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(The American Prospect)   For an object lesson in how "free-market health care" doesn't work, look at the disaster that is long-term care in the U.S   (prospect.org) divider line
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1361 clicks; posted to Politics » on 21 Oct 2020 at 1:05 PM (5 weeks ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook



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2020-10-21 10:54:11 AM  
Long term care doesn't work because after you bled them to the last cent they still need care. And holding a lien on an empty estate doesn't buy you anything.
 
2020-10-21 10:59:11 AM  
Now that we have an object lesson in the failings of private health care, can we get rid of it?
 
2020-10-21 11:03:49 AM  
Medicaid, meanwhile, currently the single-largest source of funding for long-term services, only kicks in at a point of financial ruin. Most states require long-term care recipients to draw down their financial resources to the very last $2,000 before Medicaid kicks in, even requiring them to empty out IRAs and 401(k)s and assets like real estate. Of course, financial ruin is not some far-off possibility; Americans making the median wage have a 1-in-6 chance of needing long-term care that entirely eclipses their financial resources.

One result of this is many people of significant means begin shifting their assets to their children and grandchildren years before they require long-term care.  Thus they become eligible for Medicaid while in reality they are not poor.  In addition, they are able to draw on family resources if needed. Basically the system forces people to do this.  As for the average American, as the article shows, they can't afford the insurance premiums.
 
2020-10-21 11:04:35 AM  
Insurance companies gamble you will never need what they sell. When it comes to tornados and car wrecks, probably a winning position.

But everybody gets sick, old, and dies. Bad bet.
 
2020-10-21 12:14:29 PM  
Health care does not follow the laws of supply and demand.  It requires governmental intervention and regulation of the pricing structure.

Private industry, if left to their own devices, will set up a complex system where you can't even tell the price of anything until after you have used it.

They will also set up a system where when you die, they get to keep all of your money.  They're called "retirement homes" or "long term care facilities", but in reality their entire purpose is to collect all the money you ever made and then some if possible.

So the entire system is designed to separate you from your money, and if you get some health care along the way, that's great.
 
2020-10-21 12:15:53 PM  

edmo: Insurance companies gamble you will never need what they sell


Everybody needs health care.  They use math to figure out the odds, and calibrate the payouts accordingly.  American health insurers are making money hand over fist.  Everyone in America paying a health care premium is taking it right up the ass.
 
2020-10-21 1:10:11 PM  
There's a reason we don't have privatized fire departments.

Services that are basic and good for the whole community that are required for a society to function, need to have a bare minimum or outright be provided.  The fact that America still hasn't figured out that healthcare is closer to services like Fire Departments and Sanitation and not, you know a luxury like another yacht shows how far behind the curve we are as a civilization.
 
2020-10-21 1:10:15 PM  
Adverse selection: The only people who buy long-term care insurance are people in poor health who will need it, so the premium prices are high.

This is the first thing about Obamacare that collapsed shortly after the law took effect. Obamacare had long-term care insurance as a "guaranteed issuance" budget gimmick. It was going to be about 5 years of collecting premiums and then no one could cash in on the insurance until later. This budget gimmick was to make Obamacare look like it came in at under $1 trillion, because the collection of premiums was front-loaded and then the benefits paid out later were beyond the 10-year timeframe that the CBO scored bills. This part of Obamacare immediately collapsed and was never implemented because of the reason I stated above: only people in poor health would buy it and all the young people who were theoretically expected to pay into it were put off by high premiums.
 
2020-10-21 1:10:42 PM  
media4.giphy.comView Full Size
 
2020-10-21 1:12:11 PM  

edmo: Insurance companies gamble you will never need what they sell. When it comes to tornados and car wrecks, probably a winning position.

But everybody gets sick, old, and dies. Bad bet.


most retirees think they will live long and die fast.  unfortunately most people outlive thier finances and experience "money death" before actual death.

I'm going out like Hemmingway.  I just have a few more things to take care of first.
 
2020-10-21 1:12:23 PM  
"THE END RESULT has been a powerful combination of denial, wishful thinking, and severe financial shock."

A brief description of America's healthcare system.
 
2020-10-21 1:12:33 PM  
Well, I mean, Red was right: "Get busy livin, or get busy dyin."
 
2020-10-21 1:12:51 PM  
US healthcare is not "free market." It's one of the most regulated industries in the country. For example, look up Certificate of Need.

We somehow managed to design a system that has all the worst elements of private industry AND centralized government planning, without any of the benefits of either. It's remarkable, really.
 
