Obamacare continues to crumble.

[jaeger19]

So what we should have even fewer doctors than every developed nation than we already have? To lower costs? This is senseless.

That's what other countries with single payer do. They lower the number of physicians particularly specialists making the system more efficient and therefore less expensive.

That's one way in part they get the savings they do. Of course it means higher wait times and less choice because you don't get something for nothing.

 

[jaeger19]

Breaking this down into components is apparently confusing the issue, as doing so loses the relative weight/contribution of each component to the total dollars flowing to insurers. The question was whether the amount of private dollars from business and households flowing into insurers is growing more quickly than the amount of dollars flowing from insurers to providers.

So just look at the growth in the combined total business + household dollars being paid to insurers (effectively a weighted average of the rows in the previous table).

Percent Growth from Previous Year
[table="width: 1000, class: grid"]
[tr]
[td][/td]
[td]2000[/td]
[td]2001[/td]
[td]2002[/td]
[td]2003[/td]
[td]2004[/td]
[td]2005[/td]
[td]2006[/td]
[td]2007[/td]
[td]2008[/td]
[td]2009[/td]
[td]2010[/td]
[td]2011[/td]
[td]2012[/td]
[td]2013[/td]
[td]2014[/td]
[td]2015[/td]
[/tr]
[tr]
[td]Private Health Insurance Payments to Providers[/td]
[td]

7.0​

[/td]
[td]

9.4​

[/td]
[td]

9.3​

[/td]
[td]

7.8​

[/td]
[td]

7.0​

[/td]
[td]

6.4​

[/td]
[td]

3.7​

[/td]
[td]

5.4​

[/td]
[td]

4.8​

[/td]
[td]

4.7​

[/td]
[td]

2.1​

[/td]
[td]

3.7​

[/td]
[td]

3.2​

[/td]
[td]

1.5​

[/td]
[td]

4.4​

[/td]
[td]

7.1​

[/td]
[/tr]
[tr]
[td]Total Business & Household Contributions to Insurers[/td]
[td]

9.6​

[/td]
[td]

9.0​

[/td]
[td]

11.2​

[/td]
[td]

9.2​

[/td]
[td]

6.4​

[/td]
[td]

6.0​

[/td]
[td]

3.8​

[/td]
[td]

5.1​

[/td]
[td]

3.8​

[/td]
[td]

2.7​

[/td]
[td]

2.0​

[/td]
[td]

3.4​

[/td]
[td]

4.4​

[/td]
[td]

1.7​

[/td]
[td]

3.3​

[/td]
[td]

6.1​

[/td]
[/tr]
[/table]

As I said, the two track each other. The "leader" seesaws back and forth as they pass and catch up to each other on a lagged basis. Growth in collections tracks growth in payouts, as one would expect.

Yeah.. I don't see them tracking each other. I see the result of the economy and economic conditions more so than "tracking each other". The span is too short to see that they track.

 

[phattonez]

That's what other countries with single payer do. They lower the number of physicians particularly specialists making the system more efficient and therefore less expensive.

That's one way in part they get the savings they do. Of course it means higher wait times and less choice because you don't get something for nothing.

Then let's do the opposite. Let's increase the number of physicians, lower doctor salaries, and get lower costs with lower wait times.

 

[jaeger19]

Then let's do the opposite. Let's increase the number of physicians, lower doctor salaries, and get lower costs with lower wait times.

how do you plan to do that?

How are you going to decrease my staff wages, my educational expenses, my liability expenses, my costs for malpractice, cost of computers and other IT.. etc...

In order to get all you plan to get?

 

[phattonez]

how do you plan to do that?

How are you going to decrease my staff wages, my educational expenses, my liability expenses, my costs for malpractice, cost of computers and other IT.. etc...

In order to get all you plan to get?

The institution that hires you has less incentive to keep your wages high if there are more physicians willing to take your spot.

It's not as if high educational expenses guarantee high wages. Look at social workers.

 

[jaeger19]

The institution that hires you has less incentive to keep your wages high if there are more physicians willing to take your spot.

It's not as if high educational expenses guarantee high wages. Look at social workers.

Why would I go through all that expense and time to be a physician and make way less than I can make in the business sector or any other endeavor.

Its not like the skills that make a person a good physician don't translate into almost any other job.

On the other hand.. its a very rare person that has the ability to be a good physician.

