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Source: (consider it)
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Thread: Purgatory: Health Care
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Emma Louise
Storm in a teapot
# 3571
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Posted
quote:
Originally posted by jlg:
I never received any revised statement indicating that they had debited any of the firms for the (obvious even to me) double-billing. So a roughly $6,000 procedure cost my insurance company $11,000.
...
I don't think many people in the UK necessarily know how much medical procedures cost (I've never seen a bill, just turn up and have treatment etc.)
In the last few years I've also had my gall bladder removed along with a pregnancy that included ante-natal care (scans, midwife appointments, consultant) and a labour that involved induction, a 4 night stay, 2 attempts at a caesarean (and so the anaesthetist, surgeon, paediatrician, midwives and all the other bods there) as well as post-natal care.
I have always worked and always paid tax so I guess I've paid into the system, but if I was stuck unable to pay for a gallbladder operation the amount of pain that leaves is horrid - and for something so easily treatable. Similarly I hadn't "planned" a caesarean but having had quite a tough time post labour to have had a huge great bill to worry about as well would have been horrid.
Posts: 12719 | From: Enid Blyton territory. | Registered: Nov 2002
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Scot
Deck hand
# 2095
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Posted
quote:
Originally posted by davelarge:
jlg, this all illustrates the fundamental problem: Insurance companies exist to make a profit. Their primary role is not to help people get (or stay) well.
The two goals are not necessarily in opposition to one another. An insurance company that judiciously invests in keeping their clients healthy may well have reduced major claims and greater profitability. They may also have greater retention due to happier and healthier customers. Unfortunately our current quasi-private system doesn't encourage competition for end-users.
RadicalWhig's screed notwithstanding, the potential for profit is an excellent motivation to provide exceptional service in an efficient manner. In a non-profit corporation, the individuals doing the work are motivated by personal profit. Even in a governmental system, program budgets and individual compensation drive performance, however inefficiently.
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“Here, we are not afraid to follow truth wherever it may lead, nor tolerate any error so long as reason is left free to combat it.” - Thomas Jefferson
Posts: 9515 | From: Southern California | Registered: Jan 2002
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Crœsos
Shipmate
# 238
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Posted
quote:
Originally posted by Scot:
quote:
Originally posted by davelarge:
jlg, this all illustrates the fundamental problem: Insurance companies exist to make a profit. Their primary role is not to help people get (or stay) well.
The two goals are not necessarily in opposition to one another. An insurance company that judiciously invests in keeping their clients healthy may well have reduced major claims and greater profitability. They may also have greater retention due to happier and healthier customers. Unfortunately our current quasi-private system doesn't encourage competition for end-users.
Part of the problem with this assessment, at least in regard to the current American health insurance system, is that most health insurance is provided through your employer. Thus it's only in the insurance company's financial interests to prevent long-term health problems that would occur before you change jobs or retire. Any money spent on preventing a problem that could be serious twenty years down the road (high blood pressure, high cholesterol, etc.) is pure loss for your present insurer and will only save money for whoever your insurer is twenty years from now.
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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Dafyd
Shipmate
# 5549
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Posted
quote:
Originally posted by Scot:
RadicalWhig's screed notwithstanding, the potential for profit is an excellent motivation to provide exceptional service in an efficient manner.
If so, how come there is so little exceptional and efficient service around in the private sector?
I'm not saying that there isn't exceptional and efficient service around in the private sector. I've worked for a company that strove for it. My experience was that profit is a fairly low priority for companies providing such service. It kept us in business, but the real motivation was a combination of pride in our jobs, relations with our colleagues and customers, and looking down on our competitors who got away with doing less work for more money.
quote:
In a non-profit corporation, the individuals doing the work are motivated by personal profit. Even in a governmental system, program budgets and individual compensation drive performance, however inefficiently.
There have been studies of this. In general, if you introduce opportunities for personal profit into a system that has been running without them, it becomes less efficient. The profit motivation tends to drive out other motivations. For example, to use an example of Michael Sandel's in his Reith Lectures, a nursery school introduced a series of fines for parents picking up children late. The reason was to reduce the burden on carers staying after hours to look after children. The fines had the effect of increasing the number of parents who picked up children late. Parents were now less motivated by embarrassment or a sense of responsibility to the carers.
I rather suspect (warning: unevidenced speculation follows) that the reason Radical Whig's experience was better in France than in the UK is that France is less profit-motivated as a society on the whole.
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we remain, thanks to original sin, much in love with talking about, rather than with, one another. Rowan Williams
Posts: 10567 | From: Edinburgh | Registered: Feb 2004
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Darllenwr
Shipmate
# 14520
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Posted
I would be interested to know how our American friends deal with chronic conditions such as type 1 diabetes, multiple sclerosis and colostomy. Am I right in understanding that the medical insurance providers will only foot the inevitable bills if your condition had developed after you took out insurance with them?
What would be the position of somebody diagnosed with MS at age 48, who was then told that a curious episode that occurred when she was 16 was her first episode of MS? Would the insurers then say that this invalidated her policy? (I suspect that the answer to that will be 'Yes')
And what of the teenager who developes type 1 diabetes while still living with his parents? Presumably he will have to obtain his own medical insurance in due course? Will he be told that he will have to foot the bills for treating his diabetes himself? (Again, I suspect the answer is 'Yes')
I ask these questions because, in some way or other, they all touch me, my family, or my friends. I developed type 1 diabetes when I was 35, my wife developed MS two years ago, and my son was born with imperforate anus, dyspraxia, heart murmur, fistula from gut to bladder ...
I dread to think how we would manage under the existing US system ~ I imagine we would not. All I can say is, "Be grateful for the NHS!"
Maybe I should point out that, if ever my wife has any problems with her MS, one phone call will see her booked in to see a specialist, generally the following day. If she is prepared to travel (and by this, I mean less that 40 miles, incidentally) she can generally see the specialist the same day. A word to the wise in the US; don't knock what you don't understand.
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If I've told you once, I've told you a million times: I do not exaggerate!
Posts: 1101 | From: The catbox | Registered: Jan 2009
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lily pad
Shipmate
# 11456
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Posted
If it is anything like in Canada, you make sure that you find work that includes insurance as a benefit. I am about to start a new job and will have health insurance as part of a group plan so they can't refuse to treat my pre-existing condition.
