Healthcare Industry vs Healthcare

[FluffyMcDeath]

The US health care industry is eating what's left of the productive US economy (to be fair, the US Military Industrial Complex is eating more than its share too) and it's looking for new sources of income in the public healthcare services of the OECD countries. How unwieldy is the US system compared to other countries public or mostly public systems? Quite a lot.

And even if you are insured, you may not be covered.

 

[redrumloa]

It is a very bad situation here, but honestly each piece of regulation introduced have made things worse. Obamacare was the absolute worst thing possible for the healthcare industry. My job's out of pocket contributions roughly doubled over 2 years, and their burden increased sharply. At the same time, ridiculous the out of pocket "deductible" was introduced. You had to spend $3k a person before they would cover a single penny. Taking away the capitalism portion out of the equation have been devastating. Insurance companies cover what they feel like covering, while providers bill whatever the hell they want to bill.

There should be transparency and people should be able to go where they want to go. i have no problem with a gov public option, if it is just that, an option. If it is better than my company's insurance, I should be able to move to the gov plan. The whole idea though that every human being in the country MUST be in the government option (minus Congress mind you)or get thrown in jail I will never go for.

 

[JoBBo]

There should be transparency and people should be able to go where they want to go. i have no problem with a gov public option, if it is just that, an option. If it is better than my company's insurance, I should be able to move to the gov plan. The whole idea though that every human being in the country MUST be in the government option (minus Congress mind you)or get thrown in jail I will never go for.

You already are. It's called Medicare and the related payroll taxes are mandatory regardless of whether you ever plan to use Medicare or not.

Every other Western industrialized country mandates that citizens must have health insurance regardless of whether they use a national healthcare plan (United Kingdom, France, etc) or very strictly regulated private insurance plans (Germany, Netherlands, and Switzerland). Maximizing the pool of insured people is the only way to minimize insurance premiums and to prevent insurance death spirals.

For some reason, Fox News viewers are perfectly fine being required to pay for car insurance or face serious consequences (including jail in some states), just like in all other Western industrialized countries, but once you suggest that maybe this would be a reasonable idea so 80 years old seniors as well as hard working middle-class parents are always covered and nobody needs to go bankrupt due to illness, then all hell breaks loose.

Anybody who is not completely brainwashed should be able to understand that if the requirement to have (private) car insurance would be given up then car insurance premiums would immediately skyrocket and it would incentivize more and car owners to stop paying for insurance. Health insurance faces the exact same challenges. Whether you are in favor of market-driven approaches or government plans, you simply cannot have affordable healthcare without a mandate to pay for insurance as long as you have sufficient income.

 

[ilwrath]

You already are. It's called Medicare and the related payroll taxes are mandatory regardless of whether you ever plan to use Medicare or not.

It's not really the same. You're paying in if you are making money, regardless if you are eligible (or will ever be eligible) to collect. And, conversely, many people who are on Medicare are not paying in. If you're talking about expanding Medicaid to be able to insure anyone who wants to buy in... The typical "Public Option" discussions... I'd say that is a very good idea.

For some reason, Fox News viewers are perfectly fine being required to pay for car insurance or face serious consequences (including jail in some states), just like in all other Western industrialized countries, but once you suggest that maybe this would be a reasonable idea so 80 years old seniors as well as hard working middle-class parents are always covered and nobody needs to go bankrupt due to illness, then all hell breaks loose.

Anybody who is not completely brainwashed should be able to understand that if the requirement to have (private) car insurance would be given up then car insurance premiums would immediately skyrocket and it would incentivize more and car owners to stop paying for insurance.

There are, in fact, two states that do not force you to buy car insurance. They are Virginia and New Hampshire. Care to guess where their insurance rates rank? They are, in fact, 5th and 6th lowest in the country.

Sources:
https://www.thebalance.com/states-with-no-car-insurance-requirements-4121731
https://www.insure.com/car-insurance/car-insurance-rates.html

In light of this information, would you care to reconsider this stance? Especially considering New Hampshire has terrible seasonal road conditions similar to DC (5th highest rates), Rhode Island (7th highest rates), Delaware (8th highest rates), and New York (9th highest rates), while Virginia has auto theft rates similar to Michigan (1st highest rates), Louisiana (2nd highest rates), etc...

