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Economics of healthcare in America

Discussion in 'Economy' started by ethics, Aug 16, 2018.

  1. ethics

    ethics Pomp-Dumpster Staff Member

    ShinyTop likes this.
  2. ShinyTop

    ShinyTop I know what is right or wrong!

    On one of the prostate cancer boards I regularly read we just had a thread about bankruptcies due to the treatment costs of drugs. After radiation or surgery if it is found the cancer has metastasized the next treatment(s) are hormonal or chemotherapy. These drugs can add 5-10 years to the life but are very expensive. So patients and families are mortgaging or losing their homes and depleting their saving to get those years. Read the same thing about hugely expensive MS drugs. And in both cases insurance companies are inconsistent. By that I mean they will approve the drug for 90 days and then force the patient to try cheaper drugs before reauthorizing the one that works. We are talking about cheaper drugs that had been tried the previous 90 days. In the course of that retrial of the cheaper drugs the disease progresses.

    Then you have the patient who needs to keep working past his/her normal retirement because the insurance is tied to the employment. There are two cases now in Alabama where workers with MS were working for self insured companies. They were let go after coming down with MS and are suing claiming the MS is the reason they were fired. One can see the point of companies not wanting to compromise the health care of the rest of the employees but we should hope to be beyond the point of the choice.

    I would hope this country could come up with a better solution for expensive drugs. My dream is that we find a way to keep insurance companies out of the loop but it is only a dream. They contribute far too much to campaigns to ever hope for that.
    Arc and ethics like this.
  3. ShinyTop

    ShinyTop I know what is right or wrong!

    And you also have disease victims forgoing the extra years of expensive care so they don't leave their families broke and/or homeless.
    Arc and ethics like this.
  4. Arc

    Arc Full Member

    There are lots of reasons for the high cost of healthcare and also for wide variation in the quality of it. In the USA it ranges from terrible to outstanding.

    Even though I acknowledge there are many reasons for the above the number one reason is, wait for it, the invention and vast expansion and morphing of health insurance and its deep integration into many areas of society
  5. MemphisMark

    MemphisMark Old School Conservative

    It's approaching $1Billion for the R&D and regulatory hoops to bring a drug to market. The smaller the market for that particular medication (say it's a chemotherapy to treat a cancer that less than 100 people get a year) the more the individual has to pay.

    Here's my idea to fix healthcare:

    1. Providers have a menu board where they list how much they charge by ICD-10 code. Think a McDonald's menu board.
    2. Insurance companies publish how much they reimburse for procedures, by ICD-10 code. This way the patient knows what they are getting, the cost and how much they get back. The reimbursements would be adjusted by zip code to reflect local pricing.
    3. You choose your doctor based on price vs. quality. You pay the bill, send a copy of it to the insurance company and get your reimbursement deposited to your account.

    This way you can pay or pocket the difference between the bill and the reimbursement.

    This would cut staff (and expenses) on provider's offices who hire admin staff (one for UHC, one for BCBS, one for Aetna, etc.) to keep track of all of the paperwork they have to so the provider gets paid from the insurance companies. The insurance companies could also cut paperwork-tracking staff, plus the people who negotiate the various contracts with providers.

    The end result, providers costs come down (lower staff costs plus market forces), insurance companies costs and rates go down (staff and market forces) and the customer has full knowledge and control over the transaction. No worries about in- or out-of-network and all that BS.
  6. ShinyTop

    ShinyTop I know what is right or wrong!

    Mark, don't think that would work. There are too many ailments that have a host of drugs or treatments that can be used. The insurance companies, as we all should, naturally favor the least cost treatment. But that does not take into account the patient who has already tried the least cost route. That does not give the patient any choice. For instant, a prostate cancer patient can have surgery or a plethora of different radiation treatments or even elect for Active Surveillance, doing nothing but get tested quarterly and annual biopsies. My wife has acid reflux. Only one med works but every time her company shops for lower insurance costs and changes companies the new insco wants her to go through months of trying the least cost alternative which works for most patients but not all.

