For those that are working...

[Merge]

Originally posted by SPK145:

Originally posted by Merge:
That doesn't mean that our founding fathers wouldn't want the federal government to regulate what is almost 20% GDP.

Healthcare costs that much of GDP BECAUSE of the federal government's involvement. It would never be that much if we had stuck to Constitutional principles in the first place.

Originally posted by Merge:
We are not going to go back to where you have to show your insurance card before you are treated in an emergency. That is just not going to happen, so you need to move forward from that point.

No but we should go back to health, health care, and health care payments are YOUR responsibility. Can't refuse to treat but can't refuse to pay either, after the fact. Nobody should have free health care.

So every other country that has a lower % of GDP spending for healthcare is because of capitalism and constitutional principles? I will admit they are part of the problem, but not necessarily THE problem.

As to your second point, we have proved in general that we are not responsible when it comes to healthcare. No matter what rules you impose, people will not pay a huge hospital bill they weren't expecting if they have no or limited coverage. So, where do you go from there?

 

[HALL85]

Originally posted by Merge:

Originally posted by HALL85:
haha..now you're talking out of both sides of your mouth. "People don't value doctors and drugs when they are too cheap"???, or is it your other line that $100 is catastrophic??? I really don't understand your logic.

And if it's that easy for government to hire a company to fix the fraud issue, why haven't they done it? $60 billion/year not enough motivation??? What other priorities have they had that are more important than $60 billion???

No, I'm really not.
The price for a doctor needs to be cheap enough so people can go when they need to but expensive enough that people don't go for the sniffles. I have been pretty consistent on that point... and what I said was a "few hundred" dollars may be catastrophic to some people. We are talking per doctors visit here. and sometimes you get hit with an illness that takes many doctors visits like when I had lead poisoning from painting houses when I was 19. No way I could afford the treatment I needed if I only had a high deductible plan.

and honestly, I don't understand why the government doesn't hire a private company to go after Medicare fraud. I know they set up a task force in 2007 which has had some success... Actually maybe that is how we can get a single payer system to pass through the house.

Everyone gets insurance and we pay Halliburton to go after the fraud. perfect.

Well under my plan when you were 19 you would have had the OPTION of selecting a low or a high deductable plan based on your risk tolerance and ability to pay...not be FORCED into a one-size-fits-all plan that would ultimately drive your tax rate up.

And I don't understand why the government does a lot of things that make no sense. And what "success" did that task force have if fraud is still completely out of control??? Are you using Obama's measurement criteria?

We'll obviously never agree on these points, but at least I know I live in reality where I base my opinions on historical performance and not some wish-goverment-will-solve-my-problem la-la land.

 

[Merge]

What 19 year old who is normally very healthy or low income family, would buy a low deductible plan? Speaking of la-la land... This would just lead to huge problems as they have in the past which is why governments had to step in to set minimum coverages.

The Medicare fraud task force has had some news lately and had their largest bust to date this year. Again, it was started in 2007... so I am not suggesting that it was because of Obama. Although the software we are planning on using as part of Obamacare will get us a step closer to the efficiencies in the private market.

I think a tweaked version of what other countries do/have done could work for us. I am not looking for anyone to solve "my" problems... but as a country I believe we can do better than making a family having to choose a high deductible plan because they don't have enough money to buy the plan they probably need... and are left to hope their children don't get sick, and avoid doctors when they get sick themselves.

 

[HALL85]

Originally posted by Merge:
What 19 year old who is normally very healthy or low income family, would buy a low deductible plan? Speaking of la-la land... This would just lead to huge problems as they have in the past which is why governments had to step in to set minimum coverages.

The Medicare fraud task force has had some news lately and had their largest bust to date this year. Again, it was started in 2007... so I am not suggesting that it was because of Obama. Although the software we are planning on using as part of Obamacare will get us a step closer to the efficiencies in the private market.

I think a tweaked version of what other countries do/have done could work for us. I am not looking for anyone to solve "my" problems... but as a country I believe we can do better than making a family having to choose a high deductible plan because they don't have enough money to buy the plan they probably need... and are left to hope their children don't get sick, and avoid doctors when they get sick themselves.

I don't get it then. You don't want someone to buy a low deductable plan because the premium is too high and you don't want someone to buy a high deductable plan because they won't be able to pay for the deductable if they have a medical event that uses it all up. What are you suggesting? I really don't understand your solution.

