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what if there was no such thing as insurance?

 
Trailboss
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A friend of mine had her feet go seriously bad and had to have reconstructive surgery. It looks like the bill for one foot is gonna be about $50,000. The insurance company is gonna pay about $40,000, so my friend has to pay $10,000 on top of all the premiums she has paid all of her life.
Somebody put this idea in my head about a year ago: What if there were no insurance comapanies? And as for medical stuff, what if there could be no lawsuits?
If there was no insurance and there was no chance that the doctors and hospitals would get sued, then is it possible that the amount my friend would have to pay for this surgery would be less than $10,000? Maybe as little as $5000? Not to mention that she would never pay premiums again.
Oh sure, it would put a lot of lawyers and insurance people out of work, but I'm having a hard time getting weepy about that.
So we get rid of health insurance. We save those premiums and eliminate at least half the staff at any hospital or doctor's office (cuz those people are experts at processing the insurance company paper work).
Next we get rid of malpractice insurance and all of the "the doctor made a mistake" lawsuits. This allows the doctor to charge less, and cuts out all lawyers. Any actual problems with a doctor being less than perfect can be recorded in an ebay like system where patients that have paid can report on their opinion of the doctor.
The hospital is imune to lawsuits. More cuts in insurance and lawyers.
Currently, it seems that the average person pays $100,000 over their life into health insurance premiums. And then they pay something like $100,000 again for "what insurance didn't cover". Take out the attorneys and insurance companies, it's possible that a person would pay only $50,000 for health needs over their life.
Sure, there would be problems with such a system, but would they be worse than the problems with the current system? It would definitely be cheaper and simpler.
 
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There are some of the best hospitals around the world. For 10,000$ your friend get every part of her body get fixed up in India. why dont she try exploring the options in India. They have some of the best equipped hopsitals and excellent doctors (let me remind you there is a huge number of indian doctors working in US who got very good education in india). Also ask her to check if her insurance company pays if the surgery is NOT done in US of A but other parts of the world). Round trip to india should cost her less than 1200$ (nice deal from an travel agency). cheers and good luck.
 
mister krabs
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So if the doctor maims you for life because of incompetence you get to report him to eBay? Wow! I'll bet that will really make you feel better. :roll:
As to the office staff, most doctors don't have any staff dedicated to insurance companies. They generally outsource that. Of course they still have to have a billing department under your plan so they really don't save anything anyway. Meanwhile hospitals will cut a lot of corners in order to save money and then get their friends to say how wonderful they are on eBay. And best of all, since the doctors won't be getting the money from insurance companies and most people could never afford a long hospital stay even under your plan, we can simply let sick people die and save a fortune by doing away with the medical profession altogether!
 
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Very good observation there Paul. Whole medical system here is centered around insurance. Hospitals prescribe expensive diagnostic tests for smallest of problems, doctors don't use their brains to understand problems and prefer to wait till all tests are done they do not want to use thie intution and take decisions only based on results of tests.They get so used to analysing results of diagnostics that they cannot think of anything on their own based on their years of experience. And in many cases it so happens that the real problem is somewhere else which the diagnostics may not reveal. When they can't find out what is happening the prescription ususally is an indiscriminate dosage and mixture of antibiotics, the so called multi drug therapy.

We had our two babies born at home and at a birth center respectively and both times not covered by insurance as ins.companies don't pay for births taking place at places other than hospitals.Average cost of a birth at hospital is around $13000 where as we spent less than $500. What you are talking about is not totally impossible. There are many people here in US who don't subscribe to any insurance company and save about similar amount of money in some recurring account. They take insurance to cover mishaps ( auto accidents, fire et.al.) As you said what you may pay as premium and copay may well be more than what you get as service. Well, how else can the insurance companies thrive?

I have experienced the finest medical supervision before coming to US, in India. Concept of medical insurance is very different in India.
Only employees of government and some big companies have coverage. Self employeed and business people do not have medical insurance.
Those who have do not use it for regular visits. It is generally for big events like a major surgery etc. For regular routine problems people pay from their pockets.As such there is no restrcition of care providers. Generally people choose someone to be their "Family Doctor". He knows everyone in the family, their medical history, problems and stuff.
There is a bond between the doctor and the family. Everyone pays and so doctors don't need to listen to the incurance companies and patients are not tied to their "Primary Care Physician" which results in quality in care. I agree that there are some care providers who are commercial in outlook but it is not too difficult to find those who are really service oriented.
The really poor go to government hospitals where treatment is completely free and the quality is not too good as there are too many patients and too few providers but in rare cases get to find doctors who are extremely talented and who get motivation not by money but service to people. They are treated like Gods and have the best talent and experience as they see like thousands of people regularly. They see all kinds of problems possible....
Insurance in US is a failed concept. Everyone fails - doctors / patients/ employers. It only helps in generating more paper and creating unnecessry jobs.
I hope this doesn't hurt any feelings....