2020-10-21 1:14:13 PM  
Does Canada have "free-market healthcare" too, Subby?

Ontario is failing long-term care residents on COVID and care, say protesters in Sudbury
"Fast forward to 2020 and Ontario still does not have a minimum standard of care for the 70,000 vulnerable Ontarians who live in our long-term care homes," said Gélinas.

https://www.thestar.com/news/canada/2​0​20/10/08/ontario-is-failing-long-term-​care-residents-on-covid-and-care-say-p​rotesters-in-sudbury.html
 
2020-10-21 1:15:40 PM  

runwiz: Medicaid, meanwhile, currently the single-largest source of funding for long-term services, only kicks in at a point of financial ruin. Most states require long-term care recipients to draw down their financial resources to the very last $2,000 before Medicaid kicks in, even requiring them to empty out IRAs and 401(k)s and assets like real estate. Of course, financial ruin is not some far-off possibility; Americans making the median wage have a 1-in-6 chance of needing long-term care that entirely eclipses their financial resources.

One result of this is many people of significant means begin shifting their assets to their children and grandchildren years before they require long-term care.  Thus they become eligible for Medicaid while in reality they are not poor.  In addition, they are able to draw on family resources if needed. Basically the system forces people to do this.  As for the average American, as the article shows, they can't afford the insurance premiums.


That's a feature, not a bug.

To those of significant means, as you put it, things like Medicaid are there for them, and screw the poor, who are left to die.

It's not the system that forces them to do it, it's that they play the system so that all of their wealth isn't touched and therefore they can get the lion's share of the benefit.  Perhaps we need to make it so that those of wealth and privilege should have a much harder time of accessing public social benefit if they can already afford it themselves?
 
2020-10-21 1:17:41 PM  

Nadie_AZ: Now that we have an object lesson in the failings of private health care, can we get rid of it?


Well, it's only a failure for those who don't profit from it.  Since those who profit from it are investors who hold shares in companies doing that crap, it won't change.  Society has decided that stocks and stock dividends are a super-important way to make money, so it will never change.
 
2020-10-21 1:18:39 PM  

anjin-san: US healthcare is not "free market." It's one of the most regulated industries in the country. For example, look up Certificate of Need.

We somehow managed to design a system that has all the worst elements of private industry AND centralized government planning, without any of the benefits of either. It's remarkable, really.


Yep, we tried to set up a substance abuse treatment facility in WV when we noticed that opiates were getting worse in the early 2000s and were told that we didn't have a need for that in WV and were denied a Certificate of Need.  They have denied it for years.  Mental health? we don't need that!   Disability care? We don't need that!  But by golly, we have a chiropractor or physical therapy on every corner.
 
2020-10-21 1:19:00 PM  

Nadie_AZ: Now that we have an object lesson in the failings of private health care, can we get rid of it?


On November 4th the president and Republican leaders will provide details of a healthcare system to replace Obama care (ACA) that is much lower cost and has a higher level of benefits. But before they can do this they need us to re-elect them

/same promise they made every two years since 2010
 
2020-10-21 1:23:54 PM  

fernt: Does Canada have "free-market healthcare" too, Subby?

Ontario is failing long-term care residents on COVID and care, say protesters in Sudbury
"Fast forward to 2020 and Ontario still does not have a minimum standard of care for the 70,000 vulnerable Ontarians who live in our long-term care homes," said Gélinas.

https://www.thestar.com/news/canada/20​20/10/08/ontario-is-failing-long-term-​care-residents-on-covid-and-care-say-p​rotesters-in-sudbury.html


"Despite some pay raises and promises that things are getting better in long-term care (LTC) homes, there is still a concern the Ontario Government is not doing anywhere near enough to solve the issues of staffing shortages and providing enough hands-on care for patients and it become especially critical because of the COVID-19 pandemic.
"That was evident Thursday morning when protest rallies were held in Sudbury, in Toronto and in more than a dozen other cities across Ontario in an effort to keep the LTC issues on the front burner and keep the pressure on Premier Doug Ford's Conservative government."

Found the problem.

'"The purpose of this is to tell Doug Ford and the Ontario government that we want long-term care now, not after the second wave, the third wave or the fourth wave, but now.'

Wait ..

"Sudbury MPP Jamie West, the NDP labour critic, said he was elected only two years ago, but said the problems of long-term care have been well defined for years.
"So for the government and Premier Ford to say 'I'm not aware, and I don't know, we need a commission,' is ridiculous," said West."

