Competition for medical-insurance companies?

[Loren Pechtel]

That depends on who wins the chicken and egg game that will be played. Right now 30% or more of doctors won't accept medicaid patients because the reimbursement level is too low. Will the government and people be okay with a 20% decline in medical offices/facilities?

Too bad the govt has no leverage over the medical industry.

Consider a letter to the editor here some years back addressing this.

A doctor was explaining why he was refusing to do a certain procedure for Medicaid patients, thus forcing them to go out of state.

I forget the numbers but it was a few thousand dollars for roughly an hour in the OR. Excellent pay, isn't it?

Oops--that's only the OR time. By the time you count pre-op and post-op time it's about 10 hours.

Oops--he's got an office and staff that most be paid from that money. The office costs him $250/hr.

Oops--as a surgeon he has a high malpractice premium.

When the dust settles he's making around minimum wage for that surgery. Any wonder he said no?

Now, under a UHC system his office expense would be somewhat lower as he wouldn't need as many people handling paperwork. However, the rest of the cost would remain.

 

[Loren Pechtel]

And every year they said they were going to cut the reimbursement rates to doctors but they always kept raising it. As I said chicken game. How long would people in the US suffer to control costs?

Yeah, they don't actually cut it because they know that 30% will become much, much higher.

Another example, this one out of Tennessee. They had their own flavor of Medicaid. A doc was explaining his problem with it--a few hundred bucks for a series of well-baby visits. Again, on the surface, reasonable.

Oops--that money has to cover the vaccines administered during those visits. Assuming perfect utilization (which never happens, a 10cc vial does not yield 10 1cc shots) what's left is mere coins. In reality, he would lose money on every such patient even before looking at overhead.

 

[James Brown]

I'm not sure that profits is the best metric to measure. There's a reason why actors negotiate with movie studios over percentages of revenues, not percentages of profits, because creative accounting can turn high revenues into minuscule profits.

When it comes to health insurance, I believe a better metric is the Medical Loss Ratio (MLR), the percentage of your premiums that go toward health expenditures. The Platonic ideal would be 100%, wouldn't it? Yet pre-Obamacare, 80% was standard for for-profit health insurance companies.

Link

2011 was the first year that insurance companies were required to bring down their overhead, unless they were approved for waivers. So what happens if the companies do not meet their overhead target? You get a rebate. The final numbers are yet to be released, but Kaiser Family Foundation estimates that $1.3 billion will be returned back to employers and consumers.

So I run an insurance company and collect $100 in premiums. I get creative with what procedures I decide aren't covered. $75 of the premiums goes to the doctor, $20 gets written off as "overhead", and I report a profit of $5 to Uncle Sam, paying $1 in taxes. Meanwhile Medicare collects $100, pays $95 to the doctor and declares $5 in overhead. Which scenario would provide better outcomes for patients?

Medicare Loss Ratios are also around or just under 80%. It's pretty standard.

http://www.naic.org/prod_serv/MED-BB-16.pdf (page 12)


aa

Your NAIC report is about Medicare Supplement Policies, not Medicare itself. Medicare Supplement Policies are private insurance that covers the 20% or so not paid by Medicare itself. So it stands to reason they would have the same skim rate as any other private insurance.

Administrative costs.

However, the Congressional Budget Office (CBO) has found that administrative costs under the public Medicare plan are less than 2 percent of expenditures, compared with approximately 11 percent of spending by private plans under Medicare Advantage.

 

[Horatio Parker]

That depends on who wins the chicken and egg game that will be played. Right now 30% or more of doctors won't accept medicaid patients because the reimbursement level is too low. Will the government and people be okay with a 20% decline in medical offices/facilities?

Too bad the govt has no leverage over the medical industry.

Consider a letter to the editor here some years back addressing this.

A doctor was explaining why he was refusing to do a certain procedure for Medicaid patients, thus forcing them to go out of state.

I forget the numbers but it was a few thousand dollars for roughly an hour in the OR. Excellent pay, isn't it?

Oops--that's only the OR time. By the time you count pre-op and post-op time it's about 10 hours.

Oops--he's got an office and staff that most be paid from that money. The office costs him $250/hr.

Oops--as a surgeon he has a high malpractice premium.

When the dust settles he's making around minimum wage for that surgery. Any wonder he said no?

