An idea to reduce healthcare costs

Masterhawk · Apr 30, 2018

Many people such as Bernie Sanders advocate for single payer. They believe that since healthcare cost are too high that government should cover costs. In 2016, each American spent, on average, almost $10,000 on healthcare, which is the highest in the world. Supporters of single payer say that the reason the US has the most expensive healthcare is because there are several payers such as employers, insurance providers, and government in the form of medicare and medicaid. They advocate that government should take on all of the costs of paying for healthcare.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

Opponents often cite the cost of single payer. In 2016, the federal government spent $1.38 trillion on healthcare, mostly from medicare. There is no official number for what single payer would cost per year but they range from $1.38 trillion by Sanders to $2.8 trillion by the committee for a responsible federal budget; other cost estimates were $2.4 trillion and $2.5 trillion by Kenneth Thorpe and the Urban Institute respectively.
How expensive would a single-payer system be? | PolitiFact

To pay for single payer, supporters often advocate taxing the top 1% which has over a third of America's wealth. The average income for individuals in the top 1% was $717,000 in 2012 and the US population was 314 million (3,400,000 were in the top 1%) that same year. Doing the math, the total income of the top 1% came out to $2,251,380,000,000 (approximately $2.25 trillion) in 2012. Assuming the higher numbers, single payer would cost almost double of what the federal government currently pays for healthcare. And based on how much the NHS spending has increased since its inception in 1948, the cost of single payer in the US would likely rise in the coming decades.
https://www.forbes.com/sites/moneyw...rage-america-vs-the-one-percent/#1b21e72d2395
Why Sanders?s Single-Payer Plan Would Cost More Than His Campaign Says
https://www.urban.org/research/publ...federal-and-private-spending/view/full_report
https://www.ifs.org.uk/tools_and_resources/fiscal_facts/public_spending_survey/health_spending

Advocates also say that single payer is cheaper in countries which actually have it. Opponents then say that single payer leads to waiting periods and to their credit, it is a major problem in Canada. In 2016, 63,000 Canadians went abroad for health care. Although these people exist, they make up a small percentage of the population of 36.29 million that same year.
https://www.ctvnews.ca/health/63-00...reatment-last-year-fraser-institute-1.3486635

But are these really the only two options? Is US health care really the result of free market? Sure the US healthcare system has its problems but so does single payer.

In truth, there are many regulations on health insurance. Health insurance providers are prohibited from charging more for pre existing conditions and everyone must have health insurance or they pay a fine. Employers in the US are often mandated to provide health insurance, even though the practice originated in WWII to get around price controls. After WWII was over, the practice became so widespread that it remained. Eventually, government got the idea to mandate employer insurance in the form of payroll taxes in the Federal Insurance Contributions Act (FICA).
https://en.wikipedia.org/wiki/Federal_Insurance_Contributions_Act_tax

In comparison, there isn't nearly as much regulation on car insurance. While most states require people to have car insurance to legally drive, this typically only applies to bodily injuries and property damage to a third party. In addition, car insurance companies are allowed to charge differently based on conditions such as age, occupation, gender, and the history of car accidents which a person has been in. When it comes to most types of insurance, the stuff they cover has price transparency, not so with health insurance.

Another driver behind rising healthcare costs has to do with pharmaceuticals. The FDA's slow approval process combined with drug patents (lasting 20 years) causes medication to be more expensive.

A possible solution to rising health care is to regulate health insurance no more than other insurances.

Glen Contrarian · Apr 30, 2018

Masterhawk said:
A possible solution to rising health care is to regulate health insurance no more than other insurances.

The 800-lb. gorilla in the room of your idea is the fact that health care for humans is nearly infinitely more complex than any vehicle or anything else that's insured, and so the regulations involved with health care and health insurance must also be that much more complex. Ruin somebody's Mercedes, and that person might be outraged...but they'll get over it. Ruin someone's child or spouse, and that person will never get over it. Why? Humans are infinitely more precious than any car.

In other words, comparing regulations between those for vehicle insurance and those for health insurance really is an apples-and-oranges comparison.

jaeger19 · Apr 30, 2018

Glen Contrarian said:
The 800-lb. gorilla in the room of your idea is the fact that health care for humans is nearly infinitely more complex than any vehicle or anything else that's insured, and so the regulations involved with health care and health insurance must also be that much more complex. Ruin somebody's Mercedes, and that person might be outraged...but they'll get over it. Ruin someone's child or spouse, and that person will never get over it. Why? Humans are infinitely more precious than any car.

