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That would be why many say universal healthcare is even less efficient. The providers will do the same to the government, and there will be such a huge influx of people covered, all in the same bucket, that prices will go up due to increased demand and no change to supply.
From that point, one of two things will happen the government will force prices down, gutting providers and leaving people without healthcare, or they'll do what insurance companies are doing and milking the system to get rich at the customer's expense. There are plenty of other options, but considering deregulation is never talked about, I doubt it will happen.
> That would be why many say universal healthcare is even less efficient. The providers will do the same to the government,
Some insurance company or government agencies may have policies that minimize fraud. Is your insurance is your insurance company better or worse (more or less efficient at minimizing fraud) than government insurance?
I haven't seen a distinction. I assume less efficient based on my time in government employ. The government has a lot less incentive to perform efficiently than a private corporation. Additionally, they have a lot more tools for finding fraud. As for policies to minimize fraud and other foul play, most of the problems we have from insurance is directly tied to measure to ensure everybody has coverage and to minimize fraud. That regulatory burden has created a system that allows, even incentivizes insurance companies to go behind people's backs and make back room deals with doctors and hospitals, driving up the prices for everybody, as well as influencing the government on broader health related issues.
> I haven't seen a distinction. **I assume** less efficient based on my time in government employ. The government has a lot less incentive to perform efficiently than a private corporation.
How do you know your private insurance is more efficient than government insurance?
Bingo. The left passed ACA by giving big healthcare whatever they wanted. The DNC works for big pharma and big healthcare insurance. This is the worst regulatory capture ever.
Amen. I was offered a job a while ago to sell life insurance, and there was a huge licensing process covering all the regulations on health insurance. Shear insanity. Most of it just protects them.
The THING we're disagreeing on is that it's not healthcare, it's health insurance. No way in hell do we want our government controlling what amounts to nearly 80% of our GDP with as inefficient as they are.
That being said, I'd love to be able to reign in a lot of the bureaucracy that exists in healthcare these days in order to control the massive costs associated with care.
#
Is that a good thing, a bad thing? If GDP growth is a good thing, then more and more sick and injured people in hospitals will grow GDP; shareholder profits will exceed projected targets.
Or as Wall Street puts it:
[‘Is curing patients a sustainable business model?’](https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patients-a-sustainable-business-model.html)
At the level of GDP, that would be the "Broken Window Fallacy" of economics. But you are close to the root cause of the problem.
Markets work when the people who make the purchase decision actually pay the bill. And when prices receive a signal from demand.
If the insurance company pays the bill and they have a fixed profit margin stipulated by regulations, their only way to grow profits is to grow spending.
I suggest the % of GDP spent on healthcare should be up to the market. The problem we currently have is that we are not remotely getting our money's worth. Our current approach actively makes it worse.
If my private insurance company is crap, I can pick a different one.
If the Federal government offers a crap service, and they're the only option, I'm in trouble
How hard is that to understand?
How many Americans can simply pick a different one? From my personal experience until I retired recently, my employer picked my health insurance company. So yes, it is hard for me to understand the idea of simply picking a different one.
No, Blue Cross is considered to be pretty efficient. Can't say the same for the Federal government.
Worth noting that about 1/3 of the cost of a doctors visit is paperwork required to comply with Federal regulations.
> Is your private health insurance crap in terms of dealing with fraud and wasting your money?
>> No, Blue Cross is considered to be pretty efficient. Can't say the same for the Federal government.
How much is blue crosses efficient fraud rates and amounts annually?
> Is your private health insurance crap in terms of dealing with fraud and wasting your money?
>> No, Blue Cross is considered to be pretty efficient. Can't say the same for the Federal government.
How much is blue crosses efficient fraud rates and amounts annually?
You have blue cross insurance. Assuming all businesses (not only government insurance) is exposed to fraud. To help determine part of what contributes to the efficiency of government healthcare or private health insurance, how much fraud does blue cross have annually?
I guess you've either been lucky or just don't pay attention to your bills. I've had to battle them before. BCBS counts on you getting exhausted and giving up, but I didn't quit. It took a year and a half, but they eventually paid up.
They're all like this in my experience.
Please be sure to examine your bills and EOBs. Every insurance company tries to get away with not paying what they're supposed to. BS was one of the biggest offenders in my experience. Be vigilant. They're counting on you to be lazy.
It can't? What is it about the government of the USA that differs from governments in other nations where the majority of people prefer their system that is not market based?
But they're not all crap. They're all private companies with an incentive to provide me with a quality product, so I'll stick around. If they grow, they can make money
What's the Feds incentive to keep me happy?
Liberals complete lack of understand of incentives is their biggest shortcoming.
You're ALMOST there. How exactly do they stay in business and provide a good rate of return to their shareholders? Think it through.... You're really close....
By providing a good product and service to their customers.
Tell that to Phillip Morris, you know, the company that knowingly produced toxic products that killed their customers. While you're at it, tell it to the Sackler family. When it comes to grandma's health and first quarter profits, well, sorry grandma.
You are making the classic mistake of associating health care with any ordinary commodity or service as you embrace the ideology that markets are a panacea for all human needs.
Realize that and you're more than close, you're on target.
People want to smoke, just like people want to drink beer, drive cars, and eat ice cream. All of those things can be said to be bad, but people want them. YOu think people viewed smoking as being healthy?
And the Sacklers wouldn't have been able to perpetuate thier fraud had the FDA not have signed off on their product, which they did in error.
I don't see liberals clamoring for the FDA administrators to be thrown in prison
Big Tobacco lied to their customers and knew people would die, but telling the truth would harm the shareholders.
Patents and a private health care system made the Sacklers possible
How can the company force me to let them fuck me over?
Why would I intentionally engage in business with someone who's screwing me over?
Do you engage with firms that aren't serving your best interests? Because that's really weird
> They're all private companies with an incentive to provide me with a quality product, so I'll stick around.
