The ACA supposedly limits how much of a skim the “JCs” can take. Defense contractors are expert at burying profits in the cost data. I recall reading about the case of an engine Packard was building for the Navy in the 50s. The contracts were supposedly priced to guarantee a reasonable profit for the company. An engineer in that engine program started running the numbers, and concluded that the Navy could have bought a perfectly serviceable engine from Cummins, on the open market, for what Packard was charging the Navy in overhead alone.
There is more to that than meets your eye. The insurance carriers discuss their float or surplus as being under their costs and requiring a return for the company to be profitable.
But what are their costs before they decide what to do with the surplus? That includes over paying the executives, stock buy backs, hiring too many workers to ‘police’ even paying out on claims. Then they need premiums that are about 1% less than their costs and the company will work to make up their profits on the surplus.
It an extremely dishonest business where there is no trust on the administrative side because the insurers are lining their pockets.
Blockquote Social Security and Medicare are regarded by many as the third-rail of politics.
I’m not so sure there are third rails anymore. One party is openly talking about making SS and Medicare something to be voted on every 5 years, if not annual. And most boomers who rely on these benefits also vote exclusively for the party that wants to take that benefit from them.
Private health insurance has the problem that it needs to pay for marketing and sales expenses, needs to have a profit, needs to make executives tons of money. No wonder we have the highest costs per capita in the developed world! Capitalism! Yeah! And for some reason we defend a system that puts too many of us into bankruptcy and robs the rest of us.
Boomers are roughly split evenly between the two major parties. Can you explain what you mean by “exclusively” here? And many more than half the boomers rely on social security benefits at least to some extent.
Many people who deferred cancer screenings during the Covid years (2020-2021) ended up with advanced cancer that is very expensive and difficult to treat.
Whether or not you are an employer or employee, be sure to get your screening tests!
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Thing here is that the article is looking at costs in a demographic that is currently adding to these healthcare costs (probably less to do with screening alone…but rather a failure to institute treatment in a timely fashion as well) Those who’re of an age to still be part of the workforce. Apparently…and in spite of a belief that cancer is a disease of old age…mortality is still greater in this “younger” demographic and so, by inference, morbidity and attempts to prevent death (what mortality means)
Now, this morning was my ~60 mins Z2/MAF/low lactate/ASCVD reversal training session on the treadmill…podcast time. This morning was a very timely gift from Peter Attia. An.interview with Erin Michos MD who is a preventive cardiologist specializing in cardiovascular disease in women. Personal trials and fibrillations aside, the preamble went along the lines of the disease and financial burden of ASCVD globally…but especially the US (we take the Gold Medal here!)
Now here’s the thing…and why I’ma thinking that these healthcare costs are set to look pretty trivial for employers with the passage of time…the risk enhancers that’ve been historically responsible for morbidity and mortality in the older demographic…high BP, acquired dyslipidemias, T2D etc, the Usual Suspects that’re secondary effects of the obesity epidemic…are happening in an increasingly younger demographic.
Now, I’m still only halfway through the podcast but thus far, it’s been something of an exercise in "…what you * know * that just ain’t so that I will be digesting this for a good many more training sessions.
P.S. it was my third Repatha shot this morning…$600 or so per month
Employees of prime working age, who used to be healthy in earlier generations, will develop expensive-to-treat chronic conditions at age 30 - 60 and burden employers with higher healthcare costs.
Many of those same working-age chronically-ill people will become disabled enough to qualify for Social Security Disability and Medicare/ Medicaid disability coverage. That will burden the system more than the actuarial estimates that were based on the earlier, healthier generations. For those people, 40 will be the new 60 and they will have decades of morbidity.
Only change I’d make your observation is from the “will” to “already are”
Per dh’s observation, he’s already seeing patients under 40 with NAFLD/NASH and end stage liver disease on the list for liver transplants. Almost totally replacing Hep C. And this is Colorado …still officially the least obese State, I believe.
I’m not sure what you mean by “cap benefits at $5000.” I’m assuming that you mean that the Medicare for all that you’re surmising would cover all your healthcare cost on admission to a hospital up to $5,000.
$5,000 would just barely cover the cost of admission to a hospital. Covering childbirth and prenatal care?
" Giving birth costs $18,865 on average , including pregnancy, delivery and postpartum care, according to the Peterson-Kaiser Family Foundation (KFF) Health System Tracker."
Are you implying that a good medicare healthcare plan would cover people up to $5,000 and after that you’re on your own?
The basic problem with the affordable care act is its a cadillac program. Unlimited benefits for all is very costly. So big deductible coverage is expensive and the young decide not to insure. Rates go up because its the sick who like to insure.
Basic limited coverage for all gives every access to the basics. And that coverage may well cover the most common needs. Better coverage can then be available in increments that may be more affordable. Big expenses still need assistance from government. We’ve been through several rounds of govt trying to get voters to pay for catastrophic coverage. ACA is the most recent plan that failed. An earlier one put the cost on retirees and quickly got repealed.
