Thank you Chief Justice Roberts, you are a wise man.

[jasetaro]

Probably you getting ripped since with catastrophic high deductible they would not be paying any of the $100K so they collect $2,000 a year and pay nothing. You've obviously left something out of your story, the high deductible and high copay. Always best to leave the personal anecdotes that, wonder of wonder, agree with your world view, funny that. Stick with the real world stats. US 20% of GDP, Europe 10% of GDP. US 70% with some health care, Europe 100% with full coverage. US 37th in world health stats. US No. 1 in health care costs.

I don't know the specifics of DBA's plan, but for the sake of argument I'm going to assume it's similar to mine... The plan I have is basically a traditional indemnity plan with a PPO rider and HSA -- Health Savings Account. The plan has $5,000.00 per calendar year deductible, there's no co-pays or co-insurance, I pay out of pocket or out of my HSA actually until I've satisfied my deductible for the year then the insurance company pays 100% of covered expenses.

Two years ago when I had my appendix removed the total bill came to roughly $30,000.00, I paid my share and they paid the rest no questions asked.

 

[BGL]

The plan has $5,000.00 per calendar year deductible, there's no co-pays or co-insurance

DBA somehow left out the $5,000K deductible.

Two years ago when I had my appendix removed the total bill came to roughly $30,000.00.

An interesting example in that $33,000 is average for appendectomy in CA. It is one of the simplest, most common procedures, maybe running up $5K in costs in hospital. The other $28,000K is result of crazily out of whack insurance industry run health care system, paying, in part, for all the people in ER with no insurance.

 

[DBA]

Probably you getting ripped since with catastrophic high deductible they would not be paying any of the $100K so they collect $2,000 a year and pay nothing. You've obviously left something out of your story, the high deductible and high copay. Always best to leave the personal anecdotes that, wonder of wonder, agree with your world view, funny that. Stick with the real world stats.

I am, it's called my own life, I didn't make those numbers up. I can go pull out some statements/bills if you'd like me to.

I have a $2,500 deductible and no copay (or network for that matter).

So I'm the one getting ripped of by getting my health care at $0.10 on the dollar? Your logic escapes me.

You said you had catastrophic with high deductible which means unless you have catastrophic injury they don't pay and you pay cash, usually about $10K and then pay 20% after that usually another $10K. So an ACL, about $10K, you'd pay it all plus your $2K a year insurance. Insurance company would pay nothing. That's how catastrophic, high deductible's work..

My health insurance plan is officially called Individual Blue Traditional and it's through BCBS (see attached). It has a $2,500 annual deductible (highest that that plan offers), which means I pay up to $2,500 and then they pay 100% after that. I don't have copay's or networks to worry about. (with the exception of out-of-network organ & tissue transplants)

The no network option is a great feature of that plan as I ride out of state a lot and don't want to worry about if I'm in-network. (Yes the following actually happened to me ) Got hurt at a track that was out of state and needed to be transferred, via ambulance, to a hospital (which was ~20 miles away). Ambulance transport ended up being ~$1100, plus they're "out of network". Some time later I get a letter from BCBS saying that since the ambulance service is out of network, they couldn't pay them directly. However here's a check in your name for $1100, please use this to pay them.

Another true story (of me), broke my left clavicle into 5 pieces and needed surgery to plate it. The surgery ended up being $32,090.45, of which I paid $2,500. Also had a number of post op physical therapy and checkups, all of which BCBS paid for as I'd already met my deductible.

Charges break down:
Hospital - $28,470.45
Surgeon - $2,500
Anesthesia - $1,120

 

[DBA]

An interesting example in that $33,000 is average for appendectomy in CA. It is one of the simplest, most common procedures, maybe running up $5K in costs in hospital. The other $28,000K is result of crazily out of whack insurance industry run health care system, paying, in part, for all the people in ER with no insurance.

So who decides to charge $33K for appendectomy? The hospitals or insurance companies?

Are there issues with our current system? Uh yeah! However putting everyone on an insurance plan doesn't fix anything or bring the cost of health care down. It might make the insurance plan average cost a little lower however it won't lower health care costs.

