[Winstonm]

 luke warm, on 2012-June-29, 15:25, said:

yeah, must be that 170 i.q.

I don't suppose you want to venture the same rationale for Rick Perry, do you?

From Yahoo News:

Quote

Texas Gov. Rick Perry has vowed not to implement state programs required under President Barack Obama's federal health care law

[luke warm]

 lalldonn, on 2012-July-01, 17:04, said:

It's only cavalier when you omit the reasoning in your quotation rather than doing the normal thing and pointing out why you disagree with it. Allow me to reiterate, that analogy, as you used it anyway, was CLEARLY nonsense.

it's possible you don't understand how insurance works... we were (or i was, anyway) speaking of hsa-type policies

[lalldonn]

 luke warm, on 2012-July-09, 15:45, said:

it's possible you don't understand how insurance works... we were (or i was, anyway) speaking of hsa-type policies

I knew exactly what you were speaking of, which is how I know your analogy was nonsense.

Anything is possible, but you might want to know that I was an actuary working in health insurance for several years. Care to try again?

[y66]

What's up with this thread title? Did hrothgar have a lobotomy or something?

[hrothgar]

 y66, on 2012-July-09, 18:51, said:

What's up with this thread title? Did hrothgar have a lobotomy or something?

Luke Warm predicted that Roberts would vote to uphold the affordable care act
I thought that he'd take a much more partisan position
Seemed right and proper to give credit where credit is due

[luke warm]

 lalldonn, on 2012-July-09, 17:14, said:

I knew exactly what you were speaking of, which is how I know your analogy was nonsense.

Anything is possible, but you might want to know that I was an actuary working in health insurance for several years. Care to try again?

oh, an actuary? well that explains everything

[Zelandakh]

 luke warm, on 2012-July-01, 09:36, said:

hsa type plans (high deductible/low premium) also lower costs... such plans do two things: 1) because they have a high deductible they let patients (consumers, actually) understand that shopping for health care is just as important as shopping for anything else... and 2) they cover the catastrophic illnesses at an acceptable level... so you end up paying for your own doc visits but the bigger illnesses are more or less paid for... it's kinda like you buying your own batteries and tires, but having geico pay when you get rear-ended

 lalldonn, on 2012-July-01, 10:43, said:

That analogy is clearly nonsense. If I have to buy my own batteries and tires, and I neglect them and they suffer serious damage that was avoidable, I have to pay to solve the problem. If I have to pay for my own doctors visits, and I neglect them and I suffer serious illness that was avoidable, everyone else has to pay to solve the problem.

 luke warm, on 2012-July-10, 03:56, said:

oh, an actuary? well that explains everything

Rather than simply making a cheap jibe in typical Republican style, why not explain why the anaology is not nonsense for those of us who find the entire American healcare model (on both sides of the aisle) completely crazy.

[luke warm]

 Zelandakh, on 2012-July-10, 04:51, said:

Rather than simply making a cheap jibe in typical Republican style

as opposed to the more expensive democratic gibe? ok, most hsa (low premium/high deductible)accounts are high deductible for the very reason i stated - not all physicians charge the same for all treatments, just as not all tire stores charge the same for michelins... regardless of that fact, wellness benefits are usually paid in full, up to a preset amount (around $200/year)... most plans also include psa tests, mammograms, paps, etc, also at no charge, depending on age... those tests are apart from the wellness visits, which are normally used for one's yearly physical... the more catastrophic illnesses are usually covered apart from the yearly deductible, but this depends on the plan chosen

lalldonn's statement, "If I have to buy my own batteries and tires, and I neglect them and they suffer serious damage that was avoidable, I have to pay to solve the problem. If I have to pay for my own doctors visits, and I neglect them and I suffer serious illness that was avoidable, everyone else has to pay to solve the problem." makes no sense in the context of health insurance... if he neglects his tires or batteries, whose fault is it? not everyone has to pay for his health care "neglect" unless he has no insurance at all... i'm not speaking of those w/out insurance, i'm speaking of those *with* insurance... besides, if he neglects his tires, battery, or doctor visits, and if he has insurance, why should he not be held responsible for it? if you're ill, go see the doctor... but if you do, it doesn't hurt to shop around a little

