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Anyone know how med school in India works? Lot of doctors get imported from other countries which I assume is cause it’s cheaper and easier to find good candidates.
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Nov 1, 2018 19:35
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Invalid Validation posted:Anyone know how med school in India works? Lot of doctors get imported from other countries which I assume is cause it’s cheaper and easier to find good candidates. It falls along the british system of being an undergrad program where graduates get a bachelor of medicine/bachelor of surgery degree.
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Nov 1, 2018 19:39
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CAPS LOCK BROKEN posted:Not really, pharmacists have been wanting to be providers for a while now too and probably have enough training to handle basic sniffles and birth control questions. Pharmacists absolutely are not qualified to be MDs. Can they diagnose some sniffles? Sure. That's a very tiny portion of doctoring. Also even with pharmicists they have to earn an undergrad degree; then 4-5 years in a specific pharm program. And most states then also require supervised hours on top of that to become licensed. So really the comparison here is nonsensical. The solution to a shortage of qualified MDs is not to allow pharmacists to practice general medicine. CAPS LOCK BROKEN posted:No other profession works like this. Consultants start out at the analyst level making 70-80k a year doing the grunt work. They are not matched to a 'residency' according to an opaque, collusive process designed to kneecap the number of doctors and create an artifical shortage. If medicine wasn't exempt from anti-trust provisions the residency matching bullshit would be blatantly illegal. The lack of residencies is because of budget cuts as they are all funded via CMS; the solution there would be to increase the # of residency slots. Congress obviously has under its jurisdiction the ability to craft antitrust laws to exempt certain industries. I don't see how that is an argument against requiring newly minted doctors to remain supervised though. CAPS LOCK BROKEN posted:Currently, med school is a grindfest that attracts sociopaths and money-driven suburban kids who should not be doctors. I would reform medical school as well and make it far less competitive than what it is currently, which is again part of a cartel system designed to reduce the supply of doctors. Generally people who are "money-driven" do not pursue medicine. While it can be a lucrative career path; the amount of work, effort, and debt required make the value proposition not that attractive unless there is something about the field that you enjoy. Didn't you bring up how consultants make $80k out of the gate? Now that's a field that is full of money-drive people. Making medical school less competitive sounds like a good recipe to lower the quality of doctors; but maybe there's some research that suggests it would be beneficial? Anyway, you seem to be really focused on the "cartel" aspect (which I guess is just every hospital that participates in the residency match system?) but your initial argument was that doctors should be able to go from med school to independent unsupervised practice with nothing in-between. That is what I object to; those supervised hours are absolutely necessary. Reform of how we do that is fine; eliminating it completely is not. How is it "polite awfulness" to acknowledge that newly minted doctors aren't experienced enough to be unsupervised yet? Invalid Validation posted:Anyone know how med school in India works? Lot of doctors get imported from other countries which I assume is cause it’s cheaper and easier to find good candidates. People who earned their medical degree outside of the US will need to pass the medical licensing exams as well as complete a residency. And with the residency system there is definitely a lack of slots that is causing the shortage; the lack of qualified candidates isn't really a problem with the shortage. Raldikuk fucked around with this message at 20:31 on Nov 1, 2018 |
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Nov 1, 2018 20:29
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Raldikuk posted:Anyway, you seem to be really focused on the "cartel" aspect (which I guess is just every hospital that participates in the residency match system?) but your initial argument was that doctors should be able to go from med school to independent unsupervised practice with nothing in-between. That is what I object to; those supervised hours are absolutely necessary. Reform of how we do that is fine; eliminating it completely is not. How is it "polite awfulness" to acknowledge that newly minted doctors aren't experienced enough to be unsupervised yet? Because you can have them work a real, no bullshit job to learn the ropes that isn't the hazing and ritual abuse of a residency. To be honest, the attending physician contributes negligible value in most of my interactions with my allergist, who is part of a large academic practice. You could replace him with a computer and it would probably still result in the same outcome. Raldikuk posted:Generally people who are "money-driven" do not pursue medicine. While it can be a lucrative career path; the amount of work, effort, and debt required make the value proposition not that attractive unless there is something about the field that you enjoy. Didn't you bring up how consultants make $80k out of the gate? Now that's a field that is full of money-drive people. I'm sure all the petit bougie suburban types flood the premed track out of sheer altruism and not because its a well paying gig in a field with artifically induced shortages.
