ACA Not So Affordable

[OriZ 3,157]

I have to say a word about deductibles. Health insurance deductibles do not exist in most countries. I find them to be utterly retarded and contrary to the whole point of having insurance. Why have health insurance if you still have to pay so much out of pocket? It took me a while to get used to it as the system in Israel is a HMO system with certain co pays but no deductibles. There is no way that in 2016, people with health insurance should pay thousands before they can even begin to enjoy their insurance. I am a free market person but to me any plan that will eliminate deductibles completely without significantly raising premiums is something I might support. Universal health care is not without issues, though.

Nineteen years after enacting a universal coverage law, Israel continues to grapple with the triangular constraints of cost, access and quality that define the limits of any national health care system, according to David Chintz.

Speaking at a health policy seminar at the University of Pennsylvania's Leonard Davis Institute of Health Economics (LDI), the Hebrew University Professor of Health Policy and Management provided an overview of the Israeli system. Entitled "Governing the Health Sector: Insights from Israel," it detailed the country's essential health benefits, information systems, financing and efforts to increase cost consciousness and quality improvement.

Second-to-last
In 1995, Israel became the second-to-last country of the developed world to provide health care insurance coverage to all of its citizens, leaving the U.S. as the only holdout.

"It was a big deal and a sea change not only in our health system but also in the whole Israeli political economy," Chintz said.

Funded by a health tax and other government funding, the Israeli national system is administered through four different health plans. It guarantees a basic basket of health services to everyone and has established a transparent national Finance Ministry committee that governs what, if any, new services can be added to the basic basket each year.

Since 1998, the Ministry has indexed inflationary increases for that basket of services to the standard national inflation rate -- and eliminated the previous practice of recognizing a separate and substantially higher inflation rate for the medical industry.

Tightly limited budget increases
The Ministry also limited the total of annual increases for those essential services to 1.5% of the total budget and only for "new technologies." Chintz said a major controversy has been the Ministry's unwillingness to recognize the increased cost of demographic changes in an aging population.

The tax revenues and government funding are pooled and distributed to the four health plans to pay for the basket of services according to a risk-adjusted capitation. For the first 15 years, that adjustment was exclusively for age. Since then, sex and socioeconomic status have been added.

HMOs that are part of the national system offer supplemental insurance for items not covered by the basic benefits.

"The (Finance Ministry's annual budgeting process) process is very open, structured and orderly," Chintz said. A 17-member Ministry committee consisting of 4 physicians, 4 economists, 4 health plan executives, 4 public representatives and the Ministry's health ombudsman makes the decisions. The process is heavily covered by the press and the total funding requested is usually about ten times the amount the government agrees to spend.

115% hospital overflow rate
Chintz pointed out that Israel's hospitals are "extremely efficient." The average length of stay is four days; occupancy rate is 98% and during the flu season it rises to 115% as an overflow of patients are housed in the hallways.

This annual flu-season ritual, he said, "leads to a lot of press and questions about the financing of the health system."

He said Israel now has 3.2 physicians per thousand residents, "but based on the age of our physicians and workforce, we anticipate a shortage that will dip below 3 per thousand. We're making efforts to produce more physicians; we're also very low in both the number of nurses-per-patient-population and the number of general hospital beds."

Overall cost and quality
According to the latest Organization for Economic Co-operation and Development (OECD) figures, Israel's health care costs constitute 7.5% of its GDP; in the U.S. they account for 17.9% of GDP.

According to the World Bank's latest tally, Israel ranks 8th in the world for life expectancy; the U.S. ranks 26th.

http://ldi.upenn.edu/news/overview-israels-universal-health-care-system

Edited August 14, 2016 by OriZ

[yuna628 9,547]

Hey OriZ about the flu statistics: What about minute/spot/urgent care clinics that actually can help take the burden off of hospitals? Are there none in Israel?

The part that angers me is that on the basic plan we're paying over $400 a month, with a $60-75 co-pay (usually I just go to a minute clinic because the PC is so far away), and then whatever cost for medication if needed. Our deductible is 5K. I've been to the clinic three times this year, and each time required medication which wasn't cheap. But even with that I will never scratch a dent of that unless I'm hospitalized. The highest tier plan with a deductible that is insignificant costs over 1K a month. It's always going to be cheaper to just to go without insurance and take the penalty, but it's the risky unknown of what ifs.

[OriZ 3,157]

Hey OriZ about the flu statistics: What about minute/spot/urgent care clinics that actually can help take the burden off of hospitals? Are there none in Israel?

