Health insurance

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dualstow
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Re: Gold's Time To Shine?

Post by dualstow » Fri Feb 07, 2020 3:11 pm

•^ Those pluses and minuses are referring to the military system, not the past five years, right, kbg?
Xan, this is turning out to be a good subthread. If you get a chance, would you mind splitting and calling it self-insuring or something? If you search for

Code: Select all

10:14
on the page before this or 'Canadian wait times', I think that's where the new branch begins.
Feels like the end of the everything rally.
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Re: Gold's Time To Shine?

Post by sophie » Fri Feb 07, 2020 3:53 pm

Xan, that is really good to know.

Some of the more well known health sharing ministries feature some potentially serious limitations - like, a limit of 120 days of drug coverage per occurrence. If you needed multiple rounds of chemotherapy after a cancer diagnosis or an expensive immunomodulator after, say, a liver transplant you'd really be up a creek.

It's hard to compare that to the numerous examples of people with legitimate private insurance who somehow got stuck with tens or hundreds of thousands in medical bills. It may well be that the risk of that happening with a cost sharing ministry is no worse than with traditional insurance, but it would be nice if someone studied that.
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Re: Health insurance

Post by Xan » Fri Feb 07, 2020 4:05 pm

That would be an interesting study, for sure.

And you're right: CHM doesn't cover "maintenance prescriptions", although they do cover "incident-related" prescriptions. I think the chemo in your example would be covered, but you may be right that the post-implant drug wouldn't. Huh.

Well, I'd just have Smithy ship me some from Canada if it came to it. :-)
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Re: Gold's Time To Shine?

Post by Maddy » Fri Feb 07, 2020 4:55 pm

sophie wrote:
Fri Feb 07, 2020 3:53 pm
Some of the more well known health sharing ministries feature some potentially serious limitations. . .
Yes, like having to go to church and to attest to a multi-faceted statement of belief with which a large number of Christians would not necessarily agree--requirements that apparently get interpreted and applied according to entirely subjective standards that have more to do with evangelical culture and the maintenance of institutional authority than anything else. It's a bit unnerving to have your health insurance depend upon somebody else's view of what is, and is not, sufficiently "Christian."

So far I've managed to keep my membership in a health sharing ministry without donning mascara and poofing my hair up with hairspray, although the thing about my not being "under a man" may eventually get me booted.
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Re: Health insurance

Post by sophie » Sat Feb 08, 2020 11:02 am

So which health sharing ministry are you a member of, Maddy? If you are ok with posting that.

The restrictions vary across organizations, but...didn't think that there might be special restrictions on single women. Sigh. The pink tax strikes again.
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Re: Health insurance

Post by Maddy » Sat Feb 08, 2020 2:32 pm

sophie wrote:
Sat Feb 08, 2020 11:02 am
So which health sharing ministry are you a member of, Maddy? If you are ok with posting that.

The restrictions vary across organizations, but...didn't think that there might be special restrictions on single women. Sigh. The pink tax strikes again.
I'd rather not say, Sophie. At the moment this is the only type of health coverage I can afford, and I don't want to risk losing it. I would guess that even citing Bart Ehrman with intellectual enthusiasm (see the "Figuring Out Religion" thread) would be enough to get me booted. Suffice it to say that it's one of the more well-established and financially stable health sharing ministries.

P.S. I was being a bit tongue-in-cheek when I made the comment about not being "under a man." That's not, strictly speaking, a requirement of membership, but on one occasion I was indeed pulled aside by a church leader (who was required to sign off on my HSM membership form) for counseling on the subject of my marital status and the fact that I was not "under a man." The fact that I had actually chosen to be single was, according to this leader, "selfish." The whole episode was so completely bizarre that I was tempted to quip, "So I'm personally responsible for condemning some poor schlub to Saturday nights at home with his right hand?" But I didn't think my humor would be much appreciated.
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Re: Health insurance

Post by pugchief » Sat Feb 08, 2020 3:17 pm

Maddy wrote:
Sat Feb 08, 2020 2:32 pm
I was tempted to quip, "So I'm personally responsible for condemning some poor schlub to Saturday nights at home with his right hand?" But I didn't think my humor would be much appreciated.
;D I appreciate it. Another Maddy gem!
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Re: Health insurance

Post by pugchief » Thu Feb 13, 2020 7:23 am

For a devil's advocate take on healthcare sharing ministries:
https://www.mymoneyblog.com/do-not-buy- ... istry.html
  • -HCSMs are not health insurance. This also means they are not overseen by state insurance agencies. There no government oversight, nobody to appeal to and have them say “hey that’s not right, you can’t do that”.
    -HCSMs provide no guarantee of payment. The ministry looks at each claim and has sole discretion as to whether they want to provide payment.
    -HCSMs do not have to accept or cover pre-existing conditions.
    -HCSMs cap lifetime payments at relatively low amounts like $250,000. ACA-compliant health insurance has no lifetime limits.
The problem is that by design, yes, MOST people will be satisfied by these programs. MOST people get their bills paid. MOST people can thus leave a positive review. MOST people won’t have an extreme event that requires $500,000 of medical care over time. However, that is not the point of insurance! Insurance is there to protect you from bankruptcy due to a catastrophic event out of your control. Insurance is there so when your child is sick and dying, you don’t have to worry about taking out a second mortgage or skipping the best treatment because it costs too much.