However.. that's not really the point.

When you hire those physicians.. there are offices needed, support staff needed, x ray techs.. x ray machines,, so on and so forth that go along with a physician practicing. the more physicians practicing. the more costs. AND the fewer patients to cover those costs.. so the amount you have to charge the patients increases.

You are assuming the only cost is physicians.

 

[phattonez]

Why would I go through all that expense and time to be a physician and make way less than I can make in the business sector or any other endeavor.

Its not like the skills that make a person a good physician don't translate into almost any other job.

On the other hand.. its a very rare person that has the ability to be a good physician.

However.. that's not really the point.

When you hire those physicians.. there are offices needed, support staff needed, x ray techs.. x ray machines,, so on and so forth that go along with a physician practicing. the more physicians practicing. the more costs. AND the fewer patients to cover those costs.. so the amount you have to charge the patients increases.

You are assuming the only cost is physicians.

Rarer in this country than in every other developed country?

 

[jaeger19]

Rarer in this country than in every other developed country?

Well, as pointed out.. they generally REDUCE the number of physicians particularly specialists. .. and often foreign physicians come to America to practice.

Secondly.. its a matter of competition.. its relatively rare in other countries as well. and they compete with what a person can make in the business sector.

 

[Dittohead not!]

Well, as pointed out.. they generally REDUCE the number of physicians particularly specialists. .. and often foreign physicians come to America to practice.

Secondly.. its a matter of competition.. its relatively rare in other countries as well. and they compete with what a person can make in the business sector.

No kidding. It seems like every other physician is from somewhere else. It's high time we started training more doctors, particularly GP doctors. Maybe then we could actually have a universal health care plan and have enough physicians to go around.

 

[jaeger19]

No kidding. It seems like every other physician is from somewhere else. It's high time we started training more doctors, particularly GP doctors. Maybe then we could actually have a universal health care plan and have enough physicians to go around.

What I think is weird is the intellectual disconnect that seems to be made here (not talking you specifically just in general)..

we want more doctors.. so we can pay them less. One of the big reasons for lack of recruiting in the healthcare field is that not only is the requirements necessarily difficult.. (do you want the class idiot performing brain surgery on you?).. but that the advantages of being a physician are rapidly decreasing.

and so its somewhat of a intellectual disconnect if you think that you are going to be able to get more doctors in the field by announcing them that you will be severely reducing the amount they get paid.

My sons are talking about wanting to go into healthcare. I am cautioning them against going into the medical field. Why go into medicine when you can work way less hours and make more money in business? And you are hailed as brilliant for making money (if you are rich.. then of course you must be smart)...

One of the reasons that you get foreign trained physicians is because they are willing to work for less.. (and their education often cost them less etc) than American born folks with the same talents.

 

[Dittohead not!]

What I think is weird is the intellectual disconnect that seems to be made here (not talking you specifically just in general)..

we want more doctors.. so we can pay them less. One of the big reasons for lack of recruiting in the healthcare field is that not only is the requirements necessarily difficult.. (do you want the class idiot performing brain surgery on you?).. but that the advantages of being a physician are rapidly decreasing.

and so its somewhat of a intellectual disconnect if you think that you are going to be able to get more doctors in the field by announcing them that you will be severely reducing the amount they get paid.

My sons are talking about wanting to go into healthcare. I am cautioning them against going into the medical field. Why go into medicine when you can work way less hours and make more money in business? And you are hailed as brilliant for making money (if you are rich.. then of course you must be smart)...

One of the reasons that you get foreign trained physicians is because they are willing to work for less.. (and their education often cost them less etc) than American born folks with the same talents.

I'm not suggesting more doctors so that we can pay them less, but more doctors so that everyone can see a doctor when they need one. The amount paid to doctors is, as you've pointed out, only a small part of the money paid for health care.

Doctors are highly trained and should be well compensated. If it's really so much easier to make more money in business with less effort, then it's no wonder that we don't train enough doctors and so have to import them from abroad.

Maybe the solution is to have more of the money that we spend on health care going to the people who provide that care. That's what I'd call and efficient system. It doesn't look to me like we have a very efficient system.

 

[Dittohead not!]

Here's an example: I have a niece who is an ob/gyn. She has reported having done a half dozen or more C sections in a single shift.

That got me to wondering just how much a C section costs in today's market, so I asked Google, "How much does a Cesarean section cost?