As Derick Coleman once said "Whoopty-damn-do". One bust so you think the government can now solve a $60 billion fraud issue? And finally, go back and read my post. I wasn't indicating Obama had anything to do with the fraud that exists, but rather that you are using his "funny math" to justify your points....(see the stimulus ensuring unemployment drops below 8%...lol)

 

[Merge]

What I am suggesting is that when you give consumers their choice in healthcare. Poor people who probably need the low deductible plan will choose the high deductible plan. You may call them irresponsible... but it may be the only choice they have. It is incredibly expensive to live in this state and picture a family starting out and having to look at their bills with a child on the way... are they picking a low deductible plan? It is just not realistic.

That is why I like single player with higher copays. Even going from $20-$30 per doctor visit might be enough to change how consumers view medical usage. I'm not suggesting that is THE right number, but there is a right number somewhere that allows access but discourages overuse.

There have been many busts, I don't follow Medicare fraud stings completely but I remember reading a few months ago when they reported their biggest to date. That is a step in the right direction. I never suggested it was solved, or even close to solved yet. Private insurance companies have success using the software that we are implementing. Again, not solved but the right direction.

 

[HALL85]

Merge, you're talking about raising deductables for a primary care visit...that does nothing to fix anything that's wrong with the system. As SPK indicated, you need to have a safety net for the truly indigent, but that is a very small percentage of the population. Just because people choose to be irresponsible about how the budget their income, shouldn't be the burden of the responsible taxpayer.

Until the government can actually show me a result that shows they are making a measurable dent in fraud, everything you suggest is a plan and nothing else.

 

[SPK145]

All we've talked about so far is the demand for health care/insurance. What about the supply side? This will be a huge paradigm shift for the U.S. medical industry. Under a single-payer/government system, doctors will have to do more for less (see Medicare). What will that do?

 

[HALL85]

For starters, rationing:
* There is a physician shortage now and while there are various estimates of what providing unincumbered access to 40 million people might do, most expect it will at least intially overwhelm the system.
* With the cost and time required to become a physician (and the decreased earning opportunity and time/paperwork requirements of the job), fewer physicians will enter the labor force and more will (already are) opting to becoming physican assistants and nurse practioners. This group of NP/PA's are getting more responsibilities to diagnosis and prescribe meds. So we will have less qualified people triaging illnesses. Once again two schools of thought...may impact quality, but a more cost effective way to treat.
* Those that have money will be able to move to the front of the line. Those that are solely reliant on a single payer everyone in the pool insurance plan will now have delays in treatment due to the increase in volume. There are physicians now that have set up "preferred status" programs, so if you pay them $1,000-2,000 per year, you get preferred access for appointments, treatment, even home visits. Docs are already figuring out ways to manage the volume and make back some of the money. That's one thing many don't see with this reform package.

But don't worry, the government will convene a task force and solve all of this after they fix the Medicare fraud abomination....
This post was edited on 6/10 9:55 AM by HALL85

 

[Merge]

Originally posted by SPK145:
All we've talked about so far is the demand for health care/insurance. What about the supply side? This will be a huge paradigm shift for the U.S. medical industry. Under a single-payer/government system, doctors will have to do more for less (see Medicare). What will that do?

Which is why I was suggesting that copays go up. Studies have shown that when copays go up, usage goes down. We need to change the way consumers view their healthcare and making it accessible but not too expensive would do that.

In all honesty this conversation is pretty pointless. I am not expecting to convince you guys nor I am looking to be convinced that consumer choice would benefit the majority of Americans.

My only real contentions are these;
1. Insurance companies having to answer to shareholders do not have the correct intentions when discussing healthcare received by their customers. Executives have admitted denying legitimate claims just to make more money. That motive is always there. Personally I would prefer 10% fraud than a company denying surgery for the purpose of profiting.

2. Everyone needs adequate coverage, and everyone needs to be a part of the system. Offering high deductible plans will only lead to consumers choosing them which will raise the costs for the sick people who need a low deductible plan, along with middle class families hedging on their health. We can do better than that.

You don't want the government setting the pay rates? fine.. Establish a board of physicians from the top hospitals in the country to set them.

There are ways this can be accomplished to work much better than our current system. Again, no system will be perfect, they will always have inherent flaws. We have to choose which flaws we prefer.

 

[HALL85]

Merge, I agree that we will never convince each other, but if anything, your arguments have validated I'm on the right side of the argument. Two points:
1) Do you think private insurance is the only sector that denies claims? Medicare and Medicaid don't deny claims?
2) You need to distinquish between access to coverage and access to care.

