Thread: How to bring health care costs down?

Originally Posted by JDJarvis

You write a check and you have the money becasue you didn't have to pay for health insurance coverage and you might even earn more since your employer would use money to lure workers instead of health insurance. If you didn't have the funds, you'd owe the hospital and pay on your bill like you currently do with your credit card or other such accounts.

The problem them becomes what happens when you have medical bills that top $5,000 or more, which are not uncommon.

Hospitals would go out of business because there's no way the average person could repay such vast sums of money quickly and the hospital would have to contract out services to hunt down the money. Even if people could start making payments immediately, they wouldnt be very large payments and it would take YEARS to pay off the debt.

Eventually you'll have people avoiding hospitals and doctors because they cant possibly afford the treatments. Then, when their condition gets serious, they end up in the ER and STILL cant pay.

Originally Posted by Hoplite

And a pretty terrible one. My last medical bill was $1,500. Does that mean I go into the hospital with a briefcase full of cash?

If an idea seems radically simple and you wonder why it hasn't been implemented before, there's probably a reason you've overlooked.


They budget because they dont have the money to pay for the services, which means fewer people get medical treatment and they end up in the ER without the ability to pay.

Yes, onfg that means since you will be saving 2400 a year in a hsa you would be responsible for you own 1500. See how that works? After the 1500 you will then be covered for 80-100% based on plane choice.

You would be responsible for your bills but you will also be putting away 2400-9600 a year in an hsa!! Nice huh? That hsa would be fully portable to take from one job to another and or even if self employed or unemployed...

How can you be against it? I know because bush sucks?

Originally Posted by Hoplite

The problem them becomes what happens when you have medical bills that top $5,000 or more, which are not uncommon.

Hospitals would go out of business because there's no way the average person could repay such vast sums of money quickly and the hospital would have to contract out services to hunt down the money. Even if people could start making payments immediately, they wouldnt be very large payments and it would take YEARS to pay off the debt.

Eventually you'll have people avoiding hospitals and doctors because they cant possibly afford the treatments. Then, when their condition gets serious, they end up in the ER and STILL cant pay.

HSA+catastrophic plan would mean for a 5k bill you would pay 1500 deductible and anywhere between 0-20% of the remainer so say max 1500 plus 700 or 2200 which will be in your hsa and if not you can simple write checks from the hsa when new deposits are made each payroll period. Any further car that callender year will be covered between 80-100% based on plan choice. Costs to individuals will decrease and per capita spending on healthcare wood decrease.

It's so simple and easy... You really can't argue against it... But you will since teabaggers are racist or something

Originally Posted by CSA

Yes, onfg that means since you will be saving 2400 a year in a hsa you would be responsible for you own 1500. See how that works? After the 1500 you will then be covered for 80-100% based on plane choice.

You would be responsible for your bills but you will also be putting away 2400-9600 a year in an hsa!! Nice huh? That hsa would be fully portable to take from one job to another and or even if self employed or unemployed...

It still only covers part of the costs and doesn't help someone with chronic medical conditions or who doesn't earn enough to afford one of these plans or make enough at their job to add much to it.

You're still screwing low-income people.

Universal healthcare is the ONLY solution that makes any sense at all.

Originally Posted by JDJarvis

It depends on what you are looking at.

Let's compare a less socialized state with a more socialized state. NH and MA

Hospital Adjusted Expenses per Inpatient Day, 2009
NH $1,980
MA $2,351

Hospital Adjusted Expenses per Inpatient Day by Ownership, 2009
for-Profit Hospitals
NH $1,738
MA $1,646

Non-Profit Hospitals
NH $2,003
MA $2,397

State/local Government Hospitals
NH N/A
MA $2,154

Average Per Person Monthly Premiums in the Individual Market, 2010
NH $294
MA $437

The more socialized system is more expensive in most cases in the factors I've selected in my comparison. Is this universally true...?

Now I understand a criticism of this comparison will be in the factors I chose to compare and that's a valid criticism. All studies work this way, selections are made in what data will be compared and conclusions reached have to be judged on data compared not simply the expressed conclusion.


numbers from:
Health Costs & Budgets - New Hampshire - Kaiser State Health Facts

This is a one state versus one state comparison and fails to address differences between states. Doesn't even seem to try.

You are also treating "socialism" like some sliding scale. Doesn't work that way so you are not even testing the right comparison.

The reason why many studies use % of GDP is because it helps equalize the countries a lot. It also helps to use a lot of countries in order to try and find a trend. There is a clear distinction between the rest of the industrialized world who uses some form of universal care and the US.

The US is also partially socialized but this half way attempt at socialization fails to achieve a lot fo the efficiencies socialized systems do in other countries because it is combined with a private system.

One of the major accusations leveled at the private care industry is the claim that their economic incentives to control costs are suspect. That the demand for their good is relatively inelastic and therefor they can rise prices without decreasing sales. So they are willing to take a cost increase of $300 if they know they can turn that into an increase in revenue of $400.

