Is health care a right?

[Harlan Huckleby]

I was just listening to a guest host on the Rush Limbaugh Show explain why health care costs are high and everything is screwed up.

He says there is no free market, and nobody cares that aspirin costs $50 on a medical bill.

NO WONDER YOU CONSERVATIVES ARE SO IGNORANT ON HEALTH CARE. Apparently the convervative talking points from your gurus are full of the same nonsense that you repeat here.

We currently have a free and active market for health care services. Insurance companies are super-informed, motivated consumers who are constantly bargaining and arguing for lower costs with providers. OF course they fucking care - you think they like paying more?

And in this mythical "free market" of happy shoppers some of you have spoken of, do you propose to eliminate insurance companies from the bargaining? How would this even effect the ability of individual consumers to comparison shop?

A free market in health care doesn't work, that's the fundamental problem we face. A market only wants to insure healthy people, and many businesses and individuals can't afford coverage. Conservatives are hiding from reality.

[bobblehead]

Quick Q and A:

Q: you wake up in the morning and your arm hurts. do you:

1) go to a HMO provider and say "ouch"
2) wait a week to see if it gets better and save $70
3) find a reputable doctor who works for someone other than the HMO paying the bill?

hint: only one answer is indicative of free market capitalism.

[Harlan Huckleby]

yes, making people pay for services out of pocket would drive down demand and costs. If your only consideration is lower costs, this will work. The effect on people is another issue.

If you believe the major dysfunction in our health care system is massive numbers of people seeking unnecessary services, then I would just say you are locked into an ideology and ignoring reality.

[Fosco33]

Harlan-

Most insurance companies (and gov't providers) DONT care about individual 'costs' of healthcare.

For one, they get tremendous contractual discounts and often pay on a per diem or DRG basis (meaning set amounts).

From an insider perspective, I see those examples where the CDM is way out of line - mostly for out-of-network carriers (disincentives) and self-pay (force primary care or get some money from a large bill).

The cost of hc and depletion of resources (MDs, nurses) along with the growing need (based on wanting to provide equal care to all people, aging of America, etc) is the downfall. The current delivery and reimbursement are smaller matters.

[GK]

I was just listening to a guest host on the Rush Limbaugh Show explain why health care costs are high and everything is screwed up.

He says there is no free market, and nobody cares that aspirin costs $50 on a medical bill.

NO WONDER YOU CONSERVATIVES ARE SO IGNORANT ON HEALTH CARE. Apparently the convervative talking points from your gurus are full of the same nonsense that you repeat here.

We currently have a free and active market for health care services. Insurance companies are super-informed, motivated consumers who are constantly bargaining and arguing for lower costs with providers. OF course they fucking care - you think they like paying more?

And in this mythical "free market" of happy shoppers some of you have spoken of, do you propose to eliminate insurance companies from the bargaining? How would this even effect the ability of individual consumers to comparison shop?

A free market in health care doesn't work, that's the fundamental problem we face. A market only wants to insure healthy people, and many businesses and individuals can't afford coverage. Conservatives are hiding from reality.

I think I have figured out what you do not understand. You keep referring to the insurance companies as the consumers. The insurance companies are not the consumers. Let me repeat that again - the insurance companies are not the consumers.

You are the consumer.

I am the consumer.

Insurance companies are motivated by market forces to decrease costs. So what do they do? They eliminate services. Here is the important point - they are completely unqualified to make those decisions.

There are two major flaws with your contention that there is a "free market" in health care right now:

1) Insurance companies are not consumers. They are big businesses that are in the business of maximizing profit (as they should be). How do they do that? Get as much money from customers as possible, and pay out as little as possible. What does this lead to? High premiums, and lack of payment of health care services. Sound familiar? Patients themselves have a different motivation. They are not purely trying to maximize profit. Sure, they are partially trying to "maximize profit" (keep more of their own money), but they are also trying to maximize their own health and well being. Insurance companies have no ability, no ability whatsoever, to maximize a patient's well being. They have no interest in it at all. But the individual patient has a tremendous ability to maximize his own health and well being, because that is what he has an interest in. This distinction is worth billions of dollars.
2) By pushing the responsibility of controlling the market from patients to insurance companies, you have just guaranteed that billions of dollars that could be spent on mammograms, surgeries, and vaccinations (if spent by patients) is now spent on paperwork, meetings, seminars in Florida, and IT infrastructure, by an industry whose sole purpose is to minimized the amount of healthcare that is delivered to actual patients.

