chenGOD Posted February 20, 2012 Share Posted February 20, 2012 privatizing health insurance is fucking shit. Governments have to be responsible for some things regarding their citizens' welfare, and health is one of them. Anyone who thinks private health insurance is a good idea needs to take a long hard look at the US and what happened there. To back up what jhonny said - the US spends the most per capita on health, and their outcomes are not reflected at all in that spending. Health spending: http://www.kff.org/i.../oecd042111.cfm Outcomes: http://www.openmedic...rticle/view/8/1 The US model is not the one and only privatized model. At the moment I'm working in the Dutch health insurance system and I can tell you that it doesn't resemble in any way the US-model. And yet insurance is privatized nevertheless. And there's only a couple of basic ingredients needed: 1. everyone is obligated to buy basic insurance, and is free to buy additional insurance 2. government defines what is part of this basic insurance 3. insurers are not allowed to drop or deny people from this basic coverage 4. insurers are allowed to deny people from buying into additional insurance Privatized health insurance, in a way is nothing more than the government outsourcing the management of rising healthcare costs. Similar to what is tried in the proposed NHS bill. Insurers have a natural incentive to lower the costs of healthcare while keeping premiums low (in a well regulated market!!). In general, people have a tendency to choose a cheaper insurance (when quality is equal) and insurance companies are naturally looking for ways to minimize healthcare costs. But what makes the American market so bugged? What is bugged about the American system (I'm over simplifying here!) is that the market is not well regulated. US Insurance companies make money by dropping coverage of people when they're already sick and in need of care, even though they have been paying coverage for who knows how long. And insurance companies are allowed to deny people from any kind of insurance. Even the most basic. So they can cherry pick to only allow healthy people the expensive coverage. So the ways American insurers minimize their costs are arguably corrupt. At least from a moral point of view. From the legal point of view, the new Obama-care is a start to fix that system. But before Obama-care, the policies of the insurers were legal. With the mentioned 4 basic ingredients much of this can be solved. With the incentives still in place, insurers are forced to come up with ideas to lower the costs of this basic care. And they're forced to do this in a competitive market. (How competitive it actually is, is an entirely new discussion.) In a market like this, the insurer is the agent who studies the healthcare system looking for slack. Depending on the kind of slack, they can lower its costs in a number of ways. These range from investments in projects to implement more efficient care (eg. in hospitals) and investments into prevention, or on the other side have a more policy driven approach by controlling the conditions under which care is provided. An example would be in prescribed medicines where physicians must prescribe the cheaper alternative whenever there is one. In this market the privatized insurer is an active part of the healthcare system, without having the abilities to go into these morally sketchy practices which seem to be common in the US. TLDR: yes, governments have to remain responsible for some shit (regulation regulation regulation). no, privatized health is not necessarily fucking shit. An interesting post, and without knowing anything about the dutch system beyond what you point at, here's where things will go wrong (my opinion). 1. What insurer is going to deny people from buying additional insurance? A private insurer is going to look for ways to maximize profit, so not only will they minimize outlays as much as possible, they will never ever pass up possible increases to revenue streams. And if they are publicly traded, with American stock-holders, they stand a good chance of being sued for failing to maximize profit. 2. You will create imbalances in the system - the upper tier of privately insured clients will receive preferential treatment (otherwise why would they pay more?). To me this is fundamentally immoral - health services should be the same regardless of an individual's income. 3. Private insurance creates unnecessary middlemen, with needless paperwork. The amount of money the government spends on regulating the private investors would be better used to enhance the public bureaucracy and make health care more efficient, primarily by listening to what actual health care practitioners have to say about what works and what doesn't, and then forming policy based on that input. DeadlyTowers - that article is weird - they say the US doesn't borrow its own currency, when that is precisely what it does (it borrows from the Federal Reserve with interest). It goes on to say that the country doesn't need to issue bonds to finance its spending - and the US has something like $4.5 trillion of its debt owned by foreign investors. But it's 2 in the morning, and I've been practicing onanism instead of thinking about econ related matters, so maybe I'm not comprehending properly. edit: and yeah, germans and inflation go together like R. Kelly and girls over 18. Link to comment Share on other sites More sharing options...
