Omnibus GOP Primary ThreadFollow

Fixed your statement. It's okay, I know you smoke a lot of weed.


Edited, Mar 29th 2012 5:46pm by Kastigir

The thing is, though, those preventative visits are actually a value for the insurance company.

$100 for a visit to a doctor for strep throat today, or $10,000 for an extended hospital visit for untreated strep throat turning into pneumonia?

That math only works if 100% of all the people with a sore throat which *could* be strep actually have strep. What actually happens is that you save the cost of one $10,000 extended hospital stay at the cost of 10,000 $100 doctor visits to check if that sore throat is strep. Total cost increases by a couple orders of magnitude as a result.

Obviously, that cost differential changes if the preventative care can include checks for multiple things, all of which may avoid a costly hospital stay, but it's still hard to see how the total costs aren't higher in the long run. Imagine if we pay for everyone to get a check up every 6 months at a cost of $100. What percentage of people in any given 6 month period will develop some illness which will require an expensive hospitalization? What percentage of those illnesses might have been caught earlier and made less expensive as a result? The math and odds get really dicey IMO.

Doesn't it just make more sense to provide insurance which covers the expensive hospital stay and let the people pay for the regular/cheap stuff on their own? So instead of 10,000 people paying $110/year for the insurance to cover a $100 doctor visit, they just pay $1.10 each for insurance sufficient to pay for the actual cost of the one guy who will get sick (with the insurance company charging a 10% overhead charge in both cases). And if anyone wants to pay $100 for doctor's checkup, their total bill is still less than just the insurance cost for the checkup. Doesn't that make a hell of a lot more sense?


I think it does.

Edited, Mar 29th 2012 4:01pm by gbaji

At $100 a visit though I'd rather stay home and ride it out than spend the money only to be told it isn't strep.

At a $15 copay, it was worth it to take a day off and go get it verified and get prescribed antibiotics since it IS a bacterial infection, anyway, just not strep.

I'm pretty sure my insurance company would had love it if I had went to see the doctor when I thought it was just a cold. A $100 visit might had saved me my heart and them about 700 to 800k dollars well and medicare 1mil you know damn cobra kicks you off after 2 years (took .2 and a half to find a decent heart).

I would love that. Really. It's one of the main reasons I love Dennis Kucinich. He's one of the only federal level politicians who has consistently, for years, said that we need a single payer universal health care system. I seriously do not understand why so many Americans are afraid of doing things the way the Europeans (and Canadians) do, when what they do works! I'm all for keeping some of our national identity, but the way we do education and health care in particular are ****** up, and I think we'd be better off observing the way other industrialized nations do it, and figure out how we can adapt those methods so that they work for us.

I'm still pissed that the Demos cowed to the GOP when it came to the public option. We had a filibuster proof Congress and Senate. Why did we feel the need to work with the GOP when they haven't felt the need to work with us for years? It's crap like this that makes me seriously consider moving to a different country when I finish school.

Yeah, the VA had to pay for my father's 4 way heart bypass surgery since he had his first heart attack on duty.

Then they discovered with him, as well with all the other vets of the former 11th airborne, that maybe doing 300 jumps was actually really hard on a body's circulatory system and is probably not a good idea.

IMO, if the math was really that dicey my insurance company wouldn't be paying us for participating in a preventative care program. It's not all stuff like doctor and dentist visits of course, there's also things like:

-smoking cessation program
-weight-management program
-monetary rewards for getting exercise
-Having a PCP

among other stuff.

Edit:

Also a bit of speculation, but this kind of thing probably only works if you're planning on keeping your employees for a long period of time. Since the monetary benefits of health later are generally later in life, and the costs more short term. As bad as it sounds if you only hold on to employees for a couple of years (or have a younger work force) it's probably cheaper to just skimp on stuff and pawn off the eventual health problems on someone else's insurance program.




Edited, Mar 30th 2012 9:52am by someproteinguy

Oh Santorum. What are we going to do about you?

He'll probably end up on the ticket as Mitt's veep.

Still not seeing the math though. Divide the number of people who get a cold each year by the number of people who develop a heart condition which *can* be prevented (but would otherwise have required a super expensive transplant) and which will be caught and prevented by the doctor visit you went to because you had a cold. Assuming all 300 million people in the US will get a cold at least once a year, you're spending $30B/year for a $100 doctor visit for each of them each year. Assuming it costs $1m for a heart transplant (or whatever super expensive thing you're talking about), we would need to have 3000 people develop heart disease requiring a transplant every single year. Just to break even.

