Josh-Daniel S. Davis (joshdavis) wrote,
Josh-Daniel S. Davis

Cost of healthcare

If you skip 3/4 of this because you pick up on one technicality, then I don't really care what you have to say. However, if you have a REAL issue with something after a thorough review, and can't resolve it with Google, then let's talk about it. Also, typos and similar error corrections accepted.

There are many factors to healthcare costs, and ALL of them have to be addressed. If you can't name at least three of them, or if you simply think they are "Obama, the ACA, and Democrats," then you're not really qualified to complain.

Here's what you need to know to complain more logically. I'll use anecdotes, and lists. It's messy, because that's my brain. Then, research more about anything you think is stupid. Then, complain about what sucks, especially to all of your elected representatives. If they give you a crap answer, pick someone else next election.

Then, see if you can work out a way to improve any of these situations. Look into your ideas and see if they have been tried. Look for the faults in your plans and how to work around them. Assume everything will fail, and everyone will think your idea is stupid. How do you work around that?

In the 1980s, you could buy health insurance. REAL insurance. You can't get that now. Now, you can get managed plans. It didn't change suddenly when Obama was elected. Healthcare costs have been rising for decades. Sometimes companies would just absorb the cost, especially early on when it was a small percentage of an employee's salary. That's not the case anymore.

In 2005, my insurance costs were $5000 per year for a family of 4, standard deductibles, copays, etc. In 2007, it was $7000. In 2010, it would have been $12k. Instead, our company moved to an HDHP and it was $5k, with a $5k deductible and max out of pocket (or $2300 for one person). The next year it was $7k. To keep the same rates for 2012, we had a $6k deductible, same for in-network max out of pocket, double for out of network, and quadruple for out of network max out of pocket. For 2013, that coverage was over $9k.

Instead of this coming out of my paycheck, I just don't get raises. I've gotten one raise over the last 8 years. Instead, my company tries to keep me insured, which has been tough.

There's no magic to insurance costs. Claim Payments + overhead divided by number of insured. There are three variables: Cost, overhead, and payers.
* Insurance overhead was limited a few years ago to 15% for large plans and 20% for small plans.
* The ACA is tackling the number of payers by trying to have everyone an insured. Tinkering with coverage limits affects this: If you're not covered for something, you also don't pay a share into the claims for that.

All that's left is the cost and overhead with care providers (doctors, facilities, supplies, etc).

* Claims processing. Doctors have to hire staff, and each company does its own thing. Treatment codes have to be adjusted because maybe the same condition and treatment is represented 27 different ways.
* Technology gaps. Paper charts, physical images, etc all require handling and physical storage. Sometimes the information needed for treatment is not available because the original DR is not available, leading to lots of trial and error.
* Errors. Errors cost money, whether it's through more procedures, cash settlements, or liability insurance.
* Write-Offs. Fee reductions or non-paying patients. Sometimes there's just no-one to pay.
* Unnecessary procedures. Either a technique might be too expensive, or elective expenses get billed.
* Real Estate. Land, buildings, property taxes, etc.
* Equipment costs. Whether it's excessive or not, equipment costs a lot of money because it's not consumer grade and consumer quantity. If only 10,000 iPhones were sold per year, they would cost a $million each due to development costs.
* Education costs - Maybe not every treatment needs to be from a 12 year education.
* Time costs - Maybe not every treatment needs to be from a veteran MD. Also, there are limited numbers of Doctors (costs and stress). Even so, an RN, an LPN, a PA, DO, MD, DC, or whatever has limited time. More doctors would help.
* High stress - High workload, cost, and risk. Stress has a monetary cost, in reducing the number of doctors, and increasing the cost of unwinding. Convenient houses might be expensive. Exclusivity gets a little more peace and quiet. etc.
* Credit - Most of this is paid by credit, and will pay out interest, whether it's from a Bond or a bank loan.

I think there's probably more, but that's the big stuff. If you want to reduce the cost of healthcare, you have to reduce the actual costs. This is why many doctors charge for missed appointments but will then be late. They have to keep the schedule stacked to see everyone and cover costs.

In summary, the next step isn't to "kick out Obama" or "Repeal the ACA". The next step is to reduce the cost of becoming and/or staying a doctor.
Tags: aca, costs, healthcare, money, obama
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