goDel Posted February 20, 2012 Share Posted February 20, 2012 An interesting post, and without knowing anything about the dutch system beyond what you point at, here's where things will go wrong (my opinion). 1. What insurer is going to deny people from buying additional insurance? A private insurer is going to look for ways to maximize profit, so not only will they minimize outlays as much as possible, they will never ever pass up possible increases to revenue streams. And if they are publicly traded, with American stock-holders, they stand a good chance of being sued for failing to maximize profit. 2. You will create imbalances in the system - the upper tier of privately insured clients will receive preferential treatment (otherwise why would they pay more?). To me this is fundamentally immoral - health services should be the same regardless of an individual's income. 3. Private insurance creates unnecessary middlemen, with needless paperwork. The amount of money the government spends on regulating the private investors would be better used to enhance the public bureaucracy and make health care more efficient, primarily by listening to what actual health care practitioners have to say about what works and what doesn't, and then forming policy based on that input. 1. Two things are important here. First being: which care is covered under basic insurance? In general it is everything which falls under "necessary care". Additional coverage can have anything to do with care which is (arguably) not directly necessary Examples being: plastic surgery, alternative care (eg. voodoo doctors and other potentially weirdos), extra costs for extra service, or more general physiotherapeutic care (when it's not directly related to care which is covered under the basic insurance). People can be denied additional insurance whenever they have a history of overuse of this additional care. An insurer won't like investing in someone's addiction in plastic surgery, for example. The basic idea behind an insurance is buying off risks for possible costs in the future. There comes a point where additional insurance is used as a cheap ticket for extra - and often unnecessary - care. Of course, as always there are lots and lots of grey areas. But the point is, that denying additional insurance is not automatically the bad stuff associated with the US system. Second: insurers are not allowed to drop coverage. Whenever someone is insured, insurers are obligated to fulfill their promises. A well regulated market implies there being no loopholes for the insurer. So again, regulation is key. 2. This effects similar points. The Dutch system is defined such that there is a basic level of "health service" for everyone. As mentioned, people will pay more for a number of things. There is no premium however for buying your way into the waiting line for the next liver. I'm sure there would be a market if regulation wasn't in place. But again, regulation is key. 3. This is indeed a problem. But not necessarily because of privatization. The government is just as good, if not better in creating more paperwork. What matters is what effects these extra costs have on the system, and in the end on the premiums people have to pay. The key difference between privatized insurance and non-privatized insurance is the amount of competition in minimizing this extra paper work. The general idea was that competition is a better way to minimize these extra costs. The government has no direct competition and can basically make as much costs as long as people pay their taxes. Generally speaking, the government is not good at governing itself. And in a healthy privatized market, people have a more direct influence on what they think is good or isn't and insurers will have more direct incentives in minimizing these extra costs. Whether one solution or the other is better, is far from trivial. Personally, I think there's a best of both worlds possible somewhere down the line. In the healthcare market, there usually isn't one perfect solution for any given problem. And by stimulating competition, there is more chance for different approaches. Controlling the entire market from a single point, the government, will not necessarily lead to the optimal state. The basic premiss has to be that people must be given the basic care they deserve. And as long as this premiss is met, competition can be a good thing. Also, the assumption that practitioners know what works and what doesn't and that government just needs to follow that is very simplistic. As Jhonny mentioned, practitioners are experts at micromanaging health (patient to MD relations). Going from micro to macro there is a huge area which needs to be covered. Saying government should just follow what practitioners say completely ignores the fact that one: government does not have the knowledge, nor the resources to know everything it needs to know to make the optimal policy. And two, what practitioners say will work on a micro level, will not necessarily lead to optimal solutions on a larger scale. Also, I think you need