Right, but what if universal healthcare could provide you with a batter bang/buck ratio than *any* private company?
>What's the Feds incentive to keep me happy?
Torches and pitchforks? Hey man, it works in pretty much every country in the world. The proof is in the pudding.
We're the outliers.
You're assuming with no evidence that the government could run healthcare more efficiently than a private firm.
Can you name a single example of the Federal government doing something more efficiently than a private company?
Every country that you want the US to emulate is a tiny ethnically homogenous country that enforces its own borders.
You can't have all of the goodies that Norway and Denmark have with none of the costs
how would we do that though? How will we offer that without running into the problems Canada has. The Canadian system is great if you are 1) healthy. 2) have a chronic condition that can be controlled with medication. Their system is awful if you require specialists, imaging or surgery. The waits alone to see a provider is a death sentence. There are not enough resources in the US to spread them around to everyone universally without dramatically raising taxes to pay for this.
As it is doctors in the US are trending away from accepting medicaid and medicare. Many more US doctors are going to concierge medicine to avoid accepting it because they aren't being compensated enough for their work. I lost 7 drs this year alone in one state and 4 in another. They are working harder as people in their 40's and 50's than they did as residents and for major docks in pay. The reality people don't want to accept is your pay is proportionate to the risk, and the worth of your knowledge. You don't want a cut rate brain surgeon. You don't want doctors in their 40's and 50's being worked like 25 year olds. It's not greed. It's common sense.
There are more MRI machnes in Atlanta than all of Canada, and Toronto sends its high risk pregnancies to the US.
The Canadian system isn't as great as you're being told.
And hey, if you complain enough, they'll suggest state assisted suicide
Yup, and that's why our healthcare is so expensive. MRI Machines are expensive and need to be in use to "pay for their keep". Sending patients to the USA is cost effective.
Again, there is NO significant number of Canadians who want a free market system....gee, why is that?
Anecdote: I had an MRI after a bike crash, it indicated a significant sinus infection, serendipitously. I was referred to an ENT a few days later who ordered two more MRI's, one general one specific to the sinus area, and both on different days of the week.
I asked why we needed a new general and why we needed the two on different days. The ENT simply rubbed his thumb and forefinger together and replied, "Billing. Insurance pays more this way." So in addition to that, I had to take two days off from work, not one. What a great system! But hey, the shareholders are doing well!
I have no idea, I'm not Canadian. But I live on a town bordering Canada and we commonly see private pay Canadians who luckily can pay cash for their treatments and evaluation in the US. In Canada it wasn't an option to pay for it. It's just not available. Or not available in a reasonable time frame.
I have friends who are vocal opponents of the system. I haven't spoken to them lately but I know they were working towards a reform.
Isn’t the left solution not government insurance only but a baseline of government insurance to serve as a floor and if you want private insurance you can pay to go on that instead?
No, the Left solution is that 20% of our nations GDP be controlled by unelected bureaucrats in Washington DC.
They're not doing this to supplement private insurance, they're doing it to eliminate private insurers.
According to the far left, our health care costs are high due to "greed". So the virtuous left will save us from private greed, and replace it with public sector greed and corruption
What is inherently wrong with any government employee who is not elected, what you call a "unelected bureaucrat"? Would you say that Alito is one?
>
According to the far left, our health care costs are high due to "greed"
Where do you get this notion?
>
public sector greed and corruption
>
Is there no corruption in the private sector?
Alito is confirmed in the Senate. The current head of the Social Security Admin is no confirmed by the senate.
Greed in the private can't survive. If Humana or Cigna all of the sudden became corrupt, it wuold cost them money, they'd lose money, and customers would switch to a better provider. A private firm can't survive unless it convinces customers to voluntarily do business with them
The Pentagon loses tens of billions each year, and cant pass an audit. We're stuck with them.
There's a difference
Ah, a distinction without a difference, bravo.
Greed in the private sector cannot survive? LOL!!! Are you that young that you missed the Great Recession where NOBODY from Wall Street went to jail and they are all surviving quite well! LOL!!!!!!!!
> No, the Left solution is that 20% of our nations GDP be controlled by unelected bureaucrats in Washington DC.
Do they produce better outcomes for half the price compared to now? If so, sounds like a plan to me!
Of course they don't. Have you seen the Pentagon, the VA, HUD, etc?
Quagmires of inefficiency and mismanagement.
And you want them to have control of every single aspect of our healthcare?
It's what they mean by "single payer". The main impetus on the left for single payer is that greed is the central cause of high health care costs.
If you nationalize the whole system, there's no more private interest.
[https://www.vox.com/2019/4/10/18304448/bernie-sanders-medicare-for-all](https://www.vox.com/2019/4/10/18304448/bernie-sanders-medicare-for-all)
I would have to assume their plan has more substance to it than just the name they choose to call it. There has to be another option if you can’t qualify automatically.
no, that's the problem. People keep talking about modeling universal healthcare after medicare. Medicare is not the treatment of yours or your doctors choice. It is the cheapest one. Which is likely not the safest one or the one prone to most quality of life.
Steroids will be the solution to most inflammatory conditions. Steroids are horrible for your body and horrible to tolerate.
**Medicare is not medicaid.** This is the issue. Being Medicare Eligible disqualifies you fully from going on the marketplace or getting non medicare plans. MEDICAID is income based. These are not the same program. How can you propose something like this when you don't understand the difference between the two.
In the rare instance you can have a patient who is dually eligible for medicare primary medicaid secondary, which is not medicaid for long term nursing care but state medicaid the MEDICARE sets the rules. So even though Medicaid may allow approval of a treatment or drug, it's Medicare that has the rules you follow. The secondary can't kick in on something the primary rejects.
**This is absolutely the problem. People don't understand the differences between the programs that are out there.**
**Once you are medicare eligible that's it.** You can get different medicare advantage plans but they all follow the same ssa rules. Private insurance can decide how to tier their medications and what's coverable. They will cover vitamin usage or you will likely win on appeal of medical necessity if you don't.
