Universal Medical Insurance

[lpetrich]

How the Netherlands got universal health insurance with a private market - Vox

he Netherlands leans on private actors — private insurers, independently employed doctors, privately owned nonprofit hospitals — to provide health care. But it also places strict regulations on the health sector to achieve the goals of affordability and access. That balance of market principles and close government regulation has created a health care system that seems to work well for the Dutch.

...
Managed competition uses a combination of private markets and government regulations to try to reduce health care costs and improve the quality of care. The Netherlands strives to have the different parts of its system — the general practitioners, private insurers, home nurses, the emergency department — work together seamlessly. The Dutch have sought to use a tightly managed market to achieve universal health care, rather than a more socialized system like those seen elsewhere in Europe.

...
Critics argue that the Netherlands made a mistake in handing over so much of its health care to the private market. Dutch patients face higher financial barriers to care than their peers in more socialized systems, and spending has accelerated in recent years, trends the critics blame on the privatized market.

Much like the German system, a system which may be called Bismarckcare. It's what Obamacare ought to have been.

But this system has problems.

First, costs to patients are going up. Premiums have been increasing steadily, faster than wages. That has left the lower middle class in particular paying more of their income toward health care than in the years before. They receive assistance from the government, but it hasn’t been growing enough to keep up with rising rates.

...
Health care spending here has become a much bigger share of GDP since the switch to private insurance, though the growth has eased since the 2012 switch to global budgets.

... He argues that managed competition is an oxymoron — that market competition and social collaboration are fundamentally at odds. He cites those rising costs and the Netherlands’ middling performance on life expectancy compared to its European peers. Is this what people are paying for?

Seems like it's going the way of the US system - spiraling costs without much improvement in performance.

 

[lpetrich]

How Maryland’s unique global hospital budget system works - Vox

Maryland is the site of two big experiments in containing health care costs. The first: Since the 1970s, the state has set the prices hospitals can charge for medical care, known as all-payer rate setting.

The second experiment: Since 2014, it’s also capped how much health spending can grow overall, including how much revenue each hospital can take in.

These kinds of regulations are common abroad — France, Japan, Switzerland, the Netherlands, and Germany all have some variation of rate setting and set budgets for health care spending. But here in the United States, Maryland stands alone.

 

[Alcoholic Actuary]

This US tort system permits patients to sue doctors and hospitals for alleged medical error. The legal costs of defending and paying out on such claims - whether meritorious or to avoid the risk at trial - is substantial. Equally substantial is the professional insurance premiums that that some doctors have to pay (especially obstetricians and surgeons) and the costs of self-insurance and umbrella insurance for hospitals. If you impose Medicare for All, with its very low reimbursement costs, the likelihood is that the US medical system would collapse. Doctors and hospitals would no longer have the income to afford liability insurance. Be careful what you wish for.

If the doctors are paid exclusively through federal government, then whose liability is it? Of all reasons to abandon moving to a universal coverage, this has to be the weakest. Also, even under the current tort system, why wouldn't MedMal premiums drop if people are getting care whenever and wherever they need it?

aa

 

[Alcoholic Actuary]

The maximum loss ratio of 0.8 allowed by the ACA means that for every dollar spent on a premium 20¢ goes to an insurance company and only 80¢ goes to pay for health care. Medicare operates on a greater than 0.97 loss ratio, more than 97¢ goes to pay for actual health care from every dollar.

But this is just the start of inefficiencies of the for-profit system.

You know you are full of shit on this. I don't know why you keep posting this garbage - you are part of the problem with the misinformation.

aa

 

[Elixir]

Please, explain the difference.

For a start non-economic damages are capped at ~CA$300k. Most states have no caps, thus, you get multimillion dollar verdicts.

Well then, that should change when we go to a single payer system. Problem solved.
NEXT?

Medical malpractice lawsuits exist in Canada as well. Canadian doctors have liability insurance.

Why go with real-world examples when you can create theoretical paper tigers?

 

[steve_bank]

I can never understand why conservatives object to removing health insurance from busness. I'd think they would welcome.

I am on Medicaid right now. I have what is called generically a Medicaid Advantage private policy with zero month premiums.

You can look it up on line, Medicaid does not pay 100% of all cost. It is primarily fossilization with a deductible per year. Part A. Most major procedures are covered at 80%. Doctor visits have copay.

Part D is the drug program.

Medicaid approves supplemental plans with fic require nets for private insurance. TV is saturated with ads.. I pay $50for a doctor visit, If I wanted a plan that covers all copays I'd have a monthly premium. My Tier 1 drugs are free.