Now, under a UHC system his office expense would be somewhat lower as he wouldn't need as many people handling paperwork. However, the rest of the cost would remain.

This surgeon, does he take Medicare?

 

[dismal]

I'm all for UHC as long as there is a Constitutional Amendment that restricts how much we spend on it to an amount similar to that which other countries spend on it. The OECD average looks to be around $2500 per capita. if you want to toss out the likes of Turkey, Estonia and Mexico and take a peer group of modern countries with UHC like France, Canada, Sweden, etc you might get that up to $3000-3300 or so.

Thus ensuring our system can't be better than theirs. Bad idea.

And you've got some old data there.

The data I had was based on what was available. It really doesn't matter, it's the concept that's important.

And my goal is not to make the best possible health care system ever. It's to rein in the excesses that do not meaningfully contribute to better healthcare outcomes.

If you want to spend money on these excesses you can spend your own money.

 

[Alcoholic Actuary]

Medicare Loss Ratios are also around or just under 80%. It's pretty standard.

http://www.naic.org/prod_serv/MED-BB-16.pdf (page 12)


aa

Your NAIC report is about Medicare Supplement Policies, not Medicare itself. Medicare Supplement Policies are private insurance that covers the 20% or so not paid by Medicare itself. So it stands to reason they would have the same skim rate as any other private insurance.

Yes. I guess my greater point is that MLR is not really indicative of the measure of fraud, waste, and abuse as the extra 20% isn't a 'skim rate'. Some of that money has to go into surplus and reserves for future payouts, some has to go to legitimate expenses (keeping the lights on and whatnot), and yes some goes to profits and bloated salary expenses.

I don't think the actual Medicare part A has an MLR the way you're thinking of it, precisely because it is not a rated plan. Everyone pays the same FICA, so the 'premiums' collected for medicare will be more dependent on employment and wage levels year over year than on actual medical costs.

Administrative costs.

However, the Congressional Budget Office (CBO) has found that administrative costs under the public Medicare plan are less than 2 percent of expenditures, compared with approximately 11 percent of spending by private plans under Medicare Advantage.

I like it. This is a much better indicator of health care delivery efficiency.

aa

 

[Loren Pechtel]

The data I had was based on what was available. It really doesn't matter, it's the concept that's important.

And my goal is not to make the best possible health care system ever. It's to rein in the excesses that do not meaningfully contribute to better healthcare outcomes.

If you want to spend money on these excesses you can spend your own money.

The problem is that starving a budget is a very bad way to make it be spent better.

You get what you see in the UHC countries--the budget gets spent on the urgent stuff and the cheap/popular stuff. Quality of life and diagnosis fall by the wayside.

 

[bilby]

The data I had was based on what was available. It really doesn't matter, it's the concept that's important.

And my goal is not to make the best possible health care system ever. It's to rein in the excesses that do not meaningfully contribute to better healthcare outcomes.

If you want to spend money on these excesses you can spend your own money.

The problem is that starving a budget is a very bad way to make it be spent better.

You get what you see in the UHC countries--the budget gets spent on the urgent stuff and the cheap/popular stuff. Quality of life and diagnosis fall by the wayside.

I don't know which UHC countries you are looking at, but I don't see that in either of the ones I have lived in.

All healthcare systems have to ration care. The question is do you have the rationing decisions made by doctors, or by accountants, or by simply telling patients that if they can't afford it, they can't have it, regardless of their need?

The latter is ideal, as long as you are a psychopath who is happy to step over the corpses of people who couldn't afford even basic and inexpensive treatments. Or if you live under the delusion that poor health is no excuse for low income.

 

[LordKiran]

The data I had was based on what was available. It really doesn't matter, it's the concept that's important.

And my goal is not to make the best possible health care system ever. It's to rein in the excesses that do not meaningfully contribute to better healthcare outcomes.

If you want to spend money on these excesses you can spend your own money.

The problem is that starving a budget is a very bad way to make it be spent better.

You get what you see in the UHC countries--the budget gets spent on the urgent stuff and the cheap/popular stuff. Quality of life and diagnosis fall by the wayside.

I don't know which UHC countries you are looking at, but I don't see that in either of the ones I have lived in.

All healthcare systems have to ration care. The question is do you have the rationing decisions made by doctors, or by accountants, or by simply telling patients that if they can't afford it, they can't have it, regardless of their need?