to be somewhat more critical of practitioners. For instance, how many practitioners would put themselves out of their business if it would help society? Personally, I have huge doubts about the mental health industry. Although I'm fairly confident most of these people do what they think is in the best interest for their patients. How often do you think a practitioner would say to his/her patient "you don't need any help"? I expect the average answer to such patients is: "I don't think you need serious help, but if you'd like we could have a couple of meetings/ you should take these medicines to make sure..etc". Don't forget that practitioners need to pay their bills as well. And in general, their bills are not the smallest. Practitioners tend to be very well paid. And because of that (and their mortgages) they have put very much at stake to keep their income the way it is. I know this is very cynical, but you'd be surprised how frequently things like this are subject in negotiating with practitioners. In my business it's pretty hard not to get a bit cynical from time to time. When you're dealing with practitioners eye to eye they're only interested in securing their income. Just like the rest of us, they're human. And under certain circumstances, they're more like businessmen. Because they actually are running a business (although they're not trained to run a business in general...). If we want to put handles on quality by means of "pay for performance" they run to the media because of those horrific insurance companies. I'm not saying insurance companies are holy, but whenever you notice that the quality of care in a certain segment is not transparent, it is not rare there are certain instances benefitting from this lack of open information. For instance, you'd be amazed how much work went into having hospitals publishing numbers with respect to the amount of complications. Sure quality is a complicated subject. But there is a point where instances just block any progression by not publishing any information whatsoever. Simply because it's bad for business. Obviously, there are all kinds of slack in the entire system (be it mortgages or middlemen). But if you start with: do whatever the practitioners says should be done, you're assuming the practitioner understands the consequences of his proposals on a macro level and that he has no personal interests in the outcome. From my point of view: the MD should do what he is best at: treating people. Normally, they're well educated to do that. And given the complexity and the nature of the subject, they wouldn't have been practitioners if they didn't have that internal drive to help people. But the best treatment for an individual does not lead to the optimal treatment for everyone, or the optimal process of treating people. Practitioners with the knowledge of optimizing processes are pretty rare. And there still needs to be some kind of middleman running the business. Link to comment Share on other sites More sharing options...
Dale Posted February 20, 2012 Author Share Posted February 20, 2012 lol http://www.bbc.co.uk/news/uk-17093082 Link to comment Share on other sites More sharing options...
goDel Posted February 20, 2012 Share Posted February 20, 2012 Lots of emotions. Hardly any facts. Yep, that's healthcare in a nutshell. Link to comment Share on other sites More sharing options...
chenGOD Posted February 20, 2012 Share Posted February 20, 2012 Ahhhh goDel...i just did a little reading...you're not entirely private option...there are government subsidies...:) Still, it looks like you guys have found a good compromise, just as we have over in Canada. I'm still wary of private corporations in health (transportation etc.), though, just cause of private corporations general mandate. Regarding listening to practicioners - I didn't mean listening to them in terms of how to finance the system - I meant in terms of what sorts of areas practice needs more support in order to produce more effective outcomes. Link to comment Share on other sites More sharing options...
azatoth Posted February 20, 2012 Share Posted February 20, 2012 If people are so much in a huff about these reforms, then why did they elect these politicians in the first place? The right leaning parties have gained a lot of ground these past few years across Europe and people are surprised that these sort of reforms are happening. Link to comment Share on other sites More sharing options...
jhonny Posted February 20, 2012 Share Posted February 20, 2012 If people are so much in a huff about these reforms, then why did they elect these politicians in the first place? The right leaning parties have gained a lot of ground these past few years across Europe and people are surprised that these sort of reforms are happening. The Conservatives weren't elected, they are the majority party of a coalition government. Also, these reforms weren't part of their manifesto (nor the Lib Dems). I know plenty of tories who are just as angry about these reforms. Link to comment Share on other sites More sharing options...