The costs associated with risk pools are real for insurance companies. It is one reason why administrative costs in the US are so high. In Germany there are instances where the insurance companies are in a similar situation and surprise surprise administrative costs are high.

When comparing numbers you can't just compare them. You have to justify your conclusions and when it comes to health care the cost savings associated with socialized care all have economic reasons.

There are also parts of our health care system that are inefficient because of government regulations and are efficient because of private enterprise. So it isn't like socialization is all positive and easy.

Originally Posted by Hoplite

The problem them becomes what happens when you have medical bills that top $5,000 or more, which are not uncommon.

Hospitals would go out of business because there's no way the average person could repay such vast sums of money quickly and the hospital would have to contract out services to hunt down the money. Even if people could start making payments immediately, they wouldn't be very large payments and it would take YEARS to pay off the debt.

Yeah collecting on bills of $5,000.00 or more is so difficult for auto-dealers, appliance dealers, furniture stores, home renovation...:rolleyes:
{please note sarcasm}

Eventually you'll have people avoiding hospitals and doctors because they cant possibly afford the treatments. Then, when their condition gets serious, they end up in the ER and STILL cant pay.

Or maybe we can donate to charity hospitals, low income clinics and the like. Maybe actual measures to directly adjust cost could be taken?

In 1929, medical charges for urban families making $2,000 and $3,000 per year averaged $67, unless they faced hospitalization and then it could cost them $267.00.
So regular care was 2.68% of income. Hospitalization could bring that up to 11% and the system functioned.

Of course we had increases in medical science, professional standards and the medical care delivery. The science of health care improved but somehow as the science improved the cost grew...unlike every other sector of the economy. Costs rose with standards. Insurance became more popular to meet the risks presented by raised costs.

Insurance brought more people in to receive care. In other economic models when you have more customers costs go down, but not with U.S. health care, costs rose.

As industry couldn'' or wouldn't provide affordable insurance coverage to all the government stepped in with medicare and medicaid and costs for all went up by a factor of 15. (more then twice the rate of inflation).

Somewhere, somehow, something went wrong.

So why can't we get by on 5 or 10% of our income now when people could manage on 2.68% in the past?



source on past costs: Health Insurance in the United States | Economic History Services

Originally Posted by Stangler

This is a one state versus one state comparison and fails to address differences between states. Doesn't even seem to try.

One state has a health care system that is more socialized, one has a system that is less socialized in comparison and you can't see the comparison?

You are also treating "socialism" like some sliding scale.

I was as the question posed was to compare a more socialized system with a less socialized system. The question I was addressing implies there is indeed a sliding scale.

There is a clear distinction between the rest of the industrialized world who uses some form of universal care and the US.

I wasn't addressing that comparison. I chose two states bordering each other on purpose. As they are both examples of U.S. healthcare not a comparison of U.S. healthcare and non-U.S. healthcare.

When comparing numbers you can't just compare them. You have to justify your conclusions and when it comes to health care the cost savings associated with socialized care all have economic reasons.

Yes, when comparing numbers you have to look deeper, ideally past the political agenda being presented (or even promoted) . So why do we rank national health care systems on values of derived "fairness" and "degree of socialization" (which is most certainly done)?

Originally Posted by Hoplite

It still only covers part of the costs and doesn't help someone with chronic medical conditions or who doesn't earn enough to afford one of these plans or make enough at their job to add much to it.

You're still screwing low-income people.

Universal healthcare is the ONLY solution that makes any sense at all.

read CLOSLEY... you would have an HSA and a heath insurance plan.. Meaning it helps EVERYONE...

It actually helps the por more then anyone else as they would be able to afford a plan and save for emergencies..

Since your company would be saving they can also add to the HSA...

Originally Posted by CowboyTed

Very good post. I was working around recommending solutions to a government body in the area of healthcare a couple of years back. The simple thing which they found hard to grasp is that there in the Customer Care field. This was at the highest levels.

I was showing them simpler ways of slicing the turkey. First was to stop using specialiased healthcare software for electronic records, there is greate customer care software on the market which has way higher development costs, has been on the marketplace considerably longer and is very scable.

There's a huge culture shift happening now in the wake of the ACA, at least in state governments. Instead of relying on antiquated, clunky customized information systems, states are moving toward modern, reusable off-the-self stuff that's a lot more customer-friendly. It's going to take most of them a few years to get there but they're feeling the push toward bringing their IT systems out of the 1970s.

Outside of state governments, on the provider side I think HITECH is the biggest influence on getting them to start using interoperable electronic records that can actually move beyond the boundaries of their organization. That's still a few years down the road, as well--on a large scale, anyway. But these are exciting times all around.

Originally Posted by CSA

Basically we should allow more people to buy high deductible plans and save the rest in a HSA which can grow for their lifetime, and be used for medical emergencies.

We do allow that.

Originally Posted by JDJarvis

The more socialized system is more expensive in most cases in the factors I've selected in my comparison. Is this universally true...?

Why are hospitals in Massachusetts "more socialized" than hospitals in New Hampshire?

