Healthcare Question: If we don't force people to get coverage....Who pays if they get sick or injured??

Potentially a bigger problem is that many MRIs are useless and unnecessary (not questioning your particular test) - this is my observation working in medicine. MRIs are reflective of a bigger healthcare problem in the US...high costs for low-value care. Doctors order unnecessary MRIs either because they are practicing defensively, patients demand them, or they are getting kickbacks from the radiology center. free market could help this...anxious people who want but don't need an MRI could feel free to waste their own money for a useless test.

Although 3rd party insurance is a big part of rising costs there are definitely other factors at play here. The culture of medical practice in the US needs to change also.

Medical Doctor wrote:

Potentially a bigger problem is that many MRIs are useless and unnecessary (not questioning your particular test) - this is my observation working in medicine.

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Exactly. I made the call and didn't get the scan.

The mandate is exactly why you have to start over completely and not do these budget gimmicks that Ryan is trying to do. Make a mandate for catastrophic plans and provide temporary tax credits to fund hsas so people can get money in them to pay for out of pocket costs.

That way, society is insured against the freeloaders, individuals against catastrophic bills and they have choices. It's not that hard if you think outside the left/right dogma.

Educated guy wrote:

Every damn health insurance thread on Letsrun is terribly void of identifying the root of the problem with our health care system. Hasn't anyone taken an economics class around here? Jeez.

Here's what needs to be addressed in the US "health insurance" system:

1) It's based on a fee-for-service business model (incredibly inefficient), and 2) it is "managed" by a third party payment system (also incredibly inefficient).

The ACA did virtually nothing to address either of these characteristics. It approached the problem from the demand side. Which, of course, only exasperates the problem by increasing demand [for the inefficiently-provided care].

Neither party wants to actually fix the problem. If you believe otherwise, you're a fool.

Fixing the problem would involve reducing health insurers' involvement for basic health-related goods and services. Eliminating it in most cases. If I have a cold or flu, or have a basic broken finger, or need a prescription for something, I shouldn't need to have Mr Health Insurer come in and skim some off the top of every single transaction between me and the doctor/hospital. Those prices should be published and doctors/hospitals can compete for the business of helping me resolve these basic health problems.

Complimentary to the above, fixing the problem would involve more properly defining and allowing insurance companies to actually do what "insurance" is supposed to do (risk/actuarial management). They are currently NOT allowed to do this. I repeat: Insurance companies are not allowed to function as real insurance. Anyway, since the basic health-related issues would now NOT skimmed off the top by the health insurance companies, they'd be making their money here. We could have a true "risk pool" for the truly catastrophic health events that occur in our lives. And yes, go ahead and cover everyone here. This could be a relatively standard proportion of an individual's income, with perhaps some progressiveness built in for the upper few percentile folks.

With just these two changes (albeit major changes, in the current climate), we'd greatly reduce the fee-for-service business model and the third-party payment system we have in place, and costs would actually start to come down. And AFTER costs start to come down, then guess what you can do? That's right, you can COVER MORE PEOPLE.

Our genius lawyer-trained (also a FEE-FOR-SERVICE industry, mind you) politicians tried to cover more people first, and not deal with the costs at all second.[/quote]

Your points about what insurance should and should not have in the "risk pool" are good in my book. They sound similar to thoughts from Mark Cuban, who I hope runs in 2020.

Medical Doctor wrote:

Potentially a bigger problem is that many MRIs are useless and unnecessary (not questioning your particular test) - this is my observation working in medicine. MRIs are reflective of a bigger healthcare problem in the US...high costs for low-value care. Doctors order unnecessary MRIs either because they are practicing defensively, patients demand them, or they are getting kickbacks from the radiology center. free market could help this...anxious people who want but don't need an MRI could feel free to waste their own money for a useless test.

Although 3rd party insurance is a big part of rising costs there are definitely other factors at play here. The culture of medical practice in the US needs to change also.

I'm not saying this doesn't happen, but you can't deny that there will be genuine patients that come across and say "i have pain in my head, blurred vision, mood swings etc" and then when faced with a $1000 MRI scan to see if they have cancer they simply can't afford it. The aim of healthcare is to save lives.

What you have described is nothing to do with the free market, but is more about responsible healthcare practitioners.

What if nobody had insurance? wrote:

DiscoGary wrote:

Also, you state that nothing can bring down the cost of a scan and then immediately explain how costs could be brought down by using less powerful scanners. So the logic is confusing.