In other words, comparing regulations between those for vehicle insurance and those for health insurance really is an apples-and-oranges comparison.

the reason that insurance is so expensive is in part because there is too little regulation on the insurance industry and its allowed to develop monopolies.

Glen Contrarian · Apr 30, 2018

jaeger19 said:
the reason that insurance is so expensive is in part because there is too little regulation on the insurance industry and its allowed to develop monopolies.

One conservative says insurance is so expensive because of too much regulation...and now you're another conservative who's saying it's because of too little regulation.

*sigh*

jaeger19 · May 1, 2018

Glen Contrarian said:
One conservative says insurance is so expensive because of too much regulation...and now you're another conservative who's saying it's because of too little regulation.

*sigh*

Because this conservative understands the health insurance industry. Go find out what industries don't have to abide by anti trust laws...

Glen Contrarian · May 3, 2018

jaeger19 said:
Because this conservative understands the health insurance industry. Go find out what industries don't have to abide by anti trust laws...

I'm only pointing out the difference between you and the other conservative.

That being said, I quite agree that the health insurance industry needs more regulation - that's part of what the ACA was all about. I mean, why should it be a matter of debate to require health insurance companies to spend at least 80% of their revenue on paying for health care? That leaves them 20%...and 20% of tens of billions of dollars is still a heckuva lot of profit!

jaeger19 · May 4, 2018

Glen Contrarian said:
I'm only pointing out the difference between you and the other conservative.

That being said, I quite agree that the health insurance industry needs more regulation - that's part of what the ACA was all about. I mean, why should it be a matter of debate to require health insurance companies to spend at least 80% of their revenue on paying for health care? That leaves them 20%...and 20% of tens of billions of dollars is still a heckuva lot of profit!

just to point out.. that requiring health insurance companies to spend 80% of their revenue on paying for healthcare is a terrible idea. It encourages the insurance companies to find ways to increase the costs.

They tried to do that with healthcare in the past. So in the past.. they would only let me have a profit margin of say 50%.

So if I charged 100 for a service.. but it only cost me 20 bucks.. they would pay me say 40 dollars...

BUT.. if I charged 300 for that same service.. and could show it cost me 150 bucks... they would pay me the full 300. FOR THE SAME SERVICE.

Dumb.. very dumb. that's the problem with using percentages like that.

Glen Contrarian · May 4, 2018

jaeger19 said:
just to point out.. that requiring health insurance companies to spend 80% of their revenue on paying for healthcare is a terrible idea. It encourages the insurance companies to find ways to increase the costs.

They tried to do that with healthcare in the past. So in the past.. they would only let me have a profit margin of say 50%.

So if I charged 100 for a service.. but it only cost me 20 bucks.. they would pay me say 40 dollars...

BUT.. if I charged 300 for that same service.. and could show it cost me 150 bucks... they would pay me the full 300. FOR THE SAME SERVICE.

Dumb.. very dumb. that's the problem with using percentages like that.

I have to admit that's a good point. So how do we stop the health insurance industry from gouging the customers? Personally, I'm a big believer in single-payer since military health care (run by a system called TriCare - not the VA) is for all practical purposes single-payer health care, and I've almost always had very good results from it. In my opinion, if single-payer health care is good enough for our military, and our military (including retirees like myself) are happy with it (and we generally are), then why not extend the same kind of system to the rest of America? That way, while the profit motive for making better equipment, methods, and medicine remains (and unlike Medicare, the VA and the military are allowed to negotiate lower prices), but the profit motive for gouging all the market will bear from the patients will go away.

jaeger19 · May 4, 2018

Glen Contrarian said:
I have to admit that's a good point. So how do we stop the health insurance industry from gouging the customers? Personally, I'm a big believer in single-payer since military health care (run by a system called TriCare - not the VA) is for all practical purposes single-payer health care, and I've almost always had very good results from it. In my opinion, if single-payer health care is good enough for our military, and our military (including retirees like myself) are happy with it (and we generally are), then why not extend the same kind of system to the rest of America? That way, while the profit motive for making better equipment, methods, and medicine remains (and unlike Medicare, the VA and the military are allowed to negotiate lower prices), but the profit motive for gouging all the market will bear from the patients will go away.

Well a couple of points. In America .. the VA healthcare is among the worst of the government insurances and worse than Medicaid, and definitely worse than Medicare. Tricare for Life basically works like a supplement or wraparound to medicare part A and part B. so its not really a good example of government single payer.

So here is the issue.. first.. which government program do we have? medicare? Okay.. that's awesome.. everyone loves medicare... BUT its expensive because of that.. and it works financially because you pay your whole working life into it.. and then only take out after 65. Start throwing people onto it who haven't paid in...and you bankrupt the program completely.. so what that means is that folks like you.. will have to have LESS of a medicare type insurance because its not fiscally feasible.