Health insurance faces the exact same challenges. Whether you are in favor of market-driven approaches or government plans, you simply cannot have affordable healthcare without a mandate to pay for insurance as long as you have sufficient income.

All that being said above, I'm not sure I disagree with that statement. But, and this is a very important but... You need AT LEAST one honest player in the market. You need SOME type of alternative to the big insurance companies. Or else the insurance companies have absolutely no incentive to do anything except collect as much money as they can. And when you don't have any alternative... Let me tell you, those insurance companies can really screw you. (ie, the condition of Michigan's No Fault Auto Insurance. Highest rates in the nation. And some of the worst actual coverage.)

Obamacare, as it was originally written, might have worked pretty well. It did a good job at getting people insured. But the Public Option portion of the bill was scrapped before Obamacare was passed. And without that, Obamacare was always doomed to become the farce we're now left with. We're paying at least twice as much, and not even getting half the coverage we were 6 years ago. That is what happens when you're mandated to buy a service from a sellers market with literally nothing to keep the sellers honest.

 

[JoBBo]

It's not really the same. You're paying in if you are making money, regardless if you are eligible (or will ever be eligible) to collect. And, conversely, many people who are on Medicare are not paying in. If you're talking about expanding Medicaid to be able to insure anyone who wants to buy in... The typical "Public Option" discussions... I'd say that is a very good idea.

I was talking about the principle of having the government mandate that citizens must pay a certain percentage of their income to pay for certain healthcare services, which is exactly what red complained about.

Is it true that similar types of mandate usually ensures universal health insurance coverage in many other countries? Yes, but this is besides my point.

The usual American pseudo-conservative news media like to argue that the mere idea to ask every American to pay for healthcare is somehow "unAmerican" and a giant never-before-seen step towards turning America into a communist dystopa. My point is that this is a blatant lie. Medicare has been around for more than half a century and, by all accounts, a lot more Americans appear to generally like it rather than hate it despite any shortcomings it might have. In general, asking Americans to either buy private insurance or pay for public insurance is not fundamentally different.

There are, in fact, two states that do not force you to buy car insurance. They are Virginia and New Hampshire. Care to guess where their insurance rates rank? They are, in fact, 5th and 6th lowest in the country.

This sounds familar. I feel like we may have had this same discussion in the past but I think it got lost during an engine switch.

In light of this information, would you care to reconsider this stance? Especially considering New Hampshire has terrible seasonal road conditions similar to DC (5th highest rates), Rhode Island (7th highest rates), Delaware (8th highest rates), and New York (9th highest rates), while Virginia has auto theft rates similar to Michigan (1st highest rates), Louisiana (2nd highest rates), etc...

I would always reconsider my stance on almost anything but my opinion remains unchanged.

While you are technically correct that Virginia does not strictly mandate that you must have insurance they do mandate that you must have either car insurance or pay an annual fee of 500 USD to the DMV, which happens to be an amount that equals roughly what you would pay for a minimal car insurance plan. So, there is very little financial incentive for anybody to forego buying car insurance in favor of paying the annual fee that would allow you to legally drive an uninsured motor vehicle. Will you be thrown into jail if you are caught driving without having paid for either insurance or the annual DMV fee? No, but it is a class 3 criminal misdemeanour and will go on your criminal record potentially impacting your ability to get a job, causing you to pay more in car insurance, etc. Furthermore, you will lose your driver's license and you will need to pay a fine of up to 500 USD in addition to the annual DMV fee for driving an uninsured car in order to get your license back. All things considered, these are still some serious sanctions.

As for New Hampshire, while you are right that it does have challenging seasonal road conditions, it also has the third lowest number of deaths per 100 million vehicle miles travelled in the entire nation. My theory is that frequent exposure to difficult road conditions makes people more careful drivers overall. The fact that the only two federal states with even lower numbers are Minnesota and Massachusetts might support this as they too do get very cold during winter and drivers will encounter snow and ice on roads. Also, internationally, the top five countries with the lowest traffic-related deaths in the world includes nations such as Norway, Sweden, and Switzerland that all have cold winter climates.

