Comments on: Pre-existing Conditions

By: Tully

Tully — Wed, 23 Apr 2008 14:24:40 +0000

Adminstrative costs and profits across all payors total about 7% of the total expenditures for healthcare.

You mean for the U.S.? Source, please? (I agree with your conclusion.)

By: Chris

Chris — Wed, 23 Apr 2008 05:09:25 +0000

That should say "that wouldn’t get us near our fellow western Democracies"

By: Chris

Chris — Wed, 23 Apr 2008 05:07:44 +0000

Adminstrative costs and profits across all payors total about 7% of the total expenditures for healthcare. Our percentage is higher than other western Democracies. The UK does about 3%, France 1.5%. Having said that we Americans annually spend more than 2.5 times what the average Brit does (slightly less than for the average Frenchmen). So while eliminating admin costs would help (and even the UK can’t eliminate them) that still would get us near our fellow western democracies. Bottom line, we Americans spend too much on healthcare across the board

By: JudasPriest

JudasPriest — Tue, 22 Apr 2008 21:34:19 +0000

Health care costs can be reduced if the middle men, i.e., insurance companies, medicine importers, pharmacies are removed from the equation. Why cant each doctor/hospital offer a fee per diagnostic code that has a ceiling-cap regulated by the federal health organization. Likewise, the drugs can also be regulated in the same manner; a nominal price per medicine and let the market competition happen underneath these maximum values for the sake of the insured as something positive for once in this capitalist world. This is the root-cause of the high health care problem in US regardless of having private or universal insurances.

The insurances have a list of "reasonable" charges for each diagnostic code. They call this a nationally averaged health data for each geographical location that differs from one zip code to another. I asked to access this data but given a definite "no" by my insurance company. I’d be charged for it but I’d not be given the access of the data, what a nice-setup. I dont believe that Mc Cain’s plan if there is any would do anything that would harm these middle-men insurance and medicine companies as it’d be totally against the Republican’s party policy. I have at least some hope that the tables can be turned by Obama more aggresively than the other candidates.

By: Nihat

Nihat — Tue, 22 Apr 2008 20:59:35 +0000

Chris,

"I beleive these have become less popular because of cost issues."

Is that because, in an association, there is no employer to subsidize the premiums? Or, is it because it is not as desirable a scheme for insurance companies, and hence, they don’t offer as good rates? I don’t know, but with a freely formed association not anchored firmly to a reasonably random sampling method, you might end up with a biased pool.

By: Chris

Chris — Tue, 22 Apr 2008 19:50:00 +0000

There are other means of gathering people for insurance purposes, an association for example. I beleive these have become less popular because of cost issues.

By: Nihat

Nihat — Tue, 22 Apr 2008 17:42:30 +0000

Regarding employment-based group insurance and individual insurance…

Are there (or can there be) other scenarios to provide group insurance? I’m not talking about government-run programs, where the group is defined by need or age group. I’m curious as to why for example residents of a school district/town/city/etc cannot shop for insurance as a group. What is it that makes employment-based regime work (desirable for the insurer)? And what, if anything, would make the other undesirable? Is it that the premiums are guaranteed to flow in, or that people rarely opt out since the employer generally pays a good portion of the premiums in the employment-based regime? In a residence-based scenario, it’s hard to imagine a mayor or city council providing similar guarantees or subsidies. But other dynamics advantageous to all parties may well arise. Quality of schools is a big point of advertisement for cities; quality of health coverage could be another one, and cities may well have things to do better to help reduce costs.

By: Chris

Chris — Tue, 22 Apr 2008 13:15:32 +0000

A few comments from someone who works in the "industry"
1. Personal experience is valuable but it can be very dangerous in the conclusions it leads to. Breast cancer, Elizabeth Edwards condition, is a good example of that. Because of the "political importance" of breast cancer we have many state and national mandates regarding coverage. Setting aside how much we value each of those mandates (i.e. breast reconstruction, mammography coverage starting at age 40, MRI coverage), mandates do raise the cost of coverage. It is clear, the higher the cost, the greater difficulty employers have in covering their employees, particularly smaller employers.
2. Please note, in a large portion of the insured (those covered by their employer as part of employment) pre-existing conditions are not an issue. If I presently work for GM and I have diabetes but then get a new job at Ford, I won’t be "excluded" because of my prior condition. Now if I go out on my own and try to buy insurance (an individual policy) that will come into play.
3. There is competition, there are choices. I believe a big part of the "problem" is that the choices cost so much, particularly on an individual level. But that is how insurance works (i.e. spreading risk over a larger group). Health insurance is not a "pre-payment plan". And in any payment scheme (i.e. insurance vs. government run health system) we will be spreading costs over a larger group. The arguments come in when we discuss one’s "fair share". And the related argument is the "fairness" of illness (i.e. congenital disease due to no personal behavior vs chronic illness due to poor lifestyle)
3. "Incomprehensible system". Its not a system.
4. "Why does the company limit my options" The irony there is, I believe, many companies would be very happy to "give you your freedom". However, they’d want you to pay for that freedom. Many small businesses give their employees "complete freedom".
5. Insurers are "fine" with the movement to "taylor your own plan". Just remember, each "unique" plan will be a tiny bit of business. The insurers will probably focus more energy on getting a large client (i.e. an IBM) vs a lot little clients with difficult to administer individual plans. You’ll note that the largest governmentally run program, Medicare, doesn’t offer "taylor made plans". They have a package that you can get/buy and by and large leave the "tayloring" to you (i.e. Medigap coverage or your own dollars)