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Yes, bronze, and even silver plans, suck. You get what you pay for here. If you get a plan which offers only 60%-70% coverage of medical expenses, what the hell do you expect?
When it comes down to it, there's only a few ways to deal with medical costs. You can.
1. Have a high premium, but low out-of-pocket costs.
2. Have a low premium, but have high out-of-pocket costs.
3. Have a relatively low premium and out of pocket costs, but have a really restricted medical network (limited choice of doctors/hospitals).
4. Have the government subsidize things.
That's really all there is to it. There's no other solution here. If you tore up the ACA regs you'd be able to sell junk insurance again which covers you if you have a broken arm but not if you have cancer, but the high-cost medial problems are the entire reason we have health insurance in the first plance.
Interesting analysis! I agree with what you listed but it seems like there are a few additional things that could be put in place. These might include some of the following:
1. Remove employers from health insurance and create a more competitive market among health insurers.
2. Remove items that are currently covered by health insurance. This gets tricky because you don't want to exclude items that contribute to health such as wellness visits and vaccinations. Could overall health costs be reduced certain procedures/treatments not be covered by insurance and be subject to market competition?
3. If we don't really have competition among hospitals, why do they spend so much money on advertising? If we don't have hospitals and/or health networks actually competing with one another, would it be more cost efficient to reduce duplication of services and to create networks of providers? Do we really have competition between UPMC and Allegheny Health Network? My wife's surgeon switched from UPMC to AHN and she is unable to continue with him. We have UPMC Health Plan, and don't have the option of switch health insurance.
Nah. I've been living my best life, like I always do.
You and the rest of the minions certainly kept me amused though!
He’s been living in your head and you’re still complaining about him even after him losing. I agree about being amused though, 4 years of Trump hate is certainly that.
He’s been living in your head and you’re still complaining about him even after him losing. I agree about being amused though, 4 years of Trump hate is certainly that.
You keep struggling with your reading compression difficulties, and I'll keep laughing at the dumb **** you puke all over this site.
1. Remove employers from health insurance and create a more competitive market among health insurers.
I do not believe this would bring costs down. Until the ACA, individual markets typically had higher insurance costs than employer-based coverage - particularly for large employers. The reason for this is, quite simply, collective power. An employer which has thousands of employees in a locality is valuable to health care providers, because lots of bodies mean lots of potential patients. So they're willing to cut more of a break in order to get them through the door at the doctor's office or hospital. In contrast, there is a total imbalance of bargaining power between an individual enrollee and a health care provider, so they have no incentive to cut costs for you.
There's also the issue that the way health insurance companies make money isn't by providing the patient with coverage, it's by denying coverage to the highest extent feasible. In a totally open market you might see some insurers perceived as being better, but it most likely will come down to marketing, because in general there's just a lot of opacity when it comes to comparison-shopping across most industries.
Quote:
Originally Posted by villageidiot1
2. Remove items that are currently covered by health insurance. This gets tricky because you don't want to exclude items that contribute to health such as wellness visits and vaccinations. Could overall health costs be reduced certain procedures/treatments not be covered by insurance and be subject to market competition?
There certainly are certain areas where the U.S. over-utilizes healthcare. A good example is diagnostic medical imaging, where we are way ahead of OECD peers in terms of use. But overall we actually use less healthcare than other developed nations. We spend less days in the hospital, we go to the doctor less often, and we even take less prescriptions on average. The issue is more that the per-unit price of basically everything is higher in the U.S.
In general though, the structure of the U.S. insurance market (1-2 year contracts) hurts preventive health. Studies have shown, for example, that even if you put a modest $20 copay on something like Lipitor, it will disincentivize some people from either taking their medicine, or taking it properly ("stretching it out" over a longer time to save money). This results in larger health insurance costs in the long run, with more hospitalizations. However, the health insurer typically doesn't actually have to deal with these costs, since the "next insurer" would deal with them. Or alternatively, if they do the right thing and end drug copays for maintenance medicine, the savings will roll in for the next insurer. Plans are moving to end copays for things like anti-cholesterol drugs and insulin, but it's happening at a slow rate.