    But your system would work for the broken arm, the cold, the stitches. But patients cannot all be treated by spreadsheets so the doctor's office and the insurance company have to be able to navigate the waters when a patient's treatment cannot be pigeonholed. We bow and pay homage to the great capitalist system that lets Big Pharma raise the cost of an epi pen 7000% because there are thousands of patients who cannot live without it. There are flaws in the system that must be addressed. One has to wonder how many instances occur that do not get the publicity of the epi pen.

    Another side of the problem is doctors forming associations that build their own out patient surgical centers or diagnostic centers. I have to believe that when his bottom line is increased by profit of such centers a doctor will lean towards more diagnostic tests or even unneeded surgeries. Part of the allure of these type doctor corps is a central billing group.

    Now a central billing group has some advantages such as each doctor does have to have those specialists. The other side of those specialist is they develop a skill set of how to bill which code for more money. I have worked on the software side of billing computing systems. Many of the calls to our help center were for help on billing to make sure they got paid more or paid at all. Medicare, in particular. They would pay for some treatments for acute attacks but not for chronic. So the billing clerks quickly figured how to bill only for acute, sometimes for multiple treatments in the space of a week or month, the very definition of chronic. Or the billing clerk knows of a piece of durable equipment that can be paid for when a certain code is used. The equipment is not needed in every case but you can bet it is provided if they know Medicare will pay.
  7. MemphisMark

    MemphisMark Old School Conservative

    Shiny, I'm not sure you're seeing my point.

    You choose which doctor you want to partake the services of. Let's say you go in for a preventative checkup. Your insurance company pays you $100 for that visit. Doctor A, who is an average doctor with good bedside manner charges $110. Doctor B, who is a great doctor and only asks bullet questions, very terse with answers to yours and so on, charges $90.

    This is your choice to pay or pocket $10. My criteria of price vs. quality is different from yours. But in the end, we get to choose.

    I can understand having an administrative "insurance interpreter" to help you get the best coding and thus reimbursements possible. And yes, everything fits on a spreadsheet because doctors offices bill the insco's by ICD-10 codes. No code, no pay. With my idea, you give the codes to the patient who sends it on to the insco and they get reimbursed.

    If the insco jerks the customer/patient around with reimbursements or whatever, they can say "screw you" and go with another provider. Health insurance should not be tied to your job.
  8. ShinyTop

    ShinyTop I know what is right or wrong!

    "Health insurance should not be tied to your job." Amen, Brother!

    Insurance can pay for an auto accident or a house fire or a heart transplant because they spread the cost of the expensive event over the premiums paid by many insured. Their actuarial tables tell them what percentage of their customers in a given geographic area or a given age group will ask for coverage of an event in a given time period. Their expectation and experience tell them that they will get more in premiums that they will pay out and pay for administration.

    Now here is where health insurance differs from auto and home owners. With those two you go to insurance companies and ask for quotes and they respond, often with different payments for different coverage. You can buy health insurance the same way but it is much more expensive to buy as an individual than as a group. So group coverage is either through work or through government in the case of Medicaid and Medicare and whatever state programs operate in individual states.

    So unless you are below a certain income or over a certain age the least costly way to be insured for your health is through your employer. I have often heard that the solution is to allow individuals to form groups to either self insure or negotiate with the insurance companies. Now your're talking! But wait, won't those groups have selection criteria that have to be met. Will they require physicals and exclude pre existing conditions? The lowest cost groups will have to. And won't some groups form based on age, after all, younger people use less healthcare on those actuarial tables. So when you reach the max age for that group wouldn't you be out looking for insurance again?

    But there is some fairness there. The older you get the more health care you need so you should pay more. So how much do they have to pay? Anecdotal warning! My brother ran a successful business. He sold it at about age 50 and was a consultant to it for several years so he was able to stay on its health policy. After that he had to go open market. He and his wife have been very healthy. And in the last years before he became 65 they were paying around $1700 a month with a huge deductible that had to be paid before insurgence paid a dime. Luckily they could afford it so was it unfair? No. But I use it to illustrate what the cost of insurance can be if you are not part of a group.

