2741

A big part of the uninsured are people who are young and not eligible for a group plan, and individual insurance at current prices doesn’t seem worthwhile. – getting them into the insurance pool will help balance the risk, and they’ll be shielded from financial disaster if they get sick or hurt. They are going to have to pay more than they do now, though.

2742

Health insurance company profits are not a significant driver in medical cost inflation.

2743

This is good. This is the kind of question that I have. Only, I’m not a family of four - I’m a single dude. I imagine that my subsidies will be considerably lower than those of the family, and I will have to pay an awful lot more money for this or pay a fine. I have no doubt that paying the fine will be less, and I will likely remain uninsured.

That’s a good plan until it isn’t. Don’t get sick or hurt.

2744

Many companies in the Health Care industry are not for profit corporations.
This include many (maybe most) HMO’s like Kaiser as well as some Blue Cross/Blue Shield affiliates. There doesn’t seem to be a significant different between for profit corporation and not for profit health care providers in terms of medical care cost to consumer or quality they deliver.

My girlfriend spent many years working for Kaiser and while they definitely had organization problems, being obsessive with profits was not one of them.

As Jeff say health insurance profits just aren’t a big factor in costs.

2745

And if you do get sick or hurt, die quickly.

2746

Glenn Beck is in fine fettle today, raging for five minutes about how supporters of HCR are losers on welfare who can barely dress themselves.

Also, deeply offended that civil rights activist John Lewis compares himself to civil rights activists like John Lewis.

Can’t make this stuff up, nope.

2747

And that’s him directly insulting a sizeable chunk of his viewership, rural Christian conservatives living in areas with no economy to speak of and being supported by Medicaid or through self-pay.

And when Shepard Smith has to question Michael Steel’s use of the word “Armaggedon”:

well… you have to wonder if FOX is sometimes taking its queue straight from the Republicans.

2748

And when Shepard Smith has to question Michael Steel’s use of the word “Armaggedon”:
http://mediamatters.org/mmtv/201003220064

That was great. Steel had no defense and didn’t even try to justify the use of the word. Fucking idiots.

2749

While I haven’t seen numbers comparing ALL non-profits to for-profits, we do see that health care costs vary by as much as x2 across various systems and most of the best examples of low cost and high quality systems are non-profits.

Contrary to your GF’s anecdotal evidence Kaiser Permanente is cited often for having both a high quality of care and a low cost of care. It’s also one of the better organized medical groups out there (for example having full electronic health records whereas many other hospitals/doctors are still stuck in the dark ages of doing everything on paper).

See, for example, this New Yorker article that’s been cited on here a number of times.

2750

So here’s my question. I had cancer. I have several lingering issues with respect to that. For example I need to be checked out every several months to see if they missed any cancer and I’ll do that for the next 3-4 years.

It’s unclear to me what would happen if I changed insurances now as I don’t have a reason to change at the moment. Supposing I did, would I not have this follow-up treatment covered as it is a pre-existing condition? If the answer is yes, or a qualified yes, then how will this change between now and 2014?

2751

Ok, let’s say that you have a pool of 10,000 people, all of whom are diabetic and require monthly health care, plus emergencies and specific condition treatment. That costs on the average $20,000 per person annually (these are pure guesstimates, not real numbers). All of the $20,000 would have to be paid by the people who are generating the costs, meaning that they would all have to pay $20,000. If you take those same 10,000 people and add 90,000 people who are well, then the $20,000 per person can be amortized over the other 90,000, making them all pay $1,000 which is a lot less than the $20,000 that the sick people would have paid alone. So if your current pool has too many sick people to well people, your costs are going up. If everyone including well people has to get insurance, then your personal cost will go down because the well people are subsidizing the sick people.

And like I said, this is how all insurance works.

2752

P.S. I’m here in this thread because I’m mad about healthcare.

I’m having to have some medical stuff done that isn’t covered by my insurance (sucks that it isn’t covered but oh well, I’m at least over that). So I’m talking to my very wealthy doctor, the director of his own little center, and I’m asking him: how can I get X and Y done, with the best chance of success for the least amount of money (I have essentially 3-4 options all of which are rather expensive and none of which are sure bets). The guy flat out refused to answer my question. I asked it about 5 different ways. I reassured him that I didn’t need a perfect answer, just a guess that would be better than mine, as a complete layman. He still wouldn’t give me anything and the more we talked about it, the more I realized that he didn’t even know what his treatments cost. Grrrrrrrrrr!

