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How Big Data Is Destroying the US Healthcare System
KindMind writes "Robert Cringely writes on the idea that technological advances have changed the health care system, and not for the better. The idea is that companies now rate individuals instead of groups, and so move to a mode of simply avoiding policies that might lose money, instead of the traditional way that insurance costs were spread over a group. From the article: 'Then in the 1990s something happened: the cost of computing came down to the point where it was cost-effective to calculate likely health outcomes on an individual basis. This moved the health insurance business from being based on setting rates to denying coverage. In the U.S. the health insurance business model switched from covering as many people as possible to covering as few people as possible — selling insurance only to healthy people who didn't much need the healthcare system.'"
Is this the real Robert X. Cringley, or the dishonest Sears Robert X. Cringley.
"National Security is the chief cause of national insecurity." - Celine's First Law
Insurance companies can do what they like - who are we to tell them what policies they can and cannot agree to? Furthermore, by keeping the future-sick out of the pool, they lower costs for the patriotically healthy.
Down with Statism! Towards a Individualist Future for All!
That will require a government solution. Either laws preventing health insurance companies from turning down coverage on individuals in that manner, or an actual heath care system for all and an end to regular private insurance.
Or we can go full capitalist and just get rid of health insurance, then the cost of heathcare will have no choice but come down because almost no one will be able to afford the service (causing the providers to go out of business).
It's to their credit that we as a culture see them as the gateway to health care, and they have done many, many things to insure that people don't interact directly with providers, but in the end, they are middlemen. Nothing more. They do not provide care. Doctors, nurses, clinics and hospitals do. And, given the current state of things, they have done nothing to control costs.
Big Data isn't destroying the US health system. It's the lack of coverage, for-profit insurance protecting their margins by charging everyone more and more to do less and less, to deny payment (and therefore care) so that people get so sick that they lose their jobs and their coverage, passing on the burden to providers and taxpayers that, by law, can not deny essential care. It's a system that only pays up when absolutely necessary, that does not to help people stay off of the doctor's office.
It's a culture that insists that chronic illness or disability is a moral failing and that it is the fault of the person for merely being ill. It's the insistence that health is a privilege, not a right. It's not some computing trend that insurance companies are using to discriminate. Insurance companies have been doing that forever.
This is not destroying the healthcare system - it is (potentially) destroying the health insurance industry. The two are different things.
The auto insurance industry has had very fine grained data on drivers and their habits for many, many years. That hasn't affected the auto industry at all, and it doesn't seem to have materially affected the auto insurance industry either.
A business that makes money by turning customers away does not lend itself to "free market solutions".
So Obamacare prevents companies from refusing coverage or dropping it when the customer gets sick.
We'd better get used to things being more "personalized," this is what we're moving to.
The ability to deny coverage to higher risk individuals has been eliminated with Obamacare, and that's a good thing. If you are filthy rich you cover yourself. If you are poor you are covered by the government. If you were middle class and had some health condition you were screwed if you didn't have employer-based insurance. It didn't take much to be denied - things like macular degeneration or asthma or hyperthyroidism would deny you. One big sickness away from bankruptcy. In the richest country in the world.
Excessive greed is destroying the us healthcare system.
Great timing to have an article about insurance companies using big data to isolate individuals, when the previous article is about researchers putting together a database of people's family ties...
http://tech.slashdot.org/story/13/10/29/2223231/genome-hacker-uncovers-13-million-member-family-tree
Medicare Bills Rise As Records Turn Electronic: The goal was not only to improve efficiency and patient safety, but also to reduce health care costs. But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care. Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms, according to a NY Times analysis.
People decide to use technology a certain way, and people submit to it. Russell Brand is right, it's time for a revolution.
Mostly random stuff.
The ACA, a 995 page act expanded into 10,000 pages of new federal regulations, will improve the Doctor/Patient/Insurance/Government relationship in the same way that the 73,000 pages of IRS Tax Code promotes the middle class.
Several years ago, I was called by the company providing the extended warranty on my appliances. The were offering me a renewal of the warranty. I said I'd only renew on the dishwasher. They responded that it was the only appliance they wouldn't cover. When I declined the extension, they reminded me that things are more likely to break the older they get.
I didn't feel like pointing out the reason they were declining coverage on the one appliance was probably because it was the only one that needed to be repaired, and twice at that. As such, it would be the most likely to fail again. And it did.
Still don't make it right though.
Government will insure the rest. That's where the 'system' is headed.
Unhealthy and not wealthy: government involved at every level
Healthy: many more choices from insurer.
Wealthy: chooses own doctors, procedures and schedules. Not limited by insurers.
The fact is that with the planned disaster that's Obamacare, everything is going to go south badly enough that eventually we'll be forced to scrap it and go along with a single payer system.
Game, set, match: democrats.
-Styopa
I think this is the first time I've seen Obama referred to as "Big Dada".
The US "health care system" was already broken. This is just showing why.
This is "evidence-based medicine", n'est-ce pas?
It's the insurance industry that's destroying the US Healthcare System.
If you think that America's foremost healthcare problems have anything at all to do with technology, you are hopelessly deluded.
Over decades of gainful employment I have signed up for health insurance plans numerous times. I've never, ever, been asked any questions about my health or anything else for that matter when signing up for health insurance at any employer.
The author says "big data" is ruining healthcare. Who are the assholes taking over the system in the US? It's our BIG FUCKING GOVERNMENT with that albatross OBAMACARE that's causing people's plans to get cancelled and rates to go up.
Kind of bizarre that this whole jeremiad seems to ignore the fact that the Obamacare reforms ban exactly this practice starting in 2014? This is responsible for a lot of the disruptions to the market we're seeing now -- some young healthy people are going to be paying more, and some older sicker people are going to be paying less. (The other disruptions are that some of the old policies had coverage caps that wouldn't have covered expensive catastrophic illnesses; that's also banned, and their replacements are more expensive.)