Despite conservative rhetoric Medicare works well. What is covered is specifically defined. No haggling. To health care providers Medicare looks like any other insurance program.

The conservative argument that you can not choose doctors is false. Medicare does not control who you use.

All we really have to do make it universal with some modifications. Plenty of room for private insurance and business to offer enhancements.

As to having to wait for treatment Medicare is no different then private insource. When I had private insurance I had to wait months to get cataract surgery, high demand.

The idea that those with Medicaid are pushed to the side s bullshit.

 

[Toni]

I can never understand why conservatives object to removing health insurance from busness. I'd think they would welcome.

I am on Medicaid right now. I have what is called generically a Medicaid Advantage private policy with zero month premiums.

You can look it up on line, Medicaid does not pay 100% of all cost. It is primarily fossilization with a deductible per year. Part A. Most major procedures are covered at 80%. Doctor visits have copay.

Part D is the drug program.

Medicaid approves supplemental plans with fic require nets for private insurance. TV is saturated with ads.. I pay $50for a doctor visit, If I wanted a plan that covers all copays I'd have a monthly premium. My Tier 1 drugs are free.

Despite conservative rhetoric Medicare works well. What is covered is specifically defined. No haggling. To health care providers Medicare looks like any other insurance program.

The conservative argument that you can not choose doctors is false. Medicare does not control who you use.

All we really have to do make it universal with some modifications. Plenty of room for private insurance and business to offer enhancements.

As to having to wait for treatment Medicare is no different then private insource. When I had private insurance I had to wait months to get cataract surgery, high demand.

The idea that those with Medicaid are pushed to the side s bullshit.

Seems like you are talking about Medicare, not Medicaid.

I worked in health care for a lot of years, in more than one capacity. Medicaid (program for poor people) patients often have restricted access because the reimbursement for care does not meet the cost of providing care. This has been true for more than 20 years. It is more and more becoming true for Medicare (65 yo &+) patients as well because Medicare reimbursements are too low. To make it worse, many/most insurance companies base their reimbursements on Medicare schedules. Which means that many medical practices really struggle financially—and also means that medical practices must spend a lot of money on staff to submit claims, monitor Medicare regulations and payment schedules, etc.

It also means that patients without any insurance are charged higher prices to make up for the loss on Medicaid and Medicare patients.
Most often these are patients without the means to pay or to pay the difference between what their insurance company will pay and what the charges are.

Maximum out of pocket charges are going up dramatically. Many Americans are not able to easily afford $2k to $10K out of pocket if they have a serious injury or illness. I didn’t make those numbers up. Those are the most recent out of pocket per patient under our policy (lower amount) and the amount per patient that a friend pays for privately purchased insurance.

However, my husband and I have been very fortunate—and a little bit wise. We paid the small amount extra to cover one another through employer based insurance. While kids were young enough to be coveted by us, we both covered the kids. We didn’t complain about the extra cost because we knew it was well worth it if anyone was seriously sick or injured.

Both us us have had cancers requiring surgeries. Among the family there have been multiple broken bones, onecrequiring surgical repair, as well as a n eye injury also requiring surgery in addition to other surgeries for things like hernia repair.

Because we’ve had double coverage, we’ve never paid a thousand dollars total for any of the surgeries or other care. And we’ve taken advantage of a medical expense savings account to further reduce our costs.

We’re fortunate but we were also smart to cover each other. I have coworkers who were not so smart even when they knew they had chronic illnesses or were going to need surgery to repair injuries. Somehow they thought they had the system worked out but all it did was increase the stress they faced as well as costs. Sometimes people dnt make hood decisions. Sometimes people don’t have the same options we did.

But here’s the thing: Everybody SHOULD have the same level of coverage that we do. Period. I don’t give a fuck if it is state provided or through employers or what but we have been fortunate enough to have excellent care and excellent coverage without worrying about going broke to get the care we needed.

There is zero good reason that ALL Americans do not have such excellent care and coverage.

 

[Loren Pechtel]

The maximum loss ratio of 0.8 allowed by the ACA means that for every dollar spent on a premium 20¢ goes to an insurance company and only 80¢ goes to pay for health care. Medicare operates on a greater than 0.97 loss ratio, more than 97¢ goes to pay for actual health care from every dollar.

But this is just the start of inefficiencies of the for-profit system.

You know you are full of shit on this. I don't know why you keep posting this garbage - you are part of the problem with the misinformation.

aa

Yup. Medicare attains that high loss ratio by leaving costs off the books (the IRS collects their revenue) and having minimal fraud checking. Claim comes in, pay it. When they're sufficiently nutty turn it over to law enforcement (again, off the books.)

Look at the Medicare Advantage plans. Same money, more coverage despite more overhead. That means the waste level of Medicare must be high.