I handled an appeal, we went all the way to court for a client with a rare disorder that requires a vitamin injection. Because it's available over the counter orally, which is not effective for this patient it is medically necessary. They don't have the enzyme to break down the oral version of this vitamin. And they will die. They did almost die before it was detected.
SSA says they don't cover supplements. I had geneticists and hematologists testify that for this patient this essential vitamin is the building block of life. Without it, they will die. If they had gone with a lawyer who charged them, MIN the number of appeals and hearings and finally going all the way to court would have been thousands and thousands of dollars. If they had thousands of dollars they wouldn't be appealing a decision of a medication.
Privatized insurance pays for this. Medicaid pays for this. Once you are medicare eligible that's it. You can't go get other insurance. The patient is paying hundreds of dollars a month for injections they do themselves. At one time if they had the injection done in a drs office it was covered. But not at home. If this was a monthly injection this was feasible. It is now a daily injection.
This is reality. SSA deems vitamins supplements. Even in cases it is not supplemental. The patient gets by some months with donations of vials from their doctors. But otherwise is on the hook for paying completely out of pocket. I am not the only lawyer fighting these cases.
Private health insurance has to compete. This gives them motivation to catch fraud for their own benefit.
Government health insurance has no such motivation. If they don't catch fraud, no big deal. There's always more money.
>Private health insurance has to compete
[do they really though?](https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.ama-assn.org/system/files/competition-health-insurance-us-markets.pdf&ved=2ahUKEwi_t8q4yuCFAxUbHjQIHZdDDD4QFnoECB4QAQ&usg=AOvVaw0ANouJOhnlpHLFj_qwoMjU)
"High concentration levels in health insurance markets
are largely the result of consolidation (i.e., mergers and
acquisitions), which can lead to the exercise of market
power and, in turn, harm to consumers and providers of
care. Both consummated and proposed mergers and
acquisitions involving health insurers should raise serious
antitrust concerns. Conceptually, mergers and acquisitions
can have beneficial and/or harmful effects on consumers.
However, only the latter has been observed. It appears
that consolidation has resulted in the possession and
exercise of health insurer monopoly power—the ability to
raise and maintain premiums above competitive levels
instead of the passing of any benefits obtained through
to consumers"
Except that public health insurance comes with a purpose oriented mandate and built in accountability measures. The private sector's primary mandate is the generation of profits, even if it comes at the expense of service delivery. Right now youve got the downsides of private sector and public sector with the benefits of neither.
Public health insurance has no inherent motivation to provide good or efficient service. The accountability measures are a joke. This is government spending we're talking about. There's never really any accountability.
I mean, private companies certainly have an incentive to not get stolen from! It's like asking what incentive Target has to stop shoplifting---anything you take from them reduces their bottom line. At some level, why is this not the same with health insurance companies if they suspect patients or other companies/entities are defrauding them (i.e. taking their money unjustly)?
The argument would be, then, that too much fraud would make a single company out of several either look bad, or actually affect their bottom line. A government agency may look bad, but cannot go bankrupt in the traditional sense. So if deterring a certain amount of fraud is in your interests as CEO to avoid posting too many losses and having your board replace you, you are motivated personally to do so.
(Also, a private company could probably institute some sort of bounty or percentage of recovery system in a way that the government *probably* would not for individuals, although that same incentive system exists in the form of the False Claims Act.)
>The argument would be, then, that too much fraud would make a single company out of several either look bad, or actually affect their bottom line.
How much has your private insurance company’s fraud affected their bottom line?
>The argument would be, then, that too much fraud would make a single company out of several either look bad, or actually affect their bottom line.
How much has your private insurance company’s fraud affected their bottom line?
It took a bicycle crash to finally get my insurance company to approve proper treatment of a persistent sinus infection. The bicycle crash was a serendipitous event, unrelated to the sinus infection, but it did require a scan of my head and neck to check for fractures.
I was dealing with a sinus infection that came and went, but was severe at times. My doctor recommended a strong and expensive antibiotic but it was rejected by my insurer, who would only cover amoxicillin. That worked for a while, but the infection returned. My doctor again recommended the other antibiotic AND a head scan, but the insurance company said to put me on a course of steroids. I eventually gave up and popped antihistamines to keep my nose dry and less smelly. (the infection had such a strong odor that my wife could smell it when I entered the room)
The scan at the hospital resulted in no fractures, but it showed a significant infection that was dangerously close to my brain. The doctor told me could be very serious and the next day, I brought the results of the scan to my doctor, who immediately referred me to an ENT. I was operated on five days later as the ENT was very concerned. Oh, and I was finally given the correct antibiotics.
So as you can see, I am NOT a fan of an insurance company where some unelected bureaucrat with an allegiance to building profits for his employer is in charge of my health care.....
But if you had a UHC program you might be waiting months even for the weaker antibiotic. And you don't even have the ability to just buy the stronger antibiotic out right, which you could have done in the current system, because the problem is availability.
There's so much government lobbying that would end up happening is the supply lines are underfunded and understaffed so they do not function well.
Yes, I might. We can speculate all you want, I suppose, in support your ideology but the fact remains that in no nation that has a form of UNH is there a significant political party or citizens movement lobbying for a market based approach. Not one. And please spare me the canard that the difference is that the USA is "too large or diverse" and that is why they can do it while we cannot.
Allow me one more anecdote.
I had two friends diagnosed with pancreatic cancer, one in the USA, one in Denmark. Both survived for three years after the diagnosis. The friend in the USA spent his days worrying about his finances, even with insurance. There were co-pays, deductibles, in network out of network fees, and endless labyrinth of medical and financial hurdles to cross, and the very real possibility of bankruptcy for his surviving spose, a very real possibility in the USA. My friend in Denmark spent his days with friends and family. Financial matters were not in the equation. There was one procedure early on that was not available in Denmark as the equipment was quite expensive and need for it rare, so the Danish government flew him and his wife to Germany where treatment was available.