So stop saying that "there is a free market in healthcare" right now. There is not. Your contention that insurance companies are the consumers in healthcare (rather than the patients) is foolish. By a historical aberration, insurance companies have established a position that they are not willing to give up. But it is very clear that insurance companies are the polar opposites of "health care consumers." They want to siphon money out of the system while making sure that patients get as little care as possible.

You say that a free market in health care doesn't work. How do you know? It has never been tried.

Imagine that a magical, wonderful, superhero could overnight change our healthcare system (I know, I know, most of you liberals have already been imagining a magical superhero fixing your lives. And I am sure Dear Leader will be able to do it, too! Hope!), and put $15,000 in the hands of every American, to be spent on healthcare. No more big insurance contracts. No more middlemen. Just health care producers (doctors and hospitals), and health care consumers (patients). What would happen? What would doctors' offices do? What would hospitals do? What would people do? How long would CT scans continue to be $2000? Three days? Two days? What price would they drop to? How long before there would be spa services in hospitals? How nice would those delivery rooms become? How long before a guy could get a PSA blood test from a kiosk at the mall for three dollars?

Please don't argue against free markets. It makes you look silly.

[GK]

I was just listening to a guest host on the Rush Limbaugh Show explain why health care costs are high and everything is screwed up.

He says there is no free market, and nobody cares that aspirin costs $50 on a medical bill.

NO WONDER YOU CONSERVATIVES ARE SO IGNORANT ON HEALTH CARE. Apparently the convervative talking points from your gurus are full of the same nonsense that you repeat here.

We currently have a free and active market for health care services. Insurance companies are super-informed, motivated consumers who are constantly bargaining and arguing for lower costs with providers. OF course they fucking care - you think they like paying more?

And in this mythical "free market" of happy shoppers some of you have spoken of, do you propose to eliminate insurance companies from the bargaining? How would this even effect the ability of individual consumers to comparison shop?

A free market in health care doesn't work, that's the fundamental problem we face. A market only wants to insure healthy people, and many businesses and individuals can't afford coverage. Conservatives are hiding from reality.

If you think insurance companies are the consumers in health care, do you also think that schools are the consumers in education?

[Fosco33]

GK-
Welcome to PR.

I mostly agree with your above posts. Although there is some incentive by insurance companies to have healthier members. It costs less for preventative care and alternatives to expensive care (unneeded surgeries, drugs, ER visits, long IP stays, etc.). That's why we have SNFs, LTACs, rapid care and even incentives of lower premiums by passing medical tests (also a company initiative). My ins carrier has 'free' call centers that answer patient questions and help direct appropriate care routes (lower cost). In reality, insurance companies make their money from healthy, young patients. 80% of a person's lifetime hc cost is used in the last 20% of their life (love Pareto).

I'm not sure where the $15K number comes from... is it that admin is eliminated (overhead) and it comes from each family? Is the 15K per person (if so, imagine an average fam of 4 making $40K paying $60K for hc). I know where you're going with the free market concept - and I generally agree. I typically loathe Walmart - but their in-store clinics could be a new model of cheaper care.


Check out the latest proposal to fix hc. It's a joke.

http://www.boston.com/news/health/articles/2008/11/13/baucus_blueprint/

Force companies to provide insurance
Look up the history of employer provided hc... how far we've come

http://findarticles.com/p/articles/mi_m1094/is_n2_v28/ai_13834930/pg_2

Lower Medicare eligibile age

Medicare's insolvency date was lowered to something like 2018 a few years ago and is likely even lower today. My guess last year was 2015 - with this proposal it'd be broke in a matter of years.

I heard a terrific speaker (one of the top in the industry) - his take - lower benefits and raise eligibilty to 90 years old. And it still would not be a long-term viable program.

[Harlan Huckleby]

Quick Q and A:

Q: you wake up in the morning and your arm hurts. do you:

1) go to a HMO provider and say "ouch"
2) wait a week to see if it gets better and save $70
3) find a reputable doctor who works for someone other than the HMO paying the bill?

hint: only one answer is indicative of free market capitalism.

bobblehead,

I've thought more about your point, which is certainly true and valid in principle. Now you have to test the theory against experience.