In any suggests or points that I made, it's never about denying access to care. That has been a fundemental of our healthcare system and needs to continue to be so. All of the argument and discussion is around access to coverage (i.e. how you pay for the care you want and what choices you can have as a result of your willingness and ability to pay). My concern is that the way the system is set up today is inefficient and the way you are suggesting a single pay system is nothing more than a wealth redistribution. It does nothing to improve access to care and the resulting improvement of outcomes and reduction in cost that we should be striving to achieve.

 

[Merge]

Originally posted by HALL85:
1) Do you think private insurance is the only sector that denies claims? Medicare and Medicaid don't deny claims?

That isn't what I said. Of course they both deny claims that should be denied. but like I said... Only one of them has denied legitimate claims to appease their bosses and their shareholders.

Originally posted by HALL85:
2) You need to distinquish between access to coverage and access to care.

In any suggests or points that I made, it's never about denying access to care. That has been a fundemental of our healthcare system and needs to continue to be so. All of the argument and discussion is around access to coverage (i.e. how you pay for the care you want and what choices you can have as a result of your willingness and ability to pay).

but that's the point... when you don't have coverage, you don't get care. You get emergency treatment until you are able to leave. I will just never agree that is how we should treat our citizens. I imagine your scenario with an open market for healthcare ending with a large amount of invincibles. People never realize what kind of care they will need, and it will be too late and cause huge financial strains on the middle class.

Is single payer entirely wealth redistribution? No. People making 6 figures can be even more sick than someone making 30,000. The good thing with single payer is that they would both be protected and able to get care (preventative and emergency) It is more of a health distribution much like private insurers use except in a free market the sick will get crushed as the healthy/invincible pay less.

 

[HALL85]

So private insurers deny claims because they want to make a profit and Medicare denies claims because they are legitimate denials?? Are you serious??? That makes absolutely no sense. Ever think that if you denied claims arbitrarily, you would open yourself up for litigation or losing the contract you have with the employer? You make it sound like there are no ramifcations for an insurance company to act irresponsibly and you're wrong.

It's obvious you want nothing to do with personal accountabilty...I disagree. I hope we all raise our kids to be able to make decisions and think for themselves and not be reliant on an inept government to make those decisions for them.

 

[Merge]

Originally posted by HALL85:
So private insurers deny claims because they want to make a profit and Medicare denies claims because they are legitimate denials?? Are you serious??? That makes absolutely no sense. Ever think that if you denied claims arbitrarily, you would open yourself up for litigation or losing the contract you have with the employer? You make it sound like there are no ramifcations for an insurance company to act irresponsibly and you're wrong.

I have had to fight for legit claims. Insurance companies have admitted to denying legit claims hoping that people don't fight them. Medicare may deny claims, but they don't have a profit motive. It is morally and almost ethically much different.

Originally posted by HALL85:
It's obvious you want nothing to do with personal accountabilty...I disagree. I hope we all raise our kids to be able to make decisions and think for themselves and not be reliant on an inept government to make those decisions for them.

As a country, we have proven that doesn't work. Otherwise we wouldn't be spending over 50 billion per year on the uninsured.

 

[HALL85]

So because 80% of the population is acting responsibly, let's just give up on the small percentage that chooses not to. In that 20% there are some that are truly indigent and they need to be cared, but the statistics show that most of that number is choosing not to be insured, not because they can't afford it, but because they would rather not be responsible and live off of someone else paying for it. A system that rewards irresponsiblity is a bad one and you'll never convince me otherwise.

 

[Merge]

Originally posted by HALL85:
So because 80% of the population is acting responsibly, let's just give up on the small percentage that chooses not to. In that 20% there are some that are truly indigent and they need to be cared, but the statistics show that most of that number is choosing not to be insured, not because they can't afford it, but because they would rather not be responsible and live off of someone else paying for it. A system that rewards irresponsiblity is a bad one and you'll never convince me otherwise.

So you don't agree that we should treat people without insurance at a hospital then? That is rewarding irresponsibility.

and a free market with healthcare would actually lead to more irresponsibility when people have to choice to buy the cheapest plan possible.

 

[HALL85]

No, what I'm saying is that people that go to the ER for care without insurance that have the ability to pay (once again, very slowly, NOT the truly indigent) should have to pay for that care; in this case out of their own pocket. That's called being held accountable. Is that too difficult a concept to understand???

 

[Merge]

Originally posted by HALL85:
No, what I'm saying is that people that go to the ER for care without insurance that have the ability to pay (once again, very slowly, NOT the truly indigent) should have to pay for that care; in this case out of their own pocket. That's called being held accountable. Is that too difficult a concept to understand???

