first.

Panamah
05-11-2009, 05:36 PM
But back to the original topic, of course Health care for profit is going to be more expensive. You have investors expecting to have a growing rate of return. You have extremely, some might say outrageously, highly paid executives. You have to advertise. And because of all these pressures to attend to the bottom line for investors, the consumer gets screwed over a lot.

What's so precious about that model that it is worth preserving?

Fyyr
05-12-2009, 01:27 PM
That model was based on the underlying principle that you should provide people with the least health care possible, so you can make the most money off of them -- hardly a model I'd want our government to officially adopt.

Unlike any other plan, KP works with a strong motivation for prevention. More than any other plan I know of. In that sense, your least healthcare comment is accurate.

And is inaccurate with virtually any other regard.

If your provider focuses heavily on say compliant glucose monitoring or smoking cessation, then obviously your incidences of expensive DKA/HHNK patients and COPD exacerbations go down. Saving money.

But, as a previous Associate member, and a present member, I have NEVER had a single case where I received less care than I have needed. EVER.

And the anecdotal stories that have been told to me by aquiantences, the actual problems with the KP system, lie heavily if not wholey on the complaintant, not KP.


Besides, today Kaiser Permanente is one of the more expensive health care plans out there. For example, for me, it's nearly triple the cost of my own plan, plus I'd be stuck with their hospitals, their doctors, and their silly rules.
It is more expensive because there is rarely a member who has to pay any deductible, and the copays are very inexpensive.

And about a third of the patients are still Medicare patients. With Medicare not paying the actual cost of care. If a procedure or X care costs $1000 to provide, and Medicare pays 500 because of DRG, then the remaining 500 has to be made up somewhere else. KP makes it up with individual Associate plans. Notwithstanding their HSA, which is probably the very best, and least expensive, and most overall lucrative(for the insured) for a healthy person to have.

Group rates are much more competitive, of course. But you are not an employer of say 100K employees, so you don't see that. Most employers see pretty comparable costs between a Blue Cross premium per employee compared to a KP premium.

Whether or not it is ethical to balance the books on Associate or individual(non group) plans is a moot point. Because in a universal KP plan model, there would be no individual plans.

Deducible plans are always going to be less expensive, not just from the saved money of the differential. But because they are a social engineering system, designed to deter those with minor compliants from seeking healthcare in the first place.

And besides, iirc, your plan excludes a huge population set from the group you are in. OB and maternity, and neonatal care are very expensive. Iirc, your plan excludes all of that cost. Something you could not do with a 'real' universal plan.

Fyyr
05-12-2009, 01:36 PM
You only have access to medicaid if you're essentially broke or probably an illegal immigrant. The rest of us have to sell off all our assets or go bankrupt first. That might as well be no health care because if it comes down to meeting the monthly rent/mortgage payment or getting meds or a doctor's visit, the living expenses will come first.
How many poor people do you know, Pan?

Besides the guys mowing your lawn, now many Mexicans do you know?

You can still have soaking wet clothes from swimming the river, and get free healthcare in California. Hell, you are down by SD, and you don't know that.

We get Mexican mothers all the way up here by Stockton, coming up to give birth on your dime, so that their kids have dual citizenship, and so they don't have to pay anything for their child's birth. They make the journey on a regular basis, to the point where the nurses know their names before admit.

How many poor people do you personally know who have EVER been denied healthcare in the last 30 years? I have worked at WalMart, have been unemployed, and poor. I have tons of unemployed and completely broke or Welfare friends. And I don't know a single one of them who has EVER been denied healthcare when they needed anything taken care of.

So you personally know anyone who has had to sell off all their assets to get healthcare?
I don't. And I bet I know a lot more sick people than you know, and a lot more people who access the healthcare system.

I will tell you though, that my grandparents who just passed away 2 years ago sold their home to move into a retirement/care community up in Reno. But that is what they bought their home(s), and saved up for in the first place. You can't take it with you, and being born with a plastic spoon in my mouth I have never expected any inheritance.

Tudamorf
05-12-2009, 08:08 PM
Unlike any other plan, KP works with a strong motivation for prevention. More than any other plan I know of.Well, all I can tell you is that I had a Kaiser plan for many years, and they didn't give me a single incentive to do anything preventative.

Blue Cross, on the other hand, offers me free stuff and incentives for preventative care, like cheap screenings. It's nothing extravagant but still more than Kaiser ever did.But, as a previous Associate member, and a present member, I have NEVER had a single case where I received less care than I have needed. EVER.I don't think they provide less care now, it's just that the whole Kaiser model was originally premised on providing the least care possible. That's not a model we should be adopting, even if in the end we have to stray from it.It is more expensive because there is rarely a member who has to pay any deductible, and the copays are very inexpensive.Check again. For Northern California, they have two sets of plans, one set without a deductible that is absurdly, mind-bogglingly expensive, and one set with a deductible that is the expensive one I'm talking about.

Bottom line, Kaiser is pretty damn expensive, especially when you consider all their limitations.

And large-company group is a whole other matter entirely. It's essentially a single-payer socialist national health care system, except not quite at a national level. Like any socialist system, the majority of young, healthy, hard-working employees end up supporting an old, sick, and feeble minority, and that's why it works.

