Author Topic: What comes after the ACA?  (Read 277435 times)

bender

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Re: What comes after the ACA?
« Reply #3250 on: July 19, 2017, 08:41:28 PM »
Rawanda's health care has improved due to the charity of other nations, including the USA. 

I can't even figure out what the 'measures' were.  The article is strongly politically motivated, but I guess that's what's important after all.

teen persuasion

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Re: What comes after the ACA?
« Reply #3251 on: July 20, 2017, 05:22:01 AM »
Bill is dead for at least a week.

McCain had eye surgery for a blood clot and will not vote this week.

Does anyone else find it ironic that a medical procedure is what stalled a healthcare bill?
And now McCain is fighting cancer.    http://www.bostonglobe.com/news/nation/2017/07/19/senator-mccain-diagnosed-with-aggressive-type-brain-cancer/RYsMryuxcLQnml9mJC2q7O/story.html 

Expensive health issues only happen to other people, who make poor choices, right Congress?

beltim

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Re: What comes after the ACA?
« Reply #3252 on: July 20, 2017, 06:45:33 AM »
It seems to be a political nonstarter in the US, but is there any realistic way to get from the bizarre position of defending the mediocre at best ACA from attacks and towards some kind of single-payer system in the US?

The evidence is pretty much uncontrovertible that single payer health care is better for people and businesses (aside from some specialized HMO types, obviously).  But it seems that evidence is only a minor player in the political dramas of the US these days.

I'm not sure I was agree that the evidence is 'uncontrovertible' [sic].  A lot depends on what you are measuring and what you value. I've gone from an employer-sponsored health care program pre-ACA to one post-ACA to the individual marketplace to (currently) the Quebec health care system. Without a doubt I'd say the level of care I receive and the attention I receive from my doctors here is less than what I received previously.  Of course there are some very good things - namely that almost everyone has coverage and far fewer people go broke due to medical issues.  Other things, like access to care in rural areas - seems just as bad here (i.e. "not better", but also not worse) than in similar areas in the US.

As for how we could get to single-payer - read back over the thread; it's been discussed at length, with some decent suggestions along the way.

I agree with nereo.  Rocketpj, please provide some evidence for your statement.

Here, I'll start with some evidence that shows that single payor systems are not the world's best: http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror
This report shows that the top-ranked healthcare system (UK) is not just a single payer, but a fully government-run system.  The second best healthcare system (Switzerland) is not a single payer, but is in fact pretty close to the ACA (everyone must purchase health insurance on their own, subsidies are available for those whose incomes are too low to afford insurance).

frugalecon

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Re: What comes after the ACA?
« Reply #3253 on: July 20, 2017, 07:05:40 AM »

This is a great point.  All of the republican talking points about personal responsibility break down when you hear how stupid they sound when they claim that maternity care shouldn't be an essential benefit in all health insurance plans. "I'm a 55 year old male who doesn't want children, why should I get maternity care?" Just think about the implications of that statement.  He is saying that lifesaving procedures for premature babies should only be paid for by people of child bearing age who want children, which would cause the premiums to absolutely skyrocket for that group.

Well theoretically the 55-yr old male is right.  Why should be pay more for coverage he has no chance of using?
Perhaps the system could be changed so that there is no coverage for pregnancies. 
People who get pregnant then pay a one-time charge of $10,000 (or whatever) to coverage the procedure and any complications?
The premiums should go up for that group since they are the ones that are going to cause all the expense.  I've had my two kids and joined club V so I can confidently opt out of this cost.

In insurance ratemaking, social considerations always arise.  Theoretically a family with 10 children incurs more costs than 2 children, but I don't think they rate for it.  At some point they must figure that a family with 10 children isn't going to handle that expense well, so it gets subsidized.  But perhaps if people had to pay the explicitly pay a fee for childbirth coverage maybe it would change peoples' mindset somehow rather than having everyone always pay a little.

The 55 year old male was not dropped by a stork, he presumably was born once and benefited from his mother having health insurance.  Not too mention, he benefits from his daughters, nieces, nephews, grandchildren, and friends having coverage.  If you think it should just be every man for himself, why not just ban insurance altogether and we can go back to caveman times.

In your system where pregnancy isn't covered, $10,000 would be woefully inadequate.  That's what it costs now to have a baby when you have insurance negotiated rates and have a C-section with no complications!  And under your system would your insurance cover the prenatal visits to the doctor, blood tests, sonograms, etc or would that be out of pocket too?  It doesn't make any sense.  Either women will need to be ultra rich in order to have a child, or they will cheap out on their prenatal visits and their will be more birth defects and deaths, or hospitals won't be able to bear the costs and will stop performing births.   

It always shocks me when people make completely selfish statements like this.  We are a part of a civilized society here and we need to support each other.  Women of child bearing age get covered for pregnancy, while 55 year old men get covered for prostate cancer.  I have several friends who had premature babies - I can't imagine telling them I am pissed off that my premiums are higher so that we can cover your 2 pound baby as he fights for his life due to lung and heart problems.

Sol, my approach to these kinds of questions is "How would I want the system to be set up before I know what my particular life circumstances will be, i.e., when I am just a boozy idea in some amorous young people's minds?" I think this is also a good approach to questions of taxation. If I didn't know whether I would be born rich or poor or somewhere in between, what kind of tax system would make sense? It is a difficult mental calculus, but I think it is worth trying.

JustGettingStarted1980

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Re: What comes after the ACA?
« Reply #3254 on: July 20, 2017, 09:30:23 AM »


Sol, my approach to these kinds of questions is "How would I want the system to be set up before I know what my particular life circumstances will be, i.e., when I am just a boozy idea in some amorous young people's minds?" I think this is also a good approach to questions of taxation. If I didn't know whether I would be born rich or poor or somewhere in between, what kind of tax system would make sense? It is a difficult mental calculus, but I think it is worth trying.
[/quote]

Look up the "Veil of Ignorance", that's what you're talking about.

runewell

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Re: What comes after the ACA?
« Reply #3255 on: July 20, 2017, 09:34:29 AM »
The 55 year old male was not dropped by a stork, he presumably was born once and benefited from his mother having health insurance.  Not too mention, he benefits from his daughters, nieces, nephews, grandchildren, and friends having coverage.  If you think it should just be every man for himself, why not just ban insurance altogether and we can go back to caveman times.
But the parents of the 55-year old were both responsible for his birth and the ones who by far receive the greatest benefit of having him.   I benefit from having a boss I can ask questions to, but I don't go writing his mom thank you notes for having him.

