Fine for refusing health care?!?!?! - The Health care thread....

[PoorManQ45]

Price of gas: pay now with cash, it's cheaper than paying with a credit card.

A few reasons. With cash, there is very little transaction cost and very little time spent on the transaction. A credit card, the credit company charges a rate on the sale, there's the time value of money to the store, there are administrative costs to process the payment, and time is spent processing the payment.

Apply this concept to health care, or any other industry. Health care, pay cash, very little transaction cost and time results in a lower price. Insurance, administrative cost to doctor's office, administrative cost to insurance company, time value of money results in a higher price due to the extra time and costs involved.

Isn't there some regulation against that? Or is it only a violation of the credit card company policy?

[PoorManQ45]

Apply this concept to health care, or any other industry. Health care, pay cash, very little transaction cost and time results in a lower price. Insurance, administrative cost to doctor's office, administrative cost to insurance company, time value of money results in a higher price due to the extra time and costs involved.

So then the insurance setup is obviously creating a large amount of unneeded overhead.

Without insurance to contend with the same price would be offered to everyone. If the Doctors are on government salary that eliminates their overhead.

I believe we have eliminated all but the government overhead in this situation. If that could be gotten under control, it wont in our system, we'd have a great system.

[smockers83]

But why do we need the government to have to do all of that? It would take millions and millions of dollars spent to get the government to do that.

We already have something in place that would work. Dare I say that George Bush got this rolling. Charlieo mentioned it earlier, they're called HSAs, health spending accounts. You put money into the account, it's there for health care when you need it. Some allow money to carry over year after year, some don't.

[audtatious]

I have to ask, why do we have this sliding scale tax system?

Why not make it an across the board percentage.

Lets say 10%. If you make $100k you get taxed $10k. If you make $10k you get taxed $1k. If you make $1 million you get taxed $100k... Etc...

Because the person making 10k is more heavily hit by the tax than the person making 100k or 1 million. The thought is that the person making the higher income has less impact to their "household" by paying a higher rate.

Now, a flat rate on non-necessity items may be more appropriate. Who knows at this point but there will never be a flat tax any time soon.

[PoorManQ45]

But why do we need the government to have to do all of that? It would take millions and millions of dollars spent to get the government to do that.

Unfortunately our government wont ever get it done. The system needs to be destroyed and rebuilt from the ground up.

A lot of people are going to cry, but it needs to happen.

[C-Kwik]

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.

Not arguing against that. Just saying that there are mechanisms that help keep costs in control. How well? No idea. The model has a ton of variables and would need a lot of data just to guess at. While consumer demand is important, it must be compared to the supply. In the short term, if UH is implemented, then I think there will be pressures on the doctors to raise prices. But long term, which is a big part of what we should be considering, I think it will balance out as more people see greater opportunity as doctors.

When an employer seeks out a insurance provider, it is able to get better rates due to the law of large numbers. Whenever group insurance is used, it reduces the premium because the insurance company can assess the risk of the group better than an individual. If the company starts to negotiate premiums down, it creates competition within the insurance industry sure, but when health care costs are rising, that means insurance services will start to get cut in order to protect profits. So a company may get lower rates when it begins to negotiate, but at what cost?

I don't think its the law of large numbers that helps keeps rates low. Its more like the buying power you have when you can purchase 50+ policies at a time vs 1. I'm sure underwriters would prefer to be able to assess each individual's risk in a company, but when your sales teams are staring million dollar premiums in the face they make concessions and simply assess the risk more broadly. That said, rising healthcare costs can surely cause benefits to be lost. But that's a result of rising healthcare costs. Not a cause. And the pressure the keep rates low for procedures will still be there. Going back to the auto body repair model, over the course of 10 years, I saw labor rates in my area increase from about $30/32 per hour to about $36/$38. The price controls are not absolutely static. They do adjust with the market. Afterall, auto insurance companies do realize the necessity of keeping body shops in business or there would be noone to repair the vehicles. I'm sure a similar relationships exists in the medical insurance industry.

