Author Topic: What comes after the ACA?  (Read 310266 times)

nereo

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Re: What comes after the ACA?
« Reply #2350 on: May 15, 2017, 09:30:56 AM »

$10k per year per person is $3 trillion dollars per year.   That is a lot of money.
Most people are clueless about the real cost of healthcare.


what is the break down of the costs?
How much of that is insurance premiums, profits,  100$ overpriced ibuprofen pills and bandaids at hospitals
Interesting question. 
Here's a quick breakdown according to cms.gov

Health Spending by Type

Total 2015 health care spending = $3.2T (up 5.8% y/y)

Hospital care: $1.0T (32%)
Physician/Clinical $634.9B (20%)
Professional Services: $87.7B (3%) *
Dental Services: $117.5B (4%)
"Other" Health Services: $163.3B (5%)**
Home Health Care: $88.8B (3%)
Nursing Care: $156.8B (5%)
Prescription Drugs: $324.6B (20%)
Durable Medical Equipment: $48.5B (2%) ***
Non-durable Medical Equipment: $59B (2%) ****

* independent health-care practitioners like physical therapists, optometry, podiatry etc.
**services generally delivered in non-traditional settings (schools, community centers, workplace) as well as ambulance care and substance abuce/mental heath
*** retail spending, includes eye-glasses, hearing aids, etc.
**** retail spending, includes OTC medicines, surgical dressings, etc.

Health Spending by Major sources of funds:
Medicare $646,2B (20%)
Medicaid (17%)
Private Health insurance: $1.1T (33%)
Out of Pocket: $338.1B (11%)

Health Spending by Type of Sponsor
Federal Government (29%)
Households (28%)
Private Businesses (20%)
State/Local G'vment (17%)

Source (opens PDF)
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TheBeeKeeper

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Re: What comes after the ACA?
« Reply #2351 on: May 15, 2017, 09:54:51 AM »

$10k per year per person is $3 trillion dollars per year.   That is a lot of money.
Most people are clueless about the real cost of healthcare.


what is the break down of the costs?
How much of that is insurance premiums, profits,  100$ overpriced ibuprofen pills and bandaids at hospitals

Though you have a point, you can't just take that money out of the system. That overpriced pill goes to investment in new pills or employee's salaries. Insurance premiums support thousands of employees who would presumably need a job elsewhere, and someone would need profits to pay their salaries. It also pays for admin work, some of which will still need to be done at some level. "Exorbitant" hospital bills pay for doctors, equipment, and new hospitals; we would still need this right?

In my opinion single-payer is probably more efficient, but it's not just flicking a switch and getting health-care nirvana and saving billions. Especially not with an ingrown system like this. I don't think for a second it's a cut and dry as the Sanders crowd make it out to be. Like Trump, simple, feel-good answers to complex problems is his thing..

there are many reasons why health care costs in the US are about double the cost per capita compared to the rest of the developed world ( and the outcomes are worse in the US)
Of course there is no  simple solution, and it's no health-care nirvana in any of those other countries, but there is no reason why what has been proven to work in Europe, Canada, Australia, etc. would not work in the US

I just wasted an hour on the phone back and forth with  the Dr. office and the insurance company to figure out if my spouse's colonoscopy would be covered , and how much  we would have to pay.
Could not get passed "if the Dr. bills it in a certain way, then we would cover 90% after deductible" 90% of what? no one knows, and we are the lucky ones with awesome health insurance coverage from a large employer.
It doesn't have to be this way. Single payer just means no insurance middle-man, and nobody needs to worry about going into huge debt over medical issues. This is the real inefficiency of the system.
We need to move on from health insurance system to a real health CARE system



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Re: What comes after the ACA?
« Reply #2352 on: May 15, 2017, 09:59:28 AM »
I would shed zero tears for all the folks who would become unemployed from their jobs at private health insurance companies.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2353 on: May 15, 2017, 10:00:33 AM »

$10k per year per person is $3 trillion dollars per year.   That is a lot of money.
Most people are clueless about the real cost of healthcare.


what is the break down of the costs?
How much of that is insurance premiums, profits,  100$ overpriced ibuprofen pills and bandaids at hospitals

Great question. And I have some opinions on this being a physician and seeing a lot of waste. The US pays almost twice as much for healthcare as compared to other developed countries.  Where does that money go?

1) Physicians: I hate saying this, but physicians make more money in the US compared to other countries.  I will add that in other countries physicians don't come out $350k in debt, as well as have a shorter track to practice allowing them to start their career earlier.  Also in many of those countries physicians are not subject to frivolous law suits. 

2) Regulations: Go to any hospital and doctors office and add up all the non patient care personnel in that facility. These people do not add any value to the patient but are required to meet regulatory standards as well as billing/coding needs.

3) End of life care: Families of patients with no quality of life, severe dementia, bed bound, half paralyzed will receive medical treatment to prolong their agony. Some suspect this accounts for 20% of medicare cost.

4) Insurance company profits:  There should be no need to have an insurance middle man skimming their piece off of every transaction. Insurance should exist for catastrophic expenses not for refilling your blood pressure medication or seeing your primary care doctor for a cold.

5) Shortage of primary care physicians forcing patients into emergency departments for primary care needs.

Today if someone with insurance goes to see their doctor with a cough the process is as follows after showing up at the office:
a) give insurance info
b) insurance info must be processed
c) a person is required to fill out regulatory information regarding your lifestyle and habits
d) all that info must be placed into expensive computer software that requires IT to manage
e) physician finally sees you, examines you and gives you a recommendation and may write a prescription all of which takes about 5 minutes
f) physician spends another 5-10 minutes documenting your care
g) coder must take that documentation and turn it into something billable
h) billing process must take affect and the insurance company must agree to pay for the visit.  If rejected that bill can be requested to be re-evaluated.
i) for brevity I will not go into detail at the hoops that must be jumped through at the pharmacy when you deliver your script. But that also is filled with regulatory and insurance burdens.

or

The patient goes to see their doctor, there is a nurse/secretary at the front desk that asks you to sign in and swipe a credit card.  Basic info is documented in a much less expensive computer system. You see your doctor for 5 minutes who documents for 1 minute regarding your visit (less documentation is needed since there is no need to send to a coder/biller and there is less regulatory demand.) You get your prescription and finalize your bill through your credit card.

As you can see the second process requires less personnel and takes up less time allowing the physician to see more patients per day.  The total cost of the visit drops dramatically.

The thing is, there are hundreds of thousands of people employed by healthcare that would lose their jobs if we instantly fixed the problem. It really isn't as simple as flip a switch, increase medicare tax to 15% and everyone gets medicare. I honestly do not see any legitimate improvement for a very long time. Previous and current administrations do not show any desire to fix the problems I just laid out. I suspect future administrations will have similar attitudes.
« Last Edit: May 15, 2017, 10:28:15 AM by EnjoyIt »

TheBeeKeeper

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Re: What comes after the ACA?
« Reply #2354 on: May 15, 2017, 10:00:48 AM »

$10k per year per person is $3 trillion dollars per year.   That is a lot of money.
Most people are clueless about the real cost of healthcare.


what is the break down of the costs?
How much of that is insurance premiums, profits,  100$ overpriced ibuprofen pills and bandaids at hospitals
Interesting question. 
Here's a quick breakdown according to cms.gov

Health Spending by Type

Total 2015 health care spending = $3.2T (up 5.8% y/y)

Hospital care: $1.0T (32%)
Physician/Clinical $634.9B (20%)
Professional Services: $87.7B (3%) *
Dental Services: $117.5B (4%)
"Other" Health Services: $163.3B (5%)**
Home Health Care: $88.8B (3%)
Nursing Care: $156.8B (5%)
Prescription Drugs: $324.6B (20%)
Durable Medical Equipment: $48.5B (2%) ***
Non-durable Medical Equipment: $59B (2%) ****

* independent health-care practitioners like physical therapists, optometry, podiatry etc.
**services generally delivered in non-traditional settings (schools, community centers, workplace) as well as ambulance care and substance abuce/mental heath
*** retail spending, includes eye-glasses, hearing aids, etc.
**** retail spending, includes OTC medicines, surgical dressings, etc.

