|
Invalid Validation posted:And you would think a healthy and smart population would be a good financial investment for corporations. But what the gently caress would I know? Employees no longer dependent on their employer for access to medical care have more labor market leverage. Employers don't like that.
|
#
?
Jun 27, 2017 19:31
|
|
|
|
| # ? May 16, 2024 01:34 |
|
|
Zikan posted:https://twitter.com/jakesherman/status/879759025151377411 I'll take it for now. I know it's not a huge victory but anything that delays this is a win to me. Now get on the phones to everyone you know to call their offices and email their Senators.
|
|
#
?
Jun 27, 2017 19:43
|
|
|
Where does the american healthcare premium actually go? You guys pay a lot more for healthcare than every other first-world country, but I'm not sure who appropriates the premium. Is it insurance companies? Private hospitals? Device and drug companies?
|
|
#
?
Jun 27, 2017 20:38
|
|
|
Peel posted:Where does the american healthcare premium actually go? You guys pay a lot more for healthcare than every other first-world country, but I'm not sure who appropriates the premium. Is it insurance companies? Private hospitals? Device and drug companies? A little bit goes everywhere. A big driver of costs is that per person the US consumed more services. Even though many people are under served. So some people get over treated and a bunch get under treated. Both end up costing a ton of money in the log run. Margins for Payers and Providers are pretty slim, but huge for pharma, equipment and device makers. On top of that mix in a mishmash of conflicting regulations. There is no one single answer. The system is hosed up because every step in the system is hosed up.
|
|
#
?
Jun 27, 2017 20:41
|
|
|
Peel posted:Where does the american healthcare premium actually go? You guys pay a lot more for healthcare than every other first-world country, but I'm not sure who appropriates the premium. Is it insurance companies? Private hospitals? Device and drug companies? The underlying good being bought and sold is the device and drug companies, but hospitals and insurance companies make profit up each link in the chain. Hospitals buy overpriced MRI machines and have to bill a significant amount to make up their cost which is paid by the insurance company which usually charge about a 20% markup on all healthcare costs to cover administrative fees and a profit margin.
|
|
#
?
Jun 27, 2017 20:41
|
|
|
Peel posted:Where does the american healthcare premium actually go? You guys pay a lot more for healthcare than every other first-world country, but I'm not sure who appropriates the premium. Is it insurance companies? Private hospitals? Device and drug companies?
|
|
#
?
Jun 27, 2017 20:42
|
|
|
bawfuls posted:Mostly this, but some of it gets tangled in the web of bureaucracy the current system encourages. Most for profit insurance companies run about a 3% margin. If you think that's most of the issue with the system you're incredibly uninformed.
|
|
#
?
Jun 27, 2017 20:43
|
|
|
Reik posted:The underlying good being bought and sold is the device and drug companies, but hospitals and insurance companies make profit up each link in the chain. Hospitals buy overpriced MRI machines and have to bill a significant amount to make up their cost which is paid by the insurance company which usually charge about a 20% markup on all healthcare costs to cover administrative fees and a profit margin. Loss ratio can't go under 85% for group plans. Most insurers are at about 90% or so.
|
|
#
?
Jun 27, 2017 20:44
|
|
|
Invalid Validation posted:And you would think a healthy and smart population would be a good financial investment for corporations. But what the gently caress would I know? Corporations act against their own interest all the time, because what guides them as a group is actually the interests of the executive/investor class. Cf what Rhesus Pieces says: any given organization would see long-term benefit to its stated mission and bottom-line from its workers being healthy and well-trained, but it would erode the power of the group who cuts horizontally across the C-suites of every large and wealthy organization in the country. (I say organization rather than corporation: I've seem them running a lot of non-profits too, unconsciously perpetuating the exact same anti-human class, gender, and race relations.)
|
|
#
?
Jun 27, 2017 20:44
|
|
|
Xae posted:Loss ratio can't go under 85% for group plans. 1.0 / 0.85 = 117.6% which is about 120%
|
|
#
?
Jun 27, 2017 20:46
|
|
|
Peel posted:Where does the american healthcare premium actually go? You guys pay a lot more for healthcare than every other first-world country, but I'm not sure who appropriates the premium. Is it insurance companies? Private hospitals? Device and drug companies? Also since there is such a high number of people who simply don't/can't pay their hospital bills, the hospital passes the cost on to the insurance companies or other patients who can. This leads to higher costs for insurance companies because now they have to double check claims to make sure they are legitimate , so they need more staff. Hospitals not wanting to get underpaid now have to hire staff to negotiate prices. The pharma companies see this and slowly or drastically increase prices, because well who is going to stop them? Medical schools also increase their prices as well, since many of them are part of a hospital system and need to make up shortfalls, so doctors demand to be paid more to help with their debt when they graduate. Repeat all of this over a few decades and well, that is why we pay so much more.
|
|
#
?