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Nov 1, 2018 21:02
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CAPS LOCK BROKEN posted:I don't see why new doctors need a residency. You're falling for the assumption that the status quo is as good as it'll ever get and all that is needed are tweaks. I would never, ever go to a brain surgeon that didn’t do a residency or it’s foreign equivalent. It’s 7 years before a neurosurgeon can practice solo AFTER medical school. I mean holy poo poo this is a terrible opinion.
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Nov 2, 2018 00:29
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evilweasel posted:consultants are not making life or death decisions, and junior consultants aren't allowed to do anything at all, are basically in on the job training, and exist as a business reason to allow the equity partners to charge the client far more than the senior consultant could get away with for his time by spreading the markup around the junior people on the team (because the junior people on the team will be charged at like 50-70% of the hourly rate of the senior people to the client, even though the senior people make like 7-10x what the junior people do on a take-home basis) He's right though. Other countries do not have the same hosed up education system for doctors that saddles them with 400k in debt. The UK does a 6 year integrated med school degree as an undergrad thing and it's not like they are considered substandard.
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Nov 2, 2018 00:39
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Malcolm XML posted:He's right though. Other countries do not have the same hosed up education system for doctors that saddles them with 400k in debt. Coming from a British family with doctors in it, I was about to say something to this end though I am myself not a physician. Admittedly I am a relentless cynic, but I've always feared that the American system, even putting aside the crippling debt, had a profit motive for its bizarre way of educating doctors, and even if some people may not express themselves well I still feel that my cynicism is justified in this case. I cannot stress how necessary an affordable education is given the need for doctors; America has a shortage of them despite the pay being very high. On the other hand, France has the highest or nearly the highest number of physicians per capita of any country in the world even though French doctors don't make nearly as much as the average American MD. One key difference is that medical school in France is free (though very competitive), while in America it means a terrifying amount of debt. It's fair to assume that other countries, even comparatively poorer ones, invest in the better health of their populations while in America education, like health care, is just another commodity to be bought and sold. When you have a profession like the American doctor which is in general very well compensated and highly respected, drat near revered even, yet there is a shortage of practitioners, something's very, very wrong. Making becoming a physician a potentially crippling, lifelong financial risk, requiring an unnecessarily restrictive training structure and artificially restricting the supply of doctors in order to keep wages up are genuine concerns. I know that everyone wants to pile on CAPS, but he has a point even if he's alarmist - sometimes when someone says that the whole loving system is corrupt, it's true. The fact that virtually all education in the US comes with various degrees of crippling debt that cannot ever be discharged apart from literal death into an overcrowded job market with depressed wages and inflated living costs is a huge problem that is totally unsustainable. The status quo is maintained because it makes money for those who care only about making money, and little modifications aren't sufficient. Most likely things will stay this way until there is a total collapse of the system, because usurers are probably not going to give an inch until they can no longer make money off of the whole lot of it. For what it's worth, I think that turning education and the health of a nation into just another product that can be bought and sold and also burden people with crushing and unfulfillable financial burdens is appalling, and the fact that people don't care more about it is unconscionable.
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Nov 2, 2018 01:20
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Malcolm XML posted:He's right though. Other countries do not have the same hosed up education system for doctors that saddles them with 400k in debt. i'm not defending any of that part: how long med school should be and should be structured, and how much it should cost, are important issues. i'm telling him the idea that doctors don't need any sort of apprenticeship is loving dumb and he's not making any intelligent points. the us medical school system isn't inviolate. the idea that doctors need more training than a consultant or a pharmacist kinda is.
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Nov 2, 2018 01:53
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evilweasel posted:i'm not defending any of that part: how long med school should be and should be structured, and how much it should cost, are important issues. i'm telling him the idea that doctors don't need any sort of apprenticeship is loving dumb and he's not making any intelligent points. I never said that, I said doctors should be hired as jr doctors in a competitive marketplace for them, not this rigged horseshit where the taxpayer pays for their training while they get hazed and abused for 3 years. All in a system that is essentially colludes to keep conditions as terrible for residents as possible and slow down the growth of the profession's headcount. There's a reason why congress had to make their matching system antitrust exempt, and it isn't because the resident matching system increases the quality of care.
