SIGforum.com Main Page The Lounge Ongoing issue in politics with healthcare and covering Pre-existing conditions
Main Page The Lounge Ongoing issue in politics with healthcare and covering Pre-existing conditionsPage 1 2
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What the hell did people do before Medicare and health insurance? Didn't they pay cash to doctors who made house calls, and then maybe take up a collection when surgery was needed? And those christian and jewish hospitals did charity work for people who couldn't afford it. And county hospitals too, right? From my point of view everyone has some fault in this. Medical providers can be very inefficient and wasteful, hospitals especially. Does 4 years of med school entitle people to make several times the median income? Considering most small businesses fail in the first few years and it takes constant reinvestment by the owner, loans, equity investments, and living lean until it really gets off the ground, why are small private medical practices still the norm? If they can succeed simply by getting an MD and hanging a shingle outside then clearly the market is not functioning the same way it does other small businesses. Insurance is claims paid - premiums in plus margin. They do not make huge margins. The claims of excess profiteering and whining about executive salaries are just distractions. Yes, operating costs do soak up some of the difference between premiums in and claims out. Employer health plans work for a reason. A large group plan with a shared risk pool and level premiums for all. Many large employers are self-insured. They pay all claims and the insurance company is just a processor and provider of a network of physicians with negotiated rates. My "single" coverage from my employer is only about $32 a month (but 60% higher if you don't complete an annual health incentive). But it's an HSA with $3000 deductible so it's all out of pocket, except preventive care, before deductible. Makes you ask how much stuff costs first and consider frequency of Dr. visits versus benefit. The insurance company even helps you find the best cost provider for imaging like CT and MRI. That stuff varies by like 5-10x depending on where you go. But the people with chronic health conditions or diabetes or whatever drive the costs up compared to people that never hit the deductible (I think I just did this year, but it's the only time ever in 10 years). In the end, the company pays what they are willing to, and passes the rest off to the employees. Thankfully the premium doesn't go up every year, it's been stable for a while. So maybe the HSA high deductible thing does work to keep costs down. Every time I change jobs I get a document that shows prior coverage to avoid what used to be the pre-existing condition restriction. Obamacare attempted to use the exchanges to create groups to pool risk and share costs. But that means you have to FORCE healthy people to pay more for insurance then they would in a risk-priced system. That is why they had the individual mandate "tax" and we all know how that went with SCOTUS until it was removed by legislation. Now we have to see if removing that means the whole thing gets thrown out. Obamacare also failed by attempting to mandate coverage for things that not everyone needs or wants, which drives costs up. I can chose coverage levels on my auto, home, and life, and not include things that aren't needed. I don't have flood insurance because I am not in a flood area and my bank doesn't require it, for example. People who don't want/need coverage for substance abuse programs, or pregnancy (women who can't have kids or are too old, for example) or abortion (because they are morally opposed and would never get one) shouldn't have to pay for it either. People kind of got spoiled by the old employer plans where you pay $200 a month for a family, $20 per primary care visit, $30 per specialist, $10 for generic Rx, $25 for name brand Rx, $50 for ER, and 80/20 for everything else up to $1000 out of pocket. That was nice, and I still had one in the 2000's. People got used to everything being covered and having minimal out of pocket costs. And that's what this is all about when we say "health care". People want it for "free". Employers picked up the tab for a long time until they reached a point where they started to pass it along instead of absorb it. in 2010 I priced private family coverage because I had a contract job and my wife's (ex now) coverage was going to go COBRA soon. The application felt like being violated. Everything that had ever happened to any of us (me, her, and our son) had to be listed and explained. They came back with $2000 a month and $6000 deductible. That's $30,000 a year before the first $0.01 of benefits. So we got $100/month catastrophic no-preexisting condition coverage (resets every month so a new chronic issue gets cut off after the month ends) until I started full time a couple months later. Certainly makes you realize the value of employer insurance compared to salary. But you know what, if you look at the cost of "insurance" and compare it to the taxes people