Seriously? (Health Ins. Rant)

SVreX wrote: In reply to Swank Force One: Deal. You are smart and knowledgable on the subject, and I always appreciate your input. I won't expect you to roll over when you hear that stuff. But don't get too defensive, either. Don't assume that every time someone says, "This sucks" that they are saying you, your boss, or your industry are entirely to blame. I am a contractor. Contractors often have a pretty bad reputation. Part of being a good contractor is accepting the responsibility for the weaknesses and failures of my industry, even when it wasn't my fault.

I know, i'm not mad or trying to be defensive. The only thing i was really addressing was the premium price hikes.

I'm with you guys, i think it's E36 M3ty that my bosses get enormous bonuses and i get a couple hundred bucks as a thank you for the ~2800 hours i logged last year.

2800? What'd you do, work 1/2 time?

Half of my waking hours, yes.

you sleep??

RX Reven' wrote:

wbjones wrote: In reply to Duke: you just refuse to understand that the car liability (to protect others from you) isn't any different from you having to have health coverage to protect us from you

Hi wbjones, I believe I understand the fundamental reason why you and Duke aren’t in agreement. You’re operating from the assumption that broken people must be fixed and Duke isn’t. If fixing broken people was a given, then yes, auto insurance and health insurance would be analogous. But it’s not a given, rather, it’s on a continuum where our society is attempting to strike a balance between showing compassion for its citizens without degrading into a free for all looting of other peoples’ money. If you bang up my car, I have every right to expect you to fix it, if I get sick, I don’t have a right to expect you to fix me because you didn’t do anything to cause it….helping me in this case is about being compassionate and civilized, not about fulfilling a fundamental obligation.

I think you misunderstand where I'm coming from … the bolded part above is the disconnect … because, assuming you DON'T have health ins.

yes you do expect me to fix it … by not paying for the health services (because you can't afford to, and you WILL be treated) I / we (the royal I / we ) will have to pay for it … i.e. fix you

so while I'm IN agreement with him that the law sucks, the thing I've been trying to get across is that by not having ins. you (again the royal you) expect me to take care of you … fix you

at least this is how I see it

I'm going to add this to my anecdotal story above.

My doctors visit this morning took 39 minutes, door to door. I had no appointment, I walked in, they saw me, wrote the scrips and I was gone. It cost me $120. My last ER visit, where I thought I was having a heart attack, took under 2 hours, door to door, and cost about $1800. That one had lots of lab work and I was on a EKG machine in under 3 minutes from the time I walked in.

My FIL fell this evening and was rushed to the VA ER in a ambulance. Possible dislocated shoulder, broken elbow and ribs. They have been there three hours. He just had x-rays done after 2.5 hours, but they forgot to shoot film of the shoulder. It was on the orders for x-ray, but they misunderstood the shoulder part. He's back on the waiting list for x-ray. In another few hours he should have all the films back and can meet with the doctor again. They might make it home before midnight.

I'll stick with the expensive healthcare thank you. Having seen how the government runs healthcare, the alternative is so much worse. Sometimes you just get what you pay for.

Edit: It's now 9:40. So the second set of x-rays and the doctors visit took 2 hours and 20 minutes. They must have kicked it into high gear. Oh, and for the curious, he has broken his shoulder and has to see a orthopedic doctor...next Thursday.

wbjones wrote:

RX Reven' wrote:

wbjones wrote: In reply to Duke: you just refuse to understand that the car liability (to protect others from you) isn't any different from you having to have health coverage to protect us from you

Hi wbjones, I believe I understand the fundamental reason why you and Duke aren’t in agreement. You’re operating from the assumption that broken people must be fixed and Duke isn’t. If fixing broken people was a given, then yes, auto insurance and health insurance would be analogous. But it’s not a given, rather, it’s on a continuum where our society is attempting to strike a balance between showing compassion for its citizens without degrading into a free for all looting of other peoples’ money. If you bang up my car, I have every right to expect you to fix it, if I get sick, I don’t have a right to expect you to fix me because you didn’t do anything to cause it….helping me in this case is about being compassionate and civilized, not about fulfilling a fundamental obligation.