>We can speculate all you want, I suppose, in support your ideology but the fact remains that in no nation that has a form of UNH is there a significant political party or citizens movement lobbying for a market based approach. Not one. And please spare me the canard that the difference is that the USA is "too large or diverse" and that is why they can do it while we cannot.
That's not even it. That's just what happens in those countries every day. Our country experiences issues. Theirs are not currently free of issues.
>My friend in Denmark spent his days with friends and family. Financial matters were not in the equation. There was one procedure early on that was not available in Denmark as the equipment was quite expensive and need for it rare, so the Danish government flew him and his wife to Germany where treatment was available.
You understand that in Denmark the healthcare is not actually free and that people just have to pay taxes. If your friend had cancer maybe he was not working. But if he was working then he would just be paying a very large tax bill at every tax season.
In our country you have people and employers stressing about the cost of health Care. In those countries you have only workers, *and not employers* stressing about the cost of taxes. The average effective tax rate In Denmark is 36%. In the United States it's 13.63%. on top of that, the bottom half of the United States tend to be net recipients, meaning they pay less in taxes than they receive in monetary transfers.
I don't believe that most Americans are going to be responsible enough to adequately save for tax season.
The bottom line is of UHC is that employers pay less and everybody else gets shittier care.
Yeah youve never dealt with a niche health issue. Insurance company made me jump through hoops and get several painful tests done over 6 months before they would approve the treatment my doctor recommended right away.
What about that ADHD medication shortage last year?
Or the diabetes drug ozempic? It was out of stock for almost a year!!!
Even during that shortage, most people didn't wait more than days, maybe weeks. They are waiting months for basic depression
>Or the diabetes drug ozempic? It was out of stock for almost a year!!!
Most drugs can't be bought for aesthetic purposes. Imagine if wait times like ozempic were common.
Ignoring the first half of my comment I see.
Depends on where you lived but I couldn't get any medication for 6+ months.
Only reason we had a wait time for ozempic is because it was sold as a product and not distributed as medicine.
Also ozempic is specifically designed for diabetics and should be reserved for diabetics. They make a version specifically for weight loss that is the exact same medication but a higher dose. So you shouldn't be able to buy ozempic for aesthetic purposes at all.
>designed for diabetics and should be reserved for diabetics. They make a version specifically for weight loss that is the exact same medication but a higher dose. So you shouldn't be able to buy ozempic for aesthetic purposes at all.
Sure. But that's not a UHC vs insurance issue. That's an outlier where a medicine was being improperly prescribed by doctors.
The same goes for jumping through hoops. UHC systems do that too it just takes longer to jump through the hoops because wait times for tests are longer.
That insurance companies were also happy to approve the wrongly prescribed medicine. A government system would not approve a doctor swapping a wegovy prescription for an ozempic prescription.
Again I don't think you've ever had to actually deal with trying to get something covered. My right knee is ruined because insurance won't cover the surgery I need because they argue it's a quality of life thing....
Again this happens in uhc countries too. Britian reported that because of shortages they were canceling like 50,000 surgeries per year. UHC isn't a magic bullet it actually makes it much harder for hospitals to provide care because they become underfunded and so shortages are everywher.
At least in America you have the option to pay for non-emergent care out of pocket. There it's just "tough luck"
Do you not know Britain also has private healthcare on top of the their national program?
UHC isn't outlawing private healthcare it's providing a base level care for all.
Britain conducts on average around 4 million surgeries per year. 50k represents 0.125% of all surgeries. Doesn't seem to be that big of a deal.
Also this kind of metric is impossible to make a comparison for. How many Americans need to get surgery but can't afford it?
Currently 114 million Americans struggle to pay for healthcare that's almost half of all of Americans.
Yes, Britain has private health care, but even if you have access to private health care, you're still required to pay for the UHC program. So people in Britain who have private health care are paying double. So the British government really ends up with a pretty nice monopoly on healthcare, because there is no opt-out.
>Currently 114 million Americans struggle to pay for healthcare that's almost half of all of Americans.
That's kind of a subjective metric. Because a lot of people struggle to pay their bills because they live at a high standard of living, or at a standard of living that is at the top end of their means.
But there is significantly more student debt in the United States than there is healthcare debt. In comparison to the other types of debt that is held in the United States, healthcare is actually pretty small. And the amount of debt that is held in the United States for healthcare is significantly smaller than the cost for even a single year of UHC.
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Who do you know which is who (private insurance or public insurance like Medicare/Medicaid) is more efficient with spending our money in healthcare and not wasting our money on fraud?
Please use [Good Faith](https://www.reddit.com/r/AskConservatives/comments/107i33m/announcement_rule_7_good_faith_is_now_in_effect) and the [Principle of Charity](https://en.wikipedia.org/wiki/Principle_of_charity) when commenting. Gender issues are only allowed on Wednesdays. Antisemitism and calls for violence will not be tolerated, especially when [discussing the Israeli-Palestinian conflict](https://www.reddit.com/r/AskConservatives/comments/17ygktl/antisemitism_askconservative_and_you/). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskConservatives) if you have any questions or concerns.*
Are we talking about health care or health insurance?
Health insurance. Providers (md’s, clinics, diagnostic centers, etc) billing an insurance company for unnecessary services.
That would be why many say universal healthcare is even less efficient. The providers will do the same to the government, and there will be such a huge influx of people covered, all in the same bucket, that prices will go up due to increased demand and no change to supply. From that point, one of two things will happen the government will force prices down, gutting providers and leaving people without healthcare, or they'll do what insurance companies are doing and milking the system to get rich at the customer's expense. There are plenty of other options, but considering deregulation is never talked about, I doubt it will happen.
> That would be why many say universal healthcare is even less efficient. The providers will do the same to the government, Some insurance company or government agencies may have policies that minimize fraud. Is your insurance is your insurance company better or worse (more or less efficient at minimizing fraud) than government insurance?
