<p>"The data was collected by the Kaiser Family Foundation and comes via USA Today:</p>
<p>Since 1999, health insurance premiums for families rose 131%, the report found, far more than the general rate of inflation, which increased 28% over the same period. Overall, health care in the United States is expected to cost $2.6 trillion this year, or 17% of the nation’s economy, according to the non-partisan Congressional Budget Office."</p>
<p>“My main point is that the insurance industry is not the villain in all of this. If we had to point a finger at those profiting the most from healthcare it would be the whole provider side of the equation – pharma, devices, docs, hospitals. It feels good to blame the insurance companies, though.”</p>
<p>“In 2009, Blue Cross/Blue Shield of Michigan requested approval for premium increases of 56 percent for plans sold on the individual market.6 Regency Blue Cross Blue Shield of Oregon requested a 20-percent premium increase.7 UnitedHealth, Tufts, and Blue Cross requested 13- to 16-percent rate increases in Rhode Island.8 And rates for some individual health plans in Washington increased by up to 40 percent until Washington State imposed stiffer premium regulations.9
Leading experts have predicted that, without reform, these increases will continue, and the federal government and most states don’t have the legal authority to block or reduce health insurance rate increases.10
WellPoint and others claim that the premium increases are necessary given the rise in health care costs. While rising health care costs is a known problem with our broken health care system, some of the premium increases requested by insurance companies are 5 to 10 times larger than the growth rate in national health expenditures.11 All the while, insurance companies and their CEOs continue to thrive.
Recent economic data show that profits for the ten largest insurance companies increased 250 percent between 2000 and 2009, ten times faster than inflation.12,13 Last year, as working families struggled with rising health care costs and a recession, the five largest health insurance companies – WellPoint, UnitedHealth Group, Cigna, Aetna, and Humana – took in combined profits of $12.2 billion, up 56 percent over 2008.14 These health insurance companies’ profits grew even as nominal GDP decreased by 1 percent over this same time period.15 WellPoint accumulated more than $2.7 billion in profits in the most recent quarter alone.16
And recent data show that the CEOs of America’s five largest insurers were each compensated up to $24 million in 2008.17
Now, while insurance companies enjoy increasing profits and CEOs take in millions, American families struggle to find and maintain affordable, quality insurance coverage. A recent study found that almost 75 percent of individuals looking for coverage on the individual market never bought a plan, with 61 percent of those who did not purchase insurance citing premium costs as the primary reason.1”</p>
<p>Again, it is simplistic to point to insurers as the problem. And the cynic in me suspects that other players in the healthcare industry encourage the outrage against the insurers because it deflects attention from the cost increases they drive.</p>
<p>Also, theres the little matter of demographics. Our aging population is an increasingly expensive population in terms of healthcare. These insurers have a greater and greater proportion of elderly (expensive) members. End-of-life healthcare is by far the costliest across the life span. So its reasonable to acknowledge that our aging population is driving at least some of the premium increases.</p>
<p>And if we want to compare CEO compensation the health insurance guys aren’t that well represented at the top:</p>
<p>“Just because a society offers free healthcare doesn’t mean you actually can get a transplant - you could be put on a queue and never get out of it because they can only afford to do a limited number of them.”</p>
<p>This is all true (though it is not a case of affordability, but availability of organs). But what drove my friend into essential bankruptcy was 1) his insurance 2) having his insurance linked to his employment; and 3) moneygrubbing hospitals and doctors who knew they had to make money off him NOW, before a transplant was ever to happen (because it likely wouldn’t); and 4) Medicaid requirements for keeping any form of health care. </p>
<p>The first problem - availability of organs - isn’t easily solved anywhere. The other four are in fact quite easy to solve - it isn’t rocket science - but requires political will. </p>
<p>My friend’s “problem” is not one case - it is systemic.</p>
<p>Why are U.S. costs so much higher and yet we live not as long as people in Australia and England. Health spending per head in Australia is $3445, in the U.S. $7960, in U.K. $3487.Healthcare spending as a share of GDP is U.S. 17.4 %, Australia 8.7 and the U.K. 9.8%. Life expectancy in the U.S. is 78.2, in Australia 81.5 and the U.K. 80.4. Nurses per 1000 people in the U.K. 9.7, Australia 10.2, U.S. 10.8. You can’t tell me that healthcare is better in the U.S. I know better.</p>
<p>The insurance industry is part of the problem.</p>
<p>I never said it is the whole problem. I don’t think others said that either.</p>
<p>You see things in an interesting manner…</p>
<p>People want affordable healthcare…that means they want free healthcare.</p>
<p>People talk about private insurance as a problem when talking about
health care costs…that means private insurance is the sole reason for rising healthcare costs.</p>
<p>Profits as a percentage of sales is low in the healthcare insurance
industry compared to other industries…therefore…profits are not excessive…</p>
<p>Ok…</p>
<p>What should we be looking for? What areas should society focus on to cut healthcare costs? Anything specific you think should be cut?</p>
<p>“Why are U.S. costs so much higher and yet we live not as long as people in Australia and England.”</p>
<p>Probably because, at least intermittently, up to one fourth of the population lacks access to health care, and when they get it, the focus is on taking care of the absolute immediate needs, rather than long-term health. Then there are the issues of substandard care, many of which we’ve explored before (people with the SAME insurance and the SAME providers and the SAME income get different levels of care, based on race); then there are issues related to occupational end environmental safety, adversely affecting lower income folks; and then there are Adverse Childhood Experiences (ACEs) which, in the longer run, result in higher levels of morbidity and mortality.</p>
<p>On the whole, health status for white people in this country are among the best in the world. We pay too much (relative to, say, the Canadians) to achieve those stats.</p>