[BunnyGo]

Lukewarm, the latest economic, sociological, and practical implementation studies actually show that high deductible for regular medicine actually worsens the effects all around. A major implementation against this at the moment is something called Value Based Insurance Design (VBID). It's been shown that over 50% of patients do not adhere to simple and cheap methods (such as taking insulin as needed, or staying on a course of antibiotics) for maintaining health. It's also been shown that small financial incentives (removing copays for annual visits, and basic daily medicines) are much more effective uses of monies to maintain country-wide health. Paying big bucks for psa tests and mammograms is largely money misspent (on average--in fact there's never been a medical study done which advocates for mammograms under 50; it's not a rational decision to get one or pay for one, it's emotional). Likewise treating catastrophic non-accidental injuries is usually something that can be caught early on and treated more efficiently and cheaply--especially when removing financial disincentives from patients towards treating them.

Health Savings Accounts (HSA) are the exact opposite in reality of what many people need (on their own--they do work well in conjunction with other coverage). There are numerous studies done (both in theory and in practice) which show that high deductible is only good for major treatments, while lowering deductibles for preventative care tends to save money and have better health all around.

[Winstonm]

 luke warm, on 2012-July-10, 06:30, said:

... besides, if he neglects his tires, battery, or doctor visits, and if he has insurance, why should he not be held responsible for it? if you're ill, go see the doctor... but if you do, it doesn't hurt to shop around a little

One can have colon cancer and be asymptomatic, i.e., without feeling "ill", until it is too late. If we are going to start declining insurance coverage due to neglect, the top groups on that list should be smokers who also drink alcohol (major cancer risk) and anyone who consumes a high-fat, high-meat diet (increased heart disease risk).

And as far as shopping for services, when the diagnosis is cancer, the last thing that crosses the mind is looking for the lowest bidder.

[luke warm]

 BunnyGo, on 2012-July-10, 07:28, said:

Lukewarm, the latest economic, sociological, and practical implementation studies actually show that high deductible for regular medicine actually worsens the effects all around.

i don't know for sure if you meant "medicine" as in drugs or medical services... if drugs, most plans have rx plans that are distinct from the health coverages... i'd like to look at one of those "latest" studies you're speaking of, if it concerns medical coverage

Quote

A major implementation against this at the moment is something called Value Based Insurance Design (VBID). It's been shown that over 50% of patients do not adhere to simple and cheap methods (such as taking insulin as needed, or staying on a course of antibiotics) for maintaining health.

insulin and antiboitics are, usually, a part of a plan's rx drug rider and, as such, are subject to completely different copay restrictions... for example, a plan might pay half the cost of a drug up to a max out of pocket (per drug, per month) of $50 or so, with an additional benefit of a yearly max out of pocket leading to reduced copays... and, of course, generics do cost less... are you saying that people who are prescribed insulin or antibiotics are simply not taking them?

Quote

It's also been shown that small financial incentives (removing copays for annual visits, and basic daily medicines) are much more effective uses of monies to maintain country-wide health.

i can understand how such a thing would be desired by you or me, as covered parties, because they are cheaper for us... however, i'm unaware of any studies showing that such methods reduce overall health care costs

Quote

Paying big bucks for psa tests and mammograms is largely money misspent (on average--in fact there's never been a medical study done which advocates for mammograms under 50; it's not a rational decision to get one or pay for one, it's emotional).

i agree, which is why most of those are free, but only if age-based

Quote

Likewise treating catastrophic non-accidental injuries is usually something that can be caught early on and treated more efficiently and cheaply--especially when removing financial disincentives from patients towards treating them.

hence the need for wellness programs, which are usually free (up to, as i mentioned, a pre-determined amount)

 Winstonm, on 2012-July-10, 08:26, said:

And as far as shopping for services, when the diagnosis is cancer, the last thing that crosses the mind is looking for the lowest bidder.

we were speaking of the costs... cancer is, usually, considered to be one of those catastropic illnesses we were speaking of, not on a par with going to the doctor every time you have the sniffles, simply because the copays are low or non-existent... as for lifestyle choices, don't worry so much about those - bloomberg has already outlawed big gulps, surely big macs are next

