Obamacare

[redandguilty]

Health insurance company told my company (a small startup) rates will go up 60% next year. Our case probably represents an extreme, but still, I don't think the universal heathcare people advocated is the universal healthcare we're getting. As I said when the argument was happening, the discussion was so entirely focused on "yes" or "no", nobody paid any attention to the question of "how". Our healthcare plan looks nothing like the other nations' plans that were pointed to as examples.

 

[Michchamp]

Health insurance company told my company (a small startup) rates will go up 60% next year. Our case probably represents an extreme, but still, I don't think the universal heathcare people advocated is the universal healthcare we're getting. As I said when the argument was happening, the discussion was so entirely focused on "yes" or "no", nobody paid any attention to the question of "how". Our healthcare plan looks nothing like the other nations' plans that were pointed to as examples.

this is not surprising, since by most accounts the lobbyists for the healthcare companies wrote the bill, all while Democrats defended it as a huge accomplishment, and Republicans screeched that it was "socialism."

if we ACTUALLY had "socialism," i.e. universal, single-payer healthcare it would be cheaper for everyone, and better for most people. (But obviously the really rich would be a bit worse off.)

I also don't understand how anyone can make the claims they do about universal healthcare being terrible, inefficient, just plain bad, etc. with the mountain of evidence out there that U.S. healthcare costs are among the most expensive in the world, while delivering worse infant mortality and life-expectancy rates than many countries with universal healthcare. some of the evidence is in easy to understand graphs like this:

 

[Michchamp]

bonus point to the first person who mentions how "his uncle in Canada" had to wait "a year" for an elective procedure to correct a non-life-threatening and non-debilitating condition, and therefore universal healthcare is bad...

 

[redandguilty]

I think the US would come out all right on those easy to understand spending charts if we could normalize for cheeseburger consumption and hours spent in front of televisions.

 

[Michchamp]

I think the US would come out all right on those easy to understand spending charts if we could normalize for cheeseburger consumption and hours spent in front of televisions.

yes, it's americans' own fault their health care costs are so high...

 

[redandguilty]

yes, it's americans' own fault their health care costs are so high...

I think our obesity is a big part of it. Seems kind of obvious to me. Nobody questions that we have a higher rate of obesity or that obesity is commonly "managed" with expensive drugs addressing symptoms for years on end.

Another big part is that we go to extreme measures near the end of life. I once read that 25% of our spending is on people that are in the last year of their lives.

Also, I think malpractice lawsuits and insurance might be a big part. Don't know how big.

At the root of everything, I think the situation was doomed by 2 fundamental flaws: 1) insurance should only address catastrophic, unlikely emergencies, not routine healthcare, and 2) individuals should buy insurance, not employers. Those two things would have helped a great deal. Now, people would have had to get higher salaries all along since they're paying for insurance and I'm not against the government covering the routine healthcare that I think insurance should not address, but if things operated that way, at least market forces would have had a chance to put some pressure in the right places. Considering how stupidly we do things, I'm amazed it all works as well as it does.

 

[redandguilty]

This is from 2003. It's an accounting of the administrative costs including insurance administration. It says administrative costs in the US are 31.0% of spending and 16.7% of spending in Canada. If you adjust the US number from MC's chart to reflect what it would be if administration cost 16.7% instead of 31.0%, you drop from $7,538 to $6,244 per capita. It's a part of the problem, but not most of the problem.

http://www.pnhp.org/publications/nejmadmin.pdf

 

[Michchamp]

I think our obesity is a big part of it. Seems kind of obvious to me. Nobody questions that we have a higher rate of obesity or that obesity is commonly "managed" with expensive drugs addressing symptoms for years on end.

Another big part is that we go to extreme measures near the end of life. I once read that 25% of our spending is on people that are in the last year of their lives.

Also, I think malpractice lawsuits and insurance might be a big part. Don't know how big.

At the root of everything, I think the situation was doomed by 2 fundamental flaws: 1) insurance should only address catastrophic, unlikely emergencies, not routine healthcare, and 2) individuals should buy insurance, not employers. Those two things would have helped a great deal. Now, people would have had to get higher salaries all along since they're paying for insurance and I'm not against the government covering the routine healthcare that I think insurance should not address, but if things operated that way, at least market forces would have had a chance to put some pressure in the right places. Considering how stupidly we do things, I'm amazed it all works as well as it does.

I haven't done any in-depth studies of my own in regards to the U.S. healthcare industry. I'd be interested to learn about the ones you've conducted though.

Seems to me that routine healthcare should be covered and if it was, it would prevent some of the higher costs you see with catastrophic events (e.g. a heart attack or stroke) and allow healthcare providers to screen at-risk individuals better. I think I even read something about that once. There's even a saying about "an ounce of prevention being worth a pound of cure," but maybe that's related to something else.

the problem with some of your assumptions is that theyre premised on the idea that people are given clear choices regarding their healthcare needs & have a perfect understanding of how the choices they make will affect their health. not saying people aren't responsible for their actions, just that they may, when left to their own devices, may not have the understanding needed to make the best choices. this could be corrected more cost-effectively by providing greater access to healthcare.

 

[Mitchrapp]

If you ever go to the weight-height charts, I'm 6'5" and 220 and I'm apparently over weight. Even as a large frame type. That's ridiculous. I'm wondering if the obsessiveness in the US is a bit exaggerated, even a little bit..?

 

[redandguilty]

I haven't done any in-depth studies of my own in regards to the U.S. healthcare industry. I'd be interested to learn about the ones you've conducted though.

I didn't do a study, but I cited one. I have a reasonable degree of faith that those scientists were competent and told the truth. If you reject this method of developing beliefs, it makes the discussion very difficult. It's can be tough to hash things out with people that reject science.

