Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

Ted Cruz

7 (6.5%)

Rick Santorum

16 (14.8%)

Michelle Bachmann

13 (12%)

Chris Christie

23 (21.3%)

Rand Paul

49 (45.4%)

Total Members Voted: 107

[Chaoswizkid]

I wasn't asking anything in that original post, I was declaring that the current solution does not cure the illness, so to speak, and that is the ridiculous cost of healthcare. I still stand by my assessment that the cost of insurance is affected mostly by the cost of healthcare itself. We also wouldn't have to worry so much about insurance if healthcare costs were not nearly as ridiculous.

[mainiac]

I wasn't asking anything in that original post, I was declaring that the current solution does not cure the illness, so to speak, and that is the ridiculous cost of healthcare. I still stand by my assessment that the cost of insurance is affected mostly by the cost of healthcare itself. We also wouldn't have to worry so much about insurance if healthcare costs were not nearly as ridiculous.

Your right, it wasn't phrased as a question.  It was a statement.  But that statement was wrong.  Correcting adverse selection in insurance markets will exert a lot of downward pressure on healthcare costs.

Look at Medicare, which has no adverse selection.  Once you are eligible for Medicare, you are eligable for the rest of your life (generally speaking).  Medicare doesn't drop people when they get sick like insurance companies did before Obamacare stopped them.  This encourages Medicare to take a smarter, longer view of people's health.

The new system set up by Obamacare encourages this sort of long term thinking in the insurance market before.  Prices are controlled and tied to outcomes, something that was impossible without the mandate (least you get a cost death spiral).  This means that if insurance companies don't fight to keep costs down it eats from their profits.  Whereas before if they didn't keep costs down, it actually benefited them in a perverse way.  Whether something cost 500 or 1000, they would skim 3% off the top, so why the heck would they want it to cost less?

[Chaoswizkid]

Correcting adverse selection in insurance markets will exert a lot of downward pressure on healthcare costs.

How? How does removal of adverse selection stop a gastroenterologist from getting a six-figure yearly income working a few hours two days a week? How does removal of adverse selection stop pharmaceutical companies from charging whatever they want?

Why in the world would the medical industry (yes, industry) listen to insurance companies? "Listen, we need to charge less, so we need you to stop charging so much." How is their response anything other than "lolnothxkbai"?

[Lord Shonus]

The medical insurance companies already control the American healthcare system almost completely. For example, both me and my sister had to seek medical treatment for roughly the same condition (most likely induced by the working conditions where we were both employed.) I was in the union, and had access to insurance. She hadn't been employed long enough to get into the union, and thus had none. Her bill was roughly $5000. The same hospital charged my insurance company $700.

[Pnx]

Yes, hospitals do like to charge different amounts to different people. But that particular problem is less conspiracy on the part of insurance companies, and more that they know that people without insurance can't typically fight it if they overcharge them. They charge different prices for different insurance companies too.

[da_nang]

Sounds illegal. If it isn't, it should be.

[Max White]

Yes, hospitals do like to charge different amounts to different people. But that particular problem is less conspiracy on the part of insurance companies, and more that they know that people without insurance can't typically fight it if they overcharge them. They charge different prices for different insurance companies too.

Soooo... How is that 'fair pricing' working out for you, free market economists?

[Frumple]

Exactly as well as expected in a market that doesn't respond appropriately to market forces (well, more precisely, said market forces aren't expressed as they should be, but whatever). Surprise surprise, you can't interact with the free market appropriately when you're bleeding out or it requires many years of training (that you don't have) to actually know what the hell you're supposed to be looking for, in regards to quality/cost interaction.

Which is to say it isn't, and no one with even the most basic understanding of the free market economy is surprised.

Seriously it's part of freaking high school economy classes. "Some shit just doesn't work" (paraphrased). For the free market to function appropriately it needs certain conditions, which don't -- can't -- apply to emergency medical care and have a bugger of a time applying to preventative. Knowledge and time are up there on that condition list!

[mainiac]

Why in the world would the medical industry (yes, industry) listen to insurance companies? "Listen, we need to charge less, so we need you to stop charging so much." How is their response anything other than "lolnothxkbai"?

Medicare is an insurance company.  It doesn't happen to medicare.  I could explain you the mechanisms but you seem intent on refusing to understand them.

[MetalSlimeHunt]

The truly ironic part is that the ACA will likely actually make the insurance market a market. Since you have to have insurance and the abusive practices are banned, it becomes in the insurance company's best interest to offer the cheapest and most useful coverage, lest you take your business elsewhere.

Once again, the Democrats prove to be the party of capitalism, and the Republicans prove to be the party of crazy.

[Chaoswizkid]

Medicare is an insurance company.  It doesn't happen to medicare.  I could explain you the mechanisms but you seem intent on refusing to understand them.

I'm not refusing to understand them, I'm refusing to listen to your explanations of how insurance does its thing with regards to insurance because you refuse to tell me how insurance does its things with regards to the actual cost of healthcare. I'm not talking about how much people pay for insurance, I'm talking about how much hospitals and etc. charge.

