Again, youāre talking about cost, not which youād prefer from a service perspective.
If you went to a restaurant and they ran separate charges every time you ordered somethingā¦ You wouldnāt consider that bad service?
Also, I went to the same physician when on Tricare, so itās the same exact service, minus all the billing hassle.
I think there are lots of opportunities to make costs lower, such as reducing patent lengths (reduces medication costs) and simplify insurance (reduces admin costs).
And I think you could do the same things and still lower the cost even more by banning privatized insurance?
Also, what is the profit motive for insurance companies to simplify their process? Their systems were purpose built to be as complicated and time consuming as possible, if they make the process easier, their subscribers would utilize it more, making insurance pay more often.
patents - reduce to 5-7 years; should cut costs of pharmaceuticals
insurance - simplify and standardize coverage; coverage details and bill processing should be automated
And again, why would corporations do this? And how would we enforce this?
The Medicare billing is automated, and pretty simple. Itās what every insurance company has the option of doing, but only Medicare and Medicaid have automated the process. This is because private insurance companies have no profit motive to pay for their prescribers healthcare.
publicly post costs of common procedures, and give expected, average, and maximum costs before any procedure
Most hospitals have this information available, especially if you call their financial services office. In fact if you are a Medicare patient this information is publicly available on the CMS website, and they list exactly how they came to that figure.
The whole hidden ledger thing is primarily only a problem at privatized hospitals that were bought or built by private hospital networks operating for profit.
I think we should also cap access to Medicare for retirees at a certain income level as well, and remove FICA tax caps.
The inherent problem with this is that the elderly are fundamentally uninsurable. You canāt make a profit from an elderly subscriber, the cost of their end of life care will always cost more than any subscription fee they may pay in.
This is why the vast majority of private insurance do not offer primary insurance to people older than 65. The whole point of private insurance is to extract money from healthy patients and then dump them onto Medicaid if they become disabled, or onto Medicare when they begin to age and decline in health.
We should absolutely be discouraging employer sponsored insurance and encouraging longer term insurance plans (e.g. like life insurance, you lock in at a lower rate if you sign up while healthy).
Who would offer those plans, and why? The only reason most people can afford private insurance is because their employer collectively bartered for the price. A lot of people have no idea how much of their employee compensation package is taken up by their insurance, but the burden of cost is redistributed by the entire employer pool.
Dropping someone from insurance shouldnāt be a thing at all, and the payout for doing so should be much higher than any costs the insurance company would incur by keeping them.
This would bankrupt private insurance companiesā¦
I donāt think you fully understand how hard it is to make money on health insurance. The only way to do so is by withholding healthcare to your subscribers, or to offer plans with obscene co-pays or deductible.
The cost on average for full coverage is around 8.5k dollars a year for an individual, or 24k for a family. Meaning that the cost of a single operation, illness, or inpatient procedure will wipe away the potential profits from an individual subscriber for years. The only way to recover from having one Iāll subscriber is to balance them with a dozen healthy subscribers.
Without managing this equation of large healthy profitable pool vs small costly pool, the entire charade of private insurance would collapse upon itself.
One of the largest drivers in the increase in healthcare cost is these types of people. People whom donāt have any insurance, but still have healthcare needs. For these people the emergency room is typically their only option. This is one of the reasons emergency medicine is such a drain on hospital resources. For every person they treat without insurance, they have to raise the cost on people with insurance, simply so they donāt go out of business.
Itās funny you mention restaurants, in that case I donāt particularly care when they bill me because the menu says precisely what Iāll pay (counter order vs table service doesnāt matter as much as cost and quality). If itās market rate (steak or seafood), theyāll tell me what the dayās rate is and what cuts they have.
I donāt get that with health care, even getting a range in a quote is like pulling teeth. I pushed back a ton when my daughter needed a surgery, and after several calls I still didnāt get a clear answer, and this was for a routine surgery. The quality and speed of service was great, billing was not.
One of the benefits of socialized medicine is not having to worry about billing, but you also often get delays in care. I donāt think we need to go to socialized medicine to solve the unexpected costs issue, we can expect care providers to absorb some of the variability.
what is the profit motive for insurance companies to simplify their process?
I agree, the current profit motives are misaligned, and pushes like the ACA to further expand the number of people with insurance further entrench these practices.
The profit motive should be attracting customers who otherwise would go without. But since pricing isnāt transparent, cash payers donāt have the same leverage to get a fair price. Many care providers have an informal ācash discount,ā but thatās just not the same.
If the system works well for cash customers, insurance would need to earn customersā business, but when most people have insurance, the patient is no longer the customer, the employer is, so theyāll charge individual customers more than employers with group plans. If we separate the insurance from the employer, they would need to cater to patients.
Removing private insurance is one option, but thatās also quite disruptive and has potential for other issues (e.g. why would Medicare bother with good customer service if itās the only option?).
Most hospitals have this information available
That wasnāt my experience. We had two options for a surgery with different risks and costs, and after several calls, we couldnāt get any numbers, just A costs more than B. Thatās why Iām so interested and āit depends on your insuranceā blah blah blah. Thatās why Iām so interested in this. And this wasnāt some podunk hospital, it was the premier childrenās hospital in the state, run by the premier public university in the state, and services kids outside the state.
I should be able to get quotes on a procedure from multiple care givers for a non-urgent procedure (like the one we had).
how would we enforce this?
Patients should be able to switch insurance if they donāt like the one they have. Right now, you either use the insurance you have or pay out the nose by giving up company cost share and ACA subsidies.
If my company offers a crappy plan, I should be able to take what they wouldāve contributed and pick my own plan. If that was the case, insurance companies would try harder to make their service more convenient, just like auto insurance does (not a gold standard, but much better), and HR orgs would probably try harder to pick better plans.
You canāt make a profit from an elderly subscriber, the cost of their end of life care will always cost more than any subscription fee they may pay in.
If youāre wealthy, you donāt need much from your insurance. End of life care could be self funded, and insurance is there for the other surprises that could ruin your retirement. It would be totally acceptable for an insurance company to require some kind of down payment to cover EOL care, or a minimum number of years for coverage (if you die before the end of the contract, it counts as debt the estate needs to pay back).
their employer collectively bartered for the price
Iāve run the numbers and can get a similar price (within 10% or so) for similar coverage without ACA subsidies, but I need to factor in how much theyād contribute to their own plan. Add to that couples who both work, your options are: have separate plans (less efficient) or give up the employer subsidy.
This would bankrupt private insurance companies
No, theyād just adjust rates to compensate. If thereās something insurance companies are good at, itās averaging costs and holding a surplus. So a company thatās better able to estimate this should get more customers and stay in business longer.
If they offer a 10-year or longer plan, they just need to average costs across their target demographic over those years to come up with a premium. Term life insurance companies do this, so why not health insurance?
For these people the emergency room is typically their only option.
Especially for homeless people. Which is a huge part of why Iām a fan of government funded ER. Thatās a huge risk factor for insurance companies and hospitals, and itās also a huge complexity for visitors and whatnot, so it should just be provided. If the paramedic thinks you need emergency care, it should be 100% free. However, hospitals should be empowered to deny care (and charge for wasting ER capacity) for non-emergencies.
But any extended care once youāre stabilized should be covered by insurance instead, because you have actual choices in your care (and could theoretically walk out if you choose not to accept further care).
Itās funny you mention restaurants, in that case I donāt particularly care when they bill me because the menu says precisely what Iāll pay (counter order vs table service doesnāt matter as much as cost and quality). If itās market rate (steak or seafood), theyāll tell me what the dayās rate is and what cuts they have.