The answer:

The average total price charged for pregnancy and newborn care was about $30,000for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found.Jul 1, 2013

Since that's from four years ago, one would expect the cost to be more now, but let's take the difference actually paid by the insurers, $27866 - $18324 = $9,537.

If she performed six of them in a shift, then she generated $57,222 for the hospital (an HMO).

If even 10% of that amount was paid in salaries, she must have made nearly six grand in one shift.

While doctors are pretty well paid, they're not that well paid.

The other thing is the difference between what was billed and what was paid by the insurer. Care providers routinely bill far more than they expect to get. One has to wonder whether the uninsured patient is billed the full amount.

 

[jaeger19]

I'm not suggesting more doctors so that we can pay them less, but more doctors so that everyone can see a doctor when they need one. The amount paid to doctors is, as you've pointed out, only a small part of the money paid for health care.

Doctors are highly trained and should be well compensated. If it's really so much easier to make more money in business with less effort, then it's no wonder that we don't train enough doctors and so have to import them from abroad.

Maybe the solution is to have more of the money that we spend on health care going to the people who provide that care. That's what I'd call and efficient system. It doesn't look to me like we have a very efficient system.

Well.. what you are suggesting would DECREASE efficiency and would increase costs. Its one of the reasons that healthcare is more expensive in the US. ITs very inefficient to have a doc in the box (what we call small clinics out here that treat everything) in rural areas. However, it gives needed access to patients that would otherwise have to travel 45 minutes or more to get to the next clinic in a larger community.

We just seem to have a very large intellectual disconnect from what we want in America. WE want good wages.. and more jobs.... so we then go on to hurt one of the primary wage producing and job producing industries because "they make too much"

We want access for patients wherever they are.. but we laud systems as better that have longer wait times and less choice.

We want better physicians and more.. but want to decrease the reasons for them to enter the field.

And meanwhile the insurance companies make bank.

 

[jaeger19]

Here's an example: I have a niece who is an ob/gyn. She has reported having done a half dozen or more C sections in a single shift.

That got me to wondering just how much a C section costs in today's market, so I asked Google, "How much does a Cesarean section cost?

The answer:



Since that's from four years ago, one would expect the cost to be more now, but let's take the difference actually paid by the insurers, $27866 - $18324 = $9,537.

If she performed six of them in a shift, then she generated $57,222 for the hospital (an HMO).

If even 10% of that amount was paid in salaries, she must have made nearly six grand in one shift.

While doctors are pretty well paid, they're not that well paid.

The other thing is the difference between what was billed and what was paid by the insurer. Care providers routinely bill far more than they expect to get. One has to wonder whether the uninsured patient is billed the full amount.

Well.. a couple of other things that we forget.

So that OB/GYN perform 6 C sections that shift.

On another shift she performed no c sections..

that money she made on the one shift.. basically paid for the time she was on shift and available for clients but no one came in.

(I am assuming from the way you talk that they were emergency C sections.. unplanned).


To answer your question about billing. In general the uninsured patient is billed the full amount. In general we are required to do so.. otherwise we are committing billing fraud. (in other words billing different insurances differently)

There are ways around this.. like cash discounts etc.. but in general if you are uninsured you get billed the full amount. that's why having insurance is so beneficial even if you have a high deductible. I had recent surgery. The discount on my surgery (allowable) was 50% of the billed cost.

 

[Dittohead not!]

Well.. what you are suggesting would DECREASE efficiency and would increase costs. Its one of the reasons that healthcare is more expensive in the US. ITs very inefficient to have a doc in the box (what we call small clinics out here that treat everything) in rural areas. However, it gives needed access to patients that would otherwise have to travel 45 minutes or more to get to the next clinic in a larger community.

We just seem to have a very large intellectual disconnect from what we want in America. WE want good wages.. and more jobs.... so we then go on to hurt one of the primary wage producing and job producing industries because "they make too much"

We want access for patients wherever they are.. but we laud systems as better that have longer wait times and less choice.

We want better physicians and more.. but want to decrease the reasons for them to enter the field.

And meanwhile the insurance companies make bank.

Yes, they do, and that could be one big reason why our health care is so expensive. Cut out the insurance companies, and costs would drop without cutting anyone's wages.

How might that be done, do you think?

 

[Dittohead not!]

Well.. a couple of other things that we forget.

