patrick.net

you are better off paying $800/month into an low risk investment account and banking the money and using it as needed for medical procedures or doctor's visits when you need it. now that obamacare has made it so that no one with preexisting conditions can be turned away, you can always decided to get insurance later on if you got really sick.

One possible option that was mentioned on Mish's site was to enroll at a college or university that provides a health insurance plan. The premium plus enrollment costs might still be cheaper than what you are paying. Good luck!

Going to an all-government health care system would just be jumping out of the frying pan and into the fire. Think about it: if it was actually more efficient for the government to run the nation's healthcare as a centralized bureaucracy, then it would be more efficient for the government to manage all of the goods and services society needs: food, shelter, clothing, transportation, entertainment, education, everything.

Central planning doesn't work. Free markets work. But as others observed above, we don't have a free market. We have a hybrid where profits go to the private sector and costs go to the taxpayer. That won't work. We have to get back to a true free market in health care, and that means eliminating government involvement except for the usual basic enforcement of contracts and so on.

I found among family papers an invoice for a 10 day hospital stay and surgery my grandfather paid for in 1944. The total cost, adjusted for inflation to today's prices, was just over $1,000. Compare that to a recent outpatient surgery a friend's daughter had on the tip of her finger when it was caught in a bicycle chain - $14,000.

What I never hear is a detailed explanation of how costs have gone from $1,000 for a ten day hospital stay with surgery, anaesthesia, supplies, etc, to $14,000 for an outpatient fixing of a fingertip with no hospital stay. My best guess is the government's involvement in guaranteeing payment for unlimited amounts of healthcare provided to the elderly and indigent. That eliminated the fiscal discipline of the marketplace that usually drives prices lower over time (as it has in the computer/technology field where there is essentially no government involvement).

Same thing happened to the cost of college once the government got involved with guaranteeing an unlimited supply of student loan money. Colleges were able to raise prices as much as they liked because they knew students could always get loans guaranteed by government. Again: profit going to the private sector, cost going to the taxpayer. The moral hazard problem.

Socialist health care systems are already collapsing around the world. Look at the problems with Britain's. We do not need to go that route...it will be worse than what we have now and will cost even more - the cost will simply be hidden in your taxes and interest rates rather than coming as a premium bill from an insurer. We need to get back to a real free market in health care.

kimtitu says

One drastic way is to not to have insurance and just go to ER when thing hits.
Last year, I took my son to ER for real emergency. There are several other patients and their family, who do not seem so urgent but more like having a tour in ER room, before my turn.

Emergency rooms take patients based on their acuity. You don't know what was wrong with these patients. So far as their payment source, you don't know that either. They could have been in greater need than your son.

People without insurance must go to the ER, because otherwise they have to pay cash at the time of service. ER's are mandated to see patients no matter what their payment source might be - so what seemed to you to be a person who wanted a tour in the ER could have been someone with a tumor waiting to be seen. You don't know.

cleg says

My elderly father recently spent 3 days in the hospital for observation after having a fever. The bill just came in at slightly over $9,000.

The amount Medicare paid, after deductible, was about $3,000. Billed charges are different than paid amounts.

Yes - the system sucks. Horribly. However, costs spiraled before Obamacare and this shouldn't be a partisan issue. We really do need socialized medicine, but big insurance and healthcare corporations would lose their huge-ass profits and high paid salaries.

I've said so many times that, to me, a huge waste is the double-dipping of patients in nursing homes on Medicaid ($6,000 by the state/feds) and Medicare paying for hospice ($5,000) at the same time. Sure, there are some patients who need extra care - but most of these patients benefit the hospice, not the patient. Hospice lobbies have made sure that these patients are paid at the same rate as home hospice patients, even though they have 24-hour nursing care and caregivers via Medicaid. Hospice workers love patients in nursing homes - they require substantially less assistance, cost the hospices less and therefore provide a much higher profit to the hospice. The patients don't know the difference - in fact, much of the time they don't even know they're on hospice. Medicaid cuts back the amount that it pays to the nursing homes, yet they hospices are legally allowed to pay that difference back to the nursing home (a kickback of sorts) to encourage the hospice referrals.

There is so much waste and legal ways for companies to manipulate the system - and the rest of us pay for it in the form of higher premiums to the little guys.