Think of an Amazon product that has overall 4.5 star reviews, which means mostly 4 and 5-star reviews, but the 1-star reviews are from people with cancer or a child with a serious illness and are denied coverage! Also, don’t forget that once the healthcare sharing ministry rejects your child’s claims and the family is bankrupt and desperate, they’ll likely end up falling back on taxpayer-funded Medicaid to cover their healthcare needs. Is this how we want the system to work?
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Re: Health insurance

Post by Xan » Thu Feb 13, 2020 8:08 am

ACA advocates really have no standing to lecture people on the "point of insurance", but they are correct that the point of insurance is to cover unexpected events which could bankrupt you. The lesson is to not pick a plan that has a coverage max.

Covering pre-existing conditions is very much not the "point of insurance", for example. But CHM does cover pre-existing conditions after a phase-in period.

It's true that they don't have to pay. That's what makes it technically not insurance. If they reneged on a promise, though, it would be the end of their service. Has anyone ever found one of these organizations to actually renege, or is every such "they won't pay" a result of buying insufficient coverage?
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Re: Health insurance

Post by pugchief » Thu Feb 13, 2020 9:07 am

Xan wrote:
Thu Feb 13, 2020 8:08 am
ACA advocates really have no standing to lecture people on the "point of insurance", but they are correct that the point of insurance is to cover unexpected events which could bankrupt you. The lesson is to not pick a plan that has a coverage max.

Covering pre-existing conditions is very much not the "point of insurance", for example. But CHM does cover pre-existing conditions after a phase-in period.

It's true that they don't have to pay. That's what makes it technically not insurance. If they reneged on a promise, though, it would be the end of their service. Has anyone ever found one of these organizations to actually renege, or is every such "they won't pay" a result of buying insufficient coverage?
I don't know that the author is necessarily an advocate of ACA; he is just not a fan of HCMs. Your point about not having a health incident bankrupt you is I think what his article all boils down to. If they reneged and went out of business, what would happen to all of the members expecting reimbursement? And do you want to be the one they decide not to pay on when you need it most? I don't disagree with your points, but his are also very valid.
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Re: Health insurance

Post by Xan » Thu Feb 13, 2020 10:14 am

pugchief wrote:
Thu Feb 13, 2020 9:07 am
I don't know that the author is necessarily an advocate of ACA; he is just not a fan of HCMs. Your point about not having a health incident bankrupt you is I think what his article all boils down to. If they reneged and went out of business, what would happen to all of the members expecting reimbursement? And do you want to be the one they decide not to pay on when you need it most? I don't disagree with your points, but his are also very valid.
Honest question: what happens if your traditional health insurance company goes bankrupt? Maybe it depends on who the president is. Under Obama, the federal government took care of everybody's car warranties when the manufacturer went under. (What a joke.) Would the federal government step in and pay for people's medical bills if (say) Humana went under? Seems likely. Would they do the same if an HCM went under? Hard to say. I'll admit it's less likely the government would step in than with a traditional insurer, mostly because the traditional insurers are all so enormous these days.
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Re: Health insurance

Post by Maddy » Thu Feb 13, 2020 10:16 am

HSMs vary greatly both in terms of their scope of coverage and their financial stability, so it's hard to generalize. Several have supplemental programs that extend coverage beyond the ordinary limits. A number cover preexisting conditions after a certain number of years, or have phase-in periods. There's also a great deal of difference between organizations when it comes to how they are structured and in terms of who, exactly, is responsible for making payment. Some HSMs receive monthly premiums and make payments out of their reserves, while others merely act as administrators of a program whereby members make payments directly to other members.

There is a huge demand for alternatives to mainstream insurance, so new HSMs seem to be popping up everywhere. The problem is that they are largely unregulated--which is something that I expect will change in short order as more and more fly-by-night organizations enter the marketplace and state insurance regulators wise up to the fact that these organizations have developed some pretty creative ways of concealing the fact that, from a functional standpoint, they are very much in the business of selling insurance.