To be clear, the whole system is quite complex. No one factor can be easily isolated (perhaps not at all) as multiple effects are going to be occuring simultaneously. My contention made against Charlieo's argument was that insurance doesn't cause some arbitrary price increase (i.e. doctors charging whatever they feel like).

Big problem I see with UH is that its going to hurt the middle class the most.

If we started handing out free complete health care to every single valid citizen of the US, the money is going to have to come from somewhere. Where is it going to come from? More free money printed by the fed? I don't think so.

They will have to tax the middle income people even more to pay for UH. So people like me are going to be hurt with zero benefit to me. I already have health care, I don't need UH. If we impose UH, then my payout share will more than likely rise.

I sure as hell don't want that.

We don't even know the specifics of such a program and you're already dismissing it? I'm all for scrutinizing it. While I'd like to see UH implemented, I don't want to see it done poorly.

Currently when someone who is poor and who doesn't have health care has a major problem, they go to the hospital and get fixed. The debt is still on the books so as far as the hospital is concerned, they still should be paid by the customer who was repaired. The debts don't get discharge until many years later or when the person goes bankrupt.

In which case we are already paying for it indirectly. Whether the doctors or creditors eat the cost, it gets passed on to the rest of us.

However if you cut out all that by imposing UH, then that person who went to the hosptial to get repaired, then they would not be responsible for their debt at all. The hospital would then just charge the govt for the repair job and that would affect my taxes in a much more direct manner.

The expectation is that there would be no individual debt from this.

That is why I don't want UH, it gets rid of the incentive to get a freaking job for a lot of people. Who wants to get a job if the govt will always have some sort of free fallback program espeically if that free fallback program is for life. Currently a lot of fallback programs are designed to be temporary and their ending is an incentive to get another damned job. Unemployment is an example.

Getting a job doesn't guarantee that a person gets medical benefits. Sure, there are people out there that are dependent on welfare, but that's an exception, not the rule. Most people want jobs so they can afford a roof over their heads and food to eat. UH isn't going to provide that for them. Part of the problem with our system is that its easier to live off of welfare and qualify for government sponsored health benefits than to get a job that might be marginally better than welfare and not provide any medical benefits.

UH isn't a free program that will have no negative effect on middle class folk like me, it *will* effect middle class negatively. And its going to remove a lot of incentive for lazy people to get jobs and try to better themselves. More dead weight on the economy. Who wants that?

Private medical insurance isn't free either. The way I see it, I'd rather give everyone basic insurance so that they can afford to see a doctor before a relatively minor issue becomes a major one. I'd expect we might see some savings in the bigger picture by doing so. This not only includes direct costs for medical expenses, but also in time taken off from work for bigger issues. Or perhaps that people who are facing BK or have gone through it as a result of medical expenses end up not being able to contribute to economic spending as much (especially in regards to items typically bought with credit; which is a factor in our current recession). Having UH would help people who want to start up businesses who otherwise wouldn't as they may need the insurance due to health issues. Small businesses could more easily get access to a greater pool of employees as they would have access to those who would otherwise not seek employment there if no medical benefits were provided. Employees could seek out such jobs instead of being stuck in a job they hate just because it provides medical benefits. Does the positive outweigh the negative? I have no idea. But it certainly isn't just negative.

We already have something in place that would work. Dare I say that George Bush got this rolling. Charlieo mentioned it earlier, they're called HSAs, health spending accounts. You put money into the account, it's there for health care when you need it. Some allow money to carry over year after year, some don't.

Problem with HSA's is that low-income families can't afford to do it. Secondly it can also tie up funds for people who can actually afford to use it. I'm not particulalry against HSA's as they can be beneficial to some, but it is not a ubiquitous solution for everyone. In fact, research indicates that the majority of people who use it are middle and low-middle income households:

http://www.ahipresearch.org/pdfs/HSAIncome2009.pdf

Further, this person, based on her research believes that HSA's are not an effective solution at all:

http://www.commonwealthfund.or....aspx

[PoorManQ45]

I find it disappointing when a family that has medical coverage has to file bankruptcy for medical expenses.