Good Grief! No wonder baby boomers are not prepared for retirement!

Outrageous! I'd seriously consider doing without insurance. Of course, I'm single with no dependents, so you may have other priorities.

But I've gone without health insurance plenty of times. I went without for 5 years, then had it for another 5, then went without for another 5. The Oakman is right. When the receptionist or MD would ask whether I had insurance, I noticed that they'd charge me a more reasonable rate when I was without. Seriously - the bills weren't nearly as high for the same services as they were during the times when I had insurance.

I've heard the argument "but just try to pay out of pocket - it's too expensive" and that argument doesn't hold up when it comes to routine stuff. If a person can pay $800 a month and then still shell out for a co-pay, then couldn't that same person just bank the money and pay the bills directly? That's what I did for ten years on and off. It was way more cost-effective that way.

Even if something serious happens, you would probably be better off working something out with the hospital. Here in NJ, high-deductible plans only cover 50% (or slightly more) of your costs after a $10K- $15K deductible. So, if you got socked with $50,000 in charges, the insurer would pay around $20,000. You're still on the hook for $30,000. If you've not been paying $800 in extortion fees and if you can bargain with the hospital / care providers, you might get your costs down to $25,000 or $30,000 anyway.

If I were in that situation, I'd do without the insurance.

Also, in response to "mn_mark": if we had single-payer or national health care, the whole system would not be "run" at the federal level. Like law enforcement, much of a public health care system would be run at the state, regional (e.g. county), and local levels.

Thus, I don't buy the argument that "having public health care won't work because the federal government can't run such a big system". It wouldn't make sense for the feds to run it any more than it would to have them run your town's law enforcement.

Furthermore, people against public health care often argue that the government would then get into providing all our food, shelter, clothing, entertainment, transportation, etc. Who says that ever needs to happen? What do those things have to do with health care? Does the government have to provide those things now because we have public education and public law enforcement? No.

Seriously - I doubt we'll become Communists if we have public health care.

My wife (33) and two kids (7 and 9) pay about $250/mth for a $6,000 deductible plan from Anthem/Blue Cross Blue Shield in Missouri. Everyone is fairly healthy and we have a low claims history.

Honestly, though, if rates get too high, the best catastrophic medical insurance "plan" for the typical middle-class person with few assets is Chapter 7 of Title 11 of the United States Code--i.e. personal bankruptcy. Put that $1,100/mth into your 401(k) and IRAs instead of feeding the insurance machine. Your 401(k)s and IRAs are exempt in a Chapter 7.

That is why the insurance companies sent their lobbies to Washington to make health care MANDATORY! Mr. Obama in his debate with Mrs. Clinton, said that he was opposed to mandated health care, now he has changed his mind!

mn_mark says

Socialist health care systems are already collapsing around the world. Look at the problems with Britain’s. We do not need to go that route…it will be worse than what we have now and will cost even more - the cost will simply be hidden in your taxes and interest rates rather than coming as a premium bill from an insurer. We need to get back to a real free market in health care.

Where are "socialist" (everyone else calls them public) health care systems collapsing around the world? What countries have you spent time in to make this observation? I've had health care in France, Canada, and New Zealand without any problems. The people there are fine with their system. They are mystified by the American system and why anyone would tolerate it. How will it be worse? America doesn't rank all that high on health care outcomes at all. Things like infant mortality in America are down in third world range. Oh right I forgot, everyone else lies about their health care numbers. Only America has an honest government that only tells it's citizens the truth, the whole truth, and nothing but the truth.

There are something like 60 countries with public health care including 32 of the 33 developed countries (guess the missing country). The only one you found to comment on is Britain, which is universally recognized as being poorly implemented and chronically underfunded. That's pretty objective (not). The cost per person in the other 32 developed countries of the world (oops I gave away the answer) is about half of the cost per person in America. This is pretty simple math, take the total spent on health care (which is very understated in America, a lot isn't counted properly because so much is private) then divide it by the number of people. There is nothing hidden in taxes or interest rates, the cost is the cost.

