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Thread: Pay now, care later

  1. #51
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    Quote Originally Posted by Madeline View Post
    No, prices do not vary by age. Not in a group policy purchased from the employer.
    But they do on the market.

    People should pay approximately what actuaries predict their health care will cost, plus a profit margin.
    But they don't. Some are treated special.

    That's not even insurance! There's no risk spreading at all in your regime.
    Yes there is. Not every 58 year old gets life threateningly sick or injured. We don't make 30 year olds pay the same for life insurance as 70 year olds. We don't make Corolla drivers pay the same for insurance as Ferrari drivers. Pricing needs to be variable according to risk.
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  2. #52
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    Quote Originally Posted by bajisima View Post
    Our doctors and hospitals offer an immediate 35% discount if you pay your bill in full at the time of service. So you bet the profit is indeed much higher.

    Our dentist has been doing this forever in regards to payment. "Full payment when services are rendered" is on the desk. So if you have a deductible or copay, they require it be paid when the work is done, then insurance is billed. My medical deductible currently is $10,000 so that would definitely delay me seeking anything that wasn't urgent. Its almost like some horrific Charles Dickens story where you go in to have a baby but cant afford the deductible so they hold the baby for payment...
    Sorry this is not exactly on topic but my Vet actually thought about keeping my cat until I returned with my credit card that I had not put in my purse as I had thought I did. And many Vets do this - charging you boarding fees until you pay. He ended up only holding her meds hostage. I know a cat isn't the same as a baby, but your scenario isn't too far off, imo.

    PS, I know many people with a high monthly payment AND it's still thousands until insurance kicked in. One of my friends found out that being depressed is like a buzzword. they have to pay more attention to you if you say that. She was desperate to have a procedure done before the end of last year, because she had already met her deductible.
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  3. #53
    ~Standing My Ground~ Sassy's Avatar
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    My dentist offers a cash discount. Said it's better for me and them not to waste on a plan. They don't get paid as much and I don't get as much of a savings with the middle-man.

  4. #54
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    Quote Originally Posted by bajisima View Post
    Health insurance is a gamble, we are gambling we wont lose and get sick. But the problem is we are gambling with all our money so if we do get sick we cant afford it.
    HSAs are not a gamble..

  5. #55
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    Quote Originally Posted by Neomalthusian View Post
    Your increasing insurance premiums are a reflection of deeper issues related to the cost of health care. I get it, the system is not working well. There are many problems and many regressive, backward, unfair provisions in laws and policies across the country, primarily having to do with who pays what. Lots of people on the low end get a free ride, lots of old rich people on the high end get a free ride, government employees get ultra-platinum health benefits for virtually nothing, but lots of people in the middle, young and middle-aged entrepreneurs for example, they get the shit end of this stick. Lots of arbitrary inequality embedded into our system right now.

    But your tendency to simply blame the insurance company because your premiums are increasing is not looking deeply enough at the situation. You should put down the pitchfork. Yes insurance companies want to make money, but when it comes to health insurance companies, they can't necessarily just go and do that, especially now. They face risks of huge financial losses and they face risks of adverse selection (mandates notwithstanding).
    Then perhaps it's time for insurance companies to exit the market altogether.
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  6. #56
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    Quote Originally Posted by labrea View Post
    Then perhaps it's time for insurance companies to exit the market altogether.
    This would allow providers to lay off enormous numbers of billing specialists and non-clinical staff. It would save some money. But this alone wouldn't make our health care costs in line with the rest of the world.

    The root of our problem is not merely insurance companies. People keep trying to use them as scapegoats, which is probably a leftover from the Obama era when they did nothing but blame insurance companies for everything.

    There need to be fundamental changes in the way health care is provided.
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  7. #57
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    Quote Originally Posted by Neomalthusian View Post
    Your increasing insurance premiums are a reflection of deeper issues related to the cost of health care. I get it, the system is not working well. There are many problems and many regressive, backward, unfair provisions in laws and policies across the country, primarily having to do with who pays what. Lots of people on the low end get a free ride, lots of old rich people on the high end get a free ride, government employees get ultra-platinum health benefits for virtually nothing, but lots of people in the middle, young and middle-aged entrepreneurs for example, they get the shit end of this stick. Lots of arbitrary inequality embedded into our system right now.

    But your tendency to simply blame the insurance company because your premiums are increasing is not looking deeply enough at the situation. You should put down the pitchfork. Yes insurance companies want to make money, but when it comes to health insurance companies, they can't necessarily just go and do that, especially now. They face risks of huge financial losses and they face risks of adverse selection (mandates notwithstanding).
    They're only part of the problem. But they are part of the problem. The fact that a mega industry like that, with that lobby, has a powerful incentive to increase the overall costs of medical care is a problem. I do not want to sift through every possible scenario for how they might influence studies, deploy SME's, strong-arm hospitals and patients into protocols...why should we explore every way that this completely ass-backwards profit motive can corrupt the industry? It's going to attract and fuel corruption by its nature. The setup is idiotic.

    The profit motive is supposed to be served by efficiency, reducing costs, and delivering better results, not by finding crooked ways to push more and more money into the industry through legislation, coercion, and collusion. I do not have to prove those things, because the fact is simple: the business is set up so that the players have an incentive to make things cost as much as possible. That necessitates never-ending regulations to try to deal with the corrupting influence of that system. WHY? What American has ever argued in favor of an upside-down profit motive like this? In what way does it make sense?

