Tech In the Hot Seat For Oct. 1st Obamacare Launch

bednarz writes "In four days, the health insurance marketplaces mandated by the Obama administration's Affordable Care Act are scheduled to open for business. Yet even before the sites launch, problems are emerging. Final security testing of the federal data hub isn't slated to happen until Sept. 30, one day before the rollout. Lawmakers have raised significant concerns about the ability of the system to protect personal health records and other private information. 'Lots and lots of late nights and weekends as people get ready for go-live,' says Patrick Howard, who leads Deloitte Consulting's public sector state health care practice."

Comments

Re:Is there really any point to this? (Yes)

[crow]

Yes, there is a point to this.

It may well be a long time before the Republicans have enough votes to get a repeal through the Senate. The way Demographics are headed, the Republican party of today will have to evolve significantly to stay relevant beyond this decade. And what Republicans fear about Obamacare more than anything else is that once it's implemented, people will decide that they like it, making it impossible for them to repeal it (much like Medicare and Social Security).

Re:Is there really any point to this?

[Cyberax]

Nope. In a few years you'll see Tea Party demonstrations with placards like "Don't let government get its hands into my Obamacare!".

Only if unsuccessful

[ranton]

The Republicans can only get rid of it if it is unsuccessful, which is why they tried so hard to get rid of it before it was enacted. Even so, repealing it would take a Republican president and simple majority in both the house and senate, which is much harder.

Luckily for the Republicans they will always be able to find some metrics that show that it was a failure. Health care premiums will continue to rise no matter what until we serious talk about rationing care, so any health care plan written by either party will always leave room for complaints.

Re:Only if unsuccessful

[AlphaWolf_HK]

The reason we pay so much for health care is because the recipient doesn't know and/or doesn't care how much it costs, namely because they don't pay for it. Likewise, they don't shop around. So even though it is all privatized, there isn't really much of a free market system.

Every doctor I've known (which admittedly isn't many) who has worked in a country with a nationalized health care system always talks about how it is problematic because as the end of the year approaches they have to stop caring for their patients because the money has run out. In addition to that, the pay is crap compared to here, which results in a brain drain (notice how when a foreign country needs the *best* care for a particular patient, they pay to have them shipped here for their operation. Always here. In the US resides the world's top centers for cancer, neurology, cardio, and numerous other medical disciplines, and this didn't happen by accident.)

Rationing is a horrible idea because it just reproduces that problem, in addition to putting you on long ass waiting lists for even basic operations, and making the medical field less attractive as a career choice. It's already bad enough that we have waiting lists for organ transplants (Which by the way this problem is very solvable - have a look at how Iran does transplants. With as much shit as that country gets wrong, they shockingly nailed that one better than anybody else.)

Anyways, find a way to get the patient to actually care about the cost of their medical services, and you'll see the prices go down. This socialized medicine shit is absolutely NOT without its set of problems, and price ceilings and rationing have always resulted in more problems than they solve, especially for products with inelastic demand (in the 70's we did both for gasoline, and the result was shitty. And that's just for gasoline - the notion that people want to try it with health care - basically playing with people's lives - is stupid.)

Re:Only if unsuccessful

[ranton]

Rationing is a horrible idea because it just reproduces that problem, in addition to putting you on long ass waiting lists for even basic operations, and making the medical field less attractive as a career choice. It's already bad enough that we have waiting lists for organ transplants (Which by the way this problem is very solvable - have a look at how Iran does transplants. With as much shit as that country gets wrong, they shockingly nailed that one better than anybody else.)

That is only if you have a central body such as the government doing the rationing. You could also ration care the free market way by making poor people unable to pay for certain care. Regardless of the method, we need to understand that as we continue to make new medical breakthroughs we simply cannot spend all of our resources on keeping people alive forever.

If we finally start making breakthroughs that increase our healthy age (the age where you can work) then it isn't as much of a problem. But currently all we are doing is keeping people barely alive and spending a fortune to do it.

Re:Only if unsuccessful

[artor3]

Anyways, find a way to get the patient to actually care about the cost of their medical services, and you'll see the prices go down.

No, you won't. In fact, you'll see prices rise.