If you take out the ability of insurance companies to selectively deny coverage (which the ACA does), this ability to model outcomes can enable new more effective ways of paying doctors for care and hopefully improving outcomes. Given an expected outcome, an insurance company can pay for improving that outcome rather than just paying for every test run or treatment rendered.
Think about it from the point of view from the insurance* provider...
If one provider takes on coverage for "suspected losing cases", then they will go out of business, especially if their competitor is always only taking "profitable cases".
Really, doesn't it all boil down to charity and one's lot in life? As a society, it would be nice to provide the basics, such as trauma care, like a few sutures to stop some bleeding, fixing broken bones, toss in some antibiotics, etc. because that is cheap.
However, everybody dies sooner or later. rich or poor.
Basic needs are one thing, but then there are "wants"... if you want to live? too bad, everyone dies. You want transportation? Society says the public bus is good enough. Want a chauffeur driven Mercedes? Earn it. Need an antibiotic? Society says, yeah, hear ya go. Want to extend your life with an expensive procedure? Earn it.
* don't confuse healthcare with insurance.
As a young person who pays much more than I receive in benefits, I only hope that when I'm old I will receive a little bit of what I'm contributing. The young should support the old and incapable. Hopefully some sort of program will catch me when I fall. Isn't that what a central authority is for?
This is slightly off topic, but I think it's not just the application of computing power to medical data, but the application of computing power to control and recover a lot of costs has generally been so successful that I think it's actually cutting the "slack" out of the economy and contributing to the decline of the middle class and growing economic inequality.
They're shaving the savings off the top and putting it in their own pockets, but the economic byproducts of the savings (cheaper goods) doesn't offset the economic loss of the savings not being spent on goods and labor, like additional inventory or additional workers.
Say a business sells a widget for $10. Their cost to make the widget is $4 and because of imperfect data/processing, sales forecasts, shipping, etc are all less accurate. They have to carry inventories to meet customer needs. Inventories require workers, facilities (which need construction...), they have to buy more raw materials. So $2 is added in overhead to the $4 and the profit on the widget is only $4.
With improved data/processing, they gain efficiencies. They carry as close to zero inventory as possible. They buy less raw materials. Need fewer workers. Smaller facilities (...less construction, fewer carptenters, less building materials, less ....) and so on. But the nominal cost of the widget doesn't go down, but the margin increases to $5 per widget because they save $1 in costs.
Since the price of the widget doesn't go down and at best rises slower, the consumer is only marginally benefitting, especially since the depressed employment resulting from greater operating efficiency results in lower wages, further mitigating any price declines or slowing price increases.
The $1 that was previously "lost" on administrative costs is now executive salaries, bonuses and benefits where it produces less economic impact than had it been spent on productive economic activity.
people don't have health care unless they can afford health insurance. Health Care becomes a luxury that you only get if you earn it.
A sizable number of Americans think this way already, and an equally sizable think that if we try paying for health care for everyone then there won't be enough for them. All you need to do is convince 51% of Americans of this (because we're 2 party, not a parliament) and Option 3 takes effect.
That's sorta why we ended up with the Affordable Care Act. It was the closest we could get to universal health care with two big blocks of the country convinced that Universal Health Care is impossible. It's odd really, since these same people are convinced we're both the greatest people on earth ("American Exceptionalism") and completely incapable to taking care of one another....
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Anybody could practice medicine. You could not lie about your credentials, but no degrees, or licenses, would ever be required.
Any drug would be available to anybody, any time. Anybody could buy a kilo of opium, or cocaine, or whatever, from Walgreen's.
No such thing as malpractice.
Any successful business man will tell you that there is such a thing as a customer you don't want. Ones that tie up your employees and resources are bad. It's only when you're selling commodities with a fixed price and a high turnover rate (Milk, eggs, oil, beer) that you can take all comers.
At the risk of being modded troll, let me say that that's the trouble with Capitalism. The real world doesn't fit into it's principles and ideas. Health care is too complex and purchased too rarely to make Capitalism a good fit for acquiring it. The classic example is that it's tough to comparison shop on a heart transplant....
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I am not saying that is a good thing, or a bad thing.
My take on it:
The government seems to treat the population, in many ways, much as a farmer treats his livestock. But when it comes to getting old, how DOES a farmer treat livestock?
On a farm, while livestock is healthy and producing profit, they're valuable. Once they're costing more than they're producing, it's time to get rid of them. A particularly beloved animal might be kept on as a pet. But the anonymous mass has to go.
Since at lest the late '70s or early '80s, the impending bankruptcy of Social Security has been a worry for government officials. I recall one of them making a "slip of the tongue" on a CNN interview, back when the channel was new: She lamented that small families and the success of the '60s anti-population-growth propaganda was leading to too many retired and two few working, and they had to "get the death rate up to match the birth rate" to save the program. That may not be the official position, but that sort of thinking is pervasive.
In past generations oldsters could be counted on for votes. But aging boomers aren't as solid a voting block for the party in power as some of the later generations - particularly the new, undocumented, immigrants.
What if our current party-in-power has decided that, now that the Baby Boomers are aging out of the work force, becoming a drain on, rather than paying into, the government coffers, it's time to kill them off? How could they go about it?
Just setting up "Death Panels" and picking who's going to be left to die isn't too popular. (Look at the bad press they got when they included that in a companion bill to Obamacare.)
But how about this:
- Nationalize the bulk of the medical insurance industry.
- Change the rules on all of it, so the prices for private plans goes 'way up, and the insurance companies can dump the sickly from their current, lower-priced, plans because they don't conform to the new rules.
- Then botch the rollout, so those dumped can't get new insurance, either.
Result:
- The poor boomers are dumped from their insurance. The moderately well-to-do boomers have their healthcare prices skyrocket, quickly draining them into "poor boomer" status. (Give 'em six months to three years without insurance and see how many are left.) Only the truly rich can afford to stay alive and healthy.
