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Healthcare Ramblings

2007-10-09 16:09:10.923813+00 by Dan Lyke 14 comments

Tom has been having some health issues, and in his entry titled "The pernicious US health care system", wrote:

Idiot conservatives think that it's better to make medical care more difficult and more expensive, because then people won't use as much medical services. But all that does is make people frightened to get help when they need it, exactly the time when it would cost way less to treat than when they become really sick.

My views have tempered over the years, I'm now willing to accept that the constant use of the threat of violence is a normal state of human relationships, and that sometimes so I'll engage in discussions about government run health care (despite incidents that give me pause about our system versus others). However, it seems to me that the real answer to Tom's question is "why doesn't your insurance company have a better mechanism for mid-level pre-emptive care?" If there's really a big economic gain to be made there, it seems like a better tiering system for deductibles and urgent care would be in everyone's interest.

And the big issue with healthcare that we need to address is that we can prolong life as long as we're willing to spend money, so where do we stop?

To that end, I'd like to see the stranglehold of the various guilds broken, have more primary care taken care of by nurse level practitioners, to remove the huge differences in cost between paying for insurance individually versus having a company buy it, including replacing HSA and Section 125 stuff with more general mechanisms for deferring taxes that you can do with a corporation, and have some more options about level of coverage available from insurance companies: I'd rather not pay for, for instance, coverage for various levels of psychology.

All of those things involve removing legislation, not adding new legislation.

Without a reasonable segue to get there, I'm just going to throw in Sean's look at the much pushed HR676.

[ related topics: Politics Psychology, Psychiatry and Personality Health Economics ]

comments in ascending chronological order (reverse):

#Comment Re: made: 2007-10-09 16:14:18.078118+00 by: Dan Lyke

Course it'd help if I got that last link to Sean's look at HR676 right:


#Comment Re: made: 2007-10-10 01:57:26.428725+00 by: Dori

"why doesn't your insurance company have a better mechanism for mid-level pre-emptive care?"

Why should they?

There's inexpensive care, which insurance companies cover at moderate rate, and then there's expensive care, which they cover at a low rate. Run up enough of the latter, and they drop you as a client.

In our situation, we can:

Mid-level care is something that would cost the insurance companies money but not allow them to declare you a high-risk that they can drop. There's no upside to it for them.

#Comment Re: made: 2007-10-10 02:37:04.26394+00 by: Dan Lyke

So the solution is to make sure that they can't drop you easily, then they've got reason to avoid the escalation. Right?

(There may indeed be better arguments for nationalized health care, and I'm sympathetic to them, but I think there's a lot that could be fixed mores simply and I want to explore that...)

#Comment Re: made: 2007-10-10 03:44:20.768422+00 by: Dori

So the solution is to make sure that they can't drop you easily, then they've got reason to avoid the escalation. Right?

Should a for-profit corporation be required to sell you coverage at a price that they believe will result in a loss for them?

If yes, you're requiring them to not be a for-profit company. If no, then it's the same as the current situation we're in--all they have to do is price us at some huge $$$, and they'll know that we can't pay it.

#Comment Re: made: 2007-10-10 08:16:17.28665+00 by: Larry Burton

The BCBS companies claim to be not-for-profit.

Unfortunately it seems that the largest expense for a health insurance company stems from making sure they don't overpay a claim. If they weren't worried so much about being defrauded maybe this whole mess would straighten itself out.

#Comment Re: made: 2007-10-10 12:32:50.08364+00 by: Dan Lyke [edit history]

So what are the circumstances in which a health insurance company can drop you? My impression was that once they've got you they're stuck unless you don't pay your premiums.

Later addition: regarding "not for profit", it's important to remember that that's just a tax and company ownership status. That doesn't mean that profits can't get disbursed as, say, salaries.

#Comment Re: made: 2007-10-10 13:11:55.121929+00 by: ziffle [edit history]

The root issue is that the cost of medical care is out of line. A trip to an emergency room is what - $5000?

How much for an aspirin? A gall baldder removed? A new hip? - say $50,000 and no one disputes it.

The problem is that the medical busines is so regulated no one can become competitive. Its called 'Certificate of need'. An MRI should cost say $50. But there are 90 certificates of need required to open an MRI facility. And guess how they are approved? Ayn Rand called it the 'power of pull'.

