[Pops]

Headline from Politico:
Dog Catches Car, Now What?
$this->bbcode_second_pass_quote('', 'C')ongressional Republicans are setting up their own, self-imposed deadline to make good on their vow to replace the Affordable Care Act. With buy-in from Donald Trump’s transition team, GOP leaders on both sides of the Capitol are coalescing around a plan to vote to repeal the law in early 2017 — but delay the effective date for that repeal for as long as three years.

[Plantagenet]

$this->bbcode_second_pass_quote('Pops', 'o')nce repeal passes Insurance cos can immediately drop out of the markets and stick with the more lucrative employer based market—

[Pops]

$this->bbcode_second_pass_quote('', 'W')e compare unsubsidized 2016 nongroup marketplace premiums to the average employer sponsored insurance premiums in all 50 states and 73 metropolitan areas. We adjust second lowest cost nongroup marketplace premiums to account for the differences in actuarial value, induced utilization, and age distribution of enrollees. We find that nationally, nongroup marketplace premiums are 10 percent lower than the average employer sponsored insurance premium, after the adjustments. There is variation at across states and metropolitan areas, but more than ¾ of states and more than 80 percent of metropolitan areas having lower marketplace than employer premiums.

[Cog]

The market place premiums are lower because the insurance sucks compared to what is offered through employers.

[Plantagenet]

$this->bbcode_second_pass_quote('Pops', '')$this->bbcode_second_pass_quote('', 'W')e compare unsubsidized 2016 nongroup marketplace premiums....

[Pops]

From what I gather people are opting for lower premium plans, lower premiums mean higher deductibles, fewer docs, limited networks, etc. No surprise really, most aren't switching from an employer plan, they didn't have anything before. So it seems like we're going down the same road as ever with for profit insurance, even with minimum benefits by law, uniform marketing materials to make comparison easier, etc, people shop for a deal.

[vtsnowedin]

The first thing Trump and Congress should do is make every dollar paid for healthcare, Premiums ,deductibles, prescriptions, and all the rest tax deductible regardless if paid by an employer or the patient themselves.
Second they should require that $1000 per person of medical expense be paid for by insurance companies before any deductible is charged to the premium payer, and then expenses should be split fifty/ fifty until the deductible is met.

[AgentR11]

In the end, there is a core problem for the repeal crowd.

Americans will not tolerate a return to pre-existing condition exclusions. Problem is, insurance companies can't insure individuals effectively if that remains the law. So everyone with individual policies will end up with no insurance, and relying on the ER for services. An ER trip is orders of magnitude more expensive for public health than a GP visit within insurance context. That cost is real. And there is only one payer whose check won't bounce. The state.

That is a fundamental fact of health insurance in the US.

Its why Romney's plan looked the way it did; same with obama care; etc.

Now, if they're serious about the three year delay; that is actually a good sign, it means they do have time to amend it repeatedly to get to something that is actually sound policy that can function if Trump gets a second term; but also should do little structural damage that would inhibit the current Dem thought of simply reducing the age of medicare enrollment in order to capture 90% of the health care costs in the US.

[Ibon]

When I have time in the days ahead I am going to contribute to this thread. It's a big topic. Just to preface, I sold medical devices internationally for 20 years in my previous business and know very well the differences between the US market and international markets and the pricing differences. In addition I have lived in Europe, Canada, Thailand, Panama, Mexico and the Philippines and have been a resident in these countries and received healthcare. I will share some anectodal stories. I will only post here details of what I have observed outside the US in order to keep with the theme of this thread, in what direction the US needs to move in.

I will start with the most fundamental basic point and elaborate on this repeatedly with the posts I intend to share here in the days ahead. The problem with US healthcare is not the insurance companies. It is all about the inflated price tag of medical procedures, hospital stays, drugs, medical equipment. This is the primary source of the problem. Secondary, the exhorbitant amount of money that is spent on end of life procedures. What I hope to share in these posts is that there is an exponential difference in the price of healthcare between the US and the rest of the world that in no way reflects the actual care received by patients. Why this all happened is another topic which maybe others will contribute. My contribution here will be contrasting the US to other systems and focusing on the price differences throughout the whole chain from equipment aquisition, to service, drugs, procedures, etc.

More later. Time to take some guests on a walk.

[Plantagenet]

$this->bbcode_second_pass_quote('AgentR11', '
')
Americans will not tolerate a return to pre-existing condition exclusions.

[Pops]

So when Alaskans get sick, insurers don't pay, the taxpayers do.
Thereby preserving the profits of insurance cos.
Nice.

[Plantagenet]

$this->bbcode_second_pass_quote('Pops', 'S')o when Alaskans get sick, insurers don't pay, the taxpayers do.
Thereby preserving the profits of insurance cos.

[evilgenius]

I think the problem with healthcare costs in the US is a fundamental one. There is no market based pricing. Part of this has an obvious reason: if you break your leg falling on the ice outside of your house you don't call around or ask the ambulance to take you to the cheapest place. People, also, don't ask about price when they are dealing with a health issue. They may have some remove from the immediacy of an emergency, but they don't take advantage of that in order to find the cheapest provider. As a consequence the entire healthcare system is built around marketing itself along the lines of whether they can provide a service, not a service for a certain price. I say provide a service because quality of service is also not a part of their marketing. It is assumed by the public that if a service is available it will meet some minimum standard.