in other countries pay, I think you will be surprised. Sure it's "free", but the taxes might be more than we would pay in premiums. It's not like all of this is cheaper everywhere else or government plans are more efficient. They just pay a lot more taxes. I don't have the answer. The Republican anti-pr-existing condition promise is populism. But won't lower costs. Allowing freedom to select coverage levels may help. Expanding medicaid to cover more people under some criteria of income and chronic condition, with qualification similar to social security disability might be an option. Problem is this - demand for medical services is infinite, when you need the services. People will consume as much as they need regardless of cost, and economically that is not a viable system. Markets limit consumption by price-setting. Governments limit consumption by rationing. Choose your method. I disagree with the "right" claim because no one has a right to force anyone to provide the services that comprise their livelihood for free. The Ayn Rand philosophy, more or less. | |||
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What I meant to say is expand Medicaid for people with pre-existing conditions and just tax everyone an additional $2-5 a month, and let health insurance go back to the free market system. | |||
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| Page late and a dollar short |
^^^^ Medicaid is for poor people, unwed mothers below the poverty line and the disabled who meet income guidelines. Medicare is for those over 65 and the disabled who have worked a sufficient amount of time. We already pay a payroll tax for Medicare and Seniors pay several hundred or more per month in most plans. I wish I could pay two bucks a month.[/QUOTE A Medicare recipient pays for Part B coverage about 150 a month. So it's not a free ride, Part A coverage (hospitalization only) is the only thing we don't pay for. Unless you have an Medicare Advantage plan (which takes the Part B payments and is given to an insurer for your coverage) you still may need additional insurance and prescription drug coverage which you pay for in addition to the Part B charges. And if you still work into retirement the Medicare tax is still deducted from your pay so it's no free ride either. -------------------------------------—————— ————————--Ignorance is a powerful tool if applied at the right time, even, usually, surpassing knowledge(E.J.Potter, A.K.A. The Michigan Madman) | |||
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^^^^^^^^^^^^^^^^^^^^ Thank you. You clearly understand. COVID 19 and perhaps more importantly the lockdown have made things so much more difficult. | |||
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In a perfect world "pre-existing conditions" would be minimal as chronic conditions related to metabolic health would be resolved by consuming a Proper Human Diet. Direct Primary Care (functional medicine) will be the model going forward for a true first principles, root cause approach emphasizing personal responsibility. True health insurance would be for catastrophic illness and injury (major medical). No, healthcare plan can survive the costs associated with the Standard American Diet. | |||
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A half million in debt seems low. You haven’t even considered the opportunity cost of putting off a career for a decade. If that same person had started truck driving at 23 (you really need two years experience to make any real money), and he put in the same hours as you would as a medical student/resident doc, he would immediately be making $100,000 per year. Over a decade, he would have made a million dollars before the doctor really gets started. So yes, physicians should make a lot in their 40’s and 50’s. They’ve put in the time and effort and should be rewarded. Becoming a truck driver takes a short driving school and a little experience. Relatively nothing. In areas that limit doctor pay due to socialized medicine, it seems like there are more and more third world physicians. My son had to go to the hospital in Sweden. Notwithstanding that Sweden seems to be the left’s wet dream, he said that it sucked. Nothing like the care he got from the US system. Demand not that events should happen as you wish; but wish them to happen as they do happen, and you will go on well. -Epictetus | |||
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| No double standards |
I taught business in a college in Silicon Valley. One day I asked a class if they thought doctors made too much. Most raised their hand to say yes. I then asked how many of them would like to take 4 years of hard college classes, needing top grades. Then 4 years of med school - very demanding and stressful. Then 4 years internship/residency, also demanding and stressful. Then when you are done and get a job you make median income. So, how many think doctors make too much?? No one raised their hand. I then asked how many would feel comfortable going into a critical surgery, and finding out the surgeon got into and graduated med school only because of "diversity" quotas.