Seems like Conservatives are against progress and actually helping people. Who knew?
 
2020-10-21 1:24:39 PM  

fernt: Does Canada have "free-market healthcare" too, Subby?

Ontario is failing long-term care residents on COVID and care, say protesters in Sudbury
"Fast forward to 2020 and Ontario still does not have a minimum standard of care for the 70,000 vulnerable Ontarians who live in our long-term care homes," said Gélinas.

https://www.thestar.com/news/canada/20​20/10/08/ontario-is-failing-long-term-​care-residents-on-covid-and-care-say-p​rotesters-in-sudbury.html


What's your point?  Subsidized healthcare is not working in Ontario, so the old poors here should keep buying into sketchy Medicare supplements so they can bring insulin down to $200 a month, instead of $600?
 
2020-10-21 1:27:12 PM  

Zerochance: fernt: Does Canada have "free-market healthcare" too, Subby?

Ontario is failing long-term care residents on COVID and care, say protesters in Sudbury
"Fast forward to 2020 and Ontario still does not have a minimum standard of care for the 70,000 vulnerable Ontarians who live in our long-term care homes," said Gélinas.

https://www.thestar.com/news/canada/20​20/10/08/ontario-is-failing-long-term-​care-residents-on-covid-and-care-say-p​rotesters-in-sudbury.html

What's your point?  Subsidized healthcare is not working in Ontario, so the old poors here should keep buying into sketchy Medicare supplements so they can bring insulin down to $200 a month, instead of $600?


The point is the problem isn't limited to the US.
 
2020-10-21 1:30:21 PM  
Yeah, because the British Death Panels are such a better alternative...
 
2020-10-21 1:30:37 PM  

fernt: Zerochance: fernt: Does Canada have "free-market healthcare" too, Subby?

Ontario is failing long-term care residents on COVID and care, say protesters in Sudbury
"Fast forward to 2020 and Ontario still does not have a minimum standard of care for the 70,000 vulnerable Ontarians who live in our long-term care homes," said Gélinas.

https://www.thestar.com/news/canada/20​20/10/08/ontario-is-failing-long-term-​care-residents-on-covid-and-care-say-p​rotesters-in-sudbury.html

What's your point?  Subsidized healthcare is not working in Ontario, so the old poors here should keep buying into sketchy Medicare supplements so they can bring insulin down to $200 a month, instead of $600?

The point is the problem isn't limited to the US.


The point is it's worse in the US due to our privatized system.
 
2020-10-21 1:37:44 PM  
I'm of the school that one of the functions of government is to provide things that society needs but that aren't profitable. Things like public schools, fire stations, police, and some utilities in certain areas.

Health care isn't supposed to be profitable any more than criminal justice. Our goals when providing care shouldn't be to make money, but to provide care. When it's more profitable to let someone suffer or die, that's what companies do - because that's what they were designed to do.

If SCOTUS says companies can have a religion, then they should also be made to have morals. But that's anti-capitalist. So let government handle the non-profitable portions of the market.
 
2020-10-21 1:38:38 PM  
I don't think you can claim that a system that is paid almost entirely by medicare and medicaid and that is regulated by layers of government at both the state and federal level is evidence of a free market failure. Well, I mean you *can* claim that. But it would require a level of cognitive dissonance not normally seen in functioning humans.
 
2020-10-21 1:48:45 PM  
I get health insurance through my work.

I would dearly, dearly love to know why any insurance exists to deny necessary things. Take for example my vision care. My job is paying for my vision care. The vision insurance refuses to pay for even an entire set of glasses. I now walk into the optometrist expecting a thousand dollar bill or more. One set of my lenses this year cost over $800 and my insurance laughed and refused to touch it. ONE SET OF LENSES.

And I am not buying frames. I am buying lenses, and for clarification, I am an effective -8/-9. My vision is a handicap. This is not a question of fashion frames. I'd cheerfully pay for frames out of pocket. The lenses are a life necessity. That the hell is the point of vision insurance that won't even buy a set of lenses??

And this sort of philosophy of course carries over to all insurance...

/burn it down and start over
 
2020-10-21 2:02:19 PM  

Ringshadow: I get health insurance through my work.

I would dearly, dearly love to know why any insurance exists to deny necessary things. Take for example my vision care. My job is paying for my vision care. The vision insurance refuses to pay for even an entire set of glasses. I now walk into the optometrist expecting a thousand dollar bill or more. One set of my lenses this year cost over $800 and my insurance laughed and refused to touch it. ONE SET OF LENSES.