Thanks,
Vasu
[ September 19, 2003: Message edited by: vasu maj ]
 
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VM: Insurance in US is a failed concept. Everyone fails - doctors / patients/ employers. It only helps in generating more paper and creating unnecessry jobs.
I hope this doesn't hurt any feelings....

Vasu, I'm one of the more vocal pro-Americans on the list (Herb would call me "frothy", because I froth at the mouth ), and my feelings aren't hurt. The health industry here in the US is indeed a disgrace. Privatization failed miserably, except for the folks who got rich off it.
No, you don't hurt my feelings. You also won't hurt them if you pick on our deplorable public education record. [sigh] No, as much as I love my country, I know there are places where we need help, and we need it bad, and we need it fast.
Joe
 
Anonymous
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Thats why I dont have no health insurance and yes I go to public hospital shamelessly for all the minor stuff cause I am already paying a ton of insurance money (liability only cause it is required by the law ) on my car which I am never going to get back . I once drove my car for almost an year without Insurance and registration luckily never got caught (cmon I was laid off at that time). As soon as I found Job i got insurance but not registration next day I was returning from a party cop caught me hehe i only paid for no registration (40$). I am sure plenty of americans do that but hey I figured out plenty of ways to survive without insurance where there is will, by god there is always a way.
See when gay people can finally figure out a solution for their problem, so can you folks.
CANADA
 
author and jackaroo
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For non critical surgery, as <Anonymous> mentioned, there are great hospitals in other parts of the world, where you can get first rate treatment much cheaper than in America or England.
When I was living in London, I finally decided (after years of waffling) to have laser surgery on my eyes. It was cheaper for me to fly back to Australia for a 1 month holiday and get my eyes operated on there, than it would have been to have my eyes done in London.
It is commonly acknowledged in England that it is cheaper, and the waiting lists are shorter, if people travel to Belgium for surgery.
Do Americans still travel to Mexico for surgery?
I think the problem is not with the concept of insurance per se, but with the outrageously high compensation payouts that seem to happen so often, and the frivolous claims that people can make, especially with the lawyers who are willing to take on cases for no up front fee - they just take a percentage of the payout. In those cases, why wouldn't you sue? It will cost you nothing but time, and you could rake in millions!
 
Thomas Paul
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Originally posted by Andrew Monkhouse:
Do Americans still travel to Mexico for surgery?

Huh? Amercians never went to Mexico for surgery. Where did you get this idea? Some Americans used to got to mexico to be treated for cancer with laetrile. You couldn't get it in the USA because it is a fraud.
American medical care is second to none in the world. Why anyone would want to screw up our system is beyond me. God forbid that we ever get the Canadian system here.
 
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Maybe they should treat medical negligence as a criminal matter rather than a civil matter. The doctor should get punished by jail time and struck off (maiming, endangering life). Its incredibly hard to get struck off the medical register apparently - in the UK anyway - because it is self-governing profession.
How would patients be compensated? I don't know. They could pay a negligence fee before any surgery or waive their right to it to save money. This way the doctors still have to be careful and outrageous monetary claims might be avoided.
 
paul wheaton
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I think that this idea that a friend put in my head has some flaws, but it is possible that there are some acceptable solutions to those flaws.
The idea that my friend is getting her feet rebuilt for $100,000 and if there were no insurance and no lawyers it might be $10,000 is a big red flag for me.
And if you think that insurance companies think that they are doing poor business if they pay out more than 40% of what they take in, that means that for my friends surgery, people have paid in $200,000 so that the insturance comany will pay out $80,000. Add to that my friend paying in $20,000, that means that consumers are paying $220,000 for something that would otherwise cost $10,000.
I'm not sure if the solution outlined here is good or bad. But I am sure that paying $220,000 for a $10,000 service ain't right. Especially if you pay $200,000 for premiums, and then have to co-pay more for the service than the service would have cost if there were no insurance companies.
 
