Originally Posted by Replaced_Texan (Post 505816)

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.

Originally Posted by sebastian_dangerfield (Post 505819)

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.

Originally Posted by Greedy,Greedy,Greedy (Post 505820)

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

Originally Posted by Greedy,Greedy,Greedy (Post 505820)

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

Originally Posted by Hank Chinaski (Post 505831)

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.

Originally Posted by Hank Chinaski (Post 505831)

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.

Originally Posted by Hank Chinaski (Post 505831)

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.

Originally Posted by Greedy,Greedy,Greedy (Post 505834)

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.

Originally Posted by Replaced_Texan (Post 505835)

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.

Originally Posted by sebastian_dangerfield (Post 505833)

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.

Originally Posted by sebastian_dangerfield (Post 505836)

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!

Originally Posted by Greedy,Greedy,Greedy (Post 505837)

My god this is stupid silly word salad. https://s-media-cache-ak0.pinimg.com...383f1f28ac.jpg

We have cheap preventive care now. Every payor consciously keeps it below what a market price would be. So the first statement is just patently wrong and unthought out, and it just keeps going further off the skids from there.

And preventive care is going to be a few cents out of every healthcare dollar you spend. Do we need to type slower for you? Cutting the cost of preventive care in HC is like cutting the cost of the paper your big mac is wrapped in.

I understand your motive behind the word salad is to scream "free markets solve everything". But if you aren't going to even attempt to do a cogent analysis based on actual facts, why should anyone pay attention? Free markets clearly haven't solved your analytical problems.

Originally Posted by sebastian_dangerfield (Post 505836)

Envision a situation in which costs for preventative care, premiums, and catastrophic and chronic condition care are all decreased by greater than 50%.

Originally Posted by sebastian_dangerfield (Post 505763)

I neither wanted, nor didn't want, either of these people to be President. But he is a lunatic

Originally Posted by Pretty Little Flower (Post 505839)

Done

Originally Posted by sebastian_dangerfield (Post 505768)

I figured Trump risk was low, as he was a closet centrist.

Originally Posted by Greedy,Greedy,Greedy (Post 505840)

I'm now envisioning Canada. It's very cold and snowy. Someone has put the Tragically Hip on. When I go in the bar they have 80 kinds of beer but no Bud or Miller. They have the hockey game on with the sound turned down, there's a fire in the fireplace, and Justin Trudeau is pulled up in an easy chair with his shirt off, surrounded by a multi-cultural cabinet.

This is great. Thanks.

Originally Posted by Not Bob (Post 505844)

Ok, Not Bad. It's the Leafs playing the Habs, and I'm the only Not Francophone pulling for Montreal.

I'm Not Judgy. You do you, man. Know that You're Not Alone:

Originally Posted by sebastian_dangerfield (Post 505836)

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!

Originally Posted by Tyrone Slothrop (Post 505846)

I can't figure out why you think that having consumers negotiate what preventative care they want and how much they'll pay for it is going to lead to better outcomes and lower prices than having coverage providers do it. Most people I know -- you may be the exception here -- really would prefer not to have to negotiate these things, both because of information asymmetries and because it's a pain in the ass.

Originally Posted by SEC_Chick (Post 505848)

That was quite the Trump press conference. I truly cannot stand to hear that man talk.

Maybe it's just thing on Twitter, but I have seen several calls from the Resistance to go all Tea Party and start running progressives in primaries against Dems who vote for Trump nominees. I know I do not have a vested interest in the success of such an endeavor, but it doesn't seem to me that primary challenging red state Democrats is a winning strategy. I do not believe that the proponents of such a plan grasp the fact that an Elizabeth Warren candidate probably won't run well in West Virginia, or other states that went for Trump. With a few exceptions, most Tea Party challenges were in pretty safely red states.

Originally Posted by sebastian_dangerfield (Post 505836)

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!

Originally Posted by Replaced_Texan (Post 505850)

I'm sorry that I don't think about the health care system, preventative care, or providers as much as you do.

Originally Posted by Replaced_Texan (Post 505850)

I'm sorry that I don't think about the health care system, preventative care, or providers as much as you do.

Originally Posted by Replaced_Texan (Post 505850)

I'm sorry that I don't think about the health care system, preventative care, or providers as much as you do.

Originally Posted by Replaced_Texan (Post 505850)

I'm sorry that I don't think about the health care system, preventative care, or providers as much as you do.

Originally Posted by Icky Thump (Post 505865)

a little but is basically like looking out the window to see the weather.

Real diagnostic stuff is expensive. Everything else is an educated guess.

Originally Posted by Icky Thump (Post 505865)

a little but is basically like looking out the window to see the weather.

Real diagnostic stuff is expensive. Everything else is an educated guess.

Originally Posted by Hank Chinaski (Post 505866)

isn't a yearly physical "preventative care?" Then, your liver issues are high- maybe cut back on the drinking? Or something similar for smoking? Then diagnostic stuff isn't needed?

Originally Posted by Replaced_Texan (Post 505850)

I'm sorry that I don't think about the health care system, preventative care, or providers as much as you do.

Originally Posted by sebastian_dangerfield (Post 505869)

You need an outside the system fix. HC is a sclerotic mindset. Needs volcanic positive disruption.

...Like 70% of this country.

Originally Posted by Pretty Little Flower (Post 505871)

Did you really just write the words "volcanic positive disruption"? Slap yourself in the face, you're an embarrassment to yourself and country. And apologize to RT while you are at it.

Originally Posted by Pretty Little Flower (Post 505871)

Did you really just write the words "volcanic positive disruption"? Slap yourself in the face, you're an embarrassment to yourself and country. And apologize to RT while you are at it.

Originally Posted by Greedy,Greedy,Greedy (Post 505872)

He is the Susan Sarandon of the Right.

Let RT finish laughing first.

Originally Posted by SEC_Chick (Post 505848)

I do not believe that the proponents of such a plan grasp the fact that an Elizabeth Warren candidate probably won't run well in West Virginia, or other states that went for Trump. With a few exceptions, most Tea Party challenges were in pretty safely red states.