There are two cases in which someone would seek medical help -- life-threatening situations, and non-life-threatening.

In the vast majority of life threatening situations, people aren't going to care about the cost. You've heard about the stages of grief, right? Well bargaining's a big one. Most people will do ANYTHING to get just a few more years, or months, or days. They'll throw money away on homeopathic crap and colloidal silver and psychic voodoo. People don't generally go gently into that good night, and shifting more of the cost on to them won't change that.

But in non-life-threatening situations, people will look at the price tag, and decide that they don't need to see the doctor so bad after all. And so curable illnesses go untreated, and become far more dangerous. They might be contagious and spread their illness. They might lose a limb and end up unable to work and on the public dole. They might die. That might reduce costs in the short term, but in the long run the cost to society is far higher.

Re:Only if unsuccessful

[VortexCortex]

The reason we pay so much for health care [blah blah blah, untested opinions and unproven hypotheses]. ... - basically playing with people's lives is stupid.)

Bullshit.

Here, have another vantage point to consider, fool: Say you're an individual who has a serious medical problem..... "Nice life you have there, would be terrible if something happened to it. Better pay whatever the fuck we say, or you die." Given that folks who CAN pay WILL pay whatever it takes to not die, which direction do you expect such "free market" forces to direct the price regardless of cost to provide? Even if folks DO CARE how much living costs... So, I think there should probably be SOME kind of collaborative interest on the individuals' side because alone they have likely have little leverage when it comes to health care and that whole "divide and conquer" thing.

Personally, I'm not an absolutist. I'm a scientist. I think we should try a few systems out, maybe a few hybrid ones, in various smaller test areas. Gather some evidence as to what seems to work, and roll forward making examinations and modifications as we go along. However, governments and politicians and their moronic divisionist supporters are all NOT scientists and IRRESPONSIBLY roll out huge changes to entire countries without any fucking evidence at all.

So, when it comes to this sort of thing: Any change is at least an opportunity to SEE WHAT WORKS. Unlike you morons I don't have preconceived notions about what's best. I wait for time to tell. Sadly you all want to take the slowest and most dangerous route to country-wide or world-wide possible harm or success in every fucking debate.

TL;DR: Fuck all of you morons.

Re:Only if unsuccessful

[nbauman]

The reason we pay so much for health care is because the recipient doesn't know and/or doesn't care how much it costs, namely because they don't pay for it. Likewise, they don't shop around. So even though it is all privatized, there isn't really much of a free market system.

That's not true. There are countries with government-run insurance, like Canada and Germany, and government-run socialized medicine, like the UK, where patients don't know how much it costs, or care (except to the degree that a good citizen doesn't like to see tax money wasted), and they spend roughly half what we do.

Most of the difference is in the insurance system. For every $1 you pay in health insurance premiums, 15 cents of that right off the top goes to the insurance company (look up a health insurance company financial statement under "loss ratio"), and for every 85 cents that your doctor gets, another 15 cents goes for the administrative costs of dealing with the insurance companies. Another difference is in our use of expensive medicines (erythropoetin for kidney dialysis was Medicare's single most expensive drug, and the dialysis centers, which made a profit on it, were overusing it to the point that they were actually killing people with it), and high-tech equipment (such as CAT scans, which are so overused that they're causing a significant number of radiation-associated cancers). Specialists make around $300,000 a year. Malpractice is about 2% of the health care dollar, so there's no big savings there.

Patient choice has almost nothing to do with it. The doctor has to agree on a treatment (and the more expensive procedures they do, the more money they make). A doctor tells you, "You have to do this now or you can die." What choice do you have?

Here's an example of an unusually well-informed patient, a physician assistant himself, who got appendicitis, did his research, and wanted to be treated with antibiotics, rather than surgery (which can actually be safer):

http://www.kevinmd.com/blog/2013/09/77-percent-success-good-guy-insurance.html
A 77 percent success rate is good enough for a guy without insurance
Andrew T. Gray, PA-C
September 26, 2013

How many patients know enough to resist a doctor's sales pitch: "You have to do this immediately or you could die"?

