OT - A intriguing "open lette"r on health care ...

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Yes, indeed.
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Best regards
Han
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Leon wrote:

Do you really think the medical profession would keep the cost low or would they continue to keep jacking their price up to match the ones that are charging the most?

> that will not accept insurance.
That's because they feel the "usual and customary" charges, agreed to by those practicing and accepting the payment amounts the insurance companies have negotiated, are too little and they don't like being questioned when they overcharge.

How do they handle payment for the expensive things like surgeries, cancer treatment, child births, hospital stays, etc.?
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Jack Novak
Buffalo, NY - USA
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Competition drives down prices. With insurance paying for your care there is no competition.

I suspect it is because they make more money and have lower costs extcept for the extensive advertising.

A patient that is a member of one of the Houston area groups had a daughter than needed arthroscopic knee surgery. He shopped the price and got quotes in the $15,000 range. IIRC his group did the surgery for less than $3,000.
There will probably still be insurance for catastrophic needs if you feel that living an extra year or two is woth having insurance for.
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"Leon" wrote:

Reading the above brings a question to mind about another industry.
How much competition is there among auto body shops for insured accident repair?
Lew
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Lew Hodgett wrote:

Quite a lot here, actually, anyway. All insurance companies I've dealt with pay only the lowest bid w/ confirmation work is required either by own inspection for really high-$$ jobs or simply photographic submittals for lesser amounts.
I still say one's viewpoint of costs when dealing w/ major health care isn't generally focussed on lowest bidder. For maintenance care such as long-term medications, etc., sure, but for (say) cancer are you going to the local GP or Hutchinson or Mayo or other specialty clinic?
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"dpb" wrote:

It is the market forces at work regardless of the industry.
When the talent pool is limited and the demand high, price reflects this whether you are dealing with show business talent, lawyers, or the medical profession.
Quality, perceived or otherwise, has it's price.
Lew
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Lew Hodgett wrote:

Sure, but... :)
The point I was making was that imo there isn't much pricing competition brought to bear in the selection of treatment process by most people in search of medical care--in general they're more concerned about whether they think they're going to find an effective treatment whatever the cost. Thus I don't think competition is particularly effective in holding down health care costs because I don't believe it's the driving force in most decisions.
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"dpb" wrote:

As long as private enterprise is involved in health care and are allowed to limit the "gene pool" as a means of controlling their risk, the problem will not be solved.
Some how, 100% of the population, no exceptions, must be covered, then move forward to address and control the cost issues.
Limiting the "gene pool" is not a workable solution.
Lew
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The insurance company "wants" to only pay the lowest bid. Read your policy, there is generally no mention of where you have to get the car repaired. If you choose to have the car repaired at a more expensive place the insurance so is liable to pay for the repairs up to the value of the car. Basically the lowest bid could still be thousands higher than the next guy down the street. It is a game that the insurance companies play. They try to make you and are very often successful at getting you to shop for cheap repairs.
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Leon wrote:

I didn't say anything about _which_ estimate you have to submit; only that they will only pay the amount of the lowest that is submitted that covers the required work.
Most body shops I've dealt with will come to within a few $$ of any other; they all use one of a few software packages for estimating so their labor estimates are all within a few tenths of hours/task and they all use the same or nearly after-market parts markets as well. The biggest differences I've seen is finishing but the highest here will tell you when he makes the estimate it's higher than most other shops in town because of that and he'll knock it down when the insurance company balks (as they always do).
If it's a chromed piece I'll make it be OEM; otherwise anymore I can't see any significant difference in the aftermarket parts of significance. Just been thru it w/ Mr Buck that couldn't stay on the side of the road where he belonged... :(
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That is not true, they indeed have to pay what ever price the shop charges that you choose. Been there and done that for years on end.

The insured calls the shots as to which repair shop does the work, the repair shop may drop the price to play along.

Work around genuine and aftermarket and you will soon learn to tell the difference. I bought and sold both for 15+ years. Basically you still get better parts when you pay more. some times this will make a difference some times not. After market sheet metal will dent easier and often rusts sooner. Considering chrome, most often the repaired/rechromed bumper will have a life time guarantee, the Body shop however will not often tell you that.
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When I was in the business, there was basically no competition, in Houston or Corpus Christi, in the 70's, 80's, and 90's. Because 99% of the cars being repaired were covered by an insurance company. Basically we never had to worry about a customer turning down an estimate. Additionally we did not accept payment from insurance companies unless it was MIC insurance sold by GM. We charged every one the same price whether the insurance company was involve or not. When we had to accept MIC insurance we had to discount parts $30% and give a hefty discount on labor. We stayed busy.
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Leon wrote:

The competition comes into play with the insurance providers. When I choose my medical insurance plan one of the major considerations is which doctors participated in each of the plans that are available. The lower priced plans had fewer participating doctors and specialists.
<snip>

I don't know that I'd always want my medical treatment to go to the lowest bidder.