Meanwhile, I think it's unavoidable that many of these newer market entrants are going to find themselves with insufficient reserves to meet their contractual (or quasi-contractual) obligations to members. Even now, I frequently hear rumblings from members of even the most well-established HSMs about protracted delays in reimbursement or about repeated, unavailing attempts to communicate with the organization about unreimbursed claims. It's hard to know from these anecdotal reports just how prevalent these problems are, especially when members are required, as a condition of membership, to submit to a statement of faith that purports to bind them to highly controlled dispute resolution mechanisms and to preclude them from going through the usual legal and regulatory channels.
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Re: Health insurance

Post by Maddy » Thu Feb 13, 2020 10:26 am

Would the federal government step in and pay for people's medical bills if (say) Humana went under? Seems likely. Would they do the same if an HCM went under? Hard to say. I'll admit it's less likely the government would step in than with a traditional insurer, mostly because the traditional insurers are all so enormous these days.
Samaritan Ministries Intl. is an example of an HSM that acts as the administrator of a program whereby members make payments directly to other members. So a particular member's "need" of $5,000 might typically be met with the receipt of 20 different checks from 20 different members. If one of those 20 members fails to pay, then their share is assigned to another member. This way of structuring things removes the concern about insufficient reserves and greatly reduces the risk of non-payment.
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Re: Health insurance

Post by pugchief » Thu Feb 13, 2020 4:01 pm

Xan wrote:
Thu Feb 13, 2020 10:14 am
pugchief wrote:
Thu Feb 13, 2020 9:07 am
I don't know that the author is necessarily an advocate of ACA; he is just not a fan of HCMs. Your point about not having a health incident bankrupt you is I think what his article all boils down to. If they reneged and went out of business, what would happen to all of the members expecting reimbursement? And do you want to be the one they decide not to pay on when you need it most? I don't disagree with your points, but his are also very valid.
Honest question: what happens if your traditional health insurance company goes bankrupt? Maybe it depends on who the president is. Under Obama, the federal government took care of everybody's car warranties when the manufacturer went under. (What a joke.) Would the federal government step in and pay for people's medical bills if (say) Humana went under? Seems likely. Would they do the same if an HCM went under? Hard to say. I'll admit it's less likely the government would step in than with a traditional insurer, mostly because the traditional insurers are all so enormous these days.
The likelihood that a major insurer would go bankrupt is minuscule. They are required to keep reserves and the government would most certainly bail them out in some fashion if it happened. At least currently, if an HCM went under, you'd prob be SOL.
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Re: Health insurance

Post by InsuranceGuy » Thu Feb 13, 2020 11:31 pm

There are multiple mechanisms to protect policyholders from insurer insolvency:
1) rating agencies and reserve requirements have been improved substancially since the financial crisis
2) every state has guarantee funds that insurers must contribute to as a condition of doing business in that state that pay for shortfalls if an insurer becomes impaired
3) as we saw in 2008, TARP was used to bailout insurers including "too big to fail" AIG

Sadly, none of the above apply to HCMs as HCMs are not regulated.
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Re: Gold's Time To Shine?

Post by blackomen » Sat Feb 15, 2020 1:12 pm

pugchief wrote:
Fri Jan 31, 2020 7:22 am
vnatale wrote:
Thu Jan 30, 2020 10:43 pm
Smith1776 wrote:
Sun Dec 29, 2019 8:14 am
My perspective is that I'd still rather go with the Canadian health care system than the American one if given a binary choice. Though, obviously, there is bias in my perspective.

The waiting time issue is not as bad as portrayed in my humble opinion. We follow a triage system in Canada. If it's a medical emergency, you'll get in right away. If it's a bad knee that acts up when you do sports, then yeah, you'll wait a while for a surgery.
A few days ago I made reference to what Smith1776 wrote above. That the Canadian "wait" times are not as Americans seem to think that they are. That the Canadian system works on a triage system, which does seem sensible.

Vinny
IDK about you, but I have lots of friends that have had various joints replaced, and from what I hear, you don't want the government deciding how much pain you are in or how you should walk 20 yards without a cane. I'd rather do the surgery when *I* think it's time, not some lackey with zero medical background. Ever been to the DMV? That's what government run anything will look like here. :'(
Can't we have a system like the Canadian system but with the added option that if you don't want to wait, you can pay full price to have the surgery now, just like in America?
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Re: Gold's Time To Shine?

Post by D1984 » Sun Feb 16, 2020 3:40 am

blackomen wrote:
Sat Feb 15, 2020 1:12 pm
pugchief wrote:
Fri Jan 31, 2020 7:22 am
vnatale wrote:
Thu Jan 30, 2020 10:43 pm
Smith1776 wrote:
Sun Dec 29, 2019 8:14 am
My perspective is that I'd still rather go with the Canadian health care system than the American one if given a binary choice. Though, obviously, there is bias in my perspective.