Consider this:
The amount that hospitals, etc. charge for services is incredibly high when compared to other countries.
Insurance costs are based mostly (not entirely) on healthcare rates established by hospitals, etc.

I'm trying to argue that the core issue here is healthcare, and you're trying to argue that the core issue here is insurance. However, from where I'm standing, insurance is dependent on healthcare, not the other way around. I acknowledge the possibility that insurance might be able to exert pressure on the medical industry to reduce the cost of healthcare which would then reduce the cost of insurance, but I cannot see how, which is what I've asked you to clarify. Without that piece of information, I fail to see how insurance costs are the most important issue and how the ACA is properly cutting healthcare costs (that is, what hospitals charge, not necessarily what consumers pay).

That's why this conversation is frustrating: I keep talking about healthcare costs and how I don't see how insurance influences them, and you keep talking about insurance. The only time you've referenced how insurance affects healthcare is with that "downward pressure" bit which you did not elaborate on yet, which is quite frankly the only piece of information I care about for what you've said because the rest does not address how insurance is a greater issue than healthcare costs considering insurance is dependent on healthcare costs. That is, I don't see how you can even argue your case unless you establish dependency both ways and establish that healthcare is dependent enough on insurance that prices could be lowered to rates similar to those in other countries, OR that you establish that insurance is not dependent on healthcare but healthcare is dependent on insurance, OR you establish just that insurance is not dependent on healthcare and then we're left not really being able to come to a similar conclusion.

[Sheb]

More insured people means insurance companies have more clout to apply pressure on caregivers. Moreover, other segment of the law aim to reduce cost, notably by reducing payments to hospitals for medicaid patients or by encouraging caregivers to form accountable care organization.

[PTTG??]

The truly ironic part is that the ACA will likely actually make the insurance market a market. Since you have to have insurance and the abusive practices are banned, it becomes in the insurance company's best interest to offer the cheapest and most useful coverage, lest you take your business elsewhere.

Once again, the Democrats prove to be the party of capitalism, and the Republicans prove to be the party of crazy.

Which is disappointing for people who really wish we had a party of socialism.

[Chaoswizkid]

More insured people means insurance companies have more clout to apply pressure on caregivers. Moreover, other segment of the law aim to reduce cost, notably by reducing payments to hospitals for medicaid patients or by encouraging caregivers to form accountable care organization.

See, this is the sort of useful information I was asking about. Didn't know about the ACOs. Don't know how good they actually are, but on paper I'd like to see this thing being commonplace if it's not already.

Unfortunately, both of the latter points only deal with Medicaid. Now, that's a great thing for people who qualify for Medicaid, but Medicaid still only deals with those at those low incomes. Hopefully that will cause a domino effect where pricing changes at the lowest end of the spectrum reflect up to the top and reduce overall prices, but I'm not sure how likely that is considering that caregivers are already all over the place with pricing considering just different insurance companies.

Now, the insurance companies having more customers and therefore more power to apply pressure on caregivers would deal with the general cost of healthcare. However, there's an issue that that pressure still isn't that powerful. Healthcare isn't something you can just order online (yes, you can order pharmaceuticals, but I'm talking about things like surgeries). It has geographical significance. I'm not certain that insurance companies can basically say "If you don't lower your costs, then you won't have any business with us." Their customers would either have to move away to a location that has caregivers that are accepted or they'd change insurance companies. Now, the insurance companies don't have to go that drastic and caregivers are likely to negotiate, but I don't believe the effect would have a significant enough impact on the cost of healthcare in the US to have it more closely resemble the cost of healthcare in other comparable countries. That said, I'll admit I don't actually know enough about how their negotiations work and how much power they do exert. The fact that prices are drastically different for different insurance companies is confusing to me. Maybe they do have a lot more power than I give them credit for, but I just don't see how they have those essential bargaining chips considering that healthcare is a necessary service and that it has a geographical significance, to say nothing of doctors having the most powerful lobby which they can use to influence our government.
So what am I missing here?

[mainiac]

Hospitals don't just unilaterally set prices.  They negotiate prices with insurance companies and Medicare.

The thing is that pre-Obamacare the hospitals had all the bargaining power.  They knew that they could set a higher and higher price each year and the insurance companies could still make a profit because those costs always were passed along to the insured.  So hospitals didn't need to economize because insurance companies would always play ball.  Now the incentives have changed.  Prices are capped and regulated, if a procedure costs more than it is worth to the insurance company, they will simply cut the provider out of their network and the providers know that.  Furthermore the insurers can't drop people when their care becomes expensive, again something that providers know.  So if the insurers don't negotiate prices down they don't make a profit.  You can't ask someone to give an inch when they're back is against the wall.

So whereas before insurance companies made profits by getting people into their plans and avoiding paying for the sick, now the money is in putting the squeeze on providers.

You may not think these negotiations work, but Medicare has been doing them successfully for decades and Medicaid has been doing them even more successfully than that.