Buying health insurance is almost impossible for those with chronic conditions. I did get a quote once and found the fee almost as high as my rent and medications for pre-existing conditions would not be covered at all.
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Sloppiness is not caring. Fussiness is caring about the wrong things. With thanks to Adeodatus!
Posts: 2468 | From: Truly Canadian | Registered: May 2006
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Darllenwr
Shipmate
# 14520
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Posted
Let me see if I understand you, in Canada, it is something of the case that, those who are not fully healthy need not apply?
Chalk one up for a state-provided system of health care.
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If I've told you once, I've told you a million times: I do not exaggerate!
Posts: 1101 | From: The catbox | Registered: Jan 2009
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Josephine
Orthodox Belle
# 3899
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Posted
quote:
Originally posted by Darllenwyr:
I would be interested to know how our American friends deal with chronic conditions such as type 1 diabetes, multiple sclerosis and colostomy. Am I right in understanding that the medical insurance providers will only foot the inevitable bills if your condition had developed after you took out insurance with them?
If you're trying to buy an individual policy, the answer is, yes. Pre-existing conditions are generally not covered. And, as you suspect, insurers will jump through all kinds of hoops to invalidate your insurance should you ever need it.
If you are on a group policy, the rules are different. There may be state-by-state variations; I'm not entirely sure. But, in general, if you have maintained continuous coverage (i.e., you have never been without health insurance), then a group policy has to cover your pre-existing condition. If there is a gap in your coverage, then they can refuse to cover the pre-existing condition for a limited amount of time (6 months, I think).
Depending on where you live and the details of your policy, your children may be dropped from your coverage when they turn 18, or 21, or 24. They may be able to stay on as long as they are full-time students, or until they reach a particular age, whichever comes first. After that, if they have pre-existing conditions, they're going to have to find a job that has a decent group policy.
When you're looking for a job, you're not supposed to ask about health insurance until they actually offer you a job, but that can be awkward if you know up front that, if they don't provide particular coverage, you can't take the job.
It's a bizarre situation we've got here. I don't know why anyone wants to keep it.
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
Posts: 10273 | From: Pacific Northwest, USA | Registered: Jan 2003
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lily pad
Shipmate
# 11456
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Posted
quote:
Originally posted by Darllenwyr:
Let me see if I understand you, in Canada, it is something of the case that, those who are not fully healthy need not apply?
Chalk one up for a state-provided system of health care.
In Canada, we have something like the NHS but many things that you have are not in our program, therefore we need to have supplemental health insurance.
We wait forever for specialists and for tests and we don't have enough doctors. We have no private system for those with insurance either.
People with manageable chronic health problems will generally try to work for government agencies or for bigger employers who offer group health insurance or at least one spouse will do so in order to have regular medications and medical supplies provided.
Our system works great for extremely sick people but is not so great for basic things.
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Sloppiness is not caring. Fussiness is caring about the wrong things. With thanks to Adeodatus!
Posts: 2468 | From: Truly Canadian | Registered: May 2006
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RadicalWhig
Shipmate
# 13190
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Posted
As someone above mentioned, a major problem with this whole "group policy" and "pre-existing conditions" thing is that it makes being self-employed or starting one's own business very difficult.
The case for either a state-funded universal single-payer scheme or a public-provided system like the NHS (I'm not sure which, but still mildly inclined more towards the former) seems stronger than ever.
But tell me, "Fellow Merkins", how would the proposals currently going through Congress help those with pre-existing conditions and a gap in their coverage? Would it make it easier or cheaper for them to get suitable insurance? Does anyone know?
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Radical Whiggery for Beginners: "Trampling on the Common Prayer Book, talking against the Scriptures, commending Commonwealths, justifying the murder of King Charles I, railing against priests in general." (Sir Arthur Charlett on John Toland, 1695)
Posts: 3193 | From: Scotland | Registered: Nov 2007
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Scot
Deck hand
# 2095
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Posted
quote:
Originally posted by Dafyd:
In general, if you introduce opportunities for personal profit into a system that has been running without them, it becomes less efficient. The profit motivation tends to drive out other motivations.
What system are you talking about that has been running without the opportunity for personal profit? Employees of non-profits get paid, as do government employees. Personal profit is why they show up for work.
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“Here, we are not afraid to follow truth wherever it may lead, nor tolerate any error so long as reason is left free to combat it.” - Thomas Jefferson
Posts: 9515 | From: Southern California | Registered: Jan 2002
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Scot
Deck hand
# 2095
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Posted
quote:
Originally posted by Crœsos:
quote:
Originally posted by Scot:
quote:
Originally posted by davelarge:
jlg, this all illustrates the fundamental problem: Insurance companies exist to make a profit. Their primary role is not to help people get (or stay) well.
The two goals are not necessarily in opposition to one another. An insurance company that judiciously invests in keeping their clients healthy may well have reduced major claims and greater profitability. They may also have greater retention due to happier and healthier customers. Unfortunately our current quasi-private system doesn't encourage competition for end-users.
Part of the problem with this assessment, at least in regard to the current American health insurance system, is that most health insurance is provided through your employer.
I absolutely agree that the widespread provision of insurance through employers is one of the biggest reasons for the breakdown of the current system.
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“Here, we are not afraid to follow truth wherever it may lead, nor tolerate any error so long as reason is left free to combat it.” - Thomas Jefferson
Posts: 9515 | From: Southern California | Registered: Jan 2002
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RadicalWhig
Shipmate
# 13190
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Posted
quote:
Originally posted by Scot:
Personal profit is why they show up for work.
Really? That's terrible.
In my experience, being paid is not the reason I go to work; rather, being paid enables me to go to work. The reason I do it is because it is interesting, sociable, worthwhile, challenging, and gives me a role, a status, and a purpose (that does not mean that I enjoy every minute of it, or that there are not bad days). Being paid means that I can afford to go to work. I don't think I'm alone in this. If it gets to a point where the only, or even the main reason you show up for work is so that you can get paid, you are in the wrong job and need to reassess your vocation.