- With the "It's a really GREAT program, there's just a few bugs in the rollout." claim they can stretch it out and leave the oldsters uninsured for years.
- Meanwhile the politicians who orchestrated this get to claim they're doing it to HELP the population, not to kill them off. (They even get to claim it's their opposition who is trying to kill off grandma.)
Maybe it's not what's happening. But it fits so well with the rest of their track records and the party's historical roots. I ask myself, "If they were doing this deliberately, WHAT would they do differently?". And I can't think of a single thing.
Bantam Dominique roosters crow a four-note song. Once you've heard it as "Happy BIRTHday" you can't NOT hear it that way
Those who have invested in human bodies would be wiser to instead spend it on research.
As though by adding bean counters we could improve outcomes.
What should we spend arguing about the correct code for this lack of compassion as compared to other industrialized nations with longer life expectancies and lower rates of infant mortality?
Confusing measurement with progress. Confusing samples with personalized medicine.
everybody pays a small fraction of the price proportional to their share of the risk pool.
Except the Republican Party's opposition to PPACA comes from its objection to the word "everybody".
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Insurance is all about "unlikely occurances", and spreading the risk around. X number of houses per 1000 catch fire, where X is a small number. We all pay X/1000+delta to avoid having to come up with the full tab when YOUR house burns down.
Health insurance doesn't really work that way. What you're really doing is integrating the cost of your likely healthcare over your entire life and paying for it on the installment plan. Pretty much EVERYONE gets sick or needs health care... particularly things like preventive care and regular maintenance. So it's not a matter of risk pooling. Yes, there's an element of dealing with catastrophic events, but that's a small part of the typical health care bill.
Can't people share in the profit from this efficiency by buying stock in companies that have become more efficient? Find an ETF.
This is Slashdot, after all.
Knowledge is how to play a game, intelligence is how to win, wisdom is knowing what game to play.
The pay-for-procedure model in healthcare rewards doctors and hospitals for doing more on a patient (whether it helps or not), and rewards insurance companies for collecting premiums without reimbursing hospitals (i.e. only insure healthy people). Additional computation and big data allow both groups to be more efficient in pursuing the financial incentives. Things like HMOs and the new "Accountable Care" models have in mind the idea of changing the incentives so they line up: hospitals get more money if they provide better quality care (even if there's less of it), insurance companies profit by maximizing policy count, and patients get better care. These models can only work if the systems all work pretty seamlessly. Without a functional IT system that allows for constructive data sharing between all relevant entities there isn't a chance of making this kind of model work (which was part of the 1990s failure of the HMO). Even with a better infrastructure it might not be doable.
But the "big data" isn't the problem.
Full disclaimer, I work in hospital IT and have worked on an approach to use data analytics to improve patient care.
Duh. There is nothing to calculate. I can tell you the "health outcome" of every single individual inhabitant on the planet. HE WILL DIE. Period. No uncertainty whatever. The only variable is how long he will take to do it. Of course I realize what TFS really means is calculate the likely consumption of healthcare resources during the individual's remaining lifetime and how long the "productive" lifetime will be - i.e. the period the poor sucker can pay in to the scam, so the insurance company can maximize its profit individually.
It's really no different than how any capitalistic enterprise would ideally like to run. For every transaction, the corporation would like if possible to soak the hapless victim for as much as it possibly can and still make the sale. Auction everything. Food, clothing, computers, everything. Drive its profit as high as it possibly can. If it can auction 10 million cans of spam at a mean price of $5.00, that would be preferable to 20 million cans of spam at $2.49 - for the seller. For the poor schmucks trying to live their lives, not so good. In fact, the prospect of selling a single can of spam for $50,000,001 would give the corporation an orgasm. Think of the savings due to the lower cost of having to produce only a single can.
Just look at ebay. Every goddam thing auctioned there can be bought cheaper at Amazon, Newegg, Best Buy, or the like. The only way ebay is ever worth using is for oddball items you can't find anywhere else, and sometimes used items.
The ultimate logical end of capitalistic enterprise is one fabulously wealthy and obsessive hoarder left to buy everything, and everyone else starved to death. Is that better than the logical end of socialism? Not for all the dead people; that's for damn sure.
This and many similar issues would be understood to have obvious solutions if the term "Health Insurance" were replaced with a "Health Care Subscription." Because of the structure of the health care "marketplace," health care access is very difficult without using an insurance company to negotiate payments. Health care providers appear to be unable or unwilling to provide access to health care on a pay-as-you-go basis - hospitals and doctors can't or won't quote prices for procedures. This has led to hospitals, doctors and insurance providers growing to enormous size in order to negotiate payments between them - locking out individual health care providers and individual patients from effective access. In the current corporate structure, individuals need to subscribe to health care from what we now call an insurance carrier in order to obtain care. If we understood these carriers to be providing a "Health Care Subscription" we would understand that it is essential for the carriers to offer access to all, so that everyone can obtain health care. Denial of insurance coverage is tantamount to denying health care - that's an unacceptable result.
You go in for an oil change. It costs $5 no matter what. You get a statement from the auto insurance company that is "not a bill" which is a good thing, because it shows that you were charged $500/qt. for oil.
The $5 oil change would be great, except that your auto insurance bill is $3000/mo, up from $2700/mo last year. Your lucky though. You're a 40 year old driver who hasn't had a ticket in 15 years. Family man. You've heard the horror stories about the young people and seniors trying to get car insurance. You try not to worry about it.
The real trouble comes when you get a fender bender. Totally not your fault. Your car was parked, and somebody hit it. You've got to report that, or you'll lose coverage.
You can't get the dents knocked out anywhere near here. There's a great shop that does that down the block, but they're not in your car insurance company's provider network. Being a licensed mechanic doesn't mean squat if he's not in the network. It's $20 to have the dents fixed, but you don't even know what it would cost if you just went to Joe's down the block. $2000 for out of network dent repair. Not worth it, so you're driving 40 miles down the El Camino to Sunnyvale today.