[BunnyGo]

 luke warm, on 2012-July-10, 08:34, said:

i don't know for sure if you meant "medicine" as in drugs or medical services... if drugs, most plans have rx plans that are distinct from the health coverages... i'd like to look at one of those "latest" studies you're speaking of, if it concerns medical coverage


insulin and antiboitics are, usually, a part of a plan's rx drug rider and, as such, are subject to completely different copay restrictions... for example, a plan might pay half the cost of a drug up to a max out of pocket (per drug, per month) of $50 or so, with an additional benefit of a yearly max out of pocket leading to reduced copays... and, of course, generics do cost less... are you saying that people who are prescribed insulin or antibiotics are simply not taking them?


i can understand how such a thing would be desired by you or me, as covered parties, because they are cheaper for us... however, i'm unaware of any studies showing that such methods reduce overall health care costs


i agree, which is why most of those are free, but only if age-based


hence the need for wellness programs, which are usually free (up to, as i mentioned, a pre-determined amount)

A link to a number of publications by the VBID center: http://www.sph.umich...blications.html

Yes, most of the examples I gave were prescription, but the studies have also applied to doctors visits.

And yes, over 50% of people fail to adhere to prescribed courses of treatments (I gave just a couple examples). These are largely because of financial or implementation hardships (e.g. a pensioner trying to make a dose last longer, a single mother who can't afford to travel weekly to a center for treatment etc.)

As for mammograms and prostate tests under 50, they aren't free--they cost somebody money (usually insurance, sometimes a center like Planned Parenthood). This is a lot of money, and it's for a procedure that has been shown time and again to be a useless experiment. For example, if you're a 45 year old woman who receives a positive mammogram result--meaning you're told you have a growth--it's a lot more likely to be a false positive than an actual problem. These false positives then cost money, and physical pain and suffering due to side effects of treatments and biopsies. They cost not just money, but time and physical suffering. They should NOT be free (monetarily for the patient)...the massive amounts of monies devoted to these tests should instead be put to make proven preventative treatments free/more affordable. Prostate exams are considered even more frivolous, as most cases are again false positives and the actual disease usually (not in extreme cases) takes 15 years to kill you with minimal to no symptoms till the end--treatment usually has side effects more unpleasant than the disease itself, and many older men (60+) die from other causes before the cancer kills them.

Personally, I don't care too much about having my copays reduced. I have low enough copays, and enough spare income to cover any needed treatments without breaking the bank. What the major studies have shown is that these preventative reductions would raise quality of care for a majority of people to a point where they'd be sick less. It's predicted to be a "break even" prospect on the cost of medical care, but save people suffering and save the economy from lost productivity. With (nearly) everyone getting insurance in the next couple years, the question is how to do it in a way that will bring people benefit without breaking the bank. People like you and me are already well enough off that it can be hard to see the large population that doesn't find it easy to go see an doctor on a Wednesday morning (like I will tomorrow) because it's a financial hardship to take off of work in addition to the copays and cost of medicine. Removing what financial incentives can be removed helps these people actually take advantage of the health care they'll have before it's expensive for the insurance companies to cover them.

FWIW, the VBID center is largely funded by insurance companies, is consulting with several states on implementation on Obamacare, and is run by one of the most liberal doctors I've ever spoken with on the subject.

[lalldonn]

 luke warm, on 2012-July-10, 03:56, said:

oh, an actuary? well that explains everything

Well you are on topic as much as usual but since it was funny I can smile.

[PassedOut]

 luke warm, on 2012-July-01, 09:36, said:

... they cover the catastrophic illnesses at an acceptable level... so you end up paying for your own doc visits but the bigger illnesses are more or less paid for... it's kinda like you buying your own batteries and tires, but having geico pay when you get rear-ended

Your analogy has flaws:

When a person's poor health maintenance results in illness, that person gets medical attention whether or not he or she has insurance. When a car breaks down because of poor auto maintenance, the service station has no obligation to fix it without pay. And usually the car owner picks up the full tab for his or her own negligence.

