I fear I can only offer you theory.C-Kwik wrote:
How have insurance practices increased costs? Please elaborate specifically.
No...you never actually asked for it. You merely dismissed the argument asserting that it is speculation. And it may be, but my impression from what you are saying is that you disagree with the argument wholly based on a lack of proof. A very small bit of research does come up with a large number of cites that make this argument.hsckris wrote:I basically did ask for proof. I never said or implied that a lack of proof meant a problem didn't exist. I believe my points were quite clear.
Did you see the numbers I put forth in a prior post? CA has a $250K cap on non-economic damages. The difference in malpractice insurance premiums was $61K/year in CA vs $277K in FL/year. Now granted, the example provided is likely the biggest margin found in the research paper, but there is a huge discrepancy. The paper actually breaks it down by many different specialties and it can vary. OB-GYN services can be quite high due to child birth and the fact that juries are indeed more sympathetic towards children in a trial.hsckris wrote:From your cite: "Doctors spent $6.3 billion last year on medical liability coverage."What I want to know: How much would the doctors spend if we had med mal reform? What exactly can be achieved by reform (in consideration of the fact that there will always be liability of some kind)? That is what I have yet to see hard numbers on. Health Matrix: Journal of Law Medicine; Summer2006, Vol. 16 Issue 2, p693-722, 30pIt is all well and good to talk about increased costs, but without hard numbers on what exactly will be achieved by med mal reform, you simply cannot say the reform is necessary to cheaper administration. I'm not arguing that there aren't specific instances of abuse in med mal cases, but I am questioning how anyone can say it must be reformed without accurate evidence of what will be saved by said reform.
I missed those numbers somehow or another. Certainly it makes sense there would be some savings, I never meant to say otherwise. Could we achieve similar savings via other avenues? If so, those certainly need to be explored as well.C-Kwik wrote:But its not hard to conclude that there would be a signifcant savings.
Feel free to explain the logic you're going by.charlieo wrote:
I fear I can only offer you theory.
The mere existence of insurance raises costs, because it brings more money to the table.
Look at the so called "elective" surgery market (cosmetic, lasik, even orthodontic, etc). Prices for that are EXTREMELY competitive, because people are spending their limited funds, and have the ability to choose where they spend said funds.
Absolutely. Its likely there are many causes for our healthcare costs to be higher than absolutely necessary. Some may even be related to each other.hsckris wrote:I missed those numbers somehow or another. Certainly it makes sense there would be some savings, I never meant to say otherwise. Could we achieve similar savings via other avenues? If so, those certainly need to be explored as well.
I agree with you on this for the most part. To place limitations can have its own detriminetal side effects. Some would say the root cause of that though is that we have too many attorneys. Since they make money based on everyone else's legal problems, if there are too many lawyers and not enough valid cases, then there will be a propensity to try and win any case they can get their hands on. And the damnedable part of it is they can actually lose a majority of their cases and still make money if they can manage to win a few extraordinarily high settlements every once in a while. If there were less attorneys out there, then they would be most likely to stick to cases they think they can actually win. It would certainly be a whole lot less work for them as well as they would spend less time fighting cases they would likely lose.hsckris wrote:I do have a theoretical problem with a national implementation of limits where states currently have discretion. I also know that I personally cannot value someone's legitimate pain and suffering easily, and therefore I don't necessarily approve of some arbitrary government-imposed limits. Who's to say somebody is not allowed to recover more than 250K. What if the legitimately suffered that much? Hypothetically a person could be in a position of not being able to work (due to the med mal), and not having enough recovery to cover their loss, future expenses, etc. because of some arbitrary gov't limit. Accordingly, I don't think it is just for a minimum wage earner to become a billionaire because a doctor botched up. I guess all along I've been skeptical of med mal reform because I believe there should be a full recovery where there is a valid, proven claim, and I believe there is no perfect maximum amount of allowable recovery or regulation. From that perspective, I would rather see us focus on the costs of health care itself. Doing so would in turn reduce awards for med mal, as they are in some way based on the victim's future medical expenses (to recover from the med mal). These would be reduced by lowering health care costs, thus reducing potential liability.
Somebody mentioned car repair, so we'll use that.C-Kwik wrote:
Feel free to explain the logic you're going by.
As for cosmetic surgery, I can't find any numbers that substantiate what you are contending. And it would be hard to make direct comparisons as many elective surgeries are far less complex and risky than a lot of medical surgeries (AFAIK)
I've already mentioned that, about the pay structure. Why do we need a radical change in our system and get the government involved when the system could change by itself? The government wouldn't have to charge higher taxes and the system would continue as is much more efficiently than what the government could ever do.PoorManQ45 wrote:You guys arn't understanding a properly implemented UH system.
The doctors are on salary from the government!
That is a big thing that allows UH systems to suceed. This gets rid of the competition in the car insurance analogy as there would not be a need for any.
Combine that with the protection from frivolous lawsuits and you have much cheaper healthcare.
charlieo wrote:
Somebody mentioned car repair, so we'll use that.
