Paying thousands before health insurance even kicks in

[ncole1]

Originally Posted by longnecker

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Either you are very rich or very healthy. Or someone else pays your bills.

Healthy enough to usually not use my whole out-of-pocket max ($4500) and rich enough that I could if I had to...

[Jaggy001]

Originally Posted by RecentGrad1

[*]New entrants: Who would want to enter an industry where you often can't get paid at all by Medicare recipients, and yet are mandated by the government to take them? With drugs and medical devices, where FDA approval can take 7 years or more with no guarantee of approval? I sure wouldn't be attracted to that industry.

Quite apart from your factual error re: doctors being mandated by government to take Medicare patients, all you are doing is confirming that there are significant barriers to entry. I would add that other barriers are the significant cost of establishing a fully equipped medical facility where, for example, we already have more hospital places than we probably need as well as issues attracting and paying qualified staff.

Originally Posted by RecentGrad1

[*]Threat of substitutes: The best substitute to healthcare is a healthy lifestyle. It's shocking how much of US healthcare costs are due to unhealthy choices, such as a poor diet and lack of exercise, let alone alcohol, tobacco and drug abuse. You can't substitute for treatment, but you can reduce the need for a LOT of treatment at all! By hiding healthcare costs under the government-sponsored insurance industry, we make people's poor health choices less visible to them monetarily.

A health lifestyle is not a substitute for healthcare. At best it might reduce consumption but it wqould not replace it.

Originally Posted by RecentGrad1

[*]Bargaining power of buyers: Thanks to the insurance industry, heavily encouraged and subsidized by the government (just look at employer provided healthcare and the tax subsidies, let along Obamacare), we've effectively given the buyer no bargaining power. By stopping subsidizing the insurance industry and encouraging people to bargain directly with suppliers we can change the situation completely.

Ordinary people are not really in a position to bargain with suppliers because 1) they lack the requisite specialist knowledge and skills, 2) there is no real price/cost transparency across the industry, 3) in much of America there are effective local monopolies with the nearest 'competitor' a hundred or more miles away and 4) when you are in pain, when you are suffering a health emergency, when you have limited mobility, etc. you do not have the luxury of shopping around for a better deal.

Originally Posted by RecentGrad1

[*]Bargaining power of suppliers: As a medical provider you have incredible power over your suppliers. There's still a lot of competition among medical devices and other medical supplies, even as restricted as this area is.

This is one area where the market is working.

Originally Posted by RecentGrad1

[*]Competitive rivalry: With drugs, it's very intense. With hospitals, not so much, but one can still elect to visit different hospitals in the area if some are cheaper. Looking at some of the government-mandated barriers to entry with opening more hospitals and you have the reason why there aren't more.

Where I live there is just one hospital system and virtually no competitive rivalry. The nearest competitor is 100 miles away. We actually have an oversupply of hospital beds in the USA which is one of the factors discouraging new entrants and pushing up costs.

If you take the analysis to its logical conclusion, what you have is a quasi-monopolistic situation with strong barriers to new entrants, no real substitute products and consumers with relatively little bargaining power. So we are a long way from any kind of free market dynamics and it is arguable that we will never have the conditions where they might operate.

To complicate matters, our major consumers of healthcare are those who are least able to afford it; seniors. A free market could not make money from this demographic and, indeed, neither can insurance companies in our current system. Which is why we have Medicare.

Sometimes you just need to be pragmatic and accept that we have a situation where government is involved in health care and where it is going to continue being involved. So how do we make things better and how do we get our average per capita cost down closer to other developed countries?

[longnecker]

Originally Posted by Hoonose

We all in essence have moral sliding scales. And in respect to HC yours might be a bit tight, but not irrational by any means.

But what if the patient was a new born? Or say a 12 y/o girl?

My concern would be to keep a person as pain free as possible. I am sorry but I just
do not think big bucks to keep a person alive for a short period of time is proper. Would I say that if it was Grandchild? I don't know and pray I never find out.

[Hoonose]

Originally Posted by longnecker

My concern would be to keep a person as pain free as possible. I am sorry but I just
do not think big bucks to keep a person alive for a short period of time is proper. Would I say that if it was Grandchild? I don't know and pray I never find out.

One of my office girls son developed a rare T-cell lymphoma at age 7. It took more than $2M in medical expenses, and today he is a strapping and healthy 18 y/o, fully cured. At the time the treatment was 'do or die', and no way guaranteed. Conventional insurance supplemented by some local fund raising have done a fine job with covering the costs. What would or should we have done if they had no coverage?

My SIL's sister is just wrapping up a newborn month of horror, the infant having seizures of unknown cause, in and out of neonatal IC. They are well insured, in fact she works in the HC insurance business. Bills are already in the hundred's of thousands. And the baby is doing well, and we hope to see her next weekend. What would or should happen if they did not have the means?

[Jaggy001]

Originally Posted by Hoonose

One of my office girls son developed a rare T-cell lymphoma at age 7. It took more than $2M in medical expenses, and today he is a strapping and healthy 18 y/o, fully cured. At the time the treatment was 'do or die', and no way guaranteed. Conventional insurance supplemented by some local fund raising have done a fine job with covering the costs. What would or should we have done if they had no coverage?

My SIL's sister is just wrapping up a newborn month of horror, the infant having seizures of unknown cause, in and out of neonatal IC. They are well insured, in fact she works in the HC insurance business. Bills are already in the hundred's of thousands. And the baby is doing well, and we hope to see her next weekend. What would or should happen if they did not have the means?

My EA (from when I was working) developed some kind of blood disorder when she was in her late 40s. I don't know all the details but total cost was around one million. She is fully cured now and leading an active and productive life. The firm's health insurance covered it. But, if she did not have that level of coverage, should she have been left to die?

Should we have an 'insurance lottery' as to who lives and who dies?

[Hoonose]

Originally Posted by Jaggy001

My EA (from when I was working) developed some kind of blood disorder when she was in her late 40s. I don't know all the details but total cost was around one million. She is fully cured now and leading an active and productive life. The firm's health insurance covered it. But, if she did not have that level of coverage, should she have been left to die?

Should we have an 'insurance lottery' as to who lives and who dies?

My wife and I are both survivors of life ending medical problems. Over $130K in bills for me in 2002 for extensive cardiac surgery, along with complications resulting in 2 more surgeries. Over $130K for her in 2004 for lymphoma, with declining yearly costs, $60-40K for her over the following 8 years, as she remains in remission. We are both healthy and active today. Of course today our costs would be much higher.