Every doctor I've known (which admittedly isn't many) who has worked in a country with a nationalized health care system always talks about how it is problematic because as the end of the year approaches they have to stop caring for their patients because the money has run out. In addition to that, the pay is crap compared to here, which results in a brain drain (notice how when a foreign country needs the *best* care for a particular patient, they pay to have them shipped here for their operation. Always here. In the US resides the world's top centers for cancer, neurology, cardio, and numerous other medical disciplines, and this didn't happen by accident.)

Well, I've talked to a few doctors from the UK, Canada, Germany, Sweden, and a few other countries, and I've read the studies that compare their outcomes for standard indicators like infant mortality and life expectancy, and for common procedures like cancer and heart disease. Basically the outcomes in all the developed countries are about the same. I wouldn't disparage American medical research, but if you read the New England Journal of Medicine every week, as I do, you'll see that some of the most important studies are also done in Europe, Australia, and elsewhere, The American studies are often done to get an expensive new drug approved, but the foreign studies are often done to test whether a common treatment actually works (for example this week an Australian doctor wrote an article about whether IV fluids do more harm than good). We didn't discover the AIDS virus; Luc Montagnier of France did. We didn't discover s

Re:Is there really any point to this?

[MightyMartian]

Um, no, it's not fully hands off. The Medicare act is Federal legislation that sets certain criteria for how the Provinces run their healthcare systems. The Provinces are given some latitude, but key aspects must be respected by the Provinces.

Re: Is there really any point to this?

[DoofusOfDeath]

Not their fault. They had to pass the legislation before they could know what was in it.

Re:Is there really any point to this?

[MightyMartian]

Yes, the Provinces decide how, but the parameters are not all that wide, and because the system is in considerable aspects Federally proscribed, you don't see that much variance between Provinces. And, in fact, the Feds have on occasion flexed their muscle and have sent warning shots to provinces who have traveled too far off the line.

Here's the facts. I am a resident of British Columbia. I pay about $127 per month in Medical Services Premiums. For that I won't be given a bill at any hospital or any doctor if I have a medical issue. If I need a scan or some other diagnostic test, I will not be billed. Furthermore, if I end up needing healthcare in Prince Edward Island, I will still be protected.

Let's be real...

[GerryGilmore]

For all of those if us concerned about the privacy/sanctity of our medical information, it doesn't exist *now*. If you are treated under any private health insurance plan, all of the diagnoses and treatments are fed into a database (http://www.mib.com/facts_about_mib.html) that all the insurance companies share to protect themselves against people applying for insurance and "forgetting" about a pre-existing condition. Next time you have a few minutes, pull out the mice-type on your health insurance plan and read up on how they can collect and share that information.

Re:Is there really any point to this?

[Mashiki]

Actually they're quite wide. Go and read the healthcare act then look at the provinces. In fact those "warning shots" have been at Quebec most of the time, because they simply dump the money direct into general revenue, then take it back out. In order to claim that the money came directly from their own general fund. Aka useless BS Quebec type stuff.

And to highlight difference, in Ontario I pay nothing. I don't pay for any tests or diagnostics out of pocket. I pay for notes from my doctor, and that's it. And if I end up in another province, I still won't be billed--because OHIP will cover it.

Re:Is there really any point to this? (Yes)

[clarkkent09]

What do you mean by demographics? The Us population is getting older, which is traditionally more Republican demographics. Oh, you mean the huge influx of Latinos. Right, I understand now. Only, in their own countries Latinos tend to elect fairly conservative governments so once the Democrat deception regarding the immigration issue stops working, things might change.

Alternative, you can just die

[Geoffrey.landis]

As for the second part, people in this country don't get turned away because they're poor, they get medicare or medicaid (depending on age).

Some do. Some don't. Some have too much money for medicaid, but not enough to pay for a big hospital bill. Some charge hospital bills on their credit cards, and then go bankrupt when they can't pay them (sticking you and me with the bill). Some can't get credit cards, and use the Emergency Room for health care. Some just die.

http://www.reuters.com/article/2009/09/17/us-usa-healthcare-deaths-idUSTRE58G6W520090917

"Reuters) - Nearly 45,000 people die in the United States each year -- one every 12 minutes -- in large part because they lack health insurance and can not get good care, Harvard Medical School researchers found in an analysis released on Thursday."