No, but your plan would lead to less preventative care and end up putting a strain on the middle class. 80% being responsible would dwindle down as people have the choice to spend less money today (hoping to avoid sickness altogether)

I am opposed to any system that would promote avoiding doctors out of fear of the bills. Your plan would do just that. The poor, and middle class would choose the high deductible plan. The wealthy may choose it as well (only caring to avoid a large cost) and the cost of insurance for the sick would be very high.

 

[HALL85]

It's difficult to have a debate, when you don't understand the fundamentals of how healthcare works.

The "system" now creates an environment of paying a signficant premium each month for care, with artificial restrictions (created by the government) that prevents competition, meaning better and more cost effective options. You make it sound like the middle class is getting all this preventive care for very little cost which is not the case. What I'm suggesting does not "promote" avoiding doctors as you keep misinterpreting.

I indicated a number of points (based on facts by the way) in an earlier post on how supply of healthcare is and will be effected. You seem to want to operate in a world devoid of what is actually happening in the marketplace. I believe a system that does not deny care and provides the public with options for choosing access to coverage in an enviromnent that fosters competition by providers (hospitals and insurance companies) is the right solution to lower costs and improve outcomes. After all, aren't those two metrics the ones we should be measuring???

 

[Merge]

I understand how healthcare works and I completely understand your argument. What I am suggesting is that you are wrong.

Here is how I see opening the market and letting employees chose to use the company plan or purchasing their own plan. A company would offer X plan or give you a certain amount of money to not use their plan. The majority of Americans will take that money and purchase the cheapest plan possible... or possibly no plan at all if that is allowed.

The price for low deductible plans for people who are sick will go up significantly.

Sick people will be penalized. Healthy people will buy cheap plans and avoid doctors, just as the uninsured do now.. until it is too late and end up in the ER.

I do believe that might improve costs, but not outcomes.

If you want to compare outcomes and costs... why not look to our neighbors to the north who's outcomes are comparable to ours yet their cost is about half per capita and as a percentage of GDP.

 

[HALL85]

You're proving once again that you don't have a clue how healthcare or the insurance industry works, nor what I've been suggesting through-out this thread. The overall costs will go down vis-a-vis enhanced competition and a consumer population that has more options and can choose the care that is right for them. You're assuming costs will go up, which makes absolutely no sense.

Having an option to reduce your annual contribution will not have an impact on what someone who chooses a full coverage plan, since we are both paying for the catastrophic portion of that coverage. In the first example, I'm just choosing to pay for my normal healthcare out of my own pocket. It's really no different than choosing various deductables when you purchase automobile or homeowners insurance.

The cost differential of healthcare between U.S. and Canada completely supports my argument. It's not the insurance companies, but the system we have set up in how we legislate and manage healthcare. Canada maintains it's cost structure by rationing care and limiting options. For instance, there are only about 15 approved drugs that can be used in the treatment of cancer in Canada, and that's ALL cancers. If you want to get access to another drug that might have a better profile, you need to pay on your own. You want that new drug that might extend your life another three to six months at $35,000? Well, that's on your nickel in Canada. If you think the American population is ready for that, write your Congressman and good luck. If it's so good up there, why hasn't one politician suggested we copy Canada???

 

[Merge]

The cost of insurance for sick people will rise. That makes complete sense. Lets assume 50% of the insured population drops out of their employer insurance and buys a catastrophic plan. The rest of the population wants to maintain their current level of coverage. You really think that wouldn't go up? The choice to pick that plan would become more expensive.. and honestly most people would choose a lower level of coverage then they currently have. The people who need the most care will have to select the most expensive plan and that system would make the sick people poor. It is a great model if you are healthy and never have a major illness or accident. For everyone else, it isn't so good.

I am not suggesting Canada is the model we should copy, but when using the "two metrics that we should be measuring" ... Canada is on par with outcomes, and they beat us on cost by a fair margin. We can do better than the system Canada has.

 

[HALL85]

Merge, your math is wrong. For example, if you have a population that is particpating as a whole in the catastrophic coverage, then everyone is paying in and those costs are shared by all; and then paid out to those that need them. If part of the population chooses a higher deductable to pay for their well and basic care out of pocket than those that are paying for that care in their policy are sharing from the same pool of those that pay into that. This has no effect on driving up cost and in fact, if you had more competition, those costs for insurance would come down.

You brought up Canada in the comparison; I didn't. We've debated the ways to get this country healthier while reducing our healthcare costs. The healthcare reform bill does neither, which is a failure in my view.