Let's see, twice the cost for results that are not as good. Yep it sure could be worse.

mn_mark says

I found among family papers an invoice for a 10 day hospital stay and surgery my grandfather paid for in 1944. The total cost, adjusted for inflation to today’s prices, was just over $1,000. Compare that to a recent outpatient surgery a friend’s daughter had on the tip of her finger when it was caught in a bicycle chain - $14,000.

Post a redacted image of both bills. It would be interesting to see. Especially the part about 14,000 for outpatient surgery on a fingertip. I smashed my finger badly while working on one of my properties in Oregon 3 years ago. Total charges for ER at Emmanual in Portland, three visits to an ortho with an in office surgery, and a 40 mile ambulance ride (it was really smashed, I was losing a lot of blood and couldn't drive) was less than 5000.

The other side of the story is it took almost a year, with at least 50 phone calls (from NZ) across 7 time zones, to get all the bills paid. I had travel insurance through an Australian company and they had the patience of a saint dealing with the various billing departments screw ups. Double billings, lost payments, and multiple claims from the hospital, the doctors office, and the ambulance company. Emmanual managed to lose the insurance information 4 times and threatened to sue me for failing to provide it each time they lost it. The doctors office managed to turn the account over to a collection agency even after faxing the information that the claim was paid and they had the money at least 5 times. AMR claimed they couldn't get in touch with me, turned out that they didn't know how to dial an overseas phone number or send a letter overseas. They never bothered with my email address. Absolutely no one answered phones or returned emails. I have friends tell me my billing experience is the norm for most people, not just because I live overseas. The cost of dealing with all this has to be astronomical for the providers.

Here in NZ (which has one of those terrible socialist health care systems) there is ZERO paperwork. You go to the doctor or hospital, get treated, and go home. End of story.

I don't mind mandatory insurance as long as it's capped at some reasonable cost and there is some government option to escape Blue Shield's extortion. Unlimited mandatory premiums to support Blue Shield's executive bonuses is just legalized theft.

We have mandatory elementary schools. It works well enough to provide a basic education for those who put in some effort, and those who don't like it go to private schools. Why aren't the right-wing nut jobs screaming about the communist nature of elementary school? Because they see that yes, government actually can provide some very beneficial services at a reasonable cost to everyone that the private sector cannot.

This looks like a good organization:

http://singlepayernow.net/

Why aren’t the right-wing nut jobs screaming about the communist nature of elementary school?

? they do that too.

That makes it just about the most profitable company

odd metric. Above I broke down Wellpoint:

Wellpoint had $14.6B in revenue and $2B in overhead leaving $1.2B in profits.

So that's ~80% of premiums going to care.

WPT has 10 million or so subscribers, so their overhead is $60/mo and their profit is $40/mo per subscriber.

People complain about the cost of insurance - and I get it. I work with a woman who said that she dropped her insurance because of cost.

But if you have a serious, progressive illness that requires labs, consults and chronic medications, it can cost $300 to $400/mo on top of the premiums just to treat it. I see people who have to choose between treatment and food. It sucks.

Sorry, Patrick, but this is exact, direct, and immediate result of Obama's health insurance reform.

1. The reform actually reduces amount of health care existing facilities/personnel may provide by increasing huge administrative and regulatory overhead.

2. The reduced amount of care supposed to be shared by more people.

3. Health Insurers are allowed to pass the cost to those who can pay.

So YOU should pay for all this.

Beside this, different health insurers had different levels of lobbying success. This created winners and losers among them. Blue Shield / Blue Cross is the main loser, while KP is the main winner.

Of course, the winner (ab)uses the reform as well, but may afford lower increases. So, in my case, "only" my co-payment tripled and some coverage is cut.

Sorry again, but I have an impression you really wanted that reform.

Love that Swedish medical treatment. Man has to wait five months to get an appointment then they mistakenly amputate his penis! http://www.thelocal.se/31130/20101229/

elliemae says

But if you have a serious, progressive illness that requires labs, consults and chronic medications, it can cost $300 to $400/mo on top of the premiums just to treat it.

Ellie for any sinsible person that Anyone expects to pay up to if not more $1400 a month.
I think they can swing that quite comfortably, given the option.

Where's the added benefit, to pay tripple up front for care you don't even need???

IT would be far better suited in any kind of Savings account, and that way an even bigger guarantee they'll be able to afford any minor to mid level medical calamity.