I think you misunderstand where I'm coming from … the bolded part above is the disconnect … because, assuming you DON'T have health ins. yes you do expect me to fix it … by not paying for the health services (because you can't afford to, and you WILL be treated) I / we (the royal I / we ) will have to pay for it … i.e. fix you so while I'm IN agreement with him that the law sucks, the thing I've been trying to get across is that by not having ins. you (again the royal you) expect me to take care of you … fix you at least this is how I see it

Hi wbjones,

Thank you for taking the time to provide a really well thought out reply.

So, this actually isn’t about the intrinsic principle of causation being required to claim obligation.

For those just joining us, causation is why I see a qualitative difference between forcing someone to buy car insurance and forcing someone to buy health insurance…I may cause someone’s car to get banged up creating an intrinsic obligation on my part but I’m not going to cause someone to get cancer so there is no intrinsic obligation on my part.

Instead, this is actually about expectations.

People have enjoyed so much generosity and compassion that they now expect it as a matter of course.

I bet if I committed a random act of kindness by sending someone a $100 check each month and then stopped after a few years, they’d hunt me down and say “where’s my Berkleying money you PoS.”

With this in mind, I have to concede that you’ve got a solid point.

I'm not sure I understand the assumption that everyone will need/get healthcare eventually. I spent the last year of my father's life trying to get him in to see a doctor and despite having good insurance he wouldn't go. The only way he would have gone was unconscious and against his will, and if/when he woke up he would have gotten up and left.

Babies can be born outside of hospitals and old men can die in spare bedrooms. Assuming everyone will eventually want to see a doctor or visit a hospital and create a burden on the healthcare system is based on conjecture.

Even the social security system allows groups to opt out if they can prove that they have an alternative method for taking care of their elderly. The health care legislation could have done the same for religious groups that don't believe in Western medicine or for people with strong DNRs or the like, but it didn't. To me that omission was the biggest clue that at some level some of the architects of the legislation wanted it to be a failure.

wbjones wrote: I think you misunderstand where I'm coming from … the bolded part above is the disconnect … because, assuming you DON'T have health ins. yes you do expect me to fix it … by not paying for the health services (because you can't afford to, and you WILL be treated) I / we (the royal I / we ) will have to pay for it … i.e. fix you

Well, OK, I understand, but I disagree. You're assuming that I have no principles and WILL abuse the system that I theoretically am declining to be a part of. I guess given the current state of humanity, that's an understandable assumption. It just doesn't particularly hold true in my case.

In reply to Duke:

There are certainly people out there that don't have insurance and don't abuse the system. But people like you would have to far outnumber those who do use the system without insurance. I have seen plenty of "self-pay" patients admitted to ICU or dialyzed, usually more than a handful daily at my small urban hospital. Those costs run into the millions yearly for my hospital alone.

The responsibly uninsured don't come close to making up that shortfall. Through Medicare and Medicaid, our hospital makes the majority of its money, about 66%, from your tax dollars.

I remember (way back on page 1) when this was a thread about a company being a bit inflexible on when they expected payment for services, and not really anything to do with the larger philosophical discussion that it has turned into. This place is nice in that people (usually) can have civil discussions where they disagree, but not resort to out and out name calling unlike pretty much the rest of the entire internet.

T.J. wrote: I remember (way back on page 1) when this was a thread about a company being a bit inflexible on when they expected payment for services, and not really anything to do with the larger philosophical discussion that it has turned into. This place is nice in that people (usually) can have civil discussions where they disagree, but not resort to out and out name calling unlike pretty much the rest of the entire internet.

What do you expect, this topic is heavily corrosive to both sides.....those who now get free/cheaper E36 M3, and those that are expected to pay extra for it. Both sides will fight it for a long time to come.

Datsun1500 wrote: The "They're making huge profits, my premiums should be lower" argument is an odd one to me. Don't they make most of the $$ off of investments and not premiums?

That, i don't know. I just know that they have to run/make profit on a very small percentage of every premium dollar taken in. I think it was 85% of every premium dollar has to be paid out for services.

I'm sure there's investing going on, but it'd be investing of dollars left over after paying out that 85%.