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Originally posted by Thomas Paul:
So if the doctor maims you for life because of incompetence you get to report him to eBay? Wow! I'll bet that will really make you feel better. :roll:


Medical errors (at least those caused by negligence rather than just plain bad luck) should be a criminal offense and punished as such.
That would make doctors more careful, if messing up a patient can get them in jail rather than cause their insurance to pay for a lawsuit.
 
author and iconoclast
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I really like this idea of criminal rather than civil liability. I don't think anyone doubts the veracity of the now very-often-quoted facts about the cost of malpractice insurance -- the typical U.S. physician pays on the order of $100,000 per annum. By doing away with this cost, doctors could make more money and patients could pay less.
Of course, that would put some lawyers out of work. Not sure where to send them. I have some ideas but won't repeat them here.
 
Jeroen Wenting
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Originally posted by Ernest Friedman-Hill:
Of course, that would put some lawyers out of work. Not sure where to send them. I have some ideas but won't repeat them here.


I think all those doctors in prisons would need a lot of people protecting them from the family of victims of their murdered colleagues
 
paul wheaton
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Maybe we can have both systems. Insured and uninsured. For those that want to keep their sue-the-hostpital-or-doctor option open, they can pay 20 times more than people that are going to rely on some kind of alternative program.
 
Thomas Paul
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Originally posted by Ernest Friedman-Hill:
I really like this idea of criminal rather than civil liability.

It's a great idea and I think we should move it to the IT world as well. So if I use Jess and because of a bug it screws up my database, Ernest can get 5 to 10 in Sing-Sing instead of my suing him for damages!
I think if you start putting doctors in jail for malpractice then you won't find anyone who is willing to be a doctor.
 
Thomas Paul
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Paul's theory of insurance fails to realize that insurance doesn't work the way he thinks it does. An insurance company would go bankrupt insuring one person if that one person got sick. If 10,000 people get together then a certain percent of those people will get sick. The insurance company uses actuaries to calculate how much it will cost to heal the expected number of sick people in the group. They then spread that cost among the 10,000 people.
The idea that my friend is getting her feet rebuilt for $100,000 and if there were no insurance and no lawyers it might be $10,000 is a big red flag for me.
That's a big red flag to me because it is totally bogus. It could just as well be $99,000. A world with no insurance and no lawyers to protect you from malpractice would be a very brutal world. If your friend didn't have the $10,000 I guess she would be shit out luck in that world.
 
Sheriff
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Criminal penalties for malpractice would destroy our medical system.
Under a system like this, you would be likely to get any medical care of any kind. If you got hurt and called an ambulance, nobody would come as the guys on the ambo wouldn't want to touch you for fear of going to jail. Need your teeth cleaned? You can probably forget that too, particularly if you have a heart murmur. You or someone you love needs risky surgery in order to try to save your/their life? Forget about it. No doctor would be willing to perform the procedure.
The outrageous civil penalties have crippled our medical system as it is, but criminal liability would totally wipe it out. And then you would have to fly to some third-world country in order to get even the simplest procedure taken care of.
 
paul wheaton
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Paul's theory ....
It actually isn't my theory. It was something that a friend put into my head a while back. I was reminded of it when another friend related to me how much her recent surgery cost.
That's a big red flag to me because it is totally bogus. It could just as well be $99,000.
The whole idea is bogus because my numbers may be accurate to only +/- 1%? If would be surprised if my numbers were that accurate. But I don't see how this negates the whole concept. In fact, there is a mountain that we would not know unless we actually tried it. So the only numbers at this point would be made up numbers.
I think the idea is valid as an idea. It would require significant study and number crunching by experts with far more experience than I before something like this could even begin to be implemented.
If your friend didn't have the $10,000 I guess she would be shit out luck in that world.
The current world is more brutal. She has to pay thousands of dollars per year, every year and then pay $20,000 now. If she doesn't, then she is S.O.L.
I think you're making MY point!
 
Richard Hawkes
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You can go to jail for killing someone by negligent driving. There are no lack of drivers, professional or otherwise. The financial rewards of being a doctor outweigh those of being a professional driver, so I don't think the threat of criminal prosecution would contribute to a reduction in the number of doctors.
Doctors wouldn't go to jail just because something went wrong in an op, as people recognise that there are risks involved in all medical procedures. You'd still have to prove any negligence. Definitions of negligence and acceptable risks will need to be reassessed probably.
In the UK the British Medical Association (BMA) has a lot of power and influence. The BMA would be unlikely to go along with this type of reasoning as they would have to give up some of that power, namely the right to self-regulation.
 