<p>I think mini hit the nail on the head. Although there are many different factors leading to higher costs of healthcare in the US, the main cost driver appears to be the reliance on cure/intervention later on in the progress of the illness. When people have such high deductibles, or are uninsured, they go to the doctor only when they have no choice. In England and other countries where healthcare is provided to all at low deductibles, people drop in more often. They use the system more frequently and earlier, but this allows the system to catch serious illnesses earlier, when interventions are significantly cheaper. For example, the delta between the cost of treating early stage pneumonia vs later stage pneumonia is substantial.</p>
<p>Another significant difference between our system and other systems is that we have competing providers, without any broad-based planning. You’d think competition would winnow expense from the system; but in fact it increases it geometrically. We sometimes have 2-3 hospitals in the same city within a stone’s throw of each other, each trying to survive. In order to successfully compete, each one has to have all the latest equipment. How does one medium sized city support 3 state of the art MRIs, computer surgery, etc etc. And on top of everything, the not for profit hospitals are also competing with for profit physician-owned ambulatory care centers which don’t have to provide charity care. </p>
<p>This causes our local hospital to invest heavily in technology but less and less in actual caregivers such as nurses. We may decide that government run healthcare is not the way to go, but then we have to understand why our system is more expensive and less effective.</p>
<p>US healthcare costs also serve to fund healthcare innovation for the entire world. If you look at Europe, for example, they simply do not pay as much for patented medications, devices, diagnostic equipment, surgical procedures. The US, although shrinking what it will pay for these “goods”, is the only country – except maybe Japan and a few others – that will still pay something of a premium for innovation, partly because we the healthcare consumers want it. Same with public research efforts – US funds the vast majority.</p>
<p>No part of this rat’s nest is easy to unravel. The high cost of innovation can lead to lower costs down the road. The incentive for pharma to produce statins, for example, has prevented untold expensive cardiovascular complications. But the initial costs to drive that innovation are very high. You’re just not going to get the intellectual fire power needed or the operational competence to bring to bear on it otherwise. The less the rest of the world pays for the innovation, the more the burden falls to the US, which is definitely exhausted with doing so – we could well see a big slow down in progress on many of the diseases we all dread. Look at pharma - they are cutting R&D. Simply can’t afford the wildcat oil driller nature of searching for the compound that will payoff.</p>
<p>I see what you’re saying, sewhappy. The problem is that because of our insurance structure, there are millions of Americans who don’t have access to even the most basic treatments, much less all of those expensive innovations.</p>
<p>^ Yes, and that’s why I am starting to think we need a universal single payer model that somehow doesn’t suck all the money out of the economy so that a parallel privately insured or even self-pay market also survives. For some reason I’m optimistic we’ll get there.</p>
<p>^^ I think you’re right, and in fact that was proposed a couple of years ago, the public option. Anyone who wanted to stay with their private insurer could do so. But a Medicare-like option would also have been available to any American who wanted it.</p>
<p>ETA – Which the private insurers shot down. Again.</p>
<p>Medicare for all. You can then purchase a medigap policy if you desire- just like those over 65 do now. Gives us universal coverage and still maintains a private system for those who can afford it.</p>
<p>Medicare doesn’t even have enough money right now to pay their full normal amount past the next 10 years in claims without being revamped. They need to get that under control before rolling it out to the rest of the country.</p>
<p>And that being said, medicare coverage is lot worse then what many of you have for health insurance right now (thus the need for medigap plans).</p>
<p>Medicare or single payer would have prevented untold numbers of bankruptcies in our country, which has an economic value in itself, for all of us. </p>
<p>Medicare doesn’t give physicians the reimbursement they’re looking for. Private insurance may be broader in some respects. But Medicare almost never denies coverage to a patient, while private insurance makes its money BY denying care. Anyone who says their insurance company doesn’t wrongfully deny coverage, is someone who has a limited experience. The industry’s mantra is to deny a claim 3 times, because after the third time, the patient often gives up. </p>
<p>PS- Simba was told that his/her procedure wasn’t covered because of Obamacare. Any insurance that tells you something isn’t covered because of Obamacare is selling you a bunch of bs. Obamacare mandated certain breadth of coverage, similar to what states do with auto insurance, and didn’t restrict coverage. In fact, in the case of most large employers, it is actually the employers who dictate coverage, not the insurers. </p>
<p>I’ll be ticked off if the SCOTUS overturns the whole Obamacare law, since it will cost us a lot of money. We’ll have buy to separate, individual insurance for one child who’s 23, and we’ll also have to buy double family insurance again. I stopped paying my insurance when Obamacare went into effect, since it did away with lifetime caps and we could depend on my H’s insurance. If Obamacare is overturned, insurers will go back to putting lifetime caps on policies, and the caps are way too low to be safe.</p>
<p>Over the course of a single year, it may be upwards of 80 million. When you add to that the number of underinsured, or those for whom insurance simply isn’t working and may bankrupt them (i.e. my friend), it may be that the majority of Americans are now experiencing a failing system. </p>
<p>First thing to do is bring everyone in from the cold. Canada, Taiwan, France, etc. have all proven this is a solvable problem, and can be solved in different ways. But it can’t be solved without a medical roof over everyone’s head. Start with Medicare for everyone and then work from there. </p>
<p>“Medicare or single payer would have prevented untold numbers of bankruptcies in our country, which has an economic value in itself, for all of us.”</p>
<p>No one has even begun to computer the health-related costs of bankruptcy.</p>
<p>“The industry’s mantra is to deny a claim 3 times, because after the third time, the patient often gives up.”</p>
<p>Or is dead (which is what they really hope for), or no longer can pay the premiums. Problem solved!</p>