Swank Force One wrote: These are all truths... but correlation =! causation. Look, the whole system sucks, i agree. Just don't expect someone like me who has a few years deep within the field to roll over when i see comments like "It's all a conspiracy from the insurance companies!"

Sorry. Maybe I came across wrong here.

I'm not saying Insurance companies are all to blame. They're not. One article I listed also talked about how hospitals jack up their prices too. Let's also discuss big Pharma in that same breath.

My thought is that costs are being driven up by various factors. I don't see the ACA as being the sole cause of this so am pointing out other factors to support my position.

So, again. The insurance companies are not solely to blame in this.

Duke wrote:

wbjones wrote: I think you misunderstand where I'm coming from … the bolded part above is the disconnect … because, assuming you DON'T have health ins. yes you do expect me to fix it … by not paying for the health services (because you can't afford to, and you WILL be treated) I / we (the royal I / we ) will have to pay for it … i.e. fix you

Well, OK, I understand, but I disagree. You're assuming that I have no principles and WILL abuse the system that I theoretically am declining to be a part of. I guess given the current state of humanity, that's an understandable assumption. It just doesn't particularly hold true in my case.

sorry … a lot of what I was posting was directed at the royal you … even though you were the recipient … I wasn't really directing my comments at you … I should have found a way to make the ideas I was expressing a little less personal … since there isn't an "I'm embarrassed emoticon" .. hope you'll accept my apology

I just scrolled through to see if anyone from outside the US had posted. Carry on.

Xceler8x wrote:

Swank Force One wrote: These are all truths... but correlation =! causation. Look, the whole system sucks, i agree. Just don't expect someone like me who has a few years deep within the field to roll over when i see comments like "It's all a conspiracy from the insurance companies!"

Sorry. Maybe I came across wrong here. I'm not saying Insurance companies are all to blame. They're not. One article I listed also talked about how hospitals jack up their prices too. Let's also discuss big Pharma in that same breath. My thought is that costs are being driven up by various factors. I don't see the ACA as being the sole cause of this so am pointing out other factors to support my position. So, again. The insurance companies are not solely to blame in this.

No, ACA isn't the sole cause for sure. Costs were rising before ACA, they're rising after.

Are they rising faster for Joe Schmo that had insurance prior to ACA, now that ACA is active? Yep.

Swank Force One wrote:

Xceler8x wrote:

Swank Force One wrote: These are all truths... but correlation =! causation. Look, the whole system sucks, i agree. Just don't expect someone like me who has a few years deep within the field to roll over when i see comments like "It's all a conspiracy from the insurance companies!"

Sorry. Maybe I came across wrong here. I'm not saying Insurance companies are all to blame. They're not. One article I listed also talked about how hospitals jack up their prices too. Let's also discuss big Pharma in that same breath. My thought is that costs are being driven up by various factors. I don't see the ACA as being the sole cause of this so am pointing out other factors to support my position. So, again. The insurance companies are not solely to blame in this.

No, ACA isn't the sole cause for sure. Costs were rising before ACA, they're rising after. Are they rising faster for Joe Schmo that had insurance prior to ACA, now that ACA is active? Yep.

By design, it’s impossible to add up all of the real costs at this point.

When the revenue from your business is down because some of your customers used to work in Med-Tech and lost their jobs as a result of the Medical Device tax are you going to connect the dots; doubtful.

In reply to wbjones:

No apology necessary, man, I wasn't taking it personally, just representing the good guys. But thanks!

Multiple studies conducted by entities on both sides of the political isle spanning many years have come to the strikingly similar conclusion that 15% to 18% of our total health care system expenditures are wasted on defensive medicine.

Defensive medicine is defined as activities that are not indicated but rather are preformed to guard against litigation. Basic tort reform to eliminate punitive damages meaning that plaintiffs would still be fully compensated for malpractice (medical expenses, pain, suffering, and loss of income) but no more than that to “teach them a lesson” would drastically reduce the amount we currently waste on defensive medicine.

There’s no way to precisely estimate how much before implementation but as a statistician, I know that “when in doubt, shoot for the middle’ which would put us at around 8%.