Tudamorf
05-12-2009, 08:12 PM
So you personally know anyone who has had to sell off all their assets to get healthcare?I think Panamah's point is that while the poor get a free pass, much of lower-middle class are screwed, because they sometimes can't afford health insurance, but the hospital still has an incentive to go after them for the bill since they have some assets.

Tudamorf
05-12-2009, 09:38 PM
But back to the original topic, of course Health care for profit is going to be more expensive. You have investors expecting to have a growing rate of return. You have extremely, some might say outrageously, highly paid executives. You have to advertise. And because of all these pressures to attend to the bottom line for investors, the consumer gets screwed over a lot.If you are claiming that non-profits are inherently more consumer-friendly than regular businesses, you are wrong.

The profit these types of businesses see is typically very small compared to the total revenue that the customers give them.

The real driving force is expenses, which will exist in either system. And that includes those "outrageously, highly paid executives" and advertising, which either a nonprofit (or governmental) or a for profit business will have.

The government is notoriously bad at giving the consumer the best bang for his buck, and private sector is much better at it. However, there is some things that the government must do, despite its inefficiency, because they work against the incentives of private businesses.

Panamah
05-12-2009, 10:17 PM
It's odd though that all the governments in the world that have health care manage to do it cheaper than we do. Hmmm....

Tudamorf
05-12-2009, 10:30 PM
It's odd though that all the governments in the world that have health care manage to do it cheaper than we do. Hmmm....That's just because they use an inherently more efficient, and sane system.

Our system, where we refuse to pay $100 to let you see a regular doctor, but insist on paying $10,000 to make you see that doctor at your local ER, is retarded.

Not to mention, we grossly overpay our doctors and nurses, as well as the lawyers who profit off of them.

"Retarded" is actually a generous term for our system.

Fyyr
05-13-2009, 02:35 AM
Well, all I can tell you is that I had a Kaiser plan for many years, and they didn't give me a single incentive to do anything preventative.
I would be pretty sure in betting that you are already a healthy person. I doubt you are fat, and I know you don't smoke.

I don't think they provide less care now, it's just that the whole Kaiser model was originally premised on providing the least care possible.
I don't know anything about that.

The model I know about, was based on the idea that physicians would be on a salary, get paid the same no matter what procedures they do, or how many.

It had the initial incentive of attracting MDs to remote mining communities, with guaranteed paychecks. But at a lower amount than what an average fee for service MD was making at the time. And removes any real incentive to do unnecessary procedures just because the Tahoe cabin mortgage payment is due.

It is the model that was adopted by most Euro nationalized healthcare systems(KP invented it). It certainly was advocated by MM in Sicko.

Incidently, KP still pays their Docs less than what one could make on his or her own. And KP RNs are the highest paid nurses in the nation. And there are two reasons for that.

With the best RN to patient ratio in the nation, as well. It is an increased level of care. KP is VERY compliant with the ratio law here in California, they have to be, the CNA is very vigilant and powerful, even for being a relatively small union. Second, the nursing shortage increases the cost of RN labor.(I don't know what KP RN/patient ratios are in other states).

You can outsource much of what a Doc does, Russia is experimenting with that right now with video doctoring. You can't outsource anything an RN does. The opposite, hospitals have to 'insource'. They are forced to bring over RNs from other countries, because there are not enough qualified RNs produced in this country.

My last appointment with a KP Doc was over the phone. Not only was that a huge cost and time saver, it was huge increase of convenience to me. I had never encountered that before, and don't know how long they have been doing that.


That's not a model we should be adopting, even if in the end we have to stray from it.Check again. For Northern California, they have two sets of plans, one set without a deductible that is absurdly, mind-bogglingly expensive, and one set with a deductible that is the expensive one I'm talking about.
It is expensive. I agree. I am pretty sure you would doubt my veracity or sanity, if I told you how much they take out of my paycheck for my coverage each month.

Bottom line, Kaiser is pretty damn expensive, especially when you consider all their limitations.
I don't know what limitations you are speaking of. When I bought my own KP plan, they did not screen for pre-existing conditions. Unlike BS or BC, or any of the other plans I researched at the time.

When I have researched their HSA a couple years ago, they did not have any exclusions for pre-existing conditions.

And large-company group is a whole other matter entirely. It's essentially a single-payer socialist national health care system, except not quite at a national level. Like any socialist system, the majority of young, healthy, hard-working employees end up supporting an old, sick, and feeble minority, and that's why it works.
Insurance is by definition, a socialist notion. Shared risk to prevent individual loss, or cover individual. Not in the Marxist sense, of course, for insurance companies or insurance providers have been around for several hundred(or even a couple thousand) years before he was born.

Shakespeare's Shylock in Merchant of Venice was essentially an insurance provider.

Fyyr
05-13-2009, 02:39 AM
It's odd though that all the governments in the world that have health care manage to do it cheaper than we do. Hmmm....
We expect a higher level of care than those in other countries.

We expect those who care for us, RNs, RTs, and RadTechs, to be more educated and smarter.

