<p>“I have never heard a doc say, “Gee whizz! This Mediare paperwork is a breeze!””</p>
<p>They don’t do it; their staff members do it. And since the number of staff members is dictated primarily by the amount of private insurance paperwork, they rarely spend most of their time on Medicare forms. It’s not that the paperwork itself is necessarily easy; it’s that there’s one set of rules a staffer can learn and apply over and over. A Medicaid clinic that serves a population with one kind of insurance needs fewer staff members than a clinic that accepts everything.</p>
<p>“it’s good to have health insurance linked to employment because then the health insurance is really about keeping you working because the employer is partly paying for their services.”</p>
<p>So why have so many employers been cutting back on or eliminating coverage in the last 20 years? I don’t think the incentives are set up the way you say. If a worker is easily replaceable – as most of us are in this job market – then it makes no economic sense to pay a lot for health care that keeps a particular one on the job.</p>
<p>I’ve worked with illegal immigrants, but I swear I didn’t know that 2/3 of the population was clustered in only 8 states until I read that article. Not that it’s shocking, but I really didn’t know.</p>
<p>“Administrative costs – At least 7% of health care expenditures are estimated to go toward for the administrative costs of government health care programs and the net cost of private insurance (e.g. administrative costs, reserves, taxes, profits/losses).[1] Some argue that the mixed public-private system creates overhead costs and large profits that are fueling health care spending.[8]”</p>
<p>This is from the Kaiser link…</p>
<p>If the net administration costs are 7 percent and the government is half of health care of with the administration costs are 4 percent than the private sector has costs around 10 percent. </p>
<p>I think that private sector number is low. In California, private insurance is allowed to have profits and and non related medical expenses of 20 percent of revenue. </p>
<p>I don’t know how Kaiser allocated costs.</p>
<p>In the link I provided earlier, if we cut our administration costs to the level of France’s, we could save 100 billion a year.</p>
<p>It is true. Jobs would be lost. Maybe we would prefer to keep the jobs and pay more for healthcare. I thought we were into efficiency, but maybe not…</p>
<p>Yes there are tradeoffs. Unquestionably, and that’s what we need to decide. It’s fine to choose to cut administrative costs, but must we demonize the actual human beings who work for insurance companies? I’m not sure that really helps anything.</p>
<p>We are talking about costs. There are going to be winners and losers.</p>
<p>My daughter works in the health care industry. I am not demonizing her or anybody else. My daughter is a fantastic person. She is.</p>
<p>Health care is soooooo expensive in this country.</p>
<p>If we were the leaders we would have to look at administrative costs, and drug companies, and medical companies, and doctors and nurses,
and hospitals…</p>
<p>Everything would be looked at…</p>
<p>We are talking hundreds of billions a year, adjusting for size, that we
spend on health care that other countries don’t. </p>
<p>Peoole make their livelihoods in this industry. People make a lot of money in this industry. Yeah…these people could be affected by changes.</p>
<p>We could just suck it up. We could just say we are going to throw a lot of our money into this industry. If the health care industry becomes 35 percent of the economy, that is the way it goes. I don’t think other industries are going to like it. I don’t think consumers or taxpayers are going to like it.</p>
<p>What does medicare do? It does not oversee what a patient needs or should receive. It does very little in the way of developing a drug formulary, a protocol for handling substance abuse or heart disease or diabetes. Health Insurance providers do these things. They are increasingly doing these things, in fact.</p>
<p>Medicare is a very crude service that pays a portion of basically whatever the physician prescribes. When it gets asked to really do what a health insurance provider does, we will get a look at how wonderfully government entities control administrative costs.</p>
<p>And btw, I am not reading any posts zeroing in on hospital and physician costs which are the overwhelming majority of health care expenditures. </p>
<p>What do you think European docs earn? How about hospital administrators, physical therapists, radiology techs, etc?</p>
<p>But the media and the lobbyists for the AMA and hospitals has done an excellent job here of very conveniently (for them) making insurance and pharma the big culprits.</p>
<p>I’m simply saying that we are being herded around like unquestioning cattle here. Even the Kaiser study I linked is absurd in the “findings” it draws from it’s own study.</p>
<p>I read most of your link and what I was struck by was how little actually the administrative overhead really is in terms of the overall US healthcare pie and yet again the guy being interviewed has to jump on that before he can get to stuff like the cost of getting an MRI in a US hospital vs other countries or specialist care costs. </p>
<p>We have been told the inflation is all administrative costs and that’s just baloney, unless you want to look at the inflated administrative staffs of hospitals, many of which are public or quasi-public/private – not insurance folks.</p>
<p>Containing costs will take disease management models. They use them a lot of places in Europe. Most health insurance companies are implementing them. They make sure you get trained in how to take care of your feet along with how to take your insulin. They look not just at the procedure or drug or surgery but the interplay of all aspects of care and how to make them work together for the best overall outcome – which is a healthy person who stays at work.</p>
<p>If you think about it – doctors need people to be sick so they can treat them. Insurance companies do best when their customers are healthy. Imagine that.</p>
Really? Of course the politicians are. The evil insurance companies and the evil drug companies. There is absolutely no question about that. Just another way of pitting different groups against each other and tearing at the fabric of this country.</p>
<p>I can’t speak to all insurance companies but we can only make x amount of money on a policy. If claims costs and administrative Costs are lower then what we anticipated when the rates were determined we send back refunds. I’ve seen this happen a bunch of times.</p>
