Healthcare reform

[Texsox]

I've brought this up in here many times. If the insurance industry didn't exist, then the natural consumer/provider dynamic would mean that the profit drivers align with quality of product, so yes, it would work. But as this is an insured industry, the buffering throws the at equation out the window.

 

 

Your posts certainly weighed heavily in my thinking. It is a fundementaly flawed system with consumers as the big loser.

[jasonxctf]

As I've been pondering this whole process I've come to a single thought, actually a question, about health care in this country.

 

Does the requirement for profit that drives a corporation help or hurt the quality of health care they deliver to the patient? When a customer walks into a car dealer, the employee of the car dealer they meet has the task of maximizing the profit the company makes both short term and long term. Same with walking into a restaurant, beach shop, or gas station. Does that also work in a Doctor's office or hospital? For most Americans, the people who are paying the bill (your insurance) and the people preparing the bill (the provider) both are trying to earn a profit from your visit. Seems like a losing play.

 

i'll take it a step further... should someones ability to be kept alive (either through medicine or treatment) be a for-profit making venture?

 

for comparison, we've decided that keeping someones house from burning down should not be a for-profit venture.

[kapkomet]

Your posts certainly weighed heavily in my thinking. It is a fundementaly flawed system with consumers as the big loser.

 

 

Stop working for a paycheck... you shouldn't have any "profit motive". No house, no car, no food, no anything. It should be all given to us.

[Texsox]

Stop working for a paycheck... you shouldn't have any "profit motive". No house, no car, no food, no anything. It should be all given to us.

 

 

How does a hospital and insurance company trying to make a profit improve your health care?

[Balta1701]

How does a hospital and insurance company trying to make a profit improve your health care?

In an ideal system, various hospitals and insurance companies would be setting up competitive systems where costs are kept down and innovation is fostered by competition between the organizations. That isn't the system we have right now, though. It's also not the system that the Republicans would want, and it's not the system I'd want, and it's not the system that is going to come out of the ACA (although I would argue that in some ways, it does step us closer).

[Jenksismyhero]

How does a hospital and insurance company trying to make a profit improve your health care?

 

more money --> better facilities and programs --> easier to attract better doctors and more specialists --> you recieve better and more sophisticated health care.

[Balta1701]

more money --> better facilities and programs --> easier to attract better doctors and more specialists --> you recieve better and more sophisticated health care.

Sadly though, it doesn't work anywhere close to that way.

[Texsox]

more money --> better facilities and programs --> easier to attract better doctors and more specialists --> you recieve better and more sophisticated health care.

 

 

Except insurance companies do not want to pump more money into facilities and doctors, they want lower and lower costs, fewer and fewer treatments. That is where their profit comes from.

[Balta1701]

Except insurance companies do not want to pump more money into facilities and doctors, they want lower and lower costs, fewer and fewer treatments. That is where their profit comes from.

Now in the ideal world, this would create competition between doctors for access to the population pools of insurance companies (since you can't exactly choose your doctor on the way to the ER, for example) and that competition should push prices down. And then, competition between insurance companies should push prices down at that level, because if an insurer tries to charge you too much, you leave and go to another insurer.

 

What really happens is that the insurance companies make more money if they can lock you into their service through your employer or by denying you coverage in any other way, and they pass on additional costs from doctors within their network without evaluating their effectiveness, because they don't lose customers if they pass on those costs.

[Jenksismyhero]

Sadly though, it doesn't work anywhere close to that way.

 

Um, based on what? The best hospitals in Chicago are the ones with the most money. They attract the best doctors and specialists because they have the best facilities. That's exactly how it works. If you have a serious health problem your first choice isn't Stroger.

[Jenksismyhero]

Except insurance companies do not want to pump more money into facilities and doctors, they want lower and lower costs, fewer and fewer treatments. That is where their profit comes from.

 

Ok, but hospitals try to maximize their own profit by spending money to update facilities and employ the best doctors right? So, the more a hospital makes, the more it re-invests into specialty practices (and overall, better doctors) to attract the most customers.

[Balta1701]

Ok, but hospitals try to maximize their own profit by spending money to update facilities and employ the best doctors right? So, the more a hospital makes, the more it re-invests into specialty practices (and overall, better doctors) to attract the most customers.