The waiting time issue is not as bad as portrayed in my humble opinion. We follow a triage system in Canada. If it's a medical emergency, you'll get in right away. If it's a bad knee that acts up when you do sports, then yeah, you'll wait a while for a surgery.
A few days ago I made reference to what Smith1776 wrote above. That the Canadian "wait" times are not as Americans seem to think that they are. That the Canadian system works on a triage system, which does seem sensible.

Vinny
IDK about you, but I have lots of friends that have had various joints replaced, and from what I hear, you don't want the government deciding how much pain you are in or how you should walk 20 yards without a cane. I'd rather do the surgery when *I* think it's time, not some lackey with zero medical background. Ever been to the DMV? That's what government run anything will look like here. :'(
Can't we have a system like the Canadian system but with the added option that if you don't want to wait, you can pay full price to have the surgery now, just like in America?
AFAIK you can do that in Canada too. Canada doesn't fully ban full price up front in cash-on-the-barrelhead private medical practice; it bans private health INSURANCE. Physicians (whether singly or in group practice), surgicenters, clinics, imaging centers, etc can opt out of the public payment system (their province's Medicare system) but in doing so they forfeit the right to bill Medicare for ANYTHING for a certain period; also, in some provinces (Ontario does this and I presume at least some of the other provinces do as well) physicians who opt out of Medicare and bill patients privately for cash cannot charge said patients above the agreed-upon provincial Medicare fee schedule anyway unless they are treating non-insured persons (i.e. persons for whom Medicare would not be the first-line payer...stuff like workmen's comp cases, auto accident victims, persons who are not Canadian citizens or PRs, etc).

Again, as far as I know both the Single Payer bill by Bernie and the one by Jayapal do similarly as above in allowing cash-only medicine but prohibiting providers from billing Medicare for a set period (IIRC it is 3 years) should they choose to be cash-only/prepaid/concierge practices.
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Re: Gold's Time To Shine?

Post by pugchief » Sun Feb 16, 2020 8:31 am

D1984 wrote:
Sun Feb 16, 2020 3:40 am



AFAIK you can do that in Canada too. Canada doesn't fully ban full price up front in cash-on-the-barrelhead private medical practice; it bans private health INSURANCE. Physicians (whether singly or in group practice), surgicenters, clinics, imaging centers, etc can opt out of the public payment system (their province's Medicare system) but in doing so they forfeit the right to bill Medicare for ANYTHING for a certain period; also, in some provinces (Ontario does this and I presume at least some of the other provinces do as well) physicians who opt out of Medicare and bill patients privately for cash cannot charge said patients above the agreed-upon provincial Medicare fee schedule anyway unless they are treating non-insured persons (i.e. persons for whom Medicare would not be the first-line payer...stuff like workmen's comp cases, auto accident victims, persons who are not Canadian citizens or PRs, etc).

Again, as far as I know both the Single Payer bill by Bernie and the one by Jayapal do similarly as above in allowing cash-only medicine but prohibiting providers from billing Medicare for a set period (IIRC it is 3 years) should they choose to be cash-only/prepaid/concierge practices.
::) ::) ::)
This defeats the whole purpose and incentive for opting out as a provider (capitlism!). If you can't charge more for delivering a better (or, in this case, more timely) service, you may as well stay in the system for the increased volume. The only reason the concierge model works here is because of supply and demand coupled with un restrictive pricing.

We already basically have socialized medicine here in the US in most cities, it just looks different. If you practice here in Chicago in a non-concierge practice, you are limited to charging the fees set by insurance contracts or medicare since almost all of your patients have one or the other, and if you don't participate in the PPOs, you won't have any patients at all as they will just go to the guy 2 doors down who is in-network. And the premiums of the wealthier people help pay for those receiving subsidies. Voila: defacto sociailzed medicine.
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Re: Gold's Time To Shine?

Post by D1984 » Sun Feb 16, 2020 10:34 am

pugchief wrote:
Sun Feb 16, 2020 8:31 am
D1984 wrote:
Sun Feb 16, 2020 3:40 am



AFAIK you can do that in Canada too. Canada doesn't fully ban full price up front in cash-on-the-barrelhead private medical practice; it bans private health INSURANCE. Physicians (whether singly or in group practice), surgicenters, clinics, imaging centers, etc can opt out of the public payment system (their province's Medicare system) but in doing so they forfeit the right to bill Medicare for ANYTHING for a certain period; also, in some provinces (Ontario does this and I presume at least some of the other provinces do as well) physicians who opt out of Medicare and bill patients privately for cash cannot charge said patients above the agreed-upon provincial Medicare fee schedule anyway unless they are treating non-insured persons (i.e. persons for whom Medicare would not be the first-line payer...stuff like workmen's comp cases, auto accident victims, persons who are not Canadian citizens or PRs, etc).