In your system where pregnancy isn't covered, $10,000 would be woefully inadequate.  That's what it costs now to have a baby when you have insurance negotiated rates and have a C-section with no complications!  And under your system would your insurance cover the prenatal visits to the doctor, blood tests, sonograms, etc or would that be out of pocket too?  It doesn't make any sense.  Either women will need to be ultra rich in order to have a child, or they will cheap out on their prenatal visits and their will be more birth defects and deaths, or hospitals won't be able to bear the costs and will stop performing births.   


I didn't say $10K was the right number.  Perhaps if people were required to save up for the bill they would be more cost-conscious.  Lower-cost birthing clinics could open up as a competitive alternative.  You can pay $15,000 for the traditional hospital visit with your own room, or $5,000 for a semi-private room in a no-frills location.  What's it going to be?  One of the main reasons healthcare is so expensive is because the system doesn't lend itself well to competitive market pricing.  The milk at target has finally gotten lower ($1.48) to compete with the Aldi that opened two years ago.  Without competition we would be paying more for milk.  Same idea goes for childbirth; if there isn't a good non-luxury option, we will always overpay for luxury.

It always shocks me when people make completely selfish statements like this.  We are a part of a civilized society here and we need to support each other.  Women of child bearing age get covered for pregnancy, while 55 year old men get covered for prostate cancer.  I have several friends who had premature babies - I can't imagine telling them I am pissed off that my premiums are higher so that we can cover your 2 pound baby as he fights for his life due to lung and heart problems.

Who's being selfish?  The person who doesn't want to pay for someone else's childbirth, or the person who wants everyone to subsidize it?  As for the prostate cancer comment that doesn't even seem like a poor comparison.   
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geekette

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Re: What comes after the ACA?
« Reply #3256 on: July 20, 2017, 09:47:12 AM »
The difference between a low cost birth and a high cost birth isn't the fancy room.

runewell

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Re: What comes after the ACA?
« Reply #3257 on: July 20, 2017, 09:54:03 AM »
The difference between a low cost birth and a high cost birth isn't the fancy room.
The main difference (apart from emergency treatment) is going to be labor vs C-section and whether an epidural is used.  There are a number of considerations that would need to be factored in. 
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nereo

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Re: What comes after the ACA?
« Reply #3258 on: July 20, 2017, 10:38:53 AM »
The difference between a low cost birth and a high cost birth isn't the fancy room.
The main difference (apart from emergency treatment) is going to be labor vs C-section and whether an epidural is used.  There are a number of considerations that would need to be factored in.
#1 - there are many more factors than just C-section & epidural which add significant cost
#2 - many of these costs cannot be 'planned ahead.' Everyone hopes for an easy, low-cost pregnancy. Only some wind up getting it.
#3 - as stated at least a dozen times upthread, you cannot count on 'market forces' and 'consumer choice' to do much for lowering prices precisely because people cannot anticipate the care they need and plan accordingly (see #2). Trained doctors can't even anticipate which services will be needed and when.
 
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radram

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Re: What comes after the ACA?
« Reply #3259 on: July 20, 2017, 11:09:28 AM »
  The milk at target has finally gotten lower ($1.48) to compete with the Aldi that opened two years ago.  Without competition we would be paying more for milk.  Same idea goes for childbirth; if there isn't a good non-luxury option, we will always overpay for luxury.

I find it interesting you used milk prices for your analogy. You do realize it costs more than $1.48 to produce 1 gallon of milk don't you? Why do you think it is that you can buy milk for less than it costs to produce it?

 Are you suggesting subsidizing healthcare prices in order to allow procedures to be performed below cost while still allowing to be profitable?

One byproduct of this relationship (with milk, anyway) is the requirement to be a bigger farm in order to survive, creating less competition. It sounds as though your example counters your goal of increased competition.

runewell

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Re: What comes after the ACA?
« Reply #3260 on: July 20, 2017, 11:19:37 AM »
And the american health system does not have the capability to provide firm prices ahead of time for having a baby given the uncertainty of what could happen. 

It most certainly does have the capability, or could implement it without too much trouble if there was an incentive to.  The point is not the charge for every single pill and piece of gauze.  There are zillions of babies born every year so that the insurance company can know that it should pay $X on average for a regular delivery and $Y for a C-section.  Or it could weight those together and charge $Z for coverage regardless of delivery method.  They would also be able to calculate an additional amount $W for ICU & emergencies.

I am going to get my car looked at today.  If I need a new axle, the repairman will be able to quote me $400 or whatever without too much trouble.  If I get my roof fixed i can get an estimate for that also.  Why is health insurance so different? Why is the cost is rarely discussed and until the bill arrives?  Do I really want to spend $110 on a doctor visit?  Maybe someone else will do it for $90.  But that doesn't happen; the instead the insurance company proposes to pay $110 this year instead of $108 last year, and the healthcare system goes about its business generating revenue.

It always shocks me when people make completely selfish statements like this.  We are a part of a civilized society here and we need to support each other.  Women of child bearing age get covered for pregnancy, while 55 year old men get covered for prostate cancer.  I have several friends who had premature babies - I can't imagine telling them I am pissed off that my premiums are higher so that we can cover your 2 pound baby as he fights for his life due to lung and heart problems.
Who's being selfish?  The person who doesn't want to pay for someone else's childbirth, or the person who wants everyone to subsidize it?  As for the prostate cancer comment that doesn't even seem like a poor comparison.   