We were talking about service, not costā¦ Like if they ran your card for every individual item, as soon as you ordered it. āIād like to start with a coke to drinkā takes out card to charge. āThen Iād like a starterā takes out card.
This is what i mean by bad service.
donāt get that with health care, even getting a range in a quote is like pulling teeth. I pushed back a ton when my daughter needed a surgery, and after several calls I still didnāt get a clear answer, and this was for a routine surgery. The quality and speed of service was great, billing was not.
This is likely because you called before a prior authorization was completed, meaning that you most likely were utilizing private insurance. If you were utilizing Medicaid, which doesnāt require pre authorization, then it would be really simple to tell you.
You canāt give an accurate quote for private insurance because the individual plans are so personalized by their workplace or insurance brokers to lower cost and coverage that we literally donāt know what your coverage until we submit if for authorization and equate for things like deductables and copay.
This authorization process requires not only a referral, but an itemized script, supporting notes, and a face to face with the provider. So unless they had the opportunity to complete these task, private insurance doesnāt allow us to give you a quote.
but you also often get delays in care.
Lol, you were just talking about a delay in care due to billing issues with private insurance. American private insurance also has the same exact delays in care, waiting weeks for prior auth, waiting months for people to meet their deductible, avoiding needed care because of cost, and just plain waiting for specialized care because we donāt have enough specialty providers. Many specialty providers like neurologist or or rheumatologist have left the field specifically because of paperwork burnout. The authorization process for these expensive specialty practices is so scrutinized by insurance companies that it can take months of daily negotiation to even see a patient.
I agree, the current profit motives are misaligned, and pushes like the ACA to further expand the number of people with insurance further entrench these practices.
Lol, wrong again. The plans allowed on the aca marketplace had to follow aca guidelines, which included automating the billing process. These platinum, silver, and bronze plans are actually pretty easy to work with compared to those offered by peopleās workplaces. In the beginning we were actually pretty excited to see actual changes to the system, however since the removed mandate, and the subsequent deterioration of coverage in these plans, itās rare to see patient actually utilize there benefits.
The profit motive should be attracting customers who otherwise would go without. But since pricing isnāt transparent, cash payers donāt have the same leverage to get a fair price. Many care providers have an informal ācash discount,ā but thatās just not the same
What are you talking about about? Why would an insurance company want to attract uninsured people? The uninsured people of America are some of the most at risk communities in America. They are impoverished, underemployed, and are disproportionately likely to have long term health conditions. There is no wealth to extract from these people, and the longer they have been uninsured, the more likely they are to require excessive care once they are insured.
If the system works well for cash customers, insurance would need to earn customersā business, but when most people have insurance, the patient is no longer the customer, the employer is, so theyāll charge individual customers more than employers with group plans.
Lol, you have no idea the average cost of healthcare people accumulate during their lifetimes. One serious stint at an inpatient facility would bankrupt a wealthy person. As I said, there is no profit in healthcare that isnāt created by denying healthcare.
Removing private insurance is one option, but thatās also quite disruptive and has potential for other issues (e.g. why would Medicare bother with good customer service if itās the only option?).
Why exactly would it be quite disruptive? Also, Medicare is the only option for the people who have itā¦ If you qualify for Medicare for your primary insurance, private insurance automatically becomes your secondary. Medicare still offers more coverage than any other private plan. I donāt think you quite understand that the people whom work in healthcare do so because they want to help people. Being a physician doesnāt exactly mean youāre making the big bucks anymore. There are plenty of fields that require a lot less schooling and pay way more.
That wasnāt my experience. We had two options for a surgery with different risks and costs, and after several calls, we couldnāt get any numbers, just A costs more than B.
As I said previously, this is an inherent problem created by private insurance. You canāt just call and shop around on private insurance, the way they set up the prior authorization process is expressly made to prohibit this. The only way to do this is to call your insurance as a subscriber, and talk to your plans agent. They will direct you to their preferred network, where they have negotiated cost previously.
Again, insurance companies purposely create inefficient and archaic systems so their customers wonāt utilize their services as often. They make us do all the explaining and processing, so we get the blame.
should be able to get quotes on a procedure from multiple care givers for a non-urgent procedure (like the one we had).
I agree, and if your child was on Medicaid it would have been super easyā¦ You would have been told $0.00. Medicaid is an actual healthcare system, and because their goal is to actually improve their patients health it functions as intended.
Patients should be able to switch insurance if they donāt like the one they have.
Right, but who is preventing people from switching plansā¦
Oh yeah, private insurance. Because private insurance cannot afford to have patients switching insurance every time a patient has an operation. How are you going to remain solvent if a subscriber can just run up cost and then switch to a different insurance pool without contributing?
my company offers a crappy plan, I should be able to take what they wouldāve contributed and pick my own plan. If that was the case, insurance companies would try harder to make their service more convenient, just like auto insurance does (not a gold standard, but much better), and HR orgs would probably try harder to pick better plans.
You are ignoring the fact that private insurance is a gamble. Itās a company gambling that you as an individual will contribute more to the insurance pool than you take out before you turn 65. If a person can just switch insurance companies they could just change plans every year they needed an expensive operation. The same can be done with home/car insurance, but car/home insurance is allowed to charge people with prior history of heavy utilization with higher fees and deductible. This is not legal in healthcare, as it would automatically price out people with chronic illnesses.
If youāre wealthy, you donāt need much from your insurance.
And how many people are wealthy compared to the amount of people who are poor? Is your solution to build the entire countryās healthcare system for 5% of the population? Also, why should your life savings be eaten up by healthcare cost if you already paid for life insurance your whole life? I just donāt see why you are so ardent about paying more money for less coverage?
Iāve run the numbers and can get a similar price (within 10% or so) for similar coverage without ACA subsidies,
You are comparing individual self funded plans to those offered by your work? As someone who owns a company and works for a hospitalā¦ I highly doubt that. Iām still utilizing my hospital insurance because the self funded ones offered to small companies were quite a bit higher when factoring in deductible and copays. If you were talking about individually funded plans, I would urge you too re examine the coverage.
theyād just adjust rates to compensate.
The amount they would have to raise rates exceeds their clients ability to payā¦ You canāt squeeze blood from a stone, and people are already struggling with their current cost. Raising the rate high enough to account for chronic disabilities isnāt an option. This is why they fought so hard against the law that prevented them from rejecting coverage for people with conditions like type 1 diabetes, which isnāt a disability that qualifies for Medicaid, but has a high cost.
Which is a huge part of why Iām a fan of government funded ER. Thatās a huge risk factor for insurance companies and hospitals, and itās also a huge complexity for visitors and whatnot, so it should just be provided.
Thatās just a bandaid whoās only function is to protect insurance companies. If insurance companies are not good enough to cover emergent healthcare whatās their point? If you can get free healthcare at emergency rooms instead of being insured, why not just go to the ER? This would just make the emergency room problem worse.
Why spend so much time coming up with worse work arounds when you havenāt been able to tell me a single advantage private insurance brings to the table?
service, not costā¦ Like if they ran your card for every individual item
Iām not really following the point of the analogy.
If cost doesnāt matter, Iād just give them my card and they can run it as often as they like. Thatās basically how it works on cruise lines, you set up a payment system and they scan your cruise card with each transaction. Itās not an issue at all.
individual plans are so personalized
Right, and thatās because the policy holder usually isnāt the customer, the employer is.
Health insurance would likely be a lot simpler if the average policy holder could switch insurance, especially if thereās no open enrollment period (like car insurance, I can shop rates anytime and understand what Iām buying pretty easily).
delay in care due to billing issues with private insurance
No, there was no delay in care. Once I picked the option, I got the procedure done in the next week or two.
