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Thread: Liberal states impose new individual mandate ahead of ObamaCare rollback

  1. #341
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    Re: Liberal states impose new individual mandate ahead of ObamaCare rollback

    Quote Originally Posted by TU Curmudgeon View Post
    The Canadian system includes a non-profit insurance program.

    What would the US monthly cost be if the insurance companies' profits were deducted?
    We have non-profit health insurers here, as well. My market is dominated by them.

    As for the for-profits, I think the Big 5 collectively have a net income of something like $12-$15 billion. That's not nothing, but it's also not a huge dent in a three-and-a-half trillion dollar system.

    The Canadian system also does not include provisions for "denial of claims".

    What would the US monthly cost if the amount that the insurance companies spend on "denial of claims" was also eliminated?
    I don't know, what would it be?

    The Canadian system also does not include "for profit" hospitals.

    What would the US monthly cost be if the hospitals' profits were eliminated along with the amount of insurance company profits and the insurance companies' "denial of claims" expenses?
    Most hospitals in the United States are not-for-profit.

    As it is, for-profit hospitals here have lower cost structures than their not-for-profit cousins (e.g., the cost of an inpatient day in a for-profit hospital is about 24% lower).That's why for-profit hospitals tend to do a better job of breaking even on their Medicare business, as well.
    Last edited by Greenbeard; 07-14-18 at 03:12 PM.

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    Re: Liberal states impose new individual mandate ahead of ObamaCare rollback

    Quote Originally Posted by Greenbeard View Post
    We have non-profit health insurers here, as well. My market is dominated by them.

    As for the for-profits, I think the Big 5 collectively have a net income of something like $12-$15 billion. That's not nothing, but it's also not a huge dent in a three-and-a-half trillion dollar system.

    I don't know, what would it be?

    Most hospitals in the United States are not-for-profit.

    As it is, for-profit hospitals here have lower cost structures than their not-for-profit cousins (e.g., the cost of an inpatient day in a for-profit hospital is about 24% lower).That's why for-profit hospitals tend to do a better job of breaking even on their Medicare business, as well.
    Thanks for the response.

    So if:

    1. "Insurance profits" don't contribute markedly to the 123.35% increase in average monthly cost; and
    2. "hospital profits" don't contribute markedly to the 123.35% increase in average monthly cost; then


    what DOES contribute the the 123.35% increase in average monthly cost?

    Canada has a "both sexes life expectancy" of 82.2 years, for the US it's 79.3.
    Canada has a "female life expectancy of 84.1, the US 81.6.
    Canada has a "male life expectancy" of 80.2, the US 76.9.
    Canada has a "both sexes healthy life expectancy at birth" of 73.2, the US 68.5.
    Canada has a "female healthy life expectancy at birth" of 74.3, the US 70.1.
    Canada has a "male healthy life expectancy at birth" of 72.0, the US 66.9.

    Averaging those metrics and the Canadian health care system produces a result that is 5.25% better than the US health care system.

    1. The only "logical" conclusion is that for single percentage point increase in the average monthly health care cost (over that of Canada's) you will net a 0.043% DECREASE in outcome.
    2. Obviously, if the US were to reduce its average monthly health care cost to 50% of Canada's the only possible outcome to be expected would be a health care system that produced an outcome that was 21.5% better than the Canadian one already produces and the American "both sexes healthy life expectancy at birth" would shoot up to 88.94 years.


    Now since both [A] and [B] are rather silly, what it it about the US health care system that results in lower results for more money?

    You don't think it could possibly be "Well, since some people don't have affordable medical insurance that will actually cover their medical requirements, that means that those people end up not getting the treatment that they need at all and when you calculate the people who don't get treated at all into the equation that depresses the results for things like "healthy life expectancy at birth" REGARDLESS of how much money the people who do get the treatment that they need actually pay for their health care.", do you?

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    Re: Liberal states impose new individual mandate ahead of ObamaCare rollback

    Quote Originally Posted by TU Curmudgeon View Post
    what DOES contribute the the 123.35% increase in average monthly cost?
    The inputs that comprise health care (primarily labor) cost more here. A few years ago MedPAC, the body the advises Congress on Medicare policy, looked into why Medicare prices--which are set by the federal government and are generally far lower than what private insurers pay--are still nearly 50% higher than the OECD average. Their answer was primarily about the prices of those inputs:




    The health care industry is now the largest employer in the U.S., meaning a lot of wages--livelihoods--flow through it. Those are the inputs that have to be paid for when we go to a doctor, hospital, whatever and get billed. The problem would be a lot easier if it could just be blamed on profits and not things like nurses striking for larger wage growth.