That is wrong. So they pay money for insurance. Their policy clearly states their deductables, and percentage covered. So the company is in the right. So the family has paid for insurance, then they have to pay the portion that the insurance doesn't cover.

How is this cheaper then UH?

I can tell you that I would go to the doctor more, I haven't been in over 2 years, if we had UH. I have full coverage insurance. I just don't want to have to pay the copay! And if I need a procedure i'm looking at even more money.

How does that make sense?

[Urabus GodofTraction]

Of course it's not arbitrary. I never claimed that doctors charge whatever they want.

I claimed doctors can charge more.

C-R-A-Y-O-L-A.

[C-Kwik]

Of course it's not arbitrary. I never claimed that doctors charge whatever they want.

I claimed doctors can charge more.

C-R-A-Y-O-L-A.

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.

In essence, you implicated that body shops try to charge a certain amount just because everyone else does. As opposed to the reality that insurance companies and body shops use a very methodical process of writing estimates. Outside of labor rate differences used and judgement calls, in theory, every shop using the same estimating system should be writing the exact same estimate for a give repair. The inference that shops charge what other shops do is arbitrary.

That said, lets not dance around semantics. I'd rather give you the opportunity to actually provide a valid explanation of how insurance inflates costs...

[Urabus GodofTraction]

In essence, you implicated that body shops try to charge a certain amount just because everyone else does. As opposed to the reality that insurance companies and body shops use a very methodical process of writing estimates. Outside of labor rate differences used and judgement calls, in theory, every shop using the same estimating system should be writing the exact same estimate for a give repair. The inference that shops charge what other shops do is arbitrary.

That said, lets not dance around semantics. I'd rather give you the opportunity to actually provide a valid explanation of how insurance inflates costs...

No. Your powers of implication are broken.

I'm completely giving up on attempting to educate you. Let smockers do it or something.

[smockers83]

Isn't there some regulation against that? Or is it only a violation of the credit card company policy?

No, it's legal. As long as there is a cash price and a credit price posted somewhere.

I can tell you that I would go to the doctor more, I haven't been in over 2 years, if we had UH. I have full coverage insurance. I just don't want to have to pay the copay! And if I need a procedure i'm looking at even more money.

How does that make sense?

You'll pay that copay many times over in the form of taxes. UH promotes more waste in the industry, just as you proved above. In UH systems, there are lines/wait lists for procedures that shouldn't have lines/wait lists. UH sounds all convenient because the consumer is removed from the decision making process communicated by prices, but there is always a cost to that, whether financially or in well being.

[smockers83]

Further, this person, based on her research believes that HSA's are not an effective solution at all:

http://www.commonwealthfund.or....aspx

She doesn't provide a whole lot of evidence against HSAs.

She says people are less happy about it than more comprehensive plans. What exactly are they less happy about?

She also states that HSAs won't work because lower income people can't take advantage of the tax incentives. Ok...and?

I also find that article contradicting itself and basic economics. She claims that if better information about cost and quality of providers were available, it wouldn't help in terms of efficiency and quality. The more information available to an economy, the more efficient it will be. Also, if better info is available on quality, this would lead consumers to a better product in health care, either driving those who have lesser quality out of business or forcing them to improve their quality of care. This would increase systematic quality and efficiency.

But here's where it's contradicting. She says better information wouldn't help, yet she has two bullet points in regards to providing better information. Riddle me that one Batman.

All in all, I don't find the article convincing, and in fact I don't necessarily see the purpose either. She talks about HSAs/HDHPs vs LDHPs and how people with HSAs and HDHPs pay more out of pocket than LDHPs. Well yeah, that's a given. The reason for insurance is to spread out the financial risk of a catastrophic event. If you have a HSA or HDHP, you should be setting aside additional money in the event of an emergency, otherwise they are making a high risk decision. Simple financial planning that gets ignored by the consumer that typically doesn't understand the product they have.

