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Medical bills tied to 60 percent of bankruptcies

Health Care 2009

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#41 Nick

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Posted 05 June 2009 - 12:26 PM

^Well, cost vs. value.  High-cost low-value treatments (i.e. chemo for a 95 year old) would not be favored.

#42 Themis

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Posted 05 June 2009 - 12:27 PM

View PostPalisade, on Jun 5 2009, 05:22 PM, said:

View PostRhea, on Jun 5 2009, 11:12 AM, said:

Am I understanding you that you would make decisions on who lives and who dies (and how they die) based on the cost of treatment?

Based on value.

Value to who?
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#43 Nick

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Posted 05 June 2009 - 12:28 PM

View PostThemis, on Jun 5 2009, 01:27 PM, said:

Value to who?

The patient.

#44 Cait

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Posted 05 June 2009 - 12:28 PM

View PostRhea, on Jun 5 2009, 09:48 AM, said:

And you've had a loss I can't begin to understand. Add that to your health problems and I wonder how you get out of bed in the morning.

{{{{{{{{{{{{{{{{Cait}}}}}}}}}}}}}}}}}}}}}}}}

*smiles*  You are so incredibly kind.  Thank you.

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#45 Cait

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Posted 05 June 2009 - 12:36 PM

View PostThemis, on Jun 5 2009, 10:27 AM, said:

View PostPalisade, on Jun 5 2009, 05:22 PM, said:

View PostRhea, on Jun 5 2009, 11:12 AM, said:

Am I understanding you that you would make decisions on who lives and who dies (and how they die) based on the cost of treatment?

Based on value.

Value to who?



But, the truth is insurance companies already make these deteminations when they approve or disapprove procedures.  I'm not sure what else could be added to that.  We already do forgo procedures and people do in fact die because of it.  

Additionally, it will increase the class divide to push for even more denials of treatment.  The rich will still be able to afford whatever treatments they want, and the poor and middle class will still be denied procedures by the state or the insurance companies.  This isn't new.  It's the way it already exists.

Rules for surviving an Autocracy:

Rule#1: Believe the Autocrat.
Rule#2: Do not be taken in by small signs of normality.
Rule#3: Institutions will not save you.
Rule#4: Be outraged.
Rule#5: Don't make compromises.
Rule#6: Remember the future.

Source:
http://www2.nybooks....r-survival.html


#46 The Tyrant

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Posted 05 June 2009 - 12:39 PM

It'd be nice if insurance companies actually ponied up for preventative care, instead of when you're already screwed up...might save a few bucks.

#47 Nick

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Posted 05 June 2009 - 12:47 PM

In considering Palisade's answer to my question upthread, to increase pricing transparency . . . I'm curious how we can really "dissect" the cost of medical treatment.  How much of a $200,000 surgical procedure goes to the physician(s), their liability insurance companies, the facilities, the equipment, the drugs, etc.?

I suspect a large part of balooning healthcare costs is due to the amplifying effect of healthcare plans and insurance on top of insurance.  Which is why I'd rather we went to a single-payer system.  I think it'll simplify the inherent problems tremendously.  But I do agree with Palisade that there still needs to be some mechanism that balances the costs and values of a procedure from the patient's perspective.  Proportional copays, perhaps.

#48 Nick

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Posted 05 June 2009 - 12:48 PM

View PostThe Tyrant, on Jun 5 2009, 01:39 PM, said:

It'd be nice if insurance companies actually ponied up for preventative care, instead of when you're already screwed up...might save a few bucks.

What kind of preventative care do you mean?

#49 Gambler

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Posted 05 June 2009 - 12:48 PM

View PostThe Tyrant, on Jun 5 2009, 10:39 AM, said:

It'd be nice if insurance companies actually ponied up for preventative care, instead of when you're already screwed up...might save a few bucks.


I agree....and it might save a few lives as well.

#50 The Tyrant

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Posted 05 June 2009 - 12:53 PM

View PostNick, on Jun 5 2009, 12:48 PM, said:

View PostThe Tyrant, on Jun 5 2009, 01:39 PM, said:

It'd be nice if insurance companies actually ponied up for preventative care, instead of when you're already screwed up...might save a few bucks.