 

[craigiri]

Medical Bills in the USA are the #1 cause of personal bankruptcy. I think that answers at least some questions.....

 

[jasetaro]

An interesting example in that $33,000 is average for appendectomy in CA. It is one of the simplest, most common procedures, maybe running up $5K in costs in hospital. The other $28,000K is result of crazily out of whack insurance industry run health care system, paying, in part, for all the people in ER with no insurance.

I'm in Connecticut, I dug out all the paperwork, the grand total was $28,814.12 The bulk of the charges, $22,814.00, were "Hospital Expenses" and "Room & Board" for two nights... The surgeons fee was $1931.00, and the anesthetists fee was $1760.00. I'm not inclined to blame insurance industry though, umm, never mind I'm just going to leave it at that.

 

[Brad L]

Have you really never been pointed to the stats on health care outcomes and expenditures around the world? If not, I will prepare a list - but I think we come in somewhere about #35 in total measurement...right next to Cuba, which spends $250 per person for similar results to us.

We are, by far, the outlier. That is, the cost/value proposition....we are the car that costs the most, gets the worst mileage and breaks down more often.

The easiest quick look is a simple scatter chart or cluster....there you go below. It shows we pay double and get less. If you consider that a good outcome, I have some investments I'd like to sell you.....a little wet at high tide, though!

I think it would be more accurate to look at the statistics on survivability rate of common and serious medical issues . I don't have those in front of me at the moment, but I know America looks much more favorable in that comparison. Your chart could have more to do with eating habits than access to healthcare. There is nobody in America that does not have access to healthcare. People who can't afford it have medicaid. People who can afford it have many options. The ER rooms have to by law accept everyone.

 

[craigiri]

I think it would be more accurate to look at the statistics on survivability rate of common and serious medical issues .

No, that's not relevant at all, IMHO....

As an example, it is well know what we CAUSE many of those conditions through the same profit-making system. That is many cancers, heart disease, diabetes, respiratory disease, etc - many are because of our environment and life style.

We have developed a system that profits more from causing more (deregulation of pollutants=higher profits but more diseases) and also a system that will - for a price - patch you up.

In terms of stats such as this "mortality for the money over the entire population" is really the prime stat. Just because we can patch someone up for $300,000 to get another year or two does not move the bar of our lower life expectancy.

To try to relate it to something......
Pretend one state had horrid roads because they refused to collect enough gas taxes. The cars in that state broke down quite often, but the state had a great for-profit industry to fix the cars.

Another state properly paves their roads - may even have slightly higher gas taxes. The cars last longer without repair. There is not a predatory industry to patch the up....to the same degree.

The question these days seems to be whether, when presented with the facts, people can change their views. The facts have been indisputable for a couple decades...our system is out of control and the result are poor. I am 100% certain you can dig up an example somewhere that show "our skin cancer patients last 5 years while their last 3", but that is not relevant in the sum total of public health. Total average life spans are.

Oh, also our infant mortality is lower than many countries. It's still good, but lower....again, we pay double the price. We are the wealthiest country in the history of the world. Shouldn't we do better?

 

[BGL]

. The surgeons fee was $1931.00, and the anesthetists fee was $1760.00. I'm not inclined to blame insurance industry though.

You should. Notice the anesthetists fee, anesthetist is a CRNA, Certified Registered Nurse Anesthetist, not an MD. Operation is maybe an hour, the anesthetist is not making $1,760 an hour. They get paid about $100 an hour.

The $28K for hospital stay, that pays for all the patients without insurance in the ER with their appendix. Same operation in Europe, figure half the cost and the ER is empty.

All that money going to insurance companies and not for health care, a $1T a year waste in US.

 

[Jake Bunce]

So who decides to charge $33K for appendectomy? The hospitals or insurance companies?

Well, I worked in the private sector for 40 year.

I can assure you that "how can we make the most money possible" permeates every level of corporations and individuals.