You don't need to subsidize the birth of children - you can do this by not having health insurance and paying the penalty.  But if you want the benefits of health insurance, you can't have your cake and eat it too.
[/quote]
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Mr. Green

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Re: What comes after the ACA?
« Reply #3261 on: July 20, 2017, 11:27:25 AM »
It always shocks me when people make completely selfish statements like this.  We are a part of a civilized society here and we need to support each other.  Women of child bearing age get covered for pregnancy, while 55 year old men get covered for prostate cancer.  I have several friends who had premature babies - I can't imagine telling them I am pissed off that my premiums are higher so that we can cover your 2 pound baby as he fights for his life due to lung and heart problems.

Who's being selfish?  The person who doesn't want to pay for someone else's childbirth, or the person who wants everyone to subsidize it?  As for the prostate cancer comment that doesn't even seem like a poor comparison.   
This argument is really a non-starter. We could apply the same logic to everything else. I shouldn't pay taxes for roads I don't drive on or schools for the kids I don't have. I shouldn't pay for the library I don't use. A civilization simply doesn't work that way. There are certain things that we have come to expect from each other based on our values. We value health so the expectation should exist that getting medical care isn't a privilege. It's the same reason our collective attitude isn't to have the cashier in the school lunch line look at the poor kid with an empty tray and say, "Fuck you, kid! Go chew on a napkin."
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sol

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Re: What comes after the ACA?
« Reply #3262 on: July 20, 2017, 11:36:45 AM »
Yesterday Trump claimed his proposal to allow insurance to be sold across state lines (which is ALREADY legal) would lower premiums "60 to 70 percent" below what they currently are under the ACA.  What what?

This is like claiming we could all see 70% stock market gains if only US corporations were allowed to operate overseas.  Not only do they already do that, it's totally unrelated to delivering on the promise you are making.  I don't think you understand how these things are related.

Every time he opens his mouth to talk about health care, I get the impression he understands it less than my 11 year old daughter.  Everyone in congress musty be rolling their eyes as they try to do the hard work of identifying serious solutions while grandpa goes off on another stupid tangent.

At this point Trump is just a rubber stamp for whatever congress comes up with.  He has no power, no influence, nothing to contribute.  He would be an empty chair in the executive branch if he wasn't also denigrating the office by appearing to be so corrupt.  Putin must be disappointed that his pet turned out to be so impotent.

protostache

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Re: What comes after the ACA?
« Reply #3263 on: July 20, 2017, 11:42:42 AM »
Yesterday Trump claimed his proposal to allow insurance to be sold across state lines (which is ALREADY legal) would lower premiums "60 to 70 percent" below what they currently are under the ACA.  What what?

This is like claiming we could all see 70% stock market gains if only US corporations were allowed to operate overseas.  Not only do they already do that, it's totally unrelated to delivering on the promise you are making.  I don't think you understand how these things are related.

Every time he opens his mouth to talk about health care, I get the impression he understands it less than my 11 year old daughter.  Everyone in congress musty be rolling their eyes as they try to do the hard work of identifying serious solutions while grandpa goes off on another stupid tangent.

At this point Trump is just a rubber stamp for whatever congress comes up with.  He has no power, no influence, nothing to contribute.  He would be an empty chair in the executive branch if he wasn't also denigrating the office by appearing to be so corrupt.  Putin must be disappointed that his pet turned out to be so impotent.

Veering waaaaay off topic, but Putin never cared about having a puppet. Putin's singular goal is to increase Russia's relative power and importance in the world and his chosen strategy is to sow discord and disorder everywhere else. We saw this with Brexit and various elections in Europe including Germany, Belgium, and France, and we saw it in the 2016 US elections. Trump wanting to be buddy-buddy with Putin at this point is all on Trump's side because he thinks maybe it'll help him wipe out some of his debt.

runewell

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Re: What comes after the ACA?
« Reply #3264 on: July 20, 2017, 11:49:39 AM »
We could apply the same logic to everything else. I shouldn't pay taxes for roads I don't drive on or schools for the kids I don't have. I shouldn't pay for the library I don't use.

Nice job there comparing the private health insurance market to public infrastructure.  Until it becomes the government's job to supply us with healthcare I don't buy this comparison. 
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nereo

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Re: What comes after the ACA?
« Reply #3265 on: July 20, 2017, 11:56:07 AM »
Yesterday Trump claimed his proposal to allow insurance to be sold across state lines (which is ALREADY legal) would lower premiums "60 to 70 percent" below what they currently are under the ACA.  What what?

This is like claiming we could all see 70% stock market gains if only US corporations were allowed to operate overseas.  Not only do they already do that, it's totally unrelated to delivering on the promise you are making.  I don't think you understand how these things are related.

Every time he opens his mouth to talk about health care, I get the impression he understands it less than my 11 year old daughter.  Everyone in congress musty be rolling their eyes as they try to do the hard work of identifying serious solutions while grandpa goes off on another stupid tangent.

In the NYT interview released Wednesday evening, DJT mentioned how a 21 year old could pay $12per -year for health insurance.  Whaaa??
He's so comically out of touch.  Like 3 orders of magnitude off.  What else can we get?  A new Cadillac for $300? Maybe a round of golf at a Trump Course for $1?

Quote
So preexisting conditions are a tough deal. Because you are basically saying from the moment the insurance, you’re 21 years old, you start working and you’re paying $12 a year for insurance, and by the time you’re 70, you get a nice plan.
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runewell

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Re: What comes after the ACA?
« Reply #3266 on: July 20, 2017, 12:12:58 PM »
A new Cadillac for $300? Maybe a round of golf at a Trump Course for $1?

That's about all I would spend for those two items.
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jim555

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Re: What comes after the ACA?
« Reply #3267 on: July 20, 2017, 12:22:13 PM »
Trumpcare $12 plan, covers a Band-Aid and Aspirin, nothing else. 

Dabnasty

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Re: What comes after the ACA?
« Reply #3268 on: July 20, 2017, 12:23:14 PM »
We could apply the same logic to everything else. I shouldn't pay taxes for roads I don't drive on or schools for the kids I don't have. I shouldn't pay for the library I don't use.