Health Spending by Major sources of funds:
Medicare $646,2B (20%)
Medicaid (17%)
Private Health insurance: $1.1T (33%)
Out of Pocket: $338.1B (11%)

Health Spending by Type of Sponsor
Federal Government (29%)
Households (28%)
Private Businesses (20%)
State/Local G'vment (17%)

Source (opens PDF)

Where is how much we spend on insurance premiums?
and another question would be what % of people in the country have true access to health care.
People who cannot afford insurance, or people with catastrophic plans (or maybe just bad coverage) would skip the Dr. and rely on luck or Dr. Google


EnjoyIt

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Re: What comes after the ACA?
« Reply #2355 on: May 15, 2017, 10:06:43 AM »
I just wasted an hour on the phone back and forth with  the Dr. office and the insurance company to figure out if my spouse's colonoscopy would be covered , and how much  we would have to pay.
Could not get passed "if the Dr. bills it in a certain way, then we would cover 90% after deductible" 90% of what? no one knows, and we are the lucky ones with awesome health insurance coverage from a large employer.
It doesn't have to be this way. Single payer just means no insurance middle-man, and nobody needs to worry about going into huge debt over medical issues. This is the real inefficiency of the system.
We need to move on from health insurance system to a real health CARE system

I'm sorry you had to go through all that. It is sad adn embarrassing how convoluted and complex the system is. For many years I have been against a single payer system.  My tune has changed as I study it further, but I also realize that a single payer system is not enough.  We still have the same hoops to jump through when dealing with Medicare and Medicaid that you described above.  Look at the single payer system in Germany who everybody loves so much.  There are 130 organizations that manage this insurance, all employees in the country of Germany pay ~15% in healthcare tax.  That includes those working for minimal wage, and still 1/3 of the hospitals in Germany are losing money.  Single payer is not necessarily the panacea we all hope for.

nereo

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Re: What comes after the ACA?
« Reply #2356 on: May 15, 2017, 10:15:11 AM »
I just wasted an hour on the phone back and forth with  the Dr. office and the insurance company to figure out if my spouse's colonoscopy would be covered , and how much  we would have to pay.
Could not get passed "if the Dr. bills it in a certain way, then we would cover 90% after deductible" 90% of what? no one knows, and we are the lucky ones with awesome health insurance coverage from a large employer.
It doesn't have to be this way. Single payer just means no insurance middle-man, and nobody needs to worry about going into huge debt over medical issues. This is the real inefficiency of the system.
We need to move on from health insurance system to a real health CARE system

I'm sorry you had to go through all that. It is sad adn embarrassing how convoluted and complex the system is. For many years I have been against a single payer system.  My tune has changed as I study it further, but I also realize that a single payer system is not enough.  We still have the same hoops to jump through when dealing with Medicare and Medicaid that you described above.  Look at the single payer system in Germany who everybody loves so much.  There are 130 organizations that manage this insurance, all employees in the country of Germany pay ~15% in healthcare tax.  That includes those working for minimal wage, and still 1/3 of the hospitals in Germany are losing money.  Single payer is not necessarily the panacea we all hope for.

I'll add that I've been having my own frustrations here in Canada with our health-care system in Quebec (Canada does not have a national health-care system).
I'm not certain that people in the US would be comfortable with the same system, and I'm unclear what is meant when people just brandish terms around like "for worse outcomes".
Most of the data I've seen still shows outcomes for insured patients within the US to be at or near the top in nearly every category.  The problem is that we're paying through the nose for our system, when other developed countries get nearly as good results for half to a third the cost.  And of course in the US we also have millions of uninsured or under-insured.
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beltim

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Re: What comes after the ACA?
« Reply #2357 on: May 15, 2017, 10:15:57 AM »
there are many reasons why health care costs in the US are about double the cost per capita compared to the rest of the developed world ( and the outcomes are worse in the US)
Of course there is no  simple solution, and it's no health-care nirvana in any of those other countries, but there is no reason why what has been proven to work in Europe, Canada, Australia, etc. would not work in the US

I just wasted an hour on the phone back and forth with  the Dr. office and the insurance company to figure out if my spouse's colonoscopy would be covered , and how much  we would have to pay.
Could not get passed "if the Dr. bills it in a certain way, then we would cover 90% after deductible" 90% of what? no one knows, and we are the lucky ones with awesome health insurance coverage from a large employer.
It doesn't have to be this way. Single payer just means no insurance middle-man, and nobody needs to worry about going into huge debt over medical issues. This is the real inefficiency of the system.
We need to move on from health insurance system to a real health CARE system


I copied your whole post, but am only responding to the bolded part.  You're describing a problem of regulation, not of system design.  Switzerland has mandatory private insurance but does not have people worrying about going into huge debt over medical issues because of regulation of the private insurers.  Germany has more or less single-payer system, but it is administered through over 1,000 separate intermediates.  So insurance (or other) middle-men are not the root cause of high health care costs in the US.

beltim

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Re: What comes after the ACA?
« Reply #2358 on: May 15, 2017, 10:17:42 AM »

Health Spending by Major sources of funds:
Medicare $646,2B (20%)
Medicaid (17%)
Private Health insurance: $1.1T (33%)
Out of Pocket: $338.1B (11%)

Health Spending by Type of Sponsor
Federal Government (29%)
Households (28%)
Private Businesses (20%)
State/Local G'vment (17%)

Source (opens PDF)

Where is how much we spend on insurance premiums?
and another question would be what % of people in the country have true access to health care.
People who cannot afford insurance, or people with catastrophic plans (or maybe just bad coverage) would skip the Dr. and rely on luck or Dr. Google

See bolded.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2359 on: May 15, 2017, 10:30:11 AM »

I copied your whole post, but am only responding to the bolded part.  You're describing a problem of regulation, not of system design.  Switzerland has mandatory private insurance but does not have people worrying about going into huge debt over medical issues because of regulation of the private insurers.  Germany has more or less single-payer system, but it is administered through over 1,000 separate intermediates.  So insurance (or other) middle-men are not the only root cause of high health care costs in the US.

Made slight change to your response that makes it a bit more factual I believe.

TheBeeKeeper

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Re: What comes after the ACA?
« Reply #2360 on: May 15, 2017, 10:39:23 AM »

Health Spending by Major sources of funds:
Medicare $646,2B (20%)
Medicaid (17%)
Private Health insurance: $1.1T (33%)
Out of Pocket: $338.1B (11%)

Health Spending by Type of Sponsor
Federal Government (29%)
Households (28%)
Private Businesses (20%)
State/Local G'vment (17%)

Source (opens PDF)

Where is how much we spend on insurance premiums?
and another question would be what % of people in the country have true access to health care.
People who cannot afford insurance, or people with catastrophic plans (or maybe just bad coverage) would skip the Dr. and rely on luck or Dr. Google

See bolded.

it looked to me like "health spending" meant cost of care, and  33% of that was funded by private  insurance
I still don't see in these numbers how much money is spent on premiums, and how much of that the insurance company pay to providers, so how much profit or loss overall for private insurance.