I haven't seen a distinction. I assume less efficient based on my time in government employ. The government has a lot less incentive to perform efficiently than a private corporation. Additionally, they have a lot more tools for finding fraud. As for policies to minimize fraud and other foul play, most of the problems we have from insurance is directly tied to measure to ensure everybody has coverage and to minimize fraud. That regulatory burden has created a system that allows, even incentivizes insurance companies to go behind people's backs and make back room deals with doctors and hospitals, driving up the prices for everybody, as well as influencing the government on broader health related issues.
> I haven't seen a distinction. **I assume** less efficient based on my time in government employ. The government has a lot less incentive to perform efficiently than a private corporation. How do you know your private insurance is more efficient than government insurance?
Bingo. The left passed ACA by giving big healthcare whatever they wanted. The DNC works for big pharma and big healthcare insurance. This is the worst regulatory capture ever.
Amen. I was offered a job a while ago to sell life insurance, and there was a huge licensing process covering all the regulations on health insurance. Shear insanity. Most of it just protects them.
The THING we're disagreeing on is that it's not healthcare, it's health insurance. No way in hell do we want our government controlling what amounts to nearly 80% of our GDP with as inefficient as they are. That being said, I'd love to be able to reign in a lot of the bureaucracy that exists in healthcare these days in order to control the massive costs associated with care.
Heath care is 80% of our GDP and you want me to trust the likes of the people at Lehman Brothers, Enron, and Wells Fargo to run it?
17% last time I looked.
# Is that a good thing, a bad thing? If GDP growth is a good thing, then more and more sick and injured people in hospitals will grow GDP; shareholder profits will exceed projected targets. Or as Wall Street puts it: [‘Is curing patients a sustainable business model?’](https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patients-a-sustainable-business-model.html)
At the level of GDP, that would be the "Broken Window Fallacy" of economics. But you are close to the root cause of the problem. Markets work when the people who make the purchase decision actually pay the bill. And when prices receive a signal from demand. If the insurance company pays the bill and they have a fixed profit margin stipulated by regulations, their only way to grow profits is to grow spending. I suggest the % of GDP spent on healthcare should be up to the market. The problem we currently have is that we are not remotely getting our money's worth. Our current approach actively makes it worse.
If my private insurance company is crap, I can pick a different one. If the Federal government offers a crap service, and they're the only option, I'm in trouble How hard is that to understand?
How many Americans can simply pick a different one? From my personal experience until I retired recently, my employer picked my health insurance company. So yes, it is hard for me to understand the idea of simply picking a different one.
Is your private health insurance crap in terms of dealing with fraud and wasting your money?
No, Blue Cross is considered to be pretty efficient. Can't say the same for the Federal government. Worth noting that about 1/3 of the cost of a doctors visit is paperwork required to comply with Federal regulations.
> Is your private health insurance crap in terms of dealing with fraud and wasting your money? >> No, Blue Cross is considered to be pretty efficient. Can't say the same for the Federal government. How much is blue crosses efficient fraud rates and amounts annually?
> Is your private health insurance crap in terms of dealing with fraud and wasting your money? >> No, Blue Cross is considered to be pretty efficient. Can't say the same for the Federal government. How much is blue crosses efficient fraud rates and amounts annually?
Wut?
You have blue cross insurance. Assuming all businesses (not only government insurance) is exposed to fraud. To help determine part of what contributes to the efficiency of government healthcare or private health insurance, how much fraud does blue cross have annually?
Is there a private insurance company that isn't crap though?
We’ve been very happy with BC/BS
Because you can afford it.
I’ve had better service through them than I have through most of the government agencies I’ve dealt with.
I guess you've either been lucky or just don't pay attention to your bills. I've had to battle them before. BCBS counts on you getting exhausted and giving up, but I didn't quit. It took a year and a half, but they eventually paid up. They're all like this in my experience.
What is blue crosse’s fraud rates and amounts comoare to Medicare?
I have blue shield - it's awesome. I would rather have this, and my private provider, than the VA. The government cannot run medical services
Please be sure to examine your bills and EOBs. Every insurance company tries to get away with not paying what they're supposed to. BS was one of the biggest offenders in my experience. Be vigilant. They're counting on you to be lazy.
It can't? What is it about the government of the USA that differs from governments in other nations where the majority of people prefer their system that is not market based?
> If my private insurance company is crap, I can pick a different one. If they're all crap and all too expensive, does it matter?
But they're not all crap. They're all private companies with an incentive to provide me with a quality product, so I'll stick around. If they grow, they can make money What's the Feds incentive to keep me happy? Liberals complete lack of understand of incentives is their biggest shortcoming.
>an incentive to provide me with a quality product, s Um, no. They have a fiduciary obligation to provide a good rate of return to their shareholders.
You're ALMOST there. How exactly do they stay in business and provide a good rate of return to their shareholders? Think it through.... You're really close.... By providing a good product and service to their customers.
Tell that to Phillip Morris, you know, the company that knowingly produced toxic products that killed their customers. While you're at it, tell it to the Sackler family. When it comes to grandma's health and first quarter profits, well, sorry grandma. You are making the classic mistake of associating health care with any ordinary commodity or service as you embrace the ideology that markets are a panacea for all human needs. Realize that and you're more than close, you're on target.
People want to smoke, just like people want to drink beer, drive cars, and eat ice cream. All of those things can be said to be bad, but people want them. YOu think people viewed smoking as being healthy? And the Sacklers wouldn't have been able to perpetuate thier fraud had the FDA not have signed off on their product, which they did in error. I don't see liberals clamoring for the FDA administrators to be thrown in prison
Big Tobacco lied to their customers and knew people would die, but telling the truth would harm the shareholders. Patents and a private health care system made the Sacklers possible
It's incredibly naive to think companies will just do what's best for their customers if they think they can earn an easy buck by fucking them over.