Again, as far as I know both the Single Payer bill by Bernie and the one by Jayapal do similarly as above in allowing cash-only medicine but prohibiting providers from billing Medicare for a set period (IIRC it is 3 years) should they choose to be cash-only/prepaid/concierge practices.
::) ::) ::)
This defeats the whole purpose and incentive for opting out as a provider (capitlism!). If you can't charge more for delivering a better (or, in this case, more timely) service, you may as well stay in the system for the increased volume. The only reason the concierge model works here is because of supply and demand coupled with un restrictive pricing.
I guess if you asked Ontario's Minister for Health he/she would say that was the whole point; they want to avoid as much as feasible a two-tiered system and by keeping as many doctors practicing in the public system as possible (and incentivizing as few of them as possible into cash-only practices) this helps to ensure that the vast majority of the wealthy use the same system everyone else does and thus have an incentive to want to see it working well just like the poor and middle class do.

Most countries with universal healthcare don't regulate what cash-only doctors can charge but EVERY country with universal healthcare does directly or indirectly regulate what providers can charge those insured under the system (whether that system is socialized medicine a la the NHS, single-payer like in Canada, single-payer with additional optional private insurance for stuff the public system doesn't fully cover like France, single-payer but with the ability for those who can afford and wish to to buy a private insurance policy and totally bypass the public system like Australia, government-funded hospitals, government catastrophic insurance and private health savings accounts like in Singapore, or a mandatory private but not-for-profit system like Switzerland where you are required/mandated to buy insurance--and subsidized if you are too poor--but can choose from a variety of not-for-profit private insurers and switch if you are unsatisfied); we alone in America do not have universal healthcare and don't do any kind of nationwide or statewide regulation of what providers can charge and thus we get ripped off by some of the highest prices for medical care in the world....see the IFHP reports if you don't believe this.
We already basically have socialized medicine here in the US in most cities, it just looks different. If you practice here in Chicago in a non-concierge practice, you are limited to charging the fees set by insurance contracts or medicare since almost all of your patients have one or the other, and if you don't participate in the PPOs, you won't have any patients at all as they will just go to the guy 2 doors down who is in-network. And the premiums of the wealthier people help pay for those receiving subsidies. Voila: defacto socialized medicine.
If a doctor doesn't like the prices the private insurance companies offer and doesn't like what Medicare offers either he/she can just run a cash-only practice. They would likely have plenty of cash-only patients if they charged, say, from $11 to $45 for an office visit--which is the range of prices for an office visit (not copayments...actual prices in full...and this is to see a regular GP, not an NP or a PA) in other countries (again, as per the IFHP reports...granted, this is from the 2013 and 2010 reports--they issue a report every few years but not every report includes the cost of a routine office visit--so prices may be a little higher in other countries since then due to inflation....but I'd be willing to bet US prices rose just as fast if not faster). And yes, I know that to do this (have doctors charge such low prices for a basic GP office visit) we would have to be more like other countries and revamp our whole education system and have heavily subsidized (or free) college and medical education so that doctors didn't graduate med school with a $260K (or more) millstone around their necks that makes them see the need for much higher salaries than in other countries and we'd also have to start paying them decent wages during internship/residency rather than 45K or so a year (and while we're at it, also stop working them so many crazy excessive hours during said internship/residency which means we'd need to lift the Medicare MCE cap and fund training of several thousands or tens of thousands of doctors more each year so we'd actually have enough docs without overworking/burning out the ones we have during the immediate postgrad training like we do now)...all of which I'd be fine with BTW; it would cost more upfront but it would likely save money over the long term.

We don't have de facto socialized medicine; socialized medicine is when the government runs the hospitals/clinics directly and the doctors/nurses are all salaried government employees. We do have a system of quasi-price regulation by insurance companies and Medicare but Medicare cannot negotiate as low of prices as the universal systems in other countries because it is not the monopsony buyer--since it does not cover everyone but only covers the elderly and those with ESRD-- and because since private insurance exists as well (private insurance exists in plenty of other countries too but in all of those countries private insurers negotiate with providers on a nationwide/provincewide/cantonwide basis and so have some serious negotiating clout owing to the fact that in such a situation these private insurers are negotiating all as one and are thus a quasi-monopsony buyer as well) so if Medicare offers too little in the eyes of providers they can just say no and refuse Medicare and only take privately insured patients; private insurers have little/no negotiating clout here in the US because there are typically ten (or more) of them competing whereas in many/most areas providers are effectively a monopoly or an oligopoly and so the providers (hospitals/doctors/drug companies/medical device makers) can name their price and the private insurer has little choice but to take it.