Thomas Paul
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Originally posted by Richard Hawkes:
You can go to jail for killing someone by negligent driving.

No you can't, at least not in NY. Only if you under the influence. But if you are changing the radio station, blow-drying your hair, and reading the newspaper while driving and you kill someone then you are only civily liable.
 
Thomas Paul
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Originally posted by Paul Wheaton:
The current world is more brutal. She has to pay thousands of dollars per year, every year and then pay $20,000 now. If she doesn't, then she is S.O.L.

She can do what I did. Pay the doctors $50 a month.
 
Richard Hawkes
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Originally posted by Thomas Paul:
No you can't, at least not in NY. Only if you under the influence. But if you are changing the radio station, blow-drying your hair, and reading the newspaper while driving and you kill someone then you are only civily liable.
Aye, but things be different in ye olde Engerland! 10 years is the maximum sentence and there are still too many drivers. Masses of the buggars. Can't get rid of them.
 
Sheriff
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It seems to me that there are abuses on all sides, the insurance side, the patient's side and the doctor's side.

Some insurance companies want to pay less than the provider's costs for certain things. Remember that the provider's costs include the facility overhead and staff expenses, not just the provider's time.
Some patients sue for trivial things, like getting burned by hot coffee.
Some doctors overcharge or charge for things they don't do. This is called insurance fraud and is a crime.
Some doctors charge one price for people with insurance and give a "cash discount" to people without insurance.
Some doctors order tests that might not be needed just to cover all the bases and have "proof" that what they are doing is the correct thing.
Some patients go to the emergency room every time they have a sore throat, taking time from real emergency patients, rather than going to a less expensive doctor's office or Urgent Care Clinic because Medicare or Medicaid is paying for it.

On the other hand --
Some things are unaffordable to the majority of people if insurance doesn't help, like a CT scan or MRI. Some diagnostic tools really do help the doctor treat the patient better. And some diagnostic tools are expensive. Sometimes a doctor will make an educated guess about what's wrong because he knows the uninsured patient can't afford the diagnostic test. He might be right 85% of the time. (Percentages are guestimates).
Some patients sue their insurance company because it denied valid claims. The insurance company may just be trying to delay payment so they can get more interest on their invested money, or they may hope that the patient will just give up and go away without payment.
Some patients sue a doctor because he made a mistake, intentionally or unintentionally, that caused a problem later. For example, many women got silicone breast implants. Years later it was discovered that it created problems for some women, so many of them sued the doctor for the breast implant that they had requested and received.

Is it ok for medical equipment costs to rise and for wages of health care workers to rise (3%/year is the going rate for cost of living raises), but insurance payment for many clinical tests (per test), for example, has decreased?

Do patients without insurance get poorer medical care because they can't afford certain diagnostic tests? Sometimes.
Do patients with insurance get certain diagnostic tests because doctors need to try to protect themselves from malpractice suits? Sometimes.
Do patients with insurance sometimes get tests they would not get if they didn't have insurance? Sometimes.

Brazil has socialized medicine. There is no malpractice insurance because there are no malpractice suits. If someone dies due to malpractice, that's just tough. People go to hospitals if they are dying. Sometimes there are long lines to see a doctor.

Prescription medications are available over the counter there. This has advantages and disadvantages. You might just choose the wrong medication for yourself thus possibly creating problems or just wasting your money if you're lucky. On the other hand, if you choose the correct medication, you've saved the cost (both money and time) of a visit to the doctor.

Some malpractice suits are well deserved. Some are frivolous.
I don't have a simple answer, but I've rambled on long enough for now.
 
paul wheaton
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Originally posted by Thomas Paul:
She can do what I did. Pay the doctors $50 a month.


Wouldn't she be able to do a similar thing with the alternate program?
 