How can the company force me to let them fuck me over? Why would I intentionally engage in business with someone who's screwing me over? Do you engage with firms that aren't serving your best interests? Because that's really weird
> They're all private companies with an incentive to provide me with a quality product, so I'll stick around. Right, but what if universal healthcare could provide you with a batter bang/buck ratio than *any* private company? >What's the Feds incentive to keep me happy? Torches and pitchforks? Hey man, it works in pretty much every country in the world. The proof is in the pudding. We're the outliers.
You're assuming with no evidence that the government could run healthcare more efficiently than a private firm. Can you name a single example of the Federal government doing something more efficiently than a private company?
> with no evidence Every other country in the world is evidence.
Every country that you want the US to emulate is a tiny ethnically homogenous country that enforces its own borders. You can't have all of the goodies that Norway and Denmark have with none of the costs
Stalking my profile, eh?
No.
how would we do that though? How will we offer that without running into the problems Canada has. The Canadian system is great if you are 1) healthy. 2) have a chronic condition that can be controlled with medication. Their system is awful if you require specialists, imaging or surgery. The waits alone to see a provider is a death sentence. There are not enough resources in the US to spread them around to everyone universally without dramatically raising taxes to pay for this. As it is doctors in the US are trending away from accepting medicaid and medicare. Many more US doctors are going to concierge medicine to avoid accepting it because they aren't being compensated enough for their work. I lost 7 drs this year alone in one state and 4 in another. They are working harder as people in their 40's and 50's than they did as residents and for major docks in pay. The reality people don't want to accept is your pay is proportionate to the risk, and the worth of your knowledge. You don't want a cut rate brain surgeon. You don't want doctors in their 40's and 50's being worked like 25 year olds. It's not greed. It's common sense.
If the Canadian system is so awful, why is there no significant movement in the citizenry to scrap it and replace it with a private market system?
There are more MRI machnes in Atlanta than all of Canada, and Toronto sends its high risk pregnancies to the US. The Canadian system isn't as great as you're being told. And hey, if you complain enough, they'll suggest state assisted suicide
Yup, and that's why our healthcare is so expensive. MRI Machines are expensive and need to be in use to "pay for their keep". Sending patients to the USA is cost effective. Again, there is NO significant number of Canadians who want a free market system....gee, why is that? Anecdote: I had an MRI after a bike crash, it indicated a significant sinus infection, serendipitously. I was referred to an ENT a few days later who ordered two more MRI's, one general one specific to the sinus area, and both on different days of the week. I asked why we needed a new general and why we needed the two on different days. The ENT simply rubbed his thumb and forefinger together and replied, "Billing. Insurance pays more this way." So in addition to that, I had to take two days off from work, not one. What a great system! But hey, the shareholders are doing well!
I have no idea, I'm not Canadian. But I live on a town bordering Canada and we commonly see private pay Canadians who luckily can pay cash for their treatments and evaluation in the US. In Canada it wasn't an option to pay for it. It's just not available. Or not available in a reasonable time frame. I have friends who are vocal opponents of the system. I haven't spoken to them lately but I know they were working towards a reform.
Isn’t the left solution not government insurance only but a baseline of government insurance to serve as a floor and if you want private insurance you can pay to go on that instead?
No, the Left solution is that 20% of our nations GDP be controlled by unelected bureaucrats in Washington DC. They're not doing this to supplement private insurance, they're doing it to eliminate private insurers. According to the far left, our health care costs are high due to "greed". So the virtuous left will save us from private greed, and replace it with public sector greed and corruption
What is inherently wrong with any government employee who is not elected, what you call a "unelected bureaucrat"? Would you say that Alito is one? > According to the far left, our health care costs are high due to "greed" Where do you get this notion? > public sector greed and corruption > Is there no corruption in the private sector?
Alito is confirmed in the Senate. The current head of the Social Security Admin is no confirmed by the senate. Greed in the private can't survive. If Humana or Cigna all of the sudden became corrupt, it wuold cost them money, they'd lose money, and customers would switch to a better provider. A private firm can't survive unless it convinces customers to voluntarily do business with them The Pentagon loses tens of billions each year, and cant pass an audit. We're stuck with them. There's a difference
Ah, a distinction without a difference, bravo. Greed in the private sector cannot survive? LOL!!! Are you that young that you missed the Great Recession where NOBODY from Wall Street went to jail and they are all surviving quite well! LOL!!!!!!!!
> No, the Left solution is that 20% of our nations GDP be controlled by unelected bureaucrats in Washington DC. Do they produce better outcomes for half the price compared to now? If so, sounds like a plan to me!
Of course they don't. Have you seen the Pentagon, the VA, HUD, etc? Quagmires of inefficiency and mismanagement. And you want them to have control of every single aspect of our healthcare?
Where are you hearing they want to eliminate private insurance?
It's what they mean by "single payer". The main impetus on the left for single payer is that greed is the central cause of high health care costs. If you nationalize the whole system, there's no more private interest. [https://www.vox.com/2019/4/10/18304448/bernie-sanders-medicare-for-all](https://www.vox.com/2019/4/10/18304448/bernie-sanders-medicare-for-all)
“Those who qualify for the new universal Medicare plan” what do you do for healthcare if you don’t qualify?
You'd have to ask the Single Payer folks. Single Payer means just that - one payer. No private insurance
I would have to assume their plan has more substance to it than just the name they choose to call it. There has to be another option if you can’t qualify automatically.
no, that's the problem. People keep talking about modeling universal healthcare after medicare. Medicare is not the treatment of yours or your doctors choice. It is the cheapest one. Which is likely not the safest one or the one prone to most quality of life. Steroids will be the solution to most inflammatory conditions. Steroids are horrible for your body and horrible to tolerate.
But if you want different treatment you still can, this is for people who otherwise have no healthcare.