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Re: What comes after the ACA?
« Reply #2361 on: May 15, 2017, 10:54:57 AM »
EnjoyIT there are more and more doctor's offices popping up like you described.  Maybe the change needs to come from that side of the industry.  We have 2 or 3 primary care physicians in town now that take 0 insurance.  what you see is what you pay. get more of that and let me fill an HSA with 14k a year and carry insurance against catasrophy.  works in my world.
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beltim

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Re: What comes after the ACA?
« Reply #2362 on: May 15, 2017, 10:56:35 AM »

I copied your whole post, but am only responding to the bolded part.  You're describing a problem of regulation, not of system design.  Switzerland has mandatory private insurance but does not have people worrying about going into huge debt over medical issues because of regulation of the private insurers.  Germany has more or less single-payer system, but it is administered through over 1,000 separate intermediates.  So insurance (or other) middle-men are not the only root cause of high health care costs in the US.

Made slight change to your response that makes it a bit more factual I believe.

You gave five reasons earlier, and now you're saying that middlemen are the primary reason for higher health care costs, despite not having any evidence to support your assertion?

sol

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Re: What comes after the ACA?
« Reply #2363 on: May 15, 2017, 11:19:33 AM »
Single payer is not necessarily the panacea we all hope for.

I feel like the analogous scenario is a trauma team treating a car accident victim and deciding to not stop the aortic spurting because his legs are also broken.  "Well, we could stop the bleeding but we would still have all of these other problems so why bother" is not a good way to deal with this situation.  No one expects a single quick fix.  Can we at least start taking steps in the right direction?

EnjoyIt

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Re: What comes after the ACA?
« Reply #2364 on: May 15, 2017, 11:37:20 AM »

I copied your whole post, but am only responding to the bolded part.  You're describing a problem of regulation, not of system design.  Switzerland has mandatory private insurance but does not have people worrying about going into huge debt over medical issues because of regulation of the private insurers.  Germany has more or less single-payer system, but it is administered through over 1,000 separate intermediates.  So insurance (or other) middle-men are not the only root cause of high health care costs in the US.

Made slight change to your response that makes it a bit more factual I believe.

You gave five reasons earlier, and now you're saying that middlemen are the primary reason for higher health care costs, despite not having any evidence to support your assertion?

No, I said middlemen are not the only reason.  I think you may have misread.  It may be that I did not make myself clear.

There are actually other causes for higher cost such as poor communication between providers that duplicate testing. Poor follow up to make sure patients are doing the right things at home so as to minimize complications.  There are plenty of other ways to help mitigate cost outside of the 5 I listed.

beltim

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Re: What comes after the ACA?
« Reply #2365 on: May 15, 2017, 11:38:14 AM »
Single payer is not necessarily the panacea we all hope for.

I feel like the analogous scenario is a trauma team treating a car accident victim and deciding to not stop the aortic spurting because his legs are also broken.  "Well, we could stop the bleeding but we would still have all of these other problems so why bother" is not a good way to deal with this situation.  No one expects a single quick fix.  Can we at least start taking steps in the right direction?

Your analogy isn't clear to me.  Are you saying that adopting some other form of universal healthcare is the equivalent of not stopping the aortic spurting?  Is the aortic spurting high health care costs, the lack of coverage, or something else altogether?

beltim

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Re: What comes after the ACA?
« Reply #2366 on: May 15, 2017, 11:40:12 AM »

I copied your whole post, but am only responding to the bolded part.  You're describing a problem of regulation, not of system design.  Switzerland has mandatory private insurance but does not have people worrying about going into huge debt over medical issues because of regulation of the private insurers.  Germany has more or less single-payer system, but it is administered through over 1,000 separate intermediates.  So insurance (or other) middle-men are not the only root cause of high health care costs in the US.

Made slight change to your response that makes it a bit more factual I believe.

You gave five reasons earlier, and now you're saying that middlemen are the primary reason for higher health care costs, despite not having any evidence to support your assertion?

No, I said middlemen are not the only reason.  I think you may have misread.  It may be that I did not make myself clear.

There are actually other causes for higher cost such as poor communication between providers that duplicate testing. Poor follow up to make sure patients are doing the right things at home so as to minimize complications.  There are plenty of other ways to help mitigate cost outside of the 5 I listed.

You corrected "root" to "only" implying that you think middlemen are the root cause of high health care costs in the US.  To me, that means you think it is the driving factor, if not the major reason.  Is that what you meant?

EnjoyIt

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Re: What comes after the ACA?
« Reply #2367 on: May 15, 2017, 11:57:47 AM »

I copied your whole post, but am only responding to the bolded part.  You're describing a problem of regulation, not of system design.  Switzerland has mandatory private insurance but does not have people worrying about going into huge debt over medical issues because of regulation of the private insurers.  Germany has more or less single-payer system, but it is administered through over 1,000 separate intermediates.  So insurance (or other) middle-men are not the only root cause of high health care costs in the US.

Made slight change to your response that makes it a bit more factual I believe.

You gave five reasons earlier, and now you're saying that middlemen are the primary reason for higher health care costs, despite not having any evidence to support your assertion?

No, I said middlemen are not the only reason.  I think you may have misread.  It may be that I did not make myself clear.

There are actually other causes for higher cost such as poor communication between providers that duplicate testing. Poor follow up to make sure patients are doing the right things at home so as to minimize complications.  There are plenty of other ways to help mitigate cost outside of the 5 I listed.

You corrected "root" to "only" implying that you think middlemen are the root cause of high health care costs in the US.  To me, that means you think it is the driving factor, if not the major reason.  Is that what you meant?

It says:
Quote
So insurance (or other) middle-men are not the only cause of high health care costs in the US.
to me it means that it is not the only cause and there are other causes.

beltim

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Re: What comes after the ACA?
« Reply #2368 on: May 15, 2017, 11:59:30 AM »

I copied your whole post, but am only responding to the bolded part.  You're describing a problem of regulation, not of system design.  Switzerland has mandatory private insurance but does not have people worrying about going into huge debt over medical issues because of regulation of the private insurers.  Germany has more or less single-payer system, but it is administered through over 1,000 separate intermediates.  So insurance (or other) middle-men are not the only root cause of high health care costs in the US.

Made slight change to your response that makes it a bit more factual I believe.

You gave five reasons earlier, and now you're saying that middlemen are the primary reason for higher health care costs, despite not having any evidence to support your assertion?

No, I said middlemen are not the only reason.  I think you may have misread.  It may be that I did not make myself clear.

There are actually other causes for higher cost such as poor communication between providers that duplicate testing. Poor follow up to make sure patients are doing the right things at home so as to minimize complications.  There are plenty of other ways to help mitigate cost outside of the 5 I listed.

You corrected "root" to "only" implying that you think middlemen are the root cause of high health care costs in the US.  To me, that means you think it is the driving factor, if not the major reason.  Is that what you meant?

It says:
Quote
So insurance (or other) middle-men are not the only cause of high health care costs in the US.
to me it means that it is not the only cause and there are other causes.

Okay.  I don't understand what your version says differently than the original then.

nereo

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Re: What comes after the ACA?
« Reply #2369 on: May 15, 2017, 01:13:33 PM »

it looked to me like "health spending" meant cost of care, and  33% of that was funded by private  insurance
I still don't see in these numbers how much money is spent on premiums, and how much of that the insurance company pay to providers, so how much profit or loss overall for private insurance.