Quote:
Originally Posted by villageidiot1
3. If we don't really have competition among hospitals, why do they spend so much money on advertising? If we don't have hospitals and/or health networks actually competing with one another, would it be more cost efficient to reduce duplication of services and to create networks of providers? Do we really have competition between UPMC and Allegheny Health Network? My wife's surgeon switched from UPMC to AHN and she is unable to continue with him. We have UPMC Health Plan, and don't have the option of switch health insurance.
Health systems do of course compete, but their ultimate goal is to form monopolies. Essentially:
1. The goal of a provider is to give you as much healthcare as possible at as expensive of a cost as possible.
2. The goal of an insurer is to cover as little healthcare as possible and have it be as cheap as possible.
3. The goal of a patient is to have full coverage of healthcare needs, and have it be as cheap as possible.
Hospitals and doctors form integrated healthcare systems in order to attempt to use market power to leverage higher reimbursement rates from insurers. In contrast, insurers try to form local monopolies to leverage as low prices as possible from hospitals and doctors. Consumers are stuck in the middle.
Locally, what's been going on for years is UPMC has been lowballing - selling really cheap insurance locally. Their reason for doing this is because they are attempting to sustain deep losses in order to drive Highmark out of business. Once Highmark is gone, they will jack up rates and local insurance will become prohibitively expensive.
I do not believe this would bring costs down. Until the ACA, individual markets typically had higher insurance costs than employer-based coverage - particularly for large employers. The reason for this is, quite simply, collective power. An employer which has thousands of employees in a locality is valuable to health care providers, because lots of bodies mean lots of potential patients. So they're willing to cut more of a break in order to get them through the door at the doctor's office or hospital. In contrast, there is a total imbalance of bargaining power between an individual enrollee and a health care provider, so they have no incentive to cut costs for you.
There's also the issue that the way health insurance companies make money isn't by providing the patient with coverage, it's by denying coverage to the highest extent feasible. In a totally open market you might see some insurers perceived as being better, but it most likely will come down to marketing, because in general there's just a lot of opacity when it comes to comparison-shopping across most industries.
There certainly are certain areas where the U.S. over-utilizes healthcare. A good example is diagnostic medical imaging, where we are way ahead of OECD peers in terms of use. But overall we actually use less healthcare than other developed nations. We spend less days in the hospital, we go to the doctor less often, and we even take less prescriptions on average. The issue is more that the per-unit price of basically everything is higher in the U.S.
In general though, the structure of the U.S. insurance market (1-2 year contracts) hurts preventive health. Studies have shown, for example, that even if you put a modest $20 copay on something like Lipitor, it will disincentivize some people from either taking their medicine, or taking it properly ("stretching it out" over a longer time to save money). This results in larger health insurance costs in the long run, with more hospitalizations. However, the health insurer typically doesn't actually have to deal with these costs, since the "next insurer" would deal with them. Or alternatively, if they do the right thing and end drug copays for maintenance medicine, the savings will roll in for the next insurer. Plans are moving to end copays for things like anti-cholesterol drugs and insulin, but it's happening at a slow rate.
Health systems do of course compete, but their ultimate goal is to form monopolies. Essentially:
1. The goal of a provider is to give you as much healthcare as possible at as expensive of a cost as possible.
2. The goal of an insurer is to cover as little healthcare as possible and have it be as cheap as possible.
3. The goal of a patient is to have full coverage of healthcare needs, and have it be as cheap as possible.
Hospitals and doctors form integrated healthcare systems in order to attempt to use market power to leverage higher reimbursement rates from insurers. In contrast, insurers try to form local monopolies to leverage as low prices as possible from hospitals and doctors. Consumers are stuck in the middle.
Locally, what's been going on for years is UPMC has been lowballing - selling really cheap insurance locally. Their reason for doing this is because they are attempting to sustain deep losses in order to drive Highmark out of business. Once Highmark is gone, they will jack up rates and local insurance will become prohibitively expensive.