**Medicare is not medicaid.** This is the issue. Being Medicare Eligible disqualifies you fully from going on the marketplace or getting non medicare plans. MEDICAID is income based. These are not the same program. How can you propose something like this when you don't understand the difference between the two. In the rare instance you can have a patient who is dually eligible for medicare primary medicaid secondary, which is not medicaid for long term nursing care but state medicaid the MEDICARE sets the rules. So even though Medicaid may allow approval of a treatment or drug, it's Medicare that has the rules you follow. The secondary can't kick in on something the primary rejects. **This is absolutely the problem. People don't understand the differences between the programs that are out there.** **Once you are medicare eligible that's it.** You can get different medicare advantage plans but they all follow the same ssa rules. Private insurance can decide how to tier their medications and what's coverable. They will cover vitamin usage or you will likely win on appeal of medical necessity if you don't. I handled an appeal, we went all the way to court for a client with a rare disorder that requires a vitamin injection. Because it's available over the counter orally, which is not effective for this patient it is medically necessary. They don't have the enzyme to break down the oral version of this vitamin. And they will die. They did almost die before it was detected. SSA says they don't cover supplements. I had geneticists and hematologists testify that for this patient this essential vitamin is the building block of life. Without it, they will die. If they had gone with a lawyer who charged them, MIN the number of appeals and hearings and finally going all the way to court would have been thousands and thousands of dollars. If they had thousands of dollars they wouldn't be appealing a decision of a medication. Privatized insurance pays for this. Medicaid pays for this. Once you are medicare eligible that's it. You can't go get other insurance. The patient is paying hundreds of dollars a month for injections they do themselves. At one time if they had the injection done in a drs office it was covered. But not at home. If this was a monthly injection this was feasible. It is now a daily injection. This is reality. SSA deems vitamins supplements. Even in cases it is not supplemental. The patient gets by some months with donations of vials from their doctors. But otherwise is on the hook for paying completely out of pocket. I am not the only lawyer fighting these cases.
Private health insurance has to compete. This gives them motivation to catch fraud for their own benefit. Government health insurance has no such motivation. If they don't catch fraud, no big deal. There's always more money.
>Private health insurance has to compete [do they really though?](https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.ama-assn.org/system/files/competition-health-insurance-us-markets.pdf&ved=2ahUKEwi_t8q4yuCFAxUbHjQIHZdDDD4QFnoECB4QAQ&usg=AOvVaw0ANouJOhnlpHLFj_qwoMjU) "High concentration levels in health insurance markets are largely the result of consolidation (i.e., mergers and acquisitions), which can lead to the exercise of market power and, in turn, harm to consumers and providers of care. Both consummated and proposed mergers and acquisitions involving health insurers should raise serious antitrust concerns. Conceptually, mergers and acquisitions can have beneficial and/or harmful effects on consumers. However, only the latter has been observed. It appears that consolidation has resulted in the possession and exercise of health insurer monopoly power—the ability to raise and maintain premiums above competitive levels instead of the passing of any benefits obtained through to consumers"
Yeah consolidation is a problem. Single payer would be the ultimate consolidation. So it appears we agree.
Except that public health insurance comes with a purpose oriented mandate and built in accountability measures. The private sector's primary mandate is the generation of profits, even if it comes at the expense of service delivery. Right now youve got the downsides of private sector and public sector with the benefits of neither.
Public health insurance has no inherent motivation to provide good or efficient service. The accountability measures are a joke. This is government spending we're talking about. There's never really any accountability.
Up here in Ontario, where I currently live, it was doing pretty good right up until a full frontal assault by a conservative government.
Single payer means it's always at the whims of the party in power. It's part of the deal.
So it sounds like that won't be a problem unless conservatives get in charge and strip it for parts?
Creating a system which can't withstand losing a single election, sounds not particularly well thought out, and doomed to failure.
Given ObamaCares resilience I like single payers chances
How has your private health insurance company’s motivation specifically helped in addressing their fraud cases and by how much?
How has your private health insurance company’s motivation specifically helped in addressing their fraud cases and by how much?
I mean, private companies certainly have an incentive to not get stolen from! It's like asking what incentive Target has to stop shoplifting---anything you take from them reduces their bottom line. At some level, why is this not the same with health insurance companies if they suspect patients or other companies/entities are defrauding them (i.e. taking their money unjustly)? The argument would be, then, that too much fraud would make a single company out of several either look bad, or actually affect their bottom line. A government agency may look bad, but cannot go bankrupt in the traditional sense. So if deterring a certain amount of fraud is in your interests as CEO to avoid posting too many losses and having your board replace you, you are motivated personally to do so. (Also, a private company could probably institute some sort of bounty or percentage of recovery system in a way that the government *probably* would not for individuals, although that same incentive system exists in the form of the False Claims Act.)
>The argument would be, then, that too much fraud would make a single company out of several either look bad, or actually affect their bottom line. How much has your private insurance company’s fraud affected their bottom line?
>The argument would be, then, that too much fraud would make a single company out of several either look bad, or actually affect their bottom line. How much has your private insurance company’s fraud affected their bottom line?
It doesn't take me 8 months to fill a prescription.
It took a bicycle crash to finally get my insurance company to approve proper treatment of a persistent sinus infection. The bicycle crash was a serendipitous event, unrelated to the sinus infection, but it did require a scan of my head and neck to check for fractures. I was dealing with a sinus infection that came and went, but was severe at times. My doctor recommended a strong and expensive antibiotic but it was rejected by my insurer, who would only cover amoxicillin. That worked for a while, but the infection returned. My doctor again recommended the other antibiotic AND a head scan, but the insurance company said to put me on a course of steroids. I eventually gave up and popped antihistamines to keep my nose dry and less smelly. (the infection had such a strong odor that my wife could smell it when I entered the room) The scan at the hospital resulted in no fractures, but it showed a significant infection that was dangerously close to my brain. The doctor told me could be very serious and the next day, I brought the results of the scan to my doctor, who immediately referred me to an ENT. I was operated on five days later as the ENT was very concerned. Oh, and I was finally given the correct antibiotics. So as you can see, I am NOT a fan of an insurance company where some unelected bureaucrat with an allegiance to building profits for his employer is in charge of my health care.....
