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ORIGINAL: freedomdwarf1

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ORIGINAL: DesideriScuri
It should not be that difficult to maintain a database of members and what coverage they have. Don't you see the ridiculousness of this, though? A single male buying an individual health insurance plan will be paying a higher rate for something that he will never, ever have to use. Never. Ever. The same would apply to female birth control medications and procedures.
I get that the more people there are in a pool, the less an increase in cost for a subset of that group impacts everyone, but when you get thrown into a pool that is huge and you're at the shallow end of that risk pool, you are paying the same as the ones that will be using it more.

It's not ridiculous.
And better than 99.9% of the population wouldn't be in the shallow end of the pool either.
You obviously understand the logic of decreasing costs in a pool-based system.
Now wrap your head around this little nugget -
If the whole nation is in that pool (not just a few in an insurance group, or even a whole state, I mean the whole nation of American people, all 314 million of you), the cost per person is greatly reduced and there is no 'shallow end'.
At a guess, the average Joe is reasonably healthy and most ailments are cheap to fix.
Sure, there is always childbirth and cancer etc (and any complications arising from those), but on the whole, the money going into the pot from healthier people not needing treatment will outweigh the money taken from the pot for those with serious long-term and expensive conditions.

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Let me give you a very small example when I worked at Bradford Pennine Insurance (part of Sun Alliance and dealt with motors insurance for a number of manufacturers) -
We already had a blanket plan in place from Sun Alliance but certain manufacturers wanted something special for customers buying their cars and supposedly a better deal too. So BPI got a pool of 7 programmers for the PC side, another 15ish for the mainframe side, 5 project leaders/managers to oversee it all and about 37 girls who would take customer calls and also test the system. Leaving aside the cost of office space, equipment and supplies, there were about 65 people's salaries to pay for the duration. It took 3 years to pull apart the basics of the blanket plan and re-cobble it to make a specifically worded plan, change the wording and layouts and logos and stationary, get all the small-print double-checked for legallity by the company lawyers; all for just one manufacturer. It took another 9 months~ish to iron out the bugs and implement loads of small changes before it was really usable for the customers on the end of a phone line. The same crap was done for 3 other manufacturers (each company with different sales staff) that all wanted something different. For one small subsiduary with one small office, that was a majorly huge task and it cost each company £millions just to achieve the end result.
End result after a total of 5 years solid work? We tested it...
Same basic info put in, Sun Alliance premiums were about £400pa for the insurance.
Volvo came out about 80% more expensive; Vauxhall was more than double the price; Leeds insurance was almost tripled; BMW was just out of this world and complete crap (but anyone buying a BMW could afford it, right?).
All the advertising and spin was saying to buy the specific taylored insurance to get big discounts and save money. What a load of hooey and those customers thought they were getting a good deal out of it too!!
Bottom line is, BPI made a huge profit on the investment and were laughing all the way to the bank at the expense of the pundits.
This is just one real-life example of how insurance companies recoup costs, and then some, at the expense of its customers who are duped into thinking they are getting a good deal.
Now apply that same logic to something like the size of US healthcare and it's frightening.
That's why any insurance-based private system will always be more expensive than a single-payer system.

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ORIGINAL: DesideriScuri
I know health insurance costs a shitload. I also know it costs a shitload for each procedure and service (which is what drives the cost of insurance). Obamacare doesn't impact the cost of individual procedures and services. It is nothing more than a cost shifting of the price of insurance.

I absolutely agree.
As I said in my last post, the US dropped the ball when they tried to shoe-horn the concepts of a single-payer system into a private system monopoly.

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ORIGINAL: DesideriScuri 
I see absolutely no reason why shifting to a national health care model would reduce the costs we pay in the US for health care. No one in a country that has a national health care system has chosen to show that costs have dropped. Why? That you pay less than we do now doesn't mean our costs will drop.

Very simple logic really.
Every working person pays into a single pot; costs are negotiated directly with big pharma and hospitals/doctors etc for services, equipment and proceedures and hugely reduce the overal costs by reason of direct supply. Insurance companies should be completely cut out of the equation as they aren't needed in a single-payer system.

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ORIGINAL: DesideriScuri
Even if the rate of increase slows, we'll still be spending 2-3x what everyone else is paying for the near term, and, will likely maintain the large spread (in terms of $) that exists now. Why? Should I think costs in the US will rise slower than in countries that already have a national health care system?

I would think the final cost to the end-user (the patient) and the treatment available with no deductables or pre-existing condition exclusions, would give you a good clue as to why a private system is waay more expensive than any properly designed single payer system.
Our system isn't the best, but the numbers speak for themselves.