Moreoever, similar to Virginia before, while you are technically correct that New Hampshire does not legally require you to purchase car insurance per se, there are severe penalities if you are involved in an accident and are found to be at fault that may involve the revocation of your drivers license as well as your vehicle registration until you have paid for all damages. So, there are still very strong regulatory incentives to purchase car insurance when you live and drive in New Hampshire.

Last but not least, there are quite a few articles online about people receiving fines for driving without insurance in Virgina because even members of the police assumed that the legal situation was similar to the states with insurance mandates where 97% of the rest of the American population live. I do not think it is far fetched to assume that many people living in both states are not even aware that they have the legal, albeit unattractive option to drive without car insurance.

In conclusion, I do not think these two states prove that the rules of insurance death spirals are wrong and I stand by my initial remarks.

You need AT LEAST one honest player in the market. You need SOME type of alternative to the big insurance companies.

How about not-for-profit health insurance providers such as Blue Cross or Kaiser Permanente? Do you consider them to be dishonest? Are they as bad as for-profit health insurance providers?

Or else the insurance companies have absolutely no incentive to do anything except collect as much money as they can. And when you don't have any alternative...

Well, the way this works in countries without a national health insurance plan, such as Germany, is that, based on recommendations from experts and some input from representatives from all major stakeholders, the government roughly mandates how much insurance companies may charge and what minimum set of services must be provided. If an insurer refuses to obey by these fules, they lose their license to operate and will need to pass their pool of clients and savings accounts to their former competitors.

The Affordable Care Act is a half-way step towards this model. It does dictate that insurers must offer plans to people with pre-existing conditions, for instance, but it neither properly addresses limits regarding insurance premiums nor does it really include an effective mandate for citizens to purchase health insurance. As a result, people with severe pre-existing conditions can now buy an insurance. From a humantarian point of view, this is welcome. But the sanctions for not buying health insurance are so weak that they are not effective enough to make healthy people get insurance which is the only way to ensure that premiums stay stagnant or even get lower despite many people with expensive ailments now being able to get insured.

This is where the ACA failed but with people such as red being fundamentally opposed to any mandates based purely on ideology, it is not surprising this where the US ended up. The euphemistic view is that sometimes things need to get worse before they can get better.

 

[ilwrath]

The usual American pseudo-conservative news media like to argue that the mere idea to ask every American to pay for healthcare is somehow "unAmerican" and a giant never-before-seen step towards turning America into a communist dystopa. My point is that this is a blatant lie.

Not sure I saw that statement anywhere except some obviously partisan sites, but yeah. Agreed.

In general, asking Americans to either buy private insurance or pay for public insurance is not fundamentally different.

I think you said it right there. You need that public option. Just plain mandating you have to buy something and then not providing a default option is a horribly bad idea.

This sounds familar. I feel like we may have had this same discussion in the past but I think it got lost during an engine switch.

Could be...

In conclusion, I do not think these two states prove that the rules of insurance death spirals are wrong and I stand by my initial remarks.

But then how do you explain that the states that have the longest running and strictest mandates also have highest insurance prices and worse coverage?

How about not-for-profit health insurance providers such as Blue Cross or Kaiser Permanente? Do you consider them to be dishonest? Are they as bad as for-profit health insurance providers?

I don't know enough about Kaiser Permanente to say anything about them. As for Blue Cross, yes, I absolutely consider them as dishonest as the for-profits. I think that any sufficiently large pool of money grows that way. You get too many hands in the pool, drawing bonuses for themselves and buying themselves and their friends more and more money. And all that money comes from screwing the people they should be insuring.

Well, the way this works in countries without a national health insurance plan, such as Germany, is that, based on recommendations from experts and some input from representatives from all major stakeholders, the government roughly mandates how much insurance companies may charge and what minimum set of services must be provided. If an insurer refuses to obey by these fules, they lose their license to operate and will need to pass their pool of clients and savings accounts to their former competitors.

