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PaulX2

(2,032 posts)
Tue Jan 29, 2019, 10:42 AM Jan 2019

Who Wants To Cut Their Healthcare Costs By 20% Instantly

Without cutting care for the sick?

Paying insurance companies 20% off the top for nothing is only for stupid corrupt countries.

All the profits and wages of healthcare insurance companies could be spent hiring caregivers. Or how about mental health workers. Anyone looked around America's streets lately?

Time America became less stupid.

Life and death shouldn't be decided by for profit bean counters.

106 replies = new reply since forum marked as read
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Who Wants To Cut Their Healthcare Costs By 20% Instantly (Original Post) PaulX2 Jan 2019 OP
The American Criminal Enterprise Healthcare System death panels are already in place. democratisphere Jan 2019 #1
Sorry. That's a misunderstanding of basic economics. FBaggins Jan 2019 #2
agreed NewJeffCT Jan 2019 #3
Explains why healthcare costs increase exponentially and are approaching democratisphere Jan 2019 #4
Increased cost of care, population growth, and an aging population FBaggins Jan 2019 #8
It's Obesity And Crap Diets With Little Exercise PaulX2 Jan 2019 #10
"It's how we roll." kag Jan 2019 #38
I see what you did there! Canoe52 Jan 2019 #51
that's definitely a big part of it NJCher Jan 2019 #80
Not true. 20% of $100,000.00 and 20% of $1,000,000.00 are HUGELY DIFFERENT. democratisphere Jan 2019 #11
Sorry, that's still backwards FBaggins Jan 2019 #14
WHO Ranks USA 34th For Overall Health Care Frodo PaulX2 Jan 2019 #26
Not for health care quality FBaggins Jan 2019 #35
There is nothing exceptional about the American Healthcare System. democratisphere Jan 2019 #56
Nothing? FBaggins Jan 2019 #58
He/she is correct about the quality if you have the money or insurance. EX500rider Jan 2019 #71
What does Cuban healthcare have to do with the best healthcare available in the world. democratisphere Jan 2019 #72
I said Cuba etc.. EX500rider Jan 2019 #73
Just because there are 93 Nobel Awardees in RESEARCH Physiology and Medicine, democratisphere Jan 2019 #77
And 6 of the worlds top 10 medical schools are also in the US. EX500rider Jan 2019 #78
Still has absolutely nothing to do with the reality of the lousy quality of care democratisphere Jan 2019 #79
Did you see the story on the billionaire couple NJCher Jan 2019 #81
I see what you mean. violetpastille Jan 2019 #31
Nothing is backwards except your concept of math. Sorry. democratisphere Jan 2019 #39
See #35 above FBaggins Jan 2019 #43
actually skydiving is really safe... druidity33 Jan 2019 #67
And upcoding. LanternWaste Jan 2019 #48
We have lower outcomes and higher costs than Canada because of how the 80% is spent grantcart Jan 2019 #47
Only in part. For profit health insurance enables price gouging KPN Jan 2019 #103
We know, but Medicare does the same for 3%, and there's 0 profit because there's no shareholders ... mr_lebowski Jan 2019 #55
I think some also do not realize that Medicare is not free. People pay monthly premiums, and some still_one Jan 2019 #5
And that is after you prepay into Medicare for 40 yrs. MichMan Jan 2019 #6
Of course you have to pay into Medicare throughout your life. pangaia Jan 2019 #15
Understood, but to think you could cover everyone from day one... MichMan Jan 2019 #32
Here ya go. This explains it much more clearly than I can. pangaia Jan 2019 #33
"the money to pay for Medicare for All has to be shown where it is coming from" Yavin4 Jan 2019 #7
That may be the way to do it, but it needs to be spelled out, and the most difficult part is it still_one Jan 2019 #21
Tax Carbs PaulX2 Jan 2019 #27
That won't do it Paul. However, in order to work, it MUST be mandatory. In other words, everyone still_one Jan 2019 #34
and rice and potatoes? DonCoquixote Jan 2019 #69
I eat carbs all day. Codeine Jan 2019 #96
And you pay 20% of all expenses as your co-pay. Medicare for all is NOT free healthcare Farmer-Rick Jan 2019 #23
yup, that is what Medigap(supplemental), and Advantage plans do. On a relative basis it is a lot still_one Jan 2019 #29
does that extend to other items in the U.S. budget? NJCher Jan 2019 #82
Hidden in all of this is that the Federal Government has subcontracted out.... George II Jan 2019 #20
That makes no sense or am I misunderstanding what you are saying Farmer-Rick Jan 2019 #36
you are so right NJCher Jan 2019 #83
I'm going to argue the point differently. Think about this... Pobeka Jan 2019 #50
Quite close... but one important error. FBaggins Jan 2019 #52
AFAIK, health care companies are not bound by antitrust. Pobeka Jan 2019 #59
this billionaire couple will tell you NJCher Jan 2019 #84
Did you link to the wrong video? FBaggins Jan 2019 #85
Yes, it does support my position NJCher Jan 2019 #91
Oh, I can't wait to see this FBaggins Jan 2019 #92
terrific NJCher Jan 2019 #94
Thank goodness we weren't holding our breaths, eh? FBaggins Jan 2019 #95
what you're asking for is for me to do your work for you NJCher Jan 2019 #99
Nope FBaggins Jan 2019 #100
I don't see what you're referring to NJCher Feb 2019 #104
Now you can't even be bothered to read your own posts or the context in which they were made? FBaggins Feb 2019 #105
I will be reviewing this NJCher Feb 2019 #106
Medicare has a 2-3% overhead. And the insurance on the exchange has been limited to 20%. pnwmom Jan 2019 #53
Medicare has a 2% administrative cost vs 17% claimed by insurance. sfwriter Jan 2019 #54
That's never really been true FBaggins Jan 2019 #57
Not really. The 2% is just the overhead of getting the money from Medicare to the private insurer Recursion Jan 2019 #88
My wife had a uterine biopsy. 5 minute procedure. Insurance paid $4900.00. It was labeled as surgery Pepsidog Jan 2019 #9
Yes. For profit insurance has done a horrible job at cost control TexasBushwhacker Jan 2019 #12
Incredible. I guess they bill that way cause some insurance just cuts the check. Pepsidog Jan 2019 #18
Even with the ACA, it benefits insurance to keep costs high TexasBushwhacker Jan 2019 #25
True Pepsidog Jan 2019 #62
I believe that when ever a medical procedure is needed ... aggiesal Jan 2019 #13
I'm really lucky to live in western NYS pangaia Jan 2019 #17
Out of curiosity, what is your monthly Medicare Advantage premium? I have US Healthcare, and its... George II Jan 2019 #22
In the last 10 years it has varied between zero and $85. pangaia Jan 2019 #28
Before I retired I was very worried about what my supplemental insurance would cost.... George II Jan 2019 #66
There is one of the many keys to Universal Healthcare. GulfCoast66 Jan 2019 #75
Yes they do Pepsidog Jan 2019 #19
Something else must have been involved there FBaggins Jan 2019 #41
No other country wants to switch their medical plan area51 Jan 2019 #16
If we cut out the insurance companies, who would administer "Medicare for All"? It's a misnomer... George II Jan 2019 #24
How do other countries do it? TexasBushwhacker Jan 2019 #30
Germany makes the most sense exboyfil Jan 2019 #40
I respectfully disagree. The French system is better GulfCoast66 Jan 2019 #74
Thanks for the suggestion exboyfil Jan 2019 #87
There are no countries with a version of "Medicare for All" that has as large or diverse... George II Jan 2019 #63
We also have far more income inequality than Germany has TexasBushwhacker Jan 2019 #65
It's not a misnomer it is a fact Farmer-Rick Jan 2019 #42
Do you realize that you just undercut the OP's position? FBaggins Jan 2019 #45
Reduced staffing not fooled Jan 2019 #44
That's one of the biggest reasons for the Federal government subcontracting the administration.... George II Jan 2019 #64
Like idea of single payer, but we really aren't paying them 20% off the top BECAUSE Hoyt Jan 2019 #37
So many fallacies grantcart Jan 2019 #46
Sounding sophisticated. Adding confusion. Typical corporate strategy. TryLogic Jan 2019 #68
Or perhaps facts undercutting a sophomoric explanation of the challenge. GulfCoast66 Jan 2019 #76
Jesus. We get enough of that from the Trump brigade Recursion Jan 2019 #89
Yes, of course. The answer is more yelling Codeine Jan 2019 #97
Without offering anything but thanks to all, this is an excellent thread. yonder Jan 2019 #49
#1 Reason Favoring Medicare-For-All corbettkroehler Jan 2019 #60
America isn't "stupid" whathehell Jan 2019 #61
Single payer will certainly be more efficient, but it could also bankrupt many providers. MadDAsHell Jan 2019 #70
We've already looked out for for-profit healthcare to our detriment. If they're good, the rich will ancianita Jan 2019 #86
I will never understand why so many "good democrats" hueymahl Jan 2019 #90
I don't think that's a fair representation Codeine Jan 2019 #98
Insurance companies - the REAL death panels DirtEdonE Jan 2019 #93
People who administer health plans can be well paid Turbineguy Jan 2019 #101
More like 29% Strelnikov_ Jan 2019 #102