The ACA (which is the system we are still under) imposes a minimum medical loss ratio for all private insurance companies.  Basically of all the money they take in from premiums they must spent a certain percentage on 'medical care.' For the individual and small group market it is 80%.  For large-group insurance it is 85%.
There is some quibbling about what exactly constittues 'medical care' (money spent to improve the website and reservation system? better medical records? new chairs for the waiting room?) but it absolutely excludes profits. A few states have waivers for a variety of reasons but their MLRs are still typically around 70.

So patient care from private insurance is ~ $900B.
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Re: What comes after the ACA?
« Reply #2370 on: May 15, 2017, 01:18:42 PM »
I just wasted an hour on the phone back and forth with  the Dr. office and the insurance company to figure out if my spouse's colonoscopy would be covered , and how much  we would have to pay.
Could not get passed "if the Dr. bills it in a certain way, then we would cover 90% after deductible" 90% of what? no one knows, and we are the lucky ones with awesome health insurance coverage from a large employer.
It doesn't have to be this way. Single payer just means no insurance middle-man, and nobody needs to worry about going into huge debt over medical issues. This is the real inefficiency of the system.
We need to move on from health insurance system to a real health CARE system

I'm sorry you had to go through all that. It is sad adn embarrassing how convoluted and complex the system is. For many years I have been against a single payer system.  My tune has changed as I study it further, but I also realize that a single payer system is not enough.  We still have the same hoops to jump through when dealing with Medicare and Medicaid that you described above.  Look at the single payer system in Germany who everybody loves so much.  There are 130 organizations that manage this insurance, all employees in the country of Germany pay ~15% in healthcare tax.  That includes those working for minimal wage, and still 1/3 of the hospitals in Germany are losing money.  Single payer is not necessarily the panacea we all hope for.

I've seen you repeat the bolded claim I don't know how many times in this thread (I'm not going to go back through 47 pages and count). Do you have a cite for it? I saw a reference to a study in my brief googling but the article was behind a paywall.

beltim

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Re: What comes after the ACA?
« Reply #2371 on: May 15, 2017, 02:39:43 PM »

it looked to me like "health spending" meant cost of care, and  33% of that was funded by private  insurance
I still don't see in these numbers how much money is spent on premiums, and how much of that the insurance company pay to providers, so how much profit or loss overall for private insurance.

The ACA (which is the system we are still under) imposes a minimum medical loss ratio for all private insurance companies.  Basically of all the money they take in from premiums they must spent a certain percentage on 'medical care.' For the individual and small group market it is 80%.  For large-group insurance it is 85%.
There is some quibbling about what exactly constittues 'medical care' (money spent to improve the website and reservation system? better medical records? new chairs for the waiting room?) but it absolutely excludes profits. A few states have waivers for a variety of reasons but their MLRs are still typically around 70.

So patient care from private insurance is ~ $900B.

Oh, right, I found a good link for this earlier.  Nereo describes the minimum that insurance companies must spend on medical care by law.  The actual average for what private insurance companies spend on "overhead" - that is, administrative costs rather than medical care - is 13.1%, and for comparison purposes Medicare spends 1.8% of premiums on overhead.  The average profit margin adds another 3.2%, which gives a total of 16.3% not spent on medical care, or 83.7% that is spent on medical care.

Reducing the overhead to Medicare levels would save ~$100 billion a year, which is a good start, but only explains about 5-10% of the cost difference between the US and other developed countries health systems.

http://cepr.net/blogs/cepr-blog/overhead-costs-for-private-health-insurance-keep-rising-even-as-costs-fall-for-other-types-of-insurance

EnjoyIt

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Re: What comes after the ACA?
« Reply #2372 on: May 15, 2017, 03:24:52 PM »

It says:
Quote
So insurance (or other) middle-men are not the only cause of high health care costs in the US.
to me it means that it is not the only cause and there are other causes.
Quote
Okay.  I don't understand what your version says differently than the original then.

I guess we are arguing unnecessarily about semantics.  You said "it is not the root cause"  while I said "not the only cause"
Your comments discounts the middle man from being the underlying reason for higher cost while I say that the middle man is one of several reasons for higher cost of care.


Oh, right, I found a good link for this earlier.  Nereo describes the minimum that insurance companies must spend on medical care by law.  The actual average for what private insurance companies spend on "overhead" - that is, administrative costs rather than medical care - is 13.1%, and for comparison purposes Medicare spends 1.8% of premiums on overhead.  The average profit margin adds another 3.2%, which gives a total of 16.3% not spent on medical care, or 83.7% that is spent on medical care.

Reducing the overhead to Medicare levels would save ~$100 billion a year, which is a good start, but only explains about 5-10% of the cost difference between the US and other developed countries health systems.

http://cepr.net/blogs/cepr-blog/overhead-costs-for-private-health-insurance-keep-rising-even-as-costs-fall-for-other-types-of-insurance

Those numbers only talk about the cost from the insurance standpoint.  It does not take into account the cost from the provider standpoint that has to jump though hoops to be able to bill those insurance companies as well as medicare/medicaid.  Those extra costs may very well double those figures.  For example CMS has decided to use a much more cumbersome coding system called ICD-10. To comply with this new system not only are we required to hire personnel to fully understand it, we must educate all our providers on how to properly document to actually be able to bill for the service provided.  Much of the extra documentation provides no added value to the patient but does increase time to fill out.  This extra time costs money as it is taken away from patient care.  Some providers hire scribes to assist them which also costs money.  These extra costs are invariably paid for by the end consumer (patients.)
« Last Edit: May 15, 2017, 03:32:52 PM by EnjoyIt »

EnjoyIt

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Re: What comes after the ACA?
« Reply #2373 on: May 15, 2017, 03:56:26 PM »
Quote
I'm sorry you had to go through all that. It is sad adn embarrassing how convoluted and complex the system is. For many years I have been against a single payer system.  My tune has changed as I study it further, but I also realize that a single payer system is not enough.  We still have the same hoops to jump through when dealing with Medicare and Medicaid that you described above.  Look at the single payer system in Germany who everybody loves so much.  There are 130 organizations that manage this insurance, all employees in the country of Germany pay ~15% in healthcare tax.  That includes those working for minimal wage, and still 1/3 of the hospitals in Germany are losing money.  Single payer is not necessarily the panacea we all hope for.

I've seen you repeat the bolded claim I don't know how many times in this thread (I'm not going to go back through 47 pages and count). Do you have a cite for it? I saw a reference to a study in my brief googling but the article was behind a paywall.

Please see attachment.
Most of the article discuses a prostate clinic in Germany showing how despite lower reimbursement one clinic has been able to provide improved patient care at a lower cost.  The whole article is very interesting but the point regarding Germany's system is described in just the first few pages.

EnjoyIT there are more and more doctor's offices popping up like you described.  Maybe the change needs to come from that side of the industry.  We have 2 or 3 primary care physicians in town now that take 0 insurance.  what you see is what you pay. get more of that and let me fill an HSA with 14k a year and carry insurance against catasrophy.  works in my world.