THIS is what is wrong with our healthcare system. This guy is directly responsible for millions of dollars of healthcare expenses per year and he has no idea what they’re costing people and no idea how to tell people how they might approach their medical problems from a position of cost-effectiveness. All he could keep telling me was ways that I could spend more money (that I don’t really have to spend) to try and increase my odds slightly.

2753

I understand what you’re getting at, but I disagree vehemently. I don’t think the doctors should have anything to do with “How do I affect the cost of this procedure.” I personally think that information should have to be synthesized by the person obtaining the care, although it probably ought to be a lot easier to do than it is now. Alternatively, it should be broken down by the insurance company. But a doctor should know the right ways to provide the treatment, the chances of success relative to other treatments, and the right treatment to provide for any extraneous condition you have. The doctors should be under no obligation to provide the administrative information about the treatment and the cost-effectiveness of the treatment. They have enough to deal with keeping up with the health effectiveness of the treatment and which of any potential indicators rule you out for treatment A or a good candidate for treatment B.

2754

Hitler weighs in.

2755

The problem is that the doctor and I aren’t on the same team. All he knows is that he does treatments and he gets money. He probably knows what he makes every time he does something but he didn’t know what I paid.

The doctor absolutely should be required to weigh in cost-benefit analysis to his decisions. That’s the only way we’re going to get anything that is cost-effective. That’s also what I love about Kaiser and why I think Kaiser is very successful at providing high quality care for low costs: Kaiser is responsible for almost all of my health outcomes and will have to keep paying until they get things right. Therefore they have to be responsible for taking a hand in the burden of sound financial planning for my health decisions. Every economic incentive forces them to be on my team when it comes time to pick treatment plans – both in terms of outcomes and in terms of cost.

2756

Look, would it really make a difference to you if your insurance company said “Treatment A is estimated by the doctor to be 99% effective, and we’ll charge you nothing above your standard insurance fees for it. Treatment B is 99.5% effective and we’ll charge you an additional $2000 for it.” instead of your doctor saying the same thing? Certainly you don’t want the doctor doing your cost-benefit deciding for you, right? So as long as you have trusted partners in the process, it doesn’t matter if the doctor knows about the cost or not. It simply matters if he knows about the efficacy and someone in the process can give you the cost for you to make an informed cost benefit analysis. I don’t think the doctor is either the natural source of the cost information, nor do I think he should be; that’s all I’m saying.

2757

A lot of this varies by state, but as a rule if there is no interruption of insurance coverage, then your new insurance company cannot claim your cancer as a pre-existing condition. The last time I looked into this was in Texas, so the rules may not be the same. But for example, when living in Texas, I lost my insurance due to loss of my job. I went on COBRA. If I had run out of COBRA coverage before finding new insurance, the clock would start. If I had a gap of a year where I had absolutely no insurance coverage at all then my cancer would become a pre-existing condition.

Now what changes in 2014 is that there’s no clock and neither one of us can be denied insurance because we’re cancer survivors no matter how long we went without insurance.

2758

The thing is my doctor might be completely wrong and it doesn’t matter because he has absolutely zero money on the line when he tells me that.

I see what you’re saying. It just doesn’t have any relevance to solving the actual problem. In reality the $2k often gets silently spent, even when the problem is only a $1k problem and everyone else pays more because of that.

2759

The doctor absolutely should be required to weigh in cost-benefit analysis to his decisions. That’s the only way we’re going to get anything that is cost-effective.

Actual out of pocket costs is going to vary according to each individual insurance plan. I think it’s expecting quite a bit for a physician to be familiar with each of these. In my own area, there are about a half-dozen insurance companies I work with on a frequent basis. Of course, each company also has multiple policies too, which change every six months or year.

I do have a finance person on my staff that is excellent at sorting this out. Generally, it involves phone calls to the insurance carrier and they confirm what is covered/not covered, and what the patient would be responsible for out of pocket, if anything.

Doctors, by general inclination and by training, will tend to favor the newest therapy which has the most evidence supporting its safety and efficacy. Often times that data is a lot less clear than what we’d prefer.

2760

The thing is my doctor might be completely wrong and it doesn’t matter because he has absolutely zero money on the line when he tells me that (actually worse, he probably makes more money if I take the $2k option and therefore, whether right or wrong, he has an economic incentive to recommend the treatment).

I see what you’re saying. It just doesn’t have any relevance to solving the actual problem. In reality the $2k often gets silently spent, even when the problem is only a $1k problem and everyone else pays more because of that.