It usually requires rejecting the idea that such infections are inevitable. Small changes in procedure and sanitation can result in huge benefits https://www.scientificamerican.com/article/beating-back-the-bugs/
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[quote=“anotherone, post:21, topic:104164”]
Small changes in procedure and sanitation can result in huge benefits
[/quote]I totally agree. But hospitals are bureaucracies, and bureaucracies are prone to systemic mistakes. I have a glass-half-empty attitude about institutional competence (or lack of it), honed from years of observation.
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I feel like we have lost the perspective that health insurance and health care are two different things. Health insurance is a bet you place with a company. The company takes on a risk and takes your money in the hopes that you won’t get sick and end up costing them more than you paid them. You are giving them money in the hopes that if you get sick it will cost you less than you paid them and they will cover the difference. All insurance markets work like this.
Some of the changes in the AHA made it more likely that you will win that bet instead of the company (by making them cover more things) and the Republican Party is just trying to undo some of that and make it a more even playing field. When did it become acceptable to require that business take on a risk that they wouldn’t normally take?
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U-S-A! U-S-A! U-S-A!
(Yes, this encapsulates my complete thought)
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And the GOP was recently crowing “If our plan is so bad where is the Democratic Plan? - they are doing nothing but sitting on their hands…”
We got news for you GOP - The Democratic Plan was ACA, the one you are trying to dismantle. If you want a new plan from the Dems, its going to be Bernies Single Payer. So just STFU.
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It became acceptable precisely when the same plan also made it compulsory for all non-group individuals to buy insurance, greatly increasing the Insurance businesses pool.
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You’re right, but do you honestly think at least for now, this will be the result of the current, ongoing struggle over healthcare? Should we really have to have a major health crisis to get there? Pulling out the rug from under the health care of all these people is going to be a disaster and it could have other, unintended consequences we aren’t even thinking about.
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Vets (in theory) get their own healthcare through the VA.
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Among gunshot survivors, 51-year-old House Majority Whip Steve Scalise is an outlier.
Aww, I’m sure United Healthcare would be willing to cut Scalise a break for old times’ sake, and in anticipation of future good relations.
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Most Americans are multi-national companies will billions of dollars. There was NEVER a level playing field between consumers and insurance companies.
If they don’t like paying for the health care of Americans who give them $$$, then they need to be in a different business.
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well what if you get shot by a policeman, you might have a preexisting condition of being non-white.
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I thought we were in crisis mode now. No, I do not think the right is going to ever offer single payor and that’s kind of my point. We all know what the fix is and it’s only politics that holds us back.
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I’m guessing this was meant as a joke, but it’s actually quite true.
I’m always amused when reports mention “people with preexisting conditions”, as if there is anyone that doesn’t have a preexisting condition. Those people don’t exist, or at least don’t exist over any measurable meaningful time span.
Everyone in the pool of “no preexisting condition” is simply 1 health issue away from changing categories. As soon as you use insurance for ANYTHING, that “thing” is now a preexisting condition. Perhaps your current insurance provider cannot call it that, but every other one will. Goodbye any semblance of a marketplace for purchasing insurance. You’re tied forever more to your current provider, the only one that cannot call it a preexisting condition. If it’s an employer plan, you’re also tied to that employer forever more. Goodbye to any position of equality in any of those relationships, you’ve got no other choices anymore.
That’s the devil with preexisting conditions. We talk about them like it’s some small group of people that did something wrong to end up that way. When, it’s really everyone. There’s only 1 group of people, people with preexisting conditions (either already or in their future).
The only people not in this group are those that die from that first health issue. Not exactly a group to strive to be in.
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That is true, but it fails to note the relationship between the affordability of health care with the individual’s choice to seek such care.
If my routine annual physical costs me $200 out of pocket, I’m rather less likely to get it.
Health insurance networks also have the effect of lowering overall costs, because the participating physicians agree to charge members of the network a lower rate than they charge cash customers.
If Joe Insured gets a physical, he pays a $20 copay, and his insurance pays the balance of the agreed upon fee (for a routine physical) of $80. $100 in total.