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Nov 2, 2018 02:31
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Malcolm XML posted:He's right though. Other countries do not have the same hosed up education system for doctors that saddles them with 400k in debt. Certainly the debt part is awful and is universal in American post-secondary education. I doubt many will extol the virtues of our system which saddles people with extraordinary for having the gall to become better educated. As far as the actual structure of schooling goes though they are still quite similar in many respects. 6 year programs that combine undergrad (as the US is concerned) and med school exist. Usually they cut out a ton of the 2 year general education requirements that are standard in US undergrad programs (which generally don't exist with European undergrad programs which are usually 3 years total). You will still be burdened with ungodly debt though and it is debatable if removing gen ed requirements matters here (personally I'm a big fan of them but I can see why people may not care for them when they're focused on a professional degree). Of course the problem we've been discussing isn't with the med school education. It is with the requirement for supervised training after med school. And the UK has very similar requirements to the US for what they require. Supervision of physicians after they finish med school is absolutely required because they simply don't have the experiential clinical learning yet. And that's where theory of med school gets put into practice. And yeah as far as a patient can see, an attending may not seem to be doing much. Their job is to have their rear end on the line if someone under them fucks up and to check on their juniors to make sure they're doing things correctly. Ideally people at the residency stage shouldn't appear to the patient as incompetent; but that doesn't mean the attending is useless and they certainly can't be replaced with a computer. There's no reason the US couldn't expand the number of residency slots and widen the doctor pipeline. There isn't a shortage of qualified candidates interested in med schools but those schools are limited in how many students they can admit because on the other end there is a shortage of residency slots. Like most things in the US it comes down to Congress being lovely and not doing what it needs to. But while Congress is lovely I don't think a proper solution would be to do away with supervised learning though and the idea that we should model our current standards to that of the early 1900s.
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Nov 2, 2018 02:54
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I received an unusual letter from my (now former) primary care provider this week. Effective 01JAN2019, they are not going to accept any insurance. Zippo. No Medicare, Medicaid, Cal-Med, UHC, BCBS, etc etc. All cash / credit, that's it. ' I'm guessing they got fed up of having any customers at all or something, because I can't figure out how that'd work at all when you don't offer urgent care or emergency services.
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Nov 11, 2018 00:58
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Sundae posted:I received an unusual letter from my (now former) primary care provider this week. Effective 01JAN2019, they are not going to accept any insurance. Zippo. No Medicare, Medicaid, Cal-Med, UHC, BCBS, etc etc. All cash / credit, that's it. You have rich patients. Primary care providers charge pretty reasonably bounded rates - if something goes wrong, you get referred to a specialist or a hospital, they're not gonna wheel you into the OR themselves - so it's just about charging the patients the $500 per visit directly. They are just seeing patients for consults and yearly checkups, and these rich patients will still have health insurance for the expensive specialist stuff.
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Nov 11, 2018 01:03
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There should be a "surgery school" option where new med school graduates can pay big money to skip residency and get heavily trained by practicing doctors, including supervised training on fake models and real patients. This way they can become a practicing physician faster than if they went into residency, without compromising on the quality of their work.
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Nov 11, 2018 01:11
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Sundae posted:I received an unusual letter from my (now former) primary care provider this week. Effective 01JAN2019, they are not going to accept any insurance. Zippo. No Medicare, Medicaid, Cal-Med, UHC, BCBS, etc etc. All cash / credit, that's it. Is the practice turning into a concierge practice that charges a monthly or annual fee to see docs? Regardless, it's probably incredibly advantageous for the practice to switch away from insurance; they save a massive amount of money not having dedicated staff for dealing with insurance coverage/claims, hospitals/other facilities are increasingly hiring staff doctors and putting them on fixed salaries, and most patients would be subject to paying that $500 whether they have insurance or not--at least on the first visit every year--under the new normal of high deductibles. (Yes, I know the ACA provides for a "free" physical every year, but that's only if the doc doesn't find anything wrong or if you ask about a problem you're having, in which the visit is coded as "diagnostic" instead of "preventive" and thus billed in full/subject to deductible and other out-of-pocket costs. It also doesn't cover lab costs if your doc sends your labs to an out-of-network facility.)
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Nov 11, 2018 01:18
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Sundae posted:I received an unusual letter from my (now former) primary care provider this week. Effective 01JAN2019, they are not going to accept any insurance. Zippo. No Medicare, Medicaid, Cal-Med, UHC, BCBS, etc etc. All cash / credit, that's it. What about care credit? Cant you get your insurance to reimburse the transactions you make?
