Health care increasingly out of reach for millions of Americans

[james&olya 1,121]

Don't laugh.

Seriously think about it.

1. We don't want to mandate health insurance companies to pay for "little things".

2. If there is no mandate, then the free market insurance industry decides to not pay for these "little things".

3. Doctors and clinics aren't getting whopping fees from insurance companies for these "little things".

4. So the free market should take over, and the cost of these "little things" falls into a range where the average person can afford them.

Yes or no?

It is often difficult, as I said above, to easily separate 'routine' care from acute care. The lines blur very easily and any given visit can be billed out a number of different ways depending on what the incentives and definitions are. Once you start doing this it takes a literal army of billing agents on the part of the providers and an opposing army of insurance clerks at the insurance company trying to deny all these claims. This money paid to these people is wasted as far as providing actual care is concerned. It is a big part of the problem we have now!

The other argument against trying to make the individual pay directly for routine and preventive care is that many people will put off and never get the preventive services that actually lower the long term health care costs incurred. In an ideal world people would get that care. We don't now, and never will, have that ideal world. We must deal with people in the real world. It might actually not be necessary to mandate insurance company coverage for cost-effective preventive services if we also can keep them from gaming the system. In the past they could get away with dropping people when they actually got sick so there was incentive for them to not pay for things even if it could lower long term costs. But why give them the room to try and see if they can pull the same kind of cr@p they have in the past?

[Leatherneck 693]

OK. I think your ideas have merit.

So the next question would be - if routine procedures were never covered by any kind of insurance, do you think the free market would bring these procedures down to an "affordable" level.

For example, would all doctors start charging say - $30 bucks for an office visit? A basic metabolic panel (blood test) for $25? An x-ray for $50?

Set a broken leg $100?

It would indeed, when you introduce competition and cash to that sector of medicine, it will drive down the price. Look at lasik eye surgery as an example, look at the cost of lasik in 1998 compared to today. The competition was fierce for patients, radio and print was loaded with ads for lasik. It was not covered by health insurance, it was cash or you made arrangements with the doctor for payment. Competition drove the price down from thousands per eye to now you can get it for-recently I saw it for $299 per eye on the low end and $495 per eye on the upper end.

Competition and cash would do the same for basic medicine as it does for any other service, commodity or product.

[Rebecca Jo 1,962]

It is often difficult, as I said above, to easily separate 'routine' care from acute care. The lines blur very easily and any given visit can be billed out a number of different ways depending on what the incentives and definitions are. Once you start doing this it takes a literal army of billing agents on the part of the providers and an opposing army of insurance clerks at the insurance company trying to deny all these claims. This money paid to these people is wasted as far as providing actual care is concerned. It is a big part of the problem we have now!

The other argument against trying to make the individual pay directly for routine and preventive care is that many people will put off and never get the preventive services that actually lower the long term health care costs incurred. In an ideal world people would get that care. We don't now, and never will, have that ideal world. We must deal with people in the real world. It might actually not be necessary to mandate insurance company coverage for cost-effective preventive services if we also can keep them from gaming the system. In the past they could get away with dropping people when they actually got sick so there was incentive for them to not pay for things even if it could lower long term costs. But why give them the room to try and see if they can pull the same kind of cr@p they have in the past?

I don't know if we should give them the room to try.

All I know is some preventive care can be affordable. For instance, the cheap BMP I mentioned above actually exists. Here's how I know:

Previously when my husband had insurance, we would get all his routine blood work done at the hospital. They would bill his insurance and it wouldn't be covered until we hit the $1000 deductible. The tests (of which the BMP was one) came to $330. So we were always making payments to the hospital for blood work.

When he lost his insurance, we found out through friends that a large physicians group in our town has a lab that does affordable basic tests. We started going there while Wes was uninsured. We could get all the same tests done (that the hospital were doing) for about $35. In fact, we went there last weeks (even though he is insured now) because paying the low rate was less hassle than going through the big lab corporation his insurance requires.

And the BMP was #15 of the $53 we paid.

I think our health care system is so confusing that people don't know how to find healthcare bargains. If routine stuff simply wasn't covered by insurance, would the free market come to rescue for the healthcare consumer? Or would be gouged like we are with oil?

[Leatherneck 693]

Don't laugh.

Seriously think about it.

1. We don't want to mandate health insurance companies to pay for "little things".

2. If there is no mandate, then the free market insurance industry decides to not pay for these "little things".

3. Doctors and clinics aren't getting whopping fees from insurance companies for these "little things".

4. So the free market should take over, and the cost of these "little things" falls into a range where the average person can afford them.

Yes or no?

Yes it would, granted there are those here that have little faith in the free market. Can you imagine what an oil change, tire rotation or a tune-up would cost if car insurance was mandated to covered those items? Insurance tends to distort the true price when the provider and the insurer are fighting over the payment or cost.

