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Private insurance has a customer base of all the younger, healthier, and more affluent people and needs only to diffuse the cost of the relatively few that are struck down unexpectedly by accident of illness. The government (taxpayers) foots the bill the disabled, feeble, poor, elderly, and covers an extremely large percentage of the end-of-life care for everyone (since most are on medicare at the time). Unlike private insurance, that's their entire clientele with no young/healthy people diffusing those costs.
Average cost of private insurance = $5,615
Average cost of medicare = $10,400
Average cost of medicaid = $6,775
This looks like a pretty good deal if you happen to own a private insurance company, but a pretty bad one for the taxpayers.
Cherry picking is a term used in the insurance business to basically mean "we prefer to insure iron under water against all fire hazards". That's what all for profit insurance companies really want.
In terms of health insurance companies selecting younger folks to insure, they cannot do that with employer purchased plans. However, people know more about their own health than insurance companies do. Any study you look at will tell you that the largest percentage of UNINSURED are among those 18-35, the group less likely to have major health claims outside of accident or injury. That group simply chooses to not pay for any coverage.
Therefore, the insured pool is necessarily filled more with those who DO need coverage. ObamaCare seeks to bring everyone into the health insurance pool. It's made many of those people who figure they don't need healthcare angry because they are being "forced" to buy insurance. But we "force" people to buy auto liability insurance, whether they use it or not, because it is a protection for society. We "force" people to participate in social security via payroll deductions because otherwise some people would choose to scam the system by not participating and then expect society to help them in the end.
And we would. We dont let the uninsured die on the streets if they are in need of health care. We take them into our emergency rooms and then pass the cost on to those of us who do pay. That's what those who make a choice to remain uninsured are doing to the rest of us. They are secure in the fact that if they really have a problem society will take care of them. And most of us wouldn't want to live in a society that would not.
But it's also the reason we should REQUIRE health insurance participation from every person who makes any kind of income at all. They may not need it themselves, but they have the coverage and society is better protected by everyone's participation. Just like fire insurance, the vast majority of us never, ever need it, but most of us have it anyway, because you certainly can't get a loan without the coverage and your failure to have coverage almost always results in loss not only to the individual but to the society that provides Red Cross or Salvation Army assistance, perhaps temporary government housing, or even food stamps in some cases.
This same "mandate" for coverage is working very well in Massachusetts and initiated by one Mitt Romney. Massachusetts has fewer uninsured people than any other state in the nation.
But it's also the reason we should REQUIRE health insurance participation
from every person who makes any kind of income at all.
Like with a payroll tax/contribution into a government supported plan? OK.
It can even be set up to cover the ace bandage and suture level of medical care
that MOST of us will will never need more than until we're close to retirement.
Personally though... I'd still rather see individual personal responsibility for that simple
and low level care and treatment which should be affordable if the "oh my god" level
is covered by that payroll tax/contribution government supported plan.
As an interested outsider reading this thread, especially the part about people refusing a part time job with no health cover, or staying in a job they hate so they keep cover, well, I find this amazing.
Same with Health companies cherry picking for people who are unlikely to be ill. It has been an eye opener for me.
Even though it's not perfect, a system similar to the one here in Britain, has to be better than what the American people are putting up with now. Funded by taxation, non profit, free at the point of delivery and need.
Our hospitals have managers, and boards, they keep an eye on expenditure. But, not driven by a profit motive, it must be cheaper, and need less background people than the American system. There are no insurers or bill collectors to deal with by the general public.
The more I read, the more astounded I am by the complexities of your health system.
Like with a payroll tax/contribution into a government supported plan? OK.
It can even be set up to cover the ace bandage and suture level of medical care
that MOST of us will will never need more than until we're close to retirement.
Personally though... I'd still rather see individual personal responsibility for that simple
and low level care and treatment which should be affordable if the "oh my god" level
is covered by that payroll tax/contribution government supported plan.
I dont think we are in disagreement over the need for health care by everyone, only at what level it's paid for. And that at least is a reasonable debate.