democratisphere

(17,235 posts)
1. The American Criminal Enterprise Healthcare System death panels are already in place.
Tue Jan 29, 2019, 10:55 AM
Jan 2019

Good luck getting rid of them. Maintaining the wealthiest's wealth is far more important than providing quality affordable healthcare to all. Get real!

FBaggins

(26,697 posts)
2. Sorry. That's a misunderstanding of basic economics.
Tue Jan 29, 2019, 11:03 AM
Jan 2019

You don't provide much detail, but reading between the lines it seems that you're saying that 20% of healthcare costs are the profits for the insurance companies... and that getting rid of those companies and replacing them with a government program would save that 20%.

That simply isn't true.

NewJeffCT

(56,827 posts)
3. agreed
Tue Jan 29, 2019, 11:11 AM
Jan 2019

80% must go towards medical and medical-related costs per the ACA, but the other 20% is not all profit. It's salaries of all the insurance company employees (not just the CEO, but the staff accountants and analysts, administrative assistants, IT geeks, human resources, etc), computers, office space rentals and maintenance, etc.

FBaggins

(26,697 posts)
8. Increased cost of care, population growth, and an aging population
Tue Jan 29, 2019, 11:31 AM
Jan 2019

It certainly isn't an increase in the portion of total costs eaten up by insurance company salaries and profits.

 

PaulX2

(2,032 posts)
10. It's Obesity And Crap Diets With Little Exercise
Tue Jan 29, 2019, 11:36 AM
Jan 2019

Driving costs per person up.

We eat flour and sugar to become blimps.

It's how we roll.

NJCher

(35,435 posts)
80. that's definitely a big part of it
Wed Jan 30, 2019, 01:02 AM
Jan 2019

It's why I do the work I do: I teach kids in the public school system how to garden. Eating vegetables is a whole different story when they grow their own vegetables!


democratisphere

(17,235 posts)
11. Not true. 20% of $100,000.00 and 20% of $1,000,000.00 are HUGELY DIFFERENT.
Tue Jan 29, 2019, 11:36 AM
Jan 2019

We are at the upper end and beyond. Insane, specially for the low quality of care delivered in the USA.

FBaggins

(26,697 posts)
14. Sorry, that's still backwards
Tue Jan 29, 2019, 11:51 AM
Jan 2019

20% of a number can't drive up the number. That's like saying that sales taxes are responsible for inflation.

Insane, specially for the low quality of care delivered in the USA.

That too is incorrect. Health care quality in the US is at or among the best in the world... it's just that the price for that care is the highest... and the lack of universality means that some can't get it.

 

PaulX2

(2,032 posts)
26. WHO Ranks USA 34th For Overall Health Care Frodo
Tue Jan 29, 2019, 12:05 PM
Jan 2019

For twice the price we come in at #34.

Overall.

For Profit Deathcare system is idiotic.

Medicare (which needs work) For All.

Then there is paying PHARMA Ransom for pills, but that would be another thread.