You used to think, "maybe I'll just ride the bus". A lot of people did. Then they started requiring people to buy car insurance even if they didn't have a car. Most people will be drivers at some point in their lifetime. By requiring non-drivers to purchase car insurance, we will reduce the overall cost of car insurance for everybody.
At least, that's what the car insurance companies said while they drafted the 1600 page Federal Universal Car Car Act.
As for cars, well... I wish I could tell you they were cheaper. Really, I don't know. Your car insurance plan tells you what models you can buy, where you can buy one, and whether or not the state of your current vehicle meets the standards for repurchase. The actual cost of a vehicle is anybody's guess. The list in proprietary information. It's all in the fine print, you know. The copay is $1000 no matter what though. Pretty sweet deal. Used to be a $2000 copay under my old plan. Sigh... I really wanted a Ford F-150 though. Ford is out of network...
For all intensive purposes, "whom" is no longer a word. That begs the question, "who cares"?
The Netherlands doesn't have a single payer system. Small risks and handled by multiple insurers, who cannot differentiate on premium within their customer base or care package and cannot reject customers. What they can do is select hospitals and set the premium for all their customers. However that premium is not all - even though people think 100 euro/month is "too much" for the base insurance.
The base insurance is quite complete, inclusing all transplants and chronic treatments. Basically everything that 'doctors do'. Insurers are quite good at driving down the cost of medicines: I saw 25 euro on my pharmacist bill for a patented medicine; the US price seems to be around 120 dollars, according to Google.
Big ticket treatments that are 'not insurable' like cancer, major chronic treatments and transplants are covered from a state part of the premium. They are even taken out of the risk equation of the insurers, I think.
Recently we've seen some pharma companies lobbying with patient groups and promoting single-source treatments with limited effectiveness but huge cost. There was a public discussion (not cost effective to have 10% better quality of life for 100K/year) - the result is an undisclosed price reduction of the treatment.
That goes to say there are limits to what will be funded. And rightly so.
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Civil liberties, and human rights, appear to be a huge problem for the United States. I'm just really glad that I don't live there.
Well, if I approach an insurance company and they eventually decide to sell me a medical insurance,
it would reassure me I don't really need it and I would not make a contract, right?
So, no selling insurance to healthy candidates, no selling to no so healthy candidates ... how do you sustain such business?
In the current situation, insurance firms are free to pursue a player optimum (for themselves), which means they either try not to cover people with less than optimum risk profiles or they simply raise premiums to where they can confidently expect a profit. Since they can now determine risk at individual level they will simply exclude individuals who constitute a poor risk.
Of course this means that large parts of the population become un-insurable, hence bereft of cover and as a consequence bereft of life-saving medical attention. But that's not the insurance companies' problem. In a basically free (if regulated) market they have no responsibility to anyone except their shareholders. That would be the outcome of the player optimum situation.
On the other hand, mandating medical insurance of the population as a whole allows insurance companies to set realistic premiums that will guarantee basic affordable coverage.
But it does mean that you either allow care providers to set their own prices, in which case you will have to centrally determine how much a life is worth, and cap insurance cover to that level in order to keep the whole system affordable.
Or you can start regulating prices too, and have something resembling a national health service.
In this scenario you simply legislate away companies' and hospitals' freedom to maximise profits and constrain them to beaviour that you feel is desirable.That would be the system optimum.
Note that it can work fairly well (including the cost of bureaucratic overhead), as shown in various places around the world. Note that e.g. per capita spending on medical costs in the US is about 2.5 times higher than in the UK (around $8,000 versus around $3,300 see http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita ) and that for all its warts the NHS does provide adequate medical treatment for everyone.
Please note that the issue of "rights" is removed from the equation if you legislate this, because it's a choice on part of the population as a whole. And the will of the majority is binding in this matter.
The only remaining question is whether a sufficiently large majority wants it.
Error! It is, and had been, the federal government destroying health care.
Ever ask why health care is so expensive? It's Medicare! If you raise your prices and the government just sends you a bigger check, you figure out pretty quickly you should raise your prices every year.
As far as this foreigner is aware, there isn't a "US" Healthcare System, though a rather feeble one is in the process of emerging, rabid Republicans permitting. There are a lot of private companies - in relationships which are more co-parasitic than symbiotic - which puport to offer a "system", but in fact are fighting amongst themselves over the division of the spoils. If this war results in mutually-assured destruction, you haven't lost a Healthcare System, you've lost an obstacle to the establishment of a Healthcare System.
First, we need to undo the error of tying health insurance to employment: This tie happened when companies used health insurance as a an additional employee benefit to keep/recruit good workers during the years when President Franklin D Roosevelt had frozen salaries nation-wide. Before that time, very few people had/needed health insurance
Second we need to undo the error of using health insurance as something other than real insurance. Traditionally, you buy car, or house, or health insurance with the gamble that you will suffer a catastrophe and somebody else will cover it; The guy you are betting against is the vendor of the policy who bets you will not have a catastrophe. The vendor of the policy can make that (otherwise insanely-backward because you're the one betting that the thing you can cause will not happen) bet because he knows you dread all those things and will likely go to great lengths to avoid them. Modern insurance, however, evolved as a way around pay caps (a form of under-the-table pay raise) so it pays for lots of non catastrophic stuff like normal doctor visits. We need to replace this modern, mutated non-insurance with EXCELLENT catastrophic policies that are cheap, not riddles with loop-holes, and just cover the big bad stuff that can happen to people and bankrupt them.