Let's say you ding your car. You have insurance on said car. Insurance, for simplicity, will pay 100% of the damages.
What do you do? You take it to a body shop. Body shop says "That'll be $1,000."You, not paying for anything, say "ok," and let your insurance handle it.
Now, the insurance company b****es about paying $1,000, but because every body shops knows insurance is going to pay, they all charge around there.
Now, in a world without car insurance, you ding your car. You take it in, the estimate comes out to $1,000. You, now paying for everything, say "Hell no." and take your car someplace else. Nobody gets the business until somebody budges on price. Thus, competition is fueled at a greater pace.
This is exaggerated further by the way insurance pays for things: ie, as I explained earlier.
You wanted an explanation. You got one.C-Kwik wrote:
Try actually looking into how auto insurance claims with body repairs works before making such an ignorant assumption. Typically, regardless of what a body shop write in an estimate, an insurance adjuster's inspector will go out and write their own estimate. Some body shops won't even bother writing their own unless the customer demands one. Either while the adjuster is writing the estimate, or after the fact (if inspected elsewhere such as the car owner's home or work), the shop will review the estimate and let the adjuster know what they disagree with. They will negotiate until an agreement is reached. Typically, the amounts that are disputed are minor. Since most procedures are outlined in collision repair manuals in detail; the hours of work are pretty fixed for a job other than judgement calls. And its not hard to come to an agreement on differences of a few hours. Labor rates are rarely disputed by shops as insurance companies will pay the reasonable rate for that area.
As for not being able to take it elsewhere, when I was handling insurance claims, the few cases where a shop decided to try and stand their ground on an unreasonably high rate, we simply talked to the customer and showed him the shop's estimate, our estimate, and referred him to 3 shops that would agree to our estimate. I got a call from a pissed off body shop employee the next day as the customer was having the car towed to a different shop.
The money coming out of any insurance company doesn't go unchecked. There is competetive pressure put on insurance companies by the need to try and compete for insureds. This translates pretty directly into trying to save money on claims as the loss ratio is one of the biggest variables that an insurance company will look at. Such needs have created preferred shop status with insurance companies. Insurance companies get prenegotiated rates and discounts on parts. In return, the shop gets a boatload of referral business. The relatioinship between most shops and insurance companies are more like partnerships. Both stand to benefit from working with each other. Even out-of-network shops. Keep in mind, I worked as a claims adjuster for auto insurance for nearly 10 years. Most of my relationships with body shops were quite friendly. The relationships are more symiotic than you realize. Without insurance, most of these shops would not be in business at all...
Problem is the example you provided was wrong. Not that it invalidates your "theory", but my explanation of how auto insurance works shows there is a great deal of price control built-in.charlieo wrote:You wanted an explanation. You got one.
I'm questioning your view on this as my experience in insurance tells me different. I'd expect someone who has an opinion here should have some reasoning, logic or proof to substantiate the opinion. So far you haven't been able to provide me with one. You've just reiterated the position you stated before. I'm still waiting on a reasonable explanation...charlieo wrote:Insurance, no matter how it's sliced, increased the pool of money. Hell, if you're willing to look big enough, car insurance has an affect on the price of cars!
Here's the point where I say if you can't understand basic economic theory, I can't help you.C-Kwik wrote:
Problem is the example you provided was wrong. Not that it invalidates your "theory", but my explanation of how auto insurance works shows there is a great deal of price control built-in.
I'm questioning your view on this as my experience in insurance tells me different. I'd expect someone who has an opinion here should have some reasoning, logic or proof to substantiate the opinion. So far you haven't been able to provide me with one. You've just reiterated the position you stated before. I'm still waiting on a reasonable explanation...
If it were basic, then I'd reckon it would be fairly easy to explain.charlieo wrote:Here's the point where I say if you can't understand basic economic theory, I can't help you.
Last I checked, the insurance companies work with existing money and aren't lending money directly. Therefore, its not going to be increasing the money supply as you seem to be suggesting. Insurance companies do invest unused premiums (if you consider the books on a daily basis of premiums taken in vs the claim payments and administrative costs there will be a small surplus as preiums are paid ahead slightly each time you make a monthly payment; which provides a month's worth of daily premiums ahead of time). But its going to be a relatively small portion of the premium and is done primarily to remain competetive as combined ratios for insurance companies are pretty high (in some cases above 100%).charlieo wrote:But I'll try one last time:
Think of insurance as the federal mint. They put more money out there. More money raises the cost of things. With insurance, it's a targeted inflation, which is worse.
But you haven't even explained the logic or theory. The data would only provide us with the actual results, but you still need to explain the basics.charlieo wrote:Solid logic and theory. You'll find no proof, because as was mentioned before, it would be a monumental task to sift through the data.
You have to prove or perhaps even provide some kind of logic that we are indeed paying $2.00 instead of $0.50 before you can assert this is the case.charlieo wrote:Another issue with your issue is that while a price control may be built in, it's still a higher price than the average person can pay. This keeps prices up. A bickered over $2 is still more than $.50.