[genes]

Medicaid is available for those too sick, which is poorly managed by the same bureacrats that would manage U.H... As far as BO caring one wit about you or any other individual, he doesn't. This has nothing to do with any compassion for the "down and out." He and his administration are attempting the largest power grab in the history of this country. Once they control health care we will never be able to reverse it. With over 40% of the people in this country already not paying any taxes, what makes you think that they will vote for anyone who says everyone should pay their FAIR share. This is classic strategic socialistic/ facist political thinking. We are no longer governed by leadership that believes in liberty and freedom.They don't care what we think. We've done this to ourselves by believing that government is the answer. And, there are too many of our fellow citizens who don't give a damn. How many people do you know that didn't vote in the last election. Apathy is the fatal conceit.

G.

[C-Kwik]

She doesn't provide a whole lot of evidence against HSAs.

Click the link the PDF file in the upper right corner of the page for a more thorough report. The page itself is only a summary of a 43 page report on the topic.

She says people are less happy about it than more comprehensive plans. What exactly are they less happy about?

From the PDF (citations in the text were removed due to incompatibilities):

"Low satisfaction with plans. Few Americans who are currently enrolled inHDHP/HSA plans are satisfied with them. The EBRI/Commonwealth Fund survey found that people with HDHPs, both with and without accounts, were far more likely than people in more comprehensive plans to report dissatisfaction with quality of care, out-of pocket costs, and overall satisfaction with their plans. More than half of those in the plans were not satisfied with their out-of-pocket costs. Moreover, one third of those in the HDHP/HSAs would change plans if they had the opportunity to do so, and only one-third or less would recommend the plan to a friend or co-worker."

She also states that HSAs won't work because lower income people can't take advantage of the tax incentives. Ok...and?

One of the points she is making is that its not a solution that is applicable to everyone.

I also find that article contradicting itself and basic economics. She claims that if better information about cost and quality of providers were available, it wouldn't help in terms of efficiency and quality. The more information available to an economy, the more efficient it will be. Also, if better info is available on quality, this would lead consumers to a better product in health care, either driving those who have lesser quality out of business or forcing them to improve their quality of care. This would increase systematic quality and efficiency.

But here's where it's contradicting. She says better information wouldn't help, yet she has two bullet points in regards to providing better information. Riddle me that one Batman.

She's not saying more information is a bad thing. She is saying more information in that of itself is not going to have a dramatic effect on costs. The main report speaks of how 70% of the medical expenses are borne of 10% of people in the sickest of states or in emergencies where the ability to shop around is limited.

All in all, I don't find the article convincing, and in fact I don't necessarily see the purpose either. She talks about HSAs/HDHPs vs LDHPs and how people with HSAs and HDHPs pay more out of pocket than LDHPs. Well yeah, that's a given. The reason for insurance is to spread out the financial risk of a catastrophic event. If you have a HSA or HDHP, you should be setting aside additional money in the event of an emergency, otherwise they are making a high risk decision. Simple financial planning that gets ignored by the consumer that typically doesn't understand the product they have.

I agree with you on what people SHOULD be doing, but the reality is most people don't behave that way. We live in a society that encourages affluent lifestyles. Even among those without the money to actually do so. As a result, most people tend to consider the short term results rather than the long term ones. When looking for a specific type of outcome for healthcare, we can't simply ignore that aspect or the desired results will never be achieved. Then there are those who simply can't afford to do so. When weighing how to spend limited finances, some must decide whether to have food and shelter today or healthcare at some unknown future. Hell, even those making moderate amounts of money may have to weigh such expenses over their child's education or quality of food, etc. Simple financial planning is not always that simple...

No. Your powers of implication are broken.

WTF does that even mean?

I'm completely giving up on attempting to educate you. Let smockers do it or something.

You've made one real attempt and it was inherently wrong as your understanding of the process was wrong. You've made no other attempts otherwise to "educate" me on this "basic economic theory." Perhaps I'll just have to stick with what I learned in my economics classes.