The only delay was because I wanted the quote before picking the solution, and thatās a totally artificial limitation that can be fixed by changing how insurance works (i.e. give me the cash price, and Iāll figure in the deductible and whatnot).
Youāre right, the problem is paperwork, which is why we should give the insurance companies fewer options to reject claims. Eliminate or automate the authorization step. Care providers should never need to talk to anyone at the insurance company.
Why would an insurance company want to attract uninsured people?
Higher risk just means higher costs. They can still collect some percentage of premiums, so why would they turn it down?
you have no idea the average cost of healthcare people accumulate during their lifetimes
Youāre right, and those numbers are hard to come by since most studies/articles assume Medicare in retirement and focus on out of pocket costs. If I was proposing actual policy, Iād do my due diligence, but for this kind of discussion, I use whatās readily available.
65+ insurance is indeed unique, hence why I mentioned an escrow system. Basically, you prepurchase insurance including end of life care. That amount of money buys you a certain guaranteed tier of end of life care, even if your individual costs exceed that. Iām guessing that escrow is something like $300-500k for basic EOL care, plus some extra for routine medical care. But I only have mediocre data to work from. If you have a good source, Iām interested.
I donāt know how practical it is, itās just an idea for an alternative to Medicare for the wealthy. But honestly, just uncapping income for paying in and expanding Medicare a bit for poorer people is probably more reasonable.
I donāt think you quite understand that the people whom work in healthcare do so because they want to help people
Sure, and the same is true for education. And the problems with both are pretty similar:
theyāre restricted in how they do their jobs
thereās a lot of paperwork, and paperwork sucks
there absolutely is a point where the career isnāt worth it
In many areas, the government has a near monopoly on education, yet the problems persist. Why should we expect medicine to be much different? Once government has a near monopoly on something, it becomes very political.
Maybe something like the public option doesnāt have as many tradeoffs, IDK, but socialized medicine certainly would. Iād only be in favor of a public option if care providers received the same amount from cash customers vs Medicare customers, and that amount is transparent and publicly auditable (i.e. if Medicare wants to fight high prices, that should benefit cash customers). That doesnāt happen today with the privatized system, so thatās where my focus is.
Privatized insurance isnāt the goal here, privatized medicine is. If we want to subsidize that for the poorer end of the income range, Iām fine with that, but the majority should be expected to pay for a large portion of medical care, otherwise market forces donāt work properly.
insurance companies purposely create inefficient and archaic systems so their customers wonāt utilize their services as often
They do it because it doesnāt cost them customers. I canāt vote with my wallet and switch my insurance, I can only beg my HR department to offer something different. I am not the customer here.
Many customers are willing to pay a bit more in other industries to avoid BS, I donāt see why that should be any different for health insurance.
The reason we have the system we do is because government incentivizes company-provided health insurance. We should instead encourage people to select their own plans. The ACA increases barriers to rejecting company insurance and doubles down on involving employers in health insurance decisions.
Either we need to completely put patients in control of their insurance or provide it as a public good. The current middle ground is worse than either extreme imo.
they could just change plans every year they needed an expensive operation
Auto insurance seems to work just fine with this. If I make lots of claims with one insurer, that slate wonāt just be wiped clean with the next one.
If customers can easily switch, that should encourage insurance companies to lock in customers with longer term policies to spread out the risk.
And insurance isnāt really a gamble, itās actually quite the opposite, a way to reduce risk. The insurance company doesnāt expect any particular individual customer to be profitable, they just expect that their customers will be profitable on average. Individuals buy insurance knowing that they statistically donāt get value from the insurance, theyāre merely getting it to reduce their own financial risk. For an insurance company, itās like buying an index fund instead of individual stocks, and for individuals itās like buying an annuity instead of stocks.
You are comparing individual self funded plans to those offered by your work?
Yes. Iām comparing individual, non-subsidized ACA plans with those offered by my work. My work only offers high deductible plans with a premium and HSA contribution, and Iām comparing against ACA HSA plans with a similar deductible and max out of pocket. Iāve never had a copay, everything has been a relatively simple deductible.
Specific details certainly differ, but I think it gets me in the ballpark.
And this is for a reasonably large company. We have something like 3000 employees, so it should be big enough to benefit from collective bargaining. I havenāt run the numbers for a couple years (I compared ACA when self-employed vs new company), so things could have changed. I like this method because costs are both transparent, and I actually estimate my costs (and subsidy) if i decide to stop working in a spreadsheet. Iām certainly no expert, but I do try to be reasonably thorough.
And yeah, Iāll probably redo the numbers soon. I generally do this around tax season because I like to estimate my taxes to see how close I am (was really close last year), and I have a section to compare expected total costs of care for the two plans my company offers (only difference is deductible, premium, and max out of pocket) and a comparable ACA plan (those numbers are publicly available). Specific plan details vary, and itās not something I can get super accurate with (how do you put a price on a procedure Iām unlikely to need?), but hopefully itās close.
If youāre interested, maybe Iāll run the numbers this weekend and reply with the details. Iām not a medical or insurance expert, but I am very interested in personal finance and actually enjoy spending a few hours crunching numbers.
The amount they would have to raise rates exceeds their clients ability to pay
Maybe. But thatās also assuming healthcare costs stay stagnant. If we drastically reduce the complexity of dealing with insurance, we also reduce the costs to insurance, which may be enough to offset an increase in claims.
All the paperwork is waste, and itās getting to be a massive problem, but it suffers from a prisonerās dilemma-type issue (an individual company is better off complicating the process in the short term, but if everyone does that, net costs go up) so the current setup wonāt resolve itself.
If insurance companies are not good enough to cover emergent healthcare whatās their point?
Insurance companies exist to cover extreme financial burdens, like developing cancer or other chronic conditions. Basically, things that could bankrupt you.
The issue with ER is that it often goes against your will, and getting financial consent could be the difference between life and death. What are you going to do if insurance rejects your claim? What if someone else calls an ambulance for you and you canāt pay? What if youāre a tourist and you donāt understand the US medical system? Thereās just way too many weird cases to the point where we canāt just expect insurance companies to take the hit here.
Publicly funded ER solves those problems and can protect emergency care providers from lawsuits and whatnot so they can focus on providing care. Once the patient is stabilized, they can make decisions for ongoing care, and thatās where insurance should get involved.
In general, if something is involuntary or a natural monopoly, it should be publicly provided. Thatās absolutely the case for emergency care (I canāt pick the ambulance company someone else calls for me). But routine and chronic care absolutely is voluntary and isnāt a natural monopoly.
If you can get free healthcare at emergency rooms instead of being insured, why not just go to the ER?
The ER would reject you and potentially fine you for nonemergency care. Just like calling 911 for non-emergencies.
cost doesnāt matter, Iād just give them my card and they can run it as often as they like.
Rightā¦ But the point of this hypothetical is to explain how the billing process is detrimental to service. In this hypothetical, like with any time you visit a new Drs office, you have to go through a myriad of processes explicitly for billing. Hence why in this hypothetical the ordering process is specifically made to be labourus, so no, we wonāt hold on to your card. Please hand it to me for every item.
Right, and thatās because the policy holder usually isnāt the customer, the employer is.
Wouldnāt there be even more options if individuals chose their plans instead of large employers?
Health insurance would likely be a lot simpler if the average policy holder could switch insurance,
I already explained thatās not economically viableā¦
No, there was no delay in care. Once I picked the option, I got the procedure done in the next week or two.
Your inability to choose an option is a a delay in careā¦ Any time between a prescribed written order and the fulfillment of that order is considered a delay in care.
give me the cash price, and Iāll figure in the deductible and whatnot).