The math doesn't work. It's something that sounds great when some politician says it from a podium in front of an agreeable crowd. But if you actually stop and think about it, it's a pretty dumb idea. There are some areas where preventative care is worth it because the cost of the exams and the odds of actually preventing an expensive health problem if you catch it early enough combine to make it worth it. But most illnesses don't work that way. And certainly, almost no injuries work that way. No amount of you going to the doctor regularly will prevent you from falling and hurting yourself. So when we look at the total cost for "expensive hospital stays", we find that we can only really reduce this a small amount via prevention. But the total cost required to have any significant preventative effect is so high that it's almost absurd.

Because the insurance company makes more money on the preventative care than on the actual care for an illness you get. You're thinking that what's less expensive for them is less expensive for you (you in this case being the whole number of people paying into that insurance company's pool). That's completely backwards though. If we assume that the insurance company takes 10% off the top for payoffs, under which condition does it make more money:

1. It covers 10,000 people for major medical only, with 1% of those people requiring a $10,000 hospital stay on average each year.

2. It covers the same 10,000 people for major medical, but now with only .5% requiring that hospital stay *plus* it covers preventative care, costing an extra $100 per person.


Remember, it's going to set its premiums to be 110% of the average cost it's paying out in order to cover administrative costs and make a profit. In the first case, the total cost is 100 hospitalizations at $10,000 each, for a total of $1m. It therefore charges $1.1m in premiums. That results in a $110 charge to each of the 10,000 people. In the second case, we've cut in half the rate of expensive hospitalizations (which would be a fantastic reduction by any measure), meaning only 50 people needed them at $10,000 each, for a total of $500,000. Plus, the insurance pays $100 for all 10,000 people at a total cost of $1m. Total cost is $1.5m in insurance payouts. Plus their 10% markup, they charge a total of $1,650,000, or $165 each.


So the total cost for your premiums went from $110 to $165, which is bad. The total number of people who got really sick went down, which is good. But the insurance company's profit increased from $100,000 in the first case to $150,000.

For 50% more profit? Of course the insurance company will do that. You have to understand that no cost the insurance company incurs actually costs them anything. They pass all costs on to the folks paying the premiums, and their profit is a percentage of that total cost. Thus, anything that makes health care more expensive is good for the insurance companies. Anything which increases the scope of things they have to cover is good for them.

I just think that most people don't realize this.




That's a separate issue, but entirely correct (as the system is set up now). This is why both Dems and GOP have been in agreement over things like allowing insurance companies to compete across state lines, and allowing customers to keep their insurer even as they change employers or move (or retire). For the most part though, the worst cases tend to work out. Remember that insurance companies are in the business of calculating total risks and costs and passing that on in the form of premiums. They'll make enough money on the healthy people to cover the costs for those who get sick. And while they do have some interest in dropping folks later on, as long as people have choices about their insurance, those companies who do that will tend to find fewer customers. The free market *can* correct for that factor (why would anyone buy health insurance if there was a high chance they'd just pay into it for 20 years then get dropped when they get sick?).

The problem is that most of those restrictions are government enforced, not free market. We've literally created cases where the insurance company you've paid for the last 20 years *can't* continue to cover you if you move or change jobs, and the new one is under little obligation to pick up the tab. And a whole hell of a lot of this stems directly from government meddling in the health care industry over the last 50 years.

Edited, Mar 30th 2012 7:37pm by gbaji

Viral cardiomyopathy is more common then you would like to think and not limited to viral infections but bacteria infections as well. sh*t my first dry run at transplant the would be donor had bacterial infection of the heart poor sob was sol any way. So that simple case of strep throat might do far more damage and cost the insurance company more then 100 dollar visit. Not to mention doctor visits are far less then ER visits. My heart transplant alone cost well over 1.8 million and it keeps on climbing with 1800 dollars a month going towards my anti-rejection meds and those are not even name brand. My other meds run 2000 a year for stuff like blood pressure and other side effects of having your heart cut out. Then I have biopsy's which for the first year was once a month at 1500 dollars a pop now I go every 6 months. So how many of cases would it take for that 100 dollar a pop visit to look like a sweet deal. Little prospective the longest living person with a heart transplant died 31 years after getting it and the avg survival time is 15 years.

Oh and there are 2300 heart transplants done every year that not including those that died before getting one but just waiting for one can rack up the bills too. A LVAD cost 500k and is used as a bridge to transplant or when transplant can not be done. So just a few cases like mine out of that 2300 would had saved millions. Early detection of problems make a 100 dollar visit worth it.



Edited, Mar 31st 2012 12:19am by RavennofTitan