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comment by kleinbl00
kleinbl00  ·  686 days ago  ·  link  ·    ·  parent  ·  post: Human Mealworm says people should choose between "iphones" and healthcare

The insinuation that "I can't afford to get sick or injured" is somehow not "anything that matters" is offensive to the core. There's nothing abstract about it.

I'll point out that in 1987 you were a 20-year-old man. Your health care expenses were effectively zero. That's the whole argument for mandatory health insurance: for the system to work, you have to pay for insurance you'll never need because your parents are paying far less than the insurance they actually consume. Take mandatory market participation off the table, and your parents start paying what they cost and all of a sudden they're living off dog food because they needed a hip replacement. Meanwhile, my employer paid my health insurance from the age of 19 through the age of 33 and in that time, I had three blood tests, actual cost ~$12 ea, and a checkup - and my employer was no doubt paying $200-$300/mo for fourteen years.

And that's the game: In that same time period, my buddy Fuckin' Rob decided to debut his mad street luge skillz down an inadvisable hill in Magnolia and ended up with a helicopter ride to Harborview and six months in traction. That's $130k to him because he had no insurance. Didn't affect me at all 'cuz he wasn't in my pool. However, my employer's expenses went up when they hired a 24 year old woman because well, you see, statistically she's likely to have a baby and babies are expensive.

See, when you were young, things cost what things cost. And then things got deregulated so that people had a "choice." And everyone gets upset because that "choice" made everything more expensive. But listen:

Open in front of me right now is a list of "allowed amounts" for the things my wife does. It lists fifteen different insurance companies. These are the "best case scenario" amounts that we can charge if we hit the right ICD10 codes and get the right reviewer at the insurance company. One particular line item varies from $584 to $2500. That's their "if you take our insurance, this is the most we will ever pay you for this" reimbursement. For the state insurance vendors, that number has actually gone down since 1997. For many of the line items, the reimbursement is below cost. As in, if my wife gives medicine to keep your baby from going blind, she loses money with every application. And guess what. It's not just a good idea and good healthcare, it's state-mandated that she give that medication.

So you play bingo with the codes to see how close you can get to your rack rate. That's where shit goes south: you, as a healthcare provider, need to make as much money as possible (and the bigger your organization, the better you are at it). You, as an insurance provider, need to make as much money as possible (and the bigger your organization yadda yadda). And between this irresistable force and that immovable object are people who think that somehow, you paid what it cost in 1987.

You didn't. But there were more regulations in place to keep you from being ground into powder.

And that's why you think "that people aren't even talking about anything that matters". If you want healthcare like the rest of the world, the risk pool has to be "everyone" and the profit has to be "zero." As it is right now, the risk pool is "people who can afford it" and the profit is "maximum."

The health insurance industry nets about $200b a year in profit. The Obama administration had a choice between "destroy that" or "figure out a way to increase 'people who can afford it.'" And that's why this makes no sense - when Napster destroyed the music industry in 2000, they were doing about $14b in sales. Cutting profits of the health insurance industry by 10% is the equivalent of eliminating the music industry.

    And now, somehow, we have gotten to the point where everyone just expects all heathcare to cost a $20 copay, and somehow "Insurance" is supposed to cover the rest?

My company had 13 people in it. If they'd been able to not give me insurance and just pay me instead, I would have made an extra $14,000 in the time I was there. But then I probably wouldn't have because my boss' two open-heart surgeries would have bankrupted him, dissolved the company and I would have been out of a job. There's your real problem: the bigger your risk pool, the less risk there is and republicans want a risk pool of one.




goobster  ·  685 days ago  ·  link  ·  

Yeah... I know way more of the sausage factory of medical billing than I like to let on... I wrote a database application for a medical office that handled all the ICD9 codes (yes, ICD9... it was that long ago) and CPT codes. Took almost a year to write, and still didn't catch all the edge cases and weirdnesses of that messed up system.

    And that's why you think "that people aren't even talking about anything that matters". If you want healthcare like the rest of the world, the risk pool has to be "everyone" and the profit has to be "zero." As it is right now, the risk pool is "people who can afford it" and the profit is "maximum."

This is really the crux of it.

There is no plan that works in a purely capitalist way. Because you have to force people who don't need things into buying them. The healthy have to underwrite the sick. Period. That's it. Without that pool of swirling money that everyone gets to dip in to when they need it, you have people going bankrupt and still dying of their cancer because they can't afford treatment.

Incidentally, I've filed maybe 20 insurance claims throughout my life. Sprained ankle, broken finger, cavity fillings, root canals, eye exams, glasses, liver "weird readings" diagnoses (multiple times), etc. (All "covered" expenses under whatever plan I was on at the time.)

And the FIRST time I EVER had insurance accept ANY of my claims was about 2 years ago. Working for a tech company, something happened to my brain and I couldn't stand up. In-home doctor visit within 2 hours of my call, and I was diagnosed (something minor, I think it was viral, can't recall), and insurance paid for ALL of it. Every single other claim I have ever filed in my entire life has been denied due to some loophole. So I fully expect if I ever come down with anything truly nasty, it's a shotgun and a shallow hole in the back yard for me.

bfv  ·  685 days ago  ·  link  ·  

Having had two parents with nasty somethings, denied often doesn't mean "denied" so much as "we know we should be paying for this, but we're going to make you pick a fight with our callcenter drones under the assumption that if you can pay for it yourself you're rather do that than fight with our callcenter drones."

And they're right. When the cost is less than an afternoon of hold music, vague threats about lawyers and shouting I just pay my father's bills out of pocket. They always cave when it's worth the trouble to fight over, but they save a lot of money when it isn't. Hooray for capitalism.