• A Conservative interpretation of the US Constitution
  
• Personal Responsibility
  
• Help for the truly needy
  
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ORIGINAL: LadyPact

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ORIGINAL: EdBowie
Which has been the case for a long time, and has absolutely nothing to do with Obamacare.

Funny. Neither does the OP.

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ORIGINAL: EdBowie

You weren't responding to the OP, and neither was I.

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ORIGINAL: LadyPact

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ORIGINAL: EdBowie
Which has been the case for a long time, and has absolutely nothing to do with Obamacare.

Funny. Neither does the OP.

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ORIGINAL: DesideriScuri
Would this be easier now, with today's technology (you don't mention when this happened)?

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ORIGINAL: DesideriScuri
I'm not talking about end user costs, but actual care spending.

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ORIGINAL: freedomdwarf1

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ORIGINAL: DesideriScuri
Would this be easier now, with today's technology (you don't mention when this happened)?

The process is the same regardless of the technology because there is soo much human intervention required even if the end result is delivered by computers.
So no, it wouldn't be any easier and with today's wages and costs of office space and equipment, it would probably be even more expensive.
And of course, with CEO's and shareholders wanting an even bigger slice of the profit cake, the end result would much higher in premiums for the customer.
In a single-payer system, CEO's don't dictate the level of their salary and there are no shareholders to account to.

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ORIGINAL: DesideriScuri
I'm not talking about end user costs, but actual care spending.

Its the same - vastly reduced costs because the rates being charged by those providing the services or equipment don't get to dictate those prices.

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As an example, our local hospital bought a much newer scanner.
Market price for it was, I believe, somewhere in the region of £22m to purchase it.
The private hospital just up the road from us didn't buy it because it was too expensive.
The local hospital negotiated a price of less than half the retail price through the NHS group buying and I believe it only cost them about £8m.
Now spread that cost via the 16.7 million UK population, and its cost us less than 50p ($0.75) each.
That isn't much to take out of the universal healthcare pot.
Now take that example for the US healthcare.
£22m ($33m) to equip one hospital.
Lets say an average of 20,000 people in that insurance pool.
That's an average cost of $1,650 per person to cover the price of one updated scanner.
There's no way an insurance company, or a hospital, would bear that cost alone and swallow the cost from their profits - premiums must rise to cover that cost.
With direct purchasing via a single-payer system, that only cost each person (if they had to pay with additional premium hikes), $600 each.
If you had a single-payer system, that same machine (even at the full price of $33m) would cost you less than 10 cents. At the reduced price (via direct purchasing power), the bill would be less than 4 cents each.
Which would you rather pay to update just one facility at your local hospital? $1,650 or 4 cents?
Now do you see the advantages??
Insurance companies and service/equipment suppliers have no incentive to bring the costs down because the end-user will pay the costs. It's an exclusive captive market so they really don't give a shit.

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End result is our local NHS hospital now has better equipment (and thus better detection and treatment facilities) than the privately-funded insurance based hospital.
Incidentally, my wife has been one beneficiary of the new scanner already. Being much faster, more accurate and more detailed got her refered to a neurology specialist within 2 weeks instead of 3+ months.
ETA: The risk factor you refer to is irrelevant in a single-payer system. All patients are treated equally.

• A Conservative interpretation of the US Constitution
  
• Personal Responsibility
  
• Help for the truly needy
  
• Limited Government
  
• Consumption Tax (non-profit charities and food exempt)
  

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ORIGINAL: DesideriScuri
The ability to make changes to a plan would be ridiculously simple with a program. I'd be willing to bet that there are already insurance companies out there with their own in-house IT guys developing proprietary software to simplify that process. Most of that stuff can be done digitally now, so the manpower costs wouldn't be massive (once the software is done).

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ORIGINAL: DesideriScuri
Just to make sure I'm clear, I'm not talking about the cost of care for the end user, but the aggregate cost of care, for everyone all together.

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ORIGINAL: DesideriScuri 
That's where we need to introduce fair competition. It gives equipment suppliers and service providers something to work on. If there is competition - without prohibitive requirements for entry into the Market - costs will drop.

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ORIGINAL: DesideriScuri
Government assumes all risk. What happens when providers don't accept reimbursement rates offered by the government? Obviously, that isn't an issue in the UK, where the NHS owns hospitals, too, but, I can't even imagine that happening in the US.

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ORIGINAL: thishereboi

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ORIGINAL: EdBowie

You weren't responding to the OP, and neither was I.

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ORIGINAL: LadyPact

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ORIGINAL: EdBowie
Which has been the case for a long time, and has absolutely nothing to do with Obamacare.