[audtatious]

Medicaid is available for those too sick, which is poorly managed by the same bureacrats that would manage U.H... As far as BO caring one wit about you or any other individual, he doesn't. This has nothing to do with any compassion for the "down and out." He and his administration are attempting the largest power grab in the history of this country. Once they control health care we will never be able to reverse it. With over 40% of the people in this country already not paying any taxes, what makes you think that they will vote for anyone who says everyone should pay their FAIR share. This is classic strategic socialistic/ facist political thinking. We are no longer governed by leadership that believes in liberty and freedom.They don't care what we think. We've done this to ourselves by believing that government is the answer. And, there are too many of our fellow citizens who don't give a damn. How many people do you know that didn't vote in the last election. Apathy is the fatal conceit.

G.

Welcome to the Politics forum and NICO in general

[PoorManQ45]

I'm sad, noone addresses me

What are your thoughts on countries that have successfully implemented UH?

Canada, France, UK...

[audtatious]

What do you consider "success"?

Realize that countries like the UK, Canada, France, etc. have had far more money to invest in social agendas as they do not invest into their protection as the US is there to fight for them. Thus, military spending goes into the social agenda bottomless pit.

[PoorManQ45]

So their system is less expensive?

Liek I said, the entire system needs to be destroyed. Then built properly, that is for anythign to work

[audtatious]

I have no idea if it's less expensive or not. From a Gov perspective they surely have less "on their plates" than we do.

The entire system won't be destroyed, it will be bastardized and make things worse. Sometime change is simply that, wiping the dirt off a turd still makes it a turd.

[smockers83]

"Low satisfaction with plans. Few Americans who are currently enrolled in HDHP/HSA plans are satisfied with them. The EBRI/Commonwealth Fund survey found that people with HDHPs, both with and without accounts, were far more likely than people in more comprehensive plans to report dissatisfaction with quality of care, out-of pocket costs, and overall satisfaction with their plans. More than half of those in the plans were not satisfied with their out-of-pocket costs. Moreover, one third of those in the HDHP/HSAs would change plans if they had the opportunity to do so, and only one-third or less would recommend the plan to a friend or co-worker."

I read this and I see people who don't understand what they got into. People who are in HSAs and HDHPs are upset because they paid more out of pocket? Umm, hello? I guess no one was home when they signed up. I'd find it interesting to figure out why reported quality is lower with those plans.

One of the points she is making is that its not a solution that is applicable to everyone.

Fair enough, but one product cannot be a Hail Mary pass that's right for everyone. Poor people can't afford health insurance, how are they going to afford health care by just setting aside money in a HSA? That would be similar to saying that poor people should have smart phones because all the more well-off people have them and they make their lives easier, but they have to go buy them. HSAs are great for when people are young and/or healthy, so they then can build up the account unit they need it.

[ishkabibble]

Here is my beef with many HSAs/FSAs: If they do not have a rollover feature, you are supposed to know up front how sick you will be that year. Will I be $250 sick this year, or $5000 sick this year? Who knows...

[PoorManQ45]

The entire system won't be destroyed, it will be bastardized and make things worse. Sometime change is simply that, wiping the dirt off a turd still makes it a turd.

I agree 100%

[smockers83]

Here is my beef with many HSAs/FSAs: If they do not have a rollover feature, you are supposed to know up front how sick you will be that year. Will I be $250 sick this year, or $5000 sick this year? Who knows...

Very true. The first one I heard of, it allowed you to rollover the money year over year. Then I heard of ones where you can't, I said, "What the hell is that?" Seems to me that those ones are kind of geared towards those who know some of their expenses, such as prescriptions.

[audtatious]

I agree 100%

Good. BTW, here are some links concerning the working heath care systems in other countries:

http://itn.co.uk/14197ee0899ef....htmlh ... 80...blems

etc etc etc...

yes, you can find horror stories concerning US health care too. Nothing new there. Just don't think that everything is rosy elsewhere just because some people have not been sick enough to hit the problems....

