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Message
From
12/05/2019 16:09:37
John Ryan
Captain-Cooker Appreciation Society
Taumata Whakatangi ..., New Zealand
 
 
To
09/05/2019 17:01:54
General information
Forum:
Science & Medicine
Category:
Mathematics
Title:
Miscellaneous
Thread ID:
01668508
Message ID:
01668574
Views:
31
>>There is collusion between the hospitals and private insurers to inflate insurance premiums.

I've told you that for 5 years whenever you suggest that physicians are responsible for the massive US costs. There's 3 key perverse incentives wrt costs:

1) The ACA capped profits at 20% of premiums. So as long as costs are increasing, insurers can wring their hands and raise premiums to raise their already enormous profits at a rate rendered moral in law, without regard to affordability or even any sales or business effort. The normal price controlling function of the insurer is eliminated.

2) US facilities can claim fees according to their demonstrable cost of service, not a market price. This encourages/excuses over-capacity and inefficiency, since if you build a 500-bed facility that only ever has 100 patients because there are 2 other facilities in a town that only needs one, all the facilities get to distribute all their servicing costs across their actual patient utilization rather than offering deals or innovating or going broke as any normal business would. Insurers tolerate this cost model for obvious reasons- it drives high costs so insurers get to wring their hands and raise premiums, see 1) above.

3) In proper insurance, you have to underwrite and put aside enough $ to cover reasonably predictable future costs- fires, earthquakes etc. In healthcare, once the patient reaches 65 when the big costs usually start to bite, that liability is transferred mostly to the taxpayer. Thus underwriting turns into an effort to avoid expenditure via pre-existing exclusions, denials and cancellations of contract. The ACA correctly sought to prevent that via guaranteed cover but then strangled the attempt with too many cop-outs for compulsory participation without which you can't have guaranteed cover- or else people wait for expensive sickness to sign up. Result = an increasing spiral of costs with no normal constraint.

Situation = every vested interest to raise costs with no normal market constraint- until the insurers start losing $ because only sick people ever sign up, so they close the plan.

>>Let's lock up some of these hospital execs.

You could, but that could be rearranging deck chairs on the Titanic. To control costs, you need the payers focused on market prices and normal competitive constraints. Say what you like about single payer (government) health schemes- but they tend to focus on costs and sensible rationing to avoid shareholder (taxpayer) rebellion. Ironically, that's one of the reasons why there's a $47T Medicare deficit = cowardly representatives kicking known costs down the road in the interests of another term. So if you want to look at it another way- maybe focus on shareholders, meaning the taxpayer for Medicare/Medicaid and the shareholders of the health insurers.

If you do go for single payer, for heck's sake build in shareholder (citizen) participation from the get-go and shout out that every healthcare system needs rationing of one sort or another! Let the shareholders experience the dilemma of higher premiums/taxes or accepting that every imaginable need cannot be met straight away, or even at all.
"... They ne'er cared for us
yet: suffer us to famish, and their store-houses
crammed with grain; make edicts for usury, to
support usurers; repeal daily any wholesome act
established against the rich, and provide more
piercing statutes daily, to chain up and restrain
the poor. If the wars eat us not up, they will; and
there's all the love they bear us.
"
-- Shakespeare: Coriolanus, Act 1, scene 1
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