Less powerful = inferior. Weaker MRI scans could miss your affliction/cancer. You don't know that, because you are the average American i have been talking about. Should you be expected to know all the complexities of a medical procedure or illness or treatment and shop around taking into account all these complex factors whilst potentially dying? It is unrealistic and utopian.

I'm glad for your sake that your insurance wouldn't pay for your bargain basement MRI which could have been cheap quality and also interpreted by a guy that gave it a quick glance.

Medical services are NOT basic economics.

The unrealistic Utopian ideal is one where everyone can somehow get the most advanced medical services in the world at prices that an average person could afford. Or even more ridiculous is the idea that letting the government launder the money first will somehow make it so that your neighbor magically can afford to your health care bills that you can't afford.

I am well aware of the differences in scanners and most doctors are aware as well. Without any pushback they will proscribe the most expensive procedure to boost the bottom line.

Health care absolutely is subject to market forces which is what we found out when ObamaCare tried to break the laws of economics. It can't be done.

We should concentrate and the system that creates the MOST and CHEAPEST health care, not the FAIREST health care. Once we have competition geared up and costs driven down, then paying for those who fall through the cracks will be relatively easy.

Our current path will lead to ruin. It can end no other way. Even Trump can't stop it.

You have a good point in that the cost of an MRI machine is fixed. And it's huge.

The cost of getting an MRI is variable.

The more MRI's ordered, the cheaper it is per use.

If a machine was a million dollars and it was used on two people, it would cost $500,000 a pop.

If a million people used it, it would be $1 per use.

That's why cell phones and phone coverage has gotten cheaper. More people have and use them than in the 1990s when they were really expensive.

I'm not saying that everyone should rush out and get an MRI.

I'm saying that nailing down the cost of something isn't so simple and that collectively using less of something doesn't make it cheaper.

In your scenario the GOP would say that person should just keep taking aspirin until they die of that brain tumor.

zephito wrote:

Even when they do get seriously ill, it probably costs less, as they'll wait and wait until their cancer or heart disease is extremely advanced and they'll die a month after diagnosis. An insured individual with the same condition might go through years of expensive treatment. The GOP plan does save money vis a vis Obamacare.

That makes sense. Uninsured people cost less if they wait to get care and die. Great! What if instead of healthcare we assign every individual in society a certain monetary value, and if their healthcare costs exceed that value we just "eliminate the expense"? That could solve all the problems with the healthcare system.

L L wrote:

You have a good point in that the cost of an MRI machine is fixed. And it's huge.

The cost of getting an MRI is variable.

The more MRI's ordered, the cheaper it is per use.

If a machine was a million dollars and it was used on two people, it would cost $500,000 a pop.

If a million people used it, it would be $1 per use.

That's why cell phones and phone coverage has gotten cheaper. More people have and use them than in the 1990s when they were really expensive.

I'm not saying that everyone should rush out and get an MRI.

I'm saying that nailing down the cost of something isn't so simple and that collectively using less of something doesn't make it cheaper.

That's right. It also doesn't make sense for every hospital to have the most state of the art machine. The best CT scanners are very expensive, but they can basically capture the beating heart in motion. This is critical for a very small number of cases, but is total overkill for scanning a broken leg, or for the stomach ache I had. A machine like that really only makes sense in a place where heart surgery is their specialty and happens every day. Misuse and overcharging for high priced equipment is made possible by the third party payment system where very little push back occurs when the bill comes in at $1,500 for a scan.

You say you are 'well aware' but plainly showed that you are not aware at all by asking the question as to why lower power MRI scans are cheaper.

The unrealistic Utopian ideal is one where everyone can somehow get the most advanced medical services in the world at prices that an average person could afford

This is exactly what I am saying. If we want modern healthcare and accept that people should be able to afford it, we must have either insurance or government subsidies.

To put all the financial pressure back onto the medical system itself and all the supporting companies will only result in lower standards of care, less doctors, reduced or halted research into new drugs and procedures etcetera.

There needs to be a balance and that means regulation. The free market can't just conjure up competition that will drive down prices and drive up standards.

There might only be one treatment discovered for a particular type of cancer for example and just one company that spent billions of dollars and 20 years developing it. What happens then? Competing companies are supposed appear from nowhere, spend billions and 20 years developing another effective product then sell it for half the price of the original company to help out Average Joe? It's just unrealistic.

What if nobody had insurance? wrote:

DiscoGary wrote:

Also, you state that nothing can bring down the cost of a scan and then immediately explain how costs could be brought down by using less powerful scanners. So the logic is confusing.