If we had universal Medicare for all (or at least all-payer rate setting where all the private insurers + Medicare + Medicaid negotiated prices all as one on a national or regional basis and thus functioned as a monopsony buyer de facto even if not de jure) then the power would be back in the buyer's lap and medical prices would likely come down to be somewhat closer to the prices in the rest of the OECD countries. We don't so we get stuck with some of the highest healthcare prices in the developed world.
Last edited by D1984 on Sun Feb 16, 2020 12:17 pm, edited 1 time in total.
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Re: Gold's Time To Shine?

Post by sophie » Sun Feb 16, 2020 11:40 am

pugchief wrote:
Sun Feb 16, 2020 8:31 am
D1984 wrote:
Sun Feb 16, 2020 3:40 am



AFAIK you can do that in Canada too. Canada doesn't fully ban full price up front in cash-on-the-barrelhead private medical practice; it bans private health INSURANCE. Physicians (whether singly or in group practice), surgicenters, clinics, imaging centers, etc can opt out of the public payment system (their province's Medicare system) but in doing so they forfeit the right to bill Medicare for ANYTHING for a certain period; also, in some provinces (Ontario does this and I presume at least some of the other provinces do as well) physicians who opt out of Medicare and bill patients privately for cash cannot charge said patients above the agreed-upon provincial Medicare fee schedule anyway unless they are treating non-insured persons (i.e. persons for whom Medicare would not be the first-line payer...stuff like workmen's comp cases, auto accident victims, persons who are not Canadian citizens or PRs, etc).

Again, as far as I know both the Single Payer bill by Bernie and the one by Jayapal do similarly as above in allowing cash-only medicine but prohibiting providers from billing Medicare for a set period (IIRC it is 3 years) should they choose to be cash-only/prepaid/concierge practices.
::) ::) ::)
This defeats the whole purpose and incentive for opting out as a provider (capitlism!). If you can't charge more for delivering a better (or, in this case, more timely) service, you may as well stay in the system for the increased volume. The only reason the concierge model works here is because of supply and demand coupled with un restrictive pricing.

We already basically have socialized medicine here in the US in most cities, it just looks different. If you practice here in Chicago in a non-concierge practice, you are limited to charging the fees set by insurance contracts or medicare since almost all of your patients have one or the other, and if you don't participate in the PPOs, you won't have any patients at all as they will just go to the guy 2 doors down who is in-network. And the premiums of the wealthier people help pay for those receiving subsidies. Voila: defacto sociailzed medicine.
Actually, Medicare isn't the source of delayed treatment in the American system. It's the private insurers that play the preauthorization game that results in delays and denials. Yet another reason to avoid Medicare Advantage plans like the plague.

I agree that an insurance model that covers routine, low-level expenses is idiotic and makes about as much sense as, say, getting haircut insurance, but I'm resigned to that being fixed in stone. If you accept that, then a Medicare for all system may in fact be our best solution. I wish medical insurance could work more like it does in veterinary medicine, where the added costs of a full coverage insurance policy for a pet are necessarily greater than what you'd spend for the routine care that it covers - so those policies basically amount to a stupidity tax. Also, because insurance isn't nearly so intrusive in the pet world (minimal documentation requirements, no preauths), office visit costs are a lot lower. Gives you an idea of what they would be in the human world without that added layer of insanity.
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Re: Gold's Time To Shine?

Post by Libertarian666 » Sun Feb 16, 2020 3:06 pm

sophie wrote:
Sun Feb 16, 2020 11:40 am
pugchief wrote:
Sun Feb 16, 2020 8:31 am
D1984 wrote:
Sun Feb 16, 2020 3:40 am



AFAIK you can do that in Canada too. Canada doesn't fully ban full price up front in cash-on-the-barrelhead private medical practice; it bans private health INSURANCE. Physicians (whether singly or in group practice), surgicenters, clinics, imaging centers, etc can opt out of the public payment system (their province's Medicare system) but in doing so they forfeit the right to bill Medicare for ANYTHING for a certain period; also, in some provinces (Ontario does this and I presume at least some of the other provinces do as well) physicians who opt out of Medicare and bill patients privately for cash cannot charge said patients above the agreed-upon provincial Medicare fee schedule anyway unless they are treating non-insured persons (i.e. persons for whom Medicare would not be the first-line payer...stuff like workmen's comp cases, auto accident victims, persons who are not Canadian citizens or PRs, etc).

Again, as far as I know both the Single Payer bill by Bernie and the one by Jayapal do similarly as above in allowing cash-only medicine but prohibiting providers from billing Medicare for a set period (IIRC it is 3 years) should they choose to be cash-only/prepaid/concierge practices.
::) ::) ::)
This defeats the whole purpose and incentive for opting out as a provider (capitlism!). If you can't charge more for delivering a better (or, in this case, more timely) service, you may as well stay in the system for the increased volume. The only reason the concierge model works here is because of supply and demand coupled with un restrictive pricing.