There sure are. I also see plenty of free standing Emergency Departments opening up that do not accept medicare/medicaid. I believe that at some point the regulatory burden will be so large that we will find small hospitals opening up that want nothing to do with the government.  I think that is probably more the future as opposed to a single payer utopia that so many wish for but don't fully understand all the moving parts involved.  Our current government option, CMS, does not do that great of a job as can be seen at how much the government is spending on healthcare year over year. I think our last administration did nothing to improve healthcare except provide insurance for some people.  It did nothing to address how healthcare is delivered and increased to the cost to the middle class. I do strongly agree with the pre-existing condition clause. This current administration equally has no positive plans on fixing the current problems.  I think we have a very long way to go.

gaja

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Re: What comes after the ACA?
« Reply #2374 on: May 15, 2017, 04:54:55 PM »

$10k per year per person is $3 trillion dollars per year.   That is a lot of money.
Most people are clueless about the real cost of healthcare.

what is the break down of the costs?
How much of that is insurance premiums, profits,  100$ overpriced ibuprofen pills and bandaids at hospitals

Great question. And I have some opinions on this being a physician and seeing a lot of waste. The US pays almost twice as much for healthcare as compared to other developed countries.  Where does that money go?

[...]

Today if someone with insurance goes to see their doctor with a cough the process is as follows after showing up at the office:
a) give insurance info
b) insurance info must be processed
c) a person is required to fill out regulatory information regarding your lifestyle and habits
d) all that info must be placed into expensive computer software that requires IT to manage
e) physician finally sees you, examines you and gives you a recommendation and may write a prescription all of which takes about 5 minutes
f) physician spends another 5-10 minutes documenting your care
g) coder must take that documentation and turn it into something billable
h) billing process must take affect and the insurance company must agree to pay for the visit.  If rejected that bill can be requested to be re-evaluated.
i) for brevity I will not go into detail at the hoops that must be jumped through at the pharmacy when you deliver your script. But that also is filled with regulatory and insurance burdens.

or

The patient goes to see their doctor, there is a nurse/secretary at the front desk that asks you to sign in and swipe a credit card.  Basic info is documented in a much less expensive computer system. You see your doctor for 5 minutes who documents for 1 minute regarding your visit (less documentation is needed since there is no need to send to a coder/biller and there is less regulatory demand.) You get your prescription and finalize your bill through your credit card.

As you can see the second process requires less personnel and takes up less time allowing the physician to see more patients per day.  The total cost of the visit drops dramatically.

The thing is, there are hundreds of thousands of people employed by healthcare that would lose their jobs if we instantly fixed the problem. It really isn't as simple as flip a switch, increase medicare tax to 15% and everyone gets medicare. I honestly do not see any legitimate improvement for a very long time. Previous and current administrations do not show any desire to fix the problems I just laid out. I suspect future administrations will have similar attitudes.

Norwegians generally prefer to interact with as few people as possible. Partly because we can't afford to employ a lot of people with high salaries, and partly because we are chronically introvert. Actually, I think the second reason is more important.

If I had a cough, it would go something like this:

a) order appointment via sms or online
b) get sms with time and date. With only a cough as symptoms I would probably have a bit of waiting time (a week or two). Kids and more severe stuff gets priority. A lot of people get better while waiting, and cancel the appointments. If they get worse, they can call and get in faster, or go to the ER if it is really bad.
c) be at the doctor's office five minutes before the appointment, tell the reseptionist my name and sit down and wait. All greetings are kept short, there is no small talk.
d) see the doctor for five minutes, probably not get a prescription. If she suspects bacterial, I would have to take a test before I could get antibiotics. Get back out and give the reseptionist the papers ordering the test.
e) wait until the nurse can see me and draw blood. There is usually one reseptionist and/or one nurse for 3-4 doctors.
f) give up blood
g) walk over to the automated payment booth, enter my birth day and name, and pay via card. There is a maximum co-pay of $300/year (0 for children and disabled). When you have paid more than that within a year for medication, hospital stays, doctor's appointments, etc, it is free, and you would just nod at the reseptionist and leave. All co-pays are registered, everything is automated.
h) if the test shows bacterial, I will receive an sms that I can pick up prescriptions for antibiotics at the pharmacy. This also goes via a central system, so I can get the meds at any pharmacy in Norway, and I can keep tabs online of how much is left on any prescription. If it is a virus, I might get a letter recommending hot tea with lemon, but probably just a short note telling me to wait it out.

As to the cost of developing medications; this article might be of interest (with the help of google translate). The medical tests cost the state of Norway $20 mill NOK, and the new medicine will save us at least ten times as much every year: https://www.nrk.no/norge/banebrytende-norsk-studie-apner-for-viktige-kopimedisiner-1.13512077
Sure, there is a lot of research before you get to that stage, but it is interesting that it can make economic sense to use public funding directly to fund medicine development, instead of giving public funding to private actors to let them do the development of the drugs.

My family's total tax burden (taxes/all income) for 2016 was 21 %. This includes 8.2% for social security (maternity leave, paid sick leave, unemployment, state pension, etc). Sure, we also have sale tax and stuff like that, but those are easy to reduce by not buying loads of stuff. But still, I doubt we are paying on average $10k for medical.
Travelling southern Norway, Iceland and the Faroes in an electric car: http://travelelectric.blogspot.no/

EnjoyIt

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Re: What comes after the ACA?
« Reply #2375 on: May 15, 2017, 06:10:16 PM »

Norwegians generally prefer to interact with as few people as possible. Partly because we can't afford to employ a lot of people with high salaries, and partly because we are chronically introvert. Actually, I think the second reason is more important.

If I had a cough, it would go something like this:

a) order appointment via sms or online
b) get sms with time and date. With only a cough as symptoms I would probably have a bit of waiting time (a week or two). Kids and more severe stuff gets priority. A lot of people get better while waiting, and cancel the appointments. If they get worse, they can call and get in faster, or go to the ER if it is really bad.
c) be at the doctor's office five minutes before the appointment, tell the reseptionist my name and sit down and wait. All greetings are kept short, there is no small talk.
d) see the doctor for five minutes, probably not get a prescription. If she suspects bacterial, I would have to take a test before I could get antibiotics. Get back out and give the reseptionist the papers ordering the test.
e) wait until the nurse can see me and draw blood. There is usually one reseptionist and/or one nurse for 3-4 doctors.
f) give up blood
g) walk over to the automated payment booth, enter my birth day and name, and pay via card. There is a maximum co-pay of $300/year (0 for children and disabled). When you have paid more than that within a year for medication, hospital stays, doctor's appointments, etc, it is free, and you would just nod at the reseptionist and leave. All co-pays are registered, everything is automated.
h) if the test shows bacterial, I will receive an sms that I can pick up prescriptions for antibiotics at the pharmacy. This also goes via a central system, so I can get the meds at any pharmacy in Norway, and I can keep tabs online of how much is left on any prescription. If it is a virus, I might get a letter recommending hot tea with lemon, but probably just a short note telling me to wait it out.

As to the cost of developing medications; this article might be of interest (with the help of google translate). The medical tests cost the state of Norway $20 mill NOK, and the new medicine will save us at least ten times as much every year: https://www.nrk.no/norge/banebrytende-norsk-studie-apner-for-viktige-kopimedisiner-1.13512077
Sure, there is a lot of research before you get to that stage, but it is interesting that it can make economic sense to use public funding directly to fund medicine development, instead of giving public funding to private actors to let them do the development of the drugs.

My family's total tax burden (taxes/all income) for 2016 was 21 %. This includes 8.2% for social security (maternity leave, paid sick leave, unemployment, state pension, etc). Sure, we also have sale tax and stuff like that, but those are easy to reduce by not buying loads of stuff. But still, I doubt we are paying on average $10k for medical.

