Tuesday, November 01, 2016

Health care

The fundamental problem with health care in the United States is NOT rising prices - those are the symptom.

It started 51 years ago. Medicare.

95% of all the medical costs you incur in your lifetime will happen in the last year of your life. An insurance study done decades ago and only since refined, but not altered in the conclusion. As we have increased the life span the percentage has gone done for the last year but increased for the last five years of your life - we live longer but at a cost. Still, quality and quantity have been improving.

If I told you that your car insurance was $1 a day for January though November, but $10 a day for December...you'd demand one of three things:
1. A quote from another company
2. That we spread the December amount over the whole year, or
3. You wouldn't bother with insurance in December (or conversely, for January through November)

When there is no other company - you MUST get your insurance through me - the only other options are what we have with Obamacare.

#3 is what people decide when they think they are very good drivers and they have a very good record of not getting into accidents.

#2 is what everyone gets when we take the most expensive costs and spread them out over the whole. But...you could go your entire life without getting into a car accident, but you will not get out of this life alive. And those final costs are, especially over an entire population, significant. So, we spread it out. Hundreds of thousands of dollars worth of medical care times millions of people every year.

Medicare shifted the cost of health care for the elderly onto everyone else. When the number of seniors was small and the number of workers large, the difference was pretty small. Now, the reverse is true.

In a nutshell:
A procedure cost $10,000. For a senior under Medicare, because of agreements with hospitals and doctors, the government only pays $6,400 and lets the senior pick up $2,000. What is the hospital supposed to do with the missing $1,600? Simple, it increases the cost to everyone else (not on Medicare) to $10,500. But insurance companies want some of the same deals that Medicare gets so, they pay $6,800 and leave their customers to pay $2,100. What happens to the other $1,600? Simple, the hospital charges the guy that pays for it out of pocket $11,500.

The cost is shifted from the senior to the insured to the uninsured (or self insured). Spread that out over thousands of procedures on millions of people and the numbers become staggering. Add in inflation and more expensive care as more people survive longer and the cost shifting becomes a game of who can shift the cost to someone else fastest. Government, seeing rapidly rising costs demands more shifting away from the growing number of people on medicare (and the state provided, medicare subsidized medi-programs), while insurance companies faced with their own escalating costs of complying with ever increasing documentation and regulation and inflation and rising medical costs, shift the cost to their clients in higher deductibles and more co-payments and demands for their own cost shifting. Dumping more people that can't afford it into the uninsured universe of the highest costs.

x 50 years.....

Obamacare takes the sickest of the uninsured and tells the insurance companies - insure them.

That is telling the car insurance company to insure someone sitting in an intersection with a crumpled front end and dripping fluids...

Insurance is about managing risk - there is a 100% risk to insure someone that just had an accident FOR that accident. Obamacare was not only destined to fail, it was designed to. So that the 'only solution' was government cutting insurers out of the system and just putting everyone on medicare.

Sounds good to people.....except to those people already on medicare who have watched their costs skyrocket over the last 5 years of Obamacare's initial efforts while care and service has dropped because there is a flood of new patients but no change in the numbers of nurses, doctors or hospital beds - and basic economics will tell you that increasing demand over a fixed supply means rising prices.

It is a vicious cycle that started....51 years ago. And all the people that sold Medicare, voted for Medicare, who benefited first from Medicare are long dead. We are left to live with the destruction they sowed. There are alternatives....I've considered two different options in the last dozen years....but something will change in the next two years, no matter who is elected....

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