Seriously? 18%?

[cameraman]

I just got the bill for this year's health care. The premiums went up 18% for a bit less coverage:flame: Not quite sure how they can justify an 18% increase:saywhat:

Total costs for a single adult are $6761.52 on the year.

This is some seriously ****ed up ****.:shakehead

[stroker]

I just got the bill for this year's health care. The premiums went up 18% for a bit less coverage:flame: Not quite sure how they can justify an 18% increase:saywhat:

Total costs for a single adult are $6761.52 on the year.

This is some seriously ****ed up ****.:shakehead

$500/mo+? Screw that. Put the money into 12 CDs that mature each month and take your chances. That'll teach the bastards.

[SurfaceUnits]

someone has to pay for the 35 million who will be covered under the new regs

[cameraman]

More people paying into an insurance system should lower the overall costs by spreading the risk out over a large pool. This is a private firm, more subscribers should in no way increase the costs.

[chop456]

Almost everyone I know had a 17-20% increase in premiums. Both the wife and I carry family plans. I'm starting to think about dropping one and putting that $400+/mo. into the 401K.

The e-mail notice about the increase came right out and said that it was due to the government-mandated plan.

[cameraman]

That makes no sense to me. The law drives business to the insurance companies by forcing companies to provide insurance their workers. More business should be good for the companies. Geico, Progressive, the General and AllState are not running 20 commercials an hour because more subscribers are bad for insurance companies.

The changes that could increase the insurance companies costs would be:
1. the guaranteed issue and the end of annual & lifetime caps
2. the no copay for preventive care & screening on new plans
3. can't drop sick subscribers
4. can't charge higher rates for any individuals based on pre-existing medical conditions after 2014

Those changes caused an 18% increase? How many uninsured, deathly ill people were there who suddenly swamped out all of us who had insurance along with all the non-deathly ill folks who just signed up? It does not add up.

[datachicane]

They raise the rates 'cuz they can, just like they have for years.
What's the mystery? What are you, some kind of socialist?

It's what you get when you expect market forces to make a system efficient and competitive, while the lack of price information to decision makers ensures that there is no downward pressure on prices. In real markets the folks who shell out for services they themselves receive get to know the price up front, while in our system the person who prescribes treatment (your doc) hasn't the foggiest idea what it costs, although he enjoys the attention of pharma lobbying, and the folks who theoretically carry the risk (your insurance) couldn't care less, either, since they'll simply pass the cost on to policyholders on a nice cost plus basis. You, on the other hand, get stuck with the tab.

Somehow, magically, calling that goat rodeo a market while whining about commies is supposed to do the trick.

[Napoleon]

They raise the rates 'cuz they can, just like they have for years.
What's the mystery? What are you, some kind of socialist?

It's what you get when you expect market forces to make a system efficient and competitive, while the lack of price information to decision makers ensures that there is no downward pressure on prices. In real markets the folks who shell out for services they themselves receive get to know the price up front, while in our system the person who prescribes treatment (your doc) hasn't the foggiest idea what it costs, although he enjoys the attention of pharma lobbying, and the folks who theoretically carry the risk (your insurance) couldn't care less, either, since they'll simply pass the cost on to policyholders on a nice cost plus basis. You, on the other hand, get stuck with the tab.

Somehow, magically, calling that goat rodeo a market while whining about commies is supposed to do the trick.

Bingo. That is why medical cost have risen faster then inflation for something like 30 years now. This is implicit in what you say, especially the "the folks who theoretically carry the risk (your insurance) couldn't care less" which although that is what is happening I would take issue with the motive you ascribe to insurance companies. The part of the market that has become most monopolized is the hospitals, which regardless of what insurance companies may or may want to do can essentially dictate what the insurance companies must pay. The insurance market is more fractured.

Here in Cleveland (US' 20th largest market) we essentially have a choice between only 2 hospital providers. 2, for around 2 million people (3 if you count the 1 system in the Akron area)

If you are an insurance company and don't reach an agreement with the Clinic then you must with University Hospitals, or you are out of business in this market since having hospital X in a far western suburb (or force people to drive to Akron) as your sole supplier would be a death sentence for your business.

[KLang]

The e-mail notice about the increase came right out and said that it was due to the government-mandated plan.

This. They are forcing plans to cover things that weren't before.

Unless something changes, pretty soon employers will simply stop offering coverage.

[Elmo T]

I've had something new come up in the last two years: "med checks" by the order of my family doctor.

When my prescriptions would need renewed, I used to call the doc's office and they'd renew it. If it was something where I needed bloodwork (a couple times a year for my Lipitor script), they'd send me to the local lab to have blood drawn. Understood and not a big deal.

NOW - when I need a script renewed, they make me come in to see the doc for a "med check" even if no bloodwork is required. I have to schedule an office visit (and they very specifically note this is a "med check only"). I stop in, spend 10 minutes in the waiting room, 10 minutes in the exam room waiting for the doc, and less than 2 minutes with the doc. "Jim, I see you are here for a med check... any changes I should know about?....No?........Here is your new script...." :saywhat:

I have excellent insurance - excellent. The office visit costs me $10 - no sweat. But it seems the med check is only to bill the insurance for an office visit. :irked:

[Elmo T]

employers will simply stop offering coverage.

I heard this when it first broadcast on This American Life. Second act is worth a listen to see how this all got started.

Someone Else's Money from TAL (http://www.thisamericanlife.org/radio-archives/episode/392/someone-elses-money)


The part of the market that has become most monopolized is the hospitals, which regardless of what insurance companies may or may want to do can essentially dictate what the insurance companies must pay.

Add drug companies to the list. I am in Pharma central here and I know those companies dump huge amounts of money into the R&D end, but the practices on the sales end can be questionable at best.

The first act of that podcast will show how maybe the insurance companies aren't the evil empires some make them out to be.

[racer2c]

:\

[Al Czervik]

I've had something new come up in the last two years: "med checks" by the order of my family doctor.

<snip>

I have excellent insurance - excellent. The office visit costs me $10 - no sweat. But it seems the med check is only to bill the insurance for an office visit. :irked:

Seems to me like a CYA procedure for somebody's malpractice insurance.

"Were you prescribed medications without seeing a doctor? Did you suffer a heart attack, stroke, or the heartbreak of psoriasis? Call 1-800 BAD DOC$. You may be entitled to compensation"

[High Sided]

I stop in, spend 10 minutes in the waiting room, 10 minutes in the exam room waiting for the doc, and less than 2 minutes with the doc. "Jim, I see you are here for a med check... any changes I should know about?....No?........Here is your new script...." :saywhat:

I have excellent insurance - excellent. The office visit costs me $10 - no sweat. But it seems the med check is only to bill the insurance for an office visit. :irked:

have the do the same thing with my pain management Dr. every 3 months. been on the same meds for 18 yrs. usually takes 60-90 minutes for my "medcheck", 3-5 of them with my Doctor and his trainees, the rest with my ipod.

