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Medical Loss Ratio is what you're looking for. |
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There's no magic bullet that will solve all the problems out there. What I proposed was simply a way to get everyone access to catastrophic coverage and go from there. Yes, there will be some people who have crap coverage or no coverage now and join a plan that doesn't promote wellness/prevention. But, what people are essentially doing is answering the old classroom question of "A man offers free college to 10 of 30 kids in a poor area classroom. Do you take it?" with "No, because 20 kids won't get to go to college". Even though this potentially benefits 10 kids and doesn't adversely impact the other 20, we can't do it because it doesn't solve the problem of all 30 going to college. |
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The only bone of contention I have with that is the critera for determining who lives or dies. The concept itself? Not a big problem for me tbh. |
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Hold on a sec. You started out by positing a 6K deductible catastrophic plan and did not mention the cost of doc visits, but now you're qualifying that as only a $40 difference in the cost of doc visits? That's moving the goalposts. Anyway, if we take a catastrophic plan with a 6K deductible and having to pay full costs for doctor's visits (which is what is implicit in your original proposal), I'd bet good money many women wouldn't go to the full suite of prenatal visits usually recommended, because those costs would add up too much. And then, on average, costs for live births would be considerably higher. Single-payer countries already mitigate this with births by offering more in the way of prenatal visits as it's been shown that more education and care prior to birth will lead to less overall live birth costs when aggregated across the population. Even U.S. private insurance companies realize this, and offer incentives for pregnant mothers to see their doctors, attend wellness sessions, get screened, etc.... Catching a problem only once you're in labor is far more expensive than getting it in the first trimester. |
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But if you are trying to control costs, then just giving access to catastrophic coverage doesn't do much at all. |
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The thing is, however, is that in most cases that's not the question. The question tends to be do we keep you alive for another 4 weeks at a cost of $2.3M, or do we let you die in peace now. Studies have shown that most people, when presented with the option, including the fact that those extra 4 weeks (or whatever) aren't really great from a quality of life standpoint, will choose the former. Relevant reading: A Pacemaker Wrecks a Family's Life - NYTimes.com |
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Sure there is! :D 1. Extend Medicare Advantage to the entire population. 2. Remove state-by-state regulation of health insurance (i.e. allowing plans to be truly nationwide). Single-payer, aggregated data upon which to make good health policy decisions, and private administration of the system (who tend to do it better) that still allows space for innovation and keeps a market component (with oversight based on good measures) that weeds out the lousy actors. Everyone wins! :D |
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Your whole post is horribly incorrect...but in the interest of actually trying to educate someone, I'm only going to use your last paragraph to demonstrate why perhaps you need to better understand the issue before commenting or presenting "solutions" that don't work. After all, much of what you have proposed others have commented on and shown why those ideas don't work. --- Do you know that you can't negotiate directly with doctors and hospitals? Or, more appropriately, they won't negotiate with you because those same "private companies" that you tout won't let them? *shock* I'll provide an example so it's easy to understand. For whatever reason, Blue Cross decided after 3 years of health payments to not cover my birth of daughter. Yep, they decided to drop the coverage, leaving me high and dry because it was now a preexisting condition for all the other insurance companies. That's not legal now, but that required government regulation to enforce. It was legal then. So instead of a couple of grand, I was facing about $15k in costs. I have a little money in the bank, so I went to the two hospitals nearby and had the same exact discussion. I offered to pay for the prenatal care and the birth care IN CASH if I could get a discount. Nope. Do you know why? Because the "private companies" - this insurance industry you want people to rely on - had specifically written into their contracts that they could not give Joe Average Cashpayer the same rate that they had pre-negotiated with the doctor & hospital. So while the hospital would only get about $5-$6k for birth of my daughter through the insurance companies, I had to pay full price ($12k) because of the price-fixing that is legal in this industry even if I paid in cash (meaning they had no billing or collection costs). So simply put your final paragraph demonstrates how little you understand about health care coverage and shows why your opinion is ill-informed and incorrect. It's nothing like taking your car to the shop. There are 20 repair places and they're in competition with each other. The two hospitals nearby are both owned by the same conglomerate. A defacto monopoly + an inelastic good = free market solutions don't work |
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1. If you or your husband work and get pregnant - you are covered through employer plan. 2. If you are a single mom who doesn't make much or make near the poverty level as a family - you currently can enroll in a program like ACCESS here in AZ. 3. If you are a middleclass family where neither parent has employer coverage but you make more than what is needed to qualify for state programs (maybe self employed), you would have to buy a private plan with better prenatal coverage (just like now). However, you atleast would have cheap access to catastrophic coverage - something you don't have now. So, again, who is worse off with what I proposed as compared to what's available today? |
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Well if it is just a matter of what goes to the insurance company now (your contribution + the employer's) + existing Medicare withholdings would instead go to the uber-Medicare, then it is close to a wash. |
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The concept of 'death panels' was impressing PR/marketing from the anti-ACA crowd tbh ... especially so when you consider most private policies I've seen in the US have 'maximum' amounts which are covered in most areas, effectively being exactly the sort of thing they decried. |
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Actually, most everyone does win, except the insurance companies who rake in the premiums hand over fist. From a GDP standpoint, the USA spends 50% more than any other industrialized nation in the world. The US spends 17.7% of its GDP on healthcare, whereas every other nation is 12% or less. Per capita, the US spends about $7,500k on healthcare while the next closest country (Norway) is at about $5,000. In the UK and Switzerland, that number is closer to $3k. Simply put, raising taxes $5k/yr isn't a problem for me if I don't have to spend $8k/yr on health care. I still come out with $3k more in my pocket. So yeah, most everyone does win. |
At the end of the day, no one would even consider what I proposed because it doesn't fit the agenda of the democrats (full government provided single payer system) or the republicans (no government interference at all). So, we end up with this Obamacare option that will probably end up doing more damage to quality of coverage and overall cost than just staying put. Either way, time will tell.
