I used to be disgusted, and now I try to be amused.

[Greedy,Greedy,Greedy]

Originally Posted by Replaced_Texan

Thank you. Apparently there's video of him jumping on Saturday night, but after two desperate days of searching, his wife wasn't able to find out until last evening. I feel so sad for her, and I also feel helpless since there's not much I can do from so far away other than to yell from the rooftops that there is help out there.

So sorry. This is very sad. Strength to all.

[Greedy,Greedy,Greedy]

Interesting timing.

[Tyrone Slothrop]

Originally Posted by Greedy,Greedy,Greedy

Interesting timing.

As Roseanne Rosannadanna used to say, if it ain't one thing, it's another.

[Replaced_Texan]

Originally Posted by Tyrone Slothrop

As Roseanne Rosannadanna used to say, if it ain't one thing, it's another.

That is one pissed off intelligence community.

a) Find out who the intelligence community is spying on.
b) Don't talk to the people that the intelligence community are spying on.
c) If you do talk to the people that the intelligence community are spying on DON'T PISS OFF THE INTELLIGENCE COMMUNITY.

[Icky Thump]

Originally Posted by Replaced_Texan

Thank you. Apparently there's video of him jumping on Saturday night, but after two desperate days of searching, his wife wasn't able to find out until last evening. I feel so sad for her, and I also feel helpless since there's not much I can do from so far away other than to yell from the rooftops that there is help out there.

I am so sorry. There are no words.

[Greedy,Greedy,Greedy]

Originally Posted by Replaced_Texan

That is one pissed off intelligence community.

a) Find out who the intelligence community is spying on.
b) Don't talk to the people that the intelligence community are spying on.
c) If you do talk to the people that the intelligence community are spying on DON'T PISS OFF THE INTELLIGENCE COMMUNITY.

Still wondering what Hillary did to piss them off. They were harder on her than they have been on Trump so far.

[sebastian_dangerfield]

You're not making any sense to me here.

(1) Where's the market failure? Consumers prefer to buy coverage in the current fashion, for a variety of reasons.

This assumption has nothing behind it. They've never been offered any choice. Since the 40s, when health care was, for some bizarre reason, tied to employment, the market has included a form of "insurance" acting as a TPA.

Given the choice of concierge practices, it appears a large number of people prefer to have a more direct, insurer-free relationship when it can be offered at a reasonable rate.

One is they face information asymmetries in trying to negotiate prices for these things, and know they don't do it well.

They do it just fine when TPAs are out of the picture. Concierge practices are as low as $2500 a year for something like a 6-12 preventative visits.

Another is that they would rather buy care in a bundle.

No. TPAs have created a marketplace where that is how most providers sell it.

A third, related to the first, is that they don't know how much preventative care they need and will underconsume, to the detriment of their health.

I already addressed that. In a true insurance structure, as opposed to a TPA system, preventative care unit prices will drop dramatically because:

1. They won't be warped by the artificially enhanced prices providers use to increase their realization from insurers (a "real" direct consumer price will emerge);
2. The market will naturally price to be competitive, rather than price to maximize returns under agreements with insurers demanding bulk discounts; and,
3. Given that true, real insurance would cost less than the TPA system (which has to anticipate and cover preventative and elective care), the consumer would have more dollars in his or her pocket with which to purchase preventative care (which would also now be cheaper).

(2) Insurance discounts are the real price -- almost no one is paying the nominal price.

Nope. It's a bulk rate.

But the fact that some people are shows that you're wrong about the potential for cost savings -- the prices to people who are actually negotiating for themselves instead of using their coverage are much higher, not lower.

Incorrect. Build in the cost of the TPA over time and a prudent user of health services spends tons more (or loses income he'd otherwise have had but for an employer having to pay for his health care insurance) than he would have in a real, true insurance environment.

[Greedy,Greedy,Greedy]

Originally Posted by sebastian_dangerfield

This assumption has nothing behind it. They've never been offered any choice. Since the 40s, when health care was, for some bizarre reason, tied to employment, the market has included a form of "insurance" acting as a TPA.

Given the choice of concierge practices, it appears a large number of people prefer to have a more direct, insurer-free relationship when it can be offered at a reasonable rate.



They do it just fine when TPAs are out of the picture. Concierge practices are as low as $2500 a year for something like a 6-12 preventative visits.



No. TPAs have created a marketplace where that is how most providers sell it.