[cameraman]

$500/mo+? Screw that. Put the money into 12 CDs that mature each month and take your chances. That'll teach the bastards.

That might work except if you don't have insurance your medical procedure prices are vastly higher. The hospitals give the big insurers huge discounts and make it up by sticking it to the lowly cash payer. Personally I think they should outlaw cost shifting in medicine. What you pay for a treatment to keep you alive should not vary based upon which insurer you do or don't have.

[Ankf00]

health care has inelastic demand, and the cost allocation mechanism is completely fubar'ed. that's how they can hike rates like that w/ 0 push back. UHC, and this isn't to comment on the merits of it, at least offers some better form of cost allocation.

that plus quantitative easing & subsequent inflation. F QE2.

[Insomniac]

I've had something new come up in the last two years: "med checks" by the order of my family doctor.

When my prescriptions would need renewed, I used to call the doc's office and they'd renew it. If it was something where I needed bloodwork (a couple times a year for my Lipitor script), they'd send me to the local lab to have blood drawn. Understood and not a big deal.

NOW - when I need a script renewed, they make me come in to see the doc for a "med check" even if no bloodwork is required. I have to schedule an office visit (and they very specifically note this is a "med check only"). I stop in, spend 10 minutes in the waiting room, 10 minutes in the exam room waiting for the doc, and less than 2 minutes with the doc. "Jim, I see you are here for a med check... any changes I should know about?....No?........Here is your new script...." :saywhat:

I have excellent insurance - excellent. The office visit costs me $10 - no sweat. But it seems the med check is only to bill the insurance for an office visit. :irked:

My doctor will only do this if it has been more than a year since I've been in to see him.

[Insomniac]

My vote is the providers are driving up costs, not the insurance companies. I think it's a simple cop-out to summarize the increase in costs to the new laws. I can see an increase for individual type plans not part of a larger group because they have to let people in they could exclude/drop before, but businesses already had policies that didn't exclude pre-existng conditions and as far as I know, employers didn't force employees out of the insurance ever.

Double digit increases have been the norm for a long time. All this money, but everyone claims they aren't making money. Insurance companies say they have a low ROI, doctors say it's so expensive to practice. Not hearing much in the way of complaints from my local (constantly merging, building new hospitals) health systems.

[WickerBill]

What Insomniac said. Don't forget that someone is paying for the new palaces the hospitals are building everywhere, and the advertising dollars they spend to tell you how great the new palaces are. That's you and the insurance companies.

[nissan gtp]

I see all the big fancy medical offices going up, and hospitals that look like high-end resorts, and think "now there's an industry rolling in money and tax loopholes"

[miatanut]

That makes no sense to me. The law drives business to the insurance companies by forcing companies to provide insurance their workers. More business should be good for the companies. Geico, Progressive, the General and AllState are not running 20 commercials an hour because more subscribers are bad for insurance companies.

The changes that could increase the insurance companies costs would be:
1. the guaranteed issue and the end of annual & lifetime caps
2. the no copay for preventive care & screening on new plans
3. can't drop sick subscribers
4. can't charge higher rates for any individuals based on pre-existing medical conditions after 2014

Those changes caused an 18% increase? How many uninsured, deathly ill people were there who suddenly swamped out all of us who had insurance along with all the non-deathly ill folks who just signed up? It does not add up.
:thumbup:

Bingo. That is why medical cost have risen faster then inflation for something like 30 years now. This is implicit in what you say, especially the "the folks who theoretically carry the risk (your insurance) couldn't care less" which although that is what is happening I would take issue with the motive you ascribe to insurance companies. The part of the market that has become most monopolized is the hospitals, which regardless of what insurance companies may or may want to do can essentially dictate what the insurance companies must pay. The insurance market is more fractured.

Here in Cleveland (US' 20th largest market) we essentially have a choice between only 2 hospital providers. 2, for around 2 million people (3 if you count the 1 system in the Akron area)

If you are an insurance company and don't reach an agreement with the Clinic then you must with University Hospitals, or you are out of business in this market since having hospital X in a far western suburb (or force people to drive to Akron) as your sole supplier would be a death sentence for your business.
:thumbup:

They raise the rates 'cuz they can, just like they have for years.
What's the mystery? What are you, some kind of socialist?

It's what you get when you expect market forces to make a system efficient and competitive, while the lack of price information to decision makers ensures that there is no downward pressure on prices. In real markets the folks who shell out for services they themselves receive get to know the price up front, while in our system the person who prescribes treatment (your doc) hasn't the foggiest idea what it costs, although he enjoys the attention of pharma lobbying, and the folks who theoretically carry the risk (your insurance) couldn't care less, either, since they'll simply pass the cost on to policyholders on a nice cost plus basis. You, on the other hand, get stuck with the tab.

Somehow, magically, calling that goat rodeo a market while whining about commies is supposed to do the trick.
:thumbup:

Great discussion!

It would be hard to design a system worse than what we've got.

Separate the people consuming the services from the bills.
Add a layer of litigation for any mistake. A layer of litigation to avoid paying bills. A layer of marketing expenses.
Have a small number of very powerful providers controlling prices, and the little players paying a disproportionate share because they lack negotiating clout.

If there could be some sort of anti-trust exemption so all insurers get the same rate for a procedure, and individual out-of-pocket consumers would get whatever that rate is, then there would finally be some measure of cost control. Healthcare providers would compete on quality vs price. Insurers would compete on service vs price.

Elimination of the lifetime cap was a bad idea in my view. We can all make our own decisions on what we want to pay in premiums against what kind of cap that leads to.

[racer2c]

:thumbup:

:thumbup:

:thumbup:

Great discussion!

It would be hard to design a system worse than what we've got.

Separate the people consuming the services from the bills.
Add a layer of litigation for any mistake. A layer of litigation to avoid paying bills. A layer of marketing expenses.
Have a small number of very powerful providers controlling prices, and the little players paying a disproportionate share because they lack negotiating clout.

If there could be some sort of anti-trust exemption so all insurers get the same rate for a procedure, and individual out-of-pocket consumers would get whatever that rate is, then there would finally be some measure of cost control. Healthcare providers would compete on quality vs price. Insurers would compete on service vs price.

Elimination of the lifetime cap was a bad idea in my view. We can all make our own decisions on what we want to pay in premiums against what kind of cap that leads to.