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Radical Whiggery for Beginners: "Trampling on the Common Prayer Book, talking against the Scriptures, commending Commonwealths, justifying the murder of King Charles I, railing against priests in general." (Sir Arthur Charlett on John Toland, 1695)
Posts: 3193 | From: Scotland | Registered: Nov 2007
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Darllenwyr:
I would be interested to know how our American friends deal with chronic conditions such as type 1 diabetes, multiple sclerosis and colostomy. Am I right in understanding that the medical insurance providers will only foot the inevitable bills if your condition had developed after you took out insurance with them?
What would be the position of somebody diagnosed with MS at age 48, who was then told that a curious episode that occurred when she was 16 was her first episode of MS? Would the insurers then say that this invalidated her policy? (I suspect that the answer to that will be 'Yes')
And what of the teenager who developes type 1 diabetes while still living with his parents? Presumably he will have to obtain his own medical insurance in due course? Will he be told that he will have to foot the bills for treating his diabetes himself? (Again, I suspect the answer is 'Yes')
I ask these questions because, in some way or other, they all touch me, my family, or my friends. I developed type 1 diabetes when I was 35, my wife developed MS two years ago, and my son was born with imperforate anus, dyspraxia, heart murmur, fistula from gut to bladder ...
The answer to both questions is, indeed yes, with one exception: if you find work for a large employer. It needs to be a large employer with lots and lots of employees in the benefits pool. In that scenario the insurer offers the employer a blanket plan that covers all employees for a standard rate. If the employer is large enough, bringing in a lot of business, the insurer generally will take all comers, even including pre-existing conditions, so as not to lose the contract.
But if the employer is a smaller company, the insurer will simply factor in the cost of caring for the MS or diabetic employee, and if their aren't enough healthy employees to offset the cost, they'll simply cancel the whole contract. This happened at a church I worked for when the custodian was diagnosed with prostate cancer.
At which point it will indeed be pretty much impossible for the MS or diabetic patient to fine private insurance unless they qualify for government assistance.
Note: California just cut funding for 1000s of children previously insured under our Healthy Families program.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by RadicalWhig:
But tell me, "Fellow Merkins", how would the proposals currently going through Congress help those with pre-existing conditions and a gap in their coverage? Would it make it easier or cheaper for them to get suitable insurance? Does anyone know?
Yes, because it entails universal coverage. As explained above, the problem currently for self-employed persons or people working for small businesses is you aren't in a big enough benefits pool to bargain with the big insurers. Those businesspeople-- the ones least able to pay high costs-- pay the most for insurance, and run the constant risk of having their insurance cancelled if a dependent is diagnosed with some expensive, chronic condition.
By mandating universal coverage and making a public option available, Congress would basically create a giant pool that any American can have access to. Just like the large employers, they can offer one standard rate for everyone, since mandatory universal coverage insures there will be a large body of healthy customers to offset the unfortunate few with more expensive conditions. Basically, it puts every American in the same bargaining position as IBM or Microsoft.
[ 15. August 2009, 01:30: Message edited by: cliffdweller ]
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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Sober Preacher's Kid
Presbymethegationalist
# 12699
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Posted
In Canada, you can get a true Group Health Plan with unlimited prescription drug coverage for as few as 2 employees (thank you Manulife). With 5 employees you can get a quote from all the major carriers: Manulife, Green Shield, Blue Cross, Great-West Life and Sun Life.
On the personal side, there are really only 2 companies worth considering.
1) Your provincial Blue Cross plan.
2) Manulife.
Blue Cross plans vary by province. Many have "Guaranteed Insurability Options" for individual health plans.
In lily pad's case she would have to contact Medavie Blue Cross, the individual provider in the Maritimes. They offer GIO's for their health plans. They also have unlimited drug coverage. This sort of feature is usually backstopped by the provincial government.
The personal insurance market in Canada is a bit of a zoo. I sold this stuff and still breathe it.
I'm a bit disappointed with some of the offerings by the Ontario plan, Canassurance Blue Cross. They're undercapitalized and have gone nutty with their underwriting. I'd rather they improved their health offerings a bit but my suggestions were shot down.
You can take care of yourself with health insurance in Canad but it requires a good advisor and some money.
Disclaimer: I gave up my insurance business and my license so I took my dog out of that race.
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NDP Federal Convention Ottawa 2018: A random assortment of Prots and Trots.
Posts: 7646 | From: Peterborough, Upper Canada | Registered: Jun 2007
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Sober Preacher's Kid
Presbymethegationalist
# 12699
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Posted
quote:
Originally posted by cliffdweller:
quote:
Originally posted by RadicalWhig:
But tell me, "Fellow Merkins", how would the proposals currently going through Congress help those with pre-existing conditions and a gap in their coverage? Would it make it easier or cheaper for them to get suitable insurance? Does anyone know?
Yes, because it entails universal coverage. As explained above, the problem currently for self-employed persons or people working for small businesses is you aren't in a big enough benefits pool to bargain with the big insurers. Those businesspeople-- the ones least able to pay high costs-- pay the most for insurance, and run the constant risk of having their insurance cancelled if a dependent is diagnosed with some expensive, chronic condition.
By mandating universal coverage and making a public option available, Congress would basically create a giant pool that any American can have access to. Just like the large employers, they can offer one standard rate for everyone, since mandatory universal coverage insures there will be a large body of healthy customers to offset the unfortunate few with more expensive conditions. Basically, it puts every American in the same bargaining position as IBM or Microsoft.
Yes and no. Large employers like those usually employ benefits consultants to custom design their plans. Insurers don't pay any commissions on files that large, you pay a retainer to benefit consultant.
Also in many plans there is actually little or no insurance in their insurance. What I mean is that the policy is really a tax tool rather than an actual contract placing funds at risk. Many companies have predictable bills for low-cost, high-frequency claims like drugs. Thus they pay the costs directly through the plan without an insurance cap.
I used to sell this stuff. Been there, done that, got the training.
What Obama's plan would do is allow the revival of Community Rating, that is allow insurers to get away from individual risk rating. IRR is the heart of most complaints about health insurance. Community Rating means you accept all comers and charge a premium based on their pooled risk. The Obama plan would allow that system to work by providing a good supply of health participants.