My dude, you donāt understand what the cash price represents. Nor do you understand that it is of no consequence to you if you already have insurance. The cash price is simply the Medicare allowable, minus whatever internal policy they have for discounts for people paying in cash.
If you want to know the cash price, look up the medicare allowable for the procedure or item, then call the office and see if they offer cash discounts. If your office accepts Medicare, then itās against CMS guidelines to set billing codes for cash payers more or less than the Medicare allowable. You can apply discounts after using the Medicare allowable, but you must initially bill by coding guidelines.
However, if you already have private insurance then we have to bill for the specific pricing negotiated by the insurance and office. And like I said most of the times, unless itās a plan and operation the office does frequently, we wonāt know what your cost will be until we run a prior authorization.
Youāre right, the problem is paperwork, which is why we should give the insurance companies fewer options to reject claims. Eliminate or automate the authorization step. Care providers should never need to talk to anyone at the insurance company.
These are private companiesā¦ What right does the government have over private industry to moderate them so closely? They would argue that it would risk their solvency as an industry. They would proclaim the same propaganda that has so effectively captured your own loyalty so well.
Higher risk just means higher costs. They can still collect some percentage of premiums, so why would they turn it down?
Did you even read anything I wrote about this? You arenāt legally allowed to raise prices of individual coverage based on use. This isnāt car or home insurance. And if they raised prices for everyone any more than they already haveā¦people might start getting a little more excited about things like Medicare for all.
Youāre right, and those numbers are hard to come by since most studies/articles assume Medicare in retirement and focus on out of pocket costs.
No itās notā¦ Itās all publicly available information on the CMS website. You can literally track where every single Medicare dollar goes, which is the benefit of socialized medicine, itās extremely transparent.
65+ insurance is indeed unique, hence why I mentioned an escrow system. Basically, you prepurchase insurance including end of life care.
Lol, people barely have the competency to sign up for Medicaid, a free service. The average citizen isnāt going to be able to have the funding or the ability to plan that long into their own future. I feel like you have some misconceptions about public health, and who it primarily serves.
Iām guessing that escrow is something like $300-500k for basic EOL care, plus some extra for routine medical care. But I only have mediocre data to work from. If you have a good source, Iām interested.
Do you understand that the average person in my state would have to work 10 years to earn that kind of money? Just earn, not save. Thatās virtually impossible for the vast majority of Americans. That the average working male only contributes around 60k dollars to to Medicare in their entire lifetime?
Sure, and the same is true for education. And the problems with both are pretty similar:
Right but this was a response to the claim the providers were colluding with insurance companies to make more money, which is wildly false.
In many areas, the government has a near monopoly on education, yet the problems persist.
This is assuming the problem is inherent to government, and not the decades of declining funding, or the response of white communities to integration after the civil rights movement. Other governments do have a complete monopoly on education and they donāt have these same issues. So I donāt really think itakes much sense to just blame the government.
Why should we expect medicine to be much different?
Because we already have a socialized healthcare network that treats the majority of healthcare needs, itās just being weakened by private insurance stealing funding away from the system, and is kept artificially unavailable to younger healthier patients for the sake of private profit. And even surrounded by these parasitic corporations Medicare continues being the highest standard in the industry. Offering more coverage for lower cost than any other insurer in the country.
but socialized medicine certainly would.
Any evidence to support that statement, or even a theory on what kind of negative trade offs? You are speaking as if you are an authority on the subject, however based on prior statements you seem to have some great miscommunication about health care systems, billing systems, and the over all concept of insurance pools.
if care providers received the same amount from cash customers vs Medicare customers, and that amount is transparent and publicly auditable
How is that even a possibility? The amount of people paying for their healthcare upfront in cash is so small that itās not even trackable. You are talking about cash payment as if itās a common occurrence. Iāve been working in the field for over a decade and Iāve probably had 1 maybe 2 patients pay in cash upfront.
You are also assuming your own ignorance of the subject is due to some sort of colluding shadow group of healthcare providers working against you. In reality youāre just unfamiliar with the inner workings of our healthcare system, and instead of just reading the literature available on the CMS website youāve done your own āresearchā on YouTube.
Literally every single one of the claims youāve made has been inaccurate. I have no reason to lie to you, I get paid the same no matter what I bill, or how many patients I see. I work at a state run childrenās hospital, specializing in orthopedics and rehabilitation. If I wanted to make more money I could easily take a job at a private clinic.
You do not know what you are talking about, I donāt know how to say that in any simpler terms. The assumptions you have made are not idiotic ones, in fact private insurance companies spend a lot of money (often An illegal amount) to spread this misinformation to you.
However, what would be idiotic is to assume that you know more about a system than someone who has worked with it every day for well over a decade. I assume you have some specialized knowledge or skill you utilize in your career? What would you think of the person who tried to lecture to you about your career after a couple hours or even days of āresearchā?
Privatized insurance isnāt the goal here, privatized medicine is.
Againā¦ The medical system is not profitable. There are some aspects that are profitable, but those profits are required to be cycled back into the system to help support the rest of it. If you simply privatizes the only aspects of the system that were profitable and socialized the ones that werenāt, it would raise the overall cost of insurance for everyone.
You canāt just keep repeating the same inaccurate claims when you havenāt acknowledged any of faults ive previously pointed out.
They do it because it doesnāt cost them customers. I canāt vote with my wallet and switch my insurance, I can only beg my HR department to offer something different. I am not the customer here.
Yeahā¦seems to be a problem inherent to privatized insurance, which is my point. The reason you canāt do this is because the insurance companies canāt afford to let you do this. It would make apparent that private insurance only achieves solvency via careful control over their insurance pool.
I donāt see why that should be any different for health insurance.
Because you have some inherent misconceptions about how insurance companies remain solvent, despite their cost exceeding their subscription fees. The only way insurance pools remain in solvency is by meeting a target subscription projection that would theoretically eventually cover their aging subscribers.
The way this projected growth is theoretically supposed to work is by adding multiple more young subscribers for every older subscriber they currently have. And for a while with the economic and population growth America has achieved in the past, this has been possible.
However, if the growth dwindles or if you get generations make less than their parents, the system starts to collapse. Which is why countries with disproportionately old populations have a hard time maintaining stable healthcare systems.
The reason we have the system we do is because government incentivizes company-provided health insurance. We should instead encourage people to select their own plans.
Wrong againā¦ The aca was simply a plan to get the uninsured rate down. They offered both incentives to companies and individuals to achieve this goal. Before the aca individual plans were not even offered by insurance companies. These individual plans were actually really robust, especially with medication cost, better than even my current private insurance. However, Republicans sponsored by the insurance lobbyist slowly ate away at the funding and requirements, making the individual plans basically useless, culminating with the abolishment of the mandate during the trump administration.
Auto insurance seems to work just fine with this. If I make lots of claims with one insurer, that slate wonāt just be wiped clean with the next one.
Are you a motorized vehicle? What makes you think insuring an entire population is similar to insuring a inanimate object? Iāve already pointed out that it is illegal to charge people a higher premium because of their preconditions or prior use. And if it was legal this would either lead to people being uninsurable, or would collapse the insurance pool.
A rebuttal that you have not acknowledged this entire discourse.
customers can easily switch, that should encourage insurance companies to lock in customers with longer term policies to spread out the risk.
Do you not see the internal contradictions of ācustomers can easily switchā and ālock in customers with longer term policiesā?
The insurance company doesnāt expect any particular individual customer to be profitable, they just expect that their customers will be profitable on average.