We already basically have socialized medicine here in the US in most cities, it just looks different. If you practice here in Chicago in a non-concierge practice, you are limited to charging the fees set by insurance contracts or medicare since almost all of your patients have one or the other, and if you don't participate in the PPOs, you won't have any patients at all as they will just go to the guy 2 doors down who is in-network. And the premiums of the wealthier people help pay for those receiving subsidies. Voila: defacto sociailzed medicine.
Actually, Medicare isn't the source of delayed treatment in the American system. It's the private insurers that play the preauthorization game that results in delays and denials. Yet another reason to avoid Medicare Advantage plans like the plague.

I agree that an insurance model that covers routine, low-level expenses is idiotic and makes about as much sense as, say, getting haircut insurance, but I'm resigned to that being fixed in stone. If you accept that, then a Medicare for all system may in fact be our best solution. I wish medical insurance could work more like it does in veterinary medicine, where the added costs of a full coverage insurance policy for a pet are necessarily greater than what you'd spend for the routine care that it covers - so those policies basically amount to a stupidity tax. Also, because insurance isn't nearly so intrusive in the pet world (minimal documentation requirements, no preauths), office visit costs are a lot lower. Gives you an idea of what they would be in the human world without that added layer of insanity.
So let me see if I understand this.
The current "Medicare for some" (mostly over 65 with a few others) is completely and utterly bankrupt, having unfunded liabilities in the tens of trillions of dollars (see https://www.marketwatch.com/story/the-f ... 2018-06-15).
Therefore expanding it to five times its current size is a good idea.
Is that right?
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Re: Gold's Time To Shine?

Post by D1984 » Sun Feb 16, 2020 4:05 pm

Libertarian666 wrote:
Sun Feb 16, 2020 3:06 pm
sophie wrote:
Sun Feb 16, 2020 11:40 am
pugchief wrote:
Sun Feb 16, 2020 8:31 am
D1984 wrote:
Sun Feb 16, 2020 3:40 am



AFAIK you can do that in Canada too. Canada doesn't fully ban full price up front in cash-on-the-barrelhead private medical practice; it bans private health INSURANCE. Physicians (whether singly or in group practice), surgicenters, clinics, imaging centers, etc can opt out of the public payment system (their province's Medicare system) but in doing so they forfeit the right to bill Medicare for ANYTHING for a certain period; also, in some provinces (Ontario does this and I presume at least some of the other provinces do as well) physicians who opt out of Medicare and bill patients privately for cash cannot charge said patients above the agreed-upon provincial Medicare fee schedule anyway unless they are treating non-insured persons (i.e. persons for whom Medicare would not be the first-line payer...stuff like workmen's comp cases, auto accident victims, persons who are not Canadian citizens or PRs, etc).

Again, as far as I know both the Single Payer bill by Bernie and the one by Jayapal do similarly as above in allowing cash-only medicine but prohibiting providers from billing Medicare for a set period (IIRC it is 3 years) should they choose to be cash-only/prepaid/concierge practices.
::) ::) ::)
This defeats the whole purpose and incentive for opting out as a provider (capitlism!). If you can't charge more for delivering a better (or, in this case, more timely) service, you may as well stay in the system for the increased volume. The only reason the concierge model works here is because of supply and demand coupled with un restrictive pricing.

We already basically have socialized medicine here in the US in most cities, it just looks different. If you practice here in Chicago in a non-concierge practice, you are limited to charging the fees set by insurance contracts or medicare since almost all of your patients have one or the other, and if you don't participate in the PPOs, you won't have any patients at all as they will just go to the guy 2 doors down who is in-network. And the premiums of the wealthier people help pay for those receiving subsidies. Voila: defacto sociailzed medicine.
Actually, Medicare isn't the source of delayed treatment in the American system. It's the private insurers that play the preauthorization game that results in delays and denials. Yet another reason to avoid Medicare Advantage plans like the plague.