So that OB/GYN perform 6 C sections that shift.

On another shift she performed no c sections..

that money she made on the one shift.. basically paid for the time she was on shift and available for clients but no one came in.

(I am assuming from the way you talk that they were emergency C sections.. unplanned).


To answer your question about billing. In general the uninsured patient is billed the full amount. In general we are required to do so.. otherwise we are committing billing fraud. (in other words billing different insurances differently)

There are ways around this.. like cash discounts etc.. but in general if you are uninsured you get billed the full amount. that's why having insurance is so beneficial even if you have a high deductible. I had recent surgery. The discount on my surgery (allowable) was 50% of the billed cost.

So, the hospitals have to regularly commit billing fraud in order to stay in business. That says a lot about our system, doesn't it?

That same doctor also told us that she's been assigned 800 more patients than she's supposed to have. It hardly looks like she's sitting around waiting for the next patient to come in.

Another interesting thing about that $18,000 figure - back in '69 when our son was born and insurance didn't pay for childbirth (at least ours didn't) it cost us $250 for a normal childbirth and an overnight stay in the hospital.

So, in 48 years the cost has climbed from $250 to $18,000.

Not even houses in Palo Alto have gone up that much.

 

[jaeger19]

Yes, they do, and that could be one big reason why our health care is so expensive. Cut out the insurance companies, and costs would drop without cutting anyone's wages.

How might that be done, do you think?

The problem is that cutting out the insurance companies then puts only one entity into deciding what gets paid for and what does not. And healthcare follows what gets paid.

I certainly don't want a Donald trump in charge of my healthcare.. and most certainly my not my wife's. Or worse a Bachman or any other right wing loon.

The key is to have multiple insurance companies that must really compete with each other for price and for quality of insurance.

The exchanges were a start under obamacare.. but way too limited. We need an expanded exchange marketplace

Perhaps state or federal public option to force more competition.

And we need to get individuals purchasing healthcare and not simply a large corporation.

 

[jaeger19]

So, the hospitals have to regularly commit billing fraud in order to stay in business. That says a lot about our system, doesn't it?

.

Oh no.. they aren;t committing billing fraud.. they charge EVERYONE that 6000 dollars... just that each insurance will pay something different depending on their contract. usually depends on the size of the insurance and the power they have to negotiate.

That same doctor also told us that she's been assigned 800 more patients than she's supposed to have. It hardly looks like she's sitting around waiting for the next patient to come in.

Well that's not c sections. I hardly doubt that. That's daily patient clinic visits. And I bet it won't be too long before she will be doing more surgery and less patients in the clinic while a nurse or PA is seeing the patients.

Another interesting thing about that $18,000 figure - back in '69 when our son was born and insurance didn't pay for childbirth (at least ours didn't) it cost us $250 for a normal childbirth and an overnight stay in the hospital.

So, in 48 years the cost has climbed from $250 to $18,000.

Not even houses in Palo Alto have gone up that much.

Yeah we have been over this before when it comes to billing. Honestly.. looking at that figure.. 250 to 180000 is really meaningless. Truly. And that's because the way medical billing works is so much more convoluted than the price of milk. That price could be that high because insurance companies are willing to pay close to that 18,000.. while on another procedure.. they pay hardly nothing even though its very costly (and the hospital has to provide it by law). (cost shifting)

That charge may reflect the cost of indigent care as well...

And then you figure all the available technology that's now sitting in that hospital in case your grandson or great grandson when they are borne needs that technology and services. There is a cost for that equipment to be available.. even when its not being used. And that gets shifted to others as well.

 

[Dittohead not!]

The problem is that cutting out the insurance companies then puts only one entity into deciding what gets paid for and what does not. And healthcare follows what gets paid.

I certainly don't want a Donald trump in charge of my healthcare.. and most certainly my not my wife's. Or worse a Bachman or any other right wing loon.

The key is to have multiple insurance companies that must really compete with each other for price and for quality of insurance.

The exchanges were a start under obamacare.. but way too limited. We need an expanded exchange marketplace

Perhaps state or federal public option to force more competition.

And we need to get individuals purchasing healthcare and not simply a large corporation.

I'm on a national health care now, called Medicare. It's just as good as the Blue Cross policy I had previously, and doesn't seem to be being run by Trump.