Nice job there comparing the private health insurance market to public infrastructure.  Until it becomes the government's job to supply us with healthcare I don't buy this comparison.
The pregnancy discussion has gotten too far from the original point and now we're just arguing about why each other's analogies are bad.

Let's go back to the beginning. You don't think your costs should help cover pregnancy because you, as a man, have no chance of becoming pregnant, correct?

But what about a woman that chooses not to have a child? What about a woman who biologically cannot have children? Should they also not pay for that coverage? How do we know who they are? Is it worth the added complication?

Back to Mr. Green's analogy, the things he listed are provided by the government and healthcare is not. However the analogy is that we all pay into a big pot and when something is needed the pot pays. So the analogy does work in that sense.
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sol

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Re: What comes after the ACA?
« Reply #3269 on: July 20, 2017, 12:33:30 PM »
If it's universally available to every American, I think I would support it as a step in the right direction.  First we need to agree that America is stronger when everyone gets basic healthcare, then we can argue over how much and at what cost.

Right now, republicans don't agree with that basic premise.  They want fewer people to have healthcare.  Every single one of their proposals takes healthcare away from people, which is a wildly unpopular thing to do. 

Nice job there comparing the private health insurance market to public infrastructure.  Until it becomes the government's job to supply us with healthcare I don't buy this comparison. 

Healthcare and roads are exactly analogous benefits, so I don't see why you object to this comparison.  They can be provided publicly or privately, but they either way they both benefit everyone including the people who don't personally use them.

We all benefit from having roads, even if you don't drive, because roads allow our economy to flourish and makes emergency police and fire services available to you.  We all benefit from healthcare, even if you don't go to the doctor, because healthcare keeps our workforce healthy and prevents the spread of disease. 

Optimiser

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Re: What comes after the ACA?
« Reply #3270 on: July 20, 2017, 12:38:47 PM »
#2 - many of these costs cannot be 'planned ahead.' Everyone hopes for an easy, low-cost pregnancy. Only some

I can add a data point to this. We were planning on using a midwife to do a home birth. Total cost $3,500 for all prenatal care, delivery, and postnatal care.

My wife ended up with preeclampsia, and had to go to the hospital to give birth. The hospital bill was $26,000 for a vaginal birth with no epidural, in addition to the $3,500 midwife's fee.

A low-cost pregnancy is a great thing to shoot for, but it's nice to have insurance in case things don't go the way you planned.

partgypsy

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Re: What comes after the ACA?
« Reply #3271 on: July 20, 2017, 12:41:39 PM »
If it's universally available to every American, I think I would support it as a step in the right direction.  First we need to agree that America is stronger when everyone gets basic healthcare, then we can argue over how much and at what cost.

Right now, republicans don't agree with that basic premise.  They want fewer people to have healthcare.  Every single one of their proposals takes healthcare away from people, which is a wildly unpopular thing to do. 

Nice job there comparing the private health insurance market to public infrastructure.  Until it becomes the government's job to supply us with healthcare I don't buy this comparison. 

Healthcare and roads are exactly analogous benefits, so I don't see why you object to this comparison.  They can be provided publicly or privately, but they either way they both benefit everyone including the people who don't personally use them.

We all benefit from having roads, even if you don't drive, because roads allow our economy to flourish and makes emergency police and fire services available to you.  We all benefit from healthcare, even if you don't go to the doctor, because healthcare keeps our workforce healthy and prevents the spread of disease.

I was going to make a joke how I want my taxes back for supporting the fire department, because my house has never burned down.
Instead I will just say amen to this post. You get it. It's unbelievable how many people don't get that improving public health, benefits all of us.
« Last Edit: July 20, 2017, 12:43:11 PM by partgypsy »

runewell

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Re: What comes after the ACA?
« Reply #3272 on: July 20, 2017, 01:02:48 PM »
But what about a woman that chooses not to have a child? What about a woman who biologically cannot have children? Should they also not pay for that coverage? How do we know who they are? Is it worth the added complication?

If pregnancy coverage were a standlone purchase, this wouldn't make it any more complicated.  Those who were going to have a child would pay the $15,000 and those could not have a child would certainly not.

Quote
Back to Mr. Green's analogy, the things he listed are provided by the government and healthcare is not. However the analogy is that we all pay into a big pot and when something is needed the pot pays. So the analogy does work in that sense.

When you buy auto insurance, you don't just get whatever you want, you decide what coverages and limits you want, and you pay more for more coverage.  The "big pot" comment is just a giant generalization that dodges the issue at hand.  Yet, insurance is a big pot that pays out when needed.  But how much you pay in depends on your risk characteristics. 
« Last Edit: July 20, 2017, 01:33:55 PM by runewell »
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nereo

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Re: What comes after the ACA?
« Reply #3273 on: July 20, 2017, 01:21:03 PM »

When you buy auto insurance, you don't just get whatever you want, you decide what coverages and limits you want, and you pay more for more coverage.  The "big pot" comment is just a giant generalization that dodges the issue at hand.  Yet, insurance is a big pot that pays out when needed.  But how much you pay in depends on your risk characteristics.

I'm not sure the point you are trying to make here, and I think your analogy of auto insurance does more to refute your point than support it. Yes, drivers get to chose what level of insurance they want, but in all states I know of it must at least meet minimum requirements. How much you pay depends both on your risk factors and your level of coverage.  So it is with health insurance both before the ACA and currently; there are minimum standards a health insurance policy must cover, and then you can decide things like the size of your deductible, your coverage network and whether it covers prescription medication.  Again, how much you pay depends both on your risk characteristics and your coverage.  Because old people and sick people would pay astronomically more under these situations (along with pregnant women) we've decided to cap those and spread the cost around because it's good for society in general.