:rofl::rofl::rofl: great post! Oh, that wasn't supposed to be funny?

[Insomniac]

Elimination of the lifetime cap was a bad idea in my view. We can all make our own decisions on what we want to pay in premiums against what kind of cap that leads to.

The cap has been going away for a long time. Even in the mid-90s the cap on a plan from a medium-sized insurance company was $1M. Only the really sick were hitting that limit. Transplants, severe injuries, long term treatments, etc. Costs have gone up, but 1M is a long way to go still.

Are insurance rates any better in places with efficient, patient-centered systems?

[datachicane]

http://www.washingtonpost.com/rf/image_296w/2010-2019/WashingtonPost/2011/06/07/Web-Resampled/2011-06-06/w-ezra296--300x588.jpg (http://www.washingtonpost.com/business/economy/the-hard-truth-about-health-care/2011/06/06/AG34XbKH_story.html)

[cameraman]

I think a law that prevents a medical provider (hospital, clinic, corporation, tax entity) from cost shifting among its customers would go a long way to simplifying things (it sure would make coding easier) and would provide the equal access to medical care that we currently do not have. Not to the level Maryland has gone where the state sets the prices. Just make the rule that a hospital has to charge everyone the same price per procedure. The hospital gets to set the price, it just has to be even handed about it. The uninsured cash paying patient should not have to pay more than a Blue Cross subscriber. It would not include Federally funded programs, that mess can remain as it is. Everyone else, all insurance companies and all individuals would have to be billed the same within each corporate entity. it might not make it any less expensive but it would at least be fair.

[TravelGal]

It has been my experience, both in CA and FL, that the providers charge more to those with insurance coverage. Not the other way around. I always assumed it was because they knew they were only going to get a percentage so they charged up the wazoo. Even if they knew the amount to be paid, they could take the rest as a write off.

In fact, I've noticed that if they do charge the same amount, then they give a discount if you do not have coverage to make up for the lack of it. Further, I get a 20% discount from my doctor because I'm not yet on Medicare.

Maybe there's more competition here in LA?

[miatanut]

It has been my experience, both in CA and FL, that the providers charge more to those with insurance coverage. Not the other way around. I always assumed it was because they knew they were only going to get a percentage so they charged up the wazoo. Even if they knew the amount to be paid, they could take the rest as a write off.

In fact, I've noticed that if they do charge the same amount, then they give a discount if you do not have coverage to make up for the lack of it. Further, I get a 20% discount from my doctor because I'm not yet on Medicare.

Maybe there's more competition here in LA?

We have encountered it both ways.

My wife is in the middle of $15,000 worth of dental work which is an entirely out of pocket deal and with considerable shopping, it was possible to get a little break for not being insurance, presumably because we will pay them faster than insurance. On the other hand, for regular medical stuff we get these bills with the outrageous price, the "customary charge", which still looks pretty steep to me, and since normally we aren't up to the annual deductible yet, it may look to the doc like the insurance company is paying it, but really, I'm paying it. Since I'm going to pay it anyway, maybe we could get a better deal just directly paying it. I've assumed not, but even if we did, then not running it through the insurance company means it doesn't count toward the deductible.

Even though I'm paying it, it's 2-2 1/2 moths to go through the process of submitting it to the insurance company, who changes the bill, then declares "go to our client for the money", the doc bills it and we pay it. Another broken part of the system.

Then, we've found if you go to a big provider with younger docs, there's $300 or more worth of CYA tests to pay for, with a simple med update visit. When you go to a small doc office with an older doc, and they know you are paying for this out of pocket, somehow they are able figure out what they need to know for the med update without $300 worth of tests.

Since we pay for a lot of this stuff ourselves, we do the shopping. Most of the US, working for large companies with deluxe health insurance plans, don't shop it, which is why we have the system we have.

[RaceGrrl]

IMO, some of the problem was created by the low or no copay insurance plans. It taught two generations of people that they have no personal responsibility for the cost of their health care. Snotty nose? No problem. A visit to my doc is free, so I'll go. He'll order an antibiotic I don't need because I don't believe him when he tells me it's a virus and has to run its course so I bitch until he relents.

Most of the patients we see have no clue what a deductible is. They receive nine months of maternity care and deliver a healthy baby, but feel no obligation to pay the $2500 deductible because they say " I have insurance." FWIW, the same patient who has no insurance receives a 40% discount for being a cash customer, so they get the same break that an insured patient does.

No matter what kind of health care system we end up with, people will bitch because Americans have become a bunch of whiny, self centered, entitled babies.

[KLang]

Thanks for your post RaceGrrl, very nice to hear from someone in the business. :thumbup:

[NismoZ]

A good friend of ours is "in the business" at a large hospital. She has daily contact with the "entitled"...and a huge chunk of them are NOT Americans. Pretty big factor if you ask me.

[cameraman]

FWIW, the same patient who has no insurance receives a 40% discount for being a cash customer, so they get the same break that an insured patient does.

I guess different clinics have different rules. I wish that had been the case for us. When he was employed the bills were discounted about 30% before the insurance paid them. Now paying cash, he gets billed the exact same original amount with absolutely no discount.:shakehead

Guess it is time to find a new provider.

[Tifosi24]

No matter what kind of health care system we end up with, people will bitch because Americans have become a bunch of whiny, self centered, entitled babies.

If you read Democracy in America by de Tocqueville, you will see that Americans have generally been whiny and self-centered.

[miatanut]

A good friend of ours is "in the business" at a large hospital. She has daily contact with the "entitled"...and a huge chunk of them are NOT Americans. Pretty big factor if you ask me.

Legions of recent immigrants with really good health plans?

[TravelGal]

I guess different clinics have different rules. I wish that had been the case for us. When he was employed the bills were discounted about 30% before the insurance paid them. Now paying cash, he gets billed the exact same original amount with absolutely no discount.:shakehead

Guess it is time to find a new provider.

Is it too simplistic to ask whether you've asked for the discount? Point made earlier that you'd pay quicker should be worth something. And if you can use check as opposed to credit card, something more.

I have found that sometimes a friendly but firm discussion with both the doctor and the person in the bowels of the billing department that handles my account can be very fruitful.

[cameraman]

It never crossed our minds to ask for a discount, we just paid the bills.

[TrueBrit]

Someone still needs to clue me in to why Yanks continue to buy the ******** that "socialized" medicine is a bad thing...recently had a family member in the UK that required two weeks in intensive care unit...they fully recovered thankfully
and there was no bill to pay...no worries about deductibles or premiums...i think you are all mad...

[Badger]

They raise the rates 'cuz they can, just like they have for years.
What's the mystery? What are you, some kind of socialist?