To wit:


"The North Carolina Certificate of Need Law prohibits health care providers from acquiring, replacing, or adding to their facilities and equipment, except in specified circumstances, without the prior approval of the Department of Health and Human Services. Prior approval is also required for the initiation of certain medical services. The law restricts unnecessary increases in health care costs and limits unnecessary health services and facilities based on geographic, demographic and economic considerations. "

Noitice the wording? "The law restricts unnecessary increases in health care costs". Now this is only logic a government or socialist could appreciate.

So until they totally deregulate the medical industry you can all 'swat flies' as Nietzsche said, and try and shuffle the costs back and forth, but it will be to no avail. If the medical industry built cars they would be $500,000 a copy.

At this point we need either a completely socialist system, so we can individually afford it, which will work for a while until they go broke, or a deregulated system.

#Comment Re: made: 2007-10-10 18:32:10.947291+00 by: Dan Lyke

Ziffle, in listening to the radio reports of the local nurses strike it became pretty plain to me that while getting the system deregulated would be the right direction, it ain't gonna happen because nobody in that business wants that. And the process of going through and developing structures for independent standards would be messy and kill lots of people.

The only way to get it would be for a groundswell of citizens to ask for it, but given that we've already got so much trouble evaluating medical care and options, and that, in the case of emergency medical care, often we don't have the opportunity to evaluate it, I have trouble seeing that happen.

And I too shudder at restricting "...unnecessary increases in health care costs..." because it means that there's no innovation that can happen within that jurisdiction area. To this point the U.S. has been paying for new drugs and other improvements, if the U.S. goes to socialized medicine I wonder where it'll come from next, but I'm guessing that it'll to some extent be tied in with the emerging medical tourism industry.

#Comment Re: made: 2007-10-10 19:19:43.121341+00 by: ziffle

My guess is we will see national health along time before deregulation. I have decided to vote for Ron Paul. Yes he has some issues (not identified to stop the outrage du jour) but if he gets enough votes it might signal to others that there is a better way and actually create a dialogue. So there: "for the dialogue!"

And I could see things like flat rate operations: Lung cancer (one lung or two lungs repaired) $39,900 until the end of the month! Heart bypass: $7999 per artery! Free if you die! :)

This is not so far fetched - we just haven't had the opportunity to try anything.

#Comment Re: made: 2007-10-10 20:29:34.750817+00 by: Dori

So what are the circumstances in which a health insurance company can drop you? My impression was that once they've got you they're stuck unless you don't pay your premiums.

Insurance companies can drop you pretty much any time they want. Or more precisely, you have a contract for a term, and when that term expires, they can choose to not offer you a renewal.

Deregulation is a lovely idea in theory. Unfortunately, that theory requires allowing hospitals to turn sick people away unless they can prove in advance that they can afford treatment.

#Comment Re: made: 2007-10-10 21:02:42.419252+00 by: Dan Lyke

The past few days of the local papers have been all awash in Kaiser Permanente's auction of Sarah Nome's house, you may remember the earlier case of all of the struggles Kaiser had evicting her from the hospital when she'd decided that she was going to retire in one of their hospital rooms. Given the hoops they had to jump through to kick her out, it can't be too easy.

So far as I can tell from my minimal poking around on the various policies I've got, the only gotcha they can play on me is trying to do retroactive underwriting, trying to find flaws in my application, which several insurance companies have been smacked down hard for doing in California. So I think it's harder to cancel a policy than that.

I guess I need to read the fine print a little more closely before I say anything more definitive. Or maybe y'all are buying short term health insurance? I've done that before while waiting for underwriting on a real policy.

#Comment Re: made: 2007-10-10 22:12:44.166009+00 by: ebradway

Sarah ome's case isn't about insurance - it's about hospitalization. Hospitals are generally required to admit and treat anyone. By that standard, it's kind of hard to get rid of patients as well. Insurance is another matter. You can be dropped at each renewal without any particular cause.

#Comment Re: made: 2007-10-14 16:03:49.537847+00 by: ziffle

Dori: actually people could afford treatment. Things would be much cheaper. If we had half socialized food and automobiles, poor people could not afford those either. They could 'Ask' for help. And askng is always better than telling people. e.g. ask vs guns (taxes).

#Comment Re: made: 2007-10-14 21:21:03.808476+00 by: polly

my daughter works at BCBS...her department is HUGE...it's the one that makes sure that BCBS doesn't over pay a claim. on the lighter side...she's a team leader and claims that all the staff is on prozac and the supervisers are on pamelar or zoloff. i can't imagine why, LOL