FBaggins

(26,697 posts)
35. Not for health care quality
Tue Jan 29, 2019, 12:17 PM
Jan 2019

The metrics they use make your claim somewhat circular. For instance, the fact that high costs make quality care unaffordable for many lowers our WHO ranking, but isn't really a measure of the quality of care if you can afford to pay for it. In fact, the fairness of expenditures and distribution of care are a big part of how they run their rankings. That distorts any evaluation of the quality of the care itself.

Also, outcomes are impacted by more than just quality of care. So, for instance, Americans tend to be more likely to die or be injured in car accidents. That doesn't speak to the healthcare system directly, but the impact on life expectancy has a negative impact on some of the metrics that feed their rankings. Similarly, the American diet has a significant impact on health outcomes that also drags on measures of health quality... despite the fact that the care provided may be exceptional.

democratisphere

(17,235 posts)
56. There is nothing exceptional about the American Healthcare System.
Tue Jan 29, 2019, 01:54 PM
Jan 2019

Your denial of the voluminous facts and studies by credible organizations throughout the United States and the world is stunning.

FBaggins

(26,697 posts)
58. Nothing?
Tue Jan 29, 2019, 02:16 PM
Jan 2019

Gee... I would have assumed that actual outcomes like how long people live after a cancer diagnosis or how long people wait for treatment would count for something.

But whatever floats your boat.

The issue with US healthcare is that not everyone has access to the best care and it's too expensive for too many... it isn't that the quality is low for those who can pay for it. If you remove price/equity from the evaluation, there is nowhere in the world with better healthcare.

The correct political position is that we can't remove price/equity from evaluations of something so important.

EX500rider

(10,532 posts)
71. He/she is correct about the quality if you have the money or insurance.
Tue Jan 29, 2019, 09:49 PM
Jan 2019

When rich people around the world want the best care they go to the US and the Mayo Clinic etc..
They don't go to Cuba etc who has widely available but low quality medical care.

Before the Cuba fans jump on me:

Problems within Cuba's health system, including:

Low pay of doctors.
Poor facilities—buildings in poor state of repair and mostly outdated.
Poor provision of equipment.
Frequent absence of essential drugs.
Concern regarding freedom of choice both for patient and doctor.

Katherine Hirschfeld, an anthropology professor at the University of Oklahoma, did her Ph.D. thesis on the Cuban health system, spending nine months conducting ethnographic work in Cuba in the late 1990s. According to Hirschfeld, "public criticism of the government is a crime in Cuba", which means that "formally eliciting critical narratives about health care would be viewed as a criminal act both for me as a researcher, and for people who spoke openly with me".[79] Nevertheless, she was able to hear from many Cubans, including health professionals, "serious complaints about the intrusion of politics into medical treatment and health care decision-making".[79] She points out that "there is no right to privacy in the physician-patient relationship in Cuba, no patients’ right of informed consent, no right to refuse treatment, and no right to protest or sue for malpractice".[79] In her view medical care in Cuba can be dehumanizing.

Hirschfeld explains also that the Cuban Ministry of Health (MINSAP) sets statistical targets that are viewed as production quotas. The most guarded is infant mortality rate. To illustrate this, Hirschfeld describes a case where a doctor said that if the ultrasound examination revealed "some fetal abnormalities", the woman "would have an abortion", to avoid an increase in the infant mortality rate.


https://en.wikipedia.org/wiki/Healthcare_in_Cuba#Criticism

democratisphere

(17,235 posts)
72. What does Cuban healthcare have to do with the best healthcare available in the world.
Tue Jan 29, 2019, 10:45 PM
Jan 2019

American healthcare is certainly not even close to the best available.

EX500rider

(10,532 posts)
73. I said Cuba etc..
Tue Jan 29, 2019, 10:49 PM
Jan 2019

Just pointing out widely available does not equal high quality.

United States has the most (93) of the Nobel Awardees in Physiology and Medicine.
Again, the rich go to the US for top flight care.

democratisphere

(17,235 posts)
77. Just because there are 93 Nobel Awardees in RESEARCH Physiology and Medicine,
Tue Jan 29, 2019, 11:29 PM
Jan 2019

this has very little or nothing to do with the crap quality of healthcare delivered to patients in the United States at outrageously exorbitant prices.

democratisphere

(17,235 posts)
79. Still has absolutely nothing to do with the reality of the lousy quality of care
Wed Jan 30, 2019, 12:48 AM
Jan 2019

delivered to the American patients. Enough said.

NJCher

(35,435 posts)
81. Did you see the story on the billionaire couple
Wed Jan 30, 2019, 01:06 AM
Jan 2019

fighting Big Pharma? It aired Tues., 1/29 on the NBC Nightly News. Here it is:



Worth a watch.


violetpastille

(1,483 posts)
31. I see what you mean.
Tue Jan 29, 2019, 12:12 PM
Jan 2019

Back in the days when a doctor would visit your home, and no one had or needed health insurance that same doctor didn't have antibiotics if you got an infection. Much less immunotherapy if you got cancer. I guess they had morphine, aspirin and simple surgery.

It seems like they were really good with palliative care, back in the good old days.
People died quickly and died at home.

So..if you want to save money, don't get sick.
And if you do, die quickly at home. Problem solved!

FBaggins

(26,697 posts)
43. See #35 above
Tue Jan 29, 2019, 12:30 PM
Jan 2019

Healthcare system rankings that include the cost and/or general availability of services beg the question. Similarly, rankings of outcomes can cloud the issue. Your "concept of math" jab after making the error yourself probably makes this example less useful than it would otherwise be... but if everyone in Japan took up skydiving tomorrow, their life expectancy would rapidly decline without saying anything about the actual quality of care.

druidity33

(6,435 posts)
67. actually skydiving is really safe...
Tue Jan 29, 2019, 05:25 PM
Jan 2019

now if more Japanese people drove cars instead of using the excellent public transit there. That's another story.


grantcart

(53,061 posts)
47. We have lower outcomes and higher costs than Canada because of how the 80% is spent
Tue Jan 29, 2019, 12:57 PM
Jan 2019

Not because the medical loss ratio is lower.

The Canadian system pays medical professionals for care rather than procedures, that is where the big savings are.

KPN

(15,587 posts)
103. Only in part. For profit health insurance enables price gouging
Thu Jan 31, 2019, 10:30 PM
Jan 2019

by the health industry overall. For profit health insurers have not been effective in controlling health costs for many reasons, one of which is they simply pass those costs on to their customers and reduce their own costs/maintain profit levels by reducing their risk, I.e., it’s essentially a rigged system.