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Nov 11, 2018 01:26
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Willa Rogers posted:Is the practice turning into a concierge practice that charges a monthly or annual fee to see docs? Yeah. New base cost $2,000 per year for their mandatory wellness services plus appointment costs. Immediate "gently caress no" from me and a change to a new provider. quote:Cant you get your insurance to reimburse the transactions you make? I'm not going to bother finding out. I'm just changing providers. No shortage of doctors in the bay area.
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Nov 11, 2018 01:55
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qkkl posted:There should be a "surgery school" option where new med school graduates can pay big money to skip residency and get heavily trained by practicing doctors, including supervised training on fake models and real patients. This way they can become a practicing physician faster than if they went into residency, without compromising on the quality of their work.
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Nov 11, 2018 02:17
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tetrapyloctomy posted:What exactly do you think happens in residency training that should be skipped? I mean shouldn’t we have specific tracks for specific surgeons? Like if someone wants to be a heart surgeon they should just train to be a heart surgeon. Same with a brain surgeon or bone surgeon. Just limit it to that specific part of the body. That would make a lot of sense. And we could call the people that go through original track Drs. and just call these surgeons Mr.
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Nov 11, 2018 02:48
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First off, Neurosurgery is its own residency, as is Orthopedics. Same goes for Ob/gyn, Urology, Ophthalmology, and Otolaryngology. For those other subspecialties such as cardiothoracic, GI, the process of a general surgery residency provides the fundamental physical and cognitive skills needed in order to be a competent surgeon in those fields; if you tried to skip straight to subspecialty training you'd end up putting people through the same process but with additional, non-centralized administrative and oversight overhead. You'd also lose the utility of the general surgery residency with regard to determine who actually LIKES and is competent at the subspecialty. There are plenty of issues with medical education, but if it even is one in the first place, the current fellowship model is way down on the list.
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Nov 11, 2018 09:20
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Phone posting, but lol at the thought of us after med school doing, say, a heart catheterization. Going in to independent practice immediately after med school was ok 50 years ago. Things have become incredibly more complicated since the time where a heart attack meant you got an aspirin and hoped for the best. The residency system is exploitative and imperfect in many ways, and reforms aren't a bad idea, but discussing it from such an ignorant place is a waste of time.
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Nov 11, 2018 16:53
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Coming from a completely different industry, but one that is similarly built on a sort of apprenticeship model, I think it comes down to the fact that knowledge, skill and experience are three related but distinct concepts, and doing anything sufficiently complicated means that you need all three. There's no way to get around that, as tempting as it may be.
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Nov 11, 2018 17:06
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qkkl posted:There should be a "surgery school" option where new med school graduates can pay big money to skip residency and get heavily trained by practicing doctors, including supervised training on fake models and real patients. This way they can become a practicing physician faster than if they went into residency, without compromising on the quality of their work. LOL this guy. You know that whole 10,000 hours to become a master at something. Most surgeons do 20,000 hours of training before they go out and do it independently.
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Nov 12, 2018 09:16
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Willa Rogers posted:Regardless, it's probably incredibly advantageous for the practice to switch away from insurance; they save a massive amount of money not having dedicated staff for dealing with insurance coverage/claims, hospitals/other facilities are increasingly hiring staff doctors and putting them on fixed salaries, and most patients would be subject to paying that $500 whether they have insurance or not--at least on the first visit every year--under the new normal of high deductibles. "And we pass the savings along to... the owner of the company!"
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Nov 13, 2018 14:26
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So I totally lost the plot in USPOL re: healthcare. Willa, if you would be so kind, could to tell exactly to what degree the Obamacare exchanges are hosed right now? Did the Republicans' poo poo they passed year doom it to a slow death? I apologize for my ignorance in advance.
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Nov 15, 2018 19:12
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I wish liberals would stop repeating the myth that the public option would have solved anything: CBO: Public Option Would Cost More than Private Plans quote:"That estimate of enrollment reflects CBO's assessment that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges. The rates the public plan pays to providers would, on average, probably be comparable to the rates paid by private insurers participating in the exchanges. The public plan would have lower administrative costs than those private plans but would probably engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees. (The effects of that 'adverse selection' on the public plan's premiums would be only partially offset by the 'risk adjustment' procedures that would apply to all plans operating in the exchanges.)."
