Health Insurance

It's a matter of degrees, sir.

Instead of the $60 per month cable, you get the "ultra-basic" $5 per month (yes, it exists...at least here!)

Instead of a $15K car, you drive a $3K car.

Instead of the top-end smart-phone, you do without. Or, go prepay, and show some discipline.

Most folks don't have to live like a monk to make it happen. But you can't walk around with no self-restraint, either. That's one of the major issues as it is. As comedian Stephen Wright says, "You can't have everything...where would you put it?"

 

I am not condoning people living a wasteful lifestyle. However it is a sad commentary on the country if people are expected to just buy junkers in order to afford basic health insurance. If a person earns enough, they should be able to buy a nice dependable new vehicle for themselves and their family to drive. Health care shouldn't be the reason they can't do so.

 

We can discuss what is "fair." That's above my pay grade. And no, I'm not quoting "him."

Yes, I'd like to see the costs come down. But adding millions to a government healthcare boondoggle is not the way to make that happen.

 

Paid their own way and health care was a lot less expensive without government interference. Medicare is one of the chief causes for the ever increasing cost of medical care and insurance.

 

The rising cost of health care started before 1965 when Medicare and Medicaid were instituted as a response to that rise.

I agree that Medicare/Medicaid is a significant portion of the cost of health care in the United States and a component that has been rising rapidly to a point many consider unsustainable. I wonder if people who suggest their elimination have actually thought through the implications of that, not only for the uninsured themselves but for things like unemployment, GDP, crime etc that would affect the nation as a whole, including the insured. At the same time, it needs to be reformed to become sustainable.

Can you explain how Medicare increases the cost of private insurance plans?

I found an excellent timeline on health care insurance in the United states by PBS.

 

Large private health plans increase the costs for people who can't afford them. They sign low ball cost contracts with hospitals. Many hospitals charge people who don't have a medical plan double their Blue Cross contract price.

It is the same principle at work with hospital costs that get union workers a better wage than scabs - the power to negotiate of a group vs individual power which is zilch.

 

Of course. Can't everyone?

Unless you disagree, why would you need it explained?

If that is the case, perhaps you could explain why you don't think it does.

 

It was an honest question.

I'm not aware of the ins and outs of medicare/medicaid in terms of payments, fees and contracts that might influence this relationship.

My understanding is that Medicare/Medicaid are relatively independent of private health insurance but I am probably wrong in this and would like more information or at least direction as to where to find out the details of how this relationship plays out in real world scenarios.

 

Consider me a skeptic concerning your supposed lack of knowledge. The information is entirely too easy to find for anyone to be so uninformed.

 

Medicare sets the amount they will pay which is most always less than the real hospital costs plus overhead and waste. As noted above, the hospital then over bills the people who put the charges on credit cards.

 

I can see how this is the case if hospitals and physicians were forced to take Medicare patients. My understanding is that while some hospitals and physicians work for both Medicare and private health reimbursements, the choice is theirs. My potentially incorrect understanding is that most hospitals and physicians work with one or the other system of reimbursement and determine expenses to some extent based on that. And in that system, the medicare reimbursement rates have minimal impact on private health insurance clients and vice versus. I could be wrong but that is how I understood it.

 

So you admit you have been lying about your knowledge of the impact of medicare on insurance rate. In fact, you do actually have an "understanding"...
inaccurate as it is.

One question...

Why did you lie...more than once...about it?

 

This is my guess of how the system works. It does not mean I know how the system works. That is why I'm asking for information.

 

What you are really up to is being intellectually dishonest.

I've seen you use this debate tactic many times.

Howsomever, how did you arrive at this "guess"?

 

Believe what you want.

This is an interesting topic to me being in the medical profession and I am interested in comparing how different systems work.

Here in Australia, all citizens and permanent residents have Medicare coverage but many wealthy folks also get private coverage that allows for increased coverage over basic medicare as well as access to private hospitals and private physician consultations which cost more than public ones. Most doctors in the private system also work in the public system.

In Canada, there are no private hospitals and private insurance basically covers medications and allied health (physio, occupational, dental).

I don't know the extent of interaction between the private and public systems in the United States. My guess is that they are somewhat independent of one another and Medicare reimbursement rates would have minimal impact on private insurance rates. I would like to know more about this topic and if you are not interested in sharing information, that is fine by me.

I thank billwald for shedding light on one nuance of that interaction. I can see low reimbursement rates being a factor for private health insurance rates if there is a lot of overlap between the private and public systems.

 

Gold Dragon, just ignore Carpro. He has "issues".

The reimbursement rates are somewhat independent of each other. What does drive up the cost of insurance is hospitals charging more to make up for uncompensated care for people who don't have insurance. By law, hospitals that receive Federal funding must provide emergency treatment regardless of the patient's ability to pay.

 

That is because in Canada it is a simple matter to buy an insurance policy for use in the U.S. and from most major Canadian cities it is a short drive over the border to U.S. doctors and hospitals.

It is also an admission of the short comings of the Canadian health system.

 

I drove to the U.S. border quite often for outlet shopping. Never for health care.

The Canadian system has its flaws and some people use the U.S. system to circumvent those issues. Usually it has to do with
1) non-urgent surgery wait times
2) non-urgent specialist appointment wait times
3) new or controversial technologies or treatments that are not (yet) available or covered

The wait times issue is definitely at the forefront of health care reform in Canada. I spent some time last year doing an elective medical term in Canada and was shocked by the specialist wait times that the doctors I was working under were telling to their patients. It was almost up to a year for some specialists which is practically useless in my opinion.

My experience here in Australia is a wait times of several weeks to a month and I think it has to do with the existence of a private option which allows people to pay to get faster service and alleviate pressure on the public system.

There are pros and cons to every health system and we make compromises based on our values.

 

Thanks. I didn't realize this applied only to Federally funded hospitals. Do you have an idea of the extent to which hospitals are

1) mostly privately funded
2) mostly publicly funded
3) evenly funded by both public and private.

I just want a rough idea. ie 33% in each category or 50% in one category and the rest split between the other two.

I've also been reading up on research papers about cost-shifting (between Medicare and private insurance).

The health care policy journal Health Affairs has a few good research papers and editorial articles. The research papers are probably too dry for the average reader but here are a couple of good editorials on the subject. The journal appears to be an industry leader in their field and fortunately the full articles on this topic are free to read.

Can Hospitals And Physicians Shift The Effects Of Cuts In Medicare Reimbursement To Private Payers?
Medicare Payment Policy: Does Cost Shifting Matter?
Cost Shifting: New Myths, Old Confusion, and Enduring Reality

 

The vast majority of hospitals in the United States are privately owned. About 30% are for-profit and 70% non-profit. There are government hospitals, such as those under the Department of Veterans' Affairs for veterans and the Indian Health Service. Some city and county governments also own hospitals. U.S. Healthcare is majority publicly funded. Medicare and Medicaid account for 44% of U.S. healthcare expenditures. For more information on uncompensated care and the Emergency Medical Treatment and Active Labor Act, Wikipedia (not the best source, but it will work for your purposes) has a decent overview.

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act