I already addressed that. In a true insurance structure, as opposed to a TPA system, preventative care unit prices will drop dramatically because:

1. They won't be warped by the artificially enhanced prices providers use to increase their realization from insurers (a "real" direct consumer price will emerge);
2. The market will naturally price to be competitive, rather than price to maximize returns under agreements with insurers demanding bulk discounts; and,
3. Given that true, real insurance would cost less than the TPA system (which has to anticipate and cover preventative and elective care), the consumer would have more dollars in his or her pocket with which to purchase preventative care (which would also now be cheaper).



Nope. It's a bulk rate.



Incorrect. Build in the cost of the TPA over time and a prudent user of health services spends tons more (or loses income he'd otherwise have had but for an employer having to pay for his health care insurance) than he would have in a real, true insurance environment.

It's always amusing to see posts from someone who thinks healthcare costs are driven by preventative care visits.

Jon Snow knows a lot more than you do.

[Pretty Little Flower]

Originally Posted by Greedy,Greedy,Greedy

It's always amusing to see posts from someone who thinks healthcare costs are driven by preventative care visits.

I'm amused! I mean, it's a pretty dry humor. Not really belly laugh kind of stuff, but that's o.k. Anyhoo, digging deep on the Daily Dose today with a rare cut from Shawn Lee's Ping Pong Orchestra. This one goes out to Hank. It's "Sex Beast":

https://www.youtube.com/watch?v=Vty7ed3SBiw

[Hank Chinaski]

Originally Posted by Greedy,Greedy,Greedy

It's always amusing to see posts from someone who thinks healthcare costs are driven by preventative care visits.

Preventative care not being covered leads to em not using it, leads to someone else paying em's big costs. It is hard enough getting em to covered preventative care.

[Tyrone Slothrop]

Originally Posted by Hank Chinaski

Preventative care not being covered leads to em not using it, leads to someone else paying em's big costs. It is hard enough getting em to covered preventative care.

yes

[sebastian_dangerfield]

Originally Posted by Hank Chinaski

Preventative care not being covered leads to em not using it, leads to someone else paying em's big costs. It is hard enough getting em to covered preventative care.

No one's ever had cheap preventative care to credibly test that theory. And a theory is all that is.

A true market price has never existed for preventative care since the 40s, when a TPA system was introduced and warped the market.

If what I'm proposing were introduced, all costs, including preventative care, would fall radically. And insurers acting as TPAs would infect the marketplace 1/10th as much as they do now.

You don't trust average Joe to take care of himself if he saved 50-60% on premiums and a similar percentage on preventative care?

The argument you offer is one used by half shrewd minds to disguise "we need insurers and govt. to manage people's health care" as economically wise policy.* (And really, is a guy who doesn't use TPA administered preventative care somehow going to use it less when it's cheaper and easier to buy directly? How's that even possible?) If we make health care truly cheap and people choose to spend elsewhere, that's their foolish choice. At least the cost of the catastrophic care they'll inevitably require will also be cheap, so the burden to those of us carrying them will still be less than it is now.
_____
* I don't think you're using it that way. I think you believe it economically refutes my proposal. For a lot of others, however, it's dressing up nanny state aims as math-supported policy.

[Greedy,Greedy,Greedy]

Originally Posted by Hank Chinaski

Preventative care not being covered leads to em not using it, leads to someone else paying em's big costs. It is hard enough getting em to covered preventative care.

Exactly. Cheap care that catches things early and probably saves more money than it costs.

A driver of health care costs might be not using preventative care, but it is not how much preventative care costs. That's a relatively modest number.

[Replaced_Texan]

Originally Posted by Greedy,Greedy,Greedy

Exactly. Cheap care that catches things early and probably saves more money than it costs.

A driver of health care costs might be not using preventative care, but it is not how much preventative care costs. That's a relatively modest number.

Absolutely. And the HMO model in the 1990s and the ACO model from the ACA in the 2010s were entirely built around the idea of preventative care.

[sebastian_dangerfield]

Originally Posted by Replaced_Texan

Absolutely. And the HMO model in the 1990s and the ACO model from the ACA in the 2010s were entirely built around the idea of preventative care.

I think you're all "in the box" on this one.* Envision a situation in which costs for preventative care, premiums, and catastrophic and chronic condition care are all decreased by greater than 50%. How in the hell could any TPA system beat that?

It's doable, and it would involve removing all TPA structures (except for catastrophic and chronic condition care). Think of the savings if insurers only provided actual insurance, and a market for affordable preventative care existed.

You're seeing it already, and you're going to see it a lot more as people move into concierge arrangements. It works, it provides value, and it creates a better direct doc to patient relationship.

* Hi Flower!