Leaving aside the negative consequences of pressuring people into avoiding doctors, my impression is that only modest savings could be realized from reducing services. Its not credible that excessive demands for services are currently a huge part of our health care problem. Seeing an HMO doctor is a time-consuming journey, HMO's are already filtering like mad. Those waiting rooms are not filled with malingerers.

I think health care is fundamentally different from say, the market for TVs. It is relatively cost inelastic. People NEED to get antibiotics for an infection. I don't believe that most health care is discretionary. Putting off health care purchases often costs rather than saves.

[Harlan Huckleby]

Most insurance companies (and gov't providers) DONT care about individual 'costs' of healthcare.

For one, they get tremendous contractual discounts and often pay on a per diem or DRG basis (meaning set amounts).

I can't decipher these details. But you verify that the insurance companies are negotiating contracts, demanding discounts. Ultimately they are paying the bills, so the bottom line is they are controlling costs. There are many insurance companies and many providers - that's a market.

The cost of hc and depletion of resources (MDs, nurses) along with the growing need (based on wanting to provide equal care to all people, aging of America, etc) is the downfall. The current delivery and reimbursement are smaller matters.

This sounds right to me. My primary reason for supporting single-payer health care is not to control costs, that is a bonus.

[Fosco33]

Most insurance companies (and gov't providers) DONT care about individual 'costs' of healthcare.

For one, they get tremendous contractual discounts and often pay on a per diem or DRG basis (meaning set amounts).

I can't decipher these details. But you verify that the insurance companies are negotiating contracts, demanding discounts. Ultimately they are paying the bills, so the bottom line is they are controlling costs. There are many insurance companies and many providers - that's a market.

It means a hospital could provide infinite amount of care for 'X' diagnosis (DRG). No matter the actual cost is, the insurance company (and Medicare) only pays 'Y' amount.

In fact, there are TONS of charges that are never entered on bills for precisely that reason. Something like 80% of lab charges at many institutions are never even billed. Many supplies/trays and consults are missed, too. They call it 'charge capture'. Only works when insurance companies have to pay '% of charges' type contracts.

Regardless, those missed supplies/drugs/etc cost the hospital. The list price is irrelevant.

[Harlan Huckleby]

I think I have figured out what you do not understand. You keep referring to the insurance companies as the consumers. The insurance companies are not the consumers. Let me repeat that again - the insurance companies are not the consumers.

You are the consumer.

I am the consumer.

Insurance Companys are ALSO consumers. They are shopping among health care providers. They are in a different market than we end users are, they are shopping for different services. But they most assuradly are in a free market.

1) Insurance companies are not consumers. They are big businesses that are in the business of maximizing profit (as they should be). How do they do that? Get as much money from customers as possible, and pay out as little as possible. What does this lead to? High premiums, and lack of payment of health care services. Sound familiar? Patients themselves have a different motivation. They are not purely trying to maximize profit. Sure, they are partially trying to "maximize profit" (keep more of their own money), but they are also trying to maximize their own health and well being. Insurance companies have no ability, no ability whatsoever, to maximize a patient's well being. They have no interest in it at all. But the individual patient has a tremendous ability to maximize his own health and well being, because that is what he has an interest in. This distinction is worth billions of dollars.
2) By pushing the responsibility of controlling the market from patients to insurance companies, you have just guaranteed that billions of dollars that could be spent on mammograms, surgeries, and vaccinations (if spent by patients) is now spent on paperwork, meetings, seminars in Florida, and IT infrastructure, by an industry whose sole purpose is to minimized the amount of healthcare that is delivered to actual patients.

I agree with much of what you say. I wish the Insurance Companies would go to hell.
It's your advocacy of a free markiet that keeps them in business.

So stop saying that "there is a free market in healthcare" right now. There is not.

We just have to agree to disagree about whether insurance companies are consumers in a free market.

But you and I as end consumers can shop for services right now. There are PLENTY of uninsured people looking for services and price shopping between providers - THAT IS A FREE MARKET.
I have been there.
That free market sucks ass!! Uninsured people pay much higher prices for services than the insurance companies. And you or nobody else have every explained how allowing everybody to become effectively uninsured, negotiating for themselves, would result in a favorable market for consumers.