Exactly. Years ago we had neighbors, they were Canadian, he was going to med school. I asked if they were going back to Canada after he graduated. "No, we will stay in the US. A quality doctor would be nuts to practice in Canada". "Liberty lies in the hearts of men and women. When it dies there, no constitution, no law, no court can save it....While it lies there, it needs no constitution, no law, no court to save it" - Judge Learned Hand, May 1944 | |||
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And this is the root. Most of America's "health crisis" is self inflicted. When the argument of pre-existing conditions pop up, there is always a worst case no fault of their own example that is trotted out. But, that is the exception, and not the rule. Couple that with the fact that ANYONE who speaks out against it is heartless, racist, homophobic, sexist, etc and you have the perfect narrative. When a group of consumers drive up the costs because companies are forced to insure them, everyone else has to pay. It's pretty simple economics. | |||
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Bingo right there. The Dems' arguments regarding health care, like most or all of their major fighting points, are for the most part non-existent straw men. Literally. They make up propoganda out of thin air, and unfortunately it works pretty well for them, esp. among the sheeple. Lover of the US Constitution Wile E. Coyote School of DIY Disaster | |||
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| No double standards |
To me it is clear and straight forward. If the gov't controls your access to healthcare, they own you. It's not about taking care of people, it's about power. "Liberty lies in the hearts of men and women. When it dies there, no constitution, no law, no court can save it....While it lies there, it needs no constitution, no law, no court to save it" - Judge Learned Hand, May 1944 | |||
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Agree on many pre-existing conditions being self-inflicted. Heart disease, Type 2 diabetes, joint damage due to obesity, some kinds of cancer (those from smoking and tobacco use) and many others. Proper diet and health behaviors should be the first step in preventing these. It would be very helpful to know what specifically people need to change that is not politically motivated. From what I understand, veganism is not a proper human diet but lots of vegetable are still good for you; meat is not evil, nor is animal fat; carbs are a lot worse then we are told; dietary cholesterol is not the boogeyman we have been told it is for decades and chemically modified vegetable oils can be are worse than natural animal fats; too much sugar is a huge problem, and efforts to create fat-free foods by replacing fat with sugar has made us fatter. However things like Type 1 diabetes, bipolar disorder, schizophrenia, cystic fibrosis, rheumatoid arthritis, MS, are chronic conditions that are pre-existing to a new insurer but not the fault of the patient. Those that incur a high cost of "maintenance" care are the things we really need to think about how to handle. The fact that various genetic diseases used to weed people out (for lack of a better term) but they now survive due to modern medical care and live to reproduce means we will be dealing with more and more of these as time goes on. About the time to become a doctor: Yes I know residency and specialization take time and there is a lot of upfront cost and debt. However, I would like to know if the system of training we use is efficient and validated based on evidence or if it more of a "how we've always done it" thing. I have thought that the long hours of new doctors (i.e. 24 hour shifts) were detrimental and more of a "paying your dues" thing, and that changes limiting "on hours" would be helpful. It think this has been done to some extent but I am not aware if it has resulted in better outcomes. Comparing to a "typical 9-5 worker" is not what I intended. Law takes 7 years of school and several years as a lower paid associate (or PD or ADA) working long hours before the chance of becoming a partner or other better paying position. Airline Pilots get a lot of training that is very expensive if you don't get it in the military and have a huge responsibility. They pay their dues for years (low pay in military or regional routes) before making higher pay. Science/engineering workers often need an MS or PhD to practice in their fields which is 6 - 10 years of school and a lot of years at a junior level before they are able to take on significant responsibilities. Better business and consulting jobs need an MBA or MPA from a ranked (expensive) school, and young consultants and public accountants (big 4 firms) certainly pay their dues as well. I do have comparisons in my family between MD's an PhD researchers of similar age and the time of education, residency/post-doc, and dues paying before "full employment" is reached are not that different, but the ROI certainly is much better for the MD's, even with higher debt load. Maybe it's because I live in a suburban/rural county that I see a lot of small practice docs that are part of the county hospital network. I do think that economies of scale should be driving consolidation into larger organizations that are outcome based (Kaiser?) instead of fee for service and this evolution is unavoidable. The comments confirming this trend are helpful, and also that private practices do see the typical small business startup challenges. I do think the medical industry was in the business of passing on ever higher costs to patients because of the health insurance model and insulation of consumers from true costs. From my observation there is a big difference between providers or insured services and uninsured services. Lasik and cosmetic surgery appear to follow normal economic rules - competition based on price, time, quality, costs coming down over time as a result of newer technology and the depreciation of capital assets (pay off the lasik machine and now it's a cash cow). Insured services seem to violate these rules, either due to the insurance aspect, gov't reimbursement rates, or the requirement to provide care to non-payers, or more likely all three. | |||
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SIGforum.com Main Page The Lounge Ongoing issue in politics with healthcare and covering Pre-existing conditions
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