 

mr_lebowski

(33,643 posts)
55. We know, but Medicare does the same for 3%, and there's 0 profit because there's no shareholders ...
Tue Jan 29, 2019, 01:52 PM
Jan 2019

No other 1st world country in the world has a such generous, profit-driven system for the private sector for societies basic health-care needs.

And health care is much cheaper per capita in every other 1st world country, with better overall outcomes.

still_one

(91,966 posts)
5. I think some also do not realize that Medicare is not free. People pay monthly premiums, and some
Tue Jan 29, 2019, 11:24 AM
Jan 2019

of those costs can be substantial unless they have a supplemental plan or a drug plan which also costs additional premiums. Of course they can go with an advantage plan which will lower some of those costs, but there are limits where they can go, because you may have to stay within a set of providers.

It is a very complicated issues. I know some here do like the issue of paygo, but the money to pay for Medicare for All has to be shown where it is coming from or it will fail before it even starts.



pangaia

(24,324 posts)
15. Of course you have to pay into Medicare throughout your life.
Tue Jan 29, 2019, 11:52 AM
Jan 2019

Do you really think paying $134/month is going to cover the costs of one's healthcare?

It's a tax... nothing wrong with that.

MichMan

(11,790 posts)
32. Understood, but to think you could cover everyone from day one...
Tue Jan 29, 2019, 12:12 PM
Jan 2019

...for the same $134 per month is not realistic.

Yavin4

(35,357 posts)
7. "the money to pay for Medicare for All has to be shown where it is coming from"
Tue Jan 29, 2019, 11:28 AM
Jan 2019

A combination of payroll taxes, higher taxes on high incomes, and a national sales tax on non-essential goods/services (energy, food, housing, education, healthcare, and clothing under $100 would be excluded).

still_one

(91,966 posts)
21. That may be the way to do it, but it needs to be spelled out, and the most difficult part is it
Tue Jan 29, 2019, 11:59 AM
Jan 2019

needs to voted on by Congress

still_one

(91,966 posts)
34. That won't do it Paul. However, in order to work, it MUST be mandatory. In other words, everyone
Tue Jan 29, 2019, 12:16 PM
Jan 2019

will need to pay more into it through their taxes, because it will be covering more people. Medicare today covers a high risk population, and by including Medicare for All, it will add more people, but at the same time it will also add a younger healthier population into the pool, which should help moderate those costs, whether through premiums or taxes or both





DonCoquixote

(13,615 posts)
69. and rice and potatoes?
Tue Jan 29, 2019, 06:55 PM
Jan 2019

Sorry, Carbs are a bit more complex than your statement would indicate, and they are also what many working people eat. We cannot all afford whole foods and buy that organic produce that is double the price.

 

Codeine

(25,586 posts)
96. I eat carbs all day.
Thu Jan 31, 2019, 01:44 PM
Jan 2019

I’ve been a vegan for thirty years, carbs are what I eat. And at just shy of fifty years old I seem to be trucking right along as healthy and as energetic as ever.

Farmer-Rick

(10,072 posts)
23. And you pay 20% of all expenses as your co-pay. Medicare for all is NOT free healthcare
Tue Jan 29, 2019, 12:02 PM
Jan 2019

It's always has been an insurance program not a healthcare giver. Medicare is just a little cheaper health insurance program.

still_one

(91,966 posts)
29. yup, that is what Medigap(supplemental), and Advantage plans do. On a relative basis it is a lot
Tue Jan 29, 2019, 12:08 PM
Jan 2019

cheaper because you are dealing with a higher risk population.


NJCher

(35,435 posts)
82. does that extend to other items in the U.S. budget?
Wed Jan 30, 2019, 01:12 AM
Jan 2019
the money to pay for Medicare for All has to be shown where it is coming from or it will fail before it even starts.

Like the Pentagon budget?

Like the F15?

Like the boondoggles in Afghanistan and other Middle Eastern countries?

Please tell me why we have to ask this question for medical care and why it's OK not to ask it for the above?

People who don't demand these basics have no respect for themselves. Why is it OK for our government to pay for killing people in a place like Afghanistan but NOT pay for a structure that cares for the health of the very people who provide the money for items like the F15?

Really, I am serious. I want to hear your justification for this.




George II

(67,782 posts)
20. Hidden in all of this is that the Federal Government has subcontracted out....
Tue Jan 29, 2019, 11:59 AM
Jan 2019

....the administration of many aspects of Medicare to the insurance companies. Why? Because they can do it cheaper!

That's why monthly supplemental premiums for most people on Medicare remain less than $30. If the government were administering it the premium would be $40-50 per month.

Farmer-Rick

(10,072 posts)
36. That makes no sense or am I misunderstanding what you are saying
Tue Jan 29, 2019, 12:18 PM
Jan 2019

First and foremost every single time you contract out a government function it will cost you more. Because the government need NOT make a profit AND contracting adds another layer of unnecessary administration.

Contracting out requires the government to pay the contractor enough for him to stay in business. If he is to stay in business he must make a profit. While keeping a function in house may cost more because the government usually pays workers better and has better benefits, that doesn't mean the government can't turn around and play the same nasty tricks on their workers that contractors do. The government just chooses to pay a living wage unlike most contractors.

Once an in house job has been contracted out several government workers are needed to monitor and administer the contract to ensure the government is NOT being cheated (though Traitor Trump doesn't really care about that). For the government to get the services it wants, it must go through a contract manager of some kind. They can't just go to the contract worker and tell them what to do because the contract worker doesn't work for them. It either has to write the best job descriptions in the world or go through a contractor manager to respond to changes and problems.

Trust me, I have done many reports on contracting out government functions and in the long run it always costs someone more.

NJCher

(35,435 posts)
83. you are so right
Wed Jan 30, 2019, 01:17 AM
Jan 2019

Anyone who has ever been in business will tell you that the rules of capitalism are ruthless.

There has to be a better way.


Pobeka

(4,999 posts)
50. I'm going to argue the point differently. Think about this...
Tue Jan 29, 2019, 01:22 PM
Jan 2019

Suppose you are an insurance company, and your fees are limited to a fixed percentage of the overall cost.