Gaja, thank you so much for sharing your perspective of medicine in Norway.  There are so many interesting pathways for healthcare. FYI in 2010 Norway had the second highest cost of healthcare per person which was still 40% less than the US. Looks like Norway has created a very streamlined way of billing people which saves times and money.  This is the exact opposite of the US where even billing our government payer is a very convoluted process costing the service providers a lot of time and money.  For example if the US went to a single payer system tomorrow without fixing the coding/billing part as well as some of the other very high expenses of healthcare the system would implode.


I feel like the analogous scenario is a trauma team treating a car accident victim and deciding to not stop the aortic spurting because his legs are also broken.  "Well, we could stop the bleeding but we would still have all of these other problems so why bother" is not a good way to deal with this situation.  No one expects a single quick fix.  Can we at least start taking steps in the right direction?

Sol, in your example the gushing aorta is the very high cost and regulatory waste currently occurring in healthcare.  Just fixing the broken leg will still exsanguinate our system of all the money. We need to fix the underlying problem, the gushing aorta before we jump head first into a single payer model that will create havoc. Maybe a good start is a public option which can be a subsidiary of CMS.  If the public option can prove to provide better care at a lower cost then everyone would switch to it. Currently what I see from CMS does not seam to be very promising to be able to handle 90%+ of the US population. I would honestly love to see a public option that can do better.

Lagom

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Re: What comes after the ACA?
« Reply #2376 on: May 15, 2017, 09:38:20 PM »
Aetna CEO opines that we should have a national debate on single payer:

https://www.vox.com/policy-and-politics/2017/5/12/15629716/aetna-ceo-bertolini-single-payer



gaja

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Re: What comes after the ACA?
« Reply #2378 on: May 16, 2017, 08:26:33 AM »

 FYI in 2010 Norway had the second highest cost of healthcare per person which was still 40% less than the US. Looks like Norway has created a very streamlined way of billing people which saves times and money.  This is the exact opposite of the US where even billing our government payer is a very convoluted process costing the service providers a lot of time and money.  For example if the US went to a single payer system tomorrow without fixing the coding/billing part as well as some of the other very high expenses of healthcare the system would implode.


Yes, we spend a lot on healthcare, but we also get a lot for our money:
-12 months 100% paid sick leave
-59 weeks parental leave at 80 % salary
-40 weeks training for parents of disabled children, with 100 % salary
-nearly all elderly get some sort of help; regular visits from a nurse, assisted living facilities, nursing home, etc
-maximum $300 co-pay for medicine/doctor visits/hospital stays/transport, and $250 co-pay for physical therapy (including therapy travels to warmer climates)
-free sign language interpretor services anytime, anywhere (have to pay for travel and hotel if we bring them abroad om holiday, but not if we are travelling for work/study)
-decent care for disabled, including help in the home or weekend stays at care centers to give parents some time off
-if you care for someone that is disabled, you can get a monthly stipend ranging from $150/month, up to $2000 if it equals full time work.
-if your illness/disability causes you to have higher expenses than normal (more clothes washing, batteries for hearing aids, special food...), you'll get a monthly stipend.
-if you need a wheel chair accessable house or car, you can get parts of the cost covered. Normally the additional cost compared to a "normal" house/car, or money that covers the building costs.
-transport costs are sometimes extremely high. Bringing people in from remote mountain areas with helicopter, or having a speed boat with medical personell at standby in an archipelago, can be a large part of the healthcare budget in some regions.
etc.

What we don't spend money on:
-Fancy rooms, or even single rooms, at hospitals.
-Good food at the hospitals or nursing homes.
-High salaries
-Enough people (I know the statistics say we have many nurses and doctors per person, but in real life they have very stressful work)
-Most elective surgeries
-Fast tracks (if someone else has a greater need, or your condition might get better if you wait it out, you get placed at the back of the line)

Comparisons between so different systems are difficult, but based on what you are discussing, it does sound like there is a savings potential in the US system.
Travelling southern Norway, Iceland and the Faroes in an electric car: http://travelelectric.blogspot.no/

EnjoyIt

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Re: What comes after the ACA?
« Reply #2379 on: May 16, 2017, 08:58:30 AM »

 FYI in 2010 Norway had the second highest cost of healthcare per person which was still 40% less than the US. Looks like Norway has created a very streamlined way of billing people which saves times and money.  This is the exact opposite of the US where even billing our government payer is a very convoluted process costing the service providers a lot of time and money.  For example if the US went to a single payer system tomorrow without fixing the coding/billing part as well as some of the other very high expenses of healthcare the system would implode.


Yes, we spend a lot on healthcare, but we also get a lot for our money:
-12 months 100% paid sick leave
-59 weeks parental leave at 80 % salary
-40 weeks training for parents of disabled children, with 100 % salary
-nearly all elderly get some sort of help; regular visits from a nurse, assisted living facilities, nursing home, etc
-maximum $300 co-pay for medicine/doctor visits/hospital stays/transport, and $250 co-pay for physical therapy (including therapy travels to warmer climates)
-free sign language interpretor services anytime, anywhere (have to pay for travel and hotel if we bring them abroad om holiday, but not if we are travelling for work/study)
-decent care for disabled, including help in the home or weekend stays at care centers to give parents some time off
-if you care for someone that is disabled, you can get a monthly stipend ranging from $150/month, up to $2000 if it equals full time work.
-if your illness/disability causes you to have higher expenses than normal (more clothes washing, batteries for hearing aids, special food...), you'll get a monthly stipend.
-if you need a wheel chair accessable house or car, you can get parts of the cost covered. Normally the additional cost compared to a "normal" house/car, or money that covers the building costs.
-transport costs are sometimes extremely high. Bringing people in from remote mountain areas with helicopter, or having a speed boat with medical personell at standby in an archipelago, can be a large part of the healthcare budget in some regions.
etc.

What we don't spend money on:
-Fancy rooms, or even single rooms, at hospitals.
-Good food at the hospitals or nursing homes.
-High salaries
-Enough people (I know the statistics say we have many nurses and doctors per person, but in real life they have very stressful work)
-Most elective surgeries
-Fast tracks (if someone else has a greater need, or your condition might get better if you wait it out, you get placed at the back of the line)

Comparisons between so different systems are difficult, but based on what you are discussing, it does sound like there is a savings potential in the US system.

My God, yes. There is so much room to cut cost in the US. Our system is riddled with waste and overutilization.

protostache

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Re: What comes after the ACA?
« Reply #2380 on: May 16, 2017, 07:56:01 PM »
Quote
I'm sorry you had to go through all that. It is sad adn embarrassing how convoluted and complex the system is. For many years I have been against a single payer system.  My tune has changed as I study it further, but I also realize that a single payer system is not enough.  We still have the same hoops to jump through when dealing with Medicare and Medicaid that you described above.  Look at the single payer system in Germany who everybody loves so much.  There are 130 organizations that manage this insurance, all employees in the country of Germany pay ~15% in healthcare tax.  That includes those working for minimal wage, and still 1/3 of the hospitals in Germany are losing money.  Single payer is not necessarily the panacea we all hope for.

I've seen you repeat the bolded claim I don't know how many times in this thread (I'm not going to go back through 47 pages and count). Do you have a cite for it? I saw a reference to a study in my brief googling but the article was behind a paywall.

Please see attachment.

Thank you for the paper, that's a very interesting read.