Re:Is there really any point to this?

[RabidReindeer]

Here's the facts. I am a resident of British Columbia. I pay about $127 per month in Medical Services Premiums. For that I won't be given a bill at any hospital or any doctor if I have a medical issue. If I need a scan or some other diagnostic test, I will not be billed. Furthermore, if I end up needing healthcare in Prince Edward Island, I will still be protected.

Shoot, that sounds fantastic! Why can't we get something like that here in the U.S.?

Because we got FREEDOMS!!!!

Re:Is there really any point to this? (Yes)

[clarkkent09]

Religious right most definitely does not own the Republican party. It has moved more to the right fiscally, but it has become less religious.

Re:Is there really any point to this?

[besalope]

Here's the facts. I am a resident of British Columbia. I pay about $127 per month in Medical Services Premiums. For that I won't be given a bill at any hospital or any doctor if I have a medical issue. If I need a scan or some other diagnostic test, I will not be billed. Furthermore, if I end up needing healthcare in Prince Edward Island, I will still be protected.

Shoot, that sounds fantastic! Why can't we get something like that here in the U.S.?

Because we got FREEDOMS!!!!

Especially the freedom to bend over and take it...

90 days waiting room, costs $1,000 - $1,300 /month

[raymorris]

In Canada:

A married couple with no children pay, on average, $11,381 in government healthcare premiums.
Those premiums cover 70% of healthcare costs.
The other 30% of costs are paid out of pocket.

89% of the time, the time for an appointment is less than 90 days.
11%of the time, you have to wait more than 3 months.

For any doctor other than a GP, the average wait time is longer than 30 days.

Patients are not permitted to pay for faster service.
Patients are not permitted to pay for higher quality care.
Patients may pay for services not covered by the government program.

In the US, costs are similar, but slightly higher. Wait times are measured in hours, not weeks. If you're not satisfied with one doctor, you can get a second opinion from another doctor.

The US system is of course not perfect. It does have (had?) a lot of advantages over the Canadian system.

Re:Is there really any point to this?

[MightyMartian]

And what, you don't think the US system has a ton of horror stories. My run-in with serious illness was my wife's thyroid cancer, and the only real delay was because the initial symptoms aped salivary gland blockage. Within days that that specialist figured out that it was a probable tumor (initially they thought a carotid body tumor), we were driving to Victoria to see an ENT (ear-nose-throat specialist) whose specialization was cancerous tumors. She had surgery a few weeks later, which identified it as a thyroid tumor, and the big delay for removing the thyroid gland (total thyroidectomy) was that she had to heal sufficiently from the initial surgery.

Yes, there are delays and rationing, but really that happens in any system. In the US, in many places, rationing is basically defined by the size of your wallet. In Canada and other countries with universal systems, it's defined by utilization.

The public health system saved my wife's life, and other than her need to take thyroid replacement hormone for the rest of her life, she has fully recovered. Furthermore, I was laid off right in the middle of this nightmare, and the end result was that there was no bankruptcy or loss of our house.

I'll take the odd delay in treatment over no service at all or going bankrupt to save my loved ones' lives. If you like the American system so damned much, I urge you to move there.

Re:Is there really any point to this?

[Darinbob]

Two hours for an X-Ray sounds short for the US. Note that all those people who can't afford health care wait until they're really sick and then the clog up the emergency rooms. Which means that if you have a broken bone you sit and wait while the person next to you is coughing from the flu.

Also you'll be able to get care for that back in the future. In the US this won't happen if you can't afford insurance, you'll get emergency care only followed by a string of bill collectors calling to threaten you. The US system only works so far as you've got stable employment at a medium sized company or larger. If you're a food services worker then forget it, you will probalby never be offered health insurance or be able to afford it and just have to hope that your spouse gets insurance on the job.

Re:Freeeeedumb!

[Penguinisto]

These "freedoms" and more are available... but they come at a price.

For instance? No problem...