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Dabnasty

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Re: What comes after the ACA?
« Reply #3274 on: July 20, 2017, 01:41:43 PM »
But what about a woman that chooses not to have a child? What about a woman who biologically cannot have children? Should they also not pay for that coverage? How do we know who they are? Is it worth the added complication?
If pregnancy coverage were a standlone purchase, this wouldn't make it any more complicated.  Those who were going to have a child would pay the $15,000 and those could not have a child would certainly not.
This in theory may work (if you're of the mind that parents should be responsible for the costs of pregnancy - not taking a side on that here) but the discussion started with whether men should pay for that coverage given our current insurance system. I'm thinking within that constraint and I think that cost should be applied to all, not just women.

If you really think we should all pay based on risk, that's a different argument entirely.

Edit:
In a society where only pregnant families bear the entire cost of prenatal / birth, $15,000 is probably 10% of what it would cost.
Yes, and I think you are underestimating the average cost of pregnancy. Maybe $150,000 is a little high but $15,000 is definitely low.
« Last Edit: July 20, 2017, 01:49:30 PM by Dabnasty »
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runewell

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Re: What comes after the ACA?
« Reply #3275 on: July 20, 2017, 01:44:58 PM »
If it's universally available to every American, I think I would support it as a step in the right direction.  First we need to agree that America is stronger when everyone gets basic healthcare, then we can argue over how much and at what cost.

Right now, republicans don't agree with that basic premise.  They want fewer people to have healthcare.  Every single one of their proposals takes healthcare away from people, which is a wildly unpopular thing to do. 
Just because republicans don't want to give away free health care as an entitlement, it does not follow that they want fewer people the have healthcare.

Quote
because healthcare keeps our workforce healthy and prevents the spread of disease.
Debatable.  If my cubicle neighbors opted out of having health insurance, I'm not convinced I would suffer.

Quote
I was going to make a joke how I want my taxes back for supporting the fire department, because my house has never burned down.
Instead I will just say amen to this post. You get it. It's unbelievable how many people don't get that improving public health, benefits all of us.

How does paying for someone else's pregnancy provide tangible benefits to me personally?   
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runewell

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Re: What comes after the ACA?
« Reply #3276 on: July 20, 2017, 01:46:35 PM »
In a society where only pregnant families bear the entire cost of prenatal / birth, $15,000 is probably 10% of what it would cost.
So you admit you don't know how much it would cost, OK.
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nereo

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Re: What comes after the ACA?
« Reply #3277 on: July 20, 2017, 02:12:07 PM »
Just because republicans don't want to give away free health care as an entitlement, it does not follow that they want fewer people the have healthcare.

Quote
... because healthcare keeps our workforce healthy and prevents the spread of disease.
Debatable.  If my cubicle neighbors opted out of having health insurance, I'm not convinced I would suffer.

How does paying for someone else's pregnancy provide tangible benefits to me personally?   

I'm trying very hard to see your posts as anything other than offensive trolling.
If you are actually serious (and I'll assume you've read through the arguments made on the first 64 pages of this thread)...

Regarding your comment about Republicans not wanting fewer people to have health care: First there's the very words of the non-partisan CBO - These proposals are not about expanding affordable health-care insurance along with the scoring of the various proposals that show anywhere from 22MM to 32MM will lose health insurance.  Most of those will effectively lose access to comprehensive health care.

Second - widespread access to healthcare, particularly preventative care and vaccinations, has a straightforward correlation between the life expectancy of a population and the spread of contagious diseases. 

You seem to be only concerned with yourself, personally (how does it benefit me personally & I'm not convinced I would suffer) and your examples consider just the non-insurance of one individual (my neighbor, one pregnant woman). However we're talking about tens-of-millions of people here.  Those are people who will be less able to work, pay fewer taxes, become more likely to develop chronic conditions and have an increased risk of drug dependency. Even if you reject the notion that a society should support each other the outcome of fewer people with health insurance is a drag on entire communities.
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Mr. Green

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Re: What comes after the ACA?
« Reply #3278 on: July 20, 2017, 02:27:26 PM »
And for the record, the potential costs of a childbirth tossed around here are way too low. I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills. There is no argument anyone can make that justifies that kind of cost for a C-section and some NICU time. If you want cheaper health insurance, focus of why it's illogically expensive in the first place. Butchering coverage down to just the TP we need to wipe our butts to pay reasonable premiums is not a solution.
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tyort1

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Re: What comes after the ACA?
« Reply #3279 on: July 20, 2017, 02:41:40 PM »
And for the record, the potential costs of a childbirth tossed around here are way too low. I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills. There is no argument anyone can make that justifies that kind of cost for a C-section and some NICU time. If you want cheaper health insurance, focus of why it's illogically expensive in the first place. Butchering coverage down to just the TP we need to wipe our butts to pay reasonable premiums is not a solution.

That's a good point.  Why is it so crazy expensive in the first place?
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ixtap

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Re: What comes after the ACA?
« Reply #3280 on: July 20, 2017, 02:54:26 PM »
And for the record, the potential costs of a childbirth tossed around here are way too low. I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills. There is no argument anyone can make that justifies that kind of cost for a C-section and some NICU time. If you want cheaper health insurance, focus of why it's illogically expensive in the first place. Butchering coverage down to just the TP we need to wipe our butts to pay reasonable premiums is not a solution.

That's a good point.  Why is it so crazy expensive in the first place?

Profit and all the things designed to increase profit, rather than healthcare. This is what is happening by running universities like businesses, as well.

seattlecyclone

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Re: What comes after the ACA?
« Reply #3281 on: July 20, 2017, 03:06:25 PM »
And for the record, the potential costs of a childbirth tossed around here are way too low. I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills. There is no argument anyone can make that justifies that kind of cost for a C-section and some NICU time. If you want cheaper health insurance, focus of why it's illogically expensive in the first place. Butchering coverage down to just the TP we need to wipe our butts to pay reasonable premiums is not a solution.

That's a good point.  Why is it so crazy expensive in the first place?

An oft-cited statistic is that health care makes up one-sixth of the economy. That's a lot of people to pay, and everyone needs to get their cut. The actual hospital has doctors and nurses just like anywhere else, but they also have a much larger billing department than in most other countries, and probably more lawyers, and they need to hire a collections agency to go after the folks with no insurance. All that extra cost gets baked into the price.