It's what you get when you expect market forces to make a system efficient and competitive, while the lack of price information to decision makers ensures that there is no downward pressure on prices. In real markets the folks who shell out for services they themselves receive get to know the price up front, while in our system the person who prescribes treatment (your doc) hasn't the foggiest idea what it costs, although he enjoys the attention of pharma lobbying, and the folks who theoretically carry the risk (your insurance) couldn't care less, either, since they'll simply pass the cost on to policyholders on a nice cost plus basis. You, on the other hand, get stuck with the tab.

Somehow, magically, calling that goat rodeo a market while whining about commies is supposed to do the trick.
That is a great summary of our current system.

[Indy]

Someone still needs to clue me in to why Yanks continue to buy the ******** that "socialized" medicine is a bad thing...recently had a family member in the UK that required two weeks in intensive care unit...they fully recovered thankfully
and there was no bill to pay...no worries about deductibles or premiums...i think you are all mad...

This will get deleted, but what the hell. Not all of us drink the corporate koolaid, but unfortunately we seem to lack the numbers to do something about it.

Personally, I think it will require boomers to die in great numbers for things to improve. We now face the prospect of thirty years of an aged-heavy population voting their fears.

[Insomniac]

I guess different clinics have different rules. I wish that had been the case for us. When he was employed the bills were discounted about 30% before the insurance paid them. Now paying cash, he gets billed the exact same original amount with absolutely no discount.:shakehead

Guess it is time to find a new provider.

Same here. The bill for non-insured is no discount. You would have to try and negotiate a lower amount if you want any type of discount. I can see doing it both ways, but I'd expect the no discount way to be prevalent.

[Insomniac]

Someone still needs to clue me in to why Yanks continue to buy the ******** that "socialized" medicine is a bad thing...recently had a family member in the UK that required two weeks in intensive care unit...they fully recovered thankfully
and there was no bill to pay...no worries about deductibles or premiums...i think you are all mad...

My guess is that we're just way too far down the road to go another way and we just make small band aid type fixes for something that requires stitches.

Way too many people are making way too much money to go to a system where patient care becomes the focus (over billables) and "rationed" care (not going to spend $500k on treatment to extend a life 6 months).

Any attempt to do this is an affront to our freedom to get ripped off through rigged markets.

Simple math tells me if we spend way more than everyone else who covers everyone (and has a "crappy" system), with all that extra money we could easily cover the cost to fix the system from another place.

But, like I said, the insurance companies aren't going to give up their ROI, all doctor's aren't going to switch to being salaried (I'm sure a fair amount would have no issue), hospital systems aren't going to give up all the billables for extra labs and procedures and biopharma isn't going to give up overcharging here to subsidize the rest of the world. Collectively they own Congress and they tell their constituents why changes are bad for us.

I'm pretty much of the mind the mentality is basically "get yours while you can". This isn't going to end well, so make your money before that point by any means necessary.

[datachicane]

Someone still needs to clue me in to why Yanks continue to buy the ******** that "socialized" medicine is a bad thing...recently had a family member in the UK that required two weeks in intensive care unit...they fully recovered thankfully
and there was no bill to pay...no worries about deductibles or premiums...i think you are all mad...

Hard to blame we yanks for having our perceptions a bit skewed, given the absolutely staggering amount of marketing and lobbying $$$ that's been spent here to sway public opinion towards preservation of the status quo. A whole lot of very wealthy folks face a somewhat diminished income stream, and are willing to open up their wallets to defend it.

Funny thing is, we can't even talk about a Canadian style single-payer system here, while, even setting aside our private health care system, we pay MORE as a percentage of GDP in PUBLIC health care spending than you fully-socialized Brits. Wrap your head around that one.

It's the same graph I posted earlier, at the risk of repeating myself:

http://www.washingtonpost.com/rf/image_296w/2010-2019/WashingtonPost/2011/06/07/Web-Resampled/2011-06-06/w-ezra296--300x588.jpg

[TrueBrit]

Obviously I am not trying to make a political point or statement as they are strictly verbotten here (and rightly so) just that all of the squawking about that style of health care is so vehemently attacked here in the land of the free, it seems so counter-intuitive when faced with the alternative to ever-increasing insurance is just so bloody obvious....

[Insomniac]

Obviously I am not trying to make a political point or statement as they are strictly verbotten here (and rightly so) just that all of the squawking about that style of health care is so vehemently attacked here in the land of the free, it seems so counter-intuitive when faced with the alternative to ever-increasing insurance is just so bloody obvious....

Also consider generally, health care costs for a person increase as they age, so the largest burden will be placed on Medicare. Insurance companies generally have to get you to 65 and then Medicare will become the primary insurer. Secondary would then only cover the stuff Medicare doesn't. So healthcare costs are going up double digits a year, but our wages (collectively) are not going up the same amount (where the revenue (taxes) for Medicare come from).

NOTE: Multiple insurance combinations are interesting. Say Primary covers 90% of a procedures and Secondary covers 90%. All you can use is Primary. If Primary covers 80% and Secondary covers 90%, Primary pays 80% and Secondary pays 10%. So basically, if Primary covers the same or more than Secondary, Secondary does nothing. If Secondary covers more than Primary, it will only cover the difference between Secondary and Primary.

[nrc]

Someone still needs to clue me in to why Yanks continue to buy the ******** that "socialized" medicine is a bad thing...recently had a family member in the UK that required two weeks in intensive care unit...they fully recovered thankfully
and there was no bill to pay...no worries about deductibles or premiums...i think you are all mad...

There is always a bill to pay. The U.K. is among the lowest cancer survival rates in the western world. They can keep that system.

You may as well ask why we don't have bullet trains or drive diesel micro cars everywhere. We're Americans and we want what we want, when we want it, where we want it, without anyone - least of all the government - telling us what that can or should be. We want a health care system that runs like a car, not a bus or a train. More specifically, we want a big SUV that we can drive around with only one passenger whenever we feel like it, secure in the knowledge that if we ever need to tow or haul something we've got just the thing. Oh, and if someone rear-ends us in the parking lot we want to be able to sue them out of their life savings.

The quest for the bad guy in all of this is non-productive. Doctors, hospitals, and insurance companies are not making unusually high profits relative to other industries. You could argue about pharmaceuticals or biotech, but those are not a huge chunk of our total health care costs and they're in boom or bust businesses that provide the latest drugs and technology. Americans could cut those profits by simply taking a pass on those latest drugs and technologies but we seem reticent in that department. :rolleyes:

Americans are being misled to believe that we can have everything that they like about the current system available to everyone at the same or lower cost. That's basically what this thread is about. We added more consumers to the system than we added payers so of course the price went up. That's exactly what the CBO said would happen.

