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Inflation screwing you over? Just invest!
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this post was submitted on 19 Feb 2024
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The problem is that healthcare systems are meant to take care of the entire population, not just the middle class or higher. If you are a moderately healthy and wealthy person, yes the American healthcare system is fine, but that's not exactly the what your entire system should be geared for.
The only reason they like the system is because they are the bread and butter of private insurance. Healthy working adults whom don't require lots of expensive care. However, if they were to developed a chronic illness, or get injured or I'll to the point where they can't maintain their employment....... That's when you get to experience the worst healthcare experience America has to offer.
As someone who's had socialized medicine (Tricare) and now currently has "good" private insurance (BCBS ppo), I definitely prefer socialized.
There's no worry that your going to catch an unexpected co-pays, you aren't nickle and dimed for every script or visit. No worrying about out of pocket maximums, yearly deductibles, or lack of specific coverage. You don't have to get specialized insurance for just your eyes and teeth, the benefits go on and on.
The cost problem stems from the structural problem. Private insurance steals the ability to effectively collectively bargain for lower prices. It also diverts funding away from the socialized insurance pool of Medicare, which lacks the young healthy subscribers that help stabilize and fund the care for elderly and sick.
Imagine if all the money that private insurance pockets went towards actually caring for people. Imagine if hospitals didn't have to employ a small army of managers and billing agents, just to get paid for services already rendered. Imagine the collective bargaining power that we'd all have if pharmaceutical companies knew there was only one customer in the entire nation.
You give that all away for what? A policy that goes away the moment your employer decides they don't want to pay that much this year? A policy that ties your physical well being to your employment? A policy that terminates your coverage the very moment you need it the most?
Again, you're talking about cost, not which you'd prefer from a service perspective.
I think there are lots of opportunities to make costs lower, such as reducing patent lengths (reduces medication costs) and simplify insurance (reduces admin costs). We should also make changes to liability law so doctors can focus on providing care. Some specific proposals:
And so on. And on top of that, expand Medicare/Medicaid a bit with costs phasing in the higher your income goes. I think we should also cap access to Medicare for retirees at a certain income level as well, and remove FICA tax caps.
We should absolutely be discouraging employer sponsored insurance and encouraging longer term insurance plans (e.g. like life insurance, you lock in at a lower rate if you sign up while healthy). Dropping someone from insurance shouldn't be a thing at all, and the payout for doing so should be much higher than any costs the insurance company would incur by keeping them.
If you went to a restaurant and they ran separate charges every time you ordered something..... You wouldn't consider that bad service?
Also, I went to the same physician when on Tricare, so it's the same exact service, minus all the billing hassle.
And I think you could do the same things and still lower the cost even more by banning privatized insurance?
Also, what is the profit motive for insurance companies to simplify their process? Their systems were purpose built to be as complicated and time consuming as possible, if they make the process easier, their subscribers would utilize it more, making insurance pay more often.
And again, why would corporations do this? And how would we enforce this?
The Medicare billing is automated, and pretty simple. It's what every insurance company has the option of doing, but only Medicare and Medicaid have automated the process. This is because private insurance companies have no profit motive to pay for their prescribers healthcare.
Most hospitals have this information available, especially if you call their financial services office. In fact if you are a Medicare patient this information is publicly available on the CMS website, and they list exactly how they came to that figure.
The whole hidden ledger thing is primarily only a problem at privatized hospitals that were bought or built by private hospital networks operating for profit.
The inherent problem with this is that the elderly are fundamentally uninsurable. You can't make a profit from an elderly subscriber, the cost of their end of life care will always cost more than any subscription fee they may pay in.
This is why the vast majority of private insurance do not offer primary insurance to people older than 65. The whole point of private insurance is to extract money from healthy patients and then dump them onto Medicaid if they become disabled, or onto Medicare when they begin to age and decline in health.
Who would offer those plans, and why? The only reason most people can afford private insurance is because their employer collectively bartered for the price. A lot of people have no idea how much of their employee compensation package is taken up by their insurance, but the burden of cost is redistributed by the entire employer pool.
This would bankrupt private insurance companies....... I don't think you fully understand how hard it is to make money on health insurance. The only way to do so is by withholding healthcare to your subscribers, or to offer plans with obscene co-pays or deductible.