Funny. Neither does the OP.

I believe she was pointing out that the OP (the topic of this thread) has nothing to do with Obamacare (it isn't the subject).

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ORIGINAL: EdBowie
I'm sure it would only take a moment of searching to find posts from either of you making clear that you are well aware of what 'normal thread drift' is.

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ORIGINAL: freedomdwarf1

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ORIGINAL: DesideriScuri
The ability to make changes to a plan would be ridiculously simple with a program. I'd be willing to bet that there are already insurance companies out there with their own in-house IT guys developing proprietary software to simplify that process. Most of that stuff can be done digitally now, so the manpower costs wouldn't be massive (once the software is done).

Software doesn't modify itself, unfortunately.
Whether the end result can be done and delivered digitally is irrelevant because any software development still needs humans to do the change specifications, programming and testing.
Whether you devise proprietory software to help make changes or use something off-the-shelf, the lines of code need to make a change still need to be typed up, compiled and tested by a human.
Also, design changes need to be drawn up, checked and re-checked by a human.
Even with today's advanced technology, there is no system yet that can re-write itself and perfect itself for new requirements - it still has to be done by humans.
It's like asking your PC to re-write itself to behave like a MAC without human intervention.
Sorry, can't be done without a LOT of human effort.

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ORIGINAL: DesideriScuri
Just to make sure I'm clear, I'm not talking about the cost of care for the end user, but the aggregate cost of care, for everyone all together.

And that was the purpose of my example with the cost of a single scanner for a hospital.
The total cost, whether that be equipment procurement or negotiating the cost of a service, everything is greatly reduced by wholesale and direct bargaining - something that any individual insurance company hasn't the clout to do.

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ORIGINAL: DesideriScuri 
That's where we need to introduce fair competition. It gives equipment suppliers and service providers something to work on. If there is competition - without prohibitive requirements for entry into the Market - costs will drop.

Unfortunately, real life situations don't work that way and the horrendous state of the US healthcare is proof of that.
Competition only works to drive down costs when there are sufficient adversaries, and choice, to compete against.
The US healthcare market is a closed system where there really is quite a ridiculously low choice for the consumer.
As it is currently implemented, most policies are only aimed at people within a small area (usually the local state) and that same policy isn't being offered nation-wide. Ergo, the capture market, compared to something nation-wide, is dramatically reduced and also the bargaining power to force manufacturers and service providers to reduce their charges.
As I said previously, in a closed market, those in the US healthcare market have no incentive whatsoever to reduce costs because it inevitably reduces returns (for CEO's and shareholders) or increases premiums (which they don't care about because the patient pays, regardless).
You see, unlike the automotive industry, where anyone can purchase any car anywhere across the nation and hence shop for the cheapest price, US healthcare is still boxed into local groups and rarely creeps over interstate lines.
This is why competition (or lack of) just isn't going to happen in the US healthcare industry.
Nobody, or very few (including yourself), seem to be capable of thinking beyond state limits or try to adopt blinkered thinking into national/global logic - it just doesn't work.

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ORIGINAL: DesideriScuri
Government assumes all risk. What happens when providers don't accept reimbursement rates offered by the government? Obviously, that isn't an issue in the UK, where the NHS owns hospitals, too, but, I can't even imagine that happening in the US.

I don't think they are given a choice.
As I mentioned a few posts ago, they are told you can sell it at X price if you want to sell to a mass market with preferential consideration (like our NHS), or you try to sell it on the open market or overseas. They either accept the much lower price or are refused to sell into the NHS.
And yes, that tactic does work very well and it does dramatically reduce the costs overal by quite a large margin.
Take my earlier example of our local hospital scanner costs. No doubt the company were promised future orders for many other hospital at that preferential price (but private hospitals wouldn't qualify). So it is better for the company to sell maybe a guaranteed 15-20 scanners at £8m each than possibly 3 or 4 at £22m in the private sector. Lower individual per-unit profit but greater sales units; thereby generating a greater overall profit for the year.

• A Conservative interpretation of the US Constitution
  
• Personal Responsibility
  
• Help for the truly needy
  
• Limited Government
  
• Consumption Tax (non-profit charities and food exempt)
  

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ORIGINAL: LadyPact

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ORIGINAL: EdBowie
I'm sure it would only take a moment of searching to find posts from either of you making clear that you are well aware of what 'normal thread drift' is.

Yes. Other posters drifted it to ObamaCare. I drifted it to point out the fact that your statement wasn't correct or that you weren't thinking of the whole picture when making the statement.