[datachicane]

There is always a bill to pay. The U.K. is among the lowest cancer survival rates in the western world. They can keep that system.


I'm a systems guy, so I'm big into metrics. If you can't establish practical, quantifiable metrics up front, you have no idea whether your design and/or outcome is adequate or disastrous.

Health care is easy in this regard, much easier than most of the junk I have to deal with- there's only two metrics, cost and life expectancy, and they both come with handy and simple numbers already attached. Everything else is obfuscation. Any other factor you can cook up will directly impact either one or the other if it is, in fact, significant. Since the U.K. enjoys a higher life expectancy at a cost of just over half the % of GDP that we pay, well, I'm certain you'll draw whatever conclusions your worldview will allow.

Design driving requirements rather than the other way 'round is the scourge of systems work, and we've certainly fallen into that trap here. We criticize a proposed design not on the grounds of its performance with regards to good, measurable metrics, but for whatever random ideological baggage we choose to attach to it. We've eliminated a whole range of tested and proven ideas- not exactly bleeding edge stuff- for no reason other than the fact that they didn't fit within the narrow range of designs we determined to be acceptable before we even began the analysis.

[SurfaceUnits]

I'm a systems guy, so I'm big into metrics. If you can't establish practical, quantifiable metrics up front, you have no idea whether your design and/or outcome is adequate or disastrous.

my iPhone can out-quantify your PDP-11

[nrc]

Health care is easy in this regard, much easier than most of the junk I have to deal with- there's only two metrics, cost and life expectancy, and they both come with handy and simple numbers already attached. Everything else is obfuscation. Any other factor you can cook up will directly impact either one or the other if it is, in fact, significant. Since the U.K. enjoys a higher life expectancy at a cost of just over half the % of GDP that we pay, well, I'm certain you'll draw whatever conclusions your worldview will allow.

I disagree. There are vastly more factors in this discussion than those two metrics. Even those metrics demonstrate that fact. Life expectancy statistics don't account for a variety of factors unrelated to health care. Americans die at a higher rate from accidents and homicides, they are more obese and have unhealthier diets than most other western countries. Some statisticians have claimed that the U.S. leads the world in life expectancy when accidents, homicides and suicides are excluded.

But beyond that, this isn't just about statistics, it's also about freedom of choice. If Americans want to live hard and pay a big health care bill to keep their life expectancy on par with the rest of the world then that's our choice. But it's not true to claim that we can continue to do as we please in every other facet and cover everyone at the same or lower cost simply by making some structural changes or slaying some corporate boogie man.

[miatanut]

Obviously I am not trying to make a political point or statement as they are strictly verbotten here (and rightly so) just that all of the squawking about that style of health care is so vehemently attacked here in the land of the free, it seems so counter-intuitive when faced with the alternative to ever-increasing insurance is just so bloody obvious....

It's going to have to get a lot worse before people wake up to the fact healthcare is gradually swallowing our governments and after it finishes that meal, it will swallow our economy.

The sad thing is due to lobbying, we weren't given a choice. We could have opted into a public system if we wanted, stayed out if we didn't like it. What would have been more American than another choice? If the public system got really popular, there would be this huge player in the market that could force some changes to the basic screwed-up cost structure.


The quest for the bad guy in all of this is non-productive. Doctors, hospitals, and insurance companies are not making unusually high profits relative to other industries.
Some are, some aren't. The bigger medical companies are buying smaller ones and making bigger profits.

The main problem is, as you noted, Americans' expectations, but having 20% of every health insurance dollar go to profit, marketing, and litigation doesn't help. Paying more than the rest of the world for the latest wonder drug, subsidizing drug development for the rest of the world, as others have noted, doesn't help. Over capacity of exotic, expensive test equipment doesn't help. Lack of competition in some areas doesn't help. Over-testing for CYA doesn't help.

There's a whole lot of problem areas in the system in addition to the attitudes of some of the consumers.

[datachicane]

I disagree. There are vastly more factors in this discussion than those two metrics. Even those metrics demonstrate that fact. Life expectancy statistics don't account for a variety of factors unrelated to health care. Americans die at a higher rate from accidents and homicides, they are more obese and have unhealthier diets than most other western countries. Some statisticians have claimed that the U.S. leads the world in life expectancy when accidents, homicides and suicides are excluded.


Well, let's think about that. Let's say you're correct, despite the fact that Canadians are notorious for eating such healthy fare as poutine and Tim Horton while the Brits aren't far behind with fried stuff served in newspaper, and let's forget the fact that healthy lifestyle choices can themselves be impacted by an effective healthcare system. Let's forget the fact that if violence and accidents were at fault, we'd expect to see a higher disparity between male and female life expectancy vs. other countries, when, in fact, the opposite is true.

Let's say you're absolutely correct, and that there's some other statistical anomaly artificially depressing U.S. life expectancy. We need not throw out the number because we suspect some non-comparative factor, as seems to be popular in some circles- we can just estimate the effect and adjust our range of error. Currently the U.S. trails the U.K. and Canada by 2.4 and 1.1 years respectively. What would be a reasonable factor to correct by? Let's say that we have such lousy habits and are killing each other at such a furious rate that we would otherwise enjoy the highest life expectancy in the world, tying Japan at 82.6, a jump of a whopping 4.3 years. Then consider this- those numbers don't exist in a vacuum and have no meaning without also considering the other metric, cost. If we spend twice the % of GDP on healthcare that the U.K. does, and in return improve our life expectancy by a paltry 1.9 years, is that a good and sound investment? Citizens are not exactly content with the current tax rate (per the not-exactly liberal Heritage Foundation) of 24% of GDP, claiming that it crushes the economy, innovation, and likely cute kittens as well, while we pay a full 2/3 of that, 16% of GDP, for health care. Is 8% of GDP for an absolute best-case, planetary alignment scenario increase of 1.9 years really an argument you want to make?



But beyond that, this isn't just about statistics, it's also about freedom of choice. If Americans want to live hard and pay a big health care bill to keep their life expectancy on par with the rest of the world then that's our choice. But it's not true to claim that we can continue to do as we please in every other facet and cover everyone at the same or lower cost simply by making some structural changes or slaying some corporate boogie man.

Well, when you're designing systems numbers and statistics ARE all that matters. Making a decision for any other reason is called, well, corruption. We're not talking about mysterious values that are difficult to quantify. Like Insomniac said, we're defending our freedom to get ripped off through rigged markets, to the tune of 8% of GDP. If doing so makes you feel all baseball and apple-piey, have at it, although I'd be inclined to take such a position more seriously if the same folks who agree didn't invariably also argue that 2-3% of GDP paid as taxes was soul-crushing. From here it looks like nothing more than an exercise in successful marketing.