 

[steve_bank]

Yes there is an issue with the level of reimbursement. However from my experience as a user and those around me it works well. The major hospitals and medical centers in Seattle accept Medicare. If you go to a small town in Idaho you may have trouble with Medicare.This goes back about 15 years. I had a flesh eating infection in my right foot. I ende up at a foot specialists office. He took a quick look and said I had to go to the hospital immediately. He said plainly if you have an HMO plan he would not take mme on as a patient. Fortunatly for me I had good coverage from work and he had expeince with my problem. It was life threatening.

There have been multiple reports in the past of private insurance companies routinely denying covered claims to make people jump through hoops to get reimbursed.



I worked in the tech industries and always had good coverage. Premiums and deductibles were rising well before Obama took office. Insurance companies are in business to make a profit. They mote often than not sell a packaged product to business.

Statistically given health demographics and profiles how much medical services are needed every month on the average is entirely predictable. That is why I thought the Obama claim that health care costs would go down by increasing coverage was doomed to fail.

Medicare as it I is a good model. The system is debugged and runs smoothly. Costs eventually are reflected as part of GDP. It is a matter of who carries the costs. Medical care is not a commodity for which supply and demand with free market competition will bring down costs. Take out or reduce private insurance ad overall burden comes down.

It is a moral question. The freaking conservatives upset over abortion seem to say was you slide out of the womb togh shit, you are on your own.

Unless you can afford high premiums if you get sick when you are older all you have got is Medicare.

 

[T.G.G. Moogly]

The maximum loss ratio of 0.8 allowed by the ACA means that for every dollar spent on a premium 20¢ goes to an insurance company and only 80¢ goes to pay for health care. Medicare operates on a greater than 0.97 loss ratio, more than 97¢ goes to pay for actual health care from every dollar.

But this is just the start of inefficiencies of the for-profit system.

You know you are full of shit on this. I don't know why you keep posting this garbage - you are part of the problem with the misinformation.

aa

Yup. Medicare attains that high loss ratio by leaving costs off the books (the IRS collects their revenue) and having minimal fraud checking. Claim comes in, pay it. When they're sufficiently nutty turn it over to law enforcement (again, off the books.)

Look at the Medicare Advantage plans. Same money, more coverage despite more overhead. That means the waste level of Medicare must be high.

What do you mean, "more overhead?" I would think there would be less overhead from a free market administrative standpoint.

But I agree the medicare advantage plans are good. Not familiar with medicaid.

 

[Loren Pechtel]

Yup. Medicare attains that high loss ratio by leaving costs off the books (the IRS collects their revenue) and having minimal fraud checking. Claim comes in, pay it. When they're sufficiently nutty turn it over to law enforcement (again, off the books.)

Look at the Medicare Advantage plans. Same money, more coverage despite more overhead. That means the waste level of Medicare must be high.

What do you mean, "more overhead?" I would think there would be less overhead from a free market administrative standpoint.

But I agree the medicare advantage plans are good. Not familiar with medicaid.

More overhead because they actually try to ensure what's done is sensible. Medicare gets that very low overhead by not doing much of anything.

 

[ZiprHead]

The maximum loss ratio of 0.8 allowed by the ACA means that for every dollar spent on a premium 20¢ goes to an insurance company and only 80¢ goes to pay for health care. Medicare operates on a greater than 0.97 loss ratio, more than 97¢ goes to pay for actual health care from every dollar.

But this is just the start of inefficiencies of the for-profit system.

You know you are full of shit on this. I don't know why you keep posting this garbage - you are part of the problem with the misinformation.

aa

Yup. Medicare attains that high loss ratio by leaving costs off the books (the IRS collects their revenue) and having minimal fraud checking. Claim comes in, pay it. When they're sufficiently nutty turn it over to law enforcement (again, off the books.)

The IRS will be collecting revenue, Medicare or no Medicare.

Who do private health insurers go to when they have evidence of fraud? Law enforcement just like Medicare.

The hospital system I worked in was audited yearly by Medicare. It was a pain in the ass to look up the hundreds of patient billing records for them every year. I know because I did it for them every year for about ten years. I think we got a Blue Cross audit once in that period of time.

The majority of fraud is done by doctors that own separate imaging, therapy, etc. centers. They send patients to those centers needlessly and they are also caught by Medicare audits. How often do you think private insurers audit such facilities? It's easier for them to just do what they do best, deny the claim and leave the patient hanging. I don't have any data to back this up but I suspect so much Medicare fraud is found is because Medicare is is the single biggest insurer in the country and they look for more fraud than anyone else.

