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Your anger at health insurance companies is misplaced. If the profit motive is the problem, a public option is a solution, but American voters (especially right-leaning ones) have been pretty emphatic about refusing it.
Companies have to deny some claims or else premiums would have to rise for everyone. UHC's profit margins are actually far lower than e.g. Apple's.
It's not. You need to reduce expenditure on the medical system. And way way too much of it ends one way or another as someone's salary there. so there is great resistance to any reform that will make anyone in the medical industrial complex earn less.
If you reduce expenses hundredfold it will be trivial to cover costs no matter with insurance, out of pocket or taxes. If you tipple them - the system will go bust, no matter how it is financed.
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The insurance companies, the AMA, and the feds are locked together in a perverse cycle that produces a system that somehow spends even more on healthcare than socialized medicine countries...but the lion's share of the extra money goes to doctor's salaries (artificial scarcity driven by the AMA, med schools, and residency limitations) and ever-increasing administrative costs (additional regulations and insurance bureaucracy).
Doctor's salaries are not a significant percentage of healthcare spending. What percent of spending would be required for you to consider "lion's share" to be an accurate description?
I said the lion's share goes to higher salaries and higher admin costs. The abstract of the study I linked in my comment:
The United States far outspends Canada on health care, but the sources of additional spending are unclear. We evaluated the importance of incomes, administration, and medical interventions in this difference. Pooling various sources, we calculated medical personnel incomes, administrative expenses, and procedure volume and intensity for the United States and Canada. We found that Canada spent $1,589 per capita less on physicians and hospitals in 2002. Administration accounted for the largest share of this difference (39%), followed by incomes (31%), and more intensive provision of medical services (14%). Whether this additional spending is wasteful or warranted is unknown.
31% + 39% = 70% - over two thirds of the U.S.'s increased per capita physician and hospital spend over Canada's is down to those two things. That's "the lion's share" by any measure.
Current physician salaries are 8.6% of healthcare costs per Stanford. Looking closer at your data, it seems to be very old - it's missing 15+ years of physician salary pay cuts (which have been going on yearly for decades) and 15+ years of increased administrative bloat and other factors (such as increased excess services).
If you cut physician salaries in half across the board (which simply isn't possible, if you did that some specialties would be making less than nurses, and specialties like OB with an immense malpractice burden would be financially impossible), then you would barely make a dent in total expenditures and introduce significant new problems - who is going to work weekends and holidays and nights after such a massive pay cut?
Increased administrative costs are unnecessary, expensive, and much easier to reduce.
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The ACA was designed to make private health insurance so onerous a hassle and so hideous an expense that the public would overwhelmingly approve Hillary’s single-payer she’d been working on since the 90’s.
Then Trump won, tried to kill the ACA, and was stopped by McCain’s spiteful deathbed vote. So it endures.
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So break the doctors' cartel. What do insurance companies have to do with this?
The ACA mandates that insurers have to spend at least 80% or 85% (based on size of market) of premiums on actual provision of healthcare.
Cost cutting is of little use to them. If they take in $100M, currently spend $85M on medical, but are able to cut medical costs by 30% to about $60M, then they'd also have to cut that $15M allocated to other stuff down to about $10.5M. And give up about $30M in premiums.
With this regulation becoming more efficient hurts your bottom line.
But if they can grow the amount spent total, then the 15% or 20% they're allowed to use on other things also grows.
It's basically cost plus contracting, which is apparently popular when you're spending other people's money.
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Story in healthcare same as everywhere - you have an increasingly rich populace with a rivalrous good that is non-discretionary (housing, education, childcare, healthcare), and the Government/private actor response is to subsidize demand and regulate supply than go shocked-pikachu-face.jpg when costs skyrocket.
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Insurance companies aren't allowed to be insurance companies anymore. To the degree they have a profit motive, it's highly dysfunctional.
Case in point, under the ACA the profit a health insurance company is allowed to make is capped proportional to their operation expenses. Off the top of my head, I think they are only allowed 20% overhead. So 80% of all premiums collected need to be paid out to claims. I've actually gotten refunds from my health insurance (albeit only once) when they were in violation of this law and had to give some money back.
So really, health insurance companies can't just deny claims and keep the money. They only way for them to make more money is to let the cost of everything skyrocket, raise premiums sky high, and then keep 20% of a much larger pot. Which is more or less what has happened the last 15 years since the ACA was passed.
Do you have any data to support that argument? I'm not an expert, but 5 minutes on google makes it look like premiums have been increasing in a straight line since at least the late 90s.
See figure 1.12 and also this reference.
I honestly don't know how to square those charts with my personal expenses, and the expenses of those around me, any more than I know how to square the official rates of inflation with the same. I don't know how well those indexes capture people's plans getting phased out and replaced with entirely new plans that cost twice as much. I don't know how well those indexes capture the plans raising copays, deductibles, etc so you are getting less and less despite paying more and more. I don't know how well those indexes are capturing the shrinking pool of health service providers that even accept certain plans. Pre-ACA I had zero issue with any doctor I wanted to goto accepting my insurance. Post-ACA they started getting a lot pickier about which plans they take.