[Fosco33]

Uninsured people pay much higher prices for services than the insurance companies. And you or nobody has every explained how allowing everybody to become effectively uninsured, negotiating for themselves, would result in a favorable market for consumers.

True and false.

About 5% of all non-profit hospital charges are written off to charity cases (uninsured). A good amount of uninsured patients are given decent discounts (usually 20-30%) and don't pay ANY monthly premiums (I pay like $4K/yr for my family's insurance - and I haven't seen a doctor in 10 years - do the math). I could've easily paid for catostrophic insurance or paid for most services straight-up had I been uninsured.

Also realize that many uninsured simply don't pay the bill. They get sent to debt collectors who have a very low recovery rate. Current legislation protects these patients as well. Average bad debt rates for non-profits are about 3-5% of charges - with over 50% coming from uninsured patients.

Also look up the trends in hc. CA has laws on the books basically having uninsured patients being charged no more than the reimbursement from CARE/CAID. Other states have similar things in the works.

[Harlan Huckleby]

It means a hospital could provide infinite amount of care for 'X' diagnosis (DRG). No matter the actual cost is, the insurance company (and Medicare) only pays 'Y' amount.

In fact, there are TONS of charges that are never entered on bills for precisely that reason. Something like 80% of lab charges at many institutions are never even billed. Many supplies/trays and consults are missed, too. They call it 'charge capture'. Only works when insurance companies have to pay '% of charges' type contracts.

Regardless, those missed supplies/drugs/etc cost the hospital. The list price is irrelevant.

OK, I do follow what you are saying, it sounds about how I figured things work. The detail you provide doesn't really support either side of the debate, it cuts both ways.

[Harlan Huckleby]

Uninsured people pay much higher prices for services than the insurance companies. And you or nobody has every explained how allowing everybody to become effectively uninsured, negotiating for themselves, would result in a favorable market for consumers.

True and false.

About 5% of all non-profit hospital charges are written off to charity cases (uninsured). A good amount of uninsured patients are given decent discounts (usually 20-30%) and don't pay ANY monthly premiums (I pay like $4K/yr for my family's insurance - and I haven't seen a doctor in 10 years - do the math). I could've easily paid for catostrophic insurance or paid for most services straight-up had I been uninsured.

Also realize that many uninsured simply don't pay the bill. They get sent to debt collectors who have a very low recovery rate. Current legislation protects these patients as well. Average bad debt rates for non-profits are about 3-5% of charges - with over 50% coming from uninsured patients.

Also look up the trends in hc. CA has laws on the books basically having uninsured patients being charged no more than the reimbursement from CARE/CAID. Other states have similar things in the works.

sounds like you have damn cheap health insurance! Who are you blowing?

Again, what you are saying is interesting, but it just seems to argue that the current system is rotten, which everyone agrees on.

My head hurts. Enough for me.

[Fosco33]

Uninsured people pay much higher prices for services than the insurance companies. And you or nobody has every explained how allowing everybody to become effectively uninsured, negotiating for themselves, would result in a favorable market for consumers.

True and false.

About 5% of all non-profit hospital charges are written off to charity cases (uninsured). A good amount of uninsured patients are given decent discounts (usually 20-30%) and don't pay ANY monthly premiums (I pay like $4K/yr for my family's insurance - and I haven't seen a doctor in 10 years - do the math). I could've easily paid for catostrophic insurance or paid for most services straight-up had I been uninsured.

Also realize that many uninsured simply don't pay the bill. They get sent to debt collectors who have a very low recovery rate. Current legislation protects these patients as well. Average bad debt rates for non-profits are about 3-5% of charges - with over 50% coming from uninsured patients.

Also look up the trends in hc. CA has laws on the books basically having uninsured patients being charged no more than the reimbursement from CARE/CAID. Other states have similar things in the works.

sounds like you have damn cheap health insurance! Who are you blowing?

Again, what you are saying is interesting, but it just seems to argue that the current system is rotten, which everyone agrees on.

My head hurts. Enough for me.

Haha. I work for the nation's largest, highest rated hc consulting firm in revenue cycle and am one of the 'experts' - so I better get damn good coverage (up until last year, I didn't have any premiums)...

My head hurts too.