<p>Insurance companies do well regardless of the costs because their fees are costs plus a percentage. </p>
<p>“We have been told the inflation is all administrative costs and that’s just baloney”
This is one of the arguments that is made up and then refuted by the same person. I am not persuaded by this kind of argument.</p>
<p>The link I provided shows pretty clearly that our high health care costs are caused by many elements, not just private health insurance.</p>
<p>This doesn’t mean you don’t try to cut health insurance costs. Many areas are going to have to be cut if we want drastically lower health care costs and insurance is just one of
those areas. </p>
<p>I can’t vouch for this. JHS mentioned artificial knees. He also mentioned that his 90 year old mother in law is running out of money. I find that interesting because I think that is going to be a very big problem in our society. He also mentioned nursing homes and the care at that specific one didn’t sound too good. I liked his post. Good info.</p>
<p>Much like Zooser, I’m dealing with an 80+ year old mom who has a plethora of mostly manageable health issues. She is very blunt about not wanting extreme measures, so decisions for her down the road will be somewhat easier in terms of turning down offered services. Even with that though, she has routine care (for her) that costs roughly $3000/treatment, 6x/year. With a team of 6 doctors that oversee her care in the course of a year, things like the yearly ultrasound to keep an eye on her abdominal aneurism really add up. But due to having both medicare & a private BC/BS plan, she pays her $100/year deductible & sometimes a very small co-insurance rate so she is removed from the realities of her health care costs. </p>
<p>Two things: doctors routinely order tests as a CYA maneuver to avoid malpractice suits in a sue happy culture. And while I am very thankful for the discovery of antibiotics, the reality is that most will live longer because we don’t succumb to maladies that are easily treated now, but which could be fatal in our grandparents time (think the morbid throat aka strep.) So we live longer, and body parts start to wear down & out, and because we CAN treat them, we feel we must. </p>
<p>I think end of life care is something our culture doesn’t do well. Partially because doctors are taught to be in cure mode, or they think they’ve failed. Partially because a lot of people are afraid of death because we’re removed from it now. People used to die at home & lie in state at home, so while still sad it was part of life it was vaguely familiar. And of course in those days (pre-antibiotics) life expectancies were shorter.</p>
There’s plenty of selfishness to go around including by all of those expecting ‘the other guy’ to pay for their own services. And how are the services to be permitted to non-seniors that’ll be cut off for seniors (defined as what - 80 y/o, 70 y/o, 60 y/o, AARP age of 50?) going to be determined? It’s not usually black and white - should an 80 y/o be permitted to have replacement knee surgery for a better quality of life given that it’s offered to a 50 y/o? I say ‘yes’. Should a senior be permitted to receive antibiotics and a hospital stay to get over an infection? I say yes. Is there really any difference between a 70 y/o at the end of their life with terminal cancer and an a 35 y/o with the same affliction? Should anything be done differently between the two? What if solving the medical condition allows an 80 y/o to live to be 95? Is that 15 years adequate ROI for the procedure? These are all tough calls. </p>
<p>Living off of the taxpayers is essentially what the OP proposed - purposely quitting working so he could ‘take’ the subsidies by the taxpayers for his health care costs. From the way the OP phrased it, it’s being treated as ‘free money’ by him although really it’s a burden on the taxpayers. He’s proposing ‘just working the system’ in his favor but unfortunately a lot of people will likely end up doing that and the burden to the taxpayers for the health care costs will end up to be much higher than expected. He then expanded it to see if he could get food stamps as well despite perhaps having $1M in the bank as long as he plays a game in showing earnings under a certain amount. I hope this was all just some academic exercise in the OP’s mind and he’s not really planning on trying to work the system like this to live as much as he can on the backs of others.</p>
<p>sewhappy: “What’s fun about the piece is that it singles out health insurance (a whopping 6 percent of the health care dollar) and pharma (an evil 10 percent) as the culprits when hospital services and docs weigh in at 50 percent.”</p>
<p>I think it’s a problem that ONLY 50% of healthcare dollars go to doctors and hospitals, who are actually providing healthcare! the insurance companies do not provide healthcare. I have nothing against them or their workers, but I don’t think we can afford to have 20% of health insurance premiums go to non-healthcare-related costs. And that is what the administrative costs and profit of private insurance companies come to, not 6%. The 6% in the Kaiser pie must use total healthcare expenditures, including Medicare, Medicaid, etc., as the denominator. Don’t interpret that number to mean that private insurance companies’ administrative costs are only 6%.</p>
<p>“What do you think European docs earn? How about hospital administrators, physical therapists, radiology techs, etc?”</p>
<p>I have a good friend who is a German physician. He earns less than US physicians in the same field. But when he was offered a position in the US, he could not afford to take it. Why? Two reasons. He has not saved for his retirement or for his two children’s college education, because both are provided under the German system. So a mid-career transfer to our system was not possible. So there’s no point in comparing salaries.</p>
<p>Oh, and his medical education was paid for. So no loans to repay.</p>
<p>RobD, I want to live a long time. I may change my mind in my 80’s or 90’s. I don’t think people should be dying of strep throat or something like that because they used to die.</p>
<p>Does your 80+ year old mom want to die now? Right now?</p>
<p>Don’t you think differently now than you did in your 20’s? I think it is real easy in middle age to look at the older and think why are supporting their treatments? Why do they want to live like this? I wouldn’t. I think these thoughts. I have an uncle so frail he can’t do anything. I can’t believe he is alive. I can’t believe he hasn’t overdosed on purpose. </p>
<p>Then I think, what is my thinking going to be like when I am 80?
.</p>