How much does health insurance cost in the US?

[GGT]

No, bulk pricing is not a distortion. And it's good and rational that certain groups get charged differently than others. A company insurance plan for coal miners should charge the employer more than a company insurance plan for office workers.

Depends on the reasons for that group discount. It's not always good and rational, or based on real actuarial risks. You've admitted as much when certain unions get huge discounts for their group policies. Groups like AARP, or seniors in general, are afforded plenty of "group discounts" by the insurance industry. Insurers profits (via premiums) come by enrolling large numbers of people and grouping them together --- that coal company offers the same plan for the miners and office workers, perhaps with the same premiums, or an added indemnity fee for the miners.

Those employer-subsidized, closed-group discounts are distortions! At least to anyone shut out of those special "negotiations" in pricing and access, including self-employed, contract workers, small businesses, and individuals. Why do you suppose some 40 million are still uninsured?

My point is that these kinds of rational decisions have been effectively removed from the health insurance market. I would argue that Obamacare tries to even further negate this kind of rational insurance decision-making.

And my point is that it's irrational to let the private for-profit insurance industry control our healthcare system. It's insane to anchor it to employment, employer-subsidies, their large group preferred discounts, and their tax-deductions. Obama made the mistake of continuing the "insurance" stranglehold....that's why I don't like the ACA. But at least he succeeded in some patient protections by ending the crazy pre-existing exclusions, or denying young adults family coverage.

Name any other crucial life-service that uses for-profit insurance for access, delivery, quality control, and payment methods.

[Loki]

Another great NHS story. Would you like to see a specialist for a serious quality of life issue? That will be 3-4 months. Oh, you'd like a second opinion just because the first specialist ignores you and engages in pseudo-science? That will be another 6 months. But it's free!1!!!1!

[Aimless]

Which specialties and what issues?

[Loki]

I'm not going to be any more specific than above, but let's just say it prevents the person from doing numerous day-to-day activities, including working. And the "treatment" prescribed by the first doctor is not recognized as being scientific by the US, for good reason.

[GGT]

[Loki]

GGT making fun of the suffering of others, just because it doesn't fit into her worldview. How surprising.

[Aimless]

I'm not going to be any more specific than above, but let's just say it prevents the person from doing numerous day-to-day activities, including working. And the "treatment" prescribed by the first doctor is not recognized as being scientific by the US, for good reason.

I ask mainly because there are some specialties that are in high demand but are relatively unattractive to most soon-to-be-doctors, eg. psychiatry, geriatrics. It's not always so much a problem of free healthcare as it is a problem of the exceptionally privileged life of the medic. Psychiatry in particular is a troublesome area not only because it's underserved (due to being a low-prestige specialty) but also because it's plagued by controversy, diagnostic problems and attitude problems such as the ones displayed in eg. the ADHD thread: "Depression? Anxiety? Exhaustion/burnout? Pah! Women!"

These are problems the NHS can and should fix, out of compassion as much as out of a desire to not waste society's money. And it's something that they are slowly fixing, by instilling slightly better values into each batch of new doctors than they did in the previous one.

Overall, the NHS does a good job of promoting evidence-based medicine, but you're always going to find people who won't play by the same rules and guidelines as others. That's a problem in the US as much as it is in the UK, with one major difference being that there's more money in the US for practicing non-evidence-based medicine (except in the few cases where you get sued ).

[Loki]

The difference being that if my doctor in the US is a quack, I see another one. If my doctor in the UK is a quack, I'm stuck with them for half a year.

[Aimless]

Well yeah, but in aggregate I mean looking at it another way, if your doctor in the US happens to be decent, principled and right, you have greater freedom to instead consult a quack who'll go along with your madness in order to take your money. I'm not saying that's typical or anything mind you

[Loki]

And that would be entirely my choice. You don't see the difference there?

[Aimless]

And that would be entirely my choice. You don't see the difference there?

I do, but you have to understand that I also care about outcomes for the system as a whole and am usually inclined to consider both the pros and the cons of removing choice in various ways (and to varying extents) from various agents. I don't see one person's choice as the one issue that trumps everything else.