Wow. Thesis grade analysis here. Well done, you!
It should be noted that there are different service delivery models, NOT based on the "eat what you kill" concept (meaning maximize profit on the sickest patients with the greatest potential for healthcare interventions). The Cleveland Clinic is an example of a comprehensive system that is guided by outcomes, not rewarding providers with the highest utilization. From the Forbes magazine article below: "Cleveland Clinic has a salaried physician model. So we do not incentivize our providers on anything other than the quality and experience of care that they provide.”
I do not believe this would bring costs down. Until the ACA, individual markets typically had higher insurance costs than employer-based coverage - particularly for large employers. The reason for this is, quite simply, collective power. An employer which has thousands of employees in a locality is valuable to health care providers, because lots of bodies mean lots of potential patients. So they're willing to cut more of a break in order to get them through the door at the doctor's office or hospital. In contrast, there is a total imbalance of bargaining power between an individual enrollee and a health care provider, so they have no incentive to cut costs for you.
There's also the issue that the way health insurance companies make money isn't by providing the patient with coverage, it's by denying coverage to the highest extent feasible. In a totally open market you might see some insurers perceived as being better, but it most likely will come down to marketing, because in general there's just a lot of opacity when it comes to comparison-shopping across most industries.
There certainly are certain areas where the U.S. over-utilizes healthcare. A good example is diagnostic medical imaging, where we are way ahead of OECD peers in terms of use. But overall we actually use less healthcare than other developed nations. We spend less days in the hospital, we go to the doctor less often, and we even take less prescriptions on average. The issue is more that the per-unit price of basically everything is higher in the U.S.
In general though, the structure of the U.S. insurance market (1-2 year contracts) hurts preventive health. Studies have shown, for example, that even if you put a modest $20 copay on something like Lipitor, it will disincentivize some people from either taking their medicine, or taking it properly ("stretching it out" over a longer time to save money). This results in larger health insurance costs in the long run, with more hospitalizations. However, the health insurer typically doesn't actually have to deal with these costs, since the "next insurer" would deal with them. Or alternatively, if they do the right thing and end drug copays for maintenance medicine, the savings will roll in for the next insurer. Plans are moving to end copays for things like anti-cholesterol drugs and insulin, but it's happening at a slow rate.
Health systems do of course compete, but their ultimate goal is to form monopolies. Essentially:
1. The goal of a provider is to give you as much healthcare as possible at as expensive of a cost as possible.
2. The goal of an insurer is to cover as little healthcare as possible and have it be as cheap as possible.
3. The goal of a patient is to have full coverage of healthcare needs, and have it be as cheap as possible.
Hospitals and doctors form integrated healthcare systems in order to attempt to use market power to leverage higher reimbursement rates from insurers. In contrast, insurers try to form local monopolies to leverage as low prices as possible from hospitals and doctors. Consumers are stuck in the middle.
Locally, what's been going on for years is UPMC has been lowballing - selling really cheap insurance locally. Their reason for doing this is because they are attempting to sustain deep losses in order to drive Highmark out of business. Once Highmark is gone, they will jack up rates and local insurance will become prohibitively expensive.
Regarding employer-based health insurance, your explanation seems reasonable when the market is dominated by large employers and multiple health insurance companies are competing for the business. We are moving away from that model. Look at the Pgh region and we no longer have major employers with thousands of employees in the region like Westinghouse, US Steel, Consol, etc. in previous decades. Compare it to vehicle insurance, where companies like Erie, State Farm, Allstate, and GEICO compete for individual policies. Is the difference the number of car insurance companies compared to health insurers?
I agree with you on our model hurting preventative care, but I think insurers are trying to do a better job. I just scheduled a bio-metric screening visit.
You mention that there are "certain areas where the U.S. over-utilizes healthcare," but "overall we actually use less healthcare than other developed nations." Yet we spend much more than other countries on healthcare. So obviously there are potential areas for major cost savings. What am I missing?
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