Our pharmacists are required to be doctors now. No more bachelor or masters level pharmacists here. Even pharm techs are highly educated and trained, and certified.

Lab techs are bachelor or masters level biologists.

Joint Commission compliance adds a huge overhead. Infection control, identifying, and isolating antibacterial resistant organisms has added a huge cost to our system.

We are also more obese, per capita, than any other country. That is a HUGE cost addition.
Largest smoking population.
Largest drug using population.
Largest IV drug using population.

The lawyer tax on our healthcare is MUCH greater here than in any other country, as well.

It is not odd at all.

Kamion
05-13-2009, 10:22 AM
It's odd though that all the governments in the world that have health care manage to do it cheaper than we do. Hmmm....
Government care isn't inherently cheaper, it must be managed in a way to make it cheaper. In the US, just like in Germany etc, government is the price maker, private insurance companies are the price takers. Other countries use their government to lower cost. We use government intervention to raise costs.

There is no will in congress to use the existing program to lower costs. It's silly to think that Washington will make serious steps to lower costs by merely making another public plan when they haven't done it in the existing infrastructure.

There is also no will in congress to do price controls over price controls over insurance. When people say "universal health care" lower costs, they're neglecting the fact that mandates (ie the universal part) have no effect on cost, it's the price controls that do. And you can have price controls without mandates.

Want to know something funny? The model most democrats (Clinton, Edwards, etc) have based their plans on in the past was Switzerland, yet you rarely hear about that. Want to know what country has healthcare costs almost as high as ours? Switzerland. (They spend a lower % of GDP on health care, but their GDP is far higher so the dollar values are similar.) Is this because the Swiss model can't lower cost? Nope; it can. Holland uses a similar model and keeps costs down. But Switzerland is the biotech power house of Europe and they're timid to destroy those industries like England and Germany did.

Panamah
05-13-2009, 10:35 AM
I haven't gotten around to reading it yet but it looks interesting: Why Does U.S. Health Care Cost So Much? (Part I) (http://economix.blogs.nytimes.com/2008/11/14/why-does-us-health-care-cost-so-much-part-i/)

Ummm hmmmm
One thing Americans do buy with this extra spending is an administrative overhead load that is huge by international standards. The McKinsey Global Institute estimated that excess spending on “health administration and insurance” accounted for as much as 21 percent of the estimated total excess spending ($477 billion in 2003). Brought forward, that 21 percent of excess spending on administration would amount to about $120 billion in 2006 and about $150 billion in 2008. It would have been more than enough to finance universal health insurance this year.

The McKinsey team estimated that about 85 percent of this excess administrative overhead can be attributed to the highly complex private health insurance system in the United States. Product design, underwriting and marketing account for about two-thirds of that total. The remaining 15 percent was attributed to public payers that are not saddled with the high cost of product design, medical underwriting and marketing, and that therefore spend a far smaller fraction of their total spending on administration.
...
One of these is an earlier McKinsey study explaining the difference in 1990 health spending in West Germany and in the United States. The researchers found that in 1990 Americans received $390 per capita less in actual health care but spent $360 more per capita on administration.

AbyssalMage
05-17-2009, 03:14 AM
Speaking from personal experience and 2nd hand knowledge (i.e. My direct family) if you have KP as health insurance, I pray for you and hope you are safe!!!

I had KP for 6 months (forced to through my job) and went to see a doctor for a health problem. If it wasn't for me being insistant I would of probally walked out of the hospital with some drugs and a pat on the back w/ "call me in the morning." Being insistant got me a check up and tested. Ended up getting a call 2 days later for a return visit and the drugs I really needed to get over the crap I came down with.

And the crap my family has gone through in Oregon and Washington is horrible.

So if you have had a good experience with KP and you or someone you know hasn't died, count your blessings! Ill stay away from KP and try my luck in the emergency room.

Universal Health Care FTW, privately run, government monitored

Kamion
05-17-2009, 11:47 AM
I had KP for 6 months (forced to through my job)

You mean that individuals make better choices about their health care purchases than employers do? Unpossible.

Fyyr
05-18-2009, 03:53 PM
Speaking from personal experience and 2nd hand knowledge (i.e. My direct family) if you have KP as health insurance, I pray for you and hope you are safe!!!

I had KP for 6 months (forced to through my job) and went to see a doctor for a health problem. If it wasn't for me being insistant I would of probally walked out of the hospital with some drugs and a pat on the back w/ "call me in the morning." Being insistant got me a check up and tested. Ended up getting a call 2 days later for a return visit and the drugs I really needed to get over the crap I came down with.

And the crap my family has gone through in Oregon and Washington is horrible.

So if you have had a good experience with KP and you or someone you know hasn't died, count your blessings! Ill stay away from KP and try my luck in the emergency room.

Universal Health Care FTW, privately run, government monitored

You are very non specific with what your problem was.

I have NEVER had, nor my family, has ever had a problem with KP healthcare. In terms of service. Highest level of service. Over a probably 15 year span, come and go.

And you don't need to pray for me, I'm an Atheist.

And I have no idea what level of care you are comparing it to.