Exactly!ishkabibble wrote:Because since the patient is not spending their own money, they don't give a crap what the price is! Shopping around does not take place.
Also, the doctor's office doesn't have the administrative overhead of dealing with the claim.
Same reason that buying my car with straight up cash is less expensive than financing or some other type of payment. Cash is king, the quicker you have it, the quicker you can do something with it.PoorManQ45 wrote:Um... Go to the doctor for a procedure, or something basic.
The cost to the insurance company will be at least 25% higher then the cost if paying cash. Why is that?
And don't you think that the same holds true for anything else? You don't necessarily get all the money for a procedure/claim all up front either...PoorManQ45 wrote:The reason for that is depending on the setup the dealer may only get paid a portion at a time...
I've never seen that as a trend. Bear in mind that in 3rd party liability suits where the 3rd party is uninsured, the patient is ultimately responsible for the bill. So bills submitted to an insurance company for a third party claim are typically the bill to the patient (which the patient submits to the carrier for review). Most adjusters these days have no idea what they are looking at when it comes to med bills so they are often sent off to a firm that specializes in making adjustments to such bills. They basically cut the costs to what typical healthcare insurance companies will pay for each procedure. I've never seen any bills that were less than what an insurance company would pay.PoorManQ45 wrote:Um... Go to the doctor for a procedure, or something basic.
The cost to the insurance company will be at least 25% higher then the cost if paying cash. Why is that?
Sure. They aren't spending it directly, but ultimately, it gets reflected in the rate. Surely, a patient paying for insurance may be somewhat removed from feeling the direct effects in the costs differences, but most insurance is paid for through employers who are going to negotiate for the best rates possible. This means each carrier is competing for the employer's business. This competetive force puts a lot of pressure on the healthcare carriers to drive costs of medical claims down. As with preferred body shops in the car repair model, in-network doctors, who have agreed to the pay schedule are getting referral business and perhaps not losing patients because they aren't a netowrk doctor (insureds may opt to go to a network doctor to save costs). To say how much effect this has is beyond me, but I'd say its significant given healthcare providers' size and influence in the big picture.ishkabibble wrote:Because since the patient is not spending their own money, they don't give a crap what the price is! Shopping around does not take place.
I'm thinking it would be relatively small as they tend to just input most on the computer (as far as I can tell from watching them work). And with direct billing to customers, I'd imagine it would be tougher to deal with more people who may not be able to pay their bills. Insurance will generate some kind of payment as long as the procedure is covered.ishkabibble wrote:Also, the doctor's office doesn't have the administrative overhead of dealing with the claim.
Maybe, maybe not. There is going to be some overhead everywhere regardless. Doctor's liability overhead is related more to overall cost of litigation and settlements. Its not necessarily tied in with UH, but I would hope they would address it if they effect UH to increase the efficiency of a government paid (taxpayer paid) program. I'm not sure we can do much about adminstrative overhead in a doctor's office. With private insurance or UH, it would probably have a comparable workload.PoorManQ45 wrote:So we've got Doctor's office overhead, Insurance company overhead, Doctor's liability insurance overhead, etc...
Doesn't seem very efficient.
My sister-in-law moved to Indiana from Ohio specifically due to the high amount of insurance in Ohio for her being OB/GYN. I know a couple of at least one other family OB/GYN who left the field due to the same.heliochrome85 wrote:there are doctors in PA (OB/GYN) who have given up birthing babies because of the cost of malpractice insurance. If yout hink about it, if a child comes out mentally handicapped, who is the jury going to listen to, the poor mother/child, or the big bad rich doctor?
Having the insurance in place can effectively change the elasticity of demand. Having it in place makes demand more inelastic as consumers of health care will consume it without much thought to price. Other products that are said to be inelastic are tabacco and pop/soda. People will consume these products without much thought to price. Or, in another way, demand for a product won't change much for a given price change.C-Kwik wrote:Sure. They aren't spending it directly, but ultimately, it gets reflected in the rate. Surely, a patient paying for insurance may be somewhat removed from feeling the direct effects in the costs differences, but most insurance is paid for through employers who are going to negotiate for the best rates possible. This means each carrier is competing for the employer's business. This competetive force puts a lot of pressure on the healthcare carriers to drive costs of medical claims down. As with preferred body shops in the car repair model, in-network doctors, who have agreed to the pay schedule are getting referral business and perhaps not losing patients because they aren't a netowrk doctor (insureds may opt to go to a network doctor to save costs). To say how much effect this has is beyond me, but I'd say its significant given healthcare providers' size and influence in the big picture.
Example. I went to the Dentist recently. I needed a filling. I asked how much it would be without insurance. They gave me a quote of $100. I used my insurance for that procedure. The notice from the insurance company stated that they were billed for $185...C-Kwik wrote:I've never seen any bills that were less than what an insurance company would pay.
In a properly setup UH the doctors are government employees. This removes the entire Doctor's office overheadC-Kwik wrote: I'm not sure we can do much about adminstrative overhead in a doctor's office. With private insurance or UH, it would probably have a comparable workload.
