Miscellaneous And Off Topic Subjects

[AlabamAlum]

...Here's the problem. I'm uneducated and unmarried....

That is a problem, but I would have never guessed, I thought you were married.



:::runs:::

[AlabamAlum]

This describes most every service process anymore, thus my contention that reducing demand is the best way to reduce cost.

Any entity charges what its customers will pay. Getting from here to there though....

I'm not sure how the $10 aspirin applies to what you are saying.

Anyway, re: charges: Not really with healthcare. It doesn't really matter one bit what we charge the vast majority of the time.

[Jeff Buchanan]

Yeah I'm sure the are numerous people having babies and turning down more than 8 bucks an hour to stay on Medicaid. The Welfare queens.

You've made some great posts here, Froot. This isn't one of them if I'm reading it correctly.

There are large numbers (i'm going to look into this a bit more and get some numbers rather than just generalize) of "welfare queens" despite serious effort to reduce their number. The Clinton administration did a good deal of this and it was useful.

But I believe you and I have have both witnessed in our daily working lives people preferring not to work or take responsibility for themselves instead preferring to take advantage of the generous social benefits available to them.

I have personally come into contact with people and families who are experts at this. I suspect a lot of you here have as well. It's not fraud. It's perfectly legal if it is done right and it tends to cost a lot and in the end game of social program budget cutting we are going to get from the Trump administration and the R Congress it is going to deprive those who really need help out of the help these programs are designed to provide.

Maybe I misread your post.

[froot loops]

When was the last job you had that didn't offer health insurance?

[froot loops]

Josh Barro nails it

http://www.businessinsider.com/gop-individual-mandate-polls-obamacare-2017-3

[Dr. Strangelove]

Chuck Grassley chairs the Senate Judiciary Committee and he said today (from what I've read) that the Committee will hold up Deputy AG Rosenstein's nomination until FBI Director Comey gives them an awaited briefing.

[Wild Hoss]

I'm not sure how the $10 aspirin applies to what you are saying.

Anyway, re: charges: Not really with healthcare. It doesn't really matter one bit what we charge the vast majority of the time.

We're talking about your overheaded $2 aspirin now, which is still absurd, and isn't going to get significantly cheaper. If we can reduce the number of $2 aspirin charged, costs come down.

As for charges, there is an equilibrium reached with insurance between your target recuperation and what they'll pay, even if there is a negotiation ritual involved as standard practice and potential spillover to the policyholder as well.

All that said, my original point was that seeing significant cost reductions through procedural/legal/market mechanisms as Jeff described are, IMO, unlikely. If your costs drop, you'll have other uses for the increased net in your budget. Even if the savings are passed on to the consumer, it gets squeezed by the insurer first, and they for damn sure have other "uses" for increased net. The costs savings for the average policyholder will be jack.

Real savings- IMO- have to come from changes on the demand side, first and foremost, though all avenues should be pursued of course. And, apologies if I appeared to be throwing medical admins under the bus...well, all the other medical admins anyway. :-D

[AlabamAlum]

Hoss,

I don't know that its absurd considering the salaries, overhead, and oversight required in getting that aspirin to the patient, but it's irrelevant- hospitals just aren't getting individual line-item reimbursements anymore, so, it doesn't matter.

Hospitals don't make much money because of overhead: 2% net profit and you're CEO of the year in most systems. Thats why healthcare isnt a great stock buy in most cases.

Anyway. As far as dropping costs, if that happens, the reimbursement to the medical center drops. Insurance companies and CMS are scary good at calculating UCR and adjusting DRGs and payment schedules. Do insurance companies keep costs flat or lower rates to employers if that happens? Some do. If they do, do the employers trickle down the savings and lower that monthly deduction to their employees for insurance? Some, but these are concentric circles.

[SeattleLionsFan]

It is, among other things, income based: the formula for determining Medicaid eligibility is diverse but fundamentally you are income level eligible at 133% of published (gets revised every year) Federal Poverty Level (FPL). That is based on number of persons in the household. For a family of 4, the FPL is $32.3K.

Here's the problem. I'm uneducated and unmarried. The FPL for a one person household to gain eligibility for Medicaid is around $11k. If I earn less than about $8/h I can remain eligible for Medicare. Or, I can find 4 dependents or have 4 babies and boost my FPL to $32.3K or about $16/h ...... I think everyone gets the picture here and the validity of what I posted.



On what basis do you make this claim? Aside from my question about that, if you get rid of Insurance companies who represent large groups of policy holders (e.g., AARP and there are a bunch of others like this) or large employers providing HC benefits to thousands of employees, you lose a powerful free market force to put downward pressure on HC costs. What you then have is individuals out there searching for insurance. That's not going to turn out well for the consumer.

When you start to delve into questions and issues like this, you begin to see how complex the problem of delivering HC equitably actually is.

Honestly, I've always seen it asserted that insurance is inherently inefficient for the reasons I presented, but I don't know that I ever read it in a Econ textbook. Let me know if you'd like me to look further. I'm kind of interested now.

And I don't think an insurer is the only one that can negotiate rates on behalf of customers. That said, it's a compelling argument against free markets and for single payer.

[Dr. Strangelove]

Maddow somehow got her hands on Trump's 2005 tax return. Literally 5-10 minutes before her show tonight, the WH rushed out a statement disclosing the amounts and everything. Which sorta shows they could have released this stuff any time they wanted, but Trump just didn't want to

[Dr. Strangelove]

Well, I should say it's only the first two pages. Story here

http://www.thedailybeast.com/cheats/2017/03/14/report-trump-s-2005-taxes-revealed.html

[iam416]

I like how the AMT is suggested as something other than income tax. Lol.

[SeattleLionsFan]

I thought they were just trying to distinguish it from the taxes calculated on the schedules. But you are right, it's a weird phrasing.

[Da Geezer]

SLF:

....I am more concerned about how we are going to prevent them from dying on the street or just passing their bills onto others.

Sounds exactly like the "ill-informed" during the Welfare reform in 1996-7. May we at least get this one thing clear: if you go to a hospital in the US and ask for care, you get care, even if you are illegal, poor, rich, or whatever. AA, am I correct on this or not?

The collection of payment is where insurance comes in. Health insurance carriers provide a service; ie. allowing an individual to manage risk by letting him pay an amount that roughly correlates to his periodic mathematical expectation of a catastrophic loss. As for the "passing on of bills to others", that is precisely government-provided health insurance is. That is what Medicaid (and I happen to believe Medicare) is. As I've said many times, paying taxes, then running the money through a bureaucracy, or multiple bureaucracies, to provide "insurance" to the indigent just explodes the cost. If AA has a non-paying patient, he has the amount of the loss to his hospital to the penny. Pre-ACA, health insurance premiums reflected this the cost of the bad debt was passed on to the insured through higher insurance costs, reflecting hospitals recouping their loss.

[froot loops]

He should release them all.