I agree that an insurance model that covers routine, low-level expenses is idiotic and makes about as much sense as, say, getting haircut insurance, but I'm resigned to that being fixed in stone. If you accept that, then a Medicare for all system may in fact be our best solution. I wish medical insurance could work more like it does in veterinary medicine, where the added costs of a full coverage insurance policy for a pet are necessarily greater than what you'd spend for the routine care that it covers - so those policies basically amount to a stupidity tax. Also, because insurance isn't nearly so intrusive in the pet world (minimal documentation requirements, no preauths), office visit costs are a lot lower. Gives you an idea of what they would be in the human world without that added layer of insanity.
So let me see if I understand this.
The current "Medicare for some" (mostly over 65 with a few others) is completely and utterly bankrupt, having unfunded liabilities in the tens of trillions of dollars (see https://www.marketwatch.com/story/the-f ... 2018-06-15).
Therefore expanding it to five times its current size is a good idea.
Is that right?
Medicare's unfunded liability over a 75 year period (the next 75 years) is $37 trillion as per the article. Well....that sounds scary. Actually, that is only around 2.27% of GDP per year. That doesn't sound quite as scary, does it? Think tanks that publish articles like this use the 75 year or 100 year or even (if the Trustees are still making it as of 2020; I thought they quit making that one for SS and Medicare back in the mid-2000s) the "infinite horizon" period in order to scare people. In actually it is likely even less than 2.27% of GDP per year since I derived that figure using today's GDP (and assuming per capita GDP will never grow in real terms since then....i.e. it will grow with inflation but total GDP will never grow beyond inflation and population growth i.e. I assumed ZERO productivity growth which I think we can agree is just a wee bit unrealistic), dividing $37 trillion by 75, and dividing that number by today's GDP (which again, I assumed no real increase whatsoever in except for via population growth and inflation) and projecting today's GDP out 75 years. Finally, most of the unfunded liabilities are going to occur in later years (the Trust Funds don't even start running a deficit until the mid to late 2020s) so given the time value of money it would be even less in terms of a % of GDP if we had to raise taxes enough immediately to fund it since we would be building up extra money in the trust funds staring from right now--and it would be earning interest--for at least the next several years before we spent even one extra cent out of the revenue the new taxes would generate.

Also, if you calculated private insurance companies' liabilities the same way they calculated Medicare's liabilities (IIRC the Trustees--likely quite correctly--assume costs will increase in line with the aging of the population and assume medical cost inflation will continue to outpace regular inflation) and calculated said insurance companies' income to service those liabilities by assuming premiums were never allowed to increase other than through inflation, population growth, and GDP per worker output growth (when calculating unfunded liabilities the Trustees AFAIK are assuming current tax rates and no increase in FICA or income taxes at all; the total amount of taxes can grow with more people or inflation or real output/GDP growth but tax rates themselves are assumed to stay at whatever current rates are) and that if insurance payouts for medical care increased faster than said premiums well then...too bad, too sad...you still won't be allowed premium increases enough to offset this....I'd bet that you'd come up with a pretty hefty "unfunded liability" estimate for private insurance as well. Needless to say private insurance companies do not have this problem because they can increase premiums as needed in order to stay solvent; Medicare has to rely on Congress and the White House OKing tax increases; it can't just increase its own funding stream (taxes) with the ease which insurance companies can increase their funding stream (by hiking premiums).

The problem that creates such a huge "unfunded liability" in either case is that medical costs keep increasing faster than inflation and usually they even increase faster than inflation plus real GDP per capita growth. FWIW Medicare seems to be better at controlling costs per beneficiary than private insurance; see https://www.modernhealthcare.com/articl ... study-says ; presumably this is because it has more bargaining power than private insurers.

EDIT - given that the Trustees projected the present value of Medicare's "unfunded liabilities" was $37 trillion then perhaps they should've contextualized that by comparing it to the present value of all GDP over that same 75-year period. Back in late 2010 the projected present value of 75 years worth of GDP (what you would have to pay now to receive the discounted value of 75 years worth of GDP paid to you) was $791 trillion ( https://seekingalpha.com/article/207272 ... iabilities ). Given that real inflation-adjusted GDP has increased around 23 percent or so since then we can presume the 75 year discounted present value of all the GDP for that timeframe (for the next 75 years starting today rather than starting in late 2010) has increased as well. That would put said value at around $972 trillion (give or take a trillion $ either way); $37 trillion is a bit over 3.78% of that. Not exactly insurmountable.
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Re: Health insurance

Post by Libertarian666 » Sun Feb 16, 2020 5:23 pm

Lol!
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Re: Health insurance

Post by Don » Sun Feb 16, 2020 5:40 pm

I know an illegal immigrant who suffered a massive heart attack in NYC. He was revived and spent 2 weeks in a fine hospital. After about a month he went back in for another week for a heart valve repair.

His bill is probably close to a million dollars but it's not costing him a cent.

How can this country not go bankrupt absorbing these huge health bills from illegals?
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Re: Health insurance

Post by blackomen » Sun Feb 16, 2020 6:12 pm

Don wrote:
Sun Feb 16, 2020 5:40 pm
I know an illegal immigrant who suffered a massive heart attack in NYC. He was revived and spent 2 weeks in a fine hospital. After about a month he went back in for another week for a heart valve repair.

His bill is probably close to a million dollars but it's not costing him a cent.

How can this country not go bankrupt absorbing these huge health bills from illegals?
We need to send that bill to Mexico or whatever his home country is.
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