 

[Bronzeage]

For all the hand wringing about universal healthcare and laments of "who will pay for it," the simple fact is, we have universal healthcare right now.

If a person in the United States collapses in the street and is taken to a hospital, it doesn't matter who they, citizen or immigrant, undocumented, uninsured, on and on, they will be treated.

They will be treated with the most expensive healthcare on this planet. It maybe too late to be of any real help, but it costs the same, without regard to the outcome of the treatment. The best part of this farce is that we all pay for it. In the tradition of the "there's no such thing as a free lunch" school of economics, the cost of healthcare to those who can't pay for it is squeezed out of the economy, one way or another.

This leaves the question, 'If we're already paying for bad and expensive healthcare, what are people bitching about?,

The answer is obvious. The objection is not to paying for healthcare, the objection is to good healthcare at reasonable costs. Since the greatest amount of this expensive and inadequate treatment is absorbed by the poor, the logical extension is, the real problem is supplying quality healthcare to poor people. It gets murky at this point, because it's difficult to understand the motives. Perhaps there is a belief that healthy poor people will simple result in poor people living longer and thus consume more wealth which rightfully belongs to rich people.

Personally, I think it's just a general dislike of poor people.

 

[steve_bank]

Medicaid ends when you turn 65 and are elgible for Medicare.

One of the conservatives lame arguments is that we have defacto coverage if you get sick. A hospital can not turn you away. But that is simplistic. Once you are bale to get or wheel chair around you are out. You end up paying for it. It shows up in your insurance premiums. Hospitals gave to recoup expenditures somewhere.

There is no routine care. Cities that can afford it do have clinics. But it is all piecemeal.

If you have a hear6 attacks the hospital treats you and releases you. If you need ongoing care and meds you are screwed without coverage.

 

[Alcoholic Actuary]

The maximum loss ratio of 0.8 allowed by the ACA means that for every dollar spent on a premium 20¢ goes to an insurance company and only 80¢ goes to pay for health care. Medicare operates on a greater than 0.97 loss ratio, more than 97¢ goes to pay for actual health care from every dollar.

But this is just the start of inefficiencies of the for-profit system.

You know you are full of shit on this. I don't know why you keep posting this garbage - you are part of the problem with the misinformation.

aa

Just because it's been quoted a bit...

What I'm referring to is that there is no such thing as a "Maximum Loss Ratio". The minimum loss ratio for small companies is 80% and for larger ones is 85%. That means that companies are perfectly fine running at 120% loss ratios. If they happen to accidentally have a good year with low claim counts and loss ratios at 65% - they have to refund the customer premiums to bring their loss ratio to 80% (or 85%). This is generally an amazing concession borne out of the ACA.

Don likes to rail against the insurance company "profits", but they are generally the most regulated and constrained of any link in the healthcare provider chain. If you want to understand the hurdles to ACA and how the public option was abandoned you need to look no further than the American Medical Association.

Also, there is really no Loss Ratio analogue to Medicare. Medicare Advantage and Medicare part D have Loss Ratios because they behave like typical medical insurance. Medicare premiums are based on FICA collections which are more a function of employment level than actual medical costs. Furthermore, those medical costs won't really materialize until after the current cohort of premium payers retires (if it's still around). So if the current environment of medicare is rampant with fraud waste and abuse, we have 20-30 years to try to correct it before we mess with the FICA rates. At least that is the current attitude of our present and near future congress.

aa

 

[Loren Pechtel]

Yup. Medicare attains that high loss ratio by leaving costs off the books (the IRS collects their revenue) and having minimal fraud checking. Claim comes in, pay it. When they're sufficiently nutty turn it over to law enforcement (again, off the books.)

The IRS will be collecting revenue, Medicare or no Medicare.

That doesn't mean collecting Medicare money doesn't have costs.

Who do private health insurers go to when they have evidence of fraud? Law enforcement just like Medicare.

If it's not right they generally don't pay it in the first place. Medicare pays but only refers the worst offenders to law enforcement--thus so long as you don't get too greedy it's very easy to rip them off.

The majority of fraud is done by doctors that own separate imaging, therapy, etc. centers. They send patients to those centers needlessly and they are also caught by Medicare audits. How often do you think private insurers audit such facilities? It's easier for them to just do what they do best, deny the claim and leave the patient hanging. I don't have any data to back this up but I suspect so much Medicare fraud is found is because Medicare is is the single biggest insurer in the country and they look for more fraud than anyone else.

The private insurance requires preapprovals for most expensive stuff, the patient isn't left hanging, it's just the wasteful stuff isn't even asked for.

 

[ZiprHead]

That doesn't mean collecting Medicare money doesn't have costs.