Jun 27, 2017 20:50
|
|
|
Zil posted:Also since there is such a high number of people who simply don't/can't pay their hospital bills, the hospital passes the cost on to the insurance companies or other patients who can. This leads to higher costs for insurance companies because now they have to double check claims to make sure they are legitimate , so they need more staff. Hospitals not wanting to get underpaid now have to hire staff to negotiate prices. Also Medicaid pays under cost and Medicare pays at or slightly below cost, meaning that there is a stealth "tax" on private payers or individuals who have to cover the difference between what Medicare/Medicaid allowed and what the procedure cost.
|
|
#
?
Jun 27, 2017 20:53
|
|
|
Peel posted:Where does the american healthcare premium actually go? You guys pay a lot more for healthcare than every other first-world country, but I'm not sure who appropriates the premium. Is it insurance companies? Private hospitals? Device and drug companies? The arcane bureaucracy requires a lot of support staff to maintain. Even the smallest doctor's practice must employ several people just to file claims to insurance. The insurance companies must have a similar amount of people to receive those claims. And the system encourages hospitals to "pull out all the stops" because its the insurance company paying, not the country (as in socialized medicine.) So if a hundred year old man's family wants any means necessary to save his life, they will do everything it takes, even if it ends up being cruel, when another country might recognize he is dying and recommend palliative care. This sounds great -never give up!- but if it's at the cost of a 20 year old man dying of a preventable dental abscess, it becomes not so great.
|
|
#
?
Jun 27, 2017 20:55
|
|
|
Xae posted:Also Medicaid pays under cost and Medicare pays at or slightly below cost, meaning that there is a stealth "tax" on private payers or individuals who have to cover the difference between what Medicare/Medicaid allowed and what the procedure cost. That's a line the hospitals and doctors like to push. Those reimbursement rates are reasonable, or else why would any provider accept those patients?
|
|
#
?
Jun 27, 2017 21:02
|
|
|
Reik posted:That's a line the hospitals and doctors like to push. Those reimbursement rates are reasonable, or else why would any provider accept those patients? Plenty of them don't. https://www.google.com/amp/health.u...3Fcontext%3Damp
|
|
#
?
Jun 27, 2017 21:09
|
|
|
Xae posted:Plenty of them don't. http://www.factcheck.org/2017/03/medicaids-doctor-participation-rates/ Medicaid has some issues with specialty and mental health, but Medicare is on par with private insurance.
|
|
#
?
Jun 27, 2017 21:13
|
|
|
quote:The most recent figures from the Centers for Disease Control and Prevention’s National Center for Health Statistics are for 2013, showing the percentage of physicians accepting new Medicaid patients was 68.9 percent, while 84.7 percent accepted new privately insured patients and 83.7 percent accepted new Medicare patients. That’s based on a national survey of more than 4,000 office-based physicians Exact number is up for debate, but many providers don't accept Medicaid.
|
|
#
?
Jun 27, 2017 21:15
|
|
|
Xae posted:Exact number is up for debate, but many providers don't accept Medicaid. Does that number have any actual impact on the care though? http://www.kff.org/medicaid/issue-brief/data-note-three-findings-about-access-to-care-and-health-outcomes-in-medicaid/
|
|
#
?
Jun 27, 2017 21:18
|
|
|
Reik posted:Does that number have any actual impact on the care though? Not really because in most places you can find another doc who will take new Medicaid patients. It just may be a long drive or bus ride. But it does show that providers providers are reluctant to take new patients due to reimbursement rate.
|
|
#
?
Jun 27, 2017 21:22
|
|
|
The Phlegmatist posted:
I seriously doubt Pence will overrule the parliamentarian. Doing so would have massive implications, since it means the Executive can interfere in the internal procedures of the Senate. This would be a huge transfer of power to the Executive, and would undermine the very concept of seperation of powers. The Constitution says "Each House may determine the Rules of its Proceedings" and that right is fundemental if you want an independent legislative body. Senate Republicans want to repeal Obamacare, but they don't want it badly enough to give up their own power.
|
|
#
?