Yeah. But we never did all that stuff. We bickered about if basic female health items (such as birth control, even for people who have medical need) should be included in the baseline. We came up with ridiculous sound bites "If you like your policy, you can keep your policy!" and all sorts of other nonsense, but didn't bother to actually lay any useful framework or regulations for the {bleep} insurance companies. Other than they have to quote a price on the goofy ass website. Nothing to regulate the prices, though. And nothing to stop insurer collusion.

The Affordable Care Act is a half-way step towards this model. It does dictate that insurers must offer plans to people with pre-existing conditions, for instance, but it neither properly addresses limits regarding insurance premiums nor does it really include an effective mandate for citizens to purchase health insurance. As a result, people with severe pre-existing conditions can now buy an insurance. From a humantarian point of view, this is welcome. But the sanctions for not buying health insurance are so weak that they are not effective enough to make healthy people get insurance which is the only way to ensure that premiums stay stagnant or even get lower despite many people with expensive ailments now being able to get insured.

Personally, I don't think the weak sanctions have much to do with it. You're already threatening people with sure bankruptcy should anything more severe than a hangnail happen to them. But even THAT looks like a better option than dealing with the insurance companies to many people. That is how bad medical insurance really is, at this stage.

This is where the ACA failed but with people such as red being fundamentally opposed to any mandates based purely on ideology, it is not surprising this where the US ended up. The euphemistic view is that sometimes things need to get worse before they can get better.

Where do you see it getting better?

 

[JoBBo]

But then how do you explain that the states that have the longest running and strictest mandates also have highest insurance prices and worse coverage?

I do not think there is a simple answer to this question.

That said, it does not matter if you have "strict" mandates on paper if they are not being enforced. We discussed Virginia and New Hampshire before. In both states, 10 percent of motorists lack insurance. In Michigan, a whopping 20 percent lack insurance. In Florida, it is 27 percent even, which is simply astounding.

I live in a country with a very strong mandate. You cannot even register a vehicle in your name without proof of insurance and if you get caught causing an accident while driving without insurance you can go to prison for up to 12 months. I pay 400 USD per year for a basic car insurance plan for a mid-sized sedan. Our government mandates that every car insurance plan must cover a minimum of up to 8+ million USD for bodily injuries and 1+ million for property damages. Mind you, the largest car insurance provider in this country happens to be among the ten largest insurance companies in the world so it is not like our regulations are driving insurance companies to the brink of ruin. There is still plenty of profit to be made.

I don't know enough about Kaiser Permanente to say anything about them. As for Blue Cross, yes, I absolutely consider them as dishonest as the for-profits. I think that any sufficiently large pool of money grows that way. You get too many hands in the pool, drawing bonuses for themselves and buying themselves and their friends more and more money. And all that money comes from screwing the people they should be insuring.

My health plan is provided by a not-for-profit insurance company with 11+ million members. Those are not Blue Cross numbers but I would not describe it as a tiny company. The annual salary of its chairman is 400K USD. He does not receive bonus payments.

Where do you see it getting better?

When Bernie Sanders ran in 2016, he was considered a loony fringe candidate for proposing "Medicare for All". In 2019, this is now a mainstream position within the Democratic Party that has been adopted by multiple candidates running in the primaries. Pretty much all other candidates support a public option, which was considered a "left" Democratic position back in 2016 that might risk alienating moderates.

On the other side of the aisle, 44 % of Republicans are now in favor of having a government-ran "public option", which would have been unthinkable during the Obama years.

So, the public opinion has definitely shifted by quite a bit during the past several years.

 

[ilwrath]

I do not think there is a simple answer to this question.

That said, it does not matter if you have "strict" mandates on paper if they are not being enforced. We discussed Virginia and New Hampshire before. In both states, 10 percent of motorists lack insurance. In Michigan, a whopping 20 percent lack insurance. In Florida, it is 27 percent even, which is simply astounding.

I live in a country with a very strong mandate. You cannot even register a vehicle in your name without proof of insurance and if you get caught causing an accident while driving without insurance you can go to prison for up to 12 months. I pay 400 USD per year for a basic car insurance plan for a mid-sized sedan. Our government mandates that every car insurance plan must cover a minimum of up to 8+ million USD for bodily injuries and 1+ million for property damages. Mind you, the largest car insurance provider in this country happens to be among the ten largest insurance companies in the world so it is not like our regulations are driving insurance companies to the brink of ruin. There is still plenty of profit to be made.