Basically, I gotta plead "Lies, damned lies, and statistics".
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Premiums are only one component of healthcare costs. A "straight line" is one thing, the slope of the line is what matters. Family premiums are up 89% since 2008, compared to ~43% cumulative inflation.. Outcomes and features have degraded since ACA, I'd argue.
Your point (the overall rate of change pre-and-post ACA) seems valid. However, I don't think "things continued to get way worse at the same rate" counts as a victory.
Obamacare accelerated the inevitable failure of this healthcare system and was only engineered to be a pernicious trojan horse for single-payer.
The initial argument was:
I agree, the slope of the line is what matters. If your argument is that Obamacare increased premiums, you would expect to see the slope of the line increase after the ACA was passed, correct? Do you agree that that is not what we see, and that the post I was replying to was incorrect, pending them making some kind of rebuttal?
Do you have any data about outcomes deteriorating? That doesn't seem like a straightforward thing to measure.
It doesn't, it counts as Whiningcoil being wrong. You're making a new argument and moving the goalposts.
Maybe. No offense, but I'll believe it when I see data.
WhiningCoil is correct in that the ACA means insurers make more money through larger claims. There's no downward pressure to reduce costs from insurance companies. When they destroy last year's plans and remake new ones (to get around ACA's maximum cost increases!) they just make them more expensive. There's no consequences for introducing a massive headache to everyone, every year, forever.
That's actually not my argument. I agree that the data shows premiums have continually outpaced inflation at the same horrific rate for the past 30 years. Obama promised that the ACA would reduce premiums. The CBO - which is trotted out as "non-partisan" by every NPC every time we're ramming through another enshittification mechanism through our legislature - predicted Premiums would drop by 13% by 2016.
The market competition we were promised was a lie. Instead we've watched massive mergers and regional monopolies emerge. Longer wait times, fewer services at urgent care, the death of the family practice, monopolies on software and technology, deductibles have tripled.
You can't just ask for data as a rebuttal - you would have to be blind to think the system is providing any more value for the money today then it did in 08.
In that vein, you and I both know that there's no "data" to point directly to a trojan horse, but the level of incompetence that the ACA has exhibited could easily count as malice. Almost every single promise was an outright lie, with perhaps the exception of covering the obese smokers who didn't have insurance. It's genuinely difficult to think of a more destructive force in the average american's health and wealth in my lifetime.
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How much of the change in family premiums is due to more elderly dependents?
The rate increase is only slightly higher for family than individuals. They're essentially the same.
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He's definitely right that the ACA puts that cap on non-benefit expenses (including profit), but I would tend to agree that I'm not sure how much that raised premiums. The main thing the ACA did was put the onus on paying for chronically ill people not on medicare/medicaid/Employer insurance on the taxpayer (via APTCs) and the unsubsidized making more than 250% FPL (to some extent) and 400% FPL (to a very large extent).
Not sure why we didn't just put those chronically ill in Medicare like the dialysis population....though eventually you run into the problem that Medicare rates don't sustain providers - commercial population subsidizes. Tricky little issue we have here.
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No, a “public option” is not the solution. The solution is deregulation. Medical treatments that were perfected 40 years ago should be basically free, and administered (if that’s even necessary) by a low wage technician.
A “public option” is just a shift of control from private companies to the government.
A solution is less preventive care, which does not save money despite the hype. how about a return to people only seeking healthcare when actually sick.
Ah, the medishare option.
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Most of medicine is based on prescribing drugs, for which a person needs to understand drug interactions, risk-benefit ratios, and basic biochemistry. And most of the other part is surgery, which requires an experienced hand. You know, like a doctor.
So who's going to pay for the drugs people need? And who's going to pay for the drug development? And who's going to cut your appendix out when you have appendicitis? A "low wage technician"?
All of that could be handled by a technician with a good GPT bot
I've been waiting for decades for laser eye surgery to be perfected and standardized to the point that I can get my severe nearsightedness corrected to 20/20 or better, forever, by a robot at my local CVS for $9.95.
Laser Eye surgery today is miles better than the procedure was even 20 years ago. Here in the UK you can get the full procedure done on both your eyes for $2000 combined as an outpatient case. If you're willing to spend $2500+ you can get some of the fancy bells and whistles where each little patch of your cornea gets corrected exactly rather than a uniform correction being applied all over (this is something you couldn't get done in the year 2000 for example).
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Lasik is unironically used as an example of a field that insurance doesn't touch that has in fact gotten orders of magnitude better and cheaper over the years.
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I realize you’re likely joking but you should def get lazik, my vision is now better than 2020. Very much worth it
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The same people who do now: pharmacists.