So, the whole ACA thing is about providing insurance to the 15% of Americans that didn’t have it. If we just eliminated punitive damages, it would likely solve over half of the entire problem with no adverse effect on the 85% of Americans that already had insurance.

It’s really simple folks…stop wasting resources on trying to avoid being sued and redirect them to the poor guy that just fell off a ladder.

RX Reven' wrote:

Swank Force One wrote:

Xceler8x wrote:

Swank Force One wrote: These are all truths... but correlation =! causation. Look, the whole system sucks, i agree. Just don't expect someone like me who has a few years deep within the field to roll over when i see comments like "It's all a conspiracy from the insurance companies!"

Sorry. Maybe I came across wrong here. I'm not saying Insurance companies are all to blame. They're not. One article I listed also talked about how hospitals jack up their prices too. Let's also discuss big Pharma in that same breath. My thought is that costs are being driven up by various factors. I don't see the ACA as being the sole cause of this so am pointing out other factors to support my position. So, again. The insurance companies are not solely to blame in this.

No, ACA isn't the sole cause for sure. Costs were rising before ACA, they're rising after. Are they rising faster for Joe Schmo that had insurance prior to ACA, now that ACA is active? Yep.

By design, it’s impossible to add up all of the real costs at this point. When the revenue from your business is down because some of your customers used to work in Med-Tech and lost their jobs as a result of the Medical Device tax are you going to connect the dots; doubtful.

So you're saying you agree that costs for you and me have gone up, but we don't know exactly by how much?

RX Reven' wrote: So, the whole ACA thing is about providing insurance to the 15% of Americans that didn’t have it. If we just eliminated punitive damages, it would likely solve over half of the entire problem with no adverse effect on the 85% of Americans that already had insurance.

Interestingly, the author of one of Xeler8X's linked articles was crowing about the success of the ACA because there was a 1.2% decrease in the number of uninsured. Since that article was written almost a year ago the number has likely changed but reports have noted sign-ups are consistently lower than expected, so much so that HHS fudged the numbers.

I guess it's easier to gloat over miniscule improvements than to admit that blowing-up a flawed (but repairable) system was a poor alternative.

Swank Force One wrote:

RX Reven' wrote:

Swank Force One wrote:

Xceler8x wrote:

Swank Force One wrote: These are all truths... but correlation =! causation. Look, the whole system sucks, i agree. Just don't expect someone like me who has a few years deep within the field to roll over when i see comments like "It's all a conspiracy from the insurance companies!"

Sorry. Maybe I came across wrong here. I'm not saying Insurance companies are all to blame. They're not. One article I listed also talked about how hospitals jack up their prices too. Let's also discuss big Pharma in that same breath. My thought is that costs are being driven up by various factors. I don't see the ACA as being the sole cause of this so am pointing out other factors to support my position. So, again. The insurance companies are not solely to blame in this.

No, ACA isn't the sole cause for sure. Costs were rising before ACA, they're rising after. Are they rising faster for Joe Schmo that had insurance prior to ACA, now that ACA is active? Yep.

By design, it’s impossible to add up all of the real costs at this point. When the revenue from your business is down because some of your customers used to work in Med-Tech and lost their jobs as a result of the Medical Device tax are you going to connect the dots; doubtful.

So you're saying you agree that costs for you and me have gone up, but we don't know exactly by how much?

Oh absolutely.

I’m a process engineer with a decade of experience working in the med-tech industry.

Take any of the tools of the trade…Theory of Constraints, Value Stream Flow Analysis, etc., etc., etc., and apply them to the ACA and you’ll find that we’ve not only failed to reduce the inefficiencies, we’ve literally doubled down on them.

Suggesting that the ACA will improve our health care system is in diametric opposition to the fundamental tenants of system dynamics.

Now, there will be winners - plenty of them, but the system as a whole has been significantly worsened.

You don’t get well by enrolling on the new web site or talking to a navigator or dealing with the IRS or meeting with a ACA consultant or filling out additional paperwork…you get well by having a doctor figure out what’s wrong with you and providing treatment.

The system is constrained and as a result, every penny spent on the junk is a penny that won’t be spent making you well.