The Blue Cross plans were founded on this principle, but it stopped working in the 1960's when other insurers with IRR cherry-picked the Blues' healthiest customers.
A Community Rated individual plan with subsidy for low-income earners would act like a universal plan without actually being government-run. I imagine this is what will eventually come to pass in the US.
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NDP Federal Convention Ottawa 2018: A random assortment of Prots and Trots.
Posts: 7646 | From: Peterborough, Upper Canada | Registered: Jun 2007
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Scot
Deck hand
# 2095
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Posted
quote:
Originally posted by RadicalWhig:
quote:
Originally posted by Scot:
Personal profit is why they show up for work.
Really? That's terrible.
In my experience, being paid is not the reason I go to work; rather, being paid enables me to go to work. The reason I do it is because it is interesting, sociable, worthwhile, challenging, and gives me a role, a status, and a purpose (that does not mean that I enjoy every minute of it, or that there are not bad days). Being paid means that I can afford to go to work. I don't think I'm alone in this. If it gets to a point where the only, or even the main reason you show up for work is so that you can get paid, you are in the wrong job and need to reassess your vocation.
Uh, good for you, I guess. Personally, I don't define myself by my job nearly that much. I care a lot more about my non-work roles, status, friends, and purpose. YMMV.
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“Here, we are not afraid to follow truth wherever it may lead, nor tolerate any error so long as reason is left free to combat it.” - Thomas Jefferson
Posts: 9515 | From: Southern California | Registered: Jan 2002
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M.
Ship's Spare Part
# 3291
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Posted
Can I ask a question- well, use my own experience as a case study?
A couple of weeks ago, I went to the doctor with a not-very-important thing - I had had a series of random swellings, on my foot, then my other foot, then my shoulder, then my elbow etc. No pain, no injury that I could remember. I thought they were probably unconnected and 'just one of those things' but went along to be reassured. The doctor discussed possibilitiese with me and eventually ordered some blood tests and asked me if I wanted my cholesterol level tested at the same time.
I could have had the blood tests done privately (I have medical insurance from my employer), but there is no point, my doctor's surgery provides a nurse, the appointment was made for a week later (could have been sooner but the date suited me). The results took a week and then I had an appointment with the doctor to discuss them (they were all perfectly clear and healthy, incidentally).
I have had the same doctor for as long as I have lived here - 21 years, so he knows my medical history. I have another issue my the doctor's surgery at the moment - it has just abandoned open surgery in the morning (for non-UK shippies, this is where you just turn up and queue to be seen. It worked well for me, I could turn up at, say, 8 am and be reasonably sure of being seen by about 8.45, so it minimised how late I was for work. Now I have to phone at 8.30 to secure an appointment for that morning).
I just wondered how this type of thing would be handled in other systems?
M.
Sorry, I should add that there is no paperwork for me at all - there was a form the doctor filled in for the blood test, to let the nurse know what tests were required. That was the only paperwork I saw at all.
[ 15. August 2009, 06:02: Message edited by: M. ]
Posts: 2303 | From: Lurking in Surrey | Registered: Sep 2002
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Alan Cresswell
Mad Scientist 先生
# 31
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Posted
quote:
Originally posted by davelarge:
jlg, this all illustrates the fundamental problem: Insurance companies exist to make a profit. Their primary role is not to help people get (or stay) well.
I don't think "for profit" is a big issue in relation to insurance companies. You could also have "not for profit" insurance schemes, and I don't think there would be much difference (unless the profits earned by insurance companies are excessive). An insurance company has an income stream - premiums and investments on those premiums (if nothing else, a bit of interest on cash left in the bank). There are expenses - the money paid out for treament, wages to staff, costs of running offices ... and dividends to shareholders, or whatever way profits are paid out. The profits will be a very small part of the overall expenses. In a not for profit scheme, the overall expenses won't be much less.
And, I'm not entirely sure that it would make all that much difference if the income from premiums and investments was replaced by direct funding from the tax payer.
The problem jlg outlined is that in any system where costs are charged to a payer then there will be some people who will inevitably try and charge more than they should. And, somewhere along the line it becomes more effort and cost than it's worth to identify and recover any overpayments. Most of us have probably had experience of something similar - personally I had someone claim I'd damaged their property reversing my car into it (I hadn't) but although my insurance company admitted they had a very weak case the claim was so small it was easier for them to simply pay up and write it off as a loss (in retrospect, I should have just paid myself as I lost more in extra payments due to lost no-claims and having to say I had a claim in renewing my insurance in the following years than I would have spent sending them a cheque ... but I didn't fully understand how the system worked at the time).
The only way I can see around the problem of medical practioners overcharging is to directly fund the practice. Which is, more or less, how the NHS works.
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Don't cling to a mistake just because you spent a lot of time making it.
Posts: 32413 | From: East Kilbride (Scotland) or 福島 | Registered: May 2001
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CorgiGreta
Shipmate
# 443
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Posted
In the Kaiser model, there is no possibility of a doctor padding a bill. There are no bills other than standard minimal co-payments for a few services.
Kaiser is considerably less expensive than comparable plans from competitors.
This is probably attributable to the fact that all services (other than extreme emergencies or very rare referrals) are performed in house and/or the fact that Kaiser does not have to satisfy shareholders with ever increasing dividends. It is also possible that they are relatively more efficient, due to consolidation of services, procedures, and records within their facilities.
Greta
Posts: 3677 | Registered: Jun 2001
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Clint Boggis
Shipmate
# 633
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Posted
Alan you're assuming that insurance business runs on fairly low profit margin. Are you just guessing? What kind of figures we're talking about - anyone?
I've been assuming that US health insurance is overall 'inefficient' in that the proportion of money from all premiums spent on actual necessary beneficial health costs for the patient is a long way short of 100%, but I don't know. I tried Googling a few days ago but gave up without an answer.
How much of the money they receive is spent on complex billing beaurocracy, arguing to avoid payouts, profit, legal cases, unnecessary medical tests.. [add your own non-health cost burdens] ? Can anyone point me to a simple breakdown?
.