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Not really. My wife is currently seeing a doctor for adrenal exhaustion (commonly known as Chronic Fatigue Syndrome, but with a medical explination other than "you're lazy" )
The doctor's fees are very reasonable ($40/visit, ususally 1 1/2 hr in length), but he does not accept any sort of insurance. Compare this to my sons' pediatricians: $90 - $120 / visit, usually 1/2 hour. (We pay the $10 co-pay)
However, due to the fact that the fees are low, the doctor does not offer payment plans. All payment is due upon receipt. I would suspect that in a world without insurance (and lower costs!), doctors would have to insist upon full payment upon receipt, if not actually prior to treatment.
 
paul wheaton
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Joel,
Just out of curiosity, does your wife consume any diet pop, nutrasweet or aspartame?
 
Thomas Paul
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Originally posted by Paul Wheaton:
Wouldn't she be able to do a similar thing with the alternate program?


Well no since the majority of people wouldn't be able to pay $10,000 for a procedure. But if the doctor gets 80% of his fee from the insurance company he might be willing to be flexible on the remaining 20%.
 
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Insurance is about pooling money among the masses so that when an unlike event happens to an individual, he/she can pay for it. Take for example auto insurance. Lets assume you will live for ten years. Lets also assume that the average person gets into $100,000 worth of accident within the ten years (actuarial science). So for the priveledge of driving you most "have" $100,000. Out of your whole existence (the 10 years), you make $1,000,000 (easily covering the $100,000). Since accidents happen anytime, if on the first day that you started driving you got into $100,000 worth of accident you would not have enough money to pay (you make $274 a day, this is your first day of working/living :-(. You would not have enough money to pay the other persons car or his medical bills - basicallly you and the other person are SOL.
However, if you have the concept of insurance. On the very first day you pay a premium (as do other people who has insurance -- it's $27.4 per day easily manageable since you got paid $274 for that day)... When you get into that accident, you will be covered because of the money that is collected (pooled) together by the insurance company.
Actually, the pooled money is the money collected via premiums. Obviously, there are cost associated with the existence of the insurance company -- insurance agents, IT infrastructure, etc... hence the premiums will be a little more that what is needed to cover all the drivers (this "little more" is regulated by the government - I work in the insurance field)....

The only way to lower this premiums is to lower the cost of driving (i.e., number of accidents, the $100,000).... For the malpractice field, to lower its cost is to lower the number of malpracice suites (IMHO, taking out the bad doctors who are doing a bad job)... Remember the extra "profit" that insurance companies make is dictated by the government...
-Eleison
ps. I heard that 5% of doctors are responsible for %50 of all malpractice suites (can't find the source right now).. take those doctors out and you will see lower premiums...

Originally posted by Paul Wheaton:
A friend of mine had her feet go seriously bad and had to have reconstructive surgery. It looks like the bill for one foot is gonna be about $50,000. The insurance company is gonna pay about $40,000, so my friend has to pay $10,000 on top of all the premiums she has paid all of her life.
Somebody put this idea in my head about a year ago: What if there were no insurance comapanies? And as for medical stuff, what if there could be no lawsuits?
If there was no insurance and there was no chance that the doctors and hospitals would get sued, then is it possible that the amount my friend would have to pay for this surgery would be less than $10,000? Maybe as little as $5000? Not to mention that she would never pay premiums again.
Oh sure, it would put a lot of lawyers and insurance people out of work, but I'm having a hard time getting weepy about that.
So we get rid of health insurance. We save those premiums and eliminate at least half the staff at any hospital or doctor's office (cuz those people are experts at processing the insurance company paper work).
Next we get rid of malpractice insurance and all of the "the doctor made a mistake" lawsuits. This allows the doctor to charge less, and cuts out all lawyers. Any actual problems with a doctor being less than perfect can be recorded in an ebay like system where patients that have paid can report on their opinion of the doctor.
The hospital is imune to lawsuits. More cuts in insurance and lawyers.
Currently, it seems that the average person pays $100,000 over their life into health insurance premiums. And then they pay something like $100,000 again for "what insurance didn't cover". Take out the attorneys and insurance companies, it's possible that a person would pay only $50,000 for health needs over their life.
Sure, there would be problems with such a system, but would they be worse than the problems with the current system? It would definitely be cheaper and simpler.

 
Joel McNary
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Originally posted by Paul Wheaton:
Joel,
Just out of curiosity, does your wife consume any diet pop, nutrasweet or aspartame?