Seems to me that routine healthcare should be covered and if it was, it would prevent some of the higher costs you see with catastrophic events (e.g. a heart attack or stroke) and allow healthcare providers to screen at-risk individuals better. I think I even read something about that once. There's even a saying about "an ounce of prevention being worth a pound of cure," but maybe that's related to something else.

Insurance drives up the average cost of things. It makes sense to have insurance to distribute risk for things that only impact some of the people. The price is then higher overall (to account for the insurance companies profits) but not devastating to the few that actually use it. It makes no sense to insure things that everyone uses. You can subsidize it or pay for it directly thought the government or whatever, but having it as part of private insurance is stupid. It only good for the insurance companies. I'm sure car insurance companies would like to insure oil changes and putting gas in the tank, just imagine if they could get 30 cents for every gallon of gas pumped.

the problem with some of your assumptions is that theyre premised on the idea that people are given clear choices regarding their healthcare needs & have a perfect understanding of how the choices they make will affect their health. not saying people aren't responsible for their actions, just that they may, when left to their own devices, may not have the understanding needed to make the best choices. this could be corrected more cost-effectively by providing greater access to healthcare.

People have imperfect information and it sucks, but it's still better than letting the decisions get made between large corporations with little-to-no input from the consumer. Consumers make tough calls with limited information all the time. Mostly we look to each other to avoid pitfalls.

I think the best system would be the direct government subsidy of routine healthcare combined with a private insurance system that covers only the rare and expensive things the government can't afford to cover. (Presumably, as technology progresses, the government would gradually include more things in the routine/covered category.) No employer involvement.

 

[redandguilty]

If you ever go to the weight-height charts, I'm 6'5" and 220 and I'm apparently over weight. Even as a large frame type. That's ridiculous. I'm wondering if the obsessiveness in the US is a bit exaggerated, even a little bit..?

I think the BMI metric is flawed on an individual basis, but when you look at stats involving millions, it's valid for making comparisons from nation to nation.

 

[Mitchrapp]

I think the BMI metric is flawed on an individual basis, but when you look at stats involving millions, it's valid for making comparisons from nation to nation.

No doubt the US is fat, really fat, really really fat - compared to other nations.

 

[redandguilty]

No doubt the US is fat, really fat, really really fat - compared to other nations.

Pretty amazing that our life expectancy at birth is only 4 years less than Japan's (top ranking.)

http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

 

[Mitchrapp]

Glad I don't live in Africa, my life expectancy would be over..

 

[mhughes0021]

my rates and my dedecutible went down this year for my entire family. If you dont like the insurance you have shop for a new one.....you have choices now....seems fairly american to me.

 

[redandguilty]

my rates and my dedecutible went down this year for my entire family. If you dont like the insurance you have shop for a new one.....you have choices now....seems fairly american to me.

It didn't kick in this year and I'm talking about this from the point of view of an employer. Apparently you can organize things so that rate bump doesn't hit until near the end of next year, but for the same coverage, it will cost us 60% more after the crossover in our case.

 

[Michchamp]

...

Insurance drives up the average cost of things. It makes sense to have insurance to distribute risk for things that only impact some of the people. The price is then higher overall (to account for the insurance companies profits) but not devastating to the few that actually use it. It makes no sense to insure things that everyone uses. You can subsidize it or pay for it directly thought the government or whatever, but having it as part of private insurance is stupid. It only good for the insurance companies. I'm sure car insurance companies would like to insure oil changes and putting gas in the tank, just imagine if they could get 30 cents for every gallon of gas pumped.

...[BLA BLA BLA]...

you make a good point in paragraph one, quoted above.

nationalize it already and be done with it. send the marines to seize all the health insurers assets and tell their employees they are now federal government employees, subject to the federal payscale. done.

 

[Thumb]

If you ever go to the weight-height charts, I'm 6'5" and 220 and I'm apparently over weight. Even as a large frame type. That's ridiculous. I'm wondering if the obsessiveness in the US is a bit exaggerated, even a little bit..?

Well I'm 6'2" and 227. And I'll freely admit I could stand to lose a few inches/pounds from the spare tire area, but I hardly consider myself obese (the index lists me as only being .09 lbs from obese). Really, aside from the beer-gut syndrome, I hardly have an ounce of extra fat anywhere.

I also don't exercise anymore at all really, other than just the activities from working/yard work, etc. Unless you count a few laps in the pool here and there.

 

[tigersofjustice]

Health insurance company told my company (a small startup) rates will go up 60% next year. Our case probably represents an extreme, but still, I don't think the universal heathcare people advocated is the universal healthcare we're getting. As I said when the argument was happening, the discussion was so entirely focused on "yes" or "no", nobody paid any attention to the question of "how". Our healthcare plan looks nothing like the other nations' plans that were pointed to as examples.

I agree.

The whole thing seems like a thrown together half measure. No half measures on this, you either go the whole way or don't do it at all.

The worst thing is I fear this will manage to convince a large neutral base that universal health care is a bad thing when basically every other industrialized nation can pull it off successfully. You have to do it right if you're going to do it though.

 

[tigersofjustice]

if we ACTUALLY had "socialism," i.e. universal, single-payer healthcare it would be cheaper for everyone, and better for most people. (But obviously the really rich would be a bit worse off.)

Regarding this point. I have never understood why you couldn't just circumvent this argument with a "pay more" option.

For example, just have the standard universal single payer health care, and if you are rich and want to "skip the line" so to speak pay X amount of money and you can do so, otherwise you are with everyone else. Seems easy enough. Would be the same conceptually as the new Cedar Point fast pass for you roller coaster aficionados.