It’s so frustrating to me that people don’t get this.

RX Reven' wrote: Multiple studies conducted by entities on both sides of the political isle spanning many years have come to the strikingly similar conclusion that 15% to 18% of our total health care system expenditures are wasted on defensive medicine. Defensive medicine is defined as activities that are not indicated but rather are preformed to guard against litigation. Basic tort reform to eliminate punitive damages meaning that plaintiffs would still be fully compensated for malpractice (medical expenses, pain, suffering, and loss of income) but no more than that to “teach them a lesson” would drastically reduce the amount we currently waste on defensive medicine. There’s no way to precisely estimate how much before implementation but as a statistician, I know that “when in doubt, shoot for the middle’ which would put us at around 8%. So, the whole ACA thing is about providing insurance to the 15% of Americans that didn’t have it. If we just eliminated punitive damages, it would likely solve over half of the entire problem with no adverse effect on the 85% of Americans that already had insurance. It’s really simple folks…stop wasting resources on trying to avoid being sued and redirect them to the poor guy that just fell off a ladder.

The tort reform thing is a good point, especially since multiple states have instituted their own version of tort reform for medical malpractice. I think that investigating the malpractice insurance premiums for those states would be beneficial to the conversation. As far as I am aware, those states that have enacted tort reform from medical malpractice have not seen a reduction in insurance premiums but I am willing to be further educated. From what I have seen, there has been no or negligible benefit from a cost perspective.

mattm wrote:

RX Reven' wrote: Multiple studies conducted by entities on both sides of the political isle spanning many years have come to the strikingly similar conclusion that 15% to 18% of our total health care system expenditures are wasted on defensive medicine. Defensive medicine is defined as activities that are not indicated but rather are preformed to guard against litigation. Basic tort reform to eliminate punitive damages meaning that plaintiffs would still be fully compensated for malpractice (medical expenses, pain, suffering, and loss of income) but no more than that to “teach them a lesson” would drastically reduce the amount we currently waste on defensive medicine. There’s no way to precisely estimate how much before implementation but as a statistician, I know that “when in doubt, shoot for the middle’ which would put us at around 8%. So, the whole ACA thing is about providing insurance to the 15% of Americans that didn’t have it. If we just eliminated punitive damages, it would likely solve over half of the entire problem with no adverse effect on the 85% of Americans that already had insurance. It’s really simple folks…stop wasting resources on trying to avoid being sued and redirect them to the poor guy that just fell off a ladder.

The tort reform thing is a good point, especially since multiple states have instituted their own version of tort reform for medical malpractice. I think that investigating the malpractice insurance premiums for those states would be beneficial to the conversation. As far as I am aware, those states that have enacted tort reform from medical malpractice have not seen a reduction in insurance premiums but I am willing to be further educated. From what I have seen, there has been no or negligible benefit from a cost perspective.

Hi mattm,

Although reducing malpractice insurance premiums would be a nice side benefit, it’s not the game changer I’m referring to.

What I’m proposing is resource reallocation.

In other words, stop stuffing people into MRI machines when they don’t need it just to avoid being sued and give the ride to some uninsured guy that just wadded up his Kawasaki…his outcome would really be improved by it.

With the exact same resources (doctors, nurses, beds, meds, devices, and yes MRI machines), working at the exact same rate (meaning no additional cost or burden what so ever), we could greatly improve the net yield of our health care system.

How much, well we currently have ~16.5% waste in the system due defensive medicine so we’re running at ~83.5% efficiency.

If we just cut the waste in half through tort reform (no reason we couldn’t do even better but hey, under commit / over deliver), we’d get a ~10.18% increase in yield with again, no additional cost or burden what so ever.

This liberated resource is literally within striking distance of being sufficient to provide for all of our uninsured Americans.

Bottom line...

It’s not about the malpractice insurance or the settlement awards or the attorney fees.

Rather, it’s about the gross misallocation of resources; that’s what we can leverage to drive a win-win.

So, I do get that you’re using malpractice insurance premiums as a proxy for tort effects (clever) but they wouldn’t reflect or capture the effect of resource misallocation.