Then you have the insurance companies. They have their own army of lawyers and actuaries and billing departments and whatever else, that is mostly unique to the US health care system. Pharmaceutical companies spend billions of dollars on research for new drugs. Most of this cost gets paid by Americans, because other countries are better at refusing to pay astronomical prices for new drugs than we have been thus far. The drug company is happy enough to accept half of the US price or less from other countries because that's better than nothing. If the US did that too they'd have to cut back on R&D and other expenses. Same probably goes for the companies that make the expensive, specialized equipment that ends up in the NICU. US hospitals pay through the nose for it and pass the cost along to their customers, because insurance companies will pay whatever crazy amount the hospital charges and will in turn pass the cost along to their customers.

There's a lot of potential to cut costs if there was a national takeover of this entire sector of the economy, by aggressively negotiating prices downward to what other countries pay. But all this cost cutting would come around to jobs in the end. Most folks might agree it would be better if the hospital billing department didn't need to exist, but the folks in the billing department might disagree! All told, reforming our health care system to spend like the rest of the world would cost a lot of American jobs. So far it's been politically more expedient to just subsidize the existing system through Obamacare and other things (like tax exemption for employer provided health insurance) rather than deal with the fallout of a more radical change.
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partgypsy

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Re: What comes after the ACA?
« Reply #3282 on: July 20, 2017, 03:42:05 PM »
https://www.nytimes.com/2015/03/31/upshot/income-inequality-its-also-bad-for-your-health.html

I don't know if people can read this, but there is a loss in life expectancy when you have increased income inequality. Not sure why this is, but one hypothesis is that lack of healthcare access for example disproportionately affects life expectancy, more than increased access to healthcare for the wealthy increases life expectancy. Which makes sense. That's why what was proponded through Trumpcare was directly opposite what health economists would argue one would do to increase public health.
I've noticed it seems to be much more men who are into libertarian ideals, each person goes it alone. I wonder why that is. Maybe even if a woman does not give birth, she may be more aware of the vulnerabilities that everyone goes through in one's life, from being nutured in the womb, to a helpless infant, to growing up and perhaps bearing her own young, to being an old person who again is dependent. Everyone in a sense, is dependent on other people, at some point in one's life.

runewell

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Re: What comes after the ACA?
« Reply #3283 on: July 20, 2017, 03:52:53 PM »
I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills.

Negotiated (allowed) rates can be very difference from nonnegoitated (charged) rates.  They probably paid a lot more than the typical resident would.
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sol

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Re: What comes after the ACA?
« Reply #3284 on: July 20, 2017, 04:34:57 PM »
Today's news reports that the CBO points out that the republican health care bill, as currently written, is so internally inconsistent as to make itself illegal.  One part raises the deductibles cap to about $10k per year, but another part mandates 58% actuarial plans that would require $13k per year.

So they will have to either
1.  Change the actuarial value requirement to offer better coverage, which conservatives hate, or
2.  Raise the deductibles even more, which everyone hates.

It kind of looks like they just put together a random wish list of things they wanted in a health care bill, without bothering to check those wishes against each other to see if it was even possible to have them all.

nereo

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Re: What comes after the ACA?
« Reply #3285 on: July 20, 2017, 04:43:31 PM »
Today's news reports that the CBO points out that the republican health care bill, as currently written, is so internally inconsistent as to make itself illegal.  One part raises the deductibles cap to about $10k per year, but another part mandates 58% actuarial plans that would require $13k per year.

So they will have to either
1.  Change the actuarial value requirement to offer better coverage, which conservatives hate, or
2.  Raise the deductibles even more, which everyone hates.

It kind of looks like they just put together a random wish list of things they wanted in a health care bill, without bothering to check those wishes against each other to see if it was even possible to have them all.

Huh.... had not seen that analysis yet - do you have a source to link?
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brooklynguy

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Re: What comes after the ACA?
« Reply #3286 on: July 20, 2017, 05:04:50 PM »
Huh.... had not seen that analysis yet - do you have a source to link?

https://www.vox.com/policy-and-politics/2017/7/20/16004598/cbo-bcra-deductibles-obamacare

Today's news reports that the CBO points out that the republican health care bill, as currently written, is so internally inconsistent as to make itself illegal. 

Now imagine what kind of a mess of an end-product we'll wind up with if the legislation is made up completely on the fly during vote-a-rama, one of the potential paths forward currently under consideration.

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Re: What comes after the ACA?
« Reply #3287 on: July 20, 2017, 05:47:05 PM »
I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills.

Negotiated (allowed) rates can be very difference from nonnegoitated (charged) rates.  They probably paid a lot more than the typical resident would.
The point is that it shouldn't be $250,000, ever. Negotiated or nonnegotiated. It's an astronomical sum of money that has no basis in reality for the care that is provided, because if it did, that number dropping to $25,000 for "negotiated" care would put all hospitals out of business. A business can't receive the majority of their income from negotiated rates and a small percentage from "numbers-I-pulled-out-of-my-ass" rates and claim that not charging those insane rates on a tiny portion of services (the uninsured) is paramount to them staying in business. Especially a non-profit business, like so many hospitals are. It's total bullshit.

And it matters because it's the insane "retail price" rates that are used to "negotiate" the rates the most of us actually pay.
« Last Edit: July 20, 2017, 05:48:43 PM by Mr. Green »
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Mr. Green

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Re: What comes after the ACA?
« Reply #3288 on: July 20, 2017, 09:29:25 PM »
Wow. That's something else!

"Team Trump Used Obamacare Money To Run Ads Against It"

http://www.msn.com/en-us/news/politics/team-trump-used-obamacare-money-to-run-ads-against-it/ar-AAotN6G?li=BBnbcA1
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runewell

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Re: What comes after the ACA?
« Reply #3289 on: July 21, 2017, 07:38:21 AM »
The point is that it shouldn't be $250,000, ever.
And it matters because it's the insane "retail price" rates that are used to "negotiate" the rates the most of us actually pay.