[Insomniac]

A long, but good article on cost differences stands out to me. It's 2 years old, but really fascinating.

One area spends over $14k/yr per Medicare enrollee while the Mayo clinic spends about $6.5k/yr. This isn't uncommon, and sadly the outcomes really aren't all that different.


“Come on,” the general surgeon finally said. “We all know these arguments are ********. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

I also should add in Massachusetts, BCBS is experimenting with an Alternative Quality Contract.

Working closely with providers to restructure the traditional fee for service payment system, BCBSMA is seeking to reward high quality, appropriate and efficient care. To accomplish this goal, the AQC will offer a combination of two kinds of reimbursement:


A global, risk-adjusted, fixed payment per patient, with annual increases in line with inflation; and
Performance-based incentives linked to nationally-recognized measures of quality, efficiency and patient experience.

[Andrew Longman]

http://www.washingtonmonthly.com/features/2005/0501.longman.html

Yes. That's my brother.

Tough issue

He's actually in Russia right now meeting with Putin because the Russians are looking for help too.

[WickerBill]

So, IT can make a positive change, but the key is to have the right man at the top with the power to completely change things.

It always boils down to management competence and willingness to alter status quo, doesn't it?

[nrc]

Let's say you're absolutely correct, and that there's some other statistical anomaly artificially depressing U.S. life expectancy.

Yes, lets say that I'm absolutely correct. :) Because arguing that our health habits and violence have no impact on our life expectancy would be ... interesting.


Then consider this- those numbers don't exist in a vacuum and have no meaning without also considering the other metric, cost. If we spend twice the % of GDP on healthcare that the U.K. does, and in return improve our life expectancy by a paltry 1.9 years, is that a good and sound investment?

As I've said, Americans should make an informed choice on that question and not be misled into believing that we can have everything that they like about the current system at a lower cost while covering everybody. This thread demonstrates that many Americans are being misled to believe that. If you think people are surprised now, wait until some of the other mandates start kicking in.

For my part, I'm willing to invest more in a system that gives me the choices I want and better outcomes from the conditions that are most likely to kill me. That doesn't mean that the premium that we as a nation pay for such a system has to remain the same.


Well, when you're designing systems numbers and statistics ARE all that matters. Making a decision for any other reason is called, well, corruption. We're not talking about mysterious values that are difficult to quantify.

People and freedom are all that matters. Corruption is eliminating their freedoms and then treating them as numbers.

[nrc]

Some are, some aren't. The bigger medical companies are buying smaller ones and making bigger profits.

Nobody is making a killing in health insurance. Americans are being lead to believe that insurance companies are making huge profit margins when none of them are out of the single digits. They rank near the bottom of all industries for profitability.


The main problem is, as you noted, Americans' expectations, but having 20% of every health insurance dollar go to profit, marketing, and litigation doesn't help.

Under the latest regulations only 20% of health insurance premiums are permitted to go to anything but care. So that 20% must include administrative costs and all other overhead as well as profit (gasp), marketing (gasp), and litigation (hiss). This will only drive more consolidation.

Talk about a rigged system. Imagine a system where someone can cap a competitors profits and overhead, but also uses that power to impose additional overhead.

[nrc]

So, IT can make a positive change, but the key is to have the right man at the top with the power to completely change things.

It always boils down to management competence and willingness to alter status quo, doesn't it?

And of course, willingness requires motivation.

The best thing about a national health care database with all our information will be the "Expiration" field.

[datachicane]

First off, I appreciate the thoughtful discussion.


Yes, lets say that I'm absolutely correct. :) Because arguing that our health habits and violence have no impact on our life expectancy would be ... interesting.


That's obvious, of course, but the standard here is not to establish that point, but whether or not both of the following are true:

A, those factors differ between our nation and nation X to the degree that a statistically significant impact on LE can be anticipated, and

B, there are no other differing negative factors impacting nation X disproportionately such that the impact of A is offset.

It's not a non-controversial conclusion, but my point was that, even if assumed, the conclusion that our current arrangement is superior is not well supported.



As I've said, Americans should make an informed choice on that question and not be misled into believing that we can have everything that they like about the current system at a lower cost while covering everybody. This thread demonstrates that many Americans are being misled to believe that. If you think people are surprised now, wait until some of the other mandates start kicking in.


Well, the crux of the conflict is in your first sentence- "everything that they like". I'm gonna digress a bit here.

In a previous incarnation I was in sales. As is generally the case, there were instances when my product was clearly superior to my competition, and times when it was not. My job was to close the sale regardless. I was selling to good-sized businesses, so ostensibly the decision-maker was working on rational rather than touchy-feely grounds, not like selecting drapes or what to have for lunch (for most of us, anyway :gomer:). When the numbers were in my favor, I'd use them- "Box A delivers X gigaflops per second at a cost of N dollars per biennium, with a guaranteed uptime of Z". When the numbers were not in my favor, I'd obfuscate- "Box B has superior craftsmanship and fine German engineering. It looks cool and goes *Ping!*"

There's nothing wrong with non-tangibles, but we need to be honest with ourselves when we make decisions based on them, and we need to be honest with ourselves about with what they cost.
From a purely rational perspective health care is a black box- put N dollars in and get X life expectancy out. If we define "everything that they like" as the greatest life expectancy at the lowest cost, well, the preferred system is pretty obvious. Unfortunately, folks invested in the current system have done what they've had to to preserve the status quo- do a bit of a sales pitch, a bit of obfuscation. We have lots of discussions about who chooses what doctor (never mind the fact that folks often don't have that choice in the CURRENT system, or that nothing about a single-payer or nationalized system would necessarily would prevent that), lots of talk about waiting for appointments, etc., etc. These may well be valid things that we like, but from a purely rational standpoint, if Canadians have to wait 36mos in driving snow to see a Dr. and face death panels, well, given that their LE handily exceeds our at a considerably lower cost, it must be working.

We need to have an honest conversation about what we're willing to pay for those non-tangible, non-black box niceties. We pay twice the % of GDP in healthcare than the fully-socialized Brits do and enjoy a lower LE. As I argued previously, even if our LE is artificially depressed such that we would otherwise equal the highest LE in the world (a controversial assumption at best), we would still only rate 1.9 years better than the Brits at a cost of %8 GDP. Even amongst the most ardent supporters of our current system, very few believe our LE is depressed to that extent- if the impact is genuine, a year or less is a more likely figure. When folks (not necessarily well informed, mind you) threaten revolution in the streets over budget-balancing tax proposals amounting to much less than %1 of GDP, I find it difficult to believe that they would gleefully fork over eight times that for those intangibles. The difference is, of course, that the health care industry is very good at marketing, while taxes? Not so much.