That being said, if I choose to reduce your ability to choose in a given situation (even if it is with the intention of increasing someone else's ability to choose) then the least I can do is try to make sure you don't get completely shafted, eg. by being forced to put up with a presumably dangerous doctor. Still, we both know we're never really going to agree on the merits and problems of restricting choice

[GGT]

GGT making fun of the suffering of others, just because it doesn't fit into her worldview. How surprising.

I was waiting in the popcorn gallery, to see how you'd turn a NHS story --- without specifics --- into a public policy debate.

I'm surprised Minx actually fell into the trap.

[Aimless]

It's not a "trap". Loki and people close to him have had frustrating experiences with the NHS. Even anecdotes have value in a discussion, esp. when they're true. I know many who've had frustrating experiences in the Swedish healthcare system and I'd be a fool if I pretended everything were perfect

[GGT]

As have many millions of Americans, with their anecdotes. I don't think it's particularly useful to end one of those anecdotes with "But it's free!1!!!1!", and suggest that a NHS is much different than an employer-based insurance system.

[Dreadnaught]

Depends on the reasons for that group discount. It's not always good and rational, or based on real actuarial risks. You've admitted as much when certain unions get huge discounts for their group policies. Groups like AARP, or seniors in general, are afforded plenty of "group discounts" by the insurance industry. Insurers profits (via premiums) come by enrolling large numbers of people and grouping them together --- that coal company offers the same plan for the miners and office workers, perhaps with the same premiums, or an added indemnity fee for the miners.

Those employer-subsidized, closed-group discounts are distortions! At least to anyone shut out of those special "negotiations" in pricing and access, including self-employed, contract workers, small businesses, and individuals. Why do you suppose some 40 million are still uninsured?

And my point is that it's irrational to let the private for-profit insurance industry control our healthcare system. It's insane to anchor it to employment, employer-subsidies, their large group preferred discounts, and their tax-deductions. Obama made the mistake of continuing the "insurance" stranglehold....that's why I don't like the ACA. But at least he succeeded in some patient protections by ending the crazy pre-existing exclusions, or denying young adults family coverage.

Name any other crucial life-service that uses for-profit insurance for access, delivery, quality control, and payment methods.

Jesus. My beef is that unions were getting waivers to high-cost/mandate requirements in Obamacare, note that unions were getting group discounts. Insuring large groups of people is inherently cheaper.

Large groups of people pursuing discounts based on their pricing power is good, because it exposes efficiencies. It's not a distortion when you or I get a 3-for-2 discount on toilet paper.

You keep on saying that it's irrational to anchor health insurance to employment and tax it fundamentally, which is what I've been saying all along. But I've also been saying that all these arbitrary insurance mandates have also contributed to the cost.

[GGT]

Jesus. My beef is that unions were getting waivers to high-cost/mandate requirements in Obamacare, note that unions were getting group discounts. Insuring large groups of people is inherently cheaper.

Large groups of people pursuing discounts based on their pricing power is good, because it exposes efficiencies. It's not a distortion when you or I get a 3-for-2 discount on toilet paper.

But we're talking about health care....and that's not comparable to any other consumer product or service. Especially toilet paper. Prior to Obama's proposals, you beefed about unions getting great insurance benefits without enough premium contributions. So, "insuring large groups" isn't inherently cheaper, it depends on how it's subsidized and administered. Jeez, why is that so hard for you to acknowledge?

You keep on saying that it's irrational to anchor health insurance to employment and tax it fundamentally, which is what I've been saying all along. But I've also been saying that all these arbitrary insurance mandates have also contributed to the cost.

Then we agree on something!

But those insurance mandates weren't arbitrary. They aimed to get millions of previously-excluded people coverage, expand the pool -- and required all insurance companies to have the same rules. The costs of insurance would go up, since many people have been under-paying for decades. That won't keep healthcare costs from rising exponentially, though.

[Khendraja'aro]

I'm also a bit dubious as to how healthcare can be compared to toilet paper at all.

Unless your healthcare in the US is really shitty.