 

[Merge]

Healthy people help pay for the policies for sick people. You are looking at removing the healthy people from low deductible plans. 20% of the population uses 80% of total healthcare spending. 50% of the population uses 97% of total healthcare spending. A free market would drop the amount paid in considerably for people who really do not use their health insurance at all subsidizing the cost for the sick. There is no way that the costs for a low deductible plan for sick people wouldn't go up in that scenario.

Part of your cost controls would also be slowing innovation as consumers will no longer demand new/more expensive drugs and procedures. Maybe that is a good thing overall, but a likely consequence.

How would you address the mandate btw?

My point with Canada is that for your two most important metrics, there are many other countries with similar health outcomes (in some cases better) but they are doing it for half the cost per capita... while covering their entire country.

You are right that Obamacare doesn't do enough to control costs, but I don't agree that it will not improve outcomes. There are studies for people between the ages of 25-64 that suggest somewhere between 18,000 and 54,000 people die unnecessarily each year just because they lack health insurance. I do believe we will see improvements there in the next 10 years.

 

[HALL85]

Merge, you are not "removing" healthy people from the pool; They are still paying for the component of the plan that is for catastrophic coverage. Your math makes no sense. You are also confusing the cost of insurance and cost of care. Insurance costs will go down and increased competition and choice will create more cost competitive options.

You're wrong on innovation as well. That has nothing do do with what I'm suggesting.

The reason why Canada's metric on life expectency is better than ours has little do do with the healthcare system, but more about lifestyle. They are less sedentary and obese for starters than we are.

I am for (as I've said a half dozen times on this thread) coverage for the indigent. I'm not in favor of a mandate that forces people into a terribly flawed, higher cost system with uneccessary restrictions that increase cost and have no material effect on outcomes. I would like to see REAL reform, not a feel-good access program that creates more adminsitrative red-tape. We need REAL solutions that align cost, choice and shared accountability.

 

[Merge]

I was just curious about your opinion on a mandate with your scenario. I believe any reform lacking a mandate will fail to fix our problems with healthcare especially outcomes.

Innovation will absolutely slow down. I am not even suggesting that is entirely wrong, but it would happen. Pharma companies will not spend the money on R&D if the majority of Americans pay their healthcare out of pocket. They will still be looking for breakthroughs of course, but would we see new arthritis drugs which have the similar outcomes with less side effects? There will be such a small market of consumers than could afford new medicines. This goes for procedures as well. Consumer choice leads to the cheapest options for healthcare. Again, it is a good way to lower spending but innovation will slow.

A free market will increase competition initially when it is opened up, until mergers and buyouts leave us in about the same spot we are now.

Now, as far as my math... Here is what I am suggesting is wrong with your plan.
Assume 1000 people have a $5000 plan with a 20% medical loss ratio($4,000,000 going to care). 20% of the people paying in will use 80% of the money from the insurance company.($3,200,000)

With your plan, assume the 80% that rarely use healthcare opt for a high deductible plan for $2000. 800 people now pay in 1,600,000.

The sick 200 people will still use $3,200,000 worth of care paid from their low deductible plans. They will have to pay in $2,400,000. That comes to a $12,000 plan. My math is exaggerated, but that is the general principle. The less the healthy pay in, the more the sick have to pay.

 

[HALL85]

Merge, you realize health insurance has nothing to do with drug discovery, don't you? Innovation was fostered by the length of the patent protection (18 years from the point of molecule development, which usually translates into about 7-8 years of commercialization). If you really want to ensure innovation, just lengthen the patent protection to 25 or 30 years, so a pharma company can recoup their R&D costs over a longer period. I'll also give you an example of innovation that works today in a free and competitive market: Lasik Refractive Eye Surgery...that is a procedure that was innovative as it gets on improving eyesight (eliminating the need for glasses or contacts) with a quick procedure that is non-reimbursible, meaning it's completely out-of-pocket. When it was introduced the procedure cost was high, but has come down with increased innovation and that evil thing that we call "supply and demand" to make it more affordable and expand the population that can access it. So there you have it; an innovative procedure whose cost is not covered by insurance and has dropped dramatically over the time since it's introduction...a real life example; not a theoretic view like you've suggested.

And do you also realize that there are things called "anti-trust laws" that prevent what you are suggesting in a monopolitic insurance industry??

Your numbers make absolutely no sense, so I don't even know how to respond, but at least you admit to exagerating your math to make a point...you kind of sound like Anthony Weiner, but with numbers instead of private parts...lol.

 

[Merge]

My math shows how health insurance for sick people will go up if healthy people leave the pool for a high deductible plan. Pooling of risks only works if you have a large pool with all types of people. If Healthy people leave the pool, the sick will have to pay for that pool. I am really not suggesting anything crazy. Healthy people pay for sick people.