For my part, I'm willing to invest more in a system that gives me the choices I want and better outcomes from the conditions that are most likely to kill me. That doesn't mean that the premium that we as a nation pay for such a system has to remain the same.



Well, we're likely all willing to pay a premium for greater choice. The question is, though, how much? We know that we could adopt one of the systems that the rest of the industrialized world uses and save 30-75% right out of the gate, so no, the rate shouldn't stay the same.






People and freedom are all that matters. Corruption is eliminating their freedoms and then treating them as numbers.

Hmmm. Eliminating their freedoms and treating them like numbers? Sounds like a sales pitch to me. What freedom specifically? You don't believe that the current system sees you as something besides a number? Are publicly-funded actuaries cruel-hearted villains, while privately-funded actuaries smell like sunshine? Non-tangibles are nice, but don't kid yourself- numbers matter.


How about where your freedoms intersect others? Maybe your neighbor isn't as thrilled shelling out that extra 8%- and growing- of GDP as you are. For all of the talk about 'choice', the point seems lost that, for the overwhelming majority of us, there is no choice now anyway- it's not like we can opt out of the current arrangement in favor of a nice single-payer or nationalized system. I constantly hear the argument that taxes stifle innovation and strangle the economy, and to a point I don't necessarily disagree, OTOH, we're talking about a potential savings here equivalent to over 1/3 of our current tax burden. The mind fairly boggles to think of the impact that would have on our economy. Where's the outrage?

[nrc]

First off, I appreciate the thoughtful discussion.

As do I, but I should bow out since it seems likely that this will eventually go off the rails and I may have to be involved in a different capacity.

[Indy]

I constantly hear the argument that taxes stifle innovation and strangle the economy, and to a point I don't necessarily disagree, OTOH, we're talking about a potential savings here equivalent to over 1/3 of our current tax burden. The mind fairly boggles to think of the impact that would have on our economy. Where's the outrage?

QFE.

To me, at its very base it is not only about cost and effectiveness, it is about equity. It is simply wrong, IMO, to tell any American that he or she is not worth as much health care as another American. I suppose it boils down to Christian ideals being the foundation of my thinking, but I find it greatly offensive that we are the wealthiest people on Earth and we can not find the will to take care of all of us.

[chop456]

"Box B has superior craftsmanship and fine German engineering. It looks cool and goes *Ping!*"

I'm interested in box B. Do you have any brochures?

[Corner5]

Nobody is making a killing in health insurance. Americans are being lead to believe that insurance companies are making huge profit margins when none of them are out of the single digits. They rank near the bottom of all industries for profitability.

I beg to differ, even during the recession, Health Insurers were making record profits. This from 2011-


Health Insurers Making Record Profits as Many Postpone Care
By REED ABELSON
Published: May 13, 2011
The nation’s major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among Americans who are postponing or forgoing medical

http://www.nytimes.com/2011/05/14/business/14health.html

Here is the US Healthcare rating in the world- #37 Many Americans go to other countries for operations because they can get world class doctors at a reasonable cost. I know some personally.

http://www.photius.com/rankings/healthranks.html

I will never understand why we can't have the choice between a government run health care system and private insurance, if that's your choice. That's what was proposed, choice.

[miatanut]

I will never understand why we can't have the choice between a government run health care system and private insurance, if that's your choice. That's what was proposed, choice.

That's what I wanted. Another choice. If I thought it was a good deal, I would opt in. If I thought it wasn't I wouldn't.

Being self-employed, I'm in "Individual Market" hell. I've been paying personal health insurance premiums for 22 years but have not been to a doctor once in that time. I haven't needed to. I'm a cash cow for an insurance company now, but if I ever got sick my situation would be very precarious. The new law that many want to repeal gives me some protection.

[KLang]

I'm pretty sure the real goal is no choice. A government run system. Period.

[datachicane]

I'm pretty sure the real goal is no choice. A government run system. Period.

BFD.
I don't care if it's run by Satan's personal minions- the UK's system costs half of what we pay for a comparable or greater LE. Sign me up for that ride.

OTOH, ours goes *Ping!*

[Corner5]

I'm pretty sure the real goal is no choice. A government run system. Period.

No it isn't, although one side wants you to believe that. The goal is to lower rates and make them competitive again. To insure that everyone can get insurance and will be able to get medical attention when needed.The Insurance co. don't want to compete with a government run plan. Just like they want to take away medicare. The US is the only industrialized country in the world without national health care. We pay the most and still rank 37th.

Check this out-


The Commonwealth Fund, in its annual survey, "Mirror, Mirror on the Wall", compares the performance of the health care systems in Australia, New Zealand, the United Kingdom, Germany, Canada and the U.S. Its 2007 study found that, although the U.S. system is the most expensive, it consistently under-performs compared to the other countries.[5] One difference between the U.S. and the other countries in the study is that the U.S. is the only country without universal health insurance coverage.
The Commonwealth Fund completed its thirteenth annual health policy survey in 2010.[6] A study of the survey "found significant differences in access, cost burdens, and problems with health insurance that are associated with insurance design".[6] Of the countries surveyed, the results indicated that people in the United States had more out-of-pocket expenses, more disputes with insurance companies than other countries, and more insurance payments denied; paperwork was also higher although Germany had similarly high levels of paperwork.[6]

Ask any of these countries if they want their national health care to go private, they will all say NO!

Why can't we have what the congress gets for health benefits?

http://www.factcheck.org/2009/08/health-care-for-members-of-congress/

[miatanut]

I'm pretty sure the real goal is no choice. A government run system. Period.

Most countries with "government run" systems have private systems right along side. If you don't want to wait for the care you get by virtue of being a citizen, or you think you can get better care from the private system, you can pay to use the private system. Most people prefer to wait for the free care, but they get a choice.

That approach wasn't even proposed. What was proposed was wider access to the system available to federal employees.

Now the move is on to go back to anyone who doesn't get it through their job being in danger of not having anything because they have pre-existing conditions, or get sick and their premiums get raised to be unaffordable.

But hey, at least some people get to choose their own doctor.

[Corner5]

Most countries with "government run" systems have private systems right along side. If you don't want to wait for the care you get by virtue of being a citizen, or you think you can get better care from the private system, you can pay to use the private system. Most people prefer to wait for the free care, but they get a choice.

That approach wasn't even proposed. What was proposed was wider access to the system available to federal employees.

Now the move is on to go back to anyone who doesn't get it through their job being in danger of not having anything because they have pre-existing conditions, or get sick and their premiums get raised to be unaffordable.

