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Medicare is medical insurance. That happened in 1965 and it's working pretty well.
I understand your point - most people on Medicare like it. But there are consequences. The costs of medical care are like a balloon - Medicare "squeezes the balloon" by paying health care providers less. But the costs don't disappear; they show up elsewhere. Because the balloon has been squeezed by Medicare, non-medicare pricing is higher than it otherwise would be.
Quote:
Originally Posted by Katarina Witt
It's important to keep in mind ACA is the law, not a type of insurance. Some people conflate ACA with the insurance you can get on the exchanges, but by law all insurance (with a few exceptions) has to be ACA compliant, no matter who writes the policy, or what kind of a policy it is (e.g. high-deductible, low deductible, PPO, whatever).
The problem is larger than medicare - it is all health care insurance.
We can start by saying that insurance is for the unforeseen. The clearest example is that pregnant women and their doctors know 7-8 months in advance that the woman is pregnant and will (we all hope) deliver a healthy baby after about 9-ish months of gestation.
Why in the world, then, should we pay for this joyish event the same way we pay for an automobile collision on the freeway - by filling out an insurance claim form?
We all have car insurance, but we don't submit a bill for a new air conditioning compressor -- let alone an oil change -- to State Farm, Geico or Progressive. So why do we think a health insurance should cover analogous medical services?
Imagine a world where we financed grocery store purchases via "food insurance" in the same way that today we finance health care goods & services purchases via "health insurance." This would be a "bizarro-world."
In the USA we have an exceptionally efficient food distribution system. Pretty much anywhere in the USA, you can go to a supermarket and purchase fresh food and other items; you can typically select from over 50,000 separate SKUs.
Today, of course, we each go to the checkout counter where our purchases are tallied & we pay the bill.
In a "bizarro-world" where grocery store purchases are paid for via "food insurance," there wouldn't be any prices on items or shelves in the grocery store - or at least the prices listed would be irrelevant to purchase decisions. We would go through the checkout line with our basket of goods, and the clerk would remove some items from our basket and tell us we can't buy them because of our insurance. We might pay a $10 or $25 copay, and then months later, we would get an "explanation of benefits" that would tell us the price charged by the grocery store, the allowed price, the portion picked up by the "food insurance company", etc.
As part of that "bizarro-world", our "food insurance company" would tell us we bought Kraft Macaroni & Cheese for $8.77 instead of the store brand for $3.37, and they only reimburse for store brand, but at $0.89, of which they pay 80% or $0.71, and hence we are responsible for the balance of $8.06. Yet, if you had had no "food insurance" you could have purchased the Kraft brand for $2.11. You then attempt to negotiate with the supermarket - you tell them their "real" price is $2.11, and the insurance company already reimbursed the supermarket $0.71, so you think you should only pay the balance of $1.40. You argue back and forth via US Snail Mail for the following 6 months, and they ultimately write off a portion of it.
And then you are surprised the following January when you receive a 1099 from the grocery store indicating you have IRS-reportable income in the amount of the write-off.
And of course, the once highly efficient food distribution system would have literal armies of back-office clerks who were skilled at submitting claims to the "food insurance companies", working through denials, and putting together payment plans for customers.
And somehow people would put up with this crap. People would complain, and no one would know what to do.
Agree that it has become ridiculously expensive in a lot of places, but before the ACA she probably couldn’t have gotten coverage at any price and she might lose her plan if the ACA is repealed.
There is no way for you to know that somebody could not have gotten insurance prior to Obamacare. And many people lost their truly affordable and much cheaper medical policies when Obamacare went into effect.
buy the same token no one is forced to live here in this country either .-- sorry
Wouldn't it be rather fascist to suggest that would be an intelligent rebuttal akin to car ownership, when all states reserve the right to drive a car as a privilege and not a right?
I have a right to live. I should not have to leave the country of my birth - as your rebuttal seems to suggest - in order NOT to have to buy 'by law' a product from a private company. Again, sorry.
No, it wasn't. We consume far too much health care in this country. On average, and across the nation, we consume north of $10,000 per person per year in health care - that's $10,000 for every man, woman and child in the country. Therefore, as surely as night follows day, the insurance to cover that $10,000 average health care utilization must cost at least $10,000 plus overhead & profit.
I don't think averages accurately capture per-person consumption of health care. And that's not how the insurance industry prices their policies either.
I disagree. The larger the number of people in the pool, the tighter the variance of the estimator (measured average) is to the population average. That is, the "bell curve" becomes very skinny and tall. It does not move the center of the "bell curve" left (lower cost).
There are several components of insurance premiums (including, of course, Medicare Insurance Premiums), including:
Costs of the underlying thing being covered (the health care)
Administrative costs
Regulatory costs
Compliance costs
Reporting costs
etc
As a governmental entity, the Centers for Medicare & Medicaid Services (which administers Medicare) is a large, complex bureaucratic organization with typical governmental inefficiencies - so its costs are high. Separately, the Social Security Administration (which participates in Medicare administration by being the governmental entity that is usually the front-line contact to applicants) is also a very large, inefficient, governmental bureaucracy. Thus, the administrative costs are higher than in the private sector. And, of course, those entities are staffed with union employees -- I believe they are members of the American Federation of Government Employees - and hence they have their own gold-plated government pensions & Cadillac medical care, which is expensive, and of course must be factored in to the costs.
Again, the variance on the underlying health care costs (the thing being insured) goes down - but the first moment of the distribution does not change. That is, with an individual plan, the insurance company has little information on how much health care you will consume: you might consume the average (over $10,000), you might consume very little ($1,000) or you might have a kidney transplant (at least $250,0000 plus $17,000 a year for anti-rejection drugs.) Thus, the second moment of the distribution is large. As the group gets larger, the group's second moment - variance - declines.
Don't confuse a decline in the second moment of the distribution with a decline in the first moment of the distribution.
That is, as individuals join groups, the average is still the average is still the average - well north of $10,000 to pay for the underlying health care consumption, plus administrative costs plus taxes plus regulatory fees plus compliance costs plus reporting costs plus a regulated profit margin, etc. etc etc.
Fully agree about the need to severely trim the healthcare bureaucracy. Regarding statistical parameters, you are talking about Bell curve, ie, a normal distribution. But the population of seniors starting from the age 50, plotted with the age on x axis and morbidity/health services use (per 1000 people of each age) on the y axis, does not follow normal distribution. The bulk of morbidity is skewed heavily to the right. Fifty five year olds are on average nowhere near as sick as 85 year olds, plus my guess is that there are many more 55 year olds than 85 year olds.
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