You can actually Vacation in another country and under go serious operations, for 1/10th of what that operation would cost in America. And that's with a stay over in that country to recuperate before journeying home. And again the medicine paying out of pocket in the states would still be cheaper than any premium.

Tenouncetrout says

Federal Health Care System was the only SANE option. Every thing else was just a World Wide Joke of epic proportions.

I agree with all the rest, but it was not a Joke. It was a World Wide FRAUD of epic proportions. The whole reform was created by CEOs of major Health Insurers. In no way they would accept a Federal Health Care System.

winout says

Love that Swedish medical treatment. Man has to wait five months to get an appointment then they mistakenly amputate his penis! http://www.thelocal.se/31130/20101229/

Oh one story out of hundereds of Millions of medical patients in a socialist system in the world. In the meantime, our news papers are filled with "Malpractice" and "Neglegence" on a daily basis.

Just what is the point of these retorts? If ever in the history of "Anything is better than this" Liberal school of thought, Our insurance based medical system in this country, is a shinning example of that logic.
I mean on the scale of one to hundred,
Kerry vs. Bush was a 21.4 compared to this being a hundred.

michaelsch says

The reform actually reduces amount of health care existing facilities/personnel may provide by increasing huge administrative and regulatory overhead.

I find this unsupportable foo-fah.

But I agree that it's no surprise that premiums will be rising on the already-insured. That's what insurance pools are, once we admit millions who were excluded via adverse selection we're going to have to pay for them.

I also agree that KP is the big winner here and we may see health insurers start buying care facilities to get around the MLR stuff.

Getting more care for millions of people is a good first step. That premiums are supposed to be subsidized starting in 2012 or whatever does make this a fight that is going to be continued this decade.

The fight for reform is not over, it's just beginning.

michaelsch says

In no way they would accept a Federal Health Care System.

and neither would the American people, not in 1993 and not in 2010. We're too easily bamboozled. Seniors have largely already got their reforms, and most of the electorate that matters doesn't want government messing with what they have.

I'm willing to be proved wrong on this, but I think ACA was the best the system was able to vend in 2009-2010.

We'll see how it goes from here.

michaelsch says

The reform actually reduces amount of health care existing facilities/personnel may provide by increasing huge administrative and regulatory overhead.

You're saying additional insurance company paperwork costs are responsible for a 73% increase in my premium?

That's just obviously not true, or like Troy says "I find this unsupportable foo-fah."

The main problem with Obamacare is that the insurance companies blocked the public option.

Troy says

WPT has 10 million or so subscribers, so their overhead is $60/mo and their profit is $40/mo per subscriber.

So they have profits of $400 million dollars per month? Sucked out of customers who are trapped like rats in this evil system?

It's actually way higher than that, because that additional "overhead" cost of $600 million more per month no doubt includes the executive bonuses and private jets without which they could not provide their wonderful service...

But it still doesn't explain the 73% increase in premiums.

I just got my insurance raised AGAIN from Blue Shield of CA. It is unaffordable. I don't know what to do I was forced to switch to the lowest policy after the rate hike in Oct. My insurance has gone up over 100% since 2009, plus being a woman they increased my policy by 20%. raised it again, then said they were reducing it because of the gender bias and then raised it by 31.4% on top. It is shameful. I have panic attacks about my health care and how I can't afford it. The lower monthly high deducible policies are wolves in sheep's clothing. In the end you pay thousands more and are stuck with that policy than if you could afford to pay even 100 more a month by a 5000 difference. I have done the math. . It is a greedy system, and is structured to hurt the people who can't afford it the most. My wages aren't going up, I have to buy my own insurance, I work as a freelance person, and have tried to find a full time job in my field but they are limited and most do not offer benefits or have cut them. Everything is getting too expensive. I dread getting older, I turn 45 this year and again my insurance is going to go up by 100 or more a month. I can't make these ends meet and neither can the people I know. We all have 2-3 jobs and it barely covers it. I don't know who is getting the high paying salaries to keep up, but they aren't there anymore. A job that I interviewed for paid 75,000 2 years ago and now pays 35,000 with no benefits. Same job same heavy demanding workload. I am sorry to go off, but I can't believe my insurance is going up again. Also the underwriting is so evil if you have anything, I mean even a cold or god forbid told the doctor you were sad because someone died and they wrote the word Depressed or anxiety in your records they charge 75% above the the advertised rate for the same crappy coverage for 10 years.
I support Obama. At least he is trying to do something, it is out of control. I sit up at night and cry because of this health insurance nightmare, I pray if I get sick I just die so I don't go into financial ruin and be an indentured servant to this messed up system. I hate that I can't go to the doctor when I need to and if I do god forbid there is ANYTHING wrong I will be screwed because I can't afford to treat it and then can't afford the insurance. SHAMEFUL