What kind of preventative care do you mean?

Any kind....frequently, insurance will not pay for tests that would find problems before they become debiliatating, but will cover almost all of the procedures to fix it once they are debilitating. What kind of sense does that make?

#51 Nick

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Posted 05 June 2009 - 12:58 PM

View PostThe Tyrant, on Jun 5 2009, 01:53 PM, said:

Any kind....frequently, insurance will not pay for tests that would find problems before they become debiliatating, but will cover almost all of the procedures to fix it once they are debilitating. What kind of sense does that make?

That's not my experience.  I have United Healthcare's HMO plan.  It covered all the tests they did at my last physical exam.  Bloodwork, urinalysis, chest x-ray, etc.  I think they made me pay $50 for the EKG tho because they won't pay for it before a certain age.

#52 Palisades

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Posted 05 June 2009 - 01:08 PM

View PostCertifiably Cait, on Jun 5 2009, 11:36 AM, said:

View PostThemis, on Jun 5 2009, 10:27 AM, said:

View PostPalisade, on Jun 5 2009, 05:22 PM, said:

View PostRhea, on Jun 5 2009, 11:12 AM, said:

Am I understanding you that you would make decisions on who lives and who dies (and how they die) based on the cost of treatment?

Based on value.

Value to who?


But, the truth is insurance companies already make these deteminations when they approve or disapprove procedures.

To a limited degree. Perhaps more so with some of the HMOs. Currently, our system does a very bad job of making these decisions, which is a major reason it's in the state that it's in. I never said the choices would be easy (in fact I specifically said they would be painful), but they will be made one way or another.
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#53 Cait

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Posted 05 June 2009 - 01:26 PM

View PostPalisade, on Jun 5 2009, 11:08 AM, said:

I never said the choices would be easy (in fact I specifically said they would be painful), but they will be made one way or another.

Yes.  I know.  You have stated repeatedly in fact, that it would be difficult to makes these decisions.  I don't mistake your words about the health care in this country to be a statement of ease.  

But it brings up another point.  if insurance companies are already doing this, and it will increase in the future--why have health insurance at all?  Why not self-insure?  I know this goes back to the Bush "health savings plan", but even at the time it had some merit.  I know my mother self-insures in case she needs long term care at some point.  With self insurance, she can make her own decisions on what she can and cannot afford or have regarding her health care.  Self-Insurance offers that freedom.  At least then the individual has the option of making his or her own hard and painful decisions.

Also I remember a poster over at Terran remarking on the bargaining possibilities with health care providers if we used self-insurance.  Some prices are high because the market allows it.  People don't individually demand lower prices, the insurance companies set the price.  He argued that if people were self-insured that it would make the market place more fluid regarding supply and demand.  If pricing were competitive, then market place dynamics would come into play.  I'll have to go search for that essay he wrote, at the time it seemed to be full of possibilities.

Of course catastrophic illness probably isn't going to be solved with self insurance, but preventative care certainly could be.

Rules for surviving an Autocracy:

Rule#1: Believe the Autocrat.
Rule#2: Do not be taken in by small signs of normality.
Rule#3: Institutions will not save you.
Rule#4: Be outraged.
Rule#5: Don't make compromises.
Rule#6: Remember the future.

Source:
http://www2.nybooks....r-survival.html


#54 Rhea

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Posted 05 June 2009 - 02:02 PM

View PostThe Tyrant, on Jun 5 2009, 10:39 AM, said:

It'd be nice if insurance companies actually ponied up for preventative care, instead of when you're already screwed up...might save a few bucks.

Actually, many of them already do. I have Health Net, and I know they do. More providers have gone back to paying for annual physicals (although they don't always call it that) because they find it costs less in the long run.

Edited by Rhea, 05 June 2009 - 02:04 PM.

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#55 Palisades

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Posted 05 June 2009 - 02:42 PM

Cait said:

But it brings up another point. if insurance companies are already doing this, and it will increase in the future--why have health insurance at all? Why not self-insure?