The cost on average for full coverage is around 8.5k dollars a year for an individual, or 24k for a family. Meaning that the cost of a single operation, illness, or inpatient procedure will wipe away the potential profits from an individual subscriber for years. The only way to recover from having one I'll subscriber is to balance them with a dozen healthy subscribers.
Without managing this equation of large healthy profitable pool vs small costly pool, the entire charade of private insurance would collapse upon itself.
One of the largest drivers in the increase in healthcare cost is these types of people. People whom don't have any insurance, but still have healthcare needs. For these people the emergency room is typically their only option. This is one of the reasons emergency medicine is such a drain on hospital resources. For every person they treat without insurance, they have to raise the cost on people with insurance, simply so they don't go out of business.
It's funny you mention restaurants, in that case I don't particularly care when they bill me because the menu says precisely what I'll pay (counter order vs table service doesn't matter as much as cost and quality). If it's market rate (steak or seafood), they'll tell me what the day's rate is and what cuts they have.
I don't get that with health care, even getting a range in a quote is like pulling teeth. I pushed back a ton when my daughter needed a surgery, and after several calls I still didn't get a clear answer, and this was for a routine surgery. The quality and speed of service was great, billing was not.
One of the benefits of socialized medicine is not having to worry about billing, but you also often get delays in care. I don't think we need to go to socialized medicine to solve the unexpected costs issue, we can expect care providers to absorb some of the variability.
I agree, the current profit motives are misaligned, and pushes like the ACA to further expand the number of people with insurance further entrench these practices.
The profit motive should be attracting customers who otherwise would go without. But since pricing isn't transparent, cash payers don't have the same leverage to get a fair price. Many care providers have an informal "cash discount," but that's just not the same.
If the system works well for cash customers, insurance would need to earn customers' business, but when most people have insurance, the patient is no longer the customer, the employer is, so they'll charge individual customers more than employers with group plans. If we separate the insurance from the employer, they would need to cater to patients.
Removing private insurance is one option, but that's also quite disruptive and has potential for other issues (e.g. why would Medicare bother with good customer service if it's the only option?).
That wasn't my experience. We had two options for a surgery with different risks and costs, and after several calls, we couldn't get any numbers, just A costs more than B. That's why I'm so interested and "it depends on your insurance" blah blah blah. That's why I'm so interested in this. And this wasn't some podunk hospital, it was the premier children's hospital in the state, run by the premier public university in the state, and services kids outside the state.
I should be able to get quotes on a procedure from multiple care givers for a non-urgent procedure (like the one we had).
Patients should be able to switch insurance if they don't like the one they have. Right now, you either use the insurance you have or pay out the nose by giving up company cost share and ACA subsidies.
If my company offers a crappy plan, I should be able to take what they would've contributed and pick my own plan. If that was the case, insurance companies would try harder to make their service more convenient, just like auto insurance does (not a gold standard, but much better), and HR orgs would probably try harder to pick better plans.
If you're wealthy, you don't need much from your insurance. End of life care could be self funded, and insurance is there for the other surprises that could ruin your retirement. It would be totally acceptable for an insurance company to require some kind of down payment to cover EOL care, or a minimum number of years for coverage (if you die before the end of the contract, it counts as debt the estate needs to pay back).
I've run the numbers and can get a similar price (within 10% or so) for similar coverage without ACA subsidies, but I need to factor in how much they'd contribute to their own plan. Add to that couples who both work, your options are: have separate plans (less efficient) or give up the employer subsidy.
No, they'd just adjust rates to compensate. If there's something insurance companies are good at, it's averaging costs and holding a surplus. So a company that's better able to estimate this should get more customers and stay in business longer.
If they offer a 10-year or longer plan, they just need to average costs across their target demographic over those years to come up with a premium. Term life insurance companies do this, so why not health insurance?
Especially for homeless people. Which is a huge part of why I'm a fan of government funded ER. That's a huge risk factor for insurance companies and hospitals, and it's also a huge complexity for visitors and whatnot, so it should just be provided. If the paramedic thinks you need emergency care, it should be 100% free. However, hospitals should be empowered to deny care (and charge for wasting ER capacity) for non-emergencies.
But any extended care once you're stabilized should be covered by insurance instead, because you have actual choices in your care (and could theoretically walk out if you choose not to accept further care).