Troy says

But I agree that it’s no surprise that premiums will be rising on the already-insured. That’s what insurance pools are, once we admit millions who were excluded via adverse selection we’re going to have to pay for them.

Woah, no, that's just the opposite of reality. "Adverse selection" means that only sick people want to buy insurance. Letting people buy insurance only when they want to means that we select for those with adverse health situations.

Adding the millions of others who don't have health issues right now means premiums should go down, not up. More people paying in, same few people are sick.

Tenouncetrout says

Sign up for Ruthy care, you’ll be amazed at the money you’ll save.

What's Ruthy Care? Doesn't show up in Google.

Got a URL for it?

Adding the millions of others who don’t have health issues right now means premiums should go down, not up. More people paying in, same few people are sick.

We haven't added them yet . . . the letter I got from BCBS telling me why my rates are going up 25% from $178 to $222:

ACA: BCBS says this is raising rates 1-5% now

Gender-neutral -- they say this is raising rates up to 17.7%.

ACA has the following changes for 2011:

Dependents up to age 26 now covered
Former lifetime limit of $5M removed
Preventative health care "free"
Pre-existing stuff for minors removed

I guess women have a lot higher health care costs than men . . .

I wouldn't be surprised if the health insurers were simply using Obama care as an excuse to raise rates. It's win-win for them: people will be POed at Obama and vote Republican - the party arguably favored by insurance companies - and in the meantime, the insurers enjoy higher premiums.

Any industry, being Health care, colleague education, housing, that have Gov subsidies prices go up.

These Gov tax subsidies are really Gov assisted robbery of citizen for the benefits of these industries.

Usually if people don't like something we refuse to buy that services and force the prices to go down.

But now even thought people don't like the health care price tag the Obama care will force people to buy that expensive things people hate.

absurd.

Tenouncetrout says

Sign up for Ruthy care, you’ll be amazed at the money you’ll save.

What’s Ruthy Care? Doesn’t show up in Google.
Got a URL for it?

Ruthy is my wife, she pays the Bills, she finds which Doctor we go to, and where we get our medicine. She's been pretty thrifty and effective. Still haven't managed to spend a full months worth of a $1400 monthly premium in the whole year. They've(wife and two daughters) been to the Doctor as many times as anyone else healthy with an insurance plan I know.

Me I don't go, if it aint broke don't fix it.

zongmike says

Obama care will force people to buy that expensive things people hate

you're not forced to buy anything under ACA. I forget, but something like $50/mo or 2% of income is the tax to induce you to get coverage.

I agree with your larger points that subsidies in education and housing are just making them more expensive, and the same thing will happen under ACA as tens of millions will enjoy subsidized health insurance.

This money will have to come out of taxes eventually. Or theoretically. Right now we're not too big on actually having taxes meet expenses for some reason.

I had my rates rise 30% last year for myself wife and 1 year old daughter w/ Blue Shield. I filed a complaint in CA here: http://insurance.ca.gov/contact-us/0200-file-complaint/

BY LAW the insurance company needs to give you 30 (or 60 cant remember) days WRITTEN notice before raising rates. If that did not happen then they cannot raise your rates.

The end result was that I was reimbursed the difference by the insurance company in the months it took to file the complaint and await the review/ negotiation. However I was still owed $775 and B/ Shield have tried the same trick and raised the rate another 20% (again without written notice) so I about to file complaint #2.

Importantly, I kept paying the insurance the whole time until it was resolved. Being from the UK and having been treated there, Australia, Brazil, Singapore and Thailand I can honestly say that the US system is unfair and completely ran in favor of investors. They have no accountability as far as I can see, it is a scam.....