Which is not true with healthcareā¦ Not on a long enough timeline. Which is why insurance companies boot people to Medicaid or Medicare when they start to become a financial burden. If they are forced to provide coverage past the age of 65 then there is no possibility for a return. We all end up eventually receiving more healthcare than we pay for.
For an insurance company, itās like buying an index fund instead of individual stocks, and for individuals itās like buying an annuity instead of stocks
Again, you are ignorant of the fundamental differences of health insurance when compared to ensuring inanimate objects. At this point it seems like you are purposely being obtuse, so Iām assuming you lack the mental plasticity to change your mind regardless of any new information or perspective.
havenāt run the numbers for a couple years (I compared ACA when self-employed vs new company), so things could have changed.
Aca self funded plans have significantly reduced their coverage and network size since the mandate went away. The original plans were actually a pretty decent deal, but theyāre pretty worthless by now.
Maybe. But thatās also assuming healthcare costs stay stagnant. If we drastically reduce the complexity of dealing with insurance, we also reduce the costs to insurance, which may be enough to offset an increase in claims.
Again, if you are going to be standardizing these private organizations to the point where you dictate their operating procedures, whatās the point of privatizes healthcare?
All the paperwork is waste, and itās getting to be a massive problem, but it suffers from a prisonerās dilemma-type issue (an individual company is better off complicating the process in the short term, but if everyone does that, net costs go up) so the current setup wonāt resolve itself.
Yes, it seems like every one of these ānon profitā private insurance companies are prioritizing profit over serviceā¦Strange.
Insurance companies exist to cover extreme financial burdens, like developing cancer or other chronic conditions. Basically, things that could bankrupt you.
No, private insurance companies exist to extract public funds from the government at the expense of its citizenry. The entire point of a healthcare system, is to improve the health of the entire population, not individuals. Private health insurance damages the system, and does nothing to improve it.
The issue with ER is that it often goes against your will, and getting financial consent could be the difference between life and death.
Bahahaha, what? You donāt have to take financial consent to treat someone at an ER. You donāt need ID, or insurance paperwork, or even an address. What do you think we do with people who are unconscious upon arrival? We donāt just stick them in the waiting room until they miraculously wake up.
As I said, you are making huge assumptions without a very basic understanding of healthcare. One of the reasons hospitals are inherently a natural monopoly nis because there is no choice often. You canāt dictate where your ambulance goes, and we canāt turn down a person in need.
Thereās just way too many weird cases to the point where we canāt just expect insurance companies to take the hit here.
Lol, insurance companies do not take the hit, we do. The cost is covered by the hospital, and its burden is redistributed via raising price of healthcare.
Publicly funded ER solves those problems and can protect emergency care providers from lawsuits and whatnot so they can focus on providing care.
And again this would just lead to people using the ER more than they already so.
The ER would reject you and potentially fine you for nonemergency care. Just like calling 911 for non-emergencies.
First of all, this is once again illegal. But more importantly bits highly immoral and violates the Hippocratic Oath. No ER provider is going to turn away a patient in need of emergency medicine.
And of course you will say, that they can turn away non emergent care. But this just proves you lack of understanding of the healthcare system in general. Minor ailments that go untreated will eventually turn into actual emergencies. So it doesnāt matter if you turn them away, or worse fine them, they will eventually come back in worse condition.
The only way to lower emergent healthcare cost is to provide affordable/free preventative care and education . Take for example the diabetic shoe program, every diabetic with peripheral neuropathy in America is eligible for diabetic shoes and custom inserts. At one point as a cost saving measure they cut this service, which ended up costing them hundreds of millions of dollars in the long run due to the increased incidents of wound care and amputations.
Itās a much more complicated system then you would like to assume.
If you went to a restaurant and they ran separate charges every time you ordered somethingā¦ You wouldnāt consider that bad service?
Also, I went to the same physician when on Tricare, so itās the same exact service, minus all the billing hassle.
And I think you could do the same things and still lower the cost even more by banning privatized insurance?
Also, what is the profit motive for insurance companies to simplify their process? Their systems were purpose built to be as complicated and time consuming as possible, if they make the process easier, their subscribers would utilize it more, making insurance pay more often.
And again, why would corporations do this? And how would we enforce this?
The Medicare billing is automated, and pretty simple. Itās what every insurance company has the option of doing, but only Medicare and Medicaid have automated the process. This is because private insurance companies have no profit motive to pay for their prescribers healthcare.
Most hospitals have this information available, especially if you call their financial services office. In fact if you are a Medicare patient this information is publicly available on the CMS website, and they list exactly how they came to that figure.
The whole hidden ledger thing is primarily only a problem at privatized hospitals that were bought or built by private hospital networks operating for profit.
The inherent problem with this is that the elderly are fundamentally uninsurable. You canāt make a profit from an elderly subscriber, the cost of their end of life care will always cost more than any subscription fee they may pay in.
This is why the vast majority of private insurance do not offer primary insurance to people older than 65. The whole point of private insurance is to extract money from healthy patients and then dump them onto Medicaid if they become disabled, or onto Medicare when they begin to age and decline in health.
Who would offer those plans, and why? The only reason most people can afford private insurance is because their employer collectively bartered for the price. A lot of people have no idea how much of their employee compensation package is taken up by their insurance, but the burden of cost is redistributed by the entire employer pool.
This would bankrupt private insurance companiesā¦ I donāt think you fully understand how hard it is to make money on health insurance. The only way to do so is by withholding healthcare to your subscribers, or to offer plans with obscene co-pays or deductible.
The cost on average for full coverage is around 8.5k dollars a year for an individual, or 24k for a family. Meaning that the cost of a single operation, illness, or inpatient procedure will wipe away the potential profits from an individual subscriber for years. The only way to recover from having one Iāll subscriber is to balance them with a dozen healthy subscribers.
Without managing this equation of large healthy profitable pool vs small costly pool, the entire charade of private insurance would collapse upon itself.
One of the largest drivers in the increase in healthcare cost is these types of people. People whom donāt have any insurance, but still have healthcare needs. For these people the emergency room is typically their only option. This is one of the reasons emergency medicine is such a drain on hospital resources. For every person they treat without insurance, they have to raise the cost on people with insurance, simply so they donāt go out of business.
Itās funny you mention restaurants, in that case I donāt particularly care when they bill me because the menu says precisely what Iāll pay (counter order vs table service doesnāt matter as much as cost and quality). If itās market rate (steak or seafood), theyāll tell me what the dayās rate is and what cuts they have.
I donāt get that with health care, even getting a range in a quote is like pulling teeth. I pushed back a ton when my daughter needed a surgery, and after several calls I still didnāt get a clear answer, and this was for a routine surgery. The quality and speed of service was great, billing was not.
One of the benefits of socialized medicine is not having to worry about billing, but you also often get delays in care. I donāt think we need to go to socialized medicine to solve the unexpected costs issue, we can expect care providers to absorb some of the variability.
I agree, the current profit motives are misaligned, and pushes like the ACA to further expand the number of people with insurance further entrench these practices.
The profit motive should be attracting customers who otherwise would go without. But since pricing isnāt transparent, cash payers donāt have the same leverage to get a fair price. Many care providers have an informal ācash discount,ā but thatās just not the same.
If the system works well for cash customers, insurance would need to earn customersā business, but when most people have insurance, the patient is no longer the customer, the employer is, so theyāll charge individual customers more than employers with group plans. If we separate the insurance from the employer, they would need to cater to patients.
Removing private insurance is one option, but thatās also quite disruptive and has potential for other issues (e.g. why would Medicare bother with good customer service if itās the only option?).