The county where I live offers an anus-puckering discount on poor families wanting to buy a home (imagine this - being offered a decent home in a neighborhood full of $250k homes for a mere $27k at 0% interest. No, that's not a typo.) Only thing is, the county gets to stop by and make sure you're still poor during the 5-year 'mortgage' period, else the rates and total price rises accordingly. Oh, and CPS gets to check in on your kids any time they want, among other governmental visits that would otherwise demand a warrant.

Groceries? No problem, present an appropriate sob story and proof that you lack income, and most states will lavish you with an EBT card. 'course, unless you get creative about how you dodge it, there's an approved list of foods you can and cannot buy.

Car payments? Well, most metro areas do subsidize free mass transit if you make less than a certain income level... but really - it's mass transit. That means you're stuck with living within walking distance of it, and no further.

How does this relate to healthcare? Well, there are folks already demanding that people be forced to wear health activity monitors if they want that subsidized health-care... but you're forced to buy the subsidized plan if you cannot otherwise afford it on your own, so guess what happens if you have the misfortune to be impoverished? Yup - the government now owns your health.

Long story short, the "freedom"s are there, but the dependencies and (IMHO) conditions you subject yourself to in order to receive them are, well... about to become rather dehumanizing.

Re:Is there really any point to this?

[sqrt(2)]

You'd take the US system because you have enough money to participate in it. Healthcare is ALWAYS rationed. Currently we ration it based on who can pay the most. I'd rather it be rationed based on who needs care most urgently. Societies that choose this method always pay less as percentage of their GDP on healthcare, and get better healthcare outcomes than the US system.

Re:Let us opt out.

[artor3]

And what portion of the total federal budget is taken up by SS today?

Negative 85.6 billion dollars.

Social Security has a net surplus right now. That will over the course of the next couple decades as the boomers retire, but that can be fixed by (for example) allowing the tax ceiling to be adjusted with inflation.

It's funny that you would claim our ideology thrives on misinformation and lies. Perhaps you're doing a bit of projecting?

Re:Let us opt out.

[artor3]

You're lying. Or perhaps just regurgitating lies you heard on Fox or AM radio. Not a big difference, either way.

Here's an official Senate report showing that removing the tax cap would ensure the solvency of Social Security for over 75 years (the maximum duration in their calculations).

Do you see how I keep citing numbers and figures? I'm able to do that because I'm telling the truth.

Sorry, I was there

[Anonymous Coward]

You must be too young to have 1st-hand experience in this bit of history.

First, Nixon was very far to the left in the Republican party (he implemented wage & price controls and created the EPA while hugging Communist China and trying to make nuclear arms deals with Russia that favored the Russians) but he got the support of the GOP base because [1] he had a history of fierce anti-communist action earlier in his career and [2] in each election cycle he cozied up to the social conservative base... not very hard to do given that BOTH parties used to be primarily Christian, with Democrats having somewhat higher penetration onto the Jewish communities. NOBODY in national politics back then would publicly embrace ANYTHING homo-, or drug-, or abortion- or athist-related.

Barry Goldwater was not a prophet, nor was he a conservative... the man was very Ron Paul in his views (i.e. a Libertarian) though not the same in his public persona. Barry had the strong support of a certain political block in his earlier races, and when they came back to him years later to beg him to run for president as a standard-bearer for conservatives within the Republican party he felt morally obliged to do it... which is why he ran that race (and his lack of desire to actually win was probably part of the problem with that campaign). The young conservatives at that time begged Barry to run because the establishment GOP was pushing the usual Rinos (not called that back then) like Mitt Romney's dad and the Rockefellers, none of whom were for smaller, constitutional government.

The modern GOP is FAR to the left of the GOP of 1980 (many modern Republicans have gone Libertarian on social issues like abortion, gay stuff, and half the current Republicans in the senate just voted to fund Obamacare...) you just think the GOP has moved right because the modern Democrats have moved so far left so fast that the gap between parties has grown very wide. Just 8 years ago, EVERY Democrat running for President was opposed to "gay marriage"... Democrat President Bill Clinton signed DOMA and "Don't Ask Don't Tell" military policies. During the 1980s Democrats used to scream and hollar and stomp about deficits and they repeatedly demanded Reagan negotiate with them on debt cieling limits... now they yell that the limits do not matter and they are printing money faster than anybody in history ever has...