[C-Kwik]

I read this and I see people who don't understand what they got into. People who are in HSAs and HDHPs are upset because they paid more out of pocket? Umm, hello? I guess no one was home when they signed up. I'd find it interesting to figure out why reported quality is lower with those plans.

Certainly plausible. And how people see HSA and HDHPs could change over time (as understanding of the program increases). But personally, I'd prefer a more traditional HMO style plan myself. The GF and I are both enrolled in an HDHP plan through her work and while its not terrible, more traditional HMO plans have generally provided me less worry as my share would be low compared to PPO's or HDHPs.

Fair enough, but one product cannot be a Hail Mary pass that's right for everyone. Poor people can't afford health insurance, how are they going to afford health care by just setting aside money in a HSA? That would be similar to saying that poor people should have smart phones because all the more well-off people have them and they make their lives easier, but they have to go buy them. HSAs are great for when people are young and/or healthy, so they then can build up the account unit they need it.

Of course not. UH's primary intention is likely to try and provide reasonable healthcare for everyone. HSAs tend to require more thought into what to put away. With a maximum family out of pocket limit of $11,900, it puts a whole lot of risk on the insured. Especially up front as it takes time to put that kind of money away for most families. And if one takes a big hit on expenses due to a major medical expense, they would have to build the savings back up. One of the primary purposes of insurance is to reduce the shock of unforseen circumstances. HDHP's tend to move away from that.

All the money a person might put away in an HSA might represent significant opportunity cost for some. There are plenty of people who would be much better off paying down $10K in debt rather than put away $10K in a HSA.

That said, UH is not going to be any sort of a perfect system either. But for the long term, I'd prefer to see everyone have access to healther lives and perhaps drive down long term costs as we may see a drop in the more expensive types of procedures through preventive care. If countries with UH are an indication, their medical spending is a much smaller percentage of their GDP's than the US. If that can occur here, then I'd speculate that the overall tax revenue to keep UH going would become lower overall than the average per person premiums we are paying now through the private insurance system.

[audtatious]

Nice speech by the prez in that "there is a consensus" on health care reform and agreements with hospitals and insurance agencies concerning his health care reform initiatives. He has the AMA and ANA "representing millions of nurses and doctors across the nation" supporting his reform initiatives and says that those who are betting against health care are mistaken.

Wonder how much money the AMA and ANA are expecting to get into their greedy little hands in order to support these initiatives as I know of no doctors nor nurses who support it at all.

Smoke and mirrors, don't look at the greedy bastid behind the curtains.

[Urabus GodofTraction]

You've made one real attempt and it was inherently wrong as your understanding of the process was wrong. You've made no other attempts otherwise to "educate" me on this "basic economic theory." Perhaps I'll just have to stick with what I learned in my economics classes.

You're so wrapped up in your defense of the insurance industry that you can't see the forest. I've tried. And failed, apparently.

If you learned what you espouse from an economic class, go back. Or enjoy your blissful ignorance, it won't matter shortly as we get this healthcare plan rammed down our throat.

[C-Kwik]

You're so wrapped up in your defense of the insurance industry that you can't see the forest. I've tried. And failed, apparently.

If you learned what you espouse from an economic class, go back. Or enjoy your blissful ignorance, it won't matter shortly as we get this healthcare plan rammed down our throat.

Ad hominem much?

[Urabus GodofTraction]

Ad hominem much?

Hummus is delicious!

[smockers83]

Here is a gander into what Obama has planned for his health care system. Corruption, backroom deals, and deception. Naturally.http://www.cato.org/pub_display.php?pub_id=10364

A comparison of health care systems between the US the rest of the West.http://www.cato.org/pub_display.php?pub_id=9272

What's happening in Massachusettshttp://www.cato.org/pub_display.php?pub_id=10268

You can read the little synopses, which are the links I provided, but each one has an in-depth article in PDF format, less the first link which is just an article.