That wasnāt my experience. We had two options for a surgery with different risks and costs, and after several calls, we couldnāt get any numbers, just A costs more than B. Thatās why Iām so interested and āit depends on your insuranceā blah blah blah. Thatās why Iām so interested in this. And this wasnāt some podunk hospital, it was the premier childrenās hospital in the state, run by the premier public university in the state, and services kids outside the state.
I should be able to get quotes on a procedure from multiple care givers for a non-urgent procedure (like the one we had).
Patients should be able to switch insurance if they donāt like the one they have. Right now, you either use the insurance you have or pay out the nose by giving up company cost share and ACA subsidies.
If my company offers a crappy plan, I should be able to take what they wouldāve contributed and pick my own plan. If that was the case, insurance companies would try harder to make their service more convenient, just like auto insurance does (not a gold standard, but much better), and HR orgs would probably try harder to pick better plans.
If youāre wealthy, you donāt need much from your insurance. End of life care could be self funded, and insurance is there for the other surprises that could ruin your retirement. It would be totally acceptable for an insurance company to require some kind of down payment to cover EOL care, or a minimum number of years for coverage (if you die before the end of the contract, it counts as debt the estate needs to pay back).
Iāve run the numbers and can get a similar price (within 10% or so) for similar coverage without ACA subsidies, but I need to factor in how much theyād contribute to their own plan. Add to that couples who both work, your options are: have separate plans (less efficient) or give up the employer subsidy.
No, theyād just adjust rates to compensate. If thereās something insurance companies are good at, itās averaging costs and holding a surplus. So a company thatās better able to estimate this should get more customers and stay in business longer.
If they offer a 10-year or longer plan, they just need to average costs across their target demographic over those years to come up with a premium. Term life insurance companies do this, so why not health insurance?
Especially for homeless people. Which is a huge part of why Iām a fan of government funded ER. Thatās a huge risk factor for insurance companies and hospitals, and itās also a huge complexity for visitors and whatnot, so it should just be provided. If the paramedic thinks you need emergency care, it should be 100% free. However, hospitals should be empowered to deny care (and charge for wasting ER capacity) for non-emergencies.
But any extended care once youāre stabilized should be covered by insurance instead, because you have actual choices in your care (and could theoretically walk out if you choose not to accept further care).
We were talking about service, not costā¦ Like if they ran your card for every individual item, as soon as you ordered it. āIād like to start with a coke to drinkā takes out card to charge. āThen Iād like a starterā takes out card.
This is what i mean by bad service.
This is likely because you called before a prior authorization was completed, meaning that you most likely were utilizing private insurance. If you were utilizing Medicaid, which doesnāt require pre authorization, then it would be really simple to tell you.
You canāt give an accurate quote for private insurance because the individual plans are so personalized by their workplace or insurance brokers to lower cost and coverage that we literally donāt know what your coverage until we submit if for authorization and equate for things like deductables and copay.
This authorization process requires not only a referral, but an itemized script, supporting notes, and a face to face with the provider. So unless they had the opportunity to complete these task, private insurance doesnāt allow us to give you a quote.
Lol, you were just talking about a delay in care due to billing issues with private insurance. American private insurance also has the same exact delays in care, waiting weeks for prior auth, waiting months for people to meet their deductible, avoiding needed care because of cost, and just plain waiting for specialized care because we donāt have enough specialty providers. Many specialty providers like neurologist or or rheumatologist have left the field specifically because of paperwork burnout. The authorization process for these expensive specialty practices is so scrutinized by insurance companies that it can take months of daily negotiation to even see a patient.
Lol, wrong again. The plans allowed on the aca marketplace had to follow aca guidelines, which included automating the billing process. These platinum, silver, and bronze plans are actually pretty easy to work with compared to those offered by peopleās workplaces. In the beginning we were actually pretty excited to see actual changes to the system, however since the removed mandate, and the subsequent deterioration of coverage in these plans, itās rare to see patient actually utilize there benefits.
What are you talking about about? Why would an insurance company want to attract uninsured people? The uninsured people of America are some of the most at risk communities in America. They are impoverished, underemployed, and are disproportionately likely to have long term health conditions. There is no wealth to extract from these people, and the longer they have been uninsured, the more likely they are to require excessive care once they are insured.
Lol, you have no idea the average cost of healthcare people accumulate during their lifetimes. One serious stint at an inpatient facility would bankrupt a wealthy person. As I said, there is no profit in healthcare that isnāt created by denying healthcare.
Why exactly would it be quite disruptive? Also, Medicare is the only option for the people who have itā¦ If you qualify for Medicare for your primary insurance, private insurance automatically becomes your secondary. Medicare still offers more coverage than any other private plan. I donāt think you quite understand that the people whom work in healthcare do so because they want to help people. Being a physician doesnāt exactly mean youāre making the big bucks anymore. There are plenty of fields that require a lot less schooling and pay way more.
As I said previously, this is an inherent problem created by private insurance. You canāt just call and shop around on private insurance, the way they set up the prior authorization process is expressly made to prohibit this. The only way to do this is to call your insurance as a subscriber, and talk to your plans agent. They will direct you to their preferred network, where they have negotiated cost previously.
Again, insurance companies purposely create inefficient and archaic systems so their customers wonāt utilize their services as often. They make us do all the explaining and processing, so we get the blame.
I agree, and if your child was on Medicaid it would have been super easyā¦ You would have been told $0.00. Medicaid is an actual healthcare system, and because their goal is to actually improve their patients health it functions as intended.
Right, but who is preventing people from switching plansā¦ Oh yeah, private insurance. Because private insurance cannot afford to have patients switching insurance every time a patient has an operation. How are you going to remain solvent if a subscriber can just run up cost and then switch to a different insurance pool without contributing?
You are ignoring the fact that private insurance is a gamble. Itās a company gambling that you as an individual will contribute more to the insurance pool than you take out before you turn 65. If a person can just switch insurance companies they could just change plans every year they needed an expensive operation. The same can be done with home/car insurance, but car/home insurance is allowed to charge people with prior history of heavy utilization with higher fees and deductible. This is not legal in healthcare, as it would automatically price out people with chronic illnesses.
And how many people are wealthy compared to the amount of people who are poor? Is your solution to build the entire countryās healthcare system for 5% of the population? Also, why should your life savings be eaten up by healthcare cost if you already paid for life insurance your whole life? I just donāt see why you are so ardent about paying more money for less coverage?
You are comparing individual self funded plans to those offered by your work? As someone who owns a company and works for a hospitalā¦ I highly doubt that. Iām still utilizing my hospital insurance because the self funded ones offered to small companies were quite a bit higher when factoring in deductible and copays. If you were talking about individually funded plans, I would urge you too re examine the coverage.
The amount they would have to raise rates exceeds their clients ability to payā¦ You canāt squeeze blood from a stone, and people are already struggling with their current cost. Raising the rate high enough to account for chronic disabilities isnāt an option. This is why they fought so hard against the law that prevented them from rejecting coverage for people with conditions like type 1 diabetes, which isnāt a disability that qualifies for Medicaid, but has a high cost.
Thatās just a bandaid whoās only function is to protect insurance companies. If insurance companies are not good enough to cover emergent healthcare whatās their point? If you can get free healthcare at emergency rooms instead of being insured, why not just go to the ER? This would just make the emergency room problem worse.
Why spend so much time coming up with worse work arounds when you havenāt been able to tell me a single advantage private insurance brings to the table?
Iām not really following the point of the analogy.
If cost doesnāt matter, Iād just give them my card and they can run it as often as they like. Thatās basically how it works on cruise lines, you set up a payment system and they scan your cruise card with each transaction. Itās not an issue at all.