Posts: 1505 | From: south coast | Registered: Jun 2001
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RadicalWhig
Shipmate
# 13190
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Posted
quote:
Originally posted by Scot:
Uh, good for you, I guess.
I didn't mean it in the "good for me" sense. I meant that assuming profit / payment as the main motivator - the reduction of our lives to a series of instrumental cash transactions rather than a more holistic social role and calling - is not only shallow and dehumanising, but will also result in poor quality service. People will work for cash, yes, but only when the boss is looking, or when they can't get away with slacking; they won't actually care. If you want people to care, then you have to think about things like pride, honour, fellowship, and reputation - these will motivate people even when no one is looking. The implication for health care is that a system with a "personal touch" based on on-going relationships is likely to provide a better incentive structure from high quality service than one driven primarily by the profit-motive.
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Radical Whiggery for Beginners: "Trampling on the Common Prayer Book, talking against the Scriptures, commending Commonwealths, justifying the murder of King Charles I, railing against priests in general." (Sir Arthur Charlett on John Toland, 1695)
Posts: 3193 | From: Scotland | Registered: Nov 2007
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Dafyd
Shipmate
# 5549
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Posted
quote:
Originally posted by Scot:
quote:
Originally posted by Dafyd:
In general, if you introduce opportunities for personal profit into a system that has been running without them, it becomes less efficient.
What system are you talking about that has been running without the opportunity for personal profit? Employees of non-profits get paid, as do government employees. Personal profit is why they show up for work.
Systems that function on volunteer contributions don't rely on the profit motive.
Government employees in the UK do not have the opportunity to increase their salary except as part of a general pay rise, or by changing jobs. So performance above and beyond the minimum standard to hold the job down isn't motivated by profit.
In fact, we're speaking rather loosely here. Profit is the act of returning money on an investment. Getting paid for my labour is not strictly speaking a profit. Now it doesn't particularly matter, but you're running the risk of lumping together rather different situations.
a) Employees receive a basic salary, and receive no financial motivation to do more than the bare minimum.
b) Employees receive a basic salary with a performance related review every year.
c) Employees receive a basic salary, plus on the spot financial bonuses for particular actions e.g. every customer complaint taken and dealt with within a particular period.
Now, by saying that employees in situation a are working for profit you're claiming that there's essentially no difference between a and c. If people are motivated to get paid at all, then they'll be motivated in just the same way by c. And that is quite wrong.
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we remain, thanks to original sin, much in love with talking about, rather than with, one another. Rowan Williams
Posts: 10567 | From: Edinburgh | Registered: Feb 2004
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Doublethink.
Ship's Foolwise Unperson
# 1984
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Posted
The NHS runs on b, unless you are a doctor.
NHs services are already being tendered and in some cases being delivered by third sctor organisations. One noticeable effect is problems information sharing. That and that the people comissioning sevices and organisations don't always know enough about the specialism to make - what I would consider - sensible decisions.
Health economists reckon the introduction of the internal market into the NHS did a fair amount of damage - and it engenders a lot of admin costs.
It would be interesting to see the health outcomes of funding the NHS at 10% of GDP. I suspect we would reach French standards at that point.
Patient choice is a two-edged sword, I believe people should have health care planned together with their provider. But.
What about people who are clinically health anxious, what about people in first episdoe of psychosis who don't know they are ill, what about people who want a particular intervention because they have been convinced it works when there is no actual evidence it does - like homeopathy, what about people are only prepared to see a consultant specialist - regardless of actual clinical need, what about people who want quick-fix surgery (which won't overcome the problem in the long term) rather than to make lifestlye changes that will address the clinical problem ?
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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell
Posts: 19219 | From: Erehwon | Registered: Aug 2005
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CorgiGreta
Shipmate
# 443
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Posted
Clint,
I haven't had any success with Google either, but I recall reading some figures a few months ago. I wish I could remember the source, and I'll keep trying.
Nevertheless the numbers that stick in my mind are: private insurance spends between 70% and 90% of each dollar on actual health care. Medicare, on the other hand spends 97%-98% per dollar on health care.
There may have been some bias on the part of my source, but I doubt that any manipulation of the figures could refute a conclusion that administration and profit, not to mention hefty executive conpensation, consume a healthy portion of the private premium dollar. It may not be just profit, but it seems that there is major excess somewhere.
Greta
Posts: 3677 | Registered: Jun 2001
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Alan Cresswell
Mad Scientist 先生
# 31
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Posted
quote:
Originally posted by Clint Boggis:
Alan you're assuming that insurance business runs on fairly low profit margin. Are you just guessing? What kind of figures we're talking about - anyone?
I don't know what sort of financial regulation there is in the US, but it wouldn't seem unreasonable if company profits are public domain. Whether the income from premiums and where that money was spent is available is another matter. But, if you can find an insurance company that's going to say how many customers they have (and, the big ones at least are likely to use that as an advertising line "bringing good health to 50million Americans" sort of thing) and can make a guess at the average premium paid per customer you might get an idea.
If CorgiGreta is right and 70-90% of insurance premiums fund patient care then that sounds about right to me. 90% seems high, as 10% doesn't seem much to pay staff and advertising, much less a profit return.
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Don't cling to a mistake just because you spent a lot of time making it.
Posts: 32413 | From: East Kilbride (Scotland) or 福島 | Registered: May 2001
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Imaginary Friend
Real to you
# 186
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Posted
quote:
Originally posted by Alan Cresswell:
I don't think "for profit" is a big issue in relation to insurance companies. You could also have "not for profit" insurance schemes, and I don't think there would be much difference (unless the profits earned by insurance companies are excessive). An insurance company has an income stream - premiums and investments on those premiums (if nothing else, a bit of interest on cash left in the bank). There are expenses - the money paid out for treament, wages to staff, costs of running offices ... and dividends to shareholders, or whatever way profits are paid out. The profits will be a very small part of the overall expenses. In a not for profit scheme, the overall expenses won't be much less.
I think that the difference is not so much in whether there is the additional expense of paying shareholders, but one of attitude. A for-profit exists to maximize the bottom line, and the business that they do happens to have the happy collateral of helping people. A non-profit organization who's primary purpose is to help people, but which has to keep the books balanced is (I think) more likely to take a benevolent view of marginal claims and generally be 'nicer'.