Keep developing. Somehow every other industry seems to be developing new and interesting things without needing a protection cartel to allow them to do so.
This is what insurance should be for.
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Yeah, and they're dumbasses for doing that, which is my biggest disagreement with the Republican party. I was a single-issue on this for several years in the 2010s before I realized the Democratic party would never spend political capital on solving the problem -- which they do, largely, because of lobbying by the health insurance companies, for which reason I hate them.
May I ask why you think conservatives are stupid for denying public insurance options? As someone who has experience in both (consumer side) private and public insurance, the only reason why public insurance is affordable is because expenses are shifted to taxpayers instead of the individual insurer. The actual price per service is no different: collective bargaining does not give the government any particular advantage in negotiating prices for services. Almost all public health services have massive budget overages and increased costs which are expected to increase as time continues as well as having issues with patient backlogs.
In the US, Medicare (for elderly and for certain qualified disabilities) accounts for 17% of the national budget. Once again, the only reason for affordability is due to the taxpayer shouldering the costs whose base is dwindling. This isn't even accounting for standard government inefficiency as the US government is incoherently cost insensitive and unable to make sensible budgetary decisions.
So while I agree that private health insurance has many issues, it at least is self-maintaining and doesn't have the large macro issues that government health programs are currently facing.
Let me apologize for the tone of my recent posts on this topic, which were really dumb Twitter-tier reactions and don't reflect either my values or the standards of this place.
Yes, and I'm saying this is a good thing, and the percentage should be higher. It's a fair point that the public option is unlikely to increase efficiency, but increasing efficiency isn't really the goal for me. I like the idea of a public option because it means giving money to the government that is constrained by the Constitution, the courts, administrative procedure, etc... while giving money to a private insurer, while they absolutely are regulated to death, means giving money to a party whose entire purpose is to take as much of your money as it can legally get away with while giving you as little in return as they can legally get away with. It's the alignment of incentives I find disconcerting, not the level of efficiency.
I don't agree with the "healthcare is a human right" thing, but I do believe that it's right for society as a whole to shoulder the burden to take care of people who are vulnerable, struggling, chronically ill, etc. I put social welfare policies, particularly surrounding healthcare, in the same basket of public goods as roads, bridges, police officers, defense -- it's part of the fundamental social fabric that enables people to live at all, and shouldn't be subject to the whims of the market.
To be clear, my view on the Republican party on this issue is not that conservative voters examined the evidence closely and made a cost-benefit analysis, it's that conservative voters hate the idea of the public option because it's the government doing stuff, and there's an axiomatic belief among Republicans that the public sector is inherently inferior that is just as dogmatic as the belief among Democrats that the private sector is always exploitative.
Despite what my strong feelings on healthcare may suggest, I'm not actually particularly dogmatic on economic issues: except to say that I believe what should be done is the option that empowers ordinary people to live the best and most fulfilling lives as is possible. There are some areas where giving people more choices and the freedom to make decisions in a free market gives them the most power -- but likewise there are other areas where the amount of knowledge and wisdom a person would have to accumulate to make a judicious choice is so ludicrously high that people do need government officials to regulate away bad choices and build a system where people have the legal right to be treated fairly.
If that means trickle-down in one case, fine, if that means government monopoly in another, great, if that means single payer in one context, sure, if that means tax breaks at one point, I'm all for it. I'm apparently being an economic progressive today, so I'll throw some meat to the fiscal conservatives in the audience and say I think most concerns about corporate greed are silly, and price increases usually reflect underlying economic variables. Price fixing in particular is the worst possible solution to any economic problem.
I'm happy to agree with the more libertarian side of the fence that our current system is regulated to death and has the worst aspects of both private and government-run healthcare, but I don't see the solution being deregulation and turning healthcare into a McDonald's menu where people have to price-match and pay for add-ons in times of extreme time-pressure, information asymmetry, and profound emotional and physical stress. If there's any time whatsoever where we can be absolutely sure people aren't Homo economicus, it's when they have to make serious decisions that affect the life, death, and serious suffering of themselves or a loved one.
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30% of US health expenses are attributed to administration, which in the US context usually means the armies of secretaries hired by hospitals to not mess up billing and to argue with insurance providers, who have their own armies of secretaries hired to deny claims. If there were a public option in the US, it would (hopefully) make clear what is covered and what is not in an unambiguous way, which would make these armies of secretaries redundant.
But who am I kidding? Health care inefficiency is a jobs program for millions of white-collar PMC employees of extractive middlemen, and it will remain popular to kvech about high prices while doing nothing to bargain down prices as long as we rely on "employers" to pay for our medical expenses. Meanwhile kickbacks and bribes are legal as long as the people being bribed are responsible for buying health care equipment for us (hospital administrators) and buying drugs for us (group purchasing organizations). The corruption has been normalized.
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