In my limited experience (and I have actually worked for 3 years "setting" the rates for a single healthcare provider).   The retail price doesn't necessarily have anything to do with the negotiated price, in my sample size of 1.

Nevertheless I think the lack of competition is a big reason why the system is broken.  If everyone had a $10,000 deductible and you could get a "childbirth package" quotes could come in below that, I'd like to think that people would shop around and rates would go down.  All being equal I would consider the $8,000 package would save me two grand more than the $15,000 package would. 
Please leave Dicey out of this! Have you not been paying any attention? Trolls are not welcome here!

runewell

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Re: What comes after the ACA?
« Reply #3290 on: July 21, 2017, 08:01:25 AM »
Profit and all the things designed to increase profit, rather than healthcare. This is what is happening by running universities like businesses, as well.

There's nothing wrong with earning a profit.  Insurance companies have to set their prices to keep their financials strong and provide a return for the stockholders if they are publicly traded, just like other stock companies.  Their financials are rate filings are subject to scrutiny by insurance departments.

The providers are also trying to earn a profit as well.  Are they performing too many tests in order to bill a lot of codes or are they just being careful.  I once did a study trying to determine which providers were billing too many codes on average.  If it's normal for a certain problem to have 4 codes billed but a particularl doctor bills 10 or 15, you have to take a closer look.
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Rosy

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Re: What comes after the ACA?
« Reply #3291 on: July 21, 2017, 08:47:17 AM »
Wow. That's something else!

"Team Trump Used Obamacare Money To Run Ads Against It"

http://www.msn.com/en-us/news/politics/team-trump-used-obamacare-money-to-run-ads-against-it/ar-AAotN6G?li=BBnbcA1

Oh wow, how is that not a headline around the country? Thanks for posting a link to this revealing article.

Dabnasty

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Re: What comes after the ACA?
« Reply #3292 on: July 21, 2017, 08:50:14 AM »
Profit and all the things designed to increase profit, rather than healthcare. This is what is happening by running universities like businesses, as well.

There's nothing wrong with earning a profit.  Insurance companies have to set their prices to keep their financials strong and provide a return for the stockholders if they are publicly traded, just like other stock companies.  Their financials are rate filings are subject to scrutiny by insurance departments.

The providers are also trying to earn a profit as well.  Are they performing too many tests in order to bill a lot of codes or are they just being careful.  I once did a study trying to determine which providers were billing too many codes on average.  If it's normal for a certain problem to have 4 codes billed but a particularl doctor bills 10 or 15, you have to take a closer look.
You continue to ignore the fatal flaws of free market theory in regards to healthcare. How can there be competition when so often there is no time to shop around, in rural areas there is often only one option, and even if there is competition the product can't be refused so it's not the same as a gallon of milk.

Admittedly, if prices were available costs may improve somewhat on our current situation but even providing prices is difficult because so many costs are specific to the situation. And if we paid based on results rather than inputs as some have suggested, it would disincentivize hospitals to provide costly procedures.
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BTDretire

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Re: What comes after the ACA?
« Reply #3293 on: July 21, 2017, 09:06:42 AM »
And for the record, the potential costs of a childbirth tossed around here are way too low. I used to work with a guy from the UK and he said when they sent a pregnant woman to the States for work, if she had the child here they set aside $60,000 for a birth. If it went poorly and involved a NICU for a decent length of time the costs approached $250,000. Being from a different country, the company didn't mess around with US insurance companies. They just paid the bills. There is no argument anyone can make that justifies that kind of cost for a C-section and some NICU time. If you want cheaper health insurance, focus of why it's illogically expensive in the first place. Butchering coverage down to just the TP we need to wipe our butts to pay reasonable premiums is not a solution.

That's a good point.  Why is it so crazy expensive in the first place?
I don't know, but I wonder how much medicaid reimburses for births. I suspect Medicaid's reimbursement is low. That would cause the rest of the payers to pay more, to make make up the real cost plus profit.
 Almost half of all births are paid for by taxpayers through medicaid. 48% in 2010, the latest year I find data on,. That number was rising every year up to 2010, so I suspect it's over 50% now in 2017, especially with the ACA adding many more to Medicaid.
http://www.cnsnews.com/news/article/terence-p-jeffrey/24-states-50-babies-born-medicaid
Just one possible cause of high costs, I'm sure there are others.

nereo

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Re: What comes after the ACA?
« Reply #3294 on: July 21, 2017, 09:13:56 AM »
Wow. That's something else!

"Team Trump Used Obamacare Money To Run Ads Against It"

http://www.msn.com/en-us/news/politics/team-trump-used-obamacare-money-to-run-ads-against-it/ar-AAotN6G?li=BBnbcA1

Oh wow, how is that not a headline around the country? Thanks for posting a link to this revealing article.

I suspect in a normal news year this would be the subject everyone would be talking about. 
Unfortunately, it's currently competing with:
Trump's inquiries about pardoning himself and his family members
Trump's secret meeting with Putin
Trump's subsequent decision to stop supporting anti-Assad rebels and basically side with Russia
The Trump team's meeting with Russian individuals who promised to give dirt on HRC
News that Trump may have met even more frequently with Putin before & after he was elected
The NYT's interview, Trump throwing Sessions under the bus and Session's decision not to step down (all about Russia!)
A sad story of a 10 year old who died from a mysterious and unintentional contact with opioids
Mar-A-Lago requesting 70 new foreign workers during DJT's self proclaimed "Made in America Week"
EPA Chief Pruitt accused of breaking the law by criticizing Paris agreement
Mueller expanding his probe to include financial dealings of Trump's businesses
THe Interior Dept ordering top scientists not to meet with Mark Zuckerberg
The GOP's "zombie bill" to repeal the ACA
OJ Simpson being granted parole
ExxonMobile fined while now-SOS Tillerson was at the helm for (wait for it) dealings with Russia
McCain's brain cancer and its impact on the GOPs already extremely narrow majority

...and those are just stories from the last three days.  Hard to keep up.  Sometimes I wonder how much of this is just stories intentinoally being added to the blaze so the networks can't figure out where to focus their attention and resources.  Of course this strategy ultimately results in a lot of things getting burned to the ground.