The latter is ideal, as long as you are a psychopath who is happy to step over the corpses of people who couldn't afford even basic and inexpensive treatments. Or if you live under the delusion that poor health is no excuse for low income.

No shit lol.

Literally almost everything is rationed, its called scarcity. Some of you might have heard that word when you were busy passing notes in your high school econ classes.

"Rationed healthcare" Is a lot like "Redistribution of wealth" A nothing buzz-phrase designed to scare people into voting against their own interests.

 

[untermensche]

I'm all for UHC as long as there is a Constitutional Amendment that restricts how much we spend on it to an amount similar to that which other countries spend on it. The OECD average looks to be around $2500 per capita. if you want to toss out the likes of Turkey, Estonia and Mexico and take a peer group of modern countries with UHC like France, Canada, Sweden, etc you might get that up to $3000-3300 or so.

About the stupidest most unnecessary idea I ever heard.

Take away the fucking profit.

That is how you eliminate the most waste.

Every cent taken from the system in the form of profit or over-compensation to corporate officers is total waste.

The only people who should be profiting from a healthcare system are the people actually caring for the health of people.

Nurses are horribly underpaid.

So rich corporate executives can be flown around in private jets.

 

[Loren Pechtel]

The data I had was based on what was available. It really doesn't matter, it's the concept that's important.

And my goal is not to make the best possible health care system ever. It's to rein in the excesses that do not meaningfully contribute to better healthcare outcomes.

If you want to spend money on these excesses you can spend your own money.

The problem is that starving a budget is a very bad way to make it be spent better.

You get what you see in the UHC countries--the budget gets spent on the urgent stuff and the cheap/popular stuff. Quality of life and diagnosis fall by the wayside.

I don't know which UHC countries you are looking at, but I don't see that in either of the ones I have lived in.

All healthcare systems have to ration care. The question is do you have the rationing decisions made by doctors, or by accountants, or by simply telling patients that if they can't afford it, they can't have it, regardless of their need?

The latter is ideal, as long as you are a psychopath who is happy to step over the corpses of people who couldn't afford even basic and inexpensive treatments. Or if you live under the delusion that poor health is no excuse for low income.

Most people don't have the sort of health issues that cause the problems. And people in UHC countries accept the long waits as normal.

 

[bilby]

I don't know which UHC countries you are looking at, but I don't see that in either of the ones I have lived in.

All healthcare systems have to ration care. The question is do you have the rationing decisions made by doctors, or by accountants, or by simply telling patients that if they can't afford it, they can't have it, regardless of their need?

The latter is ideal, as long as you are a psychopath who is happy to step over the corpses of people who couldn't afford even basic and inexpensive treatments. Or if you live under the delusion that poor health is no excuse for low income.

Most people don't have the sort of health issues that cause the problems. And people in UHC countries accept the long waits as normal.

I think you need to visit some of these countries, and talk to the people there.

Because every time you comment on what happens under UHC systems, you describe something that is completely at odds with my direct experience. It's like reading a description of how eagles hunt that was written by a salmon - or an account of how evolution works written by Ken Ham.

 

[Loren Pechtel]

I don't know which UHC countries you are looking at, but I don't see that in either of the ones I have lived in.

All healthcare systems have to ration care. The question is do you have the rationing decisions made by doctors, or by accountants, or by simply telling patients that if they can't afford it, they can't have it, regardless of their need?

The latter is ideal, as long as you are a psychopath who is happy to step over the corpses of people who couldn't afford even basic and inexpensive treatments. Or if you live under the delusion that poor health is no excuse for low income.

Most people don't have the sort of health issues that cause the problems. And people in UHC countries accept the long waits as normal.

I think you need to visit some of these countries, and talk to the people there.

Because every time you comment on what happens under UHC systems, you describe something that is completely at odds with my direct experience. It's like reading a description of how eagles hunt that was written by a salmon - or an account of how evolution works written by Ken Ham.

The thing is it's only a small % of the population that has the sort of issues where it's a problem.

 

[bilby]

I think you need to visit some of these countries, and talk to the people there.

Because every time you comment on what happens under UHC systems, you describe something that is completely at odds with my direct experience. It's like reading a description of how eagles hunt that was written by a salmon - or an account of how evolution works written by Ken Ham.

The thing is it's only a small % of the population that has the sort of issues where it's a problem.

Then it's not a very big problem, is it?