Well, Michigan's numbers on that are totally hosed, because people don't even bother to register cars or anything in Detroit. It's not at all a rare thing to just have your car's license plate stolen and it'll end up put on someone else's totally unregistered vehicle in Detroit. They just grab a new plate every couple months.

But, I have what we consider a compact sedan (you guys would probably call mid-size), not a performance vehicle. Model Year 2015 Dodge Dart. Simple, cheap, daily driver. FWD, 2.4L 4cyl, normally aspirated. Bought it as a dealer overflow nearly 3 years ago, now. Both wife and I have 0 accidents, 0 points in past 5 years. Both 40-45 years old. No kids driving, yet. Two small claims for damage in past 10 years. One where the car was hit while legally parked, the other was for minor vandalism. (Honestly, I think kids were screwing around and accidentally crashed a bike into it or something.) We have coverage for 500k bodily injury, 50k property damage. We pay $4800/yr. For just that one car. And that is on a policy that gets discounts for multiple vehicles, and homeowners insurance.

My health plan is provided by a not-for-profit insurance company with 11+ million members. Those are not Blue Cross numbers but I would not describe it as a tiny company. The annual salary of its chairman is 400K USD. He does not receive bonus payments.

Yeah. Compare that to this. This is just for BCBS of Michigan. Around 6 million members.
https://www.freep.com/story/money/b...o-blue-cross-blue-shield-michigan/3071484002/
(TL;DR - CEO of BCBS of MI made over 19.2 mil last year.)

When Bernie Sanders ran in 2016, he was considered a loony fringe candidate for proposing "Medicare for All". In 2019, this is now a mainstream position within the Democratic Party that has been adopted by multiple candidates running in the primaries. Pretty much all other candidates support a public option, which was considered a "left" Democratic position back in 2016 that might risk alienating moderates.

On the other side of the aisle, 44 % of Republicans are now in favor of having a government-ran "public option", which would have been unthinkable during the Obama years.

So, the public opinion has definitely shifted by quite a bit during the past several years.

I'll believe it when I see it. Those big pots of money buy politicians pretty easily.

 

[JoBBo]

Well, Michigan's numbers on that are totally hosed, because people don't even bother to register cars or anything in Detroit. It's not at all a rare thing to just have your car's license plate stolen and it'll end up put on someone else's totally unregistered vehicle in Detroit. They just grab a new plate every couple months.

The 20 percent figure is derived from the actual percentage of people who were involved in an accident but lacked insurance. In theory, it could be much higher in case uninsured drivers are much more careful drivers and cause fewer accidents but that seems unlikely to me.

Also, regardless of how bad things are in Detroit, I think it it is worth remembering that due to decades of shrinking it only represents 6.7 percent of the population of Michigan nowadays.

But, I have what we consider a compact sedan (you guys would probably call mid-size), not a performance vehicle. Model Year 2015 Dodge Dart.

I looked it up. My car is a "compact executive car" - whatever that means. Our cars have almost the exact same dimensions as well as weight. Horsepower is close to identical too (1 hp difference). Technically, they even share the same manufacturer but my car was never sold in North America and it uses a platform that was developed by GM but was never used by them due to being deemed to be "too expensive".

Simple, cheap, daily driver. FWD, 2.4L 4cyl, normally aspirated. Bought it as a dealer overflow nearly 3 years ago, now. Both wife and I have 0 accidents, 0 points in past 5 years.

Does your insurance get access to your points or do you have to volunteer that information?

Both 40-45 years old. No kids driving, yet. Two small claims for damage in past 10 years. One where the car was hit while legally parked, the other was for minor vandalism. (Honestly, I think kids were screwing around and accidentally crashed a bike into it or something.) We have coverage for 500k bodily injury, 50k property damage. We pay $4800/yr. For just that one car. And that is on a policy that gets discounts for multiple vehicles, and homeowners insurance.

That certainly sounds very, very expensive unless you drive an expensive premium car and you get coverage for theft, cracked windshields, etc.