If a driver does have an auto accident because of poor maintenance (only 1 of every 10 auto accidents results from poor maintenance), then insurance does come into play. However, the claim is limited by the value of the auto itself, and a badly damaged car can be junked.

If insurance payments for catastrophic medical care caused by poor health maintenance were capped at the potential earnings of the patient -- with no care provided beyond that -- then your analogy would be more accurate. But most of us don't want to junk patients.

[luke warm]

 PassedOut, on 2012-July-10, 12:25, said:

Your analogy has flaws:

When a person's poor health maintenance results in illness, that person gets medical attention whether or not he or she has insurance.

the whole discussion was about those who have insurance, not about people w/out insurance... it was about comparing various types of health insurance, not comparing those with and those w/out insurance... everyone knows that the uninsured will get what then need, when they need it (sometimes even when they don't need it), and that those of us with insurance foot the bill

i'll say it again: if universal healthcare is the only option being discussed, obamacare is next to useless... the costs far exceed any supposed benefits, and it will not do what it's designed (supposedly) to do... the *only* way to go (again, *if* universal healthcare is the only option) is a single payer system... nothing else will work and participation *must* be mandated, and it doesn't much matter whether you call that mandate a tax or a penalty... however, that's not to say that a single payer system is best, or, put another way, that universal healthcare is best... surely nobody is so closed minded as to want to limit discussion on various options

[PassedOut]

 luke warm, on 2012-July-10, 15:29, said:

that's not to say that a single payer system is best, or, put another way, that universal healthcare is best...

Actually, I do consider universal healthcare to be best. What are the arguments against it?

[Winstonm]

 luke warm, on 2012-July-10, 08:34, said:

we were speaking of the costs... cancer is, usually, considered to be one of those catastropic illnesses we were speaking of, not on a par with going to the doctor every time you have the sniffles, simply because the copays are low or non-existent... as for lifestyle choices, don't worry so much about those - bloomberg has already outlawed big gulps, surely big macs are next

I didn't see anything strictly about costs post diagnosis - the conversation seemed to be about weighing the costs of preventative treatment compared to post-diagnostic treatment.

I brought up cancer specifically because it is such a brutally expensive disease to address, and both the outcomes and the costs are reduced immeasurably with early diagnosis and treatment.

It would seem to me it would take very few early stage diagnostic "catches" to save enough money to cover costs of routine early-diagnostic procedures.

[luke warm]

 PassedOut, on 2012-July-10, 15:42, said:

Actually, I do consider universal healthcare to be best. What are the arguments against it?

which version?

 Winstonm, on 2012-July-10, 15:47, said:

It would seem to me it would take very few early stage diagnostic "catches" to save enough money to cover costs of routine early-diagnostic procedures.

okay, pretend you're in charge... what are your early stage diagnostic catches? on whom are they performed? how often? are they voluntary or forced?

[Winstonm]

 luke warm, on 2012-July-11, 03:55, said:

which version?


okay, pretend you're in charge... what are your early stage diagnostic catches? on whom are they performed? how often? are they voluntary or forced?

Two of the easiest and most effective methods are colonoscopies and breast examinations. On whom? Whoever wishes. Forced? No.

Should someone be penalized for failure to get tested? No, as these tests are not foolproof.

The point is that it only takes a few preventative catches that halt a disease like cancer in its earliest stages to save enough to pay for the tests. If you are in or around the industry, you know that one can build up a $250K bill in the blink of an eye treating cancer.

The issue IMO should be about encouraging more the big savings of early diagnosis than on squeezing pennies after-the-fact.

On the side issue of single payer, it would seem to me any form would be better as it would virtually eliminate the overhead administrative costs associated with the U.S. healthcare system.

[PassedOut]

 luke warm, on 2012-July-11, 03:55, said:

which version?

The single-payer version you had in mind when you made this statement:

 luke warm, on 2012-July-10, 15:29, said:

that's not to say that a single payer system is best, or, put another way, that universal healthcare is best...

You seem to know something about health insurance, and I'm interested in what your arguments are against universal healthcare. I honestly don't know what those arguments might be.