[Rebecca Jo 1,962]

It would indeed, when you introduce competition and cash to that sector of medicine, it will drive down the price. Look at lasik eye surgery as an example, look at the cost of lasik in 1998 compared to today. The competition was fierce for patients, radio and print was loaded with ads for lasik. It was not covered by health insurance, it was cash or you made arrangements with the doctor for payment. Competition drove the price down from thousands per eye to now you can get it for-recently I saw it for $299 per eye on the low end and $495 per eye on the upper end.

Competition and cash would do the same for basic medicine as it does for any other service, commodity or product.

Well, you get what you pay for and that old saying applies to medicine just as well as it does to Walmart. I don't think I would be going anywhere for $299 lasik. Some people would but not me.

You see, basic economic principle doesn't bear out your idea. You learn in Econ 101 that the more something is in demand, the more expensive it will become. So while it's possible that competition for services could create low prices, the product itself and the need for it don't quite fit a model for low cost.

[Rebecca Jo 1,962]

Yes it would, granted there are those here that have little faith in the free market. Can you imagine what an oil change, tire rotation or a tune-up would cost if car insurance was mandated to covered those items? Insurance tends to distort the true price when the provider and the insurer are fighting over the payment or cost.

But my car insurance doesn't just "not" cover those low cost items. It also doesn't cover a new transmission.

If we create an environment for insurance companies to quit paying for things in order to only cover the high-cost items, are we "safe" in letting those companies decide what is "low cost"?

Edited May 13, 2012 by Rebecca Jo

[Leatherneck 693]

Well, you get what you pay for and that old saying applies to medicine just as well as it does to Walmart. I don't think I would be going anywhere for $299 lasik. Some people would but not me.

You see, basic economic principle doesn't bear out your idea. You learn in Econ 101 that the more something is in demand, the more expensive it will become. So while it's possible that competition for services could create low prices, the product itself and the need for it don't quite fit a model for low cost.

Right, it is about choice and options, someone might only be able to afford the low end cost of $299. I wouldn't want anyone near my eyes at that price either, but for someone that can't afford &1500 per eye, they very well might choose that option. Supply is the other component to cost. The need for basic medical care isn't going away nor are less doctors being produced, why would the price not come down?

[Rebecca Jo 1,962]

Right, it is about choice and options, someone might only be able to afford the low end cost of $299. I wouldn't want anyone near my eyes at that price either, but for someone that can't afford &1500 per eye, they very well might choose that option. Supply is the other component to cost. The need for basic medical care isn't going away nor are less doctors being produced, why would the price not come down?

Because the good is in high demand?

[one...two...tree 2,762]

Most roads, schools, courts, etc. are not federally funded. Publicly yes, by state and local government. You have a choice in the state/community you live in.

Yes, poor Paul. Write to Amnesty International and tell them the U.S. gov't is holding you here against your will.

[james&olya 1,121]

I don't know if we should give them the room to try.

All I know is some preventive care can be affordable. For instance, the cheap BMP I mentioned above actually exists. Here's how I know:

Previously when my husband had insurance, we would get all his routine blood work done at the hospital. They would bill his insurance and it wouldn't be covered until we hit the $1000 deductible. The tests (of which the BMP was one) came to $330. So we were always making payments to the hospital for blood work.

When he lost his insurance, we found out through friends that a large physicians group in our town has a lab that does affordable basic tests. We started going there while Wes was uninsured. We could get all the same tests done (that the hospital were doing) for about $35. In fact, we went there last weeks (even though he is insured now) because paying the low rate was less hassle than going through the big lab corporation his insurance requires.

And the BMP was #15 of the $53 we paid.

I think our health care system is so confusing that people don't know how to find healthcare bargains. If routine stuff simply wasn't covered by insurance, would the free market come to rescue for the healthcare consumer? Or would be gouged like we are with oil?

You discovered that some things in health care are grossly over-billed. I could give you a number of other things that should be a LOT cheaper! The problem is that a lot of health-care is not reimbursed. Hospitals are forced to charge whatever they can get away with just to survive. It is very unfair to those 'cash' customers who get stuck paying for all the dead-beats. The grocery store and the car repair places are not expected, let alone mandated, as hospitals are, to provide their services to everyone regardless of whether they will pay. This is an even bigger reason why we need a system of universal health insurance! The actual costs of providing this will not be as high as some predict because the per-patient charges will be able to come down substantially once providers are getting reasonable reimbursement for everyone they give services to. In addition, if there is a single payer for all, there will be a much better opportunity to find ways to improve what we are doing to get the best return on the dollars being spent. Sarah Palin referred to this in a grossly distorted way by invoking death panels. The reality is that some sanity needs to be injected into a runaway system that spends vast sums on end-of-life care that is often relatively futile.