The part that angers me is that on the basic plan we're paying over $400 a month, with a $60-75 co-pay (usually I just go to a minute clinic because the PC is so far away), and then whatever cost for medication if needed. Our deductible is 5K. I've been to the clinic three times this year, and each time required medication which wasn't cheap. But even with that I will never scratch a dent of that unless I'm hospitalized. The highest tier plan with a deductible that is insignificant costs over 1K a month. It's always going to be cheaper to just to go without insurance and take the penalty, but it's the risky unknown of what ifs.

Well, the way it works there is unless it's an emergency, you usually go to what is considered a clinic there...here it would be considered more of a doctor's office, only that you have many types of doctors in the same place. So, say I wanted to see an eye doctor, OR a rheumatologist, OR my primary, in many cases it would actually be in the same place. You sign in, wait by the door to their room, and they call you in(you do not see a nurse first and then wait for them). Usually in the same clinics you can also do bloodwork, vaccinations and even stuff like x-rays. However, for certain things they will refer you to a different clinic or to the hospital. I am not sure if there are any "emergency" clinics that could treat the same issues say like flu complications as a hospital would. I don't believe there are any. But for a simple flu normally you would not go to the hospital, just to said clinic and they treat it there.

The 4 big HMOs own the clinics and place them wherever they feel the need to, but each city has several from each HMO. You can choose whichever HMO you want to sign up with, based on what they have to offer(while most of the basic stuff has to be the same by law, supplemental can be different) and you can switch them once a year too. Copays are usually pretty low - I needed a knee MRI once and I believe it was around $25. For most doctors you only pay about $5 once per quarter. If you switch a doctor, though, you have to start all over. If you don't see them at all during that quarter you don't pay. As I have previously mentioned my wife suffers from several chronic conditions but once she had her residency when she lived there with me, she had no problem signing up for insurance as they are obligated by law to accept whomever, irregardless of pre existing conditions, race, religion etc, which is a good thing but the bad thing is some of them have serious money issues and have actually been on the verge of collapse and have to be propped up by the government which was not mentioned in the above article. I would personally be willing to pay a reasonably higher premium if that meant that no one with pre existing conditions could be refused.

Another problem is the government deciding what they are paying for and what not and there's nothing you can do about it. For instance, several years ago they decided to fund, within the "basket", dental care at first it was for kids up to the ages of 12(back in 2009), this year supposed to be 14 and eventually even 18. While some welcomed this, there was also debate on whether or not it is the right thing to fund that on the expense of potentially life saving treatments and medicines that will not make it in due to the limited budget. I personally opposed it because I feel that a person with no kids should not have to fund other people's kids dental care on the expense of their own medicine. So there are issues, and you will never be able to make everyone happy. The good thing is the US has so many countries' experience to learn from, that if instead of the half assed ACA they actually spent a few years doing research on what is working in every country and what isn't, they could probably come up with a decent plan.

Edited August 14, 2016 by OriZ

[Dakine10 5,452]

Wow only 78 billiion, thats nothing! Can people sue doctor's like crazy in the socialist utopia you hail from?

Single payer cuts the multi billion dollar for profit health insurance industry out of the health care equation. I really don't understand the though process that thinks paying a significant amount of your health care costs for no other reason than to subsidize the middleman is a good idea.

Medical legal issues are a separate topic. Whether you have single payer or private health care or a mixture of both, doctors get sued.

[Dakine10 5,452]

I have to say a word about deductibles. Health insurance deductibles do not exist in most countries. I find them to be utterly retarded and contrary to the whole point of having insurance. Why have health insurance if you still have to pay so much out of pocket? It took me a while to get used to it as the system in Israel is a HMO system with certain co pays but no deductibles. There is no way that in 2016, people with health insurance should pay thousands before they can even begin to enjoy their insurance. I am a free market person but to me any plan that will eliminate deductibles completely without significantly raising premiums is something I might support. Universal health care is not without issues, though.

As you know, health insurance, like any insurance, is designed around maximizing profit and mitigating risk. The actual function of the insurance is secondary. Nothing cuts into profit as much as no deductible plans. The last thing a health insurance company wants is for someone to actually use their health insurance. It only sounds counter intuitive if you think health insurance is actually about health care.

[OriZ 3,157]

As you know, health insurance, like any insurance, is designed around maximizing profit and mitigating risk. The actual function of the insurance is secondary. Nothing cuts into profit as much as no deductible plans. The last thing a health insurance company wants is for someone to actually use their health insurance. It only sounds counter intuitive if you think health insurance is actually about health care.