    So we can say that in a fair system those with more money will pay more to be covered. But when you are talking fair you are going to get into what privileges we are born with. The opportunities for education and employment are still based on race and gender and gender ID and religion. What neighborhood you were raised in affects your speech and your dress and both of those can have effects on your job and education opportunities.

    So what is the fair method to provide equal health care to all at a price that all can afford? I don't believe that capitalism will fix our healthcare system. Too many people making too much money from healthcare and giving too much money to political campaigns will keep a capitalistic situation from ever working.

    What I do know that what we have now is not sustainable. Too many people are being made aware of the inequities in the current system. And if we can ever get a decent percent to vote we will have change. The funny thing is that the greedy SOB's making the headlines are speeding their own downfall. Well, I can hope, can't I?
  9. ethics

    ethics Pomp-Dumpster Staff Member

    I want to know what the cost would be if we extend medicare to younger people while everyone pays around the same fees for insurance but they go in to their Medicare?
  10. ShinyTop

    ShinyTop I know what is right or wrong!

    Since medicare is a universal system, now for 65+, I think that the calculation could be made using some sort of average paid for medical insurance. I think that recommendation has been made, probably more as a political talking point. But will see if I can find any meat to that argument to see if it has any suggested payment.
  11. ShinyTop

    ShinyTop I know what is right or wrong!

    This article looks like a scare story but estimates 10-12% increase in taxes at low end and doubling taxes at high end. And it said taxes, not specifically the Medicare taxes.
    Last edited: Aug 23, 2018
  12. ShinyTop

    ShinyTop I know what is right or wrong!

    Three pages into Google searches for Medicare for all or Medicare for all costs finds no listing of the individual costs. Mostly it talks about the total cost or about how total cost could be reduced.

    Here's the thing about medical costs. As I have written before you have get control of medical costs before you have a viable national single payer system. The new system cannot be based on existing insurance companies managing it. It must include a strong enforcement arm against those providers scamming the system, doctors, big pharma and, yes, patients.

    But a more gradual approach would be to open up current government plans to all. When I was Civil Service our group was too small for its own plan so we were allowed to join other government plans. We had, if memory serves, about 20 plans to choose from. Since these are already large plans allowing others to join should not have a huge hit. The only drawback is we have to have employment mobility and coverage for existing conditions.
  13. ethics

    ethics Pomp-Dumpster Staff Member

    Yah I don't disagree on that. I think we have options. We just need to have leadership and courage to get this instituted. Otherwise, we are in a world of hurt (if we are not there already).
  14. Arc

    Arc Full Member

    The cost of Medicare for all is not sustainable. Not even close. And even if it were its overall impact on the quality of healthcare available would overall decline.

    Not to get too political but one of the major goals or motivators behind architects and movers or shakes for the Affordable Care Act was the first step in moving us eventually down the road and morphing to having Medicare for all as our national healthcare provider.

    To achieve what shiny and ethics, as well as millions of other, strive for is only attainable to a sustainable effective single-payer healthcare system such as Canada, UK, and possibly France. I say possibly because I don't recall the specifics of their system but overall it is my recollection that whatever it is they seem to offer affordable accessible quality healthcare at reasonable or low cost. If you check where to the very wealthy in other countries go for some serious medical care it is virtually always the United States or France. That should say something of relevance to the discussion. (By the way, the UK system sucks compared to Canada's and whatever system France uses.)

    Edit: I almost forgot. Despite believing that a single-payer healthcare system is potentially the best system it also is unattainable within the social, fiscal, cultural, and political environment of the United States.
    Last edited: Aug 24, 2018
    ethics likes this.
  15. ShinyTop

    ShinyTop I know what is right or wrong!

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