Medical Cost

[Snobdds]

It's called preexisting conditions and picking who they want as patients. We were going in that direction before....hence the need for healthcare reform.

We had high risk pools that predated the ACA for those with chronic pre-existing conditions. Those worked very well. Then the ACA comes along and changes things so drastically that the industry is moving away from it ten years out. Insurance companies have discovered obamacare will bankrupt them. So now we are moving away from selling "insurance" to selling a "financial product", which doesn't have all the benefit bloat that the ACA mandated.

Healthcare reform was just reform on how to access healthcare. It took away the ability to manage selection. Well guss what, managing risk selection is very importain and being able to segregate bad risk is the best approach.

We want all the "patients" we can get, as it spreads the risk over a wider pool. However, we need to actively manage those "patients" to prevent them from arbitrarily increasing the costs for healthy people that don't need to be paying $600 on a product they never use.

 

[Snobdds]

Can you repeat that in English.

Healthcare is primarily your diet, exercise, sleep, and lifestyle habits. What people call healthcare is actually sick care. Sick care wouldn't be so expensive if people practiced better healthcare. But, since they don't, we need to manage it for them through making healthcare more expensive for people that practice poor habits.

If you weigh 500 pounds, you should pay more for care since that person will utilize more care than a person that weighs 200 pounds.

Simple logic.

 

[Jstpssng]

^^^^
I was typing mine as he posted above.

Some things are unpreventable, like growing older and many cases of cancer.
Yet if you are a chronic smoker, excessively obese for no medical reason, or a chronic risk taker; should the rest of us pay the same for insurance?
I get a 20% discount on my share of the premiums for partipating in my employer's "welness" program. So far at least, the only thing expected of me is to go through screening in December and talk to a "health coach" a couple of times per year.

 

[Snobdds]

^^^^
I was typing mine as he posted above.

Some things are unpreventable, like growing older and many cases of cancer.
Yet if you are a chronic smoker, excessively obese for no medical reason, or a chronic risk taker; should the rest of us pay the same for insurance?
I get a 20% discount on my share of the premiums for partipating in my employer's "welness" program. So far at least, the only thing expected of me is to go through screening in December and talk to a "health coach" a couple of times per year.

Wellness programs are a great way to incentivize early detection and prevention. However, due to the ACA, you couldn't really offer reduced premiums for the program. All that could happen is an employer would increase their contribution to your premium for participating. If you had a private plan without an employee sponsor, wellness programs offered no rate relief.

Now that insurance companies are moving away from the heavily bureaucratic ACA, and we sell a "financial product", we can offer rate relief for practicing better healthcare.

Insurance can be more affordable, but it can't be backstoped by .gov. Just look at student loans, once .gov backstopped student loans, ironically passed via the ACA in 2010, student loan debt went parabolic. As a colleague said, the road to hell is paved with good intentions. There was good intentions in 2010, but 15 years removed, we have only seen medical costs and student loan costs go crazy.

 

[Jstpssng]

It seems like those who benefit most from the current system are the insurance and drug companies, as well as the conglomerates buying up health care facilities. Meanwhile, on this side of the country at least, hospitals and nursing homes are struggling and failing. Drs and nurses are in short supply and I don't see that getting any better.

 

[Torvy]

It seems like those who benefit most from the current system are the insurance and drug companies, as well as the conglomerates buying up health care facilities. Meanwhile, on this side of the country at least, hospitals and nursing homes are struggling and failing. Drs and nurses are in short supply and I don't see that getting any better.

You'd think, but it's the lawyers. Fix tort in the US and the costs drop considerably.

 

[Dftodd]

And this:

My wife is being treated for wet AMD, shots in the eyes. Started out monthly, now she's up to 11 weeks between shots. We are hoping to get to 4 months between shots.
BUT - INITIALLY the Kaiser doc wanted to keep her on a less expensive med (Avastin ~$50/shot/eye, once a month), about . When I got aggravated and questioned the Kaiser doc she told me "the newer meds were cost prohibitive". I had to get the upper branches of Kaiser to call her and tell her my insurance would cover almost anything. She is now getting Eylea HD (cost ~ $2K/shot/eye) the extra 2 months between shots is well worth it. And our copay is the same $20 per visit.

My psoriasis medication was $6000 a month. Insurance would only cover 70%.

 

[Dftodd]

I resently got to pay for a 50mg drug called a clot buster.
That 50mg was $15,000.

In Britain the same drug is $1,200.

Its called the cost of doing business. And I still wanted to do business and my wife is happy with the cost.

I had to go on government assistance in order to get one of my medications. After insurance picks up 70%, i'm on the hook for $2,000.

 

[Jstpssng]

You'd think, but it's the lawyers. Fix tort in the US and the costs drop considerably.

I should know better than to argue with an economist... especially after the last time. However, I believe blaming lawsuits is just an easy way out.
A quick search of "What causes high health care costs" came up with a plethora of answers yet tort wasn't even mentioned. The leading cause based on multiple sites is that health care costs are going up due to the increasing cost of health care.

 

[Jstpssng]

A cousin with kidney disease had to pay $25,000 out of pocket for meds before medicare would kick in.