Jun 27, 2017 21:22
|
|
|
Konstantin posted:I seriously doubt Pence will overrule the parliamentarian. Doing so would have massive implications, since it means the Executive can interfere in the internal procedures of the Senate. This would be a huge transfer of power to the Executive, and would undermine the very concept of seperation of powers. The Constitution says "Each House may determine the Rules of its Proceedings" and that right is fundemental if you want an independent legislative body. Senate Republicans want to repeal Obamacare, but they don't want it badly enough to give up their own power. The VP has no executive powers whatsoever and has legislative powers in the Senate. He's a very odd duck, constitutionally speaking. Basically, this is not a concern. Pence would be acting in the VP's constitutional role, not as a puppet of the President. The real concern is it is a de facto abolition of the filibuster, and it would reopen all of the things with the HFC where they were told they couldn't get their way because of reconciliation.
|
|
#
?
Jun 27, 2017 21:26
|
|
|
Xae posted:Not really because in most places you can find another doc who will take new Medicaid patients. It just may be a long drive or bus ride. They're reluctant because they can get ridiculous rates from private insurance, but that doesn't mean the Medicaid rates don't cover costs.
|
|
#
?
Jun 27, 2017 21:27
|
|
|
Reik posted:http://www.factcheck.org/2017/03/medicaids-doctor-participation-rates/ in fact one of the most common ways to structure an insurance contract with a provider is to agree to pay x% of medicare rates. i have seen hundreds of fee schedules where everything across the board was "we pay 80% of medicare's rate".
|
|
#
?
Jun 27, 2017 21:56
|
|
|
cis autodrag posted:in fact one of the most common ways to structure an insurance contract with a provider is to agree to pay x% of medicare rates. i have seen hundreds of fee schedules where everything across the board was "we pay 80% of medicare's rate". I believe Medicare's rates are really high on labs? Were these fee schedules for lab/diagnostic services?
|
|
#
?
Jun 27, 2017 22:01
|
|
|
Reik posted:I believe Medicare's rates are really high on labs? Were these fee schedules for lab/diagnostic services? they were for all sorts of things. ive worked in the managed care industry for over 5 years now producing health plan administration software so ive seen a hell of a lot of insurers' contract structures. i've genuinely seen multiple health plans that were 80% of medicare across the board. others only use it for subsets of their coverage. insurers like this approach because once they've negotiated that rate they don't really have to do much work as their rates will automatically adjust along with medicare, and doctors are typically more willing to trust a plan that's based on an org they trust, such as medicare, than a plan that was obviously assembled surgically by a room full of actuaries.
|
|
#
?
Jun 27, 2017 22:10
|
|
|
cis autodrag posted:
Medicare rates aren't determined by actuaries?
|
|
#
?
Jun 27, 2017 22:13
|
|
|
PerniciousKnid posted:Medicare rates aren't determined by actuaries? CMS Actuaries I imagine, as opposed to Aetna Actuaries.
|
|
#
?
Jun 27, 2017 22:14
|
|
|
PerniciousKnid posted:Medicare rates aren't determined by actuaries? medicare, generally, is in the business of ensuring olds do not die rather than that the health plan makes maximum profit. i can't tell if you're being disingenuous or not.
|
|
#
?
Jun 27, 2017 22:16
|
|
|
cis autodrag posted:they were for all sorts of things. ive worked in the managed care industry for over 5 years now producing health plan administration software so ive seen a hell of a lot of insurers' contract structures. i've genuinely seen multiple health plans that were 80% of medicare across the board. others only use it for subsets of their coverage. Explains why doctors bitch about Medicare but when you ask if they'd be happier without it they immediately backpedal and clarify that Medicare should just pay them more
|
|
#
?
Jun 27, 2017 22:18
|
|
|
cis autodrag posted:medicare, generally, is in the business of ensuring olds do not die rather than that the health plan makes maximum profit. i can't tell if you're being disingenuous or not. Yes, but Medicare still uses math, which is a good and not-nefarious thing.
|
|
#
?
Jun 27, 2017 22:24
|
|
|
PerniciousKnid posted:Yes, but Medicare still uses math, which is a good and not-nefarious thing. My man, you have thoroughly missed the point
|
|
#
?
Jun 27, 2017 22:25
|
|
|
Reik posted:I believe Medicare's rates are really high on labs? Were these fee schedules for lab/diagnostic services? Which is one of the contributions to overtreatment. If you notice you get a lot more for one or another test or procedure, you start cranking them out. Not because the patients don't need them. It's just best that you keep up your competency.
|
|
#
?
Jun 27, 2017 22:34
|
|
|
Rygar201 posted:My man, you have thoroughly missed the point Pointing out when people are flat out wrong is good, Actually. Actuaries aren't the reason US healthcare sucks.
|
|
#
?
