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DesideriScuri -> RE: A question for Canadians, Brits and any other citizen of a country with nationalize health care (10/7/2013 5:41:29 PM)
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ORIGINAL: eulero83
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ORIGINAL: DesideriScuri
The Citizen should be the customer, and, generally, is here. Let's see how this plays out below...
The Citizen is the customer.
The Health care professional is the provider/producer of the services.
Health care facilities (clinics, hospitals, private practices, etc.) are the employers of health care professionals, and the source of the professionals' pay.
Health care services are the products.
For a facility to pay a professional to produce a product, the facility has to be paid for that product. That is where insurance comes in. Health care can be expensive, so to minimize the cost to any one person, groups of individuals would get together to form "risk pools." The risk is the odds of having to get health care (and, thus, pay for health care). The higher the risk, the more expensive a pool is considered to be, and the higher the premiums are (to make sure care is paid for). Risk pools are broad and there are people within one risk pool that are more risky than average of that pool, and there are people within that same risk pool that are less risky than the average of that risk pool. Treating everyone in one pool as having the same risk means that each of those people are paying the same premium. But, if you are the least risky in any given pool, you are paying more than you would individually, according to your personal risk, than the rest. And, if you are the riskiest in any given pool, you are paying less than you would individually.
Insurance is a way to lessen the cost of your health care. Now, imagine you didn't use any health care at all (never went to the Dr., never took any prescription medicines, etc.). What did you spend all that money for? You, essentially, paid your premiums so someone else can get cheaper medical care. Worth it? It was for the person who's care you subsidized. For you? Your call.
Individuals are in charge, for the most part, in whether or not they are healthy. If an individual does not take the time and/or doesn't make the effort to be healthy, why is it necessary for people who do take the time and/or make the effort to be healthy to spend more money for that other person?
Medical treatments are services. We do trade them, usually for money.
I highlighted some parts because I didn't want to discuss point by point without my text in the middle, with it it would become too long. I hope this will make less complicated read the post.
Just to make it clear I know what an insurance is and how it works.
Ok this is the way it works in your kind of system and you politically agree with its basic idea but as I told you other countries have different systems, and I was not telling if one or the other was better, it's a chioce, but must be conscious.
I don't agree when you say citizens as the governament do not provide anything so it's a matter between privates.
I did not understand what you wrote. Please explain. IIRC, you are in Italy, so it's likely a translation thing.
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comment to the blue part: you join a collective policy to pay less than how you would pay individually as there is less chance that at the same time all the individuals in the group will face big medical expences, and to eventually negotiate a better price, if you would pay less individually than you are a moron to be in that pool.
If you are put in that pool, you are in that pool, regardless. Healthy people who are at little to no risk of needing insurance are being compelled to buy insurance they neither want, not likely need. That's the only way to pay for those who are high risk without charging super high premiums.
http://taxfoundation.org/blog/what-s-insurance-premiums-under-obamacarequote:
There are three major insurance regulations that are part of Obamacare that—when taken all together—are supposed to even out the costs of healthcare across the entire population.
Community Rating: One can think of this regulation as a restriction on pricing people based on their risk. Down to the fundamentals, insurance is priced based on a person’s likelihood of incurring a large cost. Suppose you have a 5 percent chance of getting very ill any given year and this illness will cost you $10,000. In order to protect yourself from that large, unexpected cost, you are willing to pay the insurance company a premium of $500 a year (5% times $10,000). If you do get sick, the insurance company will pay.
Community rating limits the amount an insurance company can charge an individual based on their expected risk. Suppose lawmakers think a $500 premium is too much for one person, no matter what their risk, and decide that an individual’s premium can no longer exceed $400 dollars. Since the insurance company can no longer charge an actuarially fair premium (a fancy term for charging based on risk level), it will lose $100 per year on this high-risk individual. In order to stay in business, it needs to raise premiums for everyone else to make up for the loss.
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comment to the red part: NO insurance is a way to amortise expenses but not lessen costs! Can be for medical care or car incidents or travel unexpected costs, in a matter of fact insurance will always increase the costs as there is an interest to pay for the capital that ensure this expenses that makes the company profit.
Insurance lessens the cost to the individual, but not to the aggregate. The cost of individual procedures and services will not, generally, be effected. The only way to reduce health care spending, then, would be to reduce the number of procedures/services, or reduce the number of high cost procedures/services. So much for the Affordable Care Act, eh?
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comment to the green part: this is your political idea as I told you there are countries that have different systems where healt is considered a basic need so citizens as a group through their rapresentatives (aka governament) negotiate a price for the facilities and for hiring professionals and they don't act as individuals, if privates want to invest in health care they will differentiate their product giving a better service, like faster for example.
That's all well and good for them, if that's what they want. And, I have learned some things in this discussion I didn't know previously, too. I do enjoy good discussions for that very reason!
Bill Clinton signed into law, a Medicare reform law. It included a reduction in the reimbursement rates for care providers. I don't believe the reductions have ever actually occurred. Congress will write and pass a "Doc Fix" Bill that waives those cuts for some period of time. At the end of that period, another one is passed. I don't know why they don't just pass legislation that removes the cuts from existence for good, but they just keep kicking it down the road. Why don't they allow the cuts to happen? They don't want to piss off care providers and cause large scale walk outs. It's all well and good that some governments negotiate rates with providers, but they don't do that here, and they won't be able to get that done here (at least I highly doubt they will). In the UK, there are NHS hospitals and there are private hospitals. NHS hospitals, essentially, are government owned, operated, and the staff is paid a salary (I didn't know that before). So, the NHS is both provider and payer.
The Veterans Administration is pretty much like that here. The VA is for our military personnel, past and present. Medicare and Medicaid are "insurance" programs for certain populations and government does negotiate pricing.
Government spending in the US for health care is around 10-11% GDP for the programs it does run now. Health care spending in the UK is around 8% GDP. Private spending in the US is an additional 6-7% GDP (total spending in the US is 16-18% GDP). Costs of procedures/services have to be reduced, and we need to work towards less expensive care options. Obamacare was sold as a way to help get the latter, but it's not going to do anything for the former.
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Individuals can't be considered the costumers for many kind of treatments in your system, in a free market price follows demand and supply law so it's the one that gives the best profit, for the expensive treatments if individuals were the costumer no facility would provide this kind of procedures as just to cover the costs this will reduce demand around zero, so the customer are insurance companies and price is connected to how much they can pay, that's connected to how high can be the price of a policy to maximize profit. So if a hospital's CEO has a high income it's his buisness as he is a private.
Individuals are the consumers. The insurance company isn't getting the service/procedure. The individual is. The insurance is just a way to reduce the cost to the individual by spreading it out across a larger number of people.
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