It doesn't take a catastrophe to end up with astronomical medical bills. I don't foresee any major reduction is the cost of medical care regardless of who foots the bill.
As proposed in Swingman's original post:
"Each American citizen shall be able to exclude from taxation the amount of $5000 per year (adjusted for inflation) for deposit in his or her Health Savings Account, with catch up contributions allowed if the prior year's expenses exceeded this amount. There shall be no limit to the total amount of capital the citizen can accumulate in his or her HSA. .... "
How does this work for a hypothetical married couple with three young children and one wage earner making minimum wage? Obviously they won't be able to put $25,000 per year into their HSA.
Then there's:
"8. Citizens with income below the poverty level will be provided yearly with a "tax rebate" from the Federal Government, deposited directly into their HSA..... "
A "tax rebate" would indicate the citizen is paying federal tax. A family of five earning $13,624 per year ($6.55 per hour x 40 hours x 52 weeks) does not pay federal income tax.
And there's:
"10. Citizens who become ill before they have accumulated sufficient funds in their HSA to cover the "gap" (whose HSA balance falls below zero in a given year) will be LOANED the needed funds by the Federal government, to be repaid with interest in the future. This loan will show up on their credit report and will influence their ability to borrow for other purposes until it is repaid. .... "
Let's bury the hypothetical family in debt and take away all incentive to work. Tim and I can cover all their expenses with out tax dollars.
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Jack Novak
Buffalo, NY - USA
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Agreed and these guys are probably makin more off of the procedure than those having to collect from an insurance company. Remember insurance companines get deep deep discounts and often don't pay. Basically HMO's and insurance companies are more like agents for many doctors. I think I would probably have more faith in a doctor that does not rely on an insurance company to bring in it's patients.

Don't for get the major point here, insuranc companies make more than the health care system does and what overhead does an insurance company have other than an office for record keeping?
Take the insurance company out of petty coverage and every one saves, except the insurance company.
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Leon wrote:

It sound to me like the insurance companies are keeping the cost down.

> doctors. I think I would probably have more faith in a doctor that > does not rely on an insurance company to bring in it's patients.

The insurance companies rely on their participating doctors list to bring in the customers.

Medical insurance companies are gambling that the coverage premium they charge along with any returns on there investments made with your money will exceed the medical payments they make in your behalf. By them making a profit it shows that on the average they're right.

Your key word above is "petty". If you take the insurance company out of the picture you'd better hope that you're one of the customers that make their "average" profitable.
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Jack Novak
Buffalo, NY - USA
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Would you use an insurance company to hep you buy electricity, groceries, clothing? They don't keep costs down, often they perpetuate the problem.

I have never heard of any one including myself choosing an insurance company based on its doctors list. Most employees insurance is provided through their employeer. The employeer decides which insurance company to go with and you choose from the list of doctors.

But dont be fooled into thinking that every claim is not scrutinized by the insurance company. More often than not th winsurance company disallows legitimate claims.

I do not want the insurance company completely removed, just remove them from the petty, normal, illnesses by simply raising the deductible. I lower my auto and home owners, and flood insurance by paying a higher deductible. If the average person had a $2000 deductible I suspect the cost of primary care would go down when the insurance claims became fewer in number.
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Our company went to a $1000 deductible (which they will re-imburse us) and the premium went down $1200 A few people tap it out every year, a few never use any of it. Overall savings is considerable. .
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Ed Pawlowski wrote:

The trouble with that is that these days the bill for something simple can be immense. The local hospital tried to charge me 2000 bucks for four lousy stitches and a tetanus shot.
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wrote in message

Exactly! I believe that insurance costs are sky high because of abuse. IMHO insurance should only be used of those events that you could no possibly afford, not normal trips to the doctor for the regular illness.
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"Leon" wrote:

On first glance looks good, but when you dig deeper has a major flaw.
When insurance covers regular services of a person's primary giver, illnesses are detected earlier and can be handled with the lowest cost service.
When insurance does not covers regular services of a person's primary giver, illnesses are not detected as early as they should be often resulting in higher cost services to overcome the advanced problem.
Health care insurance is a tad different than other insurance products.
Lew
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