The idea that the consumer will be able to 'shop around' for the best buy is not likely to work well in practice. How many people will opt for wal-mart bargains in bypass surgery? It does actually exist, even now, in the form of medical procedures that can be done in India, Thailand, etc for a fraction of what it costs here. How many people do you know that are happy to opt for this? Leaving the system in the hands of the free market will also likely result in our being 'gouged' as you say, like we are for oil! For all these reasons and others, a government controlled health insurance program modeled after some of the better ones in other developed countries would probably be the best option here as well. Even 'medicare for all' would be a big improvement over the status quo, but we can do much better at providing high quality care at a much more reasonable price!

Edited May 13, 2012 by james&olya

[spookyturtle 9,465]

Right, it is about choice and options, someone might only be able to afford the low end cost of $299. I wouldn't want anyone near my eyes at that price either, but for someone that can't afford &1500 per eye, they very well might choose that option. Supply is the other component to cost. The need for basic medical care isn't going away nor are less doctors being produced, why would the price not come down?

Shouldn't you be counting? 3958

[Obama 2012 1,714]

I want to come back to this because I think this is just so wrong on so many levels.

How do you make the leap that a person without insurance isn't "working hard" to pay for treatments?

How is it right that a hard working person should have to ask their hard working family and friends for for help?

How do you make the leap that a person without insurance wants their city, state and nation to take care of them?

Does it ever occur to you that the hard working person just wants insurance they can afford? That they want health insurance companies to behave like they used to behave and just pay the claims?

If you want insurance that you can afford then we need to go back to COST. You want insurance companies to pay every single claim, then tell people AND doctors to stop abusing the system. There's a cause and effect for everything. Insurance companies don't make their money off of premiums they collect. They generally (most of them anyway) pay out more than they take in from actual premiums. They invest the premiums and help them grow so they can A) pay for the healthcare and B) turn somewhat of a profit which is very small in comparison to any other industry.

Until congress addresses the issue of actual cost and doesn't play politics, we're all doomed. They hand us over to the insurance companies and at the same time screw the insurance companies over by making them have actions that send their costs through the roof. At the same exact time they prop up Big Pharma guaranteeing high costs for prescriptions and screwing over the public even more.

We can't win. The Washington lobby on health care is extreme and not to the extent that your average insurance company has any type of benefit as some would make it out to be. The American Medical Association and Big Pharma have done more harm to the American populace in the past 30 years than imaginable. We need more doctors, more specialists, etc.. However thanks to the AMA we aren't going to see that anytime soon. There's a huge supply and demand issues with doctors in many areas and a lot of that is thanks to lobbying from the AMA. Amusingly enough, the AMA only makes up 18% of all doctors, which says A LOT, especially when you look at the influence on Obamacare. Lobbying works and its VERY prevalent in the Democratic party despite what the leftist jerk offs will have you believe. Democrats aren't the only ones to blame here though as Republicans have had options for years, just never taking advantage of their situations. Well, they did, just not in ways that necessarily help the American people.

As long as both parties work for lobbyists and corporate America, nothing will change in health care. We can argue about who should pay what and who should help who, but at the end of the day until costs are actually focused on; everyone is screwed and will continue to be for a very long time.

[Obama 2012 1,714]

Yes, poor Paul. Write to Amnesty International and tell them the U.S. gov't is holding you here against your will.

You really are a special one. Of course I would expect no less of a comment from someone of your stature who runs to his mommy when people challenge him.

[james&olya 1,121]

If you want insurance that you can afford then we need to go back to COST. You want insurance companies to pay every single claim, then tell people AND doctors to stop abusing the system. Until congress addresses the issue of actual cost and doesn't play politics, we're all doomed. At the same exact time they prop up Big Pharma guaranteeing high costs for prescriptions and screwing over the public even more.

We can't win. The Washington lobby on health care is extreme. Big Pharma have done more harm to the American populace in the past 30 years than imaginable. We need more doctors, more specialists, etc.. There's a huge supply and demand issues with doctors in many areas . Lobbying works . Democrats aren't the only ones to blame here though as Republicans have had options for years, just never taking advantage of their situations. Well, they did, just not in ways that necessarily help the American people.

As long as both parties work for lobbyists and corporate America, nothing will change in health care. We can argue about who should pay what and who should help who, but at the end of the day until costs are actually focused on; everyone is screwed and will continue to be for a very long time.

This much I agree with!

[james&olya 1,121]

We need more doctors, more specialists, etc.. There's a huge supply and demand issues with doctors in many areas.

The issue is less one of supply and more one of distribution. Health outcomes data for places like Minnesota are very similar to places like NYC despite huge differences in number of doctors and specialists per capita. The ugly truth is that reimbursement policies have distorted health care provision in ways that have encouraged the provision of many services that do not actually help prolong life the way the public has been led to believe. Bypass surgery is one such example!