Problem is...that's not the only thing that can make a hospital money. A hospital can also make money by doing more procedures, or by doing more expensive procedures, or by gaining a measure of exclusivity with certain insurance companies that will pay them more for the same procedures, or by cutting their expenditures on doctors without losing numbers of procedures...etc.

[Texsox]

Ok, but hospitals try to maximize their own profit by spending money to update facilities and employ the best doctors right? So, the more a hospital makes, the more it re-invests into specialty practices (and overall, better doctors) to attract the most customers.

 

 

True, to the point that insurance allows it. So the areas where the insurance companies offer the best benefits get improved at the expense of the others. In other words, we have this new whiz-bang machine, the insurance company pays $XY dollars per treatment, let's use it. That may or may not lead to better treatment for you.

 

Also, and all other things being equal (malpractice especially) they prefer the Doctors with the most active practice regardless of "quality". The doc keeping the operating room booked with lap band surgeries is better for them than a highly skilled, but lower volume doc.

[StrangeSox]

more money --> better facilities and programs --> easier to attract better doctors and more specialists --> you recieve better and more sophisticated health care.

 

 

They said profit, not revenue. Expenditures on facilities, programs, doctors, equipment etc. all come out before profit is calculated. So, they could spend even more on those things if they were non-profit.

 

But what about the insurance companies? What innovations are we looking for there with a profit model vs. a completely non-profit model?

[southsider2k5]

In an ideal system, various hospitals and insurance companies would be setting up competitive systems where costs are kept down and innovation is fostered by competition between the organizations. That isn't the system we have right now, though. It's also not the system that the Republicans would want, and it's not the system I'd want, and it's not the system that is going to come out of the ACA (although I would argue that in some ways, it does step us closer).

 

In a single payer system, this wouldn't happen. Prices would be fixed, and there would be no reason or incentive for neither care, nor cost, to reach any kind of optimal point.

[StrangeSox]

Presumably people would still prefer to go to the better hospital.

[southsider2k5]

Presumably people would still prefer to go to the better hospital.

 

That's just it. There is no incentive to be "better". You make the same payments no matter what.

[StrangeSox]

You're not guaranteed the same volume of customers no matter what. Doctor A charge $100. Doctor B charges $100. Doctor A is much better than Doctor B, so he gets a hell of a lot more customers. He's also developed more efficient methods, and so his profits are higher and he makes more.

 

Having the price fixed at a certain dollar amount doesn't mean you make the same amount of money no matter what and that competition vanishes.

[lostfan]

This thread is like herpes.

[knightni]

This thread is like herpes.

You're involved in it?

[kapkomet]

This thread is like herpes.

 

 

Then put a chastity belt on it.

[southsider2k5]

You're not guaranteed the same volume of customers no matter what. Doctor A charge $100. Doctor B charges $100. Doctor A is much better than Doctor B, so he gets a hell of a lot more customers. He's also developed more efficient methods, and so his profits are higher and he makes more.

 

Having the price fixed at a certain dollar amount doesn't mean you make the same amount of money no matter what and that competition vanishes.

 

Honestly it will lead to more shutdowns than competition to improve product. Without a profit incentive, there will be less and less reason for places to stay open to fight for smaller amounts of money. It won't lead to innovation, it will lead to a shrinking capacity as money flows away from health care into more profitable areas.

[StrangeSox]

Who says there's not a profit incentive? A fixed price doesn't mean a fixed profit.

 

Has the British NHS (or any other single-payer or national health scheme) been stagnant in terms of medical care for decades? Have they not had any medical advances in the country?

[kapkomet]

Who says there's not a profit incentive? A fixed price doesn't mean a fixed profit.

 

Has the British NHS (or any other single-payer or national health scheme) been stagnant in terms of medical care for decades? Have they not had any medical advances in the country?

 

Let's see - the answer is yes (they are stagnant), and yes (no medical advances).

 

They piggy back off of us.

 

But Barackus the Great says that's not possible anymore = once again, the US cannot lead anymore - we suck. Wow, he's not kidding, is he? I'm glad you all support this.

[StrangeSox]

So no medical research or advancement has come out of Britain and other single-payer countries for several decades? Do you really believe that?

Edited June 26, 2010 by StrangeSox