Well that's kind of the point I was trying to make. I mean, auto insurance, I understand(I still don't like it but that's a different thing and does exist in most countries). However when it comes to health insurance having such high deductibles is truly an American innovation. I do believe that the government as a whole is a very inefficient body, and I'd like it to stay out of most areas of life. Economically, I do not believe it is the government's job to create jobs. So why do I see health care differently? Well, because, any government, big or small is here for one main thing - to protect us. If the government is supposed to protect our physical well being(whether be it through police or the military without getting into the politics of either, or through different laws and regulations) then what is more directly correlated to our physical well being than our health care?

So you're going to try and protect me and keep my streets safe so no one will come and shoot me(again, in theory...never mind that that fails many times) but let insurance companies bankrupt me so I can take care of myself...just makes no sense to me.

[The Nature Boy 7,659]

One has to wonder if the academic was not another big money lobbyist boondoggle. We basically handed over our whole medical system to mega insurance companies, who were a huge part of the problem.

No way all that money and influence in Washington is going to let a single payer system happen.

[John Miller 761]

One has to wonder if the academic was not another big money lobbyist boondoggle. We basically handed over our whole medical system to mega insurance companies, who were a huge part of the problem.

No way all that money and influence in Washington is going to let a single payer system happen.

They've been given the opportunity to perform and failed. As private insurers back out of the health care exchanges, something will have to take their place. Allow that something to be Medicare and you'll have single payer in a few years time. Will the health insurance industry fight? Absolutely. But they really have an ever harder time proving their right to exist. They're sponging 15% off the system for not much in return. What's the case for their participation anymore?

[OriZ 3,157]

One has to wonder if the academic was not another big money lobbyist boondoggle. We basically handed over our whole medical system to mega insurance companies, who were a huge part of the problem.

No way all that money and influence in Washington is going to let a single payer system happen.

I do not believe that health insurance should be a for-profit industry any more than I believe law enforcement should. That's one area I agree with liberals on - health care is a human right, just as much as walking down the street safely is a human right, just as much as having enough food and water to sustain life is a human right, all things that the government plays a role in.

[Merle 458]

The problem lies in the way government runs things. Look at the TSA and The VA stuff that's goi ng on right now. Imagine if EVERYONE had to rely on the government for their health care. It will turn into another gigantic corrupt bureaucracy just like evergthing else they gets their hands on.

[John Miller 761]

Nobody is talking about universal VA. The discussion is around single payer. Something along the lines of Medicare for all.

[yuna628 9,547]

One has to wonder if the academic was not another big money lobbyist boondoggle. We basically handed over our whole medical system to mega insurance companies, who were a huge part of the problem.

No way all that money and influence in Washington is going to let a single payer system happen.

Absolutely. I think that was the idea behind it in the 90s and it still is today. The thought that capitalism/greed works when it comes to the health and well-being of citizenry is madness... but we continued thinking this way.. and yes essentially handed over quite a bit to insurance companies. They may have acted like they were upset about O'care.. but I actually think a lot of them were thrilled about the prospect. Before the mandate I was one of those 'uninsured' persons, that was young, with no health issues, would just visit a clinic for a cold or flu with minimum expense... until I got very sick and required hospitalization. The bill was costly but I paid every bit of it back slowly. When the idea of O'care was being discussed I got health insurance.. it was actually a pretty decent HMO.. can't recall the number.. somewhere around 150 a month? Every single year.. sometimes twice a year the rate increased. My old grandfathered single plan eventually cost nearly as much as the O'care approved joint spousal plan we switched to now... except no longer an HMO and worse benefits. All I can see is that literally nothing has improved but more money goes to the insurance company.

Well that's kind of the point I was trying to make. I mean, auto insurance, I understand(I still don't like it but that's a different thing and does exist in most countries). However when it comes to health insurance having such high deductibles is truly an American innovation. I do believe that the government as a whole is a very inefficient body, and I'd like it to stay out of most areas of life. Economically, I do not believe it is the government's job to create jobs. So why do I see health care differently? Well, because, any government, big or small is here for one main thing - to protect us. If the government is supposed to protect our physical well being(whether be it through police or the military without getting into the politics of either, or through different laws and regulations) then what is more directly correlated to our physical well being than our health care?

So you're going to try and protect me and keep my streets safe so no one will come and shoot me(again, in theory...never mind that that fails many times) but let insurance companies bankrupt me so I can take care of myself...just makes no sense to me.

That's kind of how I see things too. I believe the government has a responsibility to protect it's citizens... healthcare should be a part of this.