Third, we need to re-connect the consumer with the doctor, nurse, and hospital in getting costs down, reducing the paperwork, and re-establishing the competition of free markets for all day-to-day expenses. We do this with medical savings accounts. These accounts should be owned by the individual, be rolled-over year after year, and be inheritable (which each child starting-out with a pre-loaded account with some standard amount). By having individual ownership and control, the accounts encourage responsible consumer shopping tendencies (so people shop smart and do not over-consume what they do not need). Being simple and close-to-the-user (possibly like debit cards) they would enable simple minimal bookkeeping efforts by medical people. There's simply no reason to have a big insurance company or the government involved in a typical visit to your doctor for a checkup or a vaccination.
Fourth, we need to do the biggest thing Obamacare refused to do (because trial lawyers are a major source of funds to the Democrat party). We need to get the lawyers and courts out of the doctor's office. We need major reforms to remove "punitive damages" from healthcare-related lawsuits. ACTUAL damages should go to victims of either intentional bad behavior or incompetence (no lawyer should get more than his client) and if a medical person needs to be "punished" that should be in the form of jail time, loss of license, etc... it should NOT be in the form of piles of cash sucked out of an insurance company (which in-turn raises rates on other innocent people, driving up all health costs) for the benefit of huge law firms and their political action committees. We also need a new societal agreement on what to do when somebody is horribly injured through no fault of his own and when none of the medical people involved did anything truly "wrong" either. Currently, there are far too many cases of people with a "bad outcome" filing suit and dragging things into lengthy very costly court cases with millions on the line as though any injury, no matter how severe becomes a lottery ticket can be scratched in court to possibly win millions (from insurance companies - which drive up all rates for everybody)
Decades of government intrusion into the marketplace (with each law passed being on top of, but not properly coordinated with, the previous laws) have created a massive health bureaucracy in which doctors are spending more time on paperwork than on patients and NOBODY truly knows what anything really costs or whose actually paying for it. Government promises granny a new hip but underpays the hospital for it, so the hospital inflates the price (knowing the govt will knock some percentage off what's on the bill) then the hospital shif
there are no successful car, home, boat, plane, etc insurance companies?????
Your error is that you confuse "health insurance" with actual insurance (where one pays a small amount of money at regular intervals "just in case" while hoping to never need a payout) and further confuse this with "healthcare" (which, like food water, clothing, shelter, etc we all need and must work to provide ourselves - just as ALL mammals spend much of their lives working to provide themselves and their mates and offspring with the things they need) and further conflate this with the novel 1984 ("do it to HIM! not to ME! ... make HIM pay!").
Far too many people now think "insurance" is supposed to be a 100% guarantee that somebody else will pay for their day-to-day routine medical expenses. If we did this to anything else we need (like food, clothes, housing, etc) it too would become a massive mess - it's contrary to any sane economics. When a person uses somebody else's credit card, he spends recklessly buying more or better than he needs and making no effort to negotiate better prices, shop-around, etc. This is where we are. As long as "health insurance" is defined as "somebody else will buy me the stuff I need both day-to-day and in big expensive emergencies" it is a guaranteed losing bet for the "insurer" and is not actually "insurance" at all.... it's like asking a company to offer you cheap car insurance that covers all your gas, car washes, and maintenance as well as any crash and then wondering why the policy is expensive..... then trying to remedy this by saying companies must cover pre-existing conditions (so somebody can wait to buy a policy until after he has crashed his car) and becoming outraged that prices rise even more in response to this change!
" I do wonder how private insurance is allowed to exist for essential things like health care. How does the profit motive not create an inherent, unethical conflict of interest?"
First, notice that the fantastic advances in healthcare in the US have happened in the presence of the very motives you are (rightly) wary of. Oh, and please be equally wary of the motives of government (govt and corporations are run by the same sorts of imperfect people with often impure motives)
In ANY system where there is not enough of something to go around, SOMEBODY or SOMETHING will be required to moderate/allocate. So the idea that if government does this function, basic economic rules go out the window is about like saying that Space-X can never out-perform a NASA-designed rocket because Mr Musk must make an (unethical) profit whereas NASA (being government-run) is immune to the laws of gravity.
Where corporate profits are on the line, and screw-ups can lead to multi-million dollar lawsuits, insurance companies push doctors and hospitals to lower costs (which leads to demands for better devices, procedures, etc and continual re-assessments about what works best relative to dollars spent etc. and drives insurers to push doctors to try using less-expensive drugs, shorter hospital stays, etc) This all sounds bad, but it is forced efficiency and leads to innovation. The corporate profit motive drives a focus on efficiency.
When government is in the role, limits still exist, but the controls are different (the "reward" to the government (the control agent) is not a pure economic parameter (profit) but a rather more vague collection of power-to-reward supporters and friends, power-to-punish opponents and enemies of supporters, etc which are not tied to something pure like efficiency). Various politicians in response to various politically-powerful groups force certain things to be favored/provided based on demands that may be entirely unrelated to what's actually best/better. Government loves to select vendors based on things like political connections and "competence in dealing with government" rather than competence and efficiency in the subject at hand (Obamacare websites ring a bell?) and this can lead straight into the theater of the absurd. Years ago, the Canadian healthcare system stopped the use of certain expensive equipment for non-emergencies on weekends (as a cost-control play). Then some animal activists noticed these bought-and-paid-for machines sitting idle on weekends and lobbied politicians to allow them to be used on pets (as a sympathetic "why's this expensive equipment going to waste, and shouldn't the taxpayers get maximum use of it?" play) which led to the machines being used on pets on the weekends and then some outraged humans whose relatives were having to wait for care going to the press. I presume this was all reversed at some point and that sanity prevailed once the press got involved. This is a cautionary tale however because we have seen five years of an Obama-worshipping press corps that never asks anything tougher than "what's your fave color?" and with a press corps so invested in one party or one leader there will be no serious probing and no check on crazy government actions. I was no Romney supporter, but did you actually SEE ms. Crowley intervene in the 2012 presidential debate to help Obama deceive the public about his Benghazi response??????