Originally Posted by CSA

Make people pay cash... Simple idea..

If you had to pay $300 a month in order to get all the pizza you want at any pizza place what would you do?

Well, you would eat a ton of pizza... why not! its "paid for" and why waste the benifit...

Same concept...

Now if you were able to put pay say $50.00 a month for the pizza fund and instyead of all you can eat you had to pay for 20% of what you ate, but the other $250.00 was put in a saving account called a Pizza savings account on a pre tax basis would you eat as much pizza as the above example? No...

You would eat some but since it not "Free and paid for" you would not use it as much. You can then save in the Pizza savings account for when your spouse invites 35-50 friends over and forgets to tell you and you have an emergency need for pizza!

Hope that easy to follow :p

Basically we should allow more people to buy high deductible plans and save the rest in a HSA which can grow for their lifetime, and be used for medical emergencies. the high deductible place can kick in after 1500 for individuals and 3k for families. after the initial deductible is met the plan should cover 80-100 percent based on premium.

When people have to BUDGET costs will go down..

If everyone is given all the milk they want for a set price of 5 a week people will drink a shit load of milk... if they have to pay for milk they will drink less and instead drink some water.. its simple economics..

So may I ask a few questions:

How many people do you know who go down to there local hospital and ask for chemotherapy because it is free? or wanted an XRay of the whole family...

Doctors perscribe treatments. Should cost come into the equation, were a patient starts arguing with a doctor cause they have to save a few bucks so they can pay for heat (because he is sick he is getting no over time).

While there is merit to your arguement around sports injuries (let them pay to get back on the field quicker) or gettign treatments that are not essential but could help healing faster. The medical profession know best so leave that part to them.

To reduce costs the best way is standardised care as previously explained here. If you give a 10 different doctors the same patient they will treat them 10 different ways that what cost extra money.

Originally Posted by JDJarvis

It depends on what you are looking at.

Let's compare a less socialized state with a more socialized state. NH and MA

Hospital Adjusted Expenses per Inpatient Day, 2009
NH $1,980
MA $2,351

Hospital Adjusted Expenses per Inpatient Day by Ownership, 2009
for-Profit Hospitals
NH $1,738
MA $1,646

Non-Profit Hospitals
NH $2,003
MA $2,397

State/local Government Hospitals
NH N/A
MA $2,154

Average Per Person Monthly Premiums in the Individual Market, 2010
NH $294
MA $437

The more socialized system is more expensive in most cases in the factors I've selected in my comparison. Is this universally true...?

Now I understand a criticism of this comparison will be in the factors I chose to compare and that's a valid criticism. All studies work this way, selections are made in what data will be compared and conclusions reached have to be judged on data compared not simply the expressed conclusion.


numbers from:
Health Costs & Budgets - New Hampshire - Kaiser State Health Facts

JD,
thanks for your post and thanks for keeping it factual... Actually this one was a bit of mystery to me and took some checking... So I went for the latest figures.

First I have to state that this is one state comaprison against another (with one state being quite small, NH is 1M people. The other is that it is very hard to find actual figures on how socialised one in caprision to another. We are just persuming MA is more socialised. We are also leaving us out for a statistical outliner...

Massachusetts

What Massachusetts Spends On Health Care? $68 Billion
...
$68 billion. That really big number is in this report to the state from Rand (The $68 billion number is on pg. 4 of the executive summary). It’s a projection for what we were expected to spend last year (2010).

What Massachusetts Spends On Health Care? $68 Billion | CommonHealth

MA GDP for 2010 was $365bn which puts them on 17.2%.



New Hampshire

The bad news, according to Delay, is the fact that 10 years ago, the state's spending on health care was about 12 percent of the gross domestic product in the state. Today, it is about 19 percent, he said.
On average, a person spends about $8,800 on health care in New Hampshire, which Delay said is a little bit above the national average. Per family, the average annual cost of health care is $14,000, but Delay said about 75 percent of that is paid by employers.
http://www.nhpolicy.org/news/several...oastonline.pdf

That puts NH on 19%.

These are the best figures I can find but they do come with sources. Saying that I don't think the MA model is the best and it seems to have been implemented not very well. It would not be a becon of socialised healthcare it is more of a compulsory purchase order which ends up being more of a flat tax. I am not a fan of Obamacare because it was a compromise not a solution.

A through system collects the money the most econmical way which is using progressive income related payment system(Does sound like tax, yep it does). The pot is then used to provide healthcare to everyone that accesses it, complex billing and paperwork reduces as of result. Private insurance is still available in a two tiered approach.

Originally Posted by Greenbeard

Why are hospitals in Massachusetts "more socialized" than hospitals in New Hampshire?

Becasue Massachusetts had sweeping healthcare reform enacted in 2006, do a little reading on the topic.

Originally Posted by CowboyTed

First I have to state that this is one state comaprison against another (with one state being quite small, NH is 1M people.

How is that unlike comparing a European nation to the U.S. or say Canada to the U.S. ?

The lack of consistent and reliable numbers sure is a pain the butt isn't it?