I went to the doctor twice last year. Assume $200 from my insurance company and $20 from me. I had one generic prescription. $10 from me, $5 from my insurance. My insurance plan costs $6000 per year.
That means $5,595 paid in. Assume I leave for a high deductible plan. I will pay in $2,000 and use 0.

Which option will help keep the costs lower for sick people?

As far as antitrust laws. Health insurance companies are currently exempt from laws that would deny them sharing data and setting prices based on losses. If any small companies decided to lead in catastrophic plans only, they will quickly be purchased by larger companies.

Lasik a great example of a medical breakthrough. Again, what I said was that anything that would be considered a breakthrough for companies will still be researched.

What will fall behind are advancements that are not considered breakthroughs but improvements. It is hard to give you an example since the far majority of Americans have insurance plans that cover these drugs. When they pay the costs out of pocket, the demand for advancements will shrink. Would you take a generic drug for $10 per month that gives you nausea, or would you pay $200 a month for a new drug without that side effect? There will be less of a return for that research of the new drug. Again, I am not suggesting that is entirely wrong, but lasik would be no different if we had a single payer system or your plan in place.

I would be ok with extending patent protection along with tying the drugs to their results. Formulate a high ROI and use whichever comes first, 25 years or a set ROI which would be considered fair. That way effective drugs will be more accessible and companies would have a longer time to recover their costs for less prevalent problems.

 

[HALL85]

Your math is incorrect. The healthy people are still paying for the catastropic care in their premium in a theoretical high deductable plan. Your anecdotal example is not relevent.

Advancements and breakthroughs are the same thing...both are based on innovation. It's hard for you to give an example of free market choice hindering innovation because you can't find one. Lasik is a perfect example. It was a breakthrough procedure and due to advancements and refinements, it has gained broader market access because it's been made more affordable (lower cost) and more cost effective (faster procedures). Look at other non-reimbursable procedures (plastic surgery for instance)....many of them have shown innovation and a significant reduction in cost over time.

In your example, if I could afford to I would probably take the $200/month drug. Use my Lasik example...people were paying $10,000 out of pocket so they wouldn't have to wear $100 eye glasses. But if the pharma company had longer patent protection, they would be able to offer the drug at a lower price to be able to reach a broader population since they would get a better return over time. It's not good PR for a pharma company to restrict access to a drug.

 

[Merge]

My anecdotal example was my true story. The numbers are rounded to make it easier. I literally went to the doctor last year twice and had one prescription. I (along with the majority of Americans) pay in FAR more than I am currently using in healthcare. Taking that money out and putting in the cost of a high deductible plan will raise the cost of insurance for people who actually need to use healthcare.

What you are suggesting is that what I put in just covers my usage + catastrophic coverage and when I leave for a catastrophic plan that the insurance companies will charge me the total cost minus my usage. That is clearly not the case with me nor the majority of Americans (unless my catastrophic plan costs $5000).

To compare with lasik, I would need to find an example of a successful drug that was covered by insurance, and then dropped by 80% of insurance plans. That doesn't exist.My suggestion has to be hypothetical because we are talking about your hypothetical plan. However, if you look at when people lose coverage for a particular drug, they switch to a generic. If no generic exists, they try a different drug. That has happened with Medicare.

As I mentioned, I would be ok with extending patent expiration but I think pharma companies may actually be better off if we give them 25 years or X percent ROI, rather than 18 years. (the only thing that had me thinking of that was the Bernie Sanders bill which I am not a fan of)

 

[HALL85]

One year in one life is anecdotal. My year last year by contrast included a diagnosis and treatment for a herniated disc which included a cortisone epidural injection. I also had a few other non-routine health issues that came up during the year; none catastrophic, but my estimate would be about $5,000. My point is that the actuaries have that all figured out in terms of what it costs to provide catastrophic care, and in a free market plan, the majority of people will opt for a plan that includes that component which will have to be funded by that insurer. I would say that if you are higher risk for getting sick because of your lifestyle (ie. overweight, a smoker, a drinker, etc.), you're premium should be higher than someone who has taken a responsible position with respect to their health.

I don't follow your theory on drug coverage. Can you provide an example of a drug that has been dropped from coverage which forced a patient to seek a generic that provided an inferior outcome? If you're talking about formularies, that's a different animal all together. I'm supportive of formulary management to manage prescription costs. The bigger issue to me is that we over-prescribe as a nation, which is not a good thing.