Given that this is the (crap) way that healthcare operates in the US, why has someone not set up a not for profit health insurance company? We have analogies in the UK with (non-medical) mutual organisations such as the Co-operative group and building societies who have provided great services in markets that had similar problems with being dominated by profit making organisations having people over a barrel. I would have thought that such a mutual organisation would find a happy place in the market and certainly be able to help provide affordable health insurance to most?
I don't think reverting to the past way of doing things will fix everything. After all, even if we make people pay for their doctor visits and even those prices were reasonable for low-income wage earners, there'd still need to be some sort of caustrophic insurance and old-age care to avoid losing one's home.
I would still very much favor single-payer universal health care despite your argument. (I'm not the GP poster.) Regardless of how messy the paperwork is, it would be one set of paperwork to know for the whole country.
We could pay for it by higher taxes on the rich and payroll taxes (maybe just on the employer side with exemptions for smaller businesses and self-employed persons 'grossing' less than $100k/year).
Before this, we must have drug patent reform. How about limiting drug patents to 7 years from FDA approval? At that point, it becomes generic and any drug company could produce it without royalties/however-it-currently-works.
While single-payer UHC would be single-payer, I don't feel that should mean there's nothing to pay. It would only be for qualified expenses, and other expenses would have co-pays and whatnot. For example, maybe all doctor visits past 6 visits (for those aged 21-40) would require a $10 copay. Not paid to the clinic, but paid 'to the government in the plan' at the end of the year. And an out-of-pocket cap at 7% of one's taxable income. Maybe a $10/day copay for consecutive days 4, 5, 6, onward for hospital stays.
I like the idea of requiring that 85% be used for actual health care. That is, less than 15% be used for administrative costs. However, I would allow waivers (done by the state level) for small clinics in rural areas.
"Profit from health care is not unethical. It's profit from health insurance that I find questionable"
Insurance is a gamble... like what you do in Las Vegas. You bet you are going to get very sick or be severely injured (bad enough that you could not afford to pay for your care) and the insurer bets that you are so afraid of those situations that you will do what you can to avoid them; They know most people will avoid most bad things and like the casinos they will be able to make a profit from smart gambling.
If you think it's evil to buy a policy, then do not do it (there are people who self-insure because they are morally-opposed to all forms of gambling). Most people on the left seem to favor gambling (so the gambling part should not trouble you) and also seem to be pro-choice and pro-euthenasia and pro-pot (so you should not mind if a person makes choices, like not buying insurance, that leads to his death or the death of her child). Up until Obamacare, health insurance in America has always been a purely voluntary commercial transaction between individuals and insurance companies - every bit as voluntary as every other commercial purchase people make. Of course, decades of left-leaning government policy has gradually mutated "health insurance" away from a bet about severe medical needs and into a system of wealth-redistribution for day-to-day living expenses.... and THAT requires government pointing a gun at the head of "those who have" to get the cash needed for distribution to "those who need".....
And shake my head in disbelief, and a large amount of pity, at you.
How many young people will actually benefit from it without going bankrupt? Have you actually read the details? The plan is based on selling healthy young people policies they will never benefit from (and when they realize this and balk at the price, use government FORCE to make them buy). A young man buying the plan he's most-likely to afford gets a plan he will spend about $300/month on ($3K+ per year), with a $5000 deductible and huge co-pays. How many young Slashdotters have $10K sitting in their bank accounts????? Any who don't are going to go bankrupt WITH Obamacare if they have a severe medical problem.
Ha! it was a nifty trick to use mass-media, rich actors, rich singers, and college professors to fool young people into backing Obama for "free healthcare for all" while the plan itself was designed as a massive wealth redistribution play to shift money from those very same young healthy supporters to the elderly (already recipients of a massive wealth transfer from the young via medicaid and social security) and to poor immigrants (who will, indeed, get free care while pushing-down the wages of those young American (of ALL skin colors) taxpayers who are forced to participate.)
Oh, and a country that's $17 Trillion dollars in DEBT with another $90Trillion+ of unfunded liabilities is NOT the "richest nation on Earth"..... it's one of the poorest and heading further down by the day with the collapse and poverty masked by borrowing and by printed money. The guy who jumps off a cliff can look quite stylish on the way down, but eventually there's a sudden stop...........(ouch)
"Any person who arrives at a hospital cannot be denied services" - this is flatly untrue.
Only persons in an immediately life threatening condition cannot be denied the minimum services necessary to ensure their life is no longer in immediate danger.
Broken arm : if you can't pay, they don't have to fix it.
Kidneys don't work : if you're not in renal failure, then you need to pay for your dialysis.
ObamaCare really does increase availability for these types of healthcare.
Ah, rose tinted glasses. Hate to break it to you, but heathcare during that time period was pretty crappy for most people. It had the feel good of house calls, but the minimum bar for being a doctor that was affordable to low income people was pretty low and if you want that type of health care today you still have access to that level of care from natural healers and other unregulated groups or buy OTC medications.
Access was fast, but not excellent, not unless you were pretty wealthy. The vast majority of the population was shut out of what we would today consider even basic levels of access.
Yes, the federal government tweaking the economy has consequences and mistakes are made, but people tend to sorta gloss over how bad things really were and paint these creepy pictures of the past that is almost unrecognizable from the real one.
I would say that cost increases without increased benefits is what is not do any American any good.
You have to love the American system. They'll spends billions on the military trying to keep John Q Public from being killed by terrorists, but cringe at the notion of spending a dime trying to keep John Q Public from being killed by disease.
Seriously, this is the underlying premise of the entire Affordable Care Act. He's a little late to the party.
This is more or less accurate. I didn't work on the insurance side, but on the Big Data side selling the data and/or technologies.
We developed entire suites of analytics programs for medical and insurance... and even though the propaganda was how it could be used for good, everyone in the room knew it was really what they weren't talking about that it would be used for.
How to evaluate people's credit rating to determine who is likely to pay their medical bill was the first one that caused me concern.
That eventually lead to the clearly immoral: evaluating whether to approve life saving procedure based on the person's credit rating, behavior and lifestyle analytics ( derived from purchasing habits ) versus approving a lower procedure.