[GGT]

Well, US healthcare IS pretty shitty. Just because those with great employer-subsidized insurance can get the best care, or those with enough money can pay OOP costs for the best care.....doesn't mean the US delivers the best care to the most number of people. Our infant mortality rates are examples of that. The US rates pretty low on that scale, and looks more like a third world nation.

It's a crappy system that can fill <tax payer subsidized> sports arenas with thousands of people looking for basic healthcare, including the employed who have no employer-subsidized insurance policy, but also can't afford to pay for the basics.

[Dreadnaught]

It's silly to talk about the delivery of services while pretending that healthcare is somehow so special that it doesn't respond to well thought-out incentives (or poorly thought-out incentives). And this opposition to bulk pricing in open health insurance markets is sorta silly.

Housing and food are also critical, yet you don't see many people advocating forced nationalization of housing and food.

[GGT]

Define "forced nationalization". Doesn't NYC still participate in section 8 (federally subsidized) housing, or utilize "rent control"?

Call it all SILLY as a way dismiss the fundamental discussion, but it's still easier to find shelter in a cardboard box, food at a soup kitchen, or grow your own urban garden...than it is to perform your own appendectomy or culture your own antibiotics.

[Dreadnaught]

Yes, NYC has all sorts of housing market distortions.

And I'm glad you feel incentives don't work once industries become complicated.

[GGT]

Yes, NYC has all sorts of housing market distortions.

And I'm glad you feel incentives don't work once industries become complicated.

Dread, your attempts to conflate "distortions" and "incentives" aren't really working. Particularly not in the realm of healthcare, with all its complexities.

[Dreadnaught]

Well of course they don't make sense to you; you don't seem to believe that people who participate in a system can be distorted or incentivized.

Yet the systems that you seem to want seem to be little more than bread and circuses.

[Loki]

http://www.nytimes.com/2012/06/20/bu...-scene.html?hp

Interesting piece on Obama's healthcare legislation.

[Steely Glint]

The difference being that if my doctor in the US is a quack, I see another one. If my doctor in the UK is a quack, I'm stuck with them for half a year.

You do know that private health care exists in the UK, right?

[Loki]

You do know that private health care exists in the UK, right?

You know it costs a ridiculous amount of money, right? And it costs a ridiculous amount of money because it makes no sense catering to anyone but the rich in your healthcare system.

[Aimless]

You know it costs a ridiculous amount of money, right?

Of course for the vast majority of people in the UK it actually costs nothing to see a non-quack doctor within a reasonable time-frame.

You know, the few thorough investigations that've been done show that the US is indeed better than most nations at ensuring short-ish waiting times for non-urgent elective procedures (not counting those that simply don't have access because they'd turn waiting times to "infinite"). The problem is that the US doesn't do very well at ensuring short waiting times for people who're actually sick, in large part because of the disproportionate demand relative to the short supply of basic care. You know what the consequences are of that? Greater morbidity and mortality. You know what the consequences are of people--both insured and uninsured--not having easy and quick access to a GP? Overloaded EDs. You know what the consequences are of overloaded EDs? Long ED waiting times and high rates of ambulance diversion. You know what the consequences are of long ED waiting times and high rates of ambulance diversion? Higher risk of death and permanent disability.

Another thing the US is better at than most countries is helping patients "choose" not to get needed tests or fill needed prescriptions or schedule needed visits due to cost.

I'd like to pose a question to you that you've posed to me in a slightly different form, but I'll word it more plainly: how many deaths and how much permanent disability would you accept to ensure somewhat faster access to elective procedures of little clinical benefit?




Look man, there are undeniably great and numerous problems with the UK healthcare system but it's silly to pretend that the issues are so plain and simple that the US system can be said to be undeniably better.

[Steely Glint]

You know it costs a ridiculous amount of money, right? And it costs a ridiculous amount of money because it makes no sense catering to anyone but the rich in your healthcare system.

Yeah, well, it's not a right you know.

[Loki]

Yeah, well, it's not a right you know.

I thought Europeans had a right to healthcare that didn't involve being stuck with a doctor practice pseudo-science?

[Steely Glint]

And I thought health care wasn't a right at all, but rather something you should have to pay for like, like a bag of crisps or a pair of designer jeans. Obviously, one of us was misinformed... but which one?