That's really what it comes down to IMO. You can blame government, corporations, and other abstract entities, but they are all composed of self-interested individuals who perpetuate the system in the name of money. For example, the sales rep who works for an insurance company is part of the wasteful bureaucracy that plagues our medical system (I think we all agree that insurance companies suck?), but that individual is able to justify their function because it's money. Money resolves all dissonance in people, and thereby allows us to detach ourselves from our function in society. Our function becomes money instead of the service we provide. It is interesting how such a moral and humanitarian topic like health care can still be boiled down to self-interest and money.

 

[jasetaro]

I think it would be more accurate to look at the statistics on survivability rate of common and serious medical issues . I don't have those in front of me at the moment, but I know America looks much more favorable in that comparison. Your chart could have more to do with eating habits than access to healthcare. There is nobody in America that does not have access to healthcare. People who can't afford it have medicaid. People who can afford it have many options. The ER rooms have to by law accept everyone.

Lets remember those numbers distorted by the fact that we have more violent crime here than most (probably all) of the other countries on that chart... we average roughly 46 murders nationally each day in the US, add in deaths from drunk driving etc. and those the numbers aren't at all surprising.

And nothing in Obamacare is going to change that, Americans will still going to drink & drive and kill themselves and innocent bystanders by the thousands, they're still going to shoot, stab, bludgeon etc. each other to death. And anyone who thinks it will is deluding themselves.

 

[craigiri]

And nothing in Obamacare is going to change that, Americans will still going to drink & drive and kill themselves and innocent bystanders by the thousands, they're still going to shoot, stab, bludgeon etc. each other to death. And anyone who thinks it will is deluding themselves.

Some people always try to take all the FUN out of life!


bludgeoning sounds fun.....I've always wanted to swing a mace.

 

[jasetaro]

Some people always try to take all the FUN out of life!


bludgeoning sounds fun.....I've always wanted to swing a mace.

Sorry, can't help it... Once upon a time when I was younger, thinner and dumber I was a cop.

Never mind a mace, they'll use bats, pipes, shovels, crow bars, hammers, tire irons, sticks, stones, bricks, beers bottles... there's no end to the ways in which Americans can find to kill or mame each other.

 

[BGL]

So who decides to charge $33K for appendectomy? The hospitals or insurance companies

Both, the insurance company tacks on 40% to any health care. Those who can't afford "insurance" and get forced into bankruptcy with the $30,000 unpaid bill force the hospital to recover via other patients. The hospital is least to blame, simply relaying the true cost of health care system that has a 40% insurance company tax on health care.

Average cost of INSURANCE (prior to paying for health care, deductibles, copays etc) is $5429 individual and $15,073 for family of four. That is 14% of total income for individual and 30% of total income for family ($43K and $49K being median individual and family income). Again, this does not count the deductibles and copays IF the insurance will cover the illness or procedure. This is after tax costs.

Insurance is not health care.

Insurance companies are guaranteed net profit of 15%, a bit deceptive since "overhead" which comes out before profit includes real estate investments, high salaries and bonuses, payment to a massive bureaucracy the sole purpose of is to deny health care payments either initially or after the fact, causing MD's and hospitals to create counter bureaucracies to get approval and then battle for payment. So profit of 15%, overhead of 20%, another 10% for hospitals, MD's, etc. to get paid and you can easily see the "overhead" that the insurance company tax imposes on US health care system. It is why European costs are 50% less cost for 40% more coverage with 10% better results.

 

[BGL]

That's really what it comes down to IMO. You can blame government, corporations, and other abstract entities, but they are all composed of self-interested individuals who perpetuate the system in the name of money. For example, the sales rep who works for an insurance company is part of the wasteful bureaucracy that plagues our medical system (I think we all agree that insurance companies suck?), but that individual is able to justify their function because it's money. Money resolves all dissonance in people, and thereby allows us to detach ourselves from our function in society. Our function becomes money instead of the service we provide. It is interesting how such a moral and humanitarian topic like health care can still be boiled down to self-interest and money.

Jake...that should be the last word and a lock.

 

[DBA]

Both, the insurance company tacks on 40% to any health care. Those who can't afford "insurance" and get forced into bankruptcy with the $30,000 unpaid bill force the hospital to recover via other patients. The hospital is least to blame, simply relaying the true cost of health care system that has a 40% insurance company tax on health care.