 

[Merge]

It's not anecdotal. I am 33 years old. I have never had a major illness. I have had strep a few times and lead poisoning once. I have head health coverage my entire life. My input into the pool is likely to be over $100,000. There is no way in hell I have come close to using that much care.

If I had a catastrophic plan, My input would be close to $30,000.
Assume my actual cost of care is $10,000 over my life. The rest of my input helps pay for sick people. That is not even a debate. As I get older, I expect that I will start to use more and more as the younger people start to take over my spot. and I recognize this may be an outlier, but my father has been to the doctor once in the last 20 years. He never gets sick and avoids physicals. (I have been pushing for him to get a physical for the last three years) He has two healthcare plans. One from his employer and one from my mother's employer.

People like us are what keeps the costs lower for the sick people who have a a similar input but a huge amount of usage.

I would agree that people with certain lifestyle choices should pay more... but the problem is that insurance companies do not view them differently than people who were born sick, or developed a condition which was not their fault.

Finding specific drugs to explain my point is difficult. Usually it is a personal story of someone who had their coverage drop. I am looking for an economic effect but in all honesty there really hasn't been anything similar to widespread loss of coverages. Even the example with Medicare that I saw isn't a fair comparison since typically people on Medicare would need to pay less out of pocket then the rest of the population.

I do agree though that we are over prescribed in general. I worked in a local pharmacy when I was 19. I was shocked at how many people put their kids on Ritalin. Start em young I guess.

 

[SPK145]

See link for story in today's Star-Ledger that is apropos.

Medicare and Cancer

 

[HALL85]

Anectdotal stories can be true...they just aren't statistically significant. I give up on trying to debate you on this point, since you can't seem to grasp basic concepts about healthcare coverage.

So I gave you a real example of innovation being fostered by free market (non-reimbursable) forces with cost factually being reduced and you continue to only to be able to suggest "hypothetical" examples...that's the problem with the healthcare reform bill...all hypothetical.

Funny that the Mayo Clinic came out today in opposition of the Accountable Care Organization component of the healthcare reform bill. It's funny, because Mayo is about as close to an ACO that you're going to find. As it turns out the devil was in the details and they are opposing the regulations, penalties and administrative BS that the lawyers are creating to manage these ACO's. More beauracratic red tape that leading institutions know is a waste.

Thanks for agreeing on my patent extension idea...there is hope

 

[donnie_baseball]

Originally posted by SPK145:
All we've talked about so far is the demand for health care/insurance. What about the supply side? This will be a huge paradigm shift for the U.S. medical industry. Under a single-payer/government system, doctors will have to do more for less (see Medicare). What will that do?

That's already in progress. People leaving the profession in droves, and your next few generations of primary care physicians have a large percentage of folks who are ESL, poorly trained outside the country, or both. Truly getting what you pay for, thanks to Medicare.

 

[Merge]

Originally posted by HALL85:
Anectdotal stories can be true...they just aren't statistically significant. I give up on trying to debate you on this point, since you can't seem to grasp basic concepts about healthcare coverage.

So I gave you a real example of innovation being fostered by free market (non-reimbursable) forces with cost factually being reduced and you continue to only to be able to suggest "hypothetical" examples...that's the problem with the healthcare reform bill...all hypothetical.

Funny that the Mayo Clinic came out today in opposition of the Accountable Care Organization component of the healthcare reform bill. It's funny, because Mayo is about as close to an ACO that you're going to find. As it turns out the devil was in the details and they are opposing the regulations, penalties and administrative BS that the lawyers are creating to manage these ACO's. More beauracratic red tape that leading institutions know is a waste.

Thanks for agreeing on my patent extension idea...there is hope

Unless you can provide me with an example of when a large percentage of people left their current healthcare plan for a high deductible plan to their expenses out of pocket, and it's effect on costs and outcomes, then what you are suggesting is entirely hypothetical as well.

Our discussion has to be hypothetical since nothing like what we are suggesting has happened.

What it sounds like you are suggesting is that the money that goes into health insurance is Catastrophic coverage + what people consume, and if 50% of the insured leave for a high deductible plan that they would just lose the potion that they are taking out of healthcare.

What I am suggesting is that is wrong. Our population is getting older and insurance is considerably more expensive as you age. The younger crowd of people under 40 who rarely use their coverage are contributing to keeping the costs lower for older people. If they left en masse, there is really no way that the cost for insurance doesn't go up for the rest of the population.

 

[HALL85]

Merge, any discussion on new programs, as you're well aware, is hypothetical. What I base my opinions on is factual data (which your arguments seem to be devoid).