Right, and thatās because the policy holder usually isnāt the customer, the employer is.
Health insurance would likely be a lot simpler if the average policy holder could switch insurance, especially if thereās no open enrollment period (like car insurance, I can shop rates anytime and understand what Iām buying pretty easily).
No, there was no delay in care. Once I picked the option, I got the procedure done in the next week or two.
The only delay was because I wanted the quote before picking the solution, and thatās a totally artificial limitation that can be fixed by changing how insurance works (i.e. give me the cash price, and Iāll figure in the deductible and whatnot).
Youāre right, the problem is paperwork, which is why we should give the insurance companies fewer options to reject claims. Eliminate or automate the authorization step. Care providers should never need to talk to anyone at the insurance company.
Higher risk just means higher costs. They can still collect some percentage of premiums, so why would they turn it down?
Youāre right, and those numbers are hard to come by since most studies/articles assume Medicare in retirement and focus on out of pocket costs. If I was proposing actual policy, Iād do my due diligence, but for this kind of discussion, I use whatās readily available.
65+ insurance is indeed unique, hence why I mentioned an escrow system. Basically, you prepurchase insurance including end of life care. That amount of money buys you a certain guaranteed tier of end of life care, even if your individual costs exceed that. Iām guessing that escrow is something like $300-500k for basic EOL care, plus some extra for routine medical care. But I only have mediocre data to work from. If you have a good source, Iām interested.
I donāt know how practical it is, itās just an idea for an alternative to Medicare for the wealthy. But honestly, just uncapping income for paying in and expanding Medicare a bit for poorer people is probably more reasonable.
Sure, and the same is true for education. And the problems with both are pretty similar:
In many areas, the government has a near monopoly on education, yet the problems persist. Why should we expect medicine to be much different? Once government has a near monopoly on something, it becomes very political.
Maybe something like the public option doesnāt have as many tradeoffs, IDK, but socialized medicine certainly would. Iād only be in favor of a public option if care providers received the same amount from cash customers vs Medicare customers, and that amount is transparent and publicly auditable (i.e. if Medicare wants to fight high prices, that should benefit cash customers). That doesnāt happen today with the privatized system, so thatās where my focus is.
Privatized insurance isnāt the goal here, privatized medicine is. If we want to subsidize that for the poorer end of the income range, Iām fine with that, but the majority should be expected to pay for a large portion of medical care, otherwise market forces donāt work properly.
They do it because it doesnāt cost them customers. I canāt vote with my wallet and switch my insurance, I can only beg my HR department to offer something different. I am not the customer here.
Many customers are willing to pay a bit more in other industries to avoid BS, I donāt see why that should be any different for health insurance.
The reason we have the system we do is because government incentivizes company-provided health insurance. We should instead encourage people to select their own plans. The ACA increases barriers to rejecting company insurance and doubles down on involving employers in health insurance decisions.
Either we need to completely put patients in control of their insurance or provide it as a public good. The current middle ground is worse than either extreme imo.
Auto insurance seems to work just fine with this. If I make lots of claims with one insurer, that slate wonāt just be wiped clean with the next one.
If customers can easily switch, that should encourage insurance companies to lock in customers with longer term policies to spread out the risk.
And insurance isnāt really a gamble, itās actually quite the opposite, a way to reduce risk. The insurance company doesnāt expect any particular individual customer to be profitable, they just expect that their customers will be profitable on average. Individuals buy insurance knowing that they statistically donāt get value from the insurance, theyāre merely getting it to reduce their own financial risk. For an insurance company, itās like buying an index fund instead of individual stocks, and for individuals itās like buying an annuity instead of stocks.
Yes. Iām comparing individual, non-subsidized ACA plans with those offered by my work. My work only offers high deductible plans with a premium and HSA contribution, and Iām comparing against ACA HSA plans with a similar deductible and max out of pocket. Iāve never had a copay, everything has been a relatively simple deductible.
Specific details certainly differ, but I think it gets me in the ballpark.
And this is for a reasonably large company. We have something like 3000 employees, so it should be big enough to benefit from collective bargaining. I havenāt run the numbers for a couple years (I compared ACA when self-employed vs new company), so things could have changed. I like this method because costs are both transparent, and I actually estimate my costs (and subsidy) if i decide to stop working in a spreadsheet. Iām certainly no expert, but I do try to be reasonably thorough.
And yeah, Iāll probably redo the numbers soon. I generally do this around tax season because I like to estimate my taxes to see how close I am (was really close last year), and I have a section to compare expected total costs of care for the two plans my company offers (only difference is deductible, premium, and max out of pocket) and a comparable ACA plan (those numbers are publicly available). Specific plan details vary, and itās not something I can get super accurate with (how do you put a price on a procedure Iām unlikely to need?), but hopefully itās close.
If youāre interested, maybe Iāll run the numbers this weekend and reply with the details. Iām not a medical or insurance expert, but I am very interested in personal finance and actually enjoy spending a few hours crunching numbers.
Maybe. But thatās also assuming healthcare costs stay stagnant. If we drastically reduce the complexity of dealing with insurance, we also reduce the costs to insurance, which may be enough to offset an increase in claims.
All the paperwork is waste, and itās getting to be a massive problem, but it suffers from a prisonerās dilemma-type issue (an individual company is better off complicating the process in the short term, but if everyone does that, net costs go up) so the current setup wonāt resolve itself.
Insurance companies exist to cover extreme financial burdens, like developing cancer or other chronic conditions. Basically, things that could bankrupt you.
The issue with ER is that it often goes against your will, and getting financial consent could be the difference between life and death. What are you going to do if insurance rejects your claim? What if someone else calls an ambulance for you and you canāt pay? What if youāre a tourist and you donāt understand the US medical system? Thereās just way too many weird cases to the point where we canāt just expect insurance companies to take the hit here.
Publicly funded ER solves those problems and can protect emergency care providers from lawsuits and whatnot so they can focus on providing care. Once the patient is stabilized, they can make decisions for ongoing care, and thatās where insurance should get involved.
In general, if something is involuntary or a natural monopoly, it should be publicly provided. Thatās absolutely the case for emergency care (I canāt pick the ambulance company someone else calls for me). But routine and chronic care absolutely is voluntary and isnāt a natural monopoly.
The ER would reject you and potentially fine you for nonemergency care. Just like calling 911 for non-emergencies.
Rightā¦ But the point of this hypothetical is to explain how the billing process is detrimental to service. In this hypothetical, like with any time you visit a new Drs office, you have to go through a myriad of processes explicitly for billing. Hence why in this hypothetical the ordering process is specifically made to be labourus, so no, we wonāt hold on to your card. Please hand it to me for every item.
Wouldnāt there be even more options if individuals chose their plans instead of large employers?
I already explained thatās not economically viableā¦
Your inability to choose an option is a a delay in careā¦ Any time between a prescribed written order and the fulfillment of that order is considered a delay in care.
My dude, you donāt understand what the cash price represents. Nor do you understand that it is of no consequence to you if you already have insurance. The cash price is simply the Medicare allowable, minus whatever internal policy they have for discounts for people paying in cash.
If you want to know the cash price, look up the medicare allowable for the procedure or item, then call the office and see if they offer cash discounts. If your office accepts Medicare, then itās against CMS guidelines to set billing codes for cash payers more or less than the Medicare allowable. You can apply discounts after using the Medicare allowable, but you must initially bill by coding guidelines.
However, if you already have private insurance then we have to bill for the specific pricing negotiated by the insurance and office. And like I said most of the times, unless itās a plan and operation the office does frequently, we wonāt know what your cost will be until we run a prior authorization.