Your mission as an insurance company is to maximize revenues.

Given a constraint of a fixed percent, the only option to increase revenues is to drive up the base cost with whatever means you have, so the amount you receive from the fixed percentage of that base cost also goes up.

This, I believe is what's horribly broken -- no financial incentives to actually lower base costs while still providing quality health care.

And those rising base costs also cause medicare base costs to rise by some amount -- basically the same providers, equipment etc.

FBaggins

(26,697 posts)
52. Quite close... but one important error.
Tue Jan 29, 2019, 01:36 PM
Jan 2019

You've left out the power of competition.

The model that you're considering is absolutely a problem when we're talking about government-regulated monopolies (e.g., power companies in some states). There's little incentive to keep overall prices down because their revenue is restricted to a percentage of total costs. They can still improve profitability by more efficient administration of the service, but they're limited by a percentage of the top-line costs... so they have an incentive to let those rise.

That's why the government regulates the price they can charge.

This is case is different because the health insurance companies still have competitors. They can increase top-line revenue by taking business away from other insurance companies (which requires them to either improve service or decrease premiums compared to the competition- or both)... and they can also improve profitability by delivering the service more efficiently.

Pobeka

(4,999 posts)
59. AFAIK, health care companies are not bound by antitrust.
Tue Jan 29, 2019, 02:32 PM
Jan 2019

(BTW -- enjoying the discussion)

Yeps - when basic health care costs rise, all insurance companies benefit. The other side of the competition problem is the stockholders of publicly held companies would not be happy if a company didn't get as much of the allowed % and deliver that back to the stockholders (a different sort of competition, causing costs to rise).

Who has more power, stockholders of insurance companies, or clients? I don't know the breakout of publicly held insurance companies vs private so this may be a mute point, or an important one.

(Near as I can tell H.R. 372 passed the house in 2017, but has not made it through the senate. It would remove the antitrust exemption for health-care)

Even if that were not true (antitrust, stockholders), this is not like buying a gallon of milk, where at the point of sale you can go down the street and buy the same product, and that happens multiple times per year.

We are stuck and can only change insurance one a year, and at that time extracting the information about what coverage is actually provided when comparing insurance providers is nigh on impossible (we just went thru this.) It's impossible to make an informed decision necessary to make competition actually work. I'd think that competition would actually be effective it you could switch insurance providers when you get ill (cancer, accidents, whatever), and pick the one who offers the best bang for the buck. Obviously, that can't work, but something along those lines would be more effective at getting competition to lower prices...

NJCher

(35,435 posts)
84. this billionaire couple will tell you
Wed Jan 30, 2019, 01:21 AM
Jan 2019

that there is no competition. Take a look. This report appeared on Tuesday's NBC Nightly News.








p.s. oh and I used to work for Big Pharma in an executive capacity and I can tell you firsthand there is no competition. They have figured that one out.

FBaggins

(26,697 posts)
85. Did you link to the wrong video?
Wed Jan 30, 2019, 10:11 AM
Jan 2019

It certainly doesn't support your position.

Of course there is no competition when the government explicitly gives you a monopoly on a particular product. There's a whole different debate to be had re whether that patent advantage results in new drugs that benefit healthcare even at insane prices... but it certainly doesn't demonstrate that there is no competition between health insurance companies.

p.s. oh and in your years at Big Pharma you may have missed what happens when those patent monopolies expire? Multiple companies compete with generic versions and the prices plummet.

NJCher

(35,435 posts)
91. Yes, it does support my position
Wed Jan 30, 2019, 05:44 PM
Jan 2019

but go ahead and play word games so you don't look so foolish. Your last statement proves you don't know what's going on in the field.

FBaggins

(26,697 posts)
92. Oh, I can't wait to see this
Wed Jan 30, 2019, 07:52 PM
Jan 2019

By all means, explain why drug prices for medications under government-approved monopoly are sky-high while generic prices are almost free... without using the word "competition".

Don't worry. Nobody will be holding their breath.

NJCher

(35,435 posts)
94. terrific
Thu Jan 31, 2019, 01:00 PM
Jan 2019

because that is within your own purview. You, yes, you, can learn to use Google! You just need to be more current and you will understand my comments.

An aside: it is shocking how poorly informed some of our posters are. I would like to think I'm posting here with well-read, informed posters. Oh well, a few will always slip through the cracks.

FBaggins

(26,697 posts)
95. Thank goodness we weren't holding our breaths, eh?
Thu Jan 31, 2019, 01:22 PM
Jan 2019

Still waiting for a legitimate response.

"It's so simple I can't waste my time to give it but have time to belittle you for not getting it" actually translates to "Hope I can get away with this - Hey... it worked on the emperor until that meddling kid came along, didn't it?"

NJCher

(35,435 posts)
99. what you're asking for is for me to do your work for you
Thu Jan 31, 2019, 06:31 PM
Jan 2019

Not my job. It's yours. Do your own research, come up with your own search terms, and see if you can form an intelligent hypothesis or creative point based on it. If you can't do that, then your posts really aren't worth reading.

I can't speak for other posters, but I doubt too many are interested in doing your research for you. The research and reading kinda' comes with being on a discussion board.

FBaggins

(26,697 posts)
100. Nope
Thu Jan 31, 2019, 09:48 PM
Jan 2019

Entirely out of the blue you made the claim that a story about pharmaceutical companies benefitting from monopoly pricing demonstrated that insurance companies didn't compete with one another.

I'm still waiting for you to back up that unsupported claim.

Obviously, you can't.

FBaggins

(26,697 posts)
105. Now you can't even be bothered to read your own posts or the context in which they were made?
Fri Feb 1, 2019, 03:35 PM
Feb 2019

#52 - I pointed out that health insurance companies have competitors.

#84 - You replied that "there is no competition" and used as evidence a wealthy couple who were fighting the outrageous prices that pharmaceutical companies charge while they have a monopoly/patent on the drug.

#85 - I pointed out that of course having a monopoly without the government capping the price is the very opposite of competition, but that we were discussing health insurance companies, not drug companies. Then I pointed out that even drug companies had competitors again when their monopoly patentents expire and anyone who had spent years in the industry would know that generic drug prices plummet rapidly in that environment.