A lot of stuff would still be covered. Also, self-insuring requires having accumulated a large amount of savings. But I do agree there's a high amount of appeal in the freedom to make one's own decisions.


Quote

Also I remember a poster over at Terran remarking on the bargaining possibilities with health care providers if we used self-insurance. Some prices are high because the market allows it. People don't individually demand lower prices, the insurance companies set the price. He argued that if people were self-insured that it would make the market place more fluid regarding supply and demand. If pricing were competitive, then market place dynamics would come into play. I'll have to go search for that essay he wrote, at the time it seemed to be full of possibilities.

I doubt it would be particularly effective for individuals to bargain with the medical establishment-- unless large numbers of people are willing to say to the doctors and medical staff, "No, I'm not willing to pay that," and then walk away. (And if you're carried in on a stretcher, bargaining is even more unlikely.) However, if medical care providers were required to report what they charged for the procedures and treatments and what success rates they achieved, that data could be organized by geographical area and made available online in the form of a price comparison engine. That might bring about competitiveness among medical care providers. (On the other hand, it might also result in people with complications being turned away because they'd raise the costs the medical care provider would have to report.)

Edited by Palisade, 05 June 2009 - 03:00 PM.

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"In truth, 'too big to fail' is not the worst thing we should fear – our financial institutions are now on their way to becoming 'too big to save'." —Simon Johnson

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#56 Omega

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Posted 05 June 2009 - 03:17 PM

View PostPalisade, on Jun 5 2009, 07:42 PM, said:

(On the other hand, it might also result in people with complications being turned away because they'd raise the costs the medical care provider would have to report.)

So your stats would just have to include that too.

#57 Aric

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Posted 05 June 2009 - 06:08 PM

I found it rather amazing that bankruptcies still occur for people with insurance.  Granted, there may be other elements of irresponsible behaviour that contributes to the situation for any given person, and while Palisade pointed out that health care costs are relentless in its growth (and I certainly agree), I would argue that this fact, coupled with the point that increasingly people's health care costs are driving them into bankruptcy, whether or not they have insurance, means that cost growth is actually a symptom of a systemic distortion in the health system, one that fuels costs, and will not be solved even with universal insurance.

I must admit to being appalled at the notion that somehow affordability and/or capacity to pay should play a significant factor in life or death.  I would also disagree with any notion that somehow if the country bands together in common purpose that this is tantamount to a suicidal drive into national bankruptcy.  Remember that almost every other major developed nation has already made that decision, and lives on still, paying the bills, helping each other, surviving and prospering as the case may be.  I would think that an article of this type would stand to be a call to action, a warning sign of the damages being inflicted by the system, and a signal to the solutions that need to be implemented.  Imagine the impact of all these bankruptcies, how much in health care losses, which will only end of indirectly costing the health care system in higher insurance premiums and higher treatment costs from hospitals.

It seems clear to me that health care can no longer be treated as a private good, it's unaffordable for too many, and those that cannot are incurring a very substantial cost on the rest of the population.  Whether it be bankruptcy write-offs, going to emergency rooms, or just working while sick, these costs are starting to add up.  I would suggest instead that it's time to treat health care as a public good, funded through taxation (I believe payroll taxes pay health care premiums now).  The single payer would be available to all, but not the only option, there will be a parallel private system so those that wish to pay for service has that option.  This will reduce the amount of freeriding use, and make sure that all can receive affordable health care.

Aric

#58 Palisades

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Posted 05 June 2009 - 07:19 PM

View PostAric, on Jun 5 2009, 05:08 PM, said:

I would also disagree with any notion that somehow if the country bands together in common purpose that this is tantamount to a suicidal drive into national bankruptcy.  Remember that almost every other major developed nation has already made that decision, and lives on still, paying the bills, helping each other, surviving and prospering as the case may be.

Is this the case of the of the guy who jumps off the roof of a hundred story building, passes the 60th floor, and says, "All is fine..."?
"When the Fed is the bartender everybody drinks until they fall down." —Paul McCulley

"In truth, 'too big to fail' is not the worst thing we should fear – our financial institutions are now on their way to becoming 'too big to save'." —Simon Johnson

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#59 Themis

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Posted 05 June 2009 - 08:00 PM

Palisade, do you not even conceive of the idea of Aric's statement being viable?  

