About as good as the driver’s ed.
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Can you give me an example of what “preventative care” procedures they’re not happy to cover?
Are these the same sort of procedures that tend to catch big things early, leading to less cost and better outcomes overall?
It says a lot about the U.S. healthcare system that the presentation of the bill incorporates a used-car salesman’s “anchoring” trick.
Followed by the “free”-market worshippers insisting that this is “just negotiation,” totally ignoring the fact that a single-payer universal system would have vastly more negotiating clout with hospitals and pharma companies than any one for-profit insurance company would.
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There was the ‘cadillac insurance’ tax. So if you had really really expensive health insurance through work the premiums over some limit would be taxed.
That was part of the ACA funding stream, I believe.
But its implementation was delayed at least once. I don’t think it has come into effect.
Still it would have applied only to a small minority of employer provided plans.
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This is exactly correct and one which the ACA did not do enough to address. The reason why most Democrats and Republicans both hated the law was it really did nothing to fix health care costs - it was simply an insurance law.
Heath insurance != Health care
The only “plan” being tossed out there by the GOP is the old “broaden the base” fallacy - deregulate and allow insurance to be sold across state lines and theoretically increasing bargaining power and lowering prices. Problem is there is no evidence this will work and simply allows for insurance companies to return to the wild west rules of before.
Again, none of these plans actually lowers the cost of health care in America. Only a true single-payer system will do that.
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Really any regular doctor’s visit, test, scan or other preventative care involving payment to a physician, hospital or (indirectly) pharma company that occurs before a serious problem is found. The insurance companies do cover them, but the industry business model (which focuses on paying out only for catastrophic situations where the big things have already taken hold) is not happy about it.
They can depend on actuarial tables to figure out the odds they’ll have to pay out on a serious illness or injury and optimise their business decisions accordingly. But if every healthy person is allowed to go to the doc for an annual check-up on the insurer’s dime, that’s just a straight out cost on a massive scale. That’s why the ratio of co-payment/deductible to insurance payout is usually higher, relatively speaking, for an annual checkup than it is for treating a disease or injury.
In terms of prevention, the health insurers prefer to focus on offering discounts for things like not smoking, drinking, etc. that don’t involve cash payments to providers. The latest kick is offering breaks if you send them your fitness tracker data (via highly insecure systems, of course, because encryption befitting such data is a business cost).
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The story for ‘tragedy of the commons’ between health insurers would go:
It makes sense to pay for preventative care overall, but because the payout is long and people switch insurance companies regularly the company that does offer better preventative care pays the cost of preventative care, but doesn’t get all of the benefit from it (any failure to capture that benefit alters the balance of how much preventative care a rational acting insurance company would pay for). People switch insurers pretty often in the US, for various reasons (such as switching jobs).
There are a couple wrinkles that make it worse than that.
First essentially every private insurance customer switches to medicare when they turn 65. So private insurers reap none of the benefits of prevention after that.
Second really sick people often lose their income and end up on medicaid. Again removing their costs from any private health insurer’s books.
Its not clear to me how true this effect is in reality. In the employer paid insurance realm preventative care is usually pretty well covered, and they seem to put some effort into trying to get people to use it. So I suspect there is pretty good payback on the order of 1-2 years.
The individual insurance market, however, has a lot of short term customers (I think more than half). People between jobs or whatever who leave the individual market altogether after a year or less. They are surely also much more likely to switch plans to get a lower premium or different coverage.
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I always thought it was curious that everyone seems to love medicare—voters will flat out threaten to kill any candidate who suggests cutting it—but make a modest suggestion like “what if we just expanded medicare to cover everybody?” and everybody starts screaming “OMG SOCIALISM!!!”
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Which means the employer just makes the plan far shittier to save costs.
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Yea, I got a $6000 bill for a hospital transfer ambulance ride.
Called and talked to them for 10 minutes and the dropped it to $4000.
It was noticeably worse than my car buying experiences.
*irrelevant aside - the one time I bought a new car was actually far worse than buying used cars. Used cars are pretty easy. There is an object, you are trying to buy it. There are many similar objects. The parameters of the deal are simpler.
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But you saved $2000! What a deal!
Seriously, our approach to these things is incredibly messed up. I tell people in other OECD countries stories like yours and they’re flabbergasted. Even if they had to spend time inquiring into how much that ambulance ride cost while they’re recovering (which they don’t) they’d find out that it cost a helluva lost less than $4k.
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Cancer free for 36 months and the Insurance Company can’t drop me for pre-existing conditions.
That is until Her Drumpf fucks the ACA into the dirt.
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I don’t think he understands how the separation of powers works. I wonder if he honestly thinks he can just rule by decree? I think Obama’s tactic of using executive orders in some cases has him misunderstanding the limits of executive power.
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Yes. They often deny secondary mammograms. Often times a single mammogram doesn’t cut it, because of problems like dense breast tissue that you need to get rechecked or get a different kind of scan. when this happened to me, my insurance company did not pay, because it was more than on mammogram in a year. We had to pay out of pocket, and thank god we could afford to do so. In my case, the secondary scans were medically necessary because they did not get good imagining on the first go round. This is not an uncommon problem.
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Yet again demonstrating healthcare in America is not in the business of wellness.
Also thanks for your insightful post.
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Yes, who was it who ranted about socialist health care and “death panels”?
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Thanks for a good comment. This is what I was referring to with my MBA comment above. The people running these companies are obsessively (indeed irrationally) focused on making the next quarter’s numbers. So even if preventative care does benefit the corporate bottom line within 1-2 years*, these myopic greedheads can’t envision it. All they see is that they’ve been paying for checkups for healthy people for the last 3-6 months.
[* I agree that this does happen, but only with people over age 45 or so.]
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The Palin’s of the world… which I’m sure has a healthy cross over with Trump voters.
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This is what I’ve been saying. They obstructed Obama’s original plan so we got the ACA, they spent years telling us how broken and awful it was, and now they’ve realized they can get all the credit for the thing Obama tried to do in the first place. It would be a huge political coup for the GOP
On the bright side that would mean people actually have health insurance so win … ish?
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