#91 - You doubled down that the video actually supported the "no competition" claim for health insurance companies and then inexplicably claimed that the basic facts on drug pricing once the patent expires proved that I didn't understand what was going on.

#91 - I challenged you to back up the ridiculous claim and you went into your "emperor's new clothes" mode.

pnwmom

(108,925 posts)
53. Medicare has a 2-3% overhead. And the insurance on the exchange has been limited to 20%.
Tue Jan 29, 2019, 01:41 PM
Jan 2019

Insurance off the exchange could be even higher.

So the number suggested has some basis.

https://www.healthaffairs.org/do/10.1377/hblog20110920.013390/full/

Medicare Has Lower Administrative Costs Than Private Plans.

According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.

Insurance industry-funded studies exclude private plans’ marketing costs and profits from their calculation of administrative costs. Even so, Medicare’s overhead is dramatically lower.

Medicare administrative cost figures include the collection of Medicare taxes, fraud and abuse controls, and building costs.

 

sfwriter

(3,032 posts)
54. Medicare has a 2% administrative cost vs 17% claimed by insurance.
Tue Jan 29, 2019, 01:49 PM
Jan 2019

Private insurance estimates exclude advertising and marketing.


https://www.healthaffairs.org/do/10.1377/hblog20110920.013390/full/

"According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue."

FBaggins

(26,697 posts)
57. That's never really been true
Tue Jan 29, 2019, 02:08 PM
Jan 2019

Or... put more charitably... the two figures are not comparable.

Medicare has no costs related to billing (etc.). The IRS collects the taxes and the Social Security Administration collects the premiums. Private insurers pay their own auditing and accounting and investigate their own fraud cases... they don't have HHS providing the service for them (or other administrative expenses like construction and marketing that are paid by HHS). Private insurers pay taxes, while Medicare doesn't.

Then there's the big one. Simple math: Health care gets much more expensive as people age. The services that Medicare administers care for are far more expensive than those for the rest of us... making the denominator many times larger than that for private insurers.

Recursion

(56,582 posts)
88. Not really. The 2% is just the overhead of getting the money from Medicare to the private insurer
Wed Jan 30, 2019, 11:08 AM
Jan 2019

that provisions the actual care. Medicare is the largest purchaser of private medical insurance in the country.

Pepsidog

(6,252 posts)
9. My wife had a uterine biopsy. 5 minute procedure. Insurance paid $4900.00. It was labeled as surgery
Tue Jan 29, 2019, 11:33 AM
Jan 2019

Could this be part of the problem?

TexasBushwhacker

(20,044 posts)
12. Yes. For profit insurance has done a horrible job at cost control
Tue Jan 29, 2019, 11:46 AM
Jan 2019

For profit health insurance companies do negotiate some duscounts, but for the most part they just pass increased costs onto the consumer in the form of higher premiums, copays and deductibles.

I have a friend who fell and broke her elbow when she was uninsured. Surgery was required and pins were put in place. I think she may have required some physical therapy. Her hospital bill at list price? $330K - for a broken elbow. It's since been dropped down to $60K which is still ridiculous, but also shiws that it never should have cost $330K in the first place.

Hospitals charge what they charge because there are no cost controls in place. Having a single payer plan like Medicare for all would be a huge step towards controlling costs.

TexasBushwhacker

(20,044 posts)
25. Even with the ACA, it benefits insurance to keep costs high
Tue Jan 29, 2019, 12:03 PM
Jan 2019

Sure, they will still deny care left and right and they have to spend 80% of their budget on patient care, but that leaves 20% for staff compensation and profit. 20% of $100 Million is more than 20% of $80 Million r less. They have to be able to pay those CEOs millions somehow.

aggiesal

(8,864 posts)
13. I believe that when ever a medical procedure is needed ...
Tue Jan 29, 2019, 11:48 AM
Jan 2019

that the facility should provide you with an estimate cost for that procedure before it is performed.
Imagine dropping off your car at a service location and they don't provide an estimate, in California that would be illegal, yet we allow that to happen with our bodies, but not our vehicles.

Also, HMO's are pure monopolies. I hate Kaiser Permanente, because it is such a monopoly. Any prescriptions that I receive has to be filled by the Kaiser Pharmacy. I can't take it to any other more convenient pharmacy and maybe pay cheaper, it has to be filled at Kaiser, at whatever cost they charge.

Same thing for any procedure. They can charge anything they want, because it's a captured market. You can't go to any other facility to determine if you can have the procedure done cheaper.

For profit medical really sucks!

pangaia

(24,324 posts)
17. I'm really lucky to live in western NYS
Tue Jan 29, 2019, 11:57 AM
Jan 2019

where there are at least two non-profit health insurance companies - EXCELLUS and MVP. I have been enrolled in both at one time or another for my Medicare Advantage plan. There were two out of the 10 years I have had Medicare where the MVP premium was ZERO !! And that was about the best plan they had.

George II

(67,782 posts)
22. Out of curiosity, what is your monthly Medicare Advantage premium? I have US Healthcare, and its...
Tue Jan 29, 2019, 12:01 PM
Jan 2019

...only $26 per month. I've been on Medicare for four years, it hasn't varied more than a few dollars either way ($29 high, $23 low)

pangaia

(24,324 posts)
28. In the last 10 years it has varied between zero and $85.
Tue Jan 29, 2019, 12:08 PM
Jan 2019

I think this year it is about $45 ish. I choose among about 5 different plans. This is the first year I chose an only IN NETWORK providers plan.. because it was a little cheaper and also EVERY SINGLE doctor just about in all of western NY is In Network. Excellus last year and this.. MVP before that.

Co-pays are very reasonable, for me anyway, considering the current American health care system.
One big change about 3 years ago was that chemo, etc.now have a 20% copay! Before that it was just a couple hundred $$s. Good thing I had my lymphoma before they changed. :&gt ))



George II

(67,782 posts)
66. Before I retired I was very worried about what my supplemental insurance would cost....
Tue Jan 29, 2019, 05:21 PM
Jan 2019

....I was thinking a few hundred a month. Then a friend of mine, who is in the business, explained to me how it works. I was relieved when I heard it was so low.