Jun 27, 2017 22:48
|
|
|
TROIKA CURES GREEK posted:Pointing out when people are flat out wrong is good, Actually. Actuaries aren't the reason US healthcare sucks. Nah, it's a fair point. It was basically a semantics argument that is small potatoes compared to the broader point about profit-seeking insurance companies and incentives. Having said that, private insurance companies do a lot of work on what treatments create better outcomes, which gets lost among their more heinous activities. Not every employee at every corporation is a moustache-twirling villain. But profit incentives can also be counterproductive/homicidal.
|
|
#
?
Jun 27, 2017 22:59
|
|
|
PerniciousKnid posted:Nah, it's a fair point. It was basically a semantics argument that is small potatoes compared to the broader point about profit-seeking insurance companies and incentives. Instead of leaving it up to the medical directorates at insurance companies to decide what is and isn't covered I think the country could greatly benefit from an agency like NICE in the U.K. that determines what will and won't be covered by insurance. There is no reason why chiropractic care is included standard on many employer plans but other forms of witch doctoring like acupuncture isn't.
|
|
#
?
Jun 27, 2017 23:05
|
|
|
Peven Stan posted:Instead of leaving it up to the medical directorates at insurance companies to decide what is and isn't covered I think the country could greatly benefit from an agency like NICE in the U.K. that determines what will and won't be covered by insurance. There is no reason why chiropractic care is included standard on many employer plans but other forms of witch doctoring like acupuncture isn't. The ACA started a program for Evidence Based Medicine (aka "Does this poo poo work?").
|
|
#
?
Jun 27, 2017 23:27
|
|
|
bawfuls posted:Agreed. I just don't think explaining to people what single payer is has to be complicated. "Single payer means everyone gets Medicare, and instead of paying premiums it's taken out of your payroll taxes just like SS/Medicare now" Even if you expand Medicare to the entire population of the US (including undocumented immigrants) you would not have a single payer system because Medicare does not cover 100% of all medical expenses. A Medicare part A, B and D for Everyone is a multiplayer system, not a single payer system. Medicare Part A can have a premium up to 413 USD per month and a $1316 USD deductible per benefit period. Medicare part B has premiums between 134 USD per month to 428.60 USD per month and a 183 USD deductible. After the deductible Medicare part B pays 80% of the Medicare approved amount for most non-hospital related medical services. Part D is complicated. None of this comes anywhere close to anyone definition of "single payer" except for some of the fools who don't care about the nature of the health care system as long as its called "Medicare" Lying to people and saying that they won't have a premium and deductible when they are going to have a premium and deductible with Medicare A and B (and remember, D is complicated) is going to lead to the bill getting defeated in Congress and I have serious concerns about the success of any system that ends Medicare A, B, and D or transfers money away from the trust fund due to attacks of "End Medicare as we know it." I want to have a Medicare A, B and D for all, but lets not lie and say there are no premiums when there are premiums, lie and say there are no deductibles when there are deductibles, and lie and say that Medicare as we know it for All is a single payer system when we know drat well that it is a multiplayer system.
|
|
#
?
Jun 27, 2017 23:31
|
|
|
You forgot the best parts - traditional medicare has no out-of-pocket maximum, and has a lifetime limit after which they will cut you off This and the above is the reason why like 90% of traditional medicare enrollees have supplementary coverage.
|
|
#
?
Jun 27, 2017 23:35
|
|
|
Reik posted:Most for profit insurance companies run about a 3% margin. If you think that's most of the issue with the system you're incredibly uninformed. Profit is not the only place where insurers cost the public money though. A huge chunk of their expenses (and hospital/doctor expenses) would also go away if the insurance industry went away.
|
|
#
?
Jun 28, 2017 00:15
|
|
|
|
| # ? May 16, 2024 01:34 |
|
|
Xae posted:A big driver of costs is that per person the US consumed more services. Even though many people are under served. Some of what goes into that is doctors ordering too many tests, but some of that is also driven by patient expectations being really weird because they don't understand evidence-based medicine. When evidence came out that routine PSA screening was useless at best, but very likely actively detrimental to patient outcomes, Medicare tried to put an end to coverage of an annual PSA screen. Doctors flipped out because that was easy money, patients flipped out because "what if I actually get prostate cancer and this would have caught it early and saved my life, get government out of my Medicare, etc." Also the whole thing with everyone wanting monthly B-12 shots and Medicare had the gall to actually start asking for a diagnosis of pernicious anemia.
|
|
#
?
Jun 28, 2017 01:07
|
|