Quote

It seems clear to me that health care can no longer be treated as a private good, it's unaffordable for too many, and those that cannot are incurring a very substantial cost on the rest of the population. Whether it be bankruptcy write-offs, going to emergency rooms, or just working while sick, these costs are starting to add up. I would suggest instead that it's time to treat health care as a public good, funded through taxation (I believe payroll taxes pay health care premiums now). The single payer would be available to all, but not the only option, there will be a parallel private system so those that wish to pay for service has that option. This will reduce the amount of freeriding use, and make sure that all can receive affordable health care.
   Or conceive that Lil is addressing a good part of the problem with

Quote

America SHOULD provide health care. They can start by regulating the fat fat FAT profits these health care providers get. They can start by forcing insurance companies to lower their rates. They can start by making it easier to qualify for insurance. They can start by cleaning up existing subsidized health care by making it hard for people to abuse the system. They can certainly stop guaranteeing health care to illegal immigrants while letting its own citizens languish. There's all manner of things that can be done. But no one is willing to take on the powerful lobbies that are hell bent on profit above all. It's disgusting.
   Or that Cait makes a good point with

Quote

When it comes to public health the state has a compelling interest in keeping disease under control to protect the rest of the population. The state has a compelling interest in protecting private property from damage. I seldom hear anyone talking about the consequences to the rest of us for denying basic health services or housing services to those that can't live within their health care means. Most complain about the cost in taxpayer money, but no one looks at the reality of every day living without some of these services. The consequences to you and me, NOT the poor who can't afford to live within their means. It is enlightened "self interest" that motivates some of us, not some Liberal altruistic motivation.
  Do you really not see the benefit to a healthy population (if nothing else, less sick time, more work, more production, more purchasing power, more tax payments to fund what we all need...) to the country overall?  All you keep saying seems to boil down to "we can't afford it, and if you can't afford it on your own, die suka..."  

I do have some AFLAC policies because Tennessee provides few benefits to workers.  California did, but maybe that's part of the problem now... I need to check and see if I keep those after 65 or if they vanish too when I hit Medicare.  And my Blue Cross policy through work has a $300 health rider, plus covering most routine tests, yearly checkup and some frequent tests due to diabetes.  Flu shots, most standard shots, covered.  I used last year's $300 to get a shingles shot... But I have a $2,000 deductible and that contributed to my own bankruptcy (that and $270 a month in prescription co-pays in addition to doctor visit co-pays).  This is a sorry state of affairs for this country.

In my law firm, several of the attorneys do insurance defense and I see how much money insurance companies pay lawyers to get out of paying what people pay them premiums to cover.   They'd probably do better just to pay the claims.  I suspect health insurance companies do the same thing.  One can attempt to get a ride or take public transportation.  Car insurance isn't any kind of "right."  One can't do without health care, and I think the country's healthcare being doled out by for-profit companies working for their stockholders is obscene.
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#60 Palisades

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Posted 05 June 2009 - 08:42 PM

What I conceive of is that we have an out-of-control deficit as it is, and I'm not going to advocate new social programs when fiscal discipline seems a concept utterly foreign to Washington D.C. I'm certainly not going to advocate new social spending with unrestricted access to the sovereign balance sheet when every indication is that the new spending program would increase at a faster rate than our national output. We'll simply have to agree to disagree on this. If the sad state of Washington improves, I'll be willing to re-evaluate what I'm willing to trust Congress with.

I'm open to attempts to rein in medical costs, although doubtful they'd be particularly effective.


Themis said:

All you keep saying seems to boil down to "we can't afford it, and if you can't afford it on your own, die suka..."
Actually, what I said is that only so much can be spent on health care.

Edited by Palisade, 05 June 2009 - 08:45 PM.

"When the Fed is the bartender everybody drinks until they fall down." —Paul McCulley

"In truth, 'too big to fail' is not the worst thing we should fear – our financial institutions are now on their way to becoming 'too big to save'." —Simon Johnson

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