So my wife and I now pay about $125/month for Medicare and $26/month for Medicare Advantage - $302 total per month. We each have two prescriptions, copay for each is $3/month - that's $12 combined.

All things considered we're pretty lucky. But we were spoiled though - for the past 40+ years my wife worked for the biggest hospital in the state, healthcare coverage for both of us combined was $19/week with virtually no copays.

GulfCoast66

(11,949 posts)
75. There is one of the many keys to Universal Healthcare.
Tue Jan 29, 2019, 11:05 PM
Jan 2019

Nonprofit insurance. It’s been too many years since Americans realized all healthcare insurance was nonprofit.

But there are so many others. Keep employers on the hook and don’t let them get away with cutting hours to fall under healthcare requirements. Raise taxes enough to pay for insurance for those without.

Make people pay, but on their true ability. Where do I get these ideas? France. Which has one of the best Healthcare systems in the world.

FBaggins

(26,697 posts)
41. Something else must have been involved there
Tue Jan 29, 2019, 12:24 PM
Jan 2019

An endometrial biopsy should cost a few to several hundred dollars. Not several thousand.

area51

(11,868 posts)
16. No other country wants to switch their medical plan
Tue Jan 29, 2019, 11:56 AM
Jan 2019

over to ours ... because it's bloated, expensive, doesn't cover everyone and doesn't work. We need single-payer/comprehensive Medicare for All.

George II

(67,782 posts)
24. If we cut out the insurance companies, who would administer "Medicare for All"? It's a misnomer...
Tue Jan 29, 2019, 12:02 PM
Jan 2019

....that the government could do it cheaper, even if the "profit" was eliminated.

TexasBushwhacker

(20,044 posts)
30. How do other countries do it?
Tue Jan 29, 2019, 12:11 PM
Jan 2019

It's not like we're inventing the wheel. Plenty of other countries have healthcare for all at lower costs. There are different approaches but all have cost controls in place for drugs and services. We already have the Medicare system in place, so that would be expanded. My guess is that private insurance companies would still offer Medicare Advantage type plans, but on a broader scale.

exboyfil

(17,857 posts)
40. Germany makes the most sense
Tue Jan 29, 2019, 12:23 PM
Jan 2019

to study. It is the largest country that is most like us. Their spending is half what we do.

Obviously also Canada. I think the UK system would be a bridge too far.

Also has anyone noticed that India has almost reached China's population. Incredible.

GulfCoast66

(11,949 posts)
74. I respectfully disagree. The French system is better
Tue Jan 29, 2019, 10:50 PM
Jan 2019

And the ACA could get us their. I am familiar with the German system. But I think the French system is more analogous to where we can go.

George II

(67,782 posts)
63. There are no countries with a version of "Medicare for All" that has as large or diverse...
Tue Jan 29, 2019, 04:23 PM
Jan 2019

...a population of the United States.

The largest, Germany, has about one quarter the population of the United States and 90% of them are Caucasian. The higher the population and the more diverse the population the higher the overall cost of healthcare.

TexasBushwhacker

(20,044 posts)
65. We also have far more income inequality than Germany has
Tue Jan 29, 2019, 05:05 PM
Jan 2019

I would suggest that it isn't our racial diversity that causes higher healthcare costs in the US, it is the fact that so many of us are struggling. Our Gini coefficient, a measure of income inequality, is 40-45 and on par with Russia. Germany's is 25-30, one of the best in the world. Their minimum wage is approximately $10.50 an hour. They have healthcare, maternity leave, sick leave and vacation.

Providing quality healthcare for all is part of the big picture. Not having access to healthcare means things like cancer get diagnosed later, when they are more expensive to treat and more likely to be lethal. Chronic conditions like diabetes and high blood pressure can be managed better and less likely to cause expensive and deadly complications like stroke and heart disease. Not having access to healthcare means premature death and disability, costing benefits like SSDI for the disabled and SSI for the survivors of the dead. Of course premature disability and death leads to higher poverty. It's a vicious cycle.

Farmer-Rick

(10,072 posts)
42. It's not a misnomer it is a fact
Tue Jan 29, 2019, 12:27 PM
Jan 2019

The contractor do it cheaper only because they choose to pay their workers less. That's where they get their profit. Off the backs of the workers. And frequently these contracts are handed out to campaign contributors so they can make a buck off the government. It's a scam for the rich and a reward system for donors.

Like Traitor Trump's wall. That's going to get handed to a Russian firm. Scamming off of government contracts has been around since the birth of our nation.

But the government could turn around a pay the sad wages that contractors do and it would be cheaper than anything a contractor can do.

not fooled

(5,791 posts)
44. Reduced staffing
Tue Jan 29, 2019, 12:35 PM
Jan 2019

because there wouldn't be the need for a phalanx of office workers to deal with numerous different insurers and the byzantine system of payment. Thom Hartmann has addressed this issue many times--there are far, far fewer workers needed to shuffle paper with single-payer. Those people could be providing healthcare instead.

George II

(67,782 posts)
64. That's one of the biggest reasons for the Federal government subcontracting the administration....
Tue Jan 29, 2019, 04:28 PM
Jan 2019

...of Medicare Advantage, to avoid the phalanx of office workers. The Federal government does little to administer Medicare. I'm over simplifying it, but their biggest involvement is collecting the Medicare premium via a deduction from Social Security payments. They pay a set fee to the private insurance companies to administer most of everything else. That's how the insurance companies can keep the Medicare Advantage premiums low, too.

 

Hoyt

(54,770 posts)
37. Like idea of single payer, but we really aren't paying them 20% off the top BECAUSE
Tue Jan 29, 2019, 12:20 PM
Jan 2019
much of that 20% goes into:
--controlling costs and preventing providers from charging you for a one hour office visit, when they spent 5 minutes, or performing complicated costly surgeries, when you need a simple one;
--coordinating care among providers;
--controlling what providers can charge you;
--credentialing providers so that you don't end up getting your heart surgery from a quack;
--maintaining quality ratings;
--adjudicating claims so that the same thing is not paid twice, some fraudster charges a female for prostate surgery;
--answering coverage questions;
--making sure providers are following best practices as determined by their professional organizations;
--investing money in systems to do all that; etc.