So lets say we get a Medicaid like program... okay. but that's the worst of the government programs.. and is worse than what people on medicare and people on private insurance now currently have. So that's not going to go over well.

And lets say VA.. well that's worse yet.

So there is a wide range of what single payer government could be.. and the best is not fiscally feasible. You have to have supreme faith that our government.. our current government would devise a single payer plan that works for everyone and that any future government would not sabotage it and make things worse for people. You trust Trump to administer such a thing? Because I don't. you trust the current congress with such an endeavor? I certainly don't.

Now. a private system certainly has flaws obvious the CEO don't have my best interest in mind.. however, IF there is plenty of competition, the ability to choose different companies will affect their bottom line and be most responsive to me.

By the way.. the profit motive for insurance companies will not go away. In most of our government programs.. the private insurance companies are who administer that program for a nice fat fee. In all likelihood what single payer will be in America is that the poor and middle class will end up with really crappy government insurance.. administered by private companies for a fat fee.. and then the insurance companies will offer private plans and or supplemental plans tot he rich and upper middle class.

Glen Contrarian · May 4, 2018

jaeger19 said:
Well a couple of points. In America .. the VA healthcare is among the worst of the government insurances and worse than Medicaid, and definitely worse than Medicare. Tricare for Life basically works like a supplement or wraparound to medicare part A and part B. so its not really a good example of government single payer.

So here is the issue.. first.. which government program do we have? medicare? Okay.. that's awesome.. everyone loves medicare... BUT its expensive because of that.. and it works financially because you pay your whole working life into it.. and then only take out after 65. Start throwing people onto it who haven't paid in...and you bankrupt the program completely.. so what that means is that folks like you.. will have to have LESS of a medicare type insurance because its not fiscally feasible.

So lets say we get a Medicaid like program... okay. but that's the worst of the government programs.. and is worse than what people on medicare and people on private insurance now currently have. So that's not going to go over well.

And lets say VA.. well that's worse yet.

Now. a private system certainly has flaws obvious the CEO don't have my best interest in mind.. however, IF there is plenty of competition, the ability to choose different companies will affect their bottom line and be most responsive to me.

By the way.. the profit motive for insurance companies will not go away. In most of our government programs.. the private insurance companies are who administer that program for a nice fat fee. In all likelihood what single payer will be in America is that the poor and middle class will end up with really crappy government insurance.. administered by private companies for a fat fee.. and then the insurance companies will offer private plans and or supplemental plans tot he rich and upper middle class.

No, TriCare has nothing to do with Medicare A or B or D or any other kind of Medicare. It is a standalone insurance that is available to all active-duty and retired military and their dependents. IIRC, it's currently run by United Health Care. What's more - and unlike Medicare - TriCare Standard is taken in many locations overseas. In Manila alone, there's over 100 different facilities that accept TriCare Standard. That, btw, is not much different from how Canada's single-payer system works - there's many (though certainly not all) facilities here in America that accept payment from them for Canadian citizens.

And the quality of care that my family and I have gotten from this single-payer system for over a quarter century certainly obviates your claim that single-payer insurance will ensure that "the poor and middle class will end up with really crappy government insurance". It's saved my life and my wife's life. In 2016 alone, I had both my knees replaced (both at military hospitals)...and I'm very happy with the results...and the only money out of pocket was for my meals while I was in the hospital. YES, the taxpayers paid for my knee replacements...but instead of me being disabled (and a state-supported burden on the taxpayers) for the rest of my life, I have a full-time job...and I pay the taxes that I wouldn't be paying without those knee replacements.

That, sir, is the key thing about single-payer health care. Yes, your taxpayer dollars go to pay for other people's health care...but as a result, instead of being permanently disabled (or dead) and being a burden on the state, with all the social ills that comes with it, the poor and middle class people are generally healthier and better able to work and pay taxes. Just today, my wife - a Realtor - was dealing with a middle-aged couple who had lost their house back in the mid-2000's due to health issues that bankrupted them. If you'll check, at the time, half of ALL bankruptcies were due at least in part to health care costs...and with bankruptcies come a host of other social ills, all of which cost the taxpayers even more.