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
Posts: 9455 | From: Left a bit... Right a bit... | Registered: May 2001
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Clint Boggis:
How much of the money they receive is spent on complex billing beaurocracy, arguing to avoid payouts, profit, legal cases, unnecessary medical tests.. [add your own non-health cost burdens] ? Can anyone point me to a simple breakdown?
.
I don't have the precise answer, but an anecdote from my personal experience may offer some clues.
My youngest has severe visual impairment. After years of having his treatment put off/ endlessly delayed by a bureaucratic HMO, we spent considerable time/effort "working the system" to get into the right plan and the right group with the right primary care physician (you wouldn't believe the number of ducks we had to line up) so he could be seen by a very well-regarded pediatric opthamologist in our area.
Here's the anecdote: a single doctor, working in a private practice. He employs a total of 5 different employees just to handle billing. Every insurance company has a different set of forms, a different set of rules, a different set of criteria, a different procedure for approval. He only needs two nurses and a single optometrist, but 5 billing clerks.
Within a very short time of seeing my son, the doctor was ready to move forward with his long-delayed surgery. Then began the real negotiation. It took around 4 months of intense negotiations by the billing staff to set up the surgery-- negotiating what hospital to use (the doctor maintains surgical privileges as 6 different hospitals since every insurance co. has a different contract), what anaestesiologist, every aspect had to be negotiated in advance before they got the green light.
So it takes 5 different highly skilled people to manage just the billing end of a single doctor's practice. That's insane. More people are working on the billing end then are on the medical end. One of the things reform can do is streamline all those disparate practices into a single uniform form and procedure.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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Clint Boggis
Shipmate
# 633
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Posted
quote:
Originally posted by cliffdweller:
quote:
Originally posted by Clint Boggis:
How much of the money they receive is spent on complex billing beaurocracy, arguing to avoid payouts, profit, legal cases, unnecessary medical tests.. [add your own non-health cost burdens] ? Can anyone point me to a simple breakdown?
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I don't have the precise answer, but an anecdote from my personal experience may offer some clues.
My youngest has severe visual impairment. After years of having his treatment put off/ endlessly delayed by a bureaucratic HMO, we spent considerable time/effort "working the system" to get into the right plan and the right group with the right primary care physician (you wouldn't believe the number of ducks we had to line up) so he could be seen by a very well-regarded pediatric opthamologist in our area.
Here's the anecdote: a single doctor, working in a private practice. He employs a total of 5 different employees just to handle billing. Every insurance company has a different set of forms, a different set of rules, a different set of criteria, a different procedure for approval. He only needs two nurses and a single optometrist, but 5 billing clerks.
Within a very short time of seeing my son, the doctor was ready to move forward with his long-delayed surgery. Then began the real negotiation. It took around 4 months of intense negotiations by the billing staff to set up the surgery-- negotiating what hospital to use (the doctor maintains surgical privileges as 6 different hospitals since every insurance co. has a different contract), what anaestesiologist, every aspect had to be negotiated in advance before they got the green light.
So it takes 5 different highly skilled people to manage just the billing end of a single doctor's practice. That's insane. More people are working on the billing end then are on the medical end. One of the things reform can do is streamline all those disparate practices into a single uniform form and procedure.
Thanks Greta, Alan and cliffdweller for your answers.
Going by the account above, if it's typical, I can't see how the actual medical and directly related costs could possibly account for over 70% of the total while there's such a dramatic imbalance between non-medical office staff and those actually delivering the service you want.
The only 'good' point those in favour of the status quo would have is to ask about all those administrative and support staff who won't be needed any more - think of the massive unemployment!
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Posts: 1505 | From: south coast | Registered: Jun 2001
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mousethief
Ship's Thieving Rodent
# 953
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Posted
This is why my firm still employs three buggy whip makers.
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This is the last sig I'll ever write for you...
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moron
Shipmate
# 206
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Posted
David Brooks: Obama tells whoppers.
quote:
The other thing is, he just tells a lot of whoppers now. Now, believe me, Rush Limbaugh and Sarah Palin are saying some things that are extremely off the charts untrue about the plan, but I just wrote down some of the things Obama said today which are whoppers.
He said everyone can keep their health care plan. Well, the CBO doesn't say that. Six million people are going to lose their plan. Preventive care saves money. That's not true. It's going to cost $90 billion a year. That's not true. It's probably going to cost twice as much when it's fully implemented. Government will be out of health care decisions.
He tells one thing after another, making it seem so easy. Well, believe me: This is not easy. It's going to take some sacrifices and some really painful cuts for people to get this system under control.
And often, when I look at him, I think he's over-promising, not as much as the other side, but to a significant degree.
And Palin vindicated?
quote:
The Senate Finance Committee will drop a controversial provision on consultations for end-of-life care from its proposed healthcare bill, its top Republican member said Thursday.
The committee, which has worked on putting together a bipartisan healthcare reform bill, will drop the controversial provision after being derided as "death panels" to encourage euthanasia by conservatives.
"On the Finance Committee, we are working very hard to avoid unintended consequences by methodically working through the complexities of all of these issues and policy options," Sen. Chuck Grassley (R-Iowa) said in a statement. "We dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly."
Posts: 4236 | From: Bentonville | Registered: May 2001
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cliffdweller
Shipmate
# 13338
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Posted
Oh, thank God. Now we have all been spared the horror of having an uncomfortable conversation. I mean, yeah, sure, not being able to get life-saving medical treatments is annoying, but having to think about death-- why that's just awful! Thank God we've been spared such needless suffering at the hands of heartless government bureaucrats.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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Alan Cresswell
Mad Scientist 先生
# 31
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Posted
quote:
Originally posted by Clint Boggis:
Going by the account above, if it's typical, I can't see how the actual medical and directly related costs could possibly account for over 70% of the total while there's such a dramatic imbalance between non-medical office staff and those actually delivering the service you want.
I understood the 70-90% paid by insurance companies to be the amount of their income that gets passed onto medical providers in claims. It doesn't necessarily mean that all of that money is spent on medical treatment, the practioners presumably include their administrative and other indirect costs within their bill to the insurance company. And, of course, the drug companies etc include costs over and above actually making and shipping their products in what they charge.