Nope. Nada.
Also, no caffeine, wheat, dairy, or most things described as not being "Blood-Type-A friendly." (Although there were tomatoes in dinner tonight )
However, research indicates that there is no single cause of CFS other than chronic, unremitting stress in a susceptible person. My wife was born 10 weeks premature, and the stress really hasn't gone down in the 27 years since.
 
paul wheaton
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Obviously, there are cost associated with the existence of the insurance company ....
And there's the rub. Apparently, an insurance company feels that it is doing poor business if it's payout is greater than 40% of what it takes in.
And there is insurance at so many levels within the medical industry, that 80% to 95% of every dollar spent on health care goes to insurance companies and lawyers.
Based on the concept of the pools... It would seem that nearly every problem mentioned so far would be solved if we:

    1) Reduced the price of everything by a factor of five.
    2) Require doctors, hospitals, etc. to accept payment plans and
    redirected 10% of the funds to managing payment plans, non payment,
    etc.
    3) Redirected 40% of the funds to cover malpractice - with none of these
    funds going to any attorney.

    So the amount of money folks would pay would be exactly what their co-pay is now. Only there would be no premiums and no having to get permission from your insurance company. And paperwork would be reduced a great deal. You might even get a little more privacy.
 
Thomas Paul
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Originally posted by Paul Wheaton:
And there's the rub. Apparently, an insurance company feels that it is doing poor business if it's payout is greater than 40% of what it takes in.
And there is insurance at so many levels within the medical industry, that 80% to 95% of every dollar spent on health care goes to insurance companies and lawyers.

Do you have any source for these figures?
 
paul wheaton
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Originally posted by Thomas Paul:
Do you have any source for these figures?


All of these statistics are fresh from my butt. Which is why I have gone to great trouble to label all of this as nothing more than an idea for consideration.
And I would like to add one more element to this whole idea: For those folks that think that insurance is great, I see no reason why people cannot have it. It would just need to be managed outside of the medical arena. So folks that have it would pay like anyone else and then would get re-imbursed by their insurance company later.
 
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Twenty-five years ago I worked in the actuarial field. I learned the following:
Life insurance companies pay out more than their premiums. It doesn't take much work to process premiums and claims, and until the people die they invest the money.
Property / casualty companies pay out about 40% of the premiums. Most of the 60% goes for expenses. You have to pay people to analyze the risk to decide what to charge, you have to investigate the claim to decide whether it is honest and to estimate the amount of the loss. In a civilized country, property / casualty loss rates change faster than death rates, so you have to pay people to study that. Then you have to pay a reinsurer to insure the insurance company against an unusually bad year for claims. You have to pay clerks to process lots and lots of teeny little claims -- not just one big claim at the end of a person's life. And then, of course, a portion of the claim payout goes to criminals whose fraud you couldn't catch.
The lesson is that economically you lose big-time _on_the_average_ when you ensure against small losses that your could have simply absorbed. That's why I carry the largest deductible on my auto policy that my insurer offers.
So why does health insurance cover nickel and dime charges?
(1) The practice started during the inflation of WWII to evade price and wage control laws. The law neglected to recognize medical benefits as income.
(2) The practice grew as inflation pushed ordinary people into high income tax brackets. Companies learned that by diverting salary into medical benefits they could reduce their employees income and social security taxes.
(3) People got used to it, and began to treat paid medical care as an entitlement.

Malpractice insurance seemed like a good idea when it originated -- a small fee that would protect a doctor's lifestyle against the remote possibility of a lawsuit. In practice, the deep pockets of the insurance company attracts lawsuits and makes juries less sympathetic to the doctor. Decades ago a jury would think, "OK, this patient suffered terribly, but isn't this just one of those things that happen from time to time? Does this doctor deserve to be financially ruined because of a rare mistake?" Now, with the insurance companies paying, juries feel as though the award to the patient is free money.
I've read that some doctors in Florida are now going without malpractice insurance. I guess if they trust their marriages they can put their property in the spouse's name and just say, "You can't get blood from a turnip!"
 
Richard Hawkes
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Originally posted by Eleison Zeitgeist:
Insurance is about pooling money among the masses so that when an unlike event happens to an individual, he/she can pay for it.
Sounds like a nasty communist conspiracy to me
 
Marilyn de Queiroz
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Originally posted by Frank Silbermann:
The lesson is that economically you lose big-time _on_the_average_ when you ensure against small losses that your could have simply absorbed. That's why I carry the largest deductible on my auto policy that my insurer offers.