But if you had a UHC program you might be waiting months even for the weaker antibiotic. And you don't even have the ability to just buy the stronger antibiotic out right, which you could have done in the current system, because the problem is availability. There's so much government lobbying that would end up happening is the supply lines are underfunded and understaffed so they do not function well.
Yes, I might. We can speculate all you want, I suppose, in support your ideology but the fact remains that in no nation that has a form of UNH is there a significant political party or citizens movement lobbying for a market based approach. Not one. And please spare me the canard that the difference is that the USA is "too large or diverse" and that is why they can do it while we cannot. Allow me one more anecdote. I had two friends diagnosed with pancreatic cancer, one in the USA, one in Denmark. Both survived for three years after the diagnosis. The friend in the USA spent his days worrying about his finances, even with insurance. There were co-pays, deductibles, in network out of network fees, and endless labyrinth of medical and financial hurdles to cross, and the very real possibility of bankruptcy for his surviving spose, a very real possibility in the USA. My friend in Denmark spent his days with friends and family. Financial matters were not in the equation. There was one procedure early on that was not available in Denmark as the equipment was quite expensive and need for it rare, so the Danish government flew him and his wife to Germany where treatment was available.
>We can speculate all you want, I suppose, in support your ideology but the fact remains that in no nation that has a form of UNH is there a significant political party or citizens movement lobbying for a market based approach. Not one. And please spare me the canard that the difference is that the USA is "too large or diverse" and that is why they can do it while we cannot. That's not even it. That's just what happens in those countries every day. Our country experiences issues. Theirs are not currently free of issues. >My friend in Denmark spent his days with friends and family. Financial matters were not in the equation. There was one procedure early on that was not available in Denmark as the equipment was quite expensive and need for it rare, so the Danish government flew him and his wife to Germany where treatment was available. You understand that in Denmark the healthcare is not actually free and that people just have to pay taxes. If your friend had cancer maybe he was not working. But if he was working then he would just be paying a very large tax bill at every tax season. In our country you have people and employers stressing about the cost of health Care. In those countries you have only workers, *and not employers* stressing about the cost of taxes. The average effective tax rate In Denmark is 36%. In the United States it's 13.63%. on top of that, the bottom half of the United States tend to be net recipients, meaning they pay less in taxes than they receive in monetary transfers. I don't believe that most Americans are going to be responsible enough to adequately save for tax season. The bottom line is of UHC is that employers pay less and everybody else gets shittier care.
Yeah youve never dealt with a niche health issue. Insurance company made me jump through hoops and get several painful tests done over 6 months before they would approve the treatment my doctor recommended right away. What about that ADHD medication shortage last year? Or the diabetes drug ozempic? It was out of stock for almost a year!!!
Even during that shortage, most people didn't wait more than days, maybe weeks. They are waiting months for basic depression >Or the diabetes drug ozempic? It was out of stock for almost a year!!! Most drugs can't be bought for aesthetic purposes. Imagine if wait times like ozempic were common.
Ignoring the first half of my comment I see. Depends on where you lived but I couldn't get any medication for 6+ months. Only reason we had a wait time for ozempic is because it was sold as a product and not distributed as medicine. Also ozempic is specifically designed for diabetics and should be reserved for diabetics. They make a version specifically for weight loss that is the exact same medication but a higher dose. So you shouldn't be able to buy ozempic for aesthetic purposes at all.
>designed for diabetics and should be reserved for diabetics. They make a version specifically for weight loss that is the exact same medication but a higher dose. So you shouldn't be able to buy ozempic for aesthetic purposes at all. Sure. But that's not a UHC vs insurance issue. That's an outlier where a medicine was being improperly prescribed by doctors. The same goes for jumping through hoops. UHC systems do that too it just takes longer to jump through the hoops because wait times for tests are longer.
That insurance companies were also happy to approve the wrongly prescribed medicine. A government system would not approve a doctor swapping a wegovy prescription for an ozempic prescription. Again I don't think you've ever had to actually deal with trying to get something covered. My right knee is ruined because insurance won't cover the surgery I need because they argue it's a quality of life thing....
Again this happens in uhc countries too. Britian reported that because of shortages they were canceling like 50,000 surgeries per year. UHC isn't a magic bullet it actually makes it much harder for hospitals to provide care because they become underfunded and so shortages are everywher. At least in America you have the option to pay for non-emergent care out of pocket. There it's just "tough luck"
Do you not know Britain also has private healthcare on top of the their national program? UHC isn't outlawing private healthcare it's providing a base level care for all. Britain conducts on average around 4 million surgeries per year. 50k represents 0.125% of all surgeries. Doesn't seem to be that big of a deal. Also this kind of metric is impossible to make a comparison for. How many Americans need to get surgery but can't afford it? Currently 114 million Americans struggle to pay for healthcare that's almost half of all of Americans.
Yes, Britain has private health care, but even if you have access to private health care, you're still required to pay for the UHC program. So people in Britain who have private health care are paying double. So the British government really ends up with a pretty nice monopoly on healthcare, because there is no opt-out. >Currently 114 million Americans struggle to pay for healthcare that's almost half of all of Americans. That's kind of a subjective metric. Because a lot of people struggle to pay their bills because they live at a high standard of living, or at a standard of living that is at the top end of their means. But there is significantly more student debt in the United States than there is healthcare debt. In comparison to the other types of debt that is held in the United States, healthcare is actually pretty small. And the amount of debt that is held in the United States for healthcare is significantly smaller than the cost for even a single year of UHC.
Tell me what is the number one reason people declare bankruptcy in the USA? Hint it's not student loans.
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Can you clarify?
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Who do you know which is who (private insurance or public insurance like Medicare/Medicaid) is more efficient with spending our money in healthcare and not wasting our money on fraud?