Re:Is there really any point to this?

[clarkkent09]

Of course it's not a party but that doesn't mean that it doesn't have a platform. This list is a good start seeing that most Tea Party groups endorse it and most Tea Party congressmen have signed up to it:

From http://contractfromamerica.org

1. Require each bill to identify the specific provision of the Constitution that gives Congress the power to do what the bill does. (82.03%)

2. Stop costly new regulations that would increase unemployment, raise consumer prices, and weaken the nationâ(TM)s global competitiveness with virtually no impact on global temperatures. (72.20%)

3. Begin the Constitutional amendment process to require a balanced budget with a two-thirds majority needed for any tax hike. (69.69%)

4. Adopt a simple and fair single-rate tax system by scrapping the internal revenue code and replacing it with one that is no longer than 4,543 wordsâ"the length of the original Constitution. (64.90%)

5. Create a Blue Ribbon taskforce that engages in a complete audit of federal agencies and programs, assessing their Constitutionality, and identifying duplication, waste, ineffectiveness, and agencies and programs better left for the states or local authorities, or ripe for wholesale reform or elimination due to our efforts to restore limited government consistent with the US Constitutionâ(TM)s meaning. (63.37%)

6. Impose a statutory cap limiting the annual growth in total federal spending to the sum of the inflation rate plus the percentage of population growth. (56.57%)

7. Defund, repeal and replace the recently passed government-run health care with a system that actually makes health care and insurance more affordable by enabling a competitive, open, and transparent free-market health care and health insurance system that isnâ(TM)t restricted by state boundaries. (56.39%)

8. Authorize the exploration of proven energy reserves to reduce our dependence on foreign energy sources from unstable countries and reduce regulatory barriers to all other forms of energy creation, lowering prices and creating competition and jobs. (55.51%)

9. Place a moratorium on all earmarks until the budget is balanced, and then require a 2/3 majority to pass any earmark. (55.47%)

10. Permanently repeal all tax hikes, including those to the income, capital gains, and death taxes, currently scheduled to begin in 2013. (53.38%)

Re:90 days waiting room, costs $1,000 - $1,300 /mo

[artor3]

It's a misleading number. It comes from this study by the Fraser Institute. Basically, they said "the government spends X% of it's income on health care, therefore we can take X% of each citizen's tax bill as the amount that they paid for health care". This is perfectly reasonable on its own, but the GP cherry-picked the number for a married couple with no kids because they have the highest tax bill. This makes Canadian health care costs seem higher than they truly are.

If you do an apples to apples comparison, the Canadians have a clear advantage.

Single adult: $3780 in Canada, $5884 in US
Family of four: $11320 in Canada, $16351 in US

Canadian numbers are from the Fraser Institute study, US numbers are from this study by KFF.

2700 pages of legislation

[Virtucon]

"You have to pass the bill to know what's in it." - Nancy Pelosi

And this representative from California was re-elected. Huh. Well as Ron White says "You can't fix stupid."

If you wanted to fix the US Healthcare system by making care affordable for all and allowing people with pre-existing conditions to get insured, then it wouldn't take 2700 pages of other crap that's in the legislative package. What we didn't get was:

1) No direct influence over rising expenditures for Medical Care. You have a system which doesn't abide by market forces and hospital administrators get paid millions of dollars in salaries and benefits. When you're seriously ill, you don't usually have the time to shop around so whatever they charge you (or your insurance) is what's charged. Sure, there's negotiations and maximums that insurance companies negotiate but that drives further business through insurance companies, forcing you to deal with them.
2) There was no discussion on tort reform so thousands of ambulance chasers can still sue the doctors and hospitals when your scars comes out a little bit strange. A big component to care is the necessary malpractice insurance which can cost upwards of $200,000 in some high cost states. Add that to office staff, paying the Nurse, the building costs and the medical coder to bill the insurance companies correctly and you can see easily why it costs a lot to see a doctor over a routine sniffle.
3) The Drug companies were let largely intact. There are a few costs they'll have to put up with but they're still expected to rake in Billions in profits under the ACA. Ask yourself why that pill you're taking is $5 and why, if it was allowed, you could get it for $.25. Sure the drug industry will claim that "these are inferior" but really it's a smokescreen.
4) The Single Payer system died. Nobody wanted to go against the big Insurance Firms and their lobbyists so we love big business in this country, so why not throw a few billion dollars their way. Well, they do now have to spend more on direct costs for Insurance which is good but allowing interstate competition and other market driven forces into the process would have been much better. That's what the exchanges are supposed to do but here we have the US Government trying to create markets rather than creating incentives with appropriate regulatory oversight for markets to flourish. Oh wait, considering the Financial Collapse, the Regulatory Process failed, so DC can't be trusted with that.

To be honest, you could have taken this 2700 pages, cut out the BS, the Pork like the "Exchanges" which Deloitte is now merrily feeding upon it seems and done away with it and had legislation that was no more than 10 pages long. Starting next year you'll hear more pigs in DC all lining up because the Feds have just blessed one industry with unlimited monopoly powers and you have to pay what they want to charge you. You have no choice, so invest in big Pharma, Hostpital chains and big medical concerns because they'll be raking it in even more.

Re:fist pumping? US system?

[sumdumass]

Insurance is not really capable of being competitive in the same ways manufacturers are. Insurance companies are more like middle management who go between the employees doing the work and the bosses wanting the work done. The differences in costs and coverage between states is likely due to requirements imposed by the states and the risks inherent in the cultures of the people within those states. That being said, there is a little room for competition to create savings or better services. The ACA will get around much of the state regulatory issues which is why we are seeing a lot of states insurance costs actually increasing. But even though the ACA has provisions in it requiring insurance providers to refund the differences if their profit is a certain amount over the coverage paid out, those same insurance providers will still be required to collect and have the ability to pay out for a worst case scenario developed by their actuaries and approved by the government. That is where the real costs of insurance comes from- they are required to keep a certain amount of capitol liquid and available to cover their obligations. Competition cannot get around that.

Insurance is also not health care. The main reason the health care is so expensive in the US is because the government became involved in it. In 1965, the US created medicare and was so overwhelmed by the costs of it, they created HMOs in an attempt to reduce their costs. They gave people with less of a medical education then your typical EMT, Paramedic or nurse the power to deny procedures in the name of cutting costs. Of course this morphed into a mandatory payment schedule where instead of paying the health care costs that are billed, they average the costs billed for an area and pay the average. This means that if one doc charged $10 for an office visit and another charges $30, the average is $20 and both doctors get reimbursed $20 for the visit. This is despite one office being in a rural town and the other being in a large city where overhead just for having the office might be 3 or 4 times as much as in the rural location. Now this cost billed can also be different than the costs billed to an insurance provider too. Well, what happened is that the medical industry who were getting more then expected, increased their rates to $20 and those getting less increased theirs to $60 so the average is now $40.

After a while, this proved to be way to expensive on the government side (granted, insurance providers at the same place might be charged $40 or less but the discounted rates were never part of the average) so the government started paying a percentage of the average. This meant that while the payment average should have been $40, they would only pay 80% meaning only $32 would be paid out. This was acceptable to some as long as they could bill the patient for the non-covered amounts. Well, that caused a lot of outrage and a law was passed saying they had to accept the payment as payment in full and couldn't go after the difference from the patient. People in the health care industry knew that if their costs were higher, the average would be higher and they would get what they wanted again, so they moved their costs up and the doc visit is now $120 or more. Rinse and repeat as this happened in some form close enough to this to call it accurate several times until the ACA was finally passed.

The Affordable Care Act simply doesn't have any mechanism to reduce costs of health care and by all indicators, it has increased the costs of most health insurance. It might even get worse because insurance companies cannot negotiate steep discounts for in network providers the same way as before. Cutting costs might be easier done if instead of average billing, we paid out a costs plus scheme (actual cost of providing the care plus a percentage of that as profit) on the government side. There will be no easy fix for the insurance side and it might get a lot worse.