CDP45

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Re: What comes after the ACA?
« Reply #2381 on: May 17, 2017, 11:55:37 AM »

 FYI in 2010 Norway had the second highest cost of healthcare per person which was still 40% less than the US. Looks like Norway has created a very streamlined way of billing people which saves times and money.  This is the exact opposite of the US where even billing our government payer is a very convoluted process costing the service providers a lot of time and money.  For example if the US went to a single payer system tomorrow without fixing the coding/billing part as well as some of the other very high expenses of healthcare the system would implode.


Yes, we spend a lot on healthcare, but we also get a lot for our money:
-12 months 100% paid sick leave
-59 weeks parental leave at 80 % salary
-40 weeks training for parents of disabled children, with 100 % salary
-nearly all elderly get some sort of help; regular visits from a nurse, assisted living facilities, nursing home, etc
-maximum $300 co-pay for medicine/doctor visits/hospital stays/transport, and $250 co-pay for physical therapy (including therapy travels to warmer climates)
-free sign language interpretor services anytime, anywhere (have to pay for travel and hotel if we bring them abroad om holiday, but not if we are travelling for work/study)
-decent care for disabled, including help in the home or weekend stays at care centers to give parents some time off
-if you care for someone that is disabled, you can get a monthly stipend ranging from $150/month, up to $2000 if it equals full time work.
-if your illness/disability causes you to have higher expenses than normal (more clothes washing, batteries for hearing aids, special food...), you'll get a monthly stipend.
-if you need a wheel chair accessable house or car, you can get parts of the cost covered. Normally the additional cost compared to a "normal" house/car, or money that covers the building costs.
-transport costs are sometimes extremely high. Bringing people in from remote mountain areas with helicopter, or having a speed boat with medical personell at standby in an archipelago, can be a large part of the healthcare budget in some regions.
etc.

What we don't spend money on:
-Fancy rooms, or even single rooms, at hospitals.
-Good food at the hospitals or nursing homes.
-High salaries
-Enough people (I know the statistics say we have many nurses and doctors per person, but in real life they have very stressful work)
-Most elective surgeries
-Fast tracks (if someone else has a greater need, or your condition might get better if you wait it out, you get placed at the back of the line)

Comparisons between so different systems are difficult, but based on what you are discussing, it does sound like there is a savings potential in the US system.

I imagine better outcomes are easier to achieve with only 5,000,000 people, and also when a huge part of the economy is based on oil.

I'm not sure luck will solve our problems here, and given all the renewables and advanced fraking going on, pretty sure oil will never be $100, and questionable over $60. World Reserves have only being increasing.





gaja

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Re: What comes after the ACA?
« Reply #2382 on: May 17, 2017, 01:37:37 PM »
I imagine better outcomes are easier to achieve with only 5,000,000 people, and also when a huge part of the economy is based on oil.

I'm not sure luck will solve our problems here, and given all the renewables and advanced fraking going on, pretty sure oil will never be $100, and questionable over $60. World Reserves have only being increasing.

I don't get how our oil revenue or population size is relevant? As every other nation on earth, Norway spends substantially less than USA on health care costs: in total, pro capita, and compared to GDP. Page 7 here has an interesting overview: http://www.commonwealthfund.org/~/media/files/publications/fund-report/2016/jan/1857_mossialos_intl_profiles_2015_v7.pdf?la=en

As to our national economy, the oil revenue fund gives us a nice buffer against the crude oil prices (https://www.nbim.no/en/). The supply industry does get into problems when the oil price drops, but we still have other industries, such as fish and plenty of renewable energy.
Travelling southern Norway, Iceland and the Faroes in an electric car: http://travelelectric.blogspot.no/

Scandium

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Re: What comes after the ACA?
« Reply #2383 on: May 17, 2017, 01:38:50 PM »

 FYI in 2010 Norway had the second highest cost of healthcare per person which was still 40% less than the US. Looks like Norway has created a very streamlined way of billing people which saves times and money.  This is the exact opposite of the US where even billing our government payer is a very convoluted process costing the service providers a lot of time and money.  For example if the US went to a single payer system tomorrow without fixing the coding/billing part as well as some of the other very high expenses of healthcare the system would implode.


Yes, we spend a lot on healthcare, but we also get a lot for our money:
-12 months 100% paid sick leave
-59 weeks parental leave at 80 % salary

Are these counted is the healthcare spending budget? It's my understanding it works like an insurance, paid by the employer and the state in some combination. I wouldn't call that healthcare, it's just a forced short term disability insurance that comes out of your salary over your lifetime, whether you have children or not.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2384 on: May 17, 2017, 01:43:28 PM »
There's a business for those that wants to help resettle US early retirees into a country that provides good health care

gaja

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Re: What comes after the ACA?
« Reply #2385 on: May 17, 2017, 01:46:10 PM »

 FYI in 2010 Norway had the second highest cost of healthcare per person which was still 40% less than the US. Looks like Norway has created a very streamlined way of billing people which saves times and money.  This is the exact opposite of the US where even billing our government payer is a very convoluted process costing the service providers a lot of time and money.  For example if the US went to a single payer system tomorrow without fixing the coding/billing part as well as some of the other very high expenses of healthcare the system would implode.


Yes, we spend a lot on healthcare, but we also get a lot for our money:
-12 months 100% paid sick leave
-59 weeks parental leave at 80 % salary

Are these counted is the healthcare spending budget? It's my understanding it works like an insurance, paid by the employer and the state in some combination. I wouldn't call that healthcare, it's just a forced short term disability insurance that comes out of your salary over your lifetime, whether you have children or not.

I haven't been able to find what is included in the statistics, at what isn't. There are probably other parts of that list that falls outside the stats, and other things that are missing. It does depend on membership in the social security system.
Travelling southern Norway, Iceland and the Faroes in an electric car: http://travelelectric.blogspot.no/

Jrr85

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Re: What comes after the ACA?
« Reply #2386 on: May 17, 2017, 02:42:44 PM »
There's a business for those that wants to help resettle US early retirees into a country that provides good health care

Developers could probably be killing it by doing planned communities in LCOL countries that are good for ex-pats.  Somehwere like Panama or Nicaragua maybe, where you could build U.S. quality housing for very cheap and still have plenty of room to make huge profits selling to expats who like the idea of being in an expat community and having all the transitional issues figured out for them.  I assume that's already a thing I just don't know of them. 

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2387 on: May 17, 2017, 02:52:13 PM »
There's a business for those that wants to help resettle US early retirees into a country that provides good health care

Developers could probably be killing it by doing planned communities in LCOL countries that are good for ex-pats.  Somehwere like Panama or Nicaragua maybe, where you could build U.S. quality housing for very cheap and still have plenty of room to make huge profits selling to expats who like the idea of being in an expat community and having all the transitional issues figured out for them.  I assume that's already a thing I just don't know of them.

Maybe Costa Rica too

talltexan

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Re: What comes after the ACA?
« Reply #2388 on: May 18, 2017, 02:00:22 PM »
There's a business for those that wants to help resettle US early retirees into a country that provides good health care

Developers could probably be killing it by doing planned communities in LCOL countries that are good for ex-pats.  Somehwere like Panama or Nicaragua maybe, where you could build U.S. quality housing for very cheap and still have plenty of room to make huge profits selling to expats who like the idea of being in an expat community and having all the transitional issues figured out for them.  I assume that's already a thing I just don't know of them.