There was an old motor oil commercial back in the 1970's - for either Quaker State or Pennzoil - where the mechanic was saying, "If I don't change your oil, then later, I'll be changing your engine because you didn't get an oil change. You can pay me now, or you can pay me (a LOT more) later." That's the main benefit of single-payer healthcare...because like with the commercial, the taxpayers WILL pay. We'll either pay for the health care (especially the preventative care)...OR we'll pay for what happens when people can't afford the health care, or are bankrupted by it.

jaeger19 · May 7, 2018

Glen Contrarian said:
No, TriCare has nothing to do with Medicare A or B or D or any other kind of Medicare. .

First.. I said Tricare for life.. which is what I assumed you were on since I think you are medicare aged. My bad if you are not.

TRICARE For Life

TRICARE For Life is Medicare-wraparound coverage for TRICARE-eligible beneficiaries who have Medicare Part A and B.

That, btw, is not much different from how Canada's single-payer system

Actually Canadian single payer is not actually single payer.. its implemented by Territories and Provinces.. and each insurance can differ and in some cases.. you can't use the insurance if you are outside the province or it pays dramatically less for procedures done outside the province or territory.

And the quality of care that my family and I have gotten from this single-payer system for over a quarter century certainly obviates your claim that single-payer insurance.

No it doesn't. You are making the assumption.. that your type of insurance is what everyone will have. A medicare style insurance. Which MIGHT happen.. OR what will likely happen is that the poor and middle class will have a crappy government insurance. Worse possibly than Medicaid. THATS what the Canadians have by the way. the basic Canadian government insurance doesn't pay for medicines outside the hospital.. it doesn;t pay for outpatient therapies, it doesn't pay for home health. Medicaid and even the VA pay for those things in the US.

. If you'll check, at the time, half of ALL bankruptcies were due at least in part to health care costs...and with bankruptcies come a host of other social ills, all of which cost the taxpayers even more.

HUGE amount of BS. First.. If you file chapter 7 bankruptcy.. you most likely get an exemption for your house, so there is a good chance you can keep the house. So that should have made you question that. Secondly.. Bankruptcies are not due to medical bills. Heck.. why WOULD I want to put you in bankruptcy? I am not going to get paid if you declare bankruptcy...

Here some facts:

In 2005 and 2009, Elizabeth Warren and her co-authors released two papers claiming that more than 50 percent of all bankruptcy filings in the U.S. were caused by medical debts. I wrote about the problems with these studies when they first came out, and even testified in Congress against reading too much into the findings of these studies because they suffered from several biases. Now an academic study published in the New England Journal of Medicine is skeptical of these results as well. The study tracks a stratified sample of adults between the ages of 25 and 64 who were admitted to the hospital for non-birth-related reasons between 2003 and 2007. It finds that fewer than 4 percent of hospitalizations resulted in bankruptcies, far lower than the 2009 study’s claimed 62 percent

.

The Department of Justice did a similar survey of bankruptcy filers between 2000 and 2002, which included a much larger sample of 5,203 filers, and found that 90 percent of filers had medical debts less than $5,000, and 54 percent had no medical debt

https://www.forbes.com/sites/aparnamathur/2018/04/09/exposing-the-myth-of-widespread-medical-bankruptcies/#23be0278c2a1

If you do a bit of research.. if you are interesting in actual evidence... you will find out that the idea that people are being bankrupted by big medical bills .. is largely a bunch of crap. In almost all of the bankruptcies listed for medical reasons.. less than 10% of the debt was actually medical.. the rest was other bills.. like credit cards for personal use etc.

When people actually do need to file bankruptcy for medical reasons.. its not because of medical debt.. its BECAUSE OF LOSS OF INCOME.. from the medical problem.

That's the main benefit of single-payer healthcare...because like with the commercial, the taxpayers WILL pay. We'll either pay for the health care (especially the preventative care)...OR we'll pay for what happens when people can't afford the health care, or are bankrupted by it.

That can easily solved by having a universal healthcare system so that everyone can get insurance.. and that its mandated that they do so. We don't have to go to a single payer system that may be worse than what we have now.

By the way.. I bet you got outpatient physical therapy for those total knees didn't you. Probably were told that the therapy was more important to the outcome than the surgery... If you had Canada government insurance.... they don't pay for outpatient physical therapy.

if we want to improve our healthcare insurance and healthcare system.. then lets deal with facts..

Glen Contrarian · May 7, 2018

jaeger19 said:
First.. I said Tricare for life.. which is what I assumed you were on since I think you are medicare aged. My bad if you are not.

I'm on TriCare Prime - always have been. I know that will change in about seven years...but even then (unless they change the rules) I don't have to go to a civilian provider - I can still go to the military hospital. And I prefer to do so since the cost of the care is almost never an option - they never have to say, "well, sorry, but we have to check with your insurance first before we can do that."

