All health plans are now required to cover preventive health services at no cost to the patient.

https://www.healthcare.gov/coverage/preventive-care-benefits...

Few things: only one doctor visit is allowed and for some insurance companies asking about health problems voids that.

Preventative is very narrowly defined to exclude anything considered a sickness in anyway.

Getting something done that will ensure you don't get more sick might be considered preventative naively but is considered fixing a problem and so not covered.

So basically this covers vaccines (make sure if you get multiple you don't see a doctor past the first or you are paying) tests unrelated to medical problems and a single non diagnostic visit to the doctor per year.

IME the point of health insurance is simply to collect premiums and not to pay out.

It is very much not to support health in any way whatsoever. In fact the industry loves ill-health, because it's far more profitable than wellness.

Public not-for-profit health systems change that motivation into something that actually makes sense from a healthcare pov instead of just being an exercise in piratical opportunism.

Profiting from suffering without the slightest hint of altruism or empathy is simply sociopathic.

>IME the point of health insurance is simply to collect premiums and not to pay out.

ACA's medical loss ratio provisions basically makes this impossible: https://www.cms.gov/marketplace/private-health-insurance/med...

That's not to say they're not incentivized to deny claims. If you are loose with what you pay out, you could lose money by paying out more than you take in.

They don't though, because I can buy an insurer and also a medical provider, and pay the medical provider the 80% and then collect my profits through my pet medical provider.

This is an extremely valid and overlooked point.

I feel frustrated when it seems that so much money somehow is going to preventive care… But when they quantify it, it’s just looks like screening. They ask if I feel safe at home they ask if I want to attend a group weight loss class, when I’m 95 pounds. They, the gatekeeping front desk clerks or nurses, just screen screen screen and check off items on a checklist earning them loads of credit. All that screening results in an approved amount of preventative treatment.

At least you’re not in need of care, are overweight, and have state medical records. I need something looked at, and the first Dr I went to noticed my weight obviously and told me my issue is weight related and I need to lose weight before getting any further care. They then entered this info into my medical record that synchronizes with every other provider in the state. Now anybody I go to says the same and I still have pain.

How I love socialized medicine!

So the solution is to create even a bigger monopoly?

US spends 50% more per capita on healthcare than the next highest developed country, Switzerland. And double the average comparable country.

It's hard to see how regulated, single payor healthcare could be bigger or more expensive if the middle man is cut out.

https://www.healthsystemtracker.org/chart-collection/health-...

Simply replacing private payers with a single payer system ("Medicare for all" or whatever) wouldn't do much to cut US healthcare spending. Payer profit margins are relatively low and in total only constitute a small fraction of total healthcare spending. Any real savings would have to come from severe price controls on providers, drugs, and medical devices. Plus some forms of rationing. I'm not necessarily opposed to that, but it would be difficult to build a political consensus for it.

Half of our excess spending is just administrative costs dealing with insurance...

Administrative expenses on the payer side are 7.5% of total US healthcare spending. Even under a single payer system, that number would decrease only slightly.

https://www.healthsystemtracker.org/chart-collection/u-s-spe...

Bullshit single payer would vastly decrease that number. Only having one payor who has from your perspective fixed rates is going to vastly simplify that process compared to the cluster of today.

Health insurance profit would also disappear as much would their administration costs.

You would still need to determine price structures and deal with fraud but you wouldn't need to network anymore.

False.

Look up the McKinsey study. The biggest driver is that Americans get way more healthcare.

Summing up that topic that way is disingenuous at best.

The rate of self selection of healthcare is not that different in the US. While our old are more likely to seek care our young are way way less likely to.

A ton of that is unnecessary work to avoid getting sued, unnecessary work because of how our billing works (who would have thought that billing based on services rendered would result in escalating costs?), not to mention the complexity of the system helps make finding fraud more difficult.

I would love to debate the conclusions with the McKinsey team. I think their analysis was highly flawed. Do Americans consume more healthcare? Yes. Is that the primary reason for our escalating cost share? No. Market concentration at multiple layers (Payer, Provider, Tech/Data layers, etc.) is a huge issue in U.S. healthcare. In most markets we basically have 1-3 companies that have market control of the providers and inpatient facilities, and 1-2 companies that have majority market share on the carrier side. Add in the mess that is distribution (broker-controlled, and concentrated as a well), and you have a witches' brew of mis-aligned incentives, excessive costs, inefficient bureaucracies, and plain-old anti trust behaviors.