As far as I know that last one never made it into production, but the data is all there in our product. Someone could easily write a custom query themselves.
It was shameful.
Our elected representatives live in a fantasy world where their votes are now bought and paid for legally. We are no longer their concern. It's all about the money.
"First you get the money, then you get the power, then you get the women." -- Tony Montana
There should be no 'caveats' in the policy. You should be able to buy a dollar amount coverage, period. And, there should be a mandated minimum which should be adjusted annually to reflect current hospitalization costs for the most prevalent catastrophic events. Heart attack, cancer, Severe trauma. For most people, regular doctor visits won't bankrupt them. Insurance is meant to protect against events where your normal resources would be depleted if you had to use them to resolve the issue. I should be able to buy $500K 'Hospital bill' insurance. Regardless of any preexisting conditions. Realistically, this whole health care business needs to be scrapped and rebuilt from scratch. The obamacare 'bundling' of features in the insurance policies reminds me of the cable tv bundling. We don't like that in that business, we do we like it in the insurance business?
As a Canadian, here's the thing I don't get about the American "fear" of single-payer health care system : "Oh my god, the paperwork! And the bureaucrats that deny care!"
Now here's how it works for a Canadian : You go see a doctor, you give them your single-payer card and... That's it. There's no additional charges or paperwork to fill out, no administrative useless bullcrap. Heck I got surgery done a few years back and all I had to do was to show up at the hospital on time and show them my little card. No cash needed, no bill, just care.
who was the reporter who initiated the Info World techporn/rumor column, was dismissed, replaced with a series of other writers under the same masthead, and won a court judgement allowing him to continue using the pseudonym in his commercial endeavors. who has been hosted from PBS to his own website, and runs a venture capitalist operation, in addition to calling out the schnooks from cringely.com for close to a decade.
yeah, that guy. bigger than his bosses, as a court ruled ;)
if this is supposed to be a new economy, how come they still want my old fashioned money?
GOP healthcare plan, since 1993 : "fuck you, I've got mine"[*].
[*] which, to add insult to injury, you get the privilege to pay for, HAHA, suckers!
It seems to be doing it just fine all by itself.
The title is awful and misleading. It should read How Big Data Is Changing The US Healthcare System. The denial of coverage criticism is made moot by the Affordable Care Act and addressing it was a major impetus for the law being created in the first place.
"Love heals scars love left." -- Henry Rollins
Subsidized by the US and its military
Obamacare introduces all kinds of new governmental rights.
The government now has the right to tax doctors who do not use digital media. My daughter, who just turned 9, has a doctor who uses a paper filing system. They have computers for other things, but he likes having paper files. He's told us he probably will be retiring soon. Punishing him for using paper is just one of the reasons.
The government now has the right to tax individuals for not purchasing a product. I can hardly wait until the Democrats get a solid majority again to see what new and interesting products they will want us plebes to purchase. Subsidized for the poor, sick and crazy, of course. We might be bankrupt by then but why should that stop them.
The government now has the right to force insurance companies to cover whatever the government wants them to cover. I think the insurance companies are hoping to get a Military-Industrial type relationship with the government where most of the spending is cooked into the budget and the only way to trim it is by sequester type of actions. Lots of mergers and name changes in the near future.
That's just three off the top of my head.
I just think it is funny that Europeans, and the rest of the world, spend so much time boo-hooing over US health care and the US in general.
There may not be additional paperwork, but if my facebook friends are any guide, the Canadian healthcare system is far from idyllic.
"I think my toe may be broken, but I won't be seeking medical attention because I don't have time to wait 8 hours in the hospital." In the US, you wouldn't go to a hospital. You'd go to urgent care, pay $20, and be seen right away. Of course, they'd probably just make you a splint and tell you to deal with it, but at least you can get an X-Ray and make sure there isn't something else going on.
"I have been on hold for over an hour trying to call my doctor. I think they may have left and gone home." Yeah, that doesn't happen in the US. You can schedule appointments online, and there's always someone to answer the phone. Even after hours, you'll get a medical triage line.
That kind of thing. And the funny thing is, I'm not sure any of my facebook friends have bitched about the US healthcare system and most of my friends are American. For as much as our system has a bad reputation, it seems to work for the most part.
By the way, paperwork is not really a big deal here. I go to the doctor, I hand them my insurance card, and they deal with it. That's it. I pay a $20 copay, and Canadians don't, but ... well, I'll pay $20 if it means the system is accessible. Not sitting in an ER waiting room for 8 hours has value to me. Way more than $20, by the way.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
And the funny thing is, I'm not sure any of my facebook friends have bitched about the US healthcare system and most of my friends are American. For as much as our system has a bad reputation, it seems to work for the most part.
That's because most health care consumption are non-emergencies. Even the life-threatening kind.
Your American friends don't bitch as much because they can impulse spend out of pocket for all that non-emergency treatment. They end up wasting more money than they had to on treatment they didn't really need. Instead of just "dealing with it", they pay $20 so somebody can tell them to deal with it (ok, after putting on that split which probably didn't cost much, the rest of gobbled up by the health insurance industry and government, and you wonder why the government and insurance companies are only getting richer and more powerful)
Canadians however get time to deliberate if they really need that non-emergency treatment, during which they have time to bitch on facebook. Nobody likes to admit that they were wrong about what they thought they "needed" was really just a "want", so they blame the system and bitch.
Or put it another way: the American system works in the sense it makes people *feel* good, instead of other metrics like being cost efficient (and they wonder why their health care is so expensive)
His entire story is a load of bull.
The health insurance industry is one of the most over-regulated, over-overisghted, Overlord controlled industries in the U.S. aside from perhaps nuclear power.
I was involved in HealthCare I.T. for a time, and the driving force behind 99% of the decisions was some new government regulation - that always, always, always drove up costs and reduced patent care. Every single time.