But hey, at least some people get to choose their own doctor.

HUH? Yes it was proposed and that is what has passed into law.

Here-
The American Health Benefit Exchange

Beginning in 2014, you can buy into the American Health Benefit Exchange. Modeled after the FEHB, which provides insurance for federal workers including members of Congress, the Exchange is not a centralized, government-controlled plan. Instead, it is a network of choices that are offered at lower cost due to the number of people enrolled. Each state will create its own Exchange. Each Exchange will offer a minimum of two multistate plans managed by the Office of Personnel Management (the governing body of the FEHB). You may select one of the OPM plans or any other plan in the Exchange. Most states will provide Separate Exchanges for individuals and small businesses, although under certain conditions they may be merged...

Keeping Your Insurance

If you already have insurance, you will be able to keep it unchanged. The Act contains specific language preventing states or individual insurers from requiring anyone to join an Exchange or purchase a qualifying health plan. Beginning in 2014, you will be fined if you choose not to carry health insurance at all, but you can purchase any plan you want, from any company you choose.

Also- Beginning in 2014, insurers will no longer be allowed to discriminate against anyone based on pre-existing conditions, including mental health disorders. Until then, those with pre-existing conditions are eligible for a new "high risk" pool. The new pool will go into effect 90 days after the bill was passed, making insurance available and affordable for those with pre-existing disorders.

Other Reforms

H.R. 3590 also includes a number of additional reforms that are designed to bring down costs and improve quality. New standards of accountability for quality of care, modernization of record-keeping technology and measures to curtail the skyrocketing price of prescription drugs are just a few of the new reforms. The goal is to minimize bureaucratic inflation and red tape, streamline procedures and hold doctors accountable for the care that they provide. Medicaid will also be expanded to include childless adults under age 65 whose income is less than 133% of the poverty line.


Read it all here- http://phobias.about.com/od/treatment/a/obamaplan.htm

The truth will set you free.

[miatanut]

HUH? Yes it was proposed and that is what has passed into law.

Single payer was not proposed this time around. That was the Clinton plan. I was against that at the time. Now, I'm not so sure. It's obvious what we have isn't working.

A "public option" was, and was shot down. One flavor was to be the same system the federal employees are in. Not "Modeled after the FEHB..."

What happened was all these tiny little "exchanges" around the country which will have no negotiating power, and as a result no impact on controlling costs.

Computerized record-keeping was already being pushed.

Anything that would have created any sort of cost control was shot down, so that aspect of the "reform" was a complete and utter failure.

[SteveH]

I'm not in favor of government ran anything. Too many failures i.e USPS, Amtrak come to mind. Medicare is a poor example of a government ran health care program.

It might work in other countries, but it works under their form of governance. Pork barrel spending and the like will completely ruin a program as huge as this.

[cameraman]

The postal service is not a failure of anything except idiotic expectations. Your mail gets delivered two thirds or less the cost of any other nation. A stamp in Canada is 0.59 or England at 0.74 compared to a stamp here at 0.44. The USPS delivers mail six days a week to all the rural locations Fed Ex and UPS won't touch no matter what you pay them. No other postal service on the planet operates under the ridiculous expectations of US politicians.

[datachicane]

The postal service is not a failure of anything except idiotic expectations. Your mail gets delivered two thirds or less the cost of any other nation. A stamp in Canada is 0.59 or England at 0.74 compared to a stamp here at 0.44. The USPS delivers mail six days a week to all the rural locations Fed Ex and UPS won't touch no matter what you pay them. No other postal service on the planet operates under the ridiculous expectations of US politicians.

Agreed.
:thumbup:

Like I said, I don't care if Satan himself runs it- show me the numbers. Anything else is just marketing obfuscation to avoid discussing those same numbers...


*Ping!* :gomer:

[stroker]

People and freedom are all that matters. Corruption is eliminating their freedoms and then treating them as numbers.

Can I have T-shirts printed with this on them?

[racer2c]

BFD.
I don't care if it's run by Satan's personal minions- the UK's system costs half of what we pay for a comparable or greater LE. Sign me up for that ride.

OTOH, ours goes *Ping!*

Based on their teeth alone, I'll stay the the American version. :gomer:

[Insomniac]

I beg to differ, even during the recession, Health Insurers were making record profits. This from 2011-

Bear in mind that there is usually 2 ways to look at profit. The amount and the percent. Generally when people argue they make too much profit, it's the amount and when they argue they don't make that much it's the percent.

[Insomniac]

I'm pretty sure the real goal is no choice. A government run system. Period.

That idea/option has been poisoned since the early 1990s (but I bet a lot of companies that have lifetime health expenses regret it now).

[TravelGal]

That idea/option has been poisoned since the early 1990s (but I bet a lot of companies that have lifetime health expenses regret it now).

Many of those that do just said, "Oh nevermind." I suppose unions prevent that in many cases but it happened to both TravelGuy and his brother. Long before the current health plan was even proposed.

[Insomniac]

Many of those that do just said, "Oh nevermind." I suppose unions prevent that in many cases but it happened to both TravelGuy and his brother. Long before the current health plan was even proposed.

Did the companies who promised those benefits go bankrupt? (Just wondering how they weaseled out of it.)

[Indy]

The postal service is not a failure of anything except idiotic expectations. Your mail gets delivered two thirds or less the cost of any other nation. A stamp in Canada is 0.59 or England at 0.74 compared to a stamp here at 0.44. The USPS delivers mail six days a week to all the rural locations Fed Ex and UPS won't touch no matter what you pay them. No other postal service on the planet operates under the ridiculous expectations of US politicians.

Totally agree. When I was in college I delivered mail. It gave me a lifetime appreciation for the difficulty of the job they do, and how efficiently and accurately it is done.

The inefficiency of government is one of those memes that the American people just love and continue to propagate, regardless of how true it may be in any particular circumstance. Of course there are problems, the services we are talking about are huge and span a continent, but overall things are not as bad as people think. Besides, having witnessed the legislative process, what and why laws are, and the difficulty in implementing what the lobbyists, errr, legislators write in to them, I am firmly convinced that most inefficiency and corruption is enabled intentionally to benefit various special interests.

[Indy]

Many of those that do just said, "Oh nevermind." I suppose unions prevent that in many cases but it happened to both TravelGuy and his brother. Long before the current health plan was even proposed.

That has affected my family, too. For the life of me I cannot figure out why the executive crooks who ran these companies into the ground while padding their own accounts are not hanging from the beams in their 50 million dollar houses. You leave a whole lot of people with nothing to lose, and somehow you escape harm and prosecution?