These are private companiesā¦ What right does the government have over private industry to moderate them so closely? They would argue that it would risk their solvency as an industry. They would proclaim the same propaganda that has so effectively captured your own loyalty so well.
Did you even read anything I wrote about this? You arenāt legally allowed to raise prices of individual coverage based on use. This isnāt car or home insurance. And if they raised prices for everyone any more than they already haveā¦people might start getting a little more excited about things like Medicare for all.
No itās notā¦ Itās all publicly available information on the CMS website. You can literally track where every single Medicare dollar goes, which is the benefit of socialized medicine, itās extremely transparent.
Lol, people barely have the competency to sign up for Medicaid, a free service. The average citizen isnāt going to be able to have the funding or the ability to plan that long into their own future. I feel like you have some misconceptions about public health, and who it primarily serves.
Do you understand that the average person in my state would have to work 10 years to earn that kind of money? Just earn, not save. Thatās virtually impossible for the vast majority of Americans. That the average working male only contributes around 60k dollars to to Medicare in their entire lifetime?
Right but this was a response to the claim the providers were colluding with insurance companies to make more money, which is wildly false.
This is assuming the problem is inherent to government, and not the decades of declining funding, or the response of white communities to integration after the civil rights movement. Other governments do have a complete monopoly on education and they donāt have these same issues. So I donāt really think itakes much sense to just blame the government.
Because we already have a socialized healthcare network that treats the majority of healthcare needs, itās just being weakened by private insurance stealing funding away from the system, and is kept artificially unavailable to younger healthier patients for the sake of private profit. And even surrounded by these parasitic corporations Medicare continues being the highest standard in the industry. Offering more coverage for lower cost than any other insurer in the country.
Any evidence to support that statement, or even a theory on what kind of negative trade offs? You are speaking as if you are an authority on the subject, however based on prior statements you seem to have some great miscommunication about health care systems, billing systems, and the over all concept of insurance pools.
How is that even a possibility? The amount of people paying for their healthcare upfront in cash is so small that itās not even trackable. You are talking about cash payment as if itās a common occurrence. Iāve been working in the field for over a decade and Iāve probably had 1 maybe 2 patients pay in cash upfront.
You are also assuming your own ignorance of the subject is due to some sort of colluding shadow group of healthcare providers working against you. In reality youāre just unfamiliar with the inner workings of our healthcare system, and instead of just reading the literature available on the CMS website youāve done your own āresearchā on YouTube.
Literally every single one of the claims youāve made has been inaccurate. I have no reason to lie to you, I get paid the same no matter what I bill, or how many patients I see. I work at a state run childrenās hospital, specializing in orthopedics and rehabilitation. If I wanted to make more money I could easily take a job at a private clinic.
You do not know what you are talking about, I donāt know how to say that in any simpler terms. The assumptions you have made are not idiotic ones, in fact private insurance companies spend a lot of money (often An illegal amount) to spread this misinformation to you.
However, what would be idiotic is to assume that you know more about a system than someone who has worked with it every day for well over a decade. I assume you have some specialized knowledge or skill you utilize in your career? What would you think of the person who tried to lecture to you about your career after a couple hours or even days of āresearchā?
Againā¦ The medical system is not profitable. There are some aspects that are profitable, but those profits are required to be cycled back into the system to help support the rest of it. If you simply privatizes the only aspects of the system that were profitable and socialized the ones that werenāt, it would raise the overall cost of insurance for everyone.
You canāt just keep repeating the same inaccurate claims when you havenāt acknowledged any of faults ive previously pointed out.
Yeahā¦seems to be a problem inherent to privatized insurance, which is my point. The reason you canāt do this is because the insurance companies canāt afford to let you do this. It would make apparent that private insurance only achieves solvency via careful control over their insurance pool.
Because you have some inherent misconceptions about how insurance companies remain solvent, despite their cost exceeding their subscription fees. The only way insurance pools remain in solvency is by meeting a target subscription projection that would theoretically eventually cover their aging subscribers.
The way this projected growth is theoretically supposed to work is by adding multiple more young subscribers for every older subscriber they currently have. And for a while with the economic and population growth America has achieved in the past, this has been possible.
However, if the growth dwindles or if you get generations make less than their parents, the system starts to collapse. Which is why countries with disproportionately old populations have a hard time maintaining stable healthcare systems.
Wrong againā¦ The aca was simply a plan to get the uninsured rate down. They offered both incentives to companies and individuals to achieve this goal. Before the aca individual plans were not even offered by insurance companies. These individual plans were actually really robust, especially with medication cost, better than even my current private insurance. However, Republicans sponsored by the insurance lobbyist slowly ate away at the funding and requirements, making the individual plans basically useless, culminating with the abolishment of the mandate during the trump administration.
Are you a motorized vehicle? What makes you think insuring an entire population is similar to insuring a inanimate object? Iāve already pointed out that it is illegal to charge people a higher premium because of their preconditions or prior use. And if it was legal this would either lead to people being uninsurable, or would collapse the insurance pool.
A rebuttal that you have not acknowledged this entire discourse.
Do you not see the internal contradictions of ācustomers can easily switchā and ālock in customers with longer term policiesā?
Which is not true with healthcareā¦ Not on a long enough timeline. Which is why insurance companies boot people to Medicaid or Medicare when they start to become a financial burden. If they are forced to provide coverage past the age of 65 then there is no possibility for a return. We all end up eventually receiving more healthcare than we pay for.
Again, you are ignorant of the fundamental differences of health insurance when compared to ensuring inanimate objects. At this point it seems like you are purposely being obtuse, so Iām assuming you lack the mental plasticity to change your mind regardless of any new information or perspective.
Aca self funded plans have significantly reduced their coverage and network size since the mandate went away. The original plans were actually a pretty decent deal, but theyāre pretty worthless by now.
Again, if you are going to be standardizing these private organizations to the point where you dictate their operating procedures, whatās the point of privatizes healthcare?
Yes, it seems like every one of these ānon profitā private insurance companies are prioritizing profit over serviceā¦Strange.
No, private insurance companies exist to extract public funds from the government at the expense of its citizenry. The entire point of a healthcare system, is to improve the health of the entire population, not individuals. Private health insurance damages the system, and does nothing to improve it.
Bahahaha, what? You donāt have to take financial consent to treat someone at an ER. You donāt need ID, or insurance paperwork, or even an address. What do you think we do with people who are unconscious upon arrival? We donāt just stick them in the waiting room until they miraculously wake up.
As I said, you are making huge assumptions without a very basic understanding of healthcare. One of the reasons hospitals are inherently a natural monopoly nis because there is no choice often. You canāt dictate where your ambulance goes, and we canāt turn down a person in need.
Lol, insurance companies do not take the hit, we do. The cost is covered by the hospital, and its burden is redistributed via raising price of healthcare.
And again this would just lead to people using the ER more than they already so.
First of all, this is once again illegal. But more importantly bits highly immoral and violates the Hippocratic Oath. No ER provider is going to turn away a patient in need of emergency medicine.
And of course you will say, that they can turn away non emergent care. But this just proves you lack of understanding of the healthcare system in general. Minor ailments that go untreated will eventually turn into actual emergencies. So it doesnāt matter if you turn them away, or worse fine them, they will eventually come back in worse condition.
The only way to lower emergent healthcare cost is to provide affordable/free preventative care and education . Take for example the diabetic shoe program, every diabetic with peripheral neuropathy in America is eligible for diabetic shoes and custom inserts. At one point as a cost saving measure they cut this service, which ended up costing them hundreds of millions of dollars in the long run due to the increased incidents of wound care and amputations.
Itās a much more complicated system then you would like to assume.