This whole crazy idea that an insurance companies strategic objective is to make ridiculous profits while fucking all the customers is bunk. YES, they expect to make a profit - they are beholden to their stockholders, after all, that is how a public corporation works. However if you're customers are all angry because of how you treat them, they go elsewhere. This is the reality for all businesses.
Insurance companies are legalized gambling. They set the price of the policy based on what they expect to pay out in claims, plus any income they hope to gain from the investments they make from the premiums. It really is that simple.
Murphy was an optimist
As a Canadian, here's the thing I don't get about the American "fear" of single-payer health care system : "Oh my god, the paperwork! And the bureaucrats that deny care!"
As to your first question, the concern naturally arises because so many other areas of life in the USA involve excessive government, excessive paperwork and/or bureaucracy. There are vested interests that benefit from having an excessively complex legal system (such as the legal profession), and this spills over onto ordinary people in a whole variety of both direct and indirect ways.
For example, many areas of law are set up in such a way as to make it really time consuming and frustrating to try to do anything, thus "encouraging" ordinary people to hire lawyers (or other third parties) to deal with the bureaucracy and/or the legal system so they don't have to waste their own time. The wheels of justice grind slowly to make sure lots of middle-men have a chance to make money off the system. This probably happens in other countries as well, but in the USA it is a well oiled machine.
Since the US legal profession writes, prosecutes, and judges the laws in the USA (most legislators are legal professionals, as are many of their staff members), it has been absurdly easy for them to create this situation. Just as the USA is the "Land of the Lawsuit", so too is it the "Land of Excessive Law" and "The Land of Excessive Bureaucracy". The tax system alone is a disaster. Even if we consider just purely medical issues, the paperwork when one sees a doctor is already substantial, due to the fear of lawsuits, and then there's the paperwork associated with insurance. The expectation is that things will only get worse with the government taking a hand. Entropy, after all, increases in a closed system.
Not all places are equally bad. In many jurisdictions, the theme is excessive government to the max. Other places are reasonable. Even with states that are particularly bad, the smaller towns and less populated counties tend to be much better than the others with respect to these issues.
On the average, over the course of an individual's life, the more people have to interact with the government and the other big bureaucracies, the more they don't want anything to do with them due to the stress levels associated with this interaction. Stress, over the long term, kills.
As to the question of denial of care, that's probably something the young will have a different experience with than those who are older. After all, the young are both less knowledgeable about the world they live in (not having lived long enough to experience its many imperfections) plus they will heal both faster and far more completely on their own, and so are less dependent upon medical care.
Given the amount of entrenched corruption at high levels in the US government, it is natural to be suspicious that any system that government sets up will not work particularly well in making the inevitable tough decisions regarding the allocation of scarce resources.
Finally, speaking of the allocation of scarce resources, those who have studied economics at length have good reasons to be extremely suspicious of the many claims made regarding single-payer health care. The claims of lower costs to the consumer, while politically popular, do not necessarily mean that in reality the total cost to society of these systems is lower. No matter how much game playing goes on by politicians and political parties trying to buy votes by hiding these costs from consumers, sooner or later one must confront an unavoidable fact: somebody has to pay the true costs of medical care.
None of this is to say that such a system can't be made to work well, but it won't happen within the current US legal and political system without massive reform.
Reviewing these comments gave me a good feeling about my fellow Americans. I can see that most people actually do understand the basic issues involved with health insurance and healthcare. Now, if everyone just finds out how their elected officials really stand and vote accordingly. Remember, it still is a democracy, but only as long as you use it responsibly.
Actually, business people everywhere are killing the goose that taid the golden eqq by excessively gaming consumers. Cherry picking insurance clients is but one aspect of the misuse of Big Data to minimize risk by discriminating against smaller and smaller groups and down to individuals, and it is made possible by the misuse of computers and technology by business people who can't think beyond the next quarter.
We are seeing this is internet services, in banking and is short-term investing. This absurd micromanaging of tiny advantage or tiny margin. It is driven again by the abuse made possible by computers to manage tiny slices of time.
When people get tired of continually being gamed by speculation in markets, over gas and grocery prices, they are losing trust in those information sources and they will simply buy less and slow down the economy. They will resist the pressure to react now, and push back the rush to decide now. This is the latency needed in the economy for human consideration and deliberation, and it is driven by the abuse of data in the digital revolution. That will eventually be stopped.
As someone who has been in the biz, I can tell you that this has always been the case. If you wanted individual medical insurance you always had to fill out the giant ten page form listing every sniffle you ever had, and if you had a serious chronic condition or even just a risk you couldn't get insurance, long before the advent of big computer analysis. Actuarial science has been around for a heck of a long time, and the openended nature of the costs for a seriously ill person is pretty much the most obvious point in health insurance.
Our system is evil. Don't ever come here. if you get hurt you will be in the system.. er Matrix... It will have you...
Let anybody sell healthcare, in any form for which there is a market.
Let anybody collect premiums. Let anybody sell medical services.
Let the doctor and the patient decide what constitutes medicine.
Let individuals decide the competence of surgeons when they are shopping for an emergency appendectomy.
Let insurers decide whether a heart attack was due to the patient's negligence and therefore not covered.
This is not Big Data that is destroying the health, it is simply greed. Commercial health insurance will always be that - trying to make money off people's health problems. It is just that earlier it sort of aligned with the general public goods (not really actually if you look at US health care costs), but now its finally back to where it should have been -- selling health care only to the people who are not likely to use it dough...
The DATABASE is pirated from Spry Media, and the copyright removed... it is GPL (V2)... Leave it to the government, to pferform major theft of Intellectual Property! And, to charge the American taxpayer $534 MIllion! Though it cost 356 times MORE than the Ipod 5 rollout, it is not even 2X better!!!
But then how could 40% of the U.S. healthcare dollar be siphoned off into useless paperwork and administrative overhead? Where's the profit in that?