They've been given the opportunity to perform and failed. As private insurers back out of the health care exchanges, something will have to take their place. Allow that something to be Medicare and you'll have single payer in a few years time. Will the health insurance industry fight? Absolutely. But they really have an ever harder time proving their right to exist. They're sponging 15% off the system for not much in return. What's the case for their participation anymore?

It's not just insurance companies though.. drug companies also do a great deal to drive up costs. My sister deals with critically ill patients every day, especially trying to get very expensive drugs certified via insurance companies who don't care how ill the patient is but only how expensive it is. There is one illness that used to require patients to go through monthly sessions of having a type of infusion with a drug, and then also take multiple other medications along side of that. There was a high side effect rate for this, so the patient would then also require more expensive drugs to combat these drug-induced effects.. that is if the treatment even worked in the first place and the patient doesn't die from the side effects (but more money for the drug companies the sicker the patient right?). A few years ago, one of the big pharma developed a drug that costs somewhere around 100 grand (yes that much). It was so effective in trials it has produced a 90% remission/cure rate for a disease and few side effects that was once only merely able to be barely managed until death. No insurance company wants to cover this drug, for obvious monetary reasons. Patients like this then suffer through a ridiculous bureaucratic process and are still often denied. One patient managed to win a sort of 'drug lottery' grant through a foundation to receive a years worth of care... after that... they'd better hope they are put in remission.

All those scare stories about the NHS and patients who die or nearly die because the government told them they are on a 'wait list' or the old GOP talking point of 'death panels'? Well I wish people would wake up and realize that every single day someone is dead or nearly dying because of a insurance company/drug company death panel. Almighty $.

Is medicare for all sustainable though? It's a great help to the elderly, and my parents have made good use of it... but there are still issues where they cannot afford the drugs they may need.. and something we like to call the ''donut hole'' or ''gap'' in coverage.

I do not believe that health insurance should be a for-profit industry any more than I believe law enforcement should. That's one area I agree with liberals on - health care is a human right, just as much as walking down the street safely is a human right, just as much as having enough food and water to sustain life is a human right, all things that the government plays a role in.

Government has a responsibility to provide sound infrastructure, protection for its citizens at home and abroad, law enforcement, clean food and water supply, protection of natural resources etc... I just can never understand why people can't reflect on healthcare as being in the same area as these.

Edited August 15, 2016 by yuna628

[OriZ 3,157]

The problem lies in the way government runs things. Look at the TSA and The VA stuff that's goi ng on right now. Imagine if EVERYONE had to rely on the government for their health care. It will turn into another gigantic corrupt bureaucracy just like evergthing else they gets their hands on.

That's why I say they should look around the world and study other countries' systems before trying to implement one here. Fortunately for the US, at least in that way, it is the last to do so in the developed world, so plenty to learn of other's successes or shortcomings, mistakes or accomplishments, achievements and failures, what works what doesn't work. IF they did that and came up with a reasonable plan(I'd have to see details of it first of course) I could get behind it, but not just another half assed attempt like the ACA.

[OriZ 3,157]

Government has a responsibility to provide sound infrastructure, protection for its citizens at home and abroad, law enforcement, clean food and water supply, protection of natural resources etc... I just can never understand why people can't reflect on healthcare as being in the same area as these.

Yup, and people often wonder how a free market for the most part guy like me, believes that our health should be taken out of the hands of insurance companies. It's difficult to explain, but that's it in a nutshell.

[John Miller 761]

It's not just insurance companies though.. drug companies also do a great deal to drive up costs. My sister deals with critically ill patients every day, especially trying to get very expensive drugs certified via insurance companies who don't care how ill the patient is but only how expensive it is. There is one illness that used to require patients to go through monthly sessions of having a type of infusion with a drug, and then also take multiple other medications along side of that. There was a high side effect rate for this, so the patient would then also require more expensive drugs to combat these drug-induced effects.. that is if the treatment even worked in the first place and the patient doesn't die from the side effects (but more money for the drug companies the sicker the patient right?). A few years ago, one of the big pharma developed a drug that costs somewhere around 100 grand (yes that much). It was so effective in trials it has produced a 90% remission/cure rate for a disease and few side effects that was once only merely able to be barely managed until death. No insurance company wants to cover this drug, for obvious monetary reasons. Patients like this then suffer through a ridiculous bureaucratic process and are still often denied. One patient managed to win a sort of 'drug lottery' grant through a foundation to receive a years worth of care... after that... they'd better hope they are put in remission.

Agreed, drug costs are outrageous as well. Seeing that all other industrialized countries figured this out, one would think that this ever so exceptional nation can do it too.