I agree w/ some of the above comments of US doctors suggesting treatments, medicines, procedures etc just to make a quick buck, not necessarily because they are the right thing to do.......

No other country in the world (I have lived in worked in about 15) has TV adverts telling you to "go and ask your doctor if $#@%^ is right for you" If you suffer from headache, nausea, wild erratic spasms, sleep walking or chronic anal discharge then maybe, just maybe......you took the wrong medicine that "your doctor" told you to take!!!

Mikejay says

I wouldn’t be surprised if the health insurers were simply using Obama care as an excuse to raise rates. It’s win-win for them: people will be POed at Obama and vote Republican - the party arguably favored by insurance companies - and in the meantime, the insurers enjoy higher premiums.

Thing is, everyone's getting these massive bills from the insurers, not from the government. Their costs have not gone up in the last year anything remotely like the increases they are imposing and anyone with half a brain can see that.

It's another huge example of corporate lobbyists influencing the government to let the corporations rape us in the name of the "free market" while angry dimwit Republicans go along with it.

When the banana Republicans finally get their wish and we are left with nothing but a banana republic, a few ultra-wealthy people will own everything. Everyone else will be their permanent peons. Entrepreneurship in America is already lower than most other countries, and the lack of health care independent from your job is a huge reason why:

http://noapparentmotive.org/blog/2010/12/17/health-insurance-and-entrepreneurship/

"Central planning doesn’t work. Free markets work. But as others observed above, we don’t have a free market. We have a hybrid where profits go to the private sector and costs go to the taxpayer. That won’t work. We have to get back to a true free market in health care, and that means eliminating government involvement except for the usual basic enforcement of contracts and so on."

What exactly does it mean to get back to a true free market in health care? When did we have a true free market in health care?

I completely agree with your description of privatization of profits, socialization of costs. But you seem to view this as a government takeover of health care. I view it as a health care takeover of government. The insurance companies, drug companies, hospitals, etc. are using the government as an instrument of plunder.

The cost graph Patrick has posted indicates the system is in a runaway condition. This is a positive feedback loop, i.e. the hotter it gets, the hotter it gets. As he extrapolated, it will quickly ratchet up to become unaffordable to everyone anyway.

repo4sale says

This is an example of why I “date women between 20-30″…. and why I refused to get married. 3 women in the past did not sign my Pre-Nuptial contract (very fortunate). I am looking for a “10 DNA surrogate”… $100-200k???? Must pass background & DNA analysis by my Dr. Present Net worth without Debt about $50-150m. 2020 goal is $1b. Need DNA child to transfer Estate to!

You just get increasingly odd - you do know that, right? I'm not surprised that you couldn't find anyone to sign your "contract." Have you tried Angela from "The Office?" She seems to be exactly what you're looking for.

Mikejay says

I wouldn’t be surprised if the health insurers were simply using Obama care as an excuse to raise rates. It’s win-win for them: people will be POed at Obama and vote Republican - the party arguably favored by insurance companies - and in the meantime, the insurers enjoy higher premiums.

Thing is, everyone’s getting these massive bills from the insurers, not from the government. Their costs have not gone up in the last year anything remotely like the increases they are imposing and anyone with half a brain can see that.
It’s another huge example of corporate lobbyists influencing the government to let the corporations rape us in the name of the “free market” while angry dimwit Republicans go along with it.
When the banana Republicans finally get their wish and we are left with nothing but a banana republic, a few ultra-wealthy people will own everything. Everyone else will be their permanent peons. Entrepreneurship in America is already lower than most other countries, and the lack of health care independent from your job is a huge reason why:
http://noapparentmotive.org/blog/2010/12/17/health-insurance-and-entrepreneurship/

Even the Mexicans are staying home now and many who have come "for a better life" have decided to pack up and go back to Mexico. Mexicans know what it's like to live in a 3rd. World Country. Americans are just starting to learn. Mexicans are smart enough not to get onto a sinking ship.

Soon Canada will be complaining about all of the immigrants coming from south of their border to work and seek out "a better life." Maybe they'll be kinder to us and refrain from the idiocy of building a fence in the middle of nowhere that keeps no one out.

michaelsch says

The reform actually reduces amount of health care existing facilities/personnel may provide by increasing huge administrative and regulatory overhead.