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Nov 15, 2018 19:24
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Lightning Knight posted:So I totally lost the plot in USPOL re: healthcare. Willa, if you would be so kind, could to tell exactly to what degree the Obamacare exchanges are hosed right now? Did the Republicans' poo poo they passed year doom it to a slow death? I apologize for my ignorance in advance. actually, they have improved slightly in terms of access over the last year, as healthcare insurance profits have increased dramatically. this leads to more insurers entering the market. people are still buying insurance despite the higher costs for now, as people with medical conditions don't really have any other choice. a death spiral is still very possible in the future, but not the next few years. quote:Going into 2019, insurers in the individual market, including both on- and off-exchange, have factored in higher premiums due to repeal of the individual mandate penalty and expansion of short-term plans. While these legislative and policy changes have had an upward effect on 2019 premiums, they do not appear to have discouraged insurer participation on-exchange. Marketplace premium tax credits cushion enrollees from the upward effects these legislative and policy changes have had on premiums, but insurers will be closely watching the extent to which healthy people – particularly those not eligible for subsidies – leave the ACA-compliant individual insurance market, where there have already been declines in enrollment as premiums have increased in recent years. https://www.kff.org/health-reform/issue-brief/insurer-participation-on-aca-marketplaces-2014-2019/ didn't see that this was addressed to willa before i wrote this, mb.
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Nov 15, 2018 19:53
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GoluboiOgon posted:actually, they have improved slightly in terms of access over the last year, as healthcare insurance profits have increased dramatically. this leads to more insurers entering the market. people are still buying insurance despite the higher costs for now, as people with medical conditions don't really have any other choice. a death spiral is still very possible in the future, but not the next few years. No that's ok, I just wanted to continue the conversation happening already and Willa was there. Is the increase in insurer profits/interest a short-term thing or do you think it will continue? I thought I remembered reading doom and gloom for Obamacare because of some kind of poison pill bullshit Republicans snuck into the tax bill last year.
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Nov 15, 2018 19:55
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Lightning Knight posted:No that's ok, I just wanted to continue the conversation happening already and Willa was there. Is the increase in insurer profits/interest a short-term thing or do you think it will continue? I thought I remembered reading doom and gloom for Obamacare because of some kind of poison pill bullshit Republicans snuck into the tax bill last year. The key thing that Republicans did was to abolish the mandate. Some states (e.g. New Jersey) have salvaged their exchanges by passing their own mandate. Some states are essentially putting the question of "is the mandate necessary" to the test; its lack has caused a significant price hike in those states. Republicans are also trying to sabatoge the exchanges by permitting the sale of "junk insurance" through short-term plans by redefining "short-term" as 364 days, renewable at will, and through allowing anyone to create an "association" and issue "association health care plans" which have basically zero regulation. I don't know if they've managed to pass those regulations yet.
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Nov 15, 2018 19:58
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evilweasel posted:The key thing that Republicans did was to abolish the mandate. Some states (e.g. New Jersey) have salvaged their exchanges by passing their own mandate. Some states are essentially putting the question of "is the mandate necessary" to the test; its lack has caused a significant price hike in those states. Do you think the states passing state-level mandates is an intelligent solution to this problem?
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Nov 15, 2018 20:03
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CAPS LOCK BROKEN posted:I wish liberals would stop repeating the myth that the public option would have solved anything: Doesnt explain why the insurance companies hate it though. More expensive AND takes away the sickest people? That’s win - win for them.
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Nov 15, 2018 20:16
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Lote posted:Doesnt explain why the insurance companies hate it though. More expensive AND takes away the sickest people? That’s win - win for them. There would be political pressure to improve it
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Nov 15, 2018 20:24
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VitalSigns posted:There would be political pressure to improve it It also wouldn't be the first time corporations opposed something that actually benefits them out of short-sightedness. Didn't they originally oppose private funding of the FDA? Or am I misunderstanding that issue. I remember somebody explained this to me at one point but I am terrible at remembering things.