If your alternative system only caused problems for a small percentage of the population, then you might have a case. But it doesn't, so you don't. It's like arguing against vaccination on the basis that one person in a million gets anaphylactic shock and dies. You are letting perfect be the enemy of good. And using that to try to justify a status quo that is truly awful.

 

[Loren Pechtel]

I think you need to visit some of these countries, and talk to the people there.

Because every time you comment on what happens under UHC systems, you describe something that is completely at odds with my direct experience. It's like reading a description of how eagles hunt that was written by a salmon - or an account of how evolution works written by Ken Ham.

The thing is it's only a small % of the population that has the sort of issues where it's a problem.

Then it's not a very big problem, is it?

If your alternative system only caused problems for a small percentage of the population, then you might have a case. But it doesn't, so you don't. It's like arguing against vaccination on the basis that one person in a million gets anaphylactic shock and dies. You are letting perfect be the enemy of good. And using that to try to justify a status quo that is truly awful.

It's not that small a percentage and those that run into it are generally not exactly shouting it from the rooftops. So long as most people are satisfied the system continues.

 

[Alcoholic Actuary]

The thing is it's only a small % of the population...

It's not that small a percentage ...

Can you understand why it's difficult for anyone to take you seriously?

aa

 

[steve_bank]

Insurance companies of all kinds base rates on demographics and statistics of accidents and disease.

Competition will not work to any significant degree.

The heath insurance companies mostly provide a product to business. They negotiate between hospitals, doctors and businesses as to coverage and rates. Deductibles and were going up well before Obama.

They have to be able to cover worse case probabilities.

Back in the 90s there were a number of reports on low cost plans that were essentially useless.

 

[untermensche]

The thing is it's only a small % of the population...

It's not that small a percentage ...

Can you understand why it's difficult for anyone to take you seriously?

aa

He seems to think the people with no insurance in this nation have no waits to get health care.

They wait for months to get simple things looked at. They wait for years to get proper care. If they have chronic conditions they wait a long time to have them addressed.

 

[Loren Pechtel]

The thing is it's only a small % of the population...

It's not that small a percentage ...

Can you understand why it's difficult for anyone to take you seriously?

aa

No conflict.

I said it's a small %. He is pretending it's a minuscule %.

- - - Updated - - -

Can you understand why it's difficult for anyone to take you seriously?

aa

He seems to think the people with no insurance in this nation have no waits to get health care.

They wait for months to get simple things looked at. They wait for years to get proper care. If they have chronic conditions they wait a long time to have them addressed.

I realize that. What I'm saying is despite that our outcomes are at or near the top of the pack. (Beware the lying OCED data that keeps being trotted out. 20% of their evaluation of the healthcare system is whether it's UHC. Of course UHC wins such a comparison.)

 

[bilby]

Can you understand why it's difficult for anyone to take you seriously?

aa

No conflict.

I said it's a small %. He is pretending it's a minuscule %.

- - - Updated - - -

Can you understand why it's difficult for anyone to take you seriously?

aa

He seems to think the people with no insurance in this nation have no waits to get health care.

They wait for months to get simple things looked at. They wait for years to get proper care. If they have chronic conditions they wait a long time to have them addressed.

I realize that. What I'm saying is despite that our outcomes are at or near the top of the pack. (Beware the lying OCED data that keeps being trotted out. 20% of their evaluation of the healthcare system is whether it's UHC. Of course UHC wins such a comparison.)

Yes, it includes that comparison; But that's not so much 'lying' as it is 'valuing the ability of all of the population to access the system'. A health care system that can magically fix a broken leg to as good as new with no wait, no pain, and comparatively low cost, but which a hundred million of your three hundred million people are not able to access at all, is not a good system, because people don't choose to break their legs; They don't say 'Oh, I was going to be knocked off my motorcycle by that hit and run driver, but I shall decide not to because I can't afford the hospital bills'.

Everyone has a chance of becoming sick or injured; Universality of access to treatment is therefore a very important and totally reasonable performance indicator for health care systems. It's no lie to say that, by placing a significant barrier to entry in front of a sizable fraction of the population, the US is FAILING to provide an adequate health care system to her people. A treatment you don't have access to is exactly as good as no treatment at all, and it is perfectly appropriate for the OECD to include a measure of universality of access in their rankings.

That you would mis-characterize this as 'lying' just demonstrates (once again) your shocking lack of care for people who are not you.