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Don't cling to a mistake just because you spent a lot of time making it.
Posts: 32413 | From: East Kilbride (Scotland) or 福島 | Registered: May 2001
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Alan Cresswell
Mad Scientist 先生
# 31
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Posted
quote:
Originally posted by mjg:
David Brooks: ... Preventive care saves money. That's not true.
OK, I'm not going to try and read anything written on blogs about the subject. But, I just don't understand how preventative care can't be less expensive?
What conditions become cheaper to treat if left until they become serious? And, not just in direct medical costs; treating advanced illness involve longer periods of care, generally less comfort (quite often distinctly unpleasant treatments), considerable stress on patients and their family etc.
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Don't cling to a mistake just because you spent a lot of time making it.
Posts: 32413 | From: East Kilbride (Scotland) or 福島 | Registered: May 2001
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Jay-Emm
Shipmate
# 11411
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Posted
quote:
Originally posted by Alan Cresswell:
[...]OK, I'm not going to try and read anything written on blogs about the subject. But, I just don't understand how preventative care can't be less expensive?...
Looking at the context of the quote I'm wondering if he's looking very short term, currently they pay $X on treatment, next years bill they'll pay $X+Y on treatment (the people they haven't looked after till now will still get the disease) and pretreatment. In the future they'll end up paying $Z+Y with Z<X-Y, but who wants to spend for the future ![[Paranoid]](graemlins/paranoid.gif)
Anyhow that's my first guess, the other possibility is he's arguing that care on 10 moderately ill people is more expensive than care on 1 seriously ill person, 1 corpse and and 8 still moderately ill and untreated people. To be honest my example (my gut tells me) has got too few serious cases to be realistic and too many to be financial realistic.
I disagree with 2, and think 1's worth the short time cost. But if I was emotionally anti-reform I might think differently.
[ 16. August 2009, 08:11: Message edited by: Jay-Emm ]
Posts: 1643 | Registered: May 2006
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Clint Boggis
Shipmate
# 633
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Posted
quote:
Originally posted by Alan Cresswell:
quote:
Originally posted by Clint Boggis:
Going by the account above, if it's typical, I can't see how the actual medical and directly related costs could possibly account for over 70% of the total while there's such a dramatic imbalance between non-medical office staff and those actually delivering the service you want.
I understood the 70-90% paid by insurance companies to be the amount of their income that gets passed onto medical providers in claims. It doesn't necessarily mean that all of that money is spent on medical treatment, the practioners presumably include their administrative and other indirect costs within their bill to the insurance company. And, of course, the drug companies etc include costs over and above actually making and shipping their products in what they charge.
Yes, I'm sure that's right: 70-90% is what insurance companies pass on and deem health spending, but there is another tranche of admin, support and billing staff costs to be covered too.
Overall we don't know the figures but it's likely to be well under half spent on medical and medically necessary costs. I'll be generous and guess 40% 'efficient'.
I too looked at that mjg link and immediately focussed on the line: "Preventive care saves money. That's not true."
Some blogger concludes 'Obama tells whoppers' by stating something so clearly untrue (to anyone with a modicum of common sense) in a feeble-minded attempt to refute someone else's statements is - just weird. Idiot.
Don't they want to win the argument? It might get a round of applause from Obama haters but 98% of other adults will see through it. Maybe it's a typo or misquote that slipped though. Is there a 'not' missing? Those little things can end up making a big difference.
Jay-Emm may be right and they are looking at the extremely near future where it will be true for a short time but 'forget' to say they're being very selective of the facts to make a case only simpletons would accept. Or maybe they are seeing death as a cheap resolution.
I understood that in US health care, it's usual to get an annual check-up, while here in the UK it isn't. We don't do that as part of preventative care but presumably it's been deemed not cost-effective or has minimal effect on health outcomes. That's ok, it doesn't worry me because if I know that I need to, I can go to the doctor and get whatever tests or treatment I need with no bills.
ISTM that part of the US problem is that preventative care is good for those with health cover (including those annual checks which yield little benefit) but for those without cover, it costs so much that people either choose not to go or literally can't afford to. This exacerbates the divide between those with cover and the rest. Are there any figures comparing life expectancy between the two groups?
OF COURSE letting all those people who notice a pain or lump which might be the early stages of something nasty and getting it checked before it's too serious will benefit their health and their lives and save money overall. Everybody wins!
.
Posts: 1505 | From: south coast | Registered: Jun 2001
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angelicum
Shipmate
# 13515
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Posted
quote:
Originally posted by Alan Cresswell:
What conditions become cheaper to treat if left until they become serious? And, not just in direct medical costs; treating advanced illness involve longer periods of care, generally less comfort (quite often distinctly unpleasant treatments), considerable stress on patients and their family etc.
Preventive health treats population in opposition to acute medicine which treats individuals.
So it really depends on exactly what policies you're going to implement. Take for example, statin, a cholesterol lowering drug. Some studies (mostly funded by the pharmaceutical company I bet) have suggested that every adult, regardless of actual cholesterol level should be on a low dose of statin and this reduces the lifetime prevalence of a myocardial infarction by X%. Now there would obviously be a cost to that implementation. Would the cost be higher or lower than what we currently do which is targetted cholesterol lowering plus the addition of whatever percentage point increase in disease that would result because of that?
Or another example of preventive medicine - say everyone is encouraged to have yearly blood pressure checks with their GP. Some people with hypertension go on to develop strokes, heart attacks, etc. Not everyone does though, and some people carry on fine with high blood pressure. The medical guidance though would treat everyone with hypertension. Therefore the more cases of high blood pressure gets picked up, consequently more people are on drugs. Some of these people would be prevented from getting strokes, etc. Some people would get a stroke anyway. And some of these people would have never got a stroke in the first place. Is this more or less expensive than just treating the (expected) increase in stroke patients??
Posts: 364 | From: Full in the panting heart | Registered: Mar 2008
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Antisocial Alto
Shipmate
# 13810
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Posted
Widespread preventive care costs more because more people receive it, a lot of whom wouldn't have contracted a specific condition anyway.