You can get anything you want and everything you need.… if you can afford it. It’s only fair, right? ‘Justice’, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, to steal bread… ‘and acquire necessary medical attention’ Paraphrasing Anotole France
I seriously doubt that there’s ANY country in the World that allows its citizenry unfettered access to any medical intervention of choice, in unlimited amounts and at Someone Else’s expense. Doesn’t happen here …or in any other developed country of comparable wealth. Rationing exists in some form or other…even with means and willingness to pay
Interesting “Flip the Concept” approach, Paul.
It’s an out-of-the-box approach to the current JC/TPTB way-we’ve-always-done-it".
The current JC/TPTB designed approach delivers “functional” healthcare but at great cost.
Providing the “basics” up front, no deductible, in a universal health care type manner, might well influence the “healthy” to more willingly support it?
Then add a “charge”, via a deductible and/or higher copays, for treating the results of personal choices.
The JCs/TPTBs have already done this WRT smoking and obesity, and perhaps a couple other conditions. Smokers and obese are now routinely denied care due to being “too unhealthy”.
There are also moves to make engaging in dangerous activities such as extreme sports, more “self insured”.
I’m rather certain the JC/TPTB will resist the attempt to remove the “pay deductible first” - AKA “pay us our bonus/bribe/vig or we won’t protect you” - requirement.
Not to be ultra bold but you might want to rethink things entirely.
We spend as much as possible per capita. The Germans and France in Europe spend far less for far better results. I qualified my comments by the words “justice” and “injustice”.
As to what country would act as if…they were opening up the entire cookie jar? That would be us…totally based on our corruptness.
As to what country gives a single crap about people? That would place us last.
VeeEnn, since you are in a medical family as am I, doctors in Ireland are paid on a par with doctors in the US but Irish doctors do not have much medical school debt to speak of.
Not universally true. I recall a speech given by a guy from Arkansas, who said that, since his retirement, he had become rich, and, being rich, he had never been so well cared for in his life.
Indeed we do but that still doesn’t refute my statement that no similarly developed country allows its citizenry full access to what and how much care it/they want…cost comparisons notwithstanding. Certainly not here in the US, where rationing is very definitely overt and obvious …and unfair or (I’d imagine) anywhere else on your list where it’s less so.
To the point WRT pay differential between physicians in the US and Ireland, you’re wrong. You might very well have heard anecdotally that this is a fact, but the reality is that here in the US there are tremendous pay differentials across specialties, hospital systems, academia vs clinical etc.etc. so, it’s entirely possible that you’re comparing non comparable examples. The apples vs. vacuum cleaners example I normally quote.
For example, dh’s compensation package over the last 15 + years for pretty much exactly the same gig (transplant hepatology) has differed by a tremendous amount…and would probably vary by similar amounts across specialties here as they would salaries in Europe where I suspect there’s greater uniformity (there is in the UK, at least)
To the point WRT the cost of a medical education…again, as you point out, there IS no comparison. The up front costs of the free or nearly free education probably aren’t amortized anywhere in those non-US statistics but rather kicked around in an “education” budget rather than bumping up the healthcare budget.
Ooops, almost forgot. Whenever I’m back in the UK and we’re discussing these per capita figures, I always mention that a fair amount of that spending is directed to the insurance industry. The Usual Suspects such as investors and CEOs etc obviously … … but also those lesser mortals further down the totem pole. Claims adjusters, data entry folk and, on the supply side, billers and coders etc. Folk who, with a single payer taxpayer funded system such as the NHS, are almost nonexistent.
Makes you wonder what they’d do to put a crust on the table without being able to get a salary from our healthcare $$$$bucks…compose violin concertos or design cathedrals for a living ?
Not according to my cousin’s wife who is a radiologist in Waterford. The word used by her was “comparable”. That is purposely done by the Irish government because Irish doctors will pack up and leave for America. That is true for western European doctors in general.
If you are in the UK that is different. The UK is cheap on the medicine. Anything to deprive the public…usually out of bigotry but no exceptions made.
The Irish have a long history of heavily subsidized education. Medical school undergrad is $3k per year. In Ireland most students live at home.
No one can hold up the UK system as speaking for anyone else. It is not part of Europe anyway. To interested in not allowing anyone on their sacred soil.
No doubt, anyone interested in reading up on this will be Googling websites and doing their conversions from Euros.
Ability to just “pack up and leave for America” isn’t quite as easy as you imagine. Quite apart from the fact that it takes more than paychecks alone to encourage someone to leave their country of birth, there are barriers to simply leaving one job and stepping into another overseas…especially given the differences in education and post grad training requirements.
You’ve mentioned in the past that your now retired father was required to complete some further education before practising here, right…in spite of him being a Trinity man. Educational requirements…for both US trained as well as foreign medical graduates…haven’t eased up any since then.
So, you’re ok with a Medicare that covers you for the first $5.000 cost of any hospital admission, then after that you pay out of pocket? You’re saying that unlimited benefits for all is very costly, but in fact what is costly is Medicare. If you’re really interested in saving money, then after 72, no more Medicare Coverage and you’re on your own