I did actuarial work for years, so I'm a numbers guy. Here is data that is a little old, but still proportionally valid. Data is in U.S. dollar purchasing power:
(A)ll these other countries may have socialized medicine, but if you look at health outcomes, theirs are better than ours (except maybe Sweden, I'm not certain), and all of them, with comparison in U.S. dollars are cheaper than us.
Health Spending Per Capita: Exhibit 1 shows per capita health expenditures for 2008 in U.S. dollars purchasing power parity. Health spending per capita in the United States is much higher than in other countries – at least $2,535 dollars, or 51%, higher than Norway, the next largest per capita spender. Furthermore, the United States spends nearly double the average $3,923 for the 15 countries.
Exhibit 1
Total Health Expenditure per Capita, U.S. and Selected Countries, 2008
Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.
I don't think we are in disagreement over the need for health care by everyone,
only at what level it's paid for. And that at least is a reasonable debate.
My main point in this is to assert that there ARE different levels to care...
and being different they might just warrant a different approach to payment and management
than to lump them all into one big pile that most will close eyes to so long as it is managed.
But managed by "Big Medicine" or by "Governement" is a false choice.
They're just two sides of the same bloaty nannyism coin and I don't like either...
but I'm far more willing to accept the one payer approach at the level of care that NO ONE
disputes that NO ONE can afford to pay for individually (or even with private insurance).
On a practical or perhaps political basis... I suspect that this sort of middle ground is needed
before the US will (as time goes on) embrace expansion into a more all in one plan.
Should America give in to a National Healthcare system like Germany, Sweden, Thailand, England, or Japan?
Do you think it's time to take profit out of our healthcare system?
We are unique in the profit we allow others to make off people through our healthcare needs. Do you think it will last for the long haul? We go broke from medical bills unlike other people in other countries.
Other countries rely on making their profits from the U.S. in regards to prescription drugs because their countries have limits set on price but we do not. Do you think that's fair for Americans to pick up the slack financially?
Do you feel paying more makes us better or stupid? People in other countries fair as well with health without going into medical bankruptcy, do you think we should still put a price on our health? Or should we adopt the same as others and have limits to how much the medical companies can make off our medical needs?
I realize this is a political leaning discussion but I'd like to know what you think individually, without left or right leaning input. What do you truly think as an individual paying for your healthcare. Do you think what we have now, a for profit system, is working for the people of this country? Or do you think we need to limit the profit that can be made off our health? Do you like the fact that other countries come sell higher here for the same medicine to make their money? Is that ok with you? We are after all a free market.
And lastly, do you feel it sets up a strange dynamic within our country? Do you think having healthcare depend on your ability to make enough money to survive medical incident without going broke make us more distant and group in odd ways socially in our country? From medicare to welfare, do you think it sets us apart in how we communicate equally because money buys our health? Do you think fear is logical in regards to not receiving care or do you like that the poor have a label of welfare recipient? Do you like the divide?
Just wondering how everyone is feeling about this currently now that a few things have changed in regards to our healthcare. Do you think Obamacare will fix things or not? Do you think he did to much or to little?
Thanks On a personal note I am unsure in a direction at this point. I would like a change but I am unsure at what kind of change. I would like a non profit, it seems odd to me to profit from healthcare as a country, especially when other countries take advantage of our for profit medical system.
When I consider the differences in service and efficiency of the Post office vs say Fedex, I get a looko at what a non private sector health care system might be like. Ihave not seen comprehensive comparison of what innovations in healthcare developed but believe we lead in the US because of the profit motive and private sector effectiveness. Our economy can not afford all the healthcare we have available in this country, so rationing has to come soon to balance what is doable vs what is affordable. The scare over the death panels when debating obamacare was unfortunate as this is a meaningful debate we must have under any scenario. I recognize my low expectations of a gov run system is political perhaps but I feel it is a certainty we will see change if we go the ways of others and will have large unintended effects as most massive efforts to gov manage a segment of the economy has had. Profit if not the evil word so many seem to think...
I've been researching health insurance systems online for sometime now and feel I have some degree of knowledge about the inefficiency in ours. The part that is subject to debate is how far do we need to go to fix it without finding ourselves in a deeper hole. That's an argument worth having--but the whole
"everybody has healthcare" argument is dumb. They may have it in some fashion, but at societal price that is bankrupting us.