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No, it won't happen because Big Insurance doesn't allow it. Quote:
Yep, they did. Or more precisely, they refused to pay for her pregnancy even though I had the paperwork that showed we checked the appropriate box and all the documentation they sent talked about maternity coverage. They claimed we hadn't been paying for it (we fully paid the premium every month) and flat out refused to cover the pregnancy. We appealed and providedthe documentation. They refused again. We sent it to the insurance commissioner of NC. Blue Cross dropped us. The NCDOI did diddly squat for almost a year, by which time my daughter was already born and we had found other coverage. Since we no longer had coverage with Blue Cross, the insurance commission's inquiries went nowhere. Meanwhile, I got stuck paying the bill. Thank you very much. |
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I am employed, you pompous asshole. I've been working for 30 fucking years now. Don't be a jackass. And the math is simply the math. Overall costs will be reduced in a single payer system. There's no logical way to deny it, there's no historical way to refute it. The math is the math. Due to this very simple fact, there will be far more winners in a single payer solution than losers. In fact, the self employed would be some of the biggest winners because their premiums are so damned high. It's the self-insured that would likely be "losers", but the single biggest loser would be Big Insurance. Sorry if I don't cry over that. |
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You were positing a system where people were given a 6K deductible catastrophic plan. Now you're changing the context, or, simply put, moving the goalposts. It's very difficult to have a meaningful discussion with you if you keep changing the rules of the conversation. Quote:
Um, that is what's available now, due to the ACA. #1 is employer-provided coverage, #2 is Medicaid, and #3 is an Exchange plan. Prior to the ACA, #3 didn't exist. |
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Not really. Medicare Advantage reimburses at close to (sometimes above, sometimes below) Medicare A & B rates, with bonuses and penalties for plans with good and bad quality ratings, respectively. I haven't (and probably can't) run the numbers, but it probably saves money overall, from a system-perspective. But it also makes it far easier to control costs in the future, and also moves the entire system, through use of incentives and penalties, to outcome-based care, which really should be our overall objective. |
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Huh? If I'm employed and spend $8K on health care (premiums, co-pays, deductible, etc...) and the government comes along and says I can have single-payer care for an extra $5K in taxes, meaning I no longer have to pay $8K on health care, I'm taking that deal. |
I think I've figured out this thread after a long period of posting:
1. Someone comes out with an idea that isn't equal to "single payer" 2. 80% of the readers tar and feather that idea because it isn't single payer. 3. Rinse and repeat I doubt we will ever see a single payer plan anytime soon because of: 1. The hold of the insurance companies on both sides of congress 2. The increased cost and decreased coverage to people who currently have employer based coverage 3. The fact that a sizeable percentage (maybe 25-30%?) don't want a government managed health care system in the US. Hate to be realist, but that is the situation we are in. |
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Last year the average premium for employer-provided coverage was $16,351, of which $4,565 was paid by the employee. Medicare's tax rate is 1.9%. Average income last year was $50,054 per household. Take the $16,351 plus the 1.9% Medicare tax, and it sure looks like it would come out to a wash, probably even less than the 20% hike you predict. To the employee, the $4,565 (~9%) would turn into a tax. |
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Well, a normal family with an employer-sponsored plan pays ~$9,000/year for health insurance, while their employer picks up ~$12,000. So take what that family pays in tax for Medicare, plus $9,000, and keep the new taxes below that. Ta-da! And since every single other single-payer system actually costs less on a per capita basis, this seems likely. And that's not even discussing the money the employer gets back for not having to pay the other part of the premium. How to pro-business Republicans not like that? :D Data from here: Annual Healthcare Costs For Family Of 4 Now At $22,030 - Forbes |
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Since when has the government ever felt the need to increase taxes to pay for stuff?