Again your logic escapes me. So the insurance company just offers to pay the hospital 40% more just because they're nice people?

Ok lets use your 30k example. Jon has surgery and the hospital charges his insurance company $30k. The procedure actually only cost the hospital $15k, however they doubled it as they also needed to get paid for Tom's surgery. Tom doesn't have insurance. So we have two surgeries that cost a total of $30k.

Fast forward. Under the "affordable" health care law everyone now has insurance. So both Jon and Tom have this same surgery and because they both have insurance it cost $15k each. Again a total of $30k for two surgeries.

Did we really gain anything? If anything it'll be worse as the hospital isn't going to reduce the price of the surgery to $15k. Instead they'll reduce it by a small percentage. Lets say they'll now charge $20k for this surgery, sounds like a bargain compared to the 30k right? However as everyone is now under insurance it'll end up costing $40k for two of these surgeries.

My point is that putting everyone on a health insurance plan won't bring down the cost of health care. Yes our health care system is screwed up however health insurance isn't the answer.

 

[BGL]

Again your logic escapes me. So the insurance company just offers to pay the hospital 40% more just because they're nice people?

Because they all have interlocking contracts of agreed pricing and networks which is why the fiction of "choosing your own" doctor is a fiction. The MD must be signed up with your insurance company and with a particular hospital. Also the fiction of "I can see my MD anytime" as anyone knows MD's are all booked so usual wait is about 30 days.

My point is that putting everyone on a health insurance plan won't bring down the cost of health care.

Correct. Get rid of insurance, it is simply a 40% tax on health care, and put everyone on a national health plan will as we see in European models at 50% cost, 100% coverage and 20% better results. Medicare for All plan would work for US.

 

[Brad L]

The only way to get rid of medical insurance is for government to completely take over the medical industry. I'm not a fan of insurance companies and fully admit that many reforms are needed, but I much prefer them to a government run system. I don't agree with your cheaper and better European model argument.

 

[jadmperry]

The only way to get rid of medical insurance is for government to completely take over the medical industry. I'm not a fan of insurance companies and fully admit that many reforms are needed, but I much prefer them to a government run system. I don't agree with your cheaper and better European model argument.

What is wrong with a single payer system? Medicare for all?

What I don't understand is you seem to agree there is a problem (I think the majority of people do...healthcare costs are too high). And, I think most agree that insurance companies are at least part of the problem. So, it seems the options are to have what we had before Affordable Care Act (though, that seems clearly unsustainable), have something like we now have with the Affordable Care Act, or have a single payer system.

Do you see other options? If so, what are they and what do you think is the way to address the problem of healthcare costs being too high (especially for the outcomes we get for what we pay)? Or is it that you think we should have no policy and let the market function unregulated (though, if you believe that, then I think you will have to agree that many people simply will not have or be able to afford healthcare- i.e., if you are sick and can't pay, you will either stay sick or die; if so, is that okay? I also think you will essentially be arguing that Medicare should be abolished).

 

[craigiri]

The only way to get rid of medical insurance is for government to completely take over the medical industry. I'm not a fan of insurance companies and fully admit that many reforms are needed, but I much prefer them to a government run system. I don't agree with your cheaper and better European model argument.

Jut FYI since we are all probably discussing this elsewhere and in-person.

The general European model in Germany. Switzerland and some others is NOT a National Health Service nor is it government taking over the medical industry. It is basically a health insurance model with REGULATIONS.....not that much different than Obamacare with a lot of enhancements.

In Germany, for instance, you have your pick of virtually dozens (maybe hundreds) of insurance companies but if you like you don't have to choose one and are automatically in the "default basic government run" plan.....which is somewhat like Medicare. (if anyone here is German, please correct me if I am wrong!).

Medicare, Brad, is government RUN......but it is not government providing the services making the profits, taking over the entire system, etc. - it is simply government administering the payments and making some regs to make sure they get what they pay for and the treatments are sound. That's a long way from a "government takeover" .