Exactly what I was going to suggest next. It seems that people who have large deductibles (greater than $1000, sometimes treater than $5000) keep their medical expenses to a minimum. They only see a doctor when they have to. They don't go to the emergency room for every ache and pain. The doctor doesn't think he has to increase his charges for the benefit of the insurance company. The patient pays lower premiums. The insurance company doesn't get involved unless the patient has major medical expenses like a heart attack, bypass surgery, cancer, etc.
[ September 25, 2003: Message edited by: Marilyn de Queiroz ]
 
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Originally posted by Richard Hawkes: Maybe they should treat medical negligence as a criminal matter rather than a civil matter. The doctor should get punished by jail time and struck off (maiming, endangering life). Its incredibly hard to get struck off the medical register apparently - in the UK anyway - because it is self-governing profession.


I can't speak about the situation outside the UK (where I have no experience) but medical doctors are, and always have been subject to criminal proceedings as well as the civil law if they commit criminal acts.
One example is common assault (doing anything to a patient without their express consent, except in cases where the patient is unable to give consent, for example, due to unconsciousness when emergency life-saving treatment is required and no next-of-kin is available to give consent).
Another is manslaughter, usually as a result of criminal negligence. Such cases have been prosecuted on the grounds that a doctor failed seriously in his or her duty to the public, for example not checking the correct route of administration of anti-cancer drugs and so giving an intra-spinal injection instead of an intravenous one.
Yet another is grievous bodily harm. Such cases have been successfully prosecuted when surgeons have performed surgery so badly as to leave patients maimed for life. These are quite often tied up with medical negligence. The case of a gynaecologist in Kent a few years ago comes to mind.
Admittedly, news of criminal prosecution of medical doctors is uncommon, but it can and does happen in the UK. It is of course much more common for doctors to be sued in the civil courts for medical negligence, and it is becoming more and more common each year as we seem to be increasingly adopting the approach to life that something can't just go wrong without it being someone's fault.
Earlier on someone else mentioned the number of unnecessary and expensive investigations ordered by US doctors. I think it was Vasu Maj. This is true to an extent. Certainly, compared with doctors in the UK, US doctors order far more investigations. This is changing though, as in the UK doctors start to order more investigations too.
What are the reasons for this? I think there are several. Fee-for-service is one contributory factor. So is the availability of investigations. In a situation where expensive investigations are more readily available (such as MRI scans, angiography and other invasive diagnostic radiological investigations, etc) there is naturally a lower threshold for ordering them. But one of the largest contributory factors to poly- and over-investigation is defensive practise.
The more exhaustively a clinician investigates a patient, the less likely (arguably) it is that false positives or negatives from one modality of investigation will cause a wrong diagnosis to be made. I won't go into an argument here about what constitutes an acceptable level of investigation. Opinions vary. That's a whole other discussion. I make the point here because successful defense of a medical negligence claim is based upon what a body of medical peers would consider as reasonable practice. If your peers consider you underinvestigated a patient, then there is no defense and you lose your case. Do not pass go. Do not collect �200. Your medical insurance company pays out, your premiums go up, etc.
In a culture (which seems to exist in the US, and is increasingly apparent here in the UK) where doctors constantly face the risk of being sued, does it surprise you that some (not all by any means) err on the side of caution and perform more investigations than might be necessary? Some might know they are doing it and acknowledge that having a ready answer to potential litigation is part of their motivation, others might just believe what they are doing is completely medically justified.
I know this post was a bit off topic, but I couldn't resist.
 
Thomas Paul
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In the US, a doctor could be prosecuted if his negligence is so serious as to be criminal. This does not mean that doctors can be prosecuted for making mistakes. A doctor who kills a patient by giving them too much medication by accident would not be prosecuted for a crime. A doctor who gave too much medication because he was drunk would likely be prosecuted.
 
Damian Ryan
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Thomas Paul: In the US, a doctor could be prosecuted if his negligence is so serious as to be criminal. This does not mean that doctors can be prosecuted for making mistakes. A doctor who kills a patient by giving them too much medication by accident would not be prosecuted for a crime. A doctor who gave too much medication because he was drunk would likely be prosecuted.


Exactly.
 
Frank Silbermann
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Of course, some would say that if a surgeon commits malpractice you should be able to sue the manufacturer who sold the doctor his scapel -- especially if the doctor already has a worse-than-average record for being sued for malpractice.
(At least, that's the rational for current lawsuits against gun manufacturers.)
 
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