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No, I'm saying that would be a tax, not a premium payment. |
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Well, over 100M Americans get their insurance from a single-payer entity, i.e. the government, now (Medicare, Medicaid, VA). So there's that. Quote:
I know, right? |
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WE AREN'T SAYING THAT You take a line from the OpEx budget for insurance premiums, and that exact same amount moves to the increased Medicare tax. Yes, the amount paid in taxes goes up, but the amount paid by the company for insurance payments would go away. You seem to be saying that a single-payer plan would only be funded by what employees were contributing, and the amount that companies paid doesn't count. BTW, here is where I got my figures for premiums: http://www.ncsl.org/research/health/...-premiums.aspx |
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46% Oppose Single-Payer Health Care System - Rasmussen Reports™ 38% in favor 46% oppose 16% not sure You would need well over 60% support to override the big business aspect of health care and get close to a single payer across the board. Ain't happenen. |
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Thank you for that wonderful example of Ad Hominem! I imagine that if you ever have an idea that is at least equal to single payer, you'll find people more receptive. When your ideas are ill-conceived and illogical, I think you'll find that people aren't receptive to them. Also, insults don't work well either. Quote:
#1 = True. #2 = False. This was already addressed above. #3 = True, because they have a vested interest in keeping the current system or they're too ill-informed to know any better. |
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Yeah, and look at the numbers on gay marriage a few years ago. |
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Gosh, wouldn't want it to be because we don't believe that's an area where government involvement should be increased. |
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I cited a respected annual study for my numbers and provided a link. It is you who should get your numbers right. Pull it together Arles. |
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You mean Medicare's 60 to 70% approval rating? Who's Afraid Of Public Insurance? - NationalJournal.com Americans love single-payer healthcare... except when it's called single-payer, universal, or Obamacare. |
Regarding healthcare.gov, having a not-ready-for-primetime website is one thing, but a bigger issue is how prices are hidden. I still haven't been able to figure out what the marketplace prices are. Is there some complexity I am missing - shouldn't a spreadsheet be posted somewhere that lists all possible prices based on a combination of factors? How many factors go into determining price?
And their online live chat assistance makes Comcast support look awesome:
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Pretty good article on CNN about the launch:
What else could go wrong with Obamacare? - CNN.com Quote:
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I know I've seen polls where support for ACA is highest among the youngest age group and drops as age goes up. That doesn't necessarily translate into enrollments, but there is reason to believe the young want health insurance.
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Almost 30% of those aged 18-35 are uninsured. (Source) Assuming a general population of 300 million, that's 90 million young people who will likely be going to the Exchange or Medicaid. The risk you raise is a real one, of course, but it is also very easy to overstate. Quote:
You're still making the assumption that the Exchange plans are, on average, worse in terms of cost & benefits to employer-provided coverage. Quote:
As I linked before, the average family of four pays over $9,000/year for their employer-sponsored plan. Which means some are far worse than that. Again, it's a concern, but it's an easily-overstated concern. |
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Most of the factory workers also make more than 40K, so they wouldn't qualify for a subsidy. Now, I know everyone is going to say "Well, they are only paying $300 a month and the company is paying the remaining $700." That is correct, but we are not giving every worker a 5K raise if we cut benefits. There are tax benefits to our company of covering workers and if those go away or we decide to drop coverage because of financial reasons with exchanges, those employees will be forced to eat that $5700 a year. That's reality and that's what no one is saying. Just like these other "unintended consequences" we are seeing now where it's obvious the "you can keep the plan you had" line was a farce - you will see companies start dropping coverage in 2015 and most employees aren't going to get a $5K raise to makeup the difference. Finally, the plans on the exchange have double the deductible as the lowest deductible you can get on the exchange is a $1K/2K. You couldn't even get the plan subsidized by our employer if you went to an exchange. So, here's what we are going to see over the next 2-3 years: (2010) "Hey, if you like your plan, you can keep it" (2012) "Hey, if you lose your plan, there's a similar one on an exchange" (2014) "Hey if you lose your plan, there's one on an exchange that costs $5-7K more a year with a deductible twice as high as you had" I'm scared at what this will morph into in 2015+. A lot of people making between $40K and $80K are going to take it in the shorts if/when exchanges start replacing employer coverage. |
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Haven't really followed the debate here closely, but this post seems to have some flaws in reasoning. Why bring up the tax savings benefits for employers while not accounting for them on the employee side? The dire scenario you paint is one where employers drop benefits and don't give raises (thus saving ($8,400-tax savings)/employee) and lament how this will be worse for employees. Of course, in that worst-case scenario. This scenario really avoid the big picture, which is overall costs (who cares how it is split out between employees and employers - capitalism should help shake that out). |
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Because he's fear-mongering. |
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A legit #2.
Leader of Pakistan Taliban killed in US drone strike, US, Pakistani officials say - Investigations Quote:
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Good hit.
Hakimullah was a legit baddie. |
More discussion on the new 5%.....
Health Care Shoppers Aren’t as Dumb as Obama Thinks - Yahoo Finance |
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I love that in all the anecdotal examples in that article, they don't mention what the specific coverages are for these new more expensive plans or what the coverage was under the current plan these people have. That comparison would seem to be necessary, especially if you're going to use terms like "with coverage that’s more or less the same as far as he’s concerned". |
All three of those people are trying to replace their individual plans with new individual plans from their current insurer, as opposed to shopping the marketplace for a new plan. So what they're seeing is their current insurer's non-Exchange plan that their current insurer would like to keep them on (as the premiums are higher).
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