I don't think I have more than a cursory answer to "how" to fix it, because it is such a complex issue we are liable to fix the hole in the bow of the ship while opening another in the stern. That's the problem our politicians have. They're all afraid of making a mistake.
Last edited by Green Irish Eyes; 12-21-2012 at 07:15 PM..
Reason: Edited out reference to deleted post
When I consider the differences in service and efficiency of the Post office vs say Fedex, I get a looko at what a non private sector health care system might be like. Ihave not seen comprehensive comparison of what innovations in healthcare developed but believe we lead in the US because of the profit motive and private sector effectiveness. Our economy can not afford all the healthcare we have available in this country, so rationing has to come soon to balance what is doable vs what is affordable. The scare over the death panels when debating obamacare was unfortunate as this is a meaningful debate we must have under any scenario. I recognize my low expectations of a gov run system is political perhaps but I feel it is a certainty we will see change if we go the ways of others and will have large unintended effects as most massive efforts to gov manage a segment of the economy has had. Profit if not the evil word so many seem to think...
John, google "quality of VA hospitals" and read many, many articles about how effective that system is now. It was at one time so flawed that some Republicans wanted to do away with it during the Clinton years. But Bob Dole was making a lot of promises to veterans about their care and it forced Clinton into a compromise with Dole led Republicans.
The most important thing they did was hire a physician with business experience to head the department. Within two years they had begun to turn things around. I posted the better part of an article on this two or three pages back from this one.
The government CAN be efficient when led by the right person. My favorite President of all time was Theodore Roosevelt, a man who had the gonads to stand up against his own party when he felt it necessary. Believe it or not, the last President to stand against his own party was none other than Jimmy Carter. He was far more into human rights issues than Democrats felt was necessary. And more, he wouldn't make deals over drinks at parties.
Much of his inefficiency was because he early on lost support from key Democrats. So did Teddy eventually, but he accomplished a lot prior to that time. But that is why Republicans wouldn't nominate him in 1912 and he chose to run as an independent, virtually assuring Woodrow Wilson's election.
If we can find the right man (or woman) to put into place the kinds of reforms this VA hospital exec has accomplished, then a government run system can be run far more efficiently and effectively than a for profit system. Read some of the reforms he instituted and how that began to change the VA system which include a bonus system of some sort for positive outcome based care.
And I can provide you plenty of information on how the for profit system is ripping off the public. We are paying more for healthcare, overall less healthcare is being delivered, but for profit hospital corporations are making a ton of money and awarding tens of millions of dollars in bonuses to their executives.
And our current post office system should not be allowed to operate at a deficit. They should raise rates to at least breakeven, even though it may put them out of business. Then, unless we had some kind of governmental control over private delivery systems (like we do over utilities), the costs would run amuk. People in rural areas would not get service (can't make a profit delivering mail fifty miles out in the boonies). And, although that would be unfortunate, I don't believe I would find it immoral.
To let sick people die on the streets without healthcare IS immoral IMO, and I'd rather not be in a society that would allow that to happen. So we need to figure out how to make EVERYONE pay for at least some basic coverage to help spread the cost of coverage. That is the main principal behind insurance anyway.
[quote=Johnhw2;27427679]When I consider the differences in service and efficiency of the Post office vs say Fedex, I get a looko at what a non private sector health care system might be like. Well, I don't know how this works. We don't have a public option. Almost, but we didn't get it. Then, maybe you'd see the difference.
You can choose to send your package through either, most individuals choose USPS because of cost. I don't have the choice to choose a public option over a for profit option in healthcare or I would. Seniors do, they could opt. out of medicare altogether and continue their private for profit care. But, I don't see many doing that. They might add to it, but they don't choose to forgo it.
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at least we can be on the same page
On a personal note I am unsure in a direction at this point. I would like a change but I am unsure at what kind of change. I would like a non profit, it seems odd to me to profit from healthcare as a country, especially when other countries take advantage of our for profit medical system.