HUGE amount of BS. First.. If you file chapter 7 bankruptcy.. you most likely get an exemption for your house, so there is a good chance you can keep the house. So that should have made you question that. Secondly.. Bankruptcies are not due to medical bills. Heck.. why WOULD I want to put you in bankruptcy? I am not going to get paid if you declare bankruptcy... [/QUOTE]

From Snopes, quoting a Harvard study:

BACKGROUND: Our 2001 study in 5 states found that medical problems contributed to at least 46.2% of all bankruptcies. Since then, health costs and the numbers of un- and underinsured have increased, and bankruptcy laws have tightened.

METHODS: We surveyed a random national sample of 2314 bankruptcy filers in 2007, abstracted their court records, and interviewed 1032 of them. We designated bankruptcies as “medical” based on debtors’ stated reasons for filing, income loss due to illness, and the magnitude of their medical debts.

RESULTS: Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical.

(boldface mine)

And did the ACA help drive down the number of bankruptcies? From (famously non-partisan) Consumer Reports:

Filings have dropped about 50 percent, from 1,536,799 in 2010 to 770,846 in 2016. Those years also represent the time frame when the ACA took effect. Although courts never ask people to declare why they’re filing, many bankruptcy and legal experts agree that medical bills had been a leading cause of personal bankruptcy before public healthcare coverage expanded under the ACA. Unlike other causes of debt, medical bills are often unexpected, involuntary, and large.

The reference provides a graph showing that the number of bankruptcies began plummeting immediately after the ACA was passed. To be sure, that was also the period when America was recovering from the Great Recession, so bankruptcies would have been falling anyway...BUT the ACA certainly helped. Even in my own family, the ACA allowed two of my brothers-in-law to get treatment they needed quickly enough that they were able to keep their jobs. Yes, that's 'merely' anecdotal, but a big part of the ACA was enabling people to get the preventative care they needed before their conditions proceeded to something worse (and much more expensive).

That can easily solved by having a universal healthcare system so that everyone can get insurance.. and that its mandated that they do so. We don't have to go to a single payer system that may be worse than what we have now.

By the way.. I bet you got outpatient physical therapy for those total knees didn't you. Probably were told that the therapy was more important to the outcome than the surgery... If you had Canada government insurance.... they don't pay for outpatient physical therapy.

if we want to improve our healthcare insurance and healthcare system.. then lets deal with facts..

At least you and I can agree on the preference for a universal health care system - like TriCare Prime if it were (as you pointed out) mandatory for everyone. And yes, I got outpatient PT and it was very important and it was free...though I'm not sure that it would have been free if it hadn't been for my health insurance.

jaeger19 · May 7, 2018

=Glen Contrarian;1068492739]I'm on TriCare Prime - always have been. I know that will change in about seven years...but even then (unless they change the rules) I don't have to go to a civilian provider - I can still go to the military hospital. And I prefer to do so since the cost of the care is almost never an option - they never have to say, "well, sorry, but we have to check with your insurance first before we can do that."
...]

Okay.. so you have to realize a few things here. Okay first: Your experience is not a good indicator of what a single payer in this country would be like. Do veterans alone pay for your Tricare? nope.. you have 150 million workers paying for your healthcare insurance.. and maybe what 30 million of you actually eligible for Tricare? Now.. if you plan that your single payer is going to have 100% of americans putting into the single payer in taxes.. but only 20% eligible for the single payer.. than it would work financially like yours does.. but that leaves 80% uncovered. and paying into it.

Second: You realize hat you just said you have used military providers.. so now to be the same in your single payer.. now you have to have not only a single payer system.. BUT also have government run hospitals, and clinics etc.

BACKGROUND: Our 2001 study in 5 states found that medical problems contributed to at least 46.2% of all bankruptcies. Since then, health costs and the numbers of un- and underinsured have increased, and bankruptcy laws have tightened.

Yeah.. I already provided articles that debunk this study. Very poor design..

At least you and I can agree on the preference for a universal health care system - like TriCare Prime if it were (as you pointed out) mandatory for everyone

You are confusing a universal healthcare system with single payer. Single payer is a universal system.. generally.. but we can have universal healthcare without single payer.

And yes, I got outpatient PT and it was very important and it was free...though I'm not sure that it would have been free if it hadn't been for my health insurance.

Well.. in the Canadian system.. the government insurance does not pay for that outpatient therapy.

Now.. your system did.. but that's in part because while only a limited number of people are eligible for Tricare prime.. its funded by millions of tax payers that are not eligible.

So.. for a single payer system to be fiscally feasible.. its very likely that your coverage would have to decline on a single payer that covered everyone.