They would be minimal and done almost completely and automatically by computer. You know, that automation you keep touting.

Who do private health insurers go to when they have evidence of fraud? Law enforcement just like Medicare.

If it's not right they generally don't pay it in the first place. Medicare pays but only refers the worst offenders to law enforcement--thus so long as you don't get too greedy it's very easy to rip them off.

I've already said pretty much the same thing.

Do you have any proof of the bolded above? Can anyone imagine a government entity finding fraud but saying "it's just small potatoes. Let's just give them the money and not worry about it."

The majority of fraud is done by doctors that own separate imaging, therapy, etc. centers. They send patients to those centers needlessly and they are also caught by Medicare audits. How often do you think private insurers audit such facilities? It's easier for them to just do what they do best, deny the claim and leave the patient hanging. I don't have any data to back this up but I suspect so much Medicare fraud is found is because Medicare is is the single biggest insurer in the country and they look for more fraud than anyone else.

The private insurance requires preapprovals for most expensive stuff, the patient isn't left hanging, it's just the wasteful stuff isn't even asked for.

Medicare requires pre-authorization for many drugs and procedures just like private insurance does.

So far, you're not doing too well in your quest here.

 

[T.G.G. Moogly]

For all the hand wringing about universal healthcare and laments of "who will pay for it," the simple fact is, we have universal healthcare right now.

If a person in the United States collapses in the street and is taken to a hospital, it doesn't matter who they, citizen or immigrant, undocumented, uninsured, on and on, they will be treated.

They will be treated with the most expensive healthcare on this planet. It maybe too late to be of any real help, but it costs the same, without regard to the outcome of the treatment. The best part of this farce is that we all pay for it. In the tradition of the "there's no such thing as a free lunch" school of economics, the cost of healthcare to those who can't pay for it is squeezed out of the economy, one way or another.

This leaves the question, 'If we're already paying for bad and expensive healthcare, what are people bitching about?,

The answer is obvious. The objection is not to paying for healthcare, the objection is to good healthcare at reasonable costs. Since the greatest amount of this expensive and inadequate treatment is absorbed by the poor, the logical extension is, the real problem is supplying quality healthcare to poor people. It gets murky at this point, because it's difficult to understand the motives. Perhaps there is a belief that healthy poor people will simple result in poor people living longer and thus consume more wealth which rightfully belongs to rich people.

Personally, I think it's just a general dislike of poor people.

It's just unrestrained free-market greed. I don't want to be bothered by a rule change affecting my business and have to provide additional service or product when I can presently maximize my profit, so leave me alone.

But you bring up a good point, namely that there is a difference between having an accident or getting sick, and actual healthcare. Ideally, healthcare is something we do to ourselves and we only have an insurance policy because we know shit happens despite our best efforts. It should operate precisely like owning a home or an auto and having an insurance policy, but it doesn't.

With healthcare there is no obligation on the part of the insured to do anything to maintain the working condition of their asset, namely, their health. Therefore there is no way to control costs. Poor people are the least likely to be healthy long term. And as you say, if they have an accident or an illness they will get care, but it is a scary, bottomless pit to "insure" any asset unconditionally. Hence the reluctance to go full monty.

 

[James Brown]

Isn't that why there used to be a thing called Major Medical? "I can pay for a doctor's visit and a simple prescription for an antibiotic myself. But I want insurance to cover me if a Mack Truck puts me in the hospital."

Likewise, I use my auto insurance for major accidents, but not for oil changes and new tires. If I did, I bet my auto insurance premiums would go way up.

 

[T.G.G. Moogly]

Isn't that why there used to be a thing called Major Medical? "I can pay for a doctor's visit and a simple prescription for an antibiotic myself. But I want insurance to cover me if a Mack Truck puts me in the hospital."

Likewise, I use my auto insurance for major accidents, but not for oil changes and new tires. If I did, I bet my auto insurance premiums would go way up.

Of course it would. That's what makes Healthcare so expensive.

Also, healthcare doesn't care about your driving record. If you had ten citations last year and a DUI your healthcare costs are only affected to the degree that your costs will rise like everyone else's to pay for your behavior.

Also, it doesn't matter if you drive a jalopy or a Lamborghini, your cost will be the same, although replacing parts on the Lamborghini will be far more costly. Once again, to do so everyone's costs increase to pay for your Lamborghini parts.

And you can't treat healthcare like a public utility because with utilities you are billed according to how much gas, water, electricity, etc. you consume. Yes, it's regulated, but the regulations are for a different animal. With Healthcare everyone will pay one bill regardless their consumption.

In the end though it's really just a matter of political will. Don't hold your breath.