    Even people who favor a private system...why would you not favor a system that taps the competitive market forces? Why would we not want to change the health insurance marketplace so that only the players who achieve outcomes with the minimum of waste, the best science, the best relationships with doctors and hospitals, can succeed? The way things are now, they go to lawmakers and complain that they aren't making enough money, and the lawmakers agree to let them raise their rates some more, and then they get back to their golf game. In this state, it's literally a handful of people making that decision each year.

    What the fuck is good or reasonable at all about such a system? It's obviously a corrupt insider criminal racket designed to fuck over the market to make a few people ungodly rich. Analyzing which nuances of the system are not completely fucked is pointless. The system is completely fucked by its nature, at its most basic level, in every mechanism it relies on. It's built WRONG.

    And it's so big, complex, powerful, and sprawling that it will never change. We have to go around the whole thing. We have to roll out our single-payer system. There are enough examples in the world for us to learn from. We can do this. It works. It's better than what we have.

  8. #58
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    Quote Originally Posted by splansing View Post
    They're only part of the problem. But they are part of the problem. The fact that a mega industry like that, with that lobby, has a powerful incentive to increase the overall costs of medical care is a problem.
    You're assuming this is the case, but have ignored what I said about the double-edged sword when it comes to the pricing of medical care. They don't just rake it in. They incur huge risks of huge losses too.

    I do not want to sift through every possible scenario for how they might influence studies, deploy SME's, strong-arm hospitals and patients into protocols...why should we explore every way that this completely ass-backwards profit motive can corrupt the industry? It's going to attract and fuel corruption by its nature. The setup is idiotic.
    You can eliminate the profit motive from the insurance side of the equation but it won't actually go very far to address our problems because of reasons I've stated, which is that the net cost of private and government insurance administration are neither a large part of national health expenditure nor are they driving the cost growth. Your scapegoating of insurance companies is wrong.

    The profit motive is supposed to be served by efficiency, reducing costs, and delivering better results, not by finding crooked ways to push more and more money into the industry through legislation, coercion, and collusion. I do not have to prove those things, because the fact is simple: the business is set up so that the players have an incentive to make things cost as much as possible. That necessitates never-ending regulations to try to deal with the corrupting influence of that system. WHY? What American has ever argued in favor of an upside-down profit motive like this? In what way does it make sense?

    Even people who favor a private system...why would you not favor a system that taps the competitive market forces? Why would we not want to change the health insurance marketplace so that only the players who achieve outcomes with the minimum of waste, the best science, the best relationships with doctors and hospitals, can succeed? The way things are now, they go to lawmakers and complain that they aren't making enough money, and the lawmakers agree to let them raise their rates some more, and then they get back to their golf game. In this state, it's literally a handful of people making that decision each year.

    What the fuck is good or reasonable at all about such a system? It's obviously a corrupt insider criminal racket designed to fuck over the market to make a few people ungodly rich.
    No, not just "a few people." Tens of thousands of billing specialists have jobs because of this system. They're not getting "ungodly rich," but they do stand to benefit from the inefficiencies of every provider needing a billing specialist. So this is one of the small ways we could save some costs, is by eliminating the need for this.

    But a bigger need is to fundamentally change how health care is provided. People need to stop being corralled into making their health care decisions without any knowledge of actual price. And I'm not talking about the 0.005% of care that is emergency care for unconscious patients. Most health care is actively and consciously considered and chosen, it's just that people are not typically given a chance to do their shopping, make sure they understand the therapeutic benefits of all their options relative to the cost, and the comparison of what one provider charges for the same thing vs. what another does. Telehealth (web-based health care) needs to proliferate so that people can shop for medical attention in a way that is not bound by their geography. This would open up every local market to providers in every other market (*gasp, a free market reform!), putting competitive pressures on them to keep what they offer price-competitive, so that there aren't so many of them out there that can lazily sit back and benefit from their little geographic monopoly.

    These are fundamental changes with respect to how health care is provided, not just how it's paid for and by whom.
    Last edited by Neomalthusian; 14th April 2017 at 08:38 AM.

  9. #59
    Veteran Member Madeline's Avatar
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    Quote Originally Posted by Neomalthusian View Post
    But they do on the market.



    But they don't. Some are treated special.



    Yes there is. Not every 58 year old gets life threateningly sick or injured. We don't make 30 year olds pay the same for life insurance as 70 year olds. We don't make Corolla drivers pay the same for insurance as Ferrari drivers. Pricing needs to be variable according to risk.
    This is concentration of risk, and a chronic problem with Medicare supplemental policies. These people are all approximately the same advanced age. As the years go by, if the seriously ill are further segregated, the insurance company has a much greater profit opportunity, but this is because it is no longer selling insurance in a meaningful sense.

    Aggregating all the people over 70 in need of long term care into one group is not risk sharing.

  10. #60
    Veteran Member Madeline's Avatar
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    Quote Originally Posted by Sassy View Post
    Sorry this is not exactly on topic but my Vet actually thought about keeping my cat until I returned with my credit card that I had not put in my purse as I had thought I did. And many Vets do this - charging you boarding fees until you pay. He ended up only holding her meds hostage. I know a cat isn't the same as a baby, but your scenario isn't too far off, imo.

    PS, I know many people with a high monthly payment AND it's still thousands until insurance kicked in. One of my friends found out that being depressed is like a buzzword. they have to pay more attention to you if you say that. She was desperate to have a procedure done before the end of last year, because she had already met her deductible.
    None of this behavior, not the doctors or the hospitals or the patients, is a rational response to a need for health care.

    The more aggravated version of this is poisoning your baby with a mild irritant so it throws up enough to get admitted, in hopes they will finally operate on her ears before repeated infections make her deaf.
    I imagine desperate people already have done this.

    This cannot be the best possible system Americans can choose, nor is it better than the less-than-perfect universal care system.

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