You would debate them? Did you even bother to read the paper? It's easily googlable.

> Payer profit margins are relatively low and in total only constitute a small fraction of total healthcare spending.

What? The government was forced to make insurers cap their profits at 20%.

Except now that means if they want to make more money, they just raise premiums and negotiated provider payments. Even easier when you're as vertically integrated as UHC.

You appear to have confused payer profit margins with the 80 – 85% minimum medical loss ratio imposed by the Affordable Care Act (Obamacare). Medical insurance is a low margin business and industry profits have never been anywhere near 20%.

https://www.cms.gov/marketplace/private-health-insurance/med...

For the past quarter, the UnitedHealthcare business unit of UnitedHealth Group had a profit margin of 6.6%.

https://www.sec.gov/ixviewer/ix.html?doc=/Archives/edgar/dat...

The business is still highly competitive, and payers have limited ability to raise premiums due to push back from employers.

You're confusing the insurance industry with the health industry. When you have the same companies owning hospital chains and insurance, they can easily pretend to be a low profit industry.

The industry as a whole is insanely profitable. Revenue is $1.4 trillion. It posts profits of around $650bn. Which means on average it extracts around $2000 of profit from every single person in the US, with an average individual healthcare spend of more than $4000.

The profit is in the ballpark of the entire US defence budget, at around $750bn.

Healthcare is a huge boat anchor drag on the entire economy.

>The industry as a whole is insanely profitable. Revenue is $1.4 trillion. It posts profits of around $650bn. Which means on average it extracts around $2000 of profit from every single person in the US, with an average individual healthcare spend of more than $4000.

Source for these numbers? 0.65 billion in profits on 1.4 billion in revenue is an insane margin

Even if you exclude the private insurance market (!) and look only at public health costs, the US picture is dismal.

- 944 billion on Medicare (federal) - 805 billion on Medicaid (federal + state) - 118 billion on VA health costs - 21 billion on CHIP

That's 1.5 trillion alone, and that doesn't count ACA subsidies, or other state and local government-owned or subsidized medical facilities. That's $5800/year per capita - ALL persons in the US, whether they have private or public or no insurance. US government per capita health care spending is already higher than many European countries and a little more than two-thirds the Swiss number you mention. While US private health insurance companies don't help the situation, neither are they a main cause of US health care costs.

Is that what happened in countries with universal healthcare?

One without a profit motive, directly accountable via elections..?

That sounds great, compared to the status quo.

There are trade offs. The question is - are people willing to make them?

Just compare access in the US to countries with regulated universal care.

Have cystic fibrosis? Good news! There are drugs that reverse the genetic defect! In the US even Medicaid patients got access back in 2014.

In Canada? Unless you live in one of 5 provinces that fund it, you don’t get it. Oh, and if you’re an adult? Nope, not a funding priority.

In the UK, they didn’t get access until 2020. Six years after the US.

Then you can look at some of the newest advances in cancer. You might need to wait 2-3 years after the US gets it.

Then look at physician salaries. Access to primary care doctors. Waiting lists for joint replacement.

It’s good to see someone else loving that socialized medicine!

/s

What is the view on healthcare spending for IVF for 45-year-old woman? Asking because you replied right after a post about IVF and failed IVF treatments. Don’t mean to pray. I’m just very very curious

Why should I pay for somebody’s Viagra? Or IVF treatment? Because I am healthy? Diabetes is reversible with the healthy diet, no? Why not focus on reducing the costs.

Hard pass. Critical care I may be able to be convinced of, but not IVF, sex changes, hormone treatments outside of menopause or other similar issues, or anything else deemed optional.

Now imagine a world where everybody had a million dollars in the bank, a 25 room mansion, and 30 cars.

Imagining things is fun, then reality and costs come crashing in. Go look at the state of VA healthcare for an example.

VA healthcare sucks because people are more comfortable paying lip service to veterans than in actually helping veterans have better lives after their service is over. We're perfectly happy to say "Thank you for your service" but nobody is willing to fund things like a functioning medical system or a working payroll system for the military. You know, things that actually improve the quality of their lives.

This is absolutely a problem we can fix.