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    Re: Liberal states impose new individual mandate ahead of ObamaCare rollback

    Quote Originally Posted by Greenbeard View Post
    The health care industry is now the largest employer in the U.S., meaning a lot of wages--livelihoods--flow through it. Those are the inputs that have to be paid for when we go to a doctor, hospital, whatever and get billed. The problem would be a lot easier if it could just be blamed on profits and not things like nurses striking for larger wage growth.
    You might find "Here's the real reason health care costs so much more in the US" a bit more detailed.

    However, I don't find "It costs more because we get charged more." to be a REALLY satisfying answer since what it breaks down to is "It costs more because the providers are greedy and we don't have any choice but to go along with their demands.".

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    Re: Liberal states impose new individual mandate ahead of ObamaCare rollback

    Quote Originally Posted by TU Curmudgeon View Post
    Indeed, I live in a Socialist Dictatorship.

    PS - Even if it were true, I think that I'd prefer it to the "To the bottom of your wallet, and then to hell with you, care brought to you by the people that rule your life (but whom you have never heard of and most certainly never voted for)" that the US has.

    PPS - That doesn't mean that I'm going to force someone who wants a lesser level of medical care being available to the people of their own country to do what I (and the people of my country) want to have for our own country.
    Please, spare us the garbage. You decide your future in America, based on effort, sacrifice and performance. The more socialism, democratic or otherwise the more your future is determined by others.
    Better Living Through Regulation - DNC



  6. #346
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    Re: Liberal states impose new individual mandate ahead of ObamaCare rollback

    Quote Originally Posted by TU Curmudgeon View Post
    You might find "Here's the real reason health care costs so much more in the US" a bit more detailed.

    However, I don't find "It costs more because we get charged more." to be a REALLY satisfying answer since what it breaks down to is "It costs more because the providers are greedy and we don't have any choice but to go along with their demands.".
    "It costs more because we get charged more" is not what I'm saying. You will get an answer like that at many health policy conferences (phrased not in terms of charges, which are largely meaningless, but in terms of pricing: "our system is more costly because we have a health care pricing problem.") That's a circular answer.

    There are two components at play here: (1) what payers pay (reimburse) for health care services, and (2) what it costs to deliver those services.

    The former (1) is often what people think of as the cost of the system. We pay taxes to the federal and state government so they have cash to spend on health services, and we pay premiums or have our employers set aside a piece of our compensation to have cash to spend on health services. And then when we get those health services we often also kick in a share of the cash from our personal funds via deductibles, copays, or coinsurance. That's the money that gets collected from us to pay hospitals, doctors, and other providers when we get services from them. And when that money is transferred to those actually delivering the care it's doled out in accordance with pricing negotiated between the providers and the payers.

    The latter (2) is what one might think of as the actual costs of the American health care system. Health care is largely a service and delivering it has costs. For a hospital, for instance, those costs are primarily (~60% or more) labor costs but there are others: IT fees, food, postage, utilities, pharmaceuticals and medical supplies, etc. Hiring and retaining those people, paying those fees, keeping the lights on and the doors open so that you can provide the service costs money. Those costs are the actual costs of delivering health care in this environment. The money coming in the door from payers--the reimbursement ultimately provided from the pools of cash collected through premiums, taxes, and individual out-of-pocket commitments--has to be enough to cover those expenses. If they aren't, the hospital or practice or whatever closes up shop.

    The prices providers ask is high because the cash flow they need coming through the door has to be high, and that's because the real costs of delivering care are high. That's not greed, it's reality.

    There seems to be a perception among some that there's a great disconnect between (1) and (2) above: namely, that the amount we (the insurers, governments, and consumers buying care) pay is wildly higher than the actual costs that providers incur in delivering care. And that difference between the two must then be exorbitant profits for everybody along the chain. That would be great! Because it's an easy problem with an easy solution. If the money we're paying into the health care system through premiums and taxes is ending up in a vault somewhere so Scrooge McDuck can do the backstroke through it, then it isn't involved in patient care at all and clawing it back won't impact anyone's care or livelihood.

    But they're not wildly out of whack. Yes, there is some profit along the line (even non-profit hospitals need positive margins) and insurers surely take their cut. But ultimately we pay more because care costs more here. And that's because the inputs providers need to deliver health services--namely labor, but also certain supplies and pharmaceuticals--cost more here than other places. Heath care is nearly a fifth of our economy, a fact that goes hand-in-hand with the reality that it employs the plurality of people in this country--and that's not because the plurality of Americans are physicians. We can't simply rightsize what we pay (1) to be in line with the rest of the world because our underlying costs (2), which those payments must cover, really are substantially higher here.

    Health care is a sector that offers steady, good, high-paying work and is consistently a path to the middle class, particularly in places where other industries are disappearing. Said another way, it takes in a large chunk of the nation's income and spits it out in paychecks to the plurality of our workforce. That's a rather challenging "problem" to tackle. Framing this a story of "profit" and "greed" entirely misses the enormity of the task in front of us.
    Last edited by Greenbeard; 07-14-18 at 08:26 PM.

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