"...many observers point to
cases in which a simple medical test, if given early enough, can reveal a condition
that is treatable at a fraction of the cost of treating that same illness after it has
progressed. In such cases, an ounce of prevention improves health and reduces
spending—for that individual. But when analyzing the effects of preventive care
on total spending for health care, it is important to recognize that doctors do not
know beforehand which patients are going to develop costly illnesses. To avert
one case of acute illness, it is usually necessary to provide preventive care to
many patients, most of whom would not have suffered that illness anyway."
(Quoted from a letter from the Congressional Budget Office director)
Posts: 601 | From: United States | Registered: Jun 2008
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Imaginary Friend
Real to you
# 186
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Posted
quote:
Originally posted by angelicum:
So it really depends on exactly what policies you're going to implement.
Well, of course!
quote:
Originally posted by angelicum:
Take for example, statin, a cholesterol lowering drug. Some studies (mostly funded by the pharmaceutical company I bet) have suggested that every adult, regardless of actual cholesterol level should be on a low dose of statin and this reduces the lifetime prevalence of a myocardial infarction by X%. Now there would obviously be a cost to that implementation. Would the cost be higher or lower than what we currently do which is targetted cholesterol lowering plus the addition of whatever percentage point increase in disease that would result because of that?
How about a half-way house, where people in at-risk categories are allowed to take the drug, if they want it? That way, some of the unnecessary* treatment is removed, the cost lessened, but the people that are likely to benefit from the treatment still get it. The same can be said for your second example.
But in that example, isn't it better if people don't have heart attacks or strokes in the first place? Even if it does work out more expensive to minimize the number of occurrences of those conditions in the general population, isn't that a better outcome than treating the strokes etc after they have happened? It would certainly keep more people in work for longer, and potentially benefit the economy (and tax revenues) in that way. But fundamentally, keeping people healthy is (in my opinion) a morally better course than merely treating them when they are ill.
* in the sense that those people would not have gone on to have the condition if they had not taken the medicine.
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
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angelicum
Shipmate
# 13515
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Posted
quote:
Originally posted by davelarge:
But fundamentally, keeping people healthy is (in my opinion) a morally better course than merely treating them when they are ill.
I completely agree. That's why I think cost-effectiveness/economics or big government/small govt should all come a very definite secondary to the discussion on health policy.
Posts: 364 | From: Full in the panting heart | Registered: Mar 2008
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moron
Shipmate
# 206
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Posted
quote:
Originally posted by Clint Boggis:
Some blogger concludes 'Obama tells whoppers' by stating something so clearly untrue (to anyone with a modicum of common sense) in a feeble-minded attempt to refute someone else's statements is - just weird. Idiot.
David Brooks, arguably one of the more respected commentators around, pontificating on the PBS News Hour is summarily dismissed as a 'blogger'?
Weird.
Posts: 4236 | From: Bentonville | Registered: May 2001
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Alan Cresswell:
quote:
Originally posted by mjg:
David Brooks: ... Preventive care saves money. That's not true.
OK, I'm not going to try and read anything written on blogs about the subject. But, I just don't understand how preventative care can't be less expensive?
What conditions become cheaper to treat if left until they become serious? And, not just in direct medical costs; treating advanced illness involve longer periods of care, generally less comfort (quite often distinctly unpleasant treatments), considerable stress on patients and their family etc.
I guess if you can delay treatment long enough the patient just up and dies, which is really really cost-effective.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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five
Shipmate
# 14492
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Posted
An American doctor once told me that the annual check up was one of the biggest scams going. Apparently the results are deceptive as you have nothing to compare them against (apart from the last year, where if every category is marked "within normal limits" then you have no genuine measure to compare with, one shot blood pressure isn't particularly helpful (as many people get stressed and raise the blood pressure through just having the test done) and if nothing is found, you're often happily delusional that nothing can go wrong for rather a while.
Whether or not this is true, I have no idea, and I am not a doctor. Far from it! But his explanation made a lot of sense at the time.
Posts: 1250 | Registered: Jan 2009
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Clint Boggis
Shipmate
# 633
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Posted
I can't think where I got the idea he was a blogger. Sorry about that.
I was probably affected by the claim that more preventative care will result in higher costs. Does leaving problems until they're extremely serious and major action is required end up cheaper? It just makes no sense.
.
Posts: 1505 | From: south coast | Registered: Jun 2001
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Erin
Meaner than Godzilla
# 2
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Posted
quote:
Originally posted by five:
An American doctor once told me that the annual check up was one of the biggest scams going.
It depends, I think. I have a couple of chronic conditions that are controlled with medication and a family history of other unusual conditions, and the annual check-up is a good way to keep on top of them. We've been able to head off a couple of things that would have resulted in major surgery.
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Commandment number one: shut the hell up.
Posts: 17140 | From: 330 miles north of paradise | Registered: Mar 2001
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LutheranChik
Shipmate
# 9826
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Posted
Well, the latest is that the Obama administration is giving up on promoting a public option in its plan. This is very disappointing.
Meanwhile, the GOP and Big Pharma/Big Insurance have the peasants with pitchforks so riled up about "socialized medicine"...we have a church friend who's a lovely human being but whose emotions tend to override her IQ, who pays way too much attention to rightwing talk radio and spam e-mails, who's convinced that our neighbor to the north is putting Grandma out on an ice floe to die, practicing eugenics on sick babies, anesthetizing patients with seal clubs and Canadian whiskey and otherwise committing unspeakable crimes against humanity in the name of single-payer healthcare. It's part of the collective nervous breakdown the right wing is having in our country at the moment.
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Simul iustus et peccator
http://www.lutheranchiklworddiary.blogspot.com
Posts: 6462 | From: rural Michigan, USA | Registered: Jul 2005
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Imaginary Friend
Real to you
# 186
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Posted
quote:
Originally posted by LutheranChik:
It's part of the collective nervous breakdown the right wing is having in our country at the moment.
Oh, I think the right wing is fully in control of it's faculties. It's the everyday person who's having a breakdown induced in them by the right wing.
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
Posts: 9455 | From: Left a bit... Right a bit... | Registered: May 2001
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