Based on what I saw, you can get basic car insurance for around 40 to 50 USD per month in California, but this would be for a plan that only covers very low sums for bodily injuries and property damage. Even lower than your plan, which I would consider to be the absolute bare minimum any plan should cover.

Yeah. Compare that to this. This is just for BCBS of Michigan. Around 6 million members.
https://www.freep.com/story/money/b...o-blue-cross-blue-shield-michigan/3071484002/
(TL;DR - CEO of BCBS of MI made over 19.2 mil last year.)

Well, that seems obscene considering this is a not-for-profit insurance but I guess Americans have different sensibilities regarding these things. If there will ever be a public option in the US, at least the salaries of the people in charge will be nowhere near as high.

I'll believe it when I see it. Those big pots of money buy politicians pretty easily.

It is going to be an uphill battle for sure. Annual US healthcare spending exceeds 3.5 trillion USD, which US patients have to earn and pay for.

The 2016 presidential and congressional elections cost around 6.5 billion USD. Compared to 3.5 trillion USD, those numbers are peanuts and you can just imagine the type of giant campaigns that will be run next year to discredit any plans to make healthcare both more accessible and more affordable.

Well, unless Biden is the candidate for the Democrats who seems to be less serious about healthcare than the other frontrunnters.

 

[ilwrath]

The 20 percent figure is derived from the actual percentage of people who were involved in an accident but lacked insurance. In theory, it could be much higher in case uninsured drivers are much more careful drivers and cause fewer accidents but that seems unlikely to me.

Evidence points to the opposite being true. (ie, completely unregistered cars are more likely to be in an accident.)

Also, regardless of how bad things are in Detroit, I think it it is worth remembering that due to decades of shrinking it only represents 6.7 percent of the population of Michigan nowadays.

But it can still be a significant portion of the 20% of accidents.

Does your insurance get access to your points or do you have to volunteer that information?

They have access to that information, and are allowed much more, even. They also ask you to provide it. And if the two don't line up, they'll still insure you, right up till the point you have a claim. Then that claim is rejected and they sue you.

That certainly sounds very, very expensive unless you drive an expensive premium car and you get coverage for theft, cracked windshields, etc.

Well, Michigan has the highest insurance rates in the country. (Possibly world.) You know it's not an expensive car. And it is a standard $750 deductible, basic collision, basic theft, basic roadside assistance. No coverage if I need a rental vehicle (some policies pay your rental if your car is in the shop -- but if I pay for the rental, it will be insured), no glass coverage.

Based on what I saw, you can get basic car insurance for around 40 to 50 USD per month in California, but this would be for a plan that only covers very low sums for bodily injuries and property damage. Even lower than your plan, which I would consider to be the absolute bare minimum any plan should cover.

I don't doubt it is cheaper in California. I highly doubt it is 40-50 a month, though. (600/yr? No way. You're not seeing that in the US.) But my buddy out there who drives a basic Honda Accord said he pays around $1500/yr.

Well, that seems obscene considering this is a not-for-profit insurance but I guess Americans have different sensibilities regarding these things. If there will ever be a public option in the US, at least the salaries of the people in charge will be nowhere near as high.

Exactly. And my point was that this is the sort of nonsense that happens when you mandate that people have to buy insurance from a company, and then don't provide any regulations on those companies, and no incentives to keep them honest.

It is going to be an uphill battle for sure.

That might be the understatement of the year.

The 2016 presidential and congressional elections cost around 6.5 billion USD. Compared to 3.5 trillion USD, those numbers are peanuts and you can just imagine the type of giant campaigns that will be run next year to discredit any plans to make healthcare both more accessible and more affordable.

Yup. I can hardly wait. :/

Well, unless Biden is the candidate for the Democrats who seems to be less serious about healthcare than the other frontrunnters.

Yeah, him or another establishment candidate who is not interested in healthcare emerging would not surprise me one bit.

Call me a cynic, but I'm not sure this is a solvable problem in the short-to-medium term, given the current state of the nation. And if it drags out long-term, with the associated suffering, the solution implemented will likely be Socialism.

 

[metalman]

a pack 'a Luckies and a bottle 'a Bourbon approach to medicine.