* Fact: Medicare is facing insolvency and admits to $60 billion in fraud ANNUALLY. Why would you give the government the keys to a single payer plan when they have factually proven that they can't manage a segment of healthcare insurance?
* Fact: I provided you with a real example of a procedure (Lasik), that is not covered by insurance, but has shown that over time the cost of the procdure has dropped considerably, advancements through innovation have been made enabling a broader segment of the population to access the procedue.
* Fact: Healthcare costs represent 16% of our GDP and are continuing to rise at two and three times the rate of our economy. The healthcare reform package actually accellerates that curve.

A single payer health insurance plan is not an answer. In fact, history shows it will wasteful, misdirected and mismanaged. As a footnote, it's interesting that one of the components of the public employee pension and healthcare reform that Governor Christie and Steve Sweeney have introduced this week does call for high deductable plans to give employees choice to pursue options that make best sense for them. Almost like they were reading my recommendiation....lol.

I'm also a proponent of insurance reform. You can't offer these kinds of plans with the same non-compettive restrictions that exist today. Until you do that, you're just moving money around in the pool.

 

[SPK145]

Merge,

What I don't get from you is that high-deductible plans are not free. Insurance companies have actuarial tables that compute fair premiums. Many, many insured with high-deductible plans will never collect a dime from their insurance companies each year enabling said premiums to subsidize other insured.

 

[Merge]

Originally posted by HALL85:
]* Fact: I provided you with a real example of a procedure (Lasik), that is not covered by insurance, but has shown that over time the cost of the procdure has dropped considerably, advancements through innovation have been made enabling a broader segment of the population to access the procedue.
*

Looked that up today.
In 2002, the average lasik procedure cost was about $1600 per eye and it has gone up every year since then. In 2010, the average cost is $2150 per eye.

Guess what is happening. LESS people are getting lasik treatment.
I think your point just proved my point about people willing to deal with side effects to use the cheaper drug which will slow innovation.

I don't think the reform bill is perfect. It does move the cost curve, but according to the CMS, it looks more like this, and we will be covering an addition 30 million people.

Single payer isn't perfect either. There are inherent problems with any healthcare system we implement.

The problems for large scale high deductible plans will be a consequence of outcomes. When healthcare is too cheap, people use it too much. When it is too expensive, people stop using it.

“High deductible health insurance penalizes anyone who’s sick. Even common, mild problems like arthritis and high blood pressure make you a loser in a high deductible plan. And these financial penalties keep people from getting the routine care they need to prevent disastrous illness later on”, said Dr. David U. Himmelstein, study co-author and a Harvard Medical School Associate Professor. “High deductible plans are mean spirited and unfair, and they won’t save our failing health system. We need to care for everyone and spread the costs over men and women, young and old, healthy and sick. We need better coverage, not the ever-skimpier plans that politicians are pushing. In short, we need national health insurance with first dollar coverage for all Americans.”

 

[Merge]

Originally posted by SPK145:
Merge,

What I don't get from you is that high-deductible plans are not free. Insurance companies have actuarial tables that compute fair premiums. Many, many insured with high-deductible plans will never collect a dime from their insurance companies each year enabling said premiums to subsidize other insured.

I understand that... but what happens when a large potion of the insured population leaves for a high deductible plan?

Again, 97% of healthcare is consumed by 50% of the population.
There are many people with healthcare plans that have an input into the system of well over $5000 and they never use a dime.

The actuarial tables will move when you have a sick population no longer subsidized by the healthy... unless you start raising the costs for the high deductible plans as well which renders them almost useless.

The far majority of "healthy people" have a much larger input into the healthcare system then what a high deductible plan would cost.

They will also lead to reduced health outcomes as my post above shows.

They will put a strain on the middle class as people who should be choosing a low deductible plan choose a high deductible plan and avoid doctors until they have to go to the hospital and then end up having to file bankruptcy or pay the hospital in monthly payments (if allowed) for whatever period of time.

Offering people a cheap option promotes irresponsibility.
This post was edited on 6/19 11:31 AM by Merge

 

[HALL85]

Not sure what you looked up but you're wrong. The cost for Lasik in 2002 reflected the pre-wavefront technology which is more expensive "flap" procedure. The traditional procedure from back than is still comparable in cost with 85% of the Microkeratome procdures in 2010 performed under $2,000. Only 35% of Wavefront were performed for under $2,000. Less people are getting Lasik because of two things....the economy which has effected all admissions and procedures whether reimbursed or non-reimbursed and also that its a one-time procedure. You begin to reach a point of diminishing returns because the available populaton for the procedure shrinks.

"I don't think the reform bill is perfect."...that's funny Merge....thankfully we will never see single payer.