Less powerful = inferior. Weaker MRI scans could miss your affliction/cancer. You don't know that, because you are the average American i have been talking about. Should you be expected to know all the complexities of a medical procedure or illness or treatment and shop around taking into account all these complex factors whilst potentially dying? It is unrealistic and utopian.

I'm glad for your sake that your insurance wouldn't pay for your bargain basement MRI which could have been cheap quality and also interpreted by a guy that gave it a quick glance.

Medical services are NOT basic economics.

DiscoG. can find the lowest medical cost using back-alley doctors. Fresh air operations, and quick and dirty service, and "doctors" without malpractice insurance, and signing away his right to sue. He will save a ton of money.

Medicine is such an egregious profession with all their drug scams. And their gullible drug-addict patients who take no responsibility for anything in their life, whether it's their weight, diet, exercise, etc.

And while our illustrious members of Congress bicker about what type of plan should replace the ACA, they completely ignore the "elephant in the room:"

https://hub.jhu.edu/2016/05/03/medical-errors-third-leading-cause-of-death/

And the late & renowned researcher Dr. Barbara Starfield of JH compiled some very sobering data on the state of the medical system:

http://ahrp.org/us-healthcare-third-leading-cause-of-death_barbara-starfield-md/

The findings by Barbara Starfield, MD, of Johns Hopkins School of Public Health:

12,000 deaths from unnecessary surgeries;

7,000 deaths from medication errors in hospitals;

20,000 deaths from other errors in hospitals;

80,000 deaths from infections acquired in hospitals;

106,000 deaths from FDA-approved correctly prescribed medicines.

The total estimated number of deaths caused by medical treatment in the US every year is *225,000.*

>100,000+ deaths & over 2.5 million serious adverse events annually from *FDA-approved* correctly prescribed medications! 😠. This is what you get when the medical journals are polluted with industry-funded safety studies, and doctors are oblivious to the publication bias of these studies (or simply don't care).

With statistics like this, you’d think people would be running away from the system instead of wanting to be a part of it.

I chose not to get insurance this year.

15 years ago I could get a basic policy for $100/month.

This year I would have to pay $550/month with a $7,500 deductible.

I would have to pay 14,000 out of pocket before insurance would pay anything.

That is just ridiculous to me. That is based on income of 50k. Even if something bad happened that cost 100k, I could just pay for it myself. I would definitely like to have a policy that covered something catastrophic, but I just feel those rates are way too high for the possible benefit I may get.

What if nobody had insurance? wrote:

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The free market can't just conjure up competition that will drive down prices and drive up standards.

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That is exactly what free markets do.

History has shown us that every attempt to use socialism to violate the laws of economics is doomed to fail. It will fail this time as well.

It can end no other way.

Right Tackle wrote:

Every damn health insurance thread on Letsrun is terribly void of identifying the root of the problem ...

Here's what needs to be addressed in the US "health insurance" system:

1) It's based on a fee-for-service business model (incredibly inefficient), and 2) it is "managed" by a third party payment system (also incredibly inefficient).

The ACA did virtually nothing to address either of these characteristics. It approached the problem from the demand side. Which, of course, only exasperates the problem by increasing demand [for the inefficiently-provided care].

Neither party wants to actually fix the problem. If you believe otherwise, you're a fool.

^THIS

The health insurance companies are in the game to maximize profit. That is why many many hospitals have been purchased by the "industry." There is no reason to be efficient at all. Why? The more you can charge the more profit you can make. Even if the profit margin is 10% it is better to make 10% on the higher cost of a poorly run system than the lower cost of a well run system. This is simply economics 101.

So you're saying that they aren't ordering too many MRIs but making too many good MRI machines.

Fair enough.

So instead of every hospital having a good machine, maybe only 1 in 3 should have a good one.

But I'm choosing that that third hospital to go to if I can.

I'm betting most hospitals will want to be the one to boast that they have the good equipment.

DiscoGary wrote:

What if nobody had insurance? wrote:

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The free market can't just conjure up competition that will drive down prices and drive up standards.

....

That is exactly what free markets do.

I'll just repost this:

There might only be one treatment discovered for a particular type of cancer for example and just one company that spent billions of dollars and 20 years developing it. What happens then? Competing companies are supposed appear from nowhere, spend billions and 20 years developing another effective product then sell it for half the price of the original company to help out Average Joe? It's just unrealistic.

Gary, your arguments are exactly like that guy who was mocking this sort of approach earlier on in this thread. Just shout 'free market' at every problem and disregard all the details.