The trouble with individuals purchasing health insurance under current law is that (1) it has to be bought with after tax dollars, and (2) an individual with health issues or one who is past 55 or so has a difficult time finding anyone who wants to cover them at anything like an affordable rate.

 

[vesper]

It just broke on twitter a little while ago that VP Pence, Ryan, and the Freedom Caucus have made major headway in the replacement for Obamacare. It could add 15-20 votes that will ensure it's passage in the House. So it looks like they are real close to moving this legislation to the Senate as soon as they get back from their Spring break.

 

[jaeger19]

I'm on a national health care now, called Medicare. It's just as good as the Blue Cross policy I had previously, and doesn't seem to be being run by Trump.

The trouble with individuals purchasing health insurance under current law is that (1) it has to be bought with after tax dollars, and (2) an individual with health issues or one who is past 55 or so has a difficult time finding anyone who wants to cover them at anything like an affordable rate.

Yes.. you are on a national healthcare called medicare.

Medicare also covers the cost of treatment for miscarriages, and for abortions in circumstances where the pregnancy is the result of incest or rape or would threaten your life if you went to term. It doesn't cover elective abortion if you choose to terminate your pregnancy

Currently and this has been in place ffor some time.. federal dollars cannot be spent on abortion unless you meet the " criteria".

That prohibition has survived democrats as well as republicans

The trouble with individuals purchasing health insurance under current law is that (1) it has to be bought with after tax dollars,

Which is absurdly stupid.. it should be purchased with pre tax dollars from every persons healthcare savings account. Into which there is no limit of money with only the stipulation it goes toward medical expenses. and into which your employer puts money into.

an individual with health issues or one who is past 55 or so has a difficult time finding anyone who wants to cover them at anything like an affordable rate.

Which when you think about that its really BS. Because the vast majority of folks ARE being covered. BY PRIVATE INSURANCE CURRENTLY. So why CAN"T they be covered on an affordable rate again? Think about it. Its a BS argument (not saying that you are making it.. but think about it.. the insurance companies ARE ALREADY covering these folks.. and making a profit.. so how is it they can claim they can't cover these folks and make a profit?

The reason they can't get affordable insurance is because the insurance companies don't want to deal with them. the number of people is so small who cares... the insurance company is busy gouging their employer.

 

[Greenbeard]

It just broke on twitter a little while ago that VP Pence, Ryan, and the Freedom Caucus have made major headway in the replacement for Obamacare. It could add 15-20 votes that will ensure it's passage in the House. So it looks like they are real close to moving this legislation to the Senate as soon as they get back from their Spring break.

You're in for a disappointment.

 

[vesper]

You're in for a disappointment.

Everything I have read today sounds encouraging. We shall see.....

 

[Dittohead not!]

Yes.. you are on a national healthcare called medicare.

Yes, and have been for several years now. Without it, no one would sell me health insurance. I'm too old.

Currently and this has been in place ffor some time.. federal dollars cannot be spent on abortion unless you meet the " criteria".

That prohibition has survived democrats as well as republicans

Probably due to the rather low number of abortions needed for patients in the 65 + age category, don't you think?

Which is absurdly stupid.. it should be purchased with pre tax dollars from every persons healthcare savings account. Into which there is no limit of money with only the stipulation it goes toward medical expenses. and into which your employer puts money into.

It is absurdly stupid, not to mention unfair, but that's how it is.

Which when you think about that its really BS. Because the vast majority of folks ARE being covered. BY PRIVATE INSURANCE CURRENTLY. So why CAN"T they be covered on an affordable rate again? Think about it. Its a BS argument (not saying that you are making it.. but think about it.. the insurance companies ARE ALREADY covering these folks.. and making a profit.. so how is it they can claim they can't cover these folks and make a profit?

The reason they can't get affordable insurance is because the insurance companies don't want to deal with them. the number of people is so small who cares... the insurance company is busy gouging their employer.

Because it's private group insurance. The insurer is willing to cover a thousand people, a few of whom might be over 60 and/or have diabetes, heart disease, etc. They're not wiling to cover one individual who has any of those conditions. If they're forced to by government decree, they will make sure the policies are so expensive and have such high deductibles that they can still make a profit.

 

[Puigb]

Everything I have read today sounds encouraging. We shall see.....

7 years your political party had to come up with something. And they have squat, and you know it.

Good thing is, your party will likely end up paying for it in 2018 and 2020. So much for the "adults" being in charge, eh?