You’re saying additional insurance company paperwork costs are responsible for a 73% increase in my premium?
That’s just obviously not true, or like Troy says “I find this unsupportable foo-fah.”

It's not the insurance company paperwork. It's regulations compliance that creates that overhead.

The main problem with Obamacare is that the insurance companies blocked the public option.

No kidding. The bill was created by lobbyists from major insurances companies. They practically hijacked it. How would you expect public option?

Well, let me explain what I see myself. (BTW, I'm working for the biggest California Health Insurer and HMO.)

1. Health industry is an industry with finances similar to all other industries. Financing means getting loans and rolling over your debt.

2. The reform made available Government guarantees to large loans with extremely low interest rates. (much lower than inflation). Banks are still interesting in issuing these loans, since Government secures them, so banks create the whole amount out of thin air and get some interest for free. We talk about Billions, so even 1% interest is a lot of FREE money.

3. However, those guarantees are not automatic. You need to pass lots of compliance tests like HIPAA, SOX, etc., etc. to qualify. Most of these compliance requirements are not applicable to most of equipment, processes, and software used in Healthcare, (they are like 0 cholesterol in bricks.) but you still need to pass them. Passing them is very expensive. Today this is the major overhead for large H-C organizations and the major reason/excuse for increase in Your premium. Government fully recognizes cost increases caused by its regulations and allows insurers to pass the cost to You. I suspect they hope that after compliance work is finished the higher premiums will cover expenses to insure those currently uninsured.

4. The worst thing is that after you are certified, you can't make ANY change. Change becomes the worst nightmare of HealthCare management. You can't change outdated equipment, switch to better reagents, change software, implement fixes, etc., etc., etc. Health Care systems are very interdependent, change in one part often causes changes in information flows in other parts, so it's a big NO-NO on any level. As the result, everything we do turns less and less efficient. One would be amazed how quickly this works in Health Care.

As the result of 4., be ready to more sharp increases in premium.

Troy says

michaelsch says

The reform actually reduces amount of health care existing facilities/personnel may provide by increasing huge administrative and regulatory overhead.

I find this unsupportable foo-fah.

Please, take a look at my explanation above.

michaelsch says

In no way they would accept a Federal Health Care System.

and neither would the American people, not in 1993 and not in 2010. We’re too easily bamboozled. Seniors have largely already got their reforms, and most of the electorate that matters doesn’t want government messing with what they have.

I think American people are really brainwashed about things like Government Health Care System. I would say that on the one hand it is not the solution, on the other hand purely private Health Care does not work either. IMO, the solution would be some kind of combination of the two. Government Health Care System actually works nice for basic, routine care, like immunizations and anything that can be provided in a cookie-cutter approach. It does not work and never will for non-standard cases. So, Government Health Care System would be ideal most of the time, as long as everyone would understand he needs to save plus keep a good credit rating plus have very devote, caring relatives for the case of a severe medical emergency.

Of course, there are some problems with this. For example, how would you convince good doctors to work with Government Health Care System? The only way I can see is to allow private payments by patients to them. Today accepting such a payment is felony in USA.

michaelsch says

I think American people are really brainwashed about things like Government Health Care System. I would say that on the one hand it is not the solution, on the other hand purely private Health Care does not work either. IMO, the solution would be some kind of combination of the two. Government Health Care System actually works nice for basic, routine care, like immunizations and anything that can be provided in a cookie-cutter approach. It does not work and never will for non-standard cases. So, Government Health Care System would be ideal most of the time, as long as everyone would understand he needs to save plus keep a good credit rating plus have very devote, caring relatives for the case of a severe medical emergency.

My Dad is pleased with his "Government Health Care System" (Tricare + Medicare). He figures he's received closing on a million dollars in medical treatment for angina, heart attack, multiple stents, an extremely rare liver cancer, lung problems, and various other indignities that come with getting to be 89 years old. Getting treatment at the Mayo Clinic which seems to have plenty of good doctors who "work with Government Health Care System".

michaelsch says

take a look at my explanation above.

Total health care costs are 20%+ of GDP. Regulations are not a major component of this.

I just read today that 60,000 general anesthesia procedures are done every day in this country, that's 20 million a year. Stupendous.