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Nov 15, 2018 20:24
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Lightning Knight posted:Do you think the states passing state-level mandates is an intelligent solution to this problem? frankly no. the entire reason for health insurance is to spread the costs of healthcare, which are unmanagable for a single person to pay on their own, but can be spread out over a community of people, each of which gets money when they need it. the larger the pool of healthy people paying for the treatment of the sick, the more robust the insurance is, and the cheaper the cost is per individual. this is why single payer is the most efficient way to provide insurance. in a market-based model, you need for people who don't need insurance or can't afford the rates offered to buy in anyway, hence the mandate to force people to buy insurance. breaking the pool of people who can buy into insurance down by state was a terrible idea, as it split up 1 risk pool into 50 different uneven ones. it was probably necessary in order to set up the private marketplace tho, as it made it possible for smaller insurers to enter the market by only negotiating with healthcare providers in one state at a time. healthcare premiums vary wildly on the exchanges on a state-by-state level, with insurance premiums tending to be much higher in remote, rural areas, especially alaska. the only advantage of a state-level mandate is that each state would theoretically be able to adjust the penalty for non-enrollment based on the the local cost of healthcare to optimize enrollment. because of the higher insurance premiums in rural states, however, this would be a tax change that greatly hurts the rural poor, especially in low population states, as the penalty has to be much higher in rural areas to make buying overpriced insurance reasonable there. the solution is to share the risk pool across state lines, not penalize the poor even more, but this would be very hard to do in the obamacare exchange model.
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Nov 15, 2018 20:47
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GoluboiOgon posted:frankly no. the entire reason for health insurance is to spread the costs of healthcare, which are unmanagable for a single person to pay on their own, but can be spread out over a community of people, each of which gets money when they need it. the larger the pool of healthy people paying for the treatment of the sick, the more robust the insurance is, and the cheaper the cost is per individual. this is why single payer is the most efficient way to provide insurance. in a market-based model, you need for people who don't need insurance or can't afford the rates offered to buy in anyway, hence the mandate to force people to buy insurance. I see. Could interstate compacts blunt the impact or would that be a no no due to the Commerce Clause?
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Nov 15, 2018 20:49
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Didn't the republican tax bill remove the govt subsidies for cost sharing reductions? I.e if you make just barely more than the Medicaid line, the exchange sets your deductible to 0 and copays to minimal, and the govt was supposed to pay the insurance company the difference?
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Nov 15, 2018 21:00
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Lightning Knight posted:I see. Could interstate compacts blunt the impact or would that be a no no due to the Commerce Clause? Interstate compacts arn't really needed for a health care system. Every single state has a large enough population to implement a single pool and could provide affordable healthcare to all of its citizens. I would actually argue that letting people buy insurance across state lines would just lead to a race to the bottom as every insurance issuer legally relocates to a poo poo state like South Dakota and makes it impossible for states to regulate health care and insurance.
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Nov 15, 2018 21:10
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Lightning Knight posted:Do you think the states passing state-level mandates is an intelligent solution to this problem? For something a state alone can do, it's pretty much as much impact for as little work/unintended consequences as you can get. Obviously there are lots of health care systems that would be better - but you either need the federal government to do it, or you need to set up a statewide system which is...well, it's tricky and it won't happen overnight. Even if you do that, you should pass a state mandate in the interim. GoluboiOgon's post is basically how you should restructure our heath care system as a whole. None of it is wrong, per se, but it's not really an answer to "how can individual states protect their health care systems against Trump Administration sabatoge?"