If John Uninsured gets a physical from the same doctor on the same day, he has to pony up $200.
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When you put it that way, it sounds like a small thing, but it’s a mountain, I think. Getting from here to there isn’t going to be easy at all.
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I agree that it isn’t going to happen easily which is why I take every opportunity to point out the obvious solution. Until we push for it, we will certainly never see it happen.
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I worked in a hospital business office handling claims for a couple of years and one thing I learned is that it actually works more like - a routing exam costs $100. Joe pays a $20 co-pay and due to contractual adjustments the insurer pays $10 forcing the hospital to cover the cost of a $100 exam with only $30. So, to make it work the hospital charges $800 for the exam. Joe pays his $20 and the insurer pays the contractual 10% which is $80 giving the hospital $100 to cover the cost of a $100 exam which is charged at $800. Meanwhile the cash paying uninsured pay $800 because we have laws making it illegal to charge different rates for cash and insurance.
The idea the insurance pays the rest of the bill is a common misconception and one the insurance companies would like us all to believe. In fact, insurers have contracts that allow them to adjust the bill down by as much as 80% or more. This is why they only cover “in network” aka places they have a contract with.
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Roger That!
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Health insurance markets don’t work like this, though. Yes, ideally insurance is something you only rely on to get yourself out of an otherwise-debilitatingly-expensive circumstance. But because everything in the health care market is so exorbitantly priced, most people have no choice but to rely on insurance to help them cover even the basic costs of personal care. Contrast this with the car insurance market: people aren’t likely to bill their car insurance for a standard oil change, because it doesn’t cost $400 out-of-pocket to get one every few months.
Humans are also uniquely valuable and inherently irreplaceable in a way that makes cost containment a lot harder. Car insurance companies, for instance, can limit their liability by relying on the depreciating value of most products to effectively “age out” older vehicles the first time they bump into a lamp post. Cars almost never increase in value over time, so the long-term exposure for an insurer goes down the longer they insure my vehicle. By contrast, humans if anything get more valuable over time while also getting more expensive to “maintain”, meaning insurers’ exposure goes up the longer a person lives and stays insured.
The irreplaceable nature and complex interior workings of human beings also makes actuarial risk-based pricing effectively impossible. If I get into a car accident, State Farm can total my vehicle and send me off to buy a new one if the repair cost is higher than my car’s market value. Premera can’t “total” my body and send me off to get a new one just because the cost of fixing my broken bones and internal bleeding exceeds the market value of my life (what is the going market rate for a 1984 white male with a family history of high cholesterol and diabetes, anyway?). You also can’t guarantee that only people who don’t take care of themselves will get sick, or develop a permanent illness, or get cancer, or be born with a physical or mental disability. It’s therefore much harder to say that those people “deserve” to have a higher health insurance premium the way that an 18-year-old male “deserves” to have a higher car insurance premium because they’re statistically more likely to get into an accident due to reckless driving. Yes, sick people cost more to care for, but that’s a problem that insurance markets are inherently incapable of solving; they understandably don’t want to cover those costs, so before the ACA, those people were left to fend for themselves while also being less capable of making the money needed to afford their own care.
Somebody has to pay for the cost of taking care of people, and everybody will eventually need some form of expensive medical care. If you don’t, you’re a statistical outlier, not the norm. A long time ago, America apparently decided that insurance companies were the best way to manage the rising costs of health care (they’re not). The ACA’s requirements for insurers exist because 1) it was possible to buy coverage that was actually worthless, or lose it the minute you actually incurred any sort of costs, and 2) if America is going to rely on insurers to make health care “affordable”, then insurers have to hold up their end of the bargain and actually pay for things regardless of a person’s individual circumstances.
Obviously, asking a risk-based actuarial system to pay for an entire nation’s everyday health care costs is stupid. If you want to let insurers get back to the business of denying coverage to “uninsurable” people and existing only for emergencies, then you either need to contain costs to such an extent that a single trip to the doctor’s office or the pharmacy isn’t financially ruinous, or you need to come up with a way of paying for our current high health care costs that doesn’t involve relying on insurance companies to do so.
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