goDel Posted February 20, 2012 Share Posted February 20, 2012 Ahhhh goDel...i just did a little reading...you're not entirely private option...there are government subsidies...:) Still, it looks like you guys have found a good compromise, just as we have over in Canada. I'm still wary of private corporations in health (transportation etc.), though, just cause of private corporations general mandate. Regarding listening to practicioners - I didn't mean listening to them in terms of how to finance the system - I meant in terms of what sorts of areas practice needs more support in order to produce more effective outcomes. I'm not sure which government subsidies you mean, but you may be pointing at the "big" pot of money with which insurers are compensated (to some extent) for having a more than average sick population in their portfolio (given that they can't deny coverage, and the possibility that for instance every chronic patient in the country decides to buy coverage from one insurer). While it is true that the risk is averaged over every insurer to some extent, there's still enough risk for the insurer to go head under in the case of either bad policy, or more than average unhealthy portfolio. And furthermore, these subsidies are part of a transitory phase. In 2015 these subsidies will be severely cut and insurers will have more responsibility for their policies. Back on the point of why the government is not the end all/be all of managing healthcare costs: one important aspect i forgot to mention is the lack of flexibility which is almost inherent to the governing apparatus. Typically, change needs lots of time to take effect. And privatized companies tend to be way more flexible. Flexibility can actually be a good thing, from time to time. If people are so much in a huff about these reforms, then why did they elect these politicians in the first place? The right leaning parties have gained a lot of ground these past few years across Europe and people are surprised that these sort of reforms are happening. People are in huff because healthcare reforms will effect them directly. And when people are uncertain about the outcomes of change, their first reaction will resemble the things you saw in the BBC clip, or at those town hall meetings during the Obama-care discussions. Again, emotion is the primary drive in these debates. Facts are rarely listened to, understood, or even mentioned. This is not a matter of right wings left wings, conservatives or liberals. People will be in huff, no matter what. Especially when various instances benefit from stopping reforms, you'll see these instances riling up people with mostly disinformation and other kinds of fearmongering. This was pretty obvious in the US (the Obama death squads). And I wouldn't be surprised if the same is the case in the UK. For instance, I still haven't seen or read what these actual reforms are about. There are lots of instances involved in these reforms. Odds are the proposed reforms are the least of all evils. Whenever things have to change, some parties will be happy. Other won't. These last will be the most vocal. What's important to note is the extent to which these last party remain factual in their criticisms and whether they propose viable alternatives. Looking at the debate in the US, this was hardly the case. But that was more about the media having a lynch-party, than actual politics. Link to comment Share on other sites More sharing options...
chenGOD Posted February 20, 2012 Share Posted February 20, 2012 yeah i'm talking abut the risk equalization fund that i keep reading about. Also, it seems that there is some consolidation going on in the insurers. Here's an interesting article (although it's from 2008, so it's probably a little out of date) http://takingnote.tcf.org/2008/06/the-dutch-healt.html Link to comment Share on other sites More sharing options...
goDel Posted February 20, 2012 Share Posted February 20, 2012 It's funny reading about the American interest in the Dutch system. But yeah, we're awfully good at healthcare ;p Link to comment Share on other sites More sharing options...
chenGOD Posted February 21, 2012 Share Posted February 21, 2012 You guys still spend a lot of public money on healthcare though. http://www.oecd.org/dataoecd/46/8/38980162.pdf Link to comment Share on other sites More sharing options...
azatoth Posted February 21, 2012 Share Posted February 21, 2012 lol @ US Link to comment Share on other sites More sharing options...
goDel Posted February 21, 2012 Share Posted February 21, 2012 Yeah, there's definitely lots of potential for improvement in the Netherlands. The difficulty is how. Wether the market is privatized or not, there are a lot of people making a living off either providing or managing healthcare. And I'm one of those. :S Link to comment Share on other sites More sharing options...
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