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Mr. Green

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Re: What comes after the ACA?
« Reply #3295 on: July 21, 2017, 09:29:51 AM »
The point is that it shouldn't be $250,000, ever.
And it matters because it's the insane "retail price" rates that are used to "negotiate" the rates the most of us actually pay.

In my limited experience (and I have actually worked for 3 years "setting" the rates for a single healthcare provider).   The retail price doesn't necessarily have anything to do with the negotiated price, in my sample size of 1.

Nevertheless I think the lack of competition is a big reason why the system is broken.  If everyone had a $10,000 deductible and you could get a "childbirth package" quotes could come in below that, I'd like to think that people would shop around and rates would go down.  All being equal I would consider the $8,000 package would save me two grand more than the $15,000 package would.
Have you ever tried to shop around a child birth? I've never received a straight answer from a medical provider (other than my dentist) about what something will cost when asking about it up front. The answer is more or less, "It costs what it costs." I would be all about shopping around to compare costs for known medical care that is coming but you pull half your hair out just trying to talk to these people.
« Last Edit: July 21, 2017, 09:32:45 AM by Mr. Green »
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radram

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Re: What comes after the ACA?
« Reply #3296 on: July 21, 2017, 09:31:09 AM »
Profit and all the things designed to increase profit, rather than healthcare. This is what is happening by running universities like businesses, as well.

There's nothing wrong with earning a profit.  Insurance companies have to set their prices to keep their financials strong and provide a return for the stockholders if they are publicly traded, just like other stock companies.  Their financials are rate filings are subject to scrutiny by insurance departments.

The providers are also trying to earn a profit as well.  Are they performing too many tests in order to bill a lot of codes or are they just being careful.  I once did a study trying to determine which providers were billing too many codes on average.  If it's normal for a certain problem to have 4 codes billed but a particularl doctor bills 10 or 15, you have to take a closer look.
You continue to ignore the fatal flaws of free market theory in regards to healthcare. How can there be competition when so often there is no time to shop around, in rural areas there is often only one option, and even if there is competition the product can't be refused so it's not the same as a gallon of milk.

Admittedly, if prices were available costs may improve somewhat on our current situation but even providing prices is difficult because so many costs are specific to the situation. And if we paid based on results rather than inputs as some have suggested, it would disincentivize hospitals to provide costly procedures.

Not to mention the fact that in a small market, there is only 1 hospital in a multi-town area, and they claim they are struggling to survive. How in the world is the solution to build ANOTHER hospital to create competition? That would just lead to 2 hospitals with no hope to survive.

Midwest

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Re: What comes after the ACA?
« Reply #3297 on: July 21, 2017, 10:11:07 AM »
The point is that it shouldn't be $250,000, ever.
And it matters because it's the insane "retail price" rates that are used to "negotiate" the rates the most of us actually pay.

In my limited experience (and I have actually worked for 3 years "setting" the rates for a single healthcare provider).   The retail price doesn't necessarily have anything to do with the negotiated price, in my sample size of 1.

Nevertheless I think the lack of competition is a big reason why the system is broken.  If everyone had a $10,000 deductible and you could get a "childbirth package" quotes could come in below that, I'd like to think that people would shop around and rates would go down.  All being equal I would consider the $8,000 package would save me two grand more than the $15,000 package would.
Have you ever tried to shop around a child birth? I've never received a straight answer from a medical provider (other than my dentist) about what something will cost when asking about it up front. The answer is more or less, "It costs what it costs." I would be all about shopping around to compare costs for known medical care that is coming but you pull half your hair out just trying to talk to these people.

I've had 2 babies in the past 4 years, and the cost is kind of irrelevant, you are basically guaranteed to max out your deductible no matter what due to the prenatal, sonograms, and postnatal visits as well as the delivery if your deductible isn't astronomical.

Insurance cost are driven by medical costs.  The cost of childbirth is irrelevant to you only because insurance has removed you from the cost of the procedure because you've already hit your deductible.  If we had catastrophic insurance and the ability to actually shop procedures, costs would fall.

Exflyboy

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Re: What comes after the ACA?
« Reply #3298 on: July 21, 2017, 10:41:55 AM »
More positive media attention for our "leaders"... NOT.

https://finance.yahoo.com/news/cbo-under-latest-senate-healthcare-144209860.html

ketchup

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Re: What comes after the ACA?
« Reply #3299 on: July 21, 2017, 10:59:05 AM »
The point is that it shouldn't be $250,000, ever.
And it matters because it's the insane "retail price" rates that are used to "negotiate" the rates the most of us actually pay.

In my limited experience (and I have actually worked for 3 years "setting" the rates for a single healthcare provider).   The retail price doesn't necessarily have anything to do with the negotiated price, in my sample size of 1.

Nevertheless I think the lack of competition is a big reason why the system is broken.  If everyone had a $10,000 deductible and you could get a "childbirth package" quotes could come in below that, I'd like to think that people would shop around and rates would go down.  All being equal I would consider the $8,000 package would save me two grand more than the $15,000 package would.
Have you ever tried to shop around a child birth? I've never received a straight answer from a medical provider (other than my dentist) about what something will cost when asking about it up front. The answer is more or less, "It costs what it costs." I would be all about shopping around to compare costs for known medical care that is coming but you pull half your hair out just trying to talk to these people.
I've noticed this too (the dental exception).  My GF recently had to get a crown put back on and she was able to call and get a straight answer about what it would cost (even given her insurance making it a little more complicated).  My SIL recently had major unexpected surgery and nobody could tell her what anything would cost (literally the only answer she got ahead of it was "a lot").  It'd ridiculous.  I wouldn't buy a house or a car or other large purchase without knowing exactly what I was in for, yet for some reason anything goes with medical stuff.