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Nov 15, 2018 21:13
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I'm really curious to see what effect, if any, the zeroing out of the mandate has on enrollment. I would not be surprised at all if it barely makes a dent in the uninsured percentage. How many people are a) currently insured but would choose not to be if the tax penalty didn't exist, b) are policy-savvy enough to understand the nuance that while the Obamacare repeal failed, the tax penalty for not carrying insurance has gone away, c) are not in states with their own mandate and d) are not covered under the new medicaid expansions that either just passed or are just about to be implemented? Admittedly I haven't run numbers or anything but intuitively it doesn't strike me as a huge number of people. also curious how many people dropped their insurance for 2017 and 2018 not realizing the mandate was still in effect for those years: https://money.cnn.com/2018/03/03/news/economy/obamacare-tax-penalty/index.html
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Nov 15, 2018 23:21
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GoluboiOgon posted:frankly no. the entire reason for health insurance is to spread the costs of healthcare, which are unmanagable for a single person to pay on their own, but can be spread out over a community of people, each of which gets money when they need it. the larger the pool of healthy people paying for the treatment of the sick, the more robust the insurance is, and the cheaper the cost is per individual. this is why single payer is the most efficient way to provide insurance. in a market-based model, you need for people who don't need insurance or can't afford the rates offered to buy in anyway, hence the mandate to force people to buy insurance. To add to what you said, most individual plans not only operate on a state-by-state basis, but on a county-by-county basis, further diluting the risk pool. And yes, state-based mandates are an idiotic idea that penalize the poor. Fun fact: Private insurers make higher profits on their administration of Medicaid and Medicare plans than they do for both individual plans sold through the marketplace and through group-insurance plans--particularly for managed-care plans. Here's a graphic that illustrates just how lucrative managed-care Medicaid is for private insurers in California:  quote:Before the ACA expansion, California's Medicaid plans collectively were barely in the black, with $226 million of net income for 2012 and 2013 combined. Traditionally, these insurance contracts have yielded slim profit margins of 2% to 3%. California said it aims for 2% when setting rates, based on prior claims experience and projected costs. Hence my hunch that at some point, private insurers themselves may push for the government offering Medicaid to all those not on group plans, as Bertolini, CEO of Aetna, was intimating a couple years ago. And, as we know, when donors speak, politicians listen. mastershakeman posted:Didn't the republican tax bill remove the govt subsidies for cost sharing reductions? I.e if you make just barely more than the Medicaid line, the exchange sets your deductible to 0 and copays to minimal, and the govt was supposed to pay the insurance company the difference? The tax bill zeroed out the mandate penalty but It didn't affect the cost-sharing funding; rather, the Dems didn't provide government funding for the subsidies into perpetuity, as they did for the premium subsidies, and the GOP Congress refused to renew the funding. (Dems claim this was a "drafting error" but likely was also impelled by the Byrd rule to make the ACA "revenue-neutral." It takes a buttload of offsets to make the hundreds of billions of dollars the government now gives to private insurers zero out budget-wise.) But because of the convoluted way that the ACA measures affordability (basing it on the cost of the second-lowest silver plan in a particular market), the GOP not renewing the cost-sharing funds had an oddly positive effect for consumers, who were able to purchase gold plans at the prior cost of silver plans, and people making slightly above the Medicaid cliff could purchase silver plans with no deductibles and sometimes even zero-cost premiums. SousaphoneColossus posted:I'm really curious to see what effect, if any, the zeroing out of the mandate has on enrollment. I would not be surprised at all if it barely makes a dent in the uninsured percentage. The problem is that most of those who are likely to drop the premium--younger, healthy people who don't see a value in paying $300/month for policies with $7,000 annual deductibles--are the ones most needed by private insurers to balance the risk pools. It's been apparent from the beginning of individual marketplaces that the penalty was low enough that many people chose to pay it rather than paying for private insurance with low out-of-pocket costs. When Dem pols have been asked what they'd do to "preserve and protect" the ACA they usually say things like "restore the mandate and make the penalties higher" or "restore the government's funding for cost-reductions." But when voters state that healthcare is their no. 1 concern, they aren't talking about restoring mandates to stablilize private insurers, or the government restoring cost-sharing subsidies to private insurers--voters are very clear about the problems they want resolved. From an August 2018 KFF survey:  When two out of every three Americans are concerned about "surprise" medical bills (which are more prevalent now because of the new normal of ultra-narrow provider networks), it's the height of either privilege or disingenuousness to contend that the ACA reformed the insurance industry. Willa Rogers fucked around with this message at 23:48 on Nov 15, 2018 |
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Nov 15, 2018 23:43
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Willa Rogers posted:The problem is that most of those who are likely to drop the premium--younger, healthy people who don't see a value in paying $300/month for policies with $7,000 annual deductibles--are the ones most needed by private insurers to balance the risk pools. It's been apparent from the beginning of individual marketplaces that the penalty was low enough that many people chose to pay it rather than paying for private insurance with low out-of-pocket costs. Well, yeah, exactly, which is why I think it makes sense that we're not going to see a drastic increase next year in people dropping insurance to take advantage of the lack of penalty. The people who don't think it's worth it by and large seem to already be uninsured (as opposed to people who HAD insurance before and will now drop it because the penalty is zero).
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Nov 15, 2018 23:48
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