Admittedly, they also pay CEOs millions, but if you paid them $1/annually it wouldn't cut our cost $10 a year.

At best, that 20% people see as waste is really more like 6 to 8%, and that's assuming the government will put up the upfront funds necessary to do all that stuff. Sure, I'd prefer it to all be under one system, and 6 to 8% reduction is significant. But, the thought that the cost will automatically be reduced 20% is hyperbole.

Your premiums to Medicare-for-All going down 7% in this overly simplistic view, ain't going to help a lot of people. If you used to pay $800 a month, now you might pay $744, if everything goes as we hope. Your utility companies, phone companies, etc., will just figure you have an extra $56 a month for them to raise fees.

The plus side, is that it gets healthcare under one system, which would help rationalize the system in the very long-term.

grantcart

(53,061 posts)
46. So many fallacies
Tue Jan 29, 2019, 12:53 PM
Jan 2019

1) Not all medical loss ratio is at 20% under ACA

2) It assumes zero cost for medical loss ratio which is beyond absurd.

3) Medicare medical loss ratio is 3% but that doesn't include client acquisition costs and account management costs which are covered by the Social Security Administration.

If you average the medical loss ratio of private plans at 17% and estimate government medical loss ratio at about 8% (I believe Canada is 12%).

Savings from going to Medicare for all would be about 8-9% maximum.

Finally the Canadian system has lower costs and much better outcomes but that cannot be accounted for simply by a lower medical loss ratio but how the 80% (or 85%) is spent, namely transitioning from "payment for procedures" to "payment for care".

Emotional but uninformed posts like this actually undermine thoughtful discussion because while the ACA already reduced the medical loss ratio (thank you Senator Frankin) so that additional reductions would bring only minor benefit while significant reductions can be made on how the direct medical costs are controlled.

GulfCoast66

(11,949 posts)
76. Or perhaps facts undercutting a sophomoric explanation of the challenge.
Tue Jan 29, 2019, 11:15 PM
Jan 2019

Healthcare is complicated, remember.

And I do favor Universal Healthcare.

Please read how the French did it. Producing one of the best healthcare systems in the world. It will take several hours of ready but will help you understand how other nations overcame the challenges we now face. And make you realize how complicated this is

The now popular ACA has set us up to get there. We need the patience to make it happen

But it will be complicated. And will not happen overnight or with one bill. Or one Congress.

It will take 8-10 years.

Recursion

(56,582 posts)
89. Jesus. We get enough of that from the Trump brigade
Wed Jan 30, 2019, 11:10 AM
Jan 2019
Real life problems are complex and require complex solutions. Switching everyone over to Medicare would bankrupt both patients and providers.
 

Codeine

(25,586 posts)
97. Yes, of course. The answer is more yelling
Thu Jan 31, 2019, 01:50 PM
Jan 2019

and some uninformed rants with numbers pulled willy-nilly from various regions nether. Unfounded assertions repeated loudly can solve every complex issue.

corbettkroehler

(1,898 posts)
60. #1 Reason Favoring Medicare-For-All
Tue Jan 29, 2019, 03:20 PM
Jan 2019

Let's all remember that Medicare advertises very little and its top executives are civil servants, earning salaries WELL BELOW $1 million per annum yielding administrative costs of about 3%, below private insurance on almost every front.

 

MadDAsHell

(2,067 posts)
70. Single payer will certainly be more efficient, but it could also bankrupt many providers.
Tue Jan 29, 2019, 09:34 PM
Jan 2019

My sister is in healthcare finance for a small town nursing home. While dealing with a single payer could bring efficiencies, it could also bankrupt them if that single payer is the govt paying at current govt rates. The only reason they stay open is the occasional patient with a commercial payer that subsidizes the anemic payment rates of Medicaid and Medicare.

Medicare For All? Yes.

Medicare For All at current payment rates? Not unless you want half of medical providers to close within a year.

And that's what Medicare For All proposals usually lack: an explanation for how providers make up for losing the only payers that they can at least break even on.

ancianita

(35,816 posts)
86. We've already looked out for for-profit healthcare to our detriment. If they're good, the rich will
Wed Jan 30, 2019, 10:33 AM
Jan 2019

choose to stick with them.

Many health care experts have already proven that current healthcare systems' essential personnel and services can be rolled right into existing systems Medicare has had in place in all 50 states.

Single payer experts have argued that not only can private healthcare fold into existing Medicare systems, personnel included (except for non-direct service administrators, boards and CEO's), but those carriers who choose to go their own way will find the "invisible hand" of the free markets' competition, which will force their personnel, production and health delivery systems to streamline through healthy cost cutting. The very wealthy may prefer, because they like choices, to afford their services rather than single payer.

I'm not for looking out for the few healthcare corporations at the expense of millions. Let's stop worrying about their welfare when they've proven inadequate to do the same toward the public.

hueymahl

(2,418 posts)
90. I will never understand why so many "good democrats"
Wed Jan 30, 2019, 11:43 AM
Jan 2019

are hell bent on defending the insurance companies and the status quo. This whole thread is a head scratcher.

 

Codeine

(25,586 posts)
98. I don't think that's a fair representation
Thu Jan 31, 2019, 01:56 PM
Jan 2019

of this thread at all. Some people took issue with the simplistic tone of the OP and laid out some of the complexities glossed over therein. MfA may or may not be the solution to our health care dilemma, but not being able to discuss it as adults certainly won’t contribute to making anything better.

 

DirtEdonE

(1,220 posts)
93. Insurance companies - the REAL death panels
Wed Jan 30, 2019, 11:23 PM
Jan 2019

Only in America are people dumb enough to pay non-medical professionals to tell them what their doctors can or can't do for their health.

Insurance companies are like the appendix of our health care - a useless organ with no possible function other than the likelihood of becoming a problem.

Turbineguy

(37,212 posts)
101. People who administer health plans can be well paid
Thu Jan 31, 2019, 09:52 PM
Jan 2019

just not the obscene pay that management gets. It's important work.

Strelnikov_

(7,772 posts)
102. More like 29%
Thu Jan 31, 2019, 10:04 PM
Jan 2019

Off the top of my head, 'overhead' for private insurance (profit, administrative, etc.) (aka entropy) is 32% +/-, Medicare is 3%.

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