There are many reasons why people don't push for the cheapest price. Some people are not allowed to seek alternatives outside of a straight jacketed pricing system. Some people like their doctors, or believe in quality. For others, who might like to choose based upon some kind of cost vs benefit basis, there may not be enough information available as to the actual quality of the healthcare available to them, or the prices involved. There may be some standard pricing as well, but did you know those prices are set by committees of doctors associated with the AMA in many cases? Those prices are not market based. You can't get into finding that information out yourself for very long either before you become mired in commitment to the provider at hand. It isn't possible, unless you live on an island, to achieve honest discovery among all of the available options by yourself.

Recently, where I live, there was a surgical tech at one of the local hospitals who exposed hundreds of people to all of his diseases because he wanted to get high off of the drugs they were supposed to receive. It turned out that there was no system for identifying suspect people like him. They tend to have a trail, but like bad cops who move from town to town only deep reporting ever uncovers it. The hospitals have a deep interest in you not knowing. They prefer to quietly fire somebody, who will most likely start work very soon the next state over. You can't just look up a hospital to see what level of quality its staff has. You can't look up doctors for complaints. Nobody follows outcomes and reports on them, good or bad. In my town there are publications that put out the best of list for certain things having to do with medicine, but there is no list of shady operators who no one ought to go to. They get treated the same as every other provider, and become full of patients the same.

What the healthcare system in the US lacks is information, not money. Currently, we throw all kinds of money at it in hopes that will solve something. Throwing money at insurance doesn't help either because, by definition, it introduces an information obscuring middle man between the carer and the cared for. You aren't buying an advocate. We have yet to throw transparency or full disclosure at it, in order to give people real choice.

[Newfie]

Somewhere about 30% of health care dollars are lost in the insurance system. It's a bit contentious but Politifact finds it "mostly true."

http://www.politifact.com/oregon/statem ... re-dollar/

On top of this I think we spend a great deal of money because folks are not getting good primary care but let problems go until they become very expensive ER problems because they don't have health care. That was basically the argument for "managed care", that it would reduce costs by taking better care of people. That better care never materialized. They just squeezed the providers and patients.

I'm not disagreeing about the various arguments above. I'm just noting this factor IN ADDITION.

[Newfie]

http://www.commonwealthfund.org/publica ... tive-costs

$this->bbcode_second_pass_quote('', 'S')ynopsis

Administrative costs account for 25 percent of total U.S. hospital spending, according to a new study that compares these costs across eight nations. The United States had the highest administrative costs; Scotland and Canada had the lowest. Reducing U.S. per capita spending for hospital administration to Scottish or Canadian levels would have saved more than $150 billion in 2011.

[Plantagenet]

$this->bbcode_second_pass_quote('Newfie', 'S')omewhere about 30% of health care dollars are lost in the insurance system. It's a bit contentious but Politifact finds it "mostly true."

http://www.politifact.com/oregon/statem ... re-dollar/

[Subjectivist]

Well until something actually gets passed its hard to guess how it will turn out, but I am hopeful the multi state insurance feature often talked about does get enacted. Right now my wifes company supplies insurance through Massachusettes because that is where they have their headquarters. The level of confusion this causes in Ohio are remarkable because the assumption is residents have insurance from companies in the state, so charges get sent to the wrong insurer and make a mess. If we get a nationwide system all those headaches should clear up, and companies will be able to offer local insurance even though they are headquartered in a different state.

[evilgenius]

$this->bbcode_second_pass_quote('Newfie', 'S')omewhere about 30% of health care dollars are lost in the insurance system. It's a bit contentious but Politifact finds it "mostly true."

http://www.politifact.com/oregon/statem ... re-dollar/

On top of this I think we spend a great deal of money because folks are not getting good primary care but let problems go until they become very expensive ER problems because they don't have health care. That was basically the argument for "managed care", that it would reduce costs by taking better care of people. That better care never materialized. They just squeezed the providers and patients.

I'm not disagreeing about the various arguments above. I'm just noting this factor IN ADDITION.

[Newfie]

I agree on the personal responsibility aspect. My Wife agrees also and as a counselor her profession is to help people come to grips with themselves.

There should be certain limits set.

Obese people do not get medical care for obesity related diseases.
Smoker? No treatment for lung cancer.
Riding a motorcycle wo a helmet? No state care if you crush your can.
Etc.

And before folks whine again about this there are plenty of precedents.
Speeding tickets? Your premium goes up.
For some professions of you are over weight you are let go.

As it stands we reward or enable poor behavioir which we all have to pay for.

If I go into a food store or Walmart I see many folks who are grossly obese and they are buying junk food. I know healthy food is more expensive, but no more so than doubling or tripling the QUANTITY of food consumed.

We need to get over that.

[Pops]

The flaw with for profit healthcare is that the customer is a captive, I can choose to walk to the store but I can't choose to not take insulin - well I can.

Another problem with insurance based care is it is adversarial, insurance cos profit from not providing a service so there is a whole layer of bureaucracy on the provider side trying to get paid, ditto the insurer side trying to not pay.

And then, it is piece work, outcomes don't matter to the provider's bottom line, only the number of procedures—practice.

Too few GPs, due to the doctors cartel, AMA

As for responsibility, OCare, Romneycare, the R plan from the '90s all had mandates, likely the most unpopular feature of Ocare (besides the O) for regular folks. Probably 2nd least popular is that it is a government program, you know, elites and all that.

But you can exclude any number of people for any number of reasons to keep the price low, those already terminal, those likely to become terminal, those whose parents were terminal, lol