Ecuador is one I hear to be popular. Also Baja, Mexico.

jim555

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Re: What comes after the ACA?
« Reply #2389 on: May 18, 2017, 03:04:43 PM »
Health insurers and state officials say Trump is undermining Obamacare, pushing up rates

http://www.latimes.com/politics/la-na-pol-obamacare-trump-mismanagement-20170518-story.html

GOP strategy, break it and blame Obama.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2390 on: May 18, 2017, 08:01:41 PM »
Health insurers and state officials say Trump is undermining Obamacare, pushing up rates

http://www.latimes.com/politics/la-na-pol-obamacare-trump-mismanagement-20170518-story.html

GOP strategy, break it and blame Obama.

The incompetency of the Trump administration as shown by this article is unparalleled in modern US history.

former player

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Re: What comes after the ACA?
« Reply #2391 on: May 19, 2017, 01:31:36 AM »
Health insurers and state officials say Trump is undermining Obamacare, pushing up rates

http://www.latimes.com/politics/la-na-pol-obamacare-trump-mismanagement-20170518-story.html

GOP strategy, break it and blame Obama.

The incompetency of the Trump administration as shown by this article is unparalleled in modern US history.
It hasn't killed as many people as weapons of mass destruction.

Yet.
Be frugal and industrious, and you will be free (Ben Franklin)

NESailor

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Re: What comes after the ACA?
« Reply #2392 on: May 19, 2017, 07:23:31 AM »
How about reports that the AHCA passing without a CBO score may actually backfire?  I'm no expert on this so perhaps someone could help me get educated.  What would make the bill have to go through the house again?

Seems to me that Trump and the GOP are burning political capital way too fast considering they didn't start with a whole lot of it.

protostache

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Re: What comes after the ACA?
« Reply #2393 on: May 19, 2017, 02:08:35 PM »
How about reports that the AHCA passing without a CBO score may actually backfire?  I'm no expert on this so perhaps someone could help me get educated.  What would make the bill have to go through the house again?

Seems to me that Trump and the GOP are burning political capital way too fast considering they didn't start with a whole lot of it.

The Senate's reconciliation rules (the Byrd Rule) stipulates that a bill has to reduce the deficit by at least $2bil over 10 years, or else it can't be taken up by the Senate and the House would have to start all over with a fresh budget authorization, of which they normally only get one per year. They want to use their second one (that they got by stalling the 2017 budget) of those later this year on tax cuts, so there's a lot of pressure to get something over to the senate they can actually use.

The original bill had $150bil of headroom but there's no way of knowing what the impact of the late allendmenrs eill be until the CBO releases their score on Monday. If they don't save that $2bil the House is going to have to amend again and vote again.

NESailor

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Re: What comes after the ACA?
« Reply #2394 on: May 19, 2017, 02:32:35 PM »
How about reports that the AHCA passing without a CBO score may actually backfire?  I'm no expert on this so perhaps someone could help me get educated.  What would make the bill have to go through the house again?

Seems to me that Trump and the GOP are burning political capital way too fast considering they didn't start with a whole lot of it.

The Senate's reconciliation rules (the Byrd Rule) stipulates that a bill has to reduce the deficit by at least $2bil over 10 years, or else it can't be taken up by the Senate and the House would have to start all over with a fresh budget authorization, of which they normally only get one per year. They want to use their second one (that they got by stalling the 2017 budget) of those later this year on tax cuts, so there's a lot of pressure to get something over to the senate they can actually use.

The original bill had $150bil of headroom but there's no way of knowing what the impact of the late allendmenrs eill be until the CBO releases their score on Monday. If they don't save that $2bil the House is going to have to amend again and vote again.

Thank you!  So you're saying that the original bill "saved" $150B over the next decade and the assumption is that whatever they changed for version 2.0 won't increase spend by more than $148 billion over version 1.0.   I would assume that to be a safe bet given that most of the changes really related to weakening patient protections and the Medicaid block grant changes effectively put a federal cap on the safety net (which would be more stressed under version 2.0...but they stuck the states with that problem).

protostache

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Re: What comes after the ACA?
« Reply #2395 on: May 19, 2017, 06:25:28 PM »
How about reports that the AHCA passing without a CBO score may actually backfire?  I'm no expert on this so perhaps someone could help me get educated.  What would make the bill have to go through the house again?

Seems to me that Trump and the GOP are burning political capital way too fast considering they didn't start with a whole lot of it.

The Senate's reconciliation rules (the Byrd Rule) stipulates that a bill has to reduce the deficit by at least $2bil over 10 years, or else it can't be taken up by the Senate and the House would have to start all over with a fresh budget authorization, of which they normally only get one per year. They want to use their second one (that they got by stalling the 2017 budget) of those later this year on tax cuts, so there's a lot of pressure to get something over to the senate they can actually use.

The original bill had $150bil of headroom but there's no way of knowing what the impact of the late allendmenrs eill be until the CBO releases their score on Monday. If they don't save that $2bil the House is going to have to amend again and vote again.

Thank you!  So you're saying that the original bill "saved" $150B over the next decade and the assumption is that whatever they changed for version 2.0 won't increase spend by more than $148 billion over version 1.0.   I would assume that to be a safe bet given that most of the changes really related to weakening patient protections and the Medicaid block grant changes effectively put a federal cap on the safety net (which would be more stressed under version 2.0...but they stuck the states with that problem).

Right, it's a pretty safe bet, but Ryan apparently isn't willing to burn his one shot at cutting the safety net to shreds on a bet.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2396 on: May 19, 2017, 06:27:41 PM »
I just hope there are moderate Republicans in the Senate that will put a kibosh to extremes of the AHCA

RedmondStash

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Re: What comes after the ACA?
« Reply #2397 on: May 19, 2017, 07:18:41 PM »
Interesting article about the nuanced difference between "making money" and "making profit" as pertains to health care.

https://www.forbes.com/sites/peterubel/2014/02/12/is-the-profit-motive-ruining-american-healthcare/#2d0ab93f37b9

To me, the most relevant questions are: Which individual people make the most money from the American healthcare system? What's their role in the system? And why do they make so much?

EnjoyIt

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Re: What comes after the ACA?
« Reply #2398 on: May 19, 2017, 08:23:00 PM »
Interesting article about the nuanced difference between "making money" and "making profit" as pertains to health care.

https://www.forbes.com/sites/peterubel/2014/02/12/is-the-profit-motive-ruining-american-healthcare/#2d0ab93f37b9

To me, the most relevant questions are: Which individual people make the most money from the American healthcare system? What's their role in the system? And why do they make so much?

The article adds very little value other than a simple opinion, but I agree that there is nothing wrong with profit.  Profit is motivating. Most physicians and nurses would not bother going to work if they did not get compensated fairly for their time. Profit also leads to ingenuity either in technology, medicine, procedures, processes and so forth.  In general seeking profit is good, though greed can be very dangerous.  I honestly don't think insurance profits or provider profits on their own are the leading cause for the exorbitant cost of healthcare in the US. Regulations, inefficiencies, litigation, insurance friction, greed and patient expectations all add up to over $10K per person per year.

geekette

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Re: What comes after the ACA?
« Reply #2399 on: May 21, 2017, 10:19:10 PM »
http://www.buckeyesurgeon.com/2017/05/mandate.html


From an emergency surgeon's perspective, post surgery.

Quote
And the guy was not some street urchin or derelict.  He owned his own landscaping business.  He worked 60 or so hours a week.  He was married and had children.  By all metrics, he was an upstanding, contributory member of his community.  But he didn't have any health insurance.  And the reason is because he was able to choose not to have health insurance.

I'll never understand why some people think they're immune to the possibility of expensive medical care.