And I am not buying frames. I am buying lenses, and for clarification, I am an effective -8/-9. My vision is a handicap. This is not a question of fashion frames. I'd cheerfully pay for frames out of pocket. The lenses are a life necessity. That the hell is the point of vision insurance that won't even buy a set of lenses??

And this sort of philosophy of course carries over to all insurance...

/burn it down and start over


You should really at least try Zenni. They make glasses for most prescriptions. I have -5/-6 and the high index is like $30 upcharge and they do HSA receipts. My glasses with high index are better than the cheap plastic coak bottle my insurance almost pays for. I paid as much for high index with blue light and anti-reflection coating as the plastic base lenese with no coating after insurance. $60 for my zenni pair and the vision is better with thinner lenses and anti-glare.
 
2020-10-21 2:04:10 PM  
Fark user imageView Full Size
 
2020-10-21 2:17:57 PM  
Subby actually many nations like Germany also have private insurance. The US problems are not because of private insurance alone.

The idea that the entire world all has public only health insurance is just not true. Many counties while having universal coverage don't own the complete healthcare system or even insurance.
 
2020-10-21 2:19:20 PM  
i.imgur.comView Full Size
 
2020-10-21 2:47:07 PM  

runwiz: Medicaid, meanwhile, currently the single-largest source of funding for long-term services, only kicks in at a point of financial ruin. Most states require long-term care recipients to draw down their financial resources to the very last $2,000 before Medicaid kicks in, even requiring them to empty out IRAs and 401(k)s and assets like real estate. Of course, financial ruin is not some far-off possibility; Americans making the median wage have a 1-in-6 chance of needing long-term care that entirely eclipses their financial resources.

One result of this is many people of significant means begin shifting their assets to their children and grandchildren years before they require long-term care.  Thus they become eligible for Medicaid while in reality they are not poor.  In addition, they are able to draw on family resources if needed. Basically the system forces people to do this.  As for the average American, as the article shows, they can't afford the insurance premiums.i


Just a note of caution before everyone runs out to do this: When applying for Medicaid, the state looks back five years on every single account and asset you own.  If they see you giving money or assets away anywhere, even to family or charities, they will reject your application.  So basically if you want to protect your money or assets, you must dispose of them five years before you apply for Medicaid.  No one can predict what their long term needs will be five years in the future, let alone the elderly, so what happens to almost everyone is that the private long term care companies force you to sell and liquidate everything until you are truly are broke.
 
2020-10-21 2:59:20 PM  

Persnickety: When applying for Medicaid, the state looks back five years on every single account and asset you own.  If they see you giving money or assets away anywhere, even to family or charities, they will reject your application.


This is why the assets transferred from my parents to my sister and me are labeled as "Payment of loan obligations."
 
2020-10-21 4:49:04 PM  
It works for the people who sell it. Just not the people who use it.

This is America, after all, and this is how it's SUPPOSED to work, per Republicans and "libertarians."
 
2020-10-21 6:55:05 PM  

mrmopar5287: Persnickety: When applying for Medicaid, the state looks back five years on every single account and asset you own.  If they see you giving money or assets away anywhere, even to family or charities, they will reject your application.

This is why the assets transferred from my parents to my sister and me are labeled as "Payment of loan obligations."


Depending on how tenacious your state is, they may not accept that, especially if the amounts are large.  I know in NH they'd want to see proof that such a loan actually existed, including proof of monies disbursed by this loan.  The risk of playing games like this are at the least non-approval, meaning you get no money, or at the worst criminal prosecution for fraud if there's a pattern of willfully dishonest transfers.
 
2020-10-22 2:36:51 PM  

severedtoe: edmo: Insurance companies gamble you will never need what they sell. When it comes to tornados and car wrecks, probably a winning position.

But everybody gets sick, old, and dies. Bad bet.

most retirees think they will live long and die fast.  unfortunately most people outlive thier finances and experience "money death" before actual death.

I'm going out like Hemmingway.  I just have a few more things to take care of first.


Don't worry, the corpo-fascist supreme court will soon tacitly condone premium readjustment teams that ensure your not around to bleed the system.
 
2020-10-22 2:52:58 PM  

NihilismKat: Ringshadow: I get health insurance through my work.

I would dearly, dearly love to know why any insurance exists to deny necessary things. Take for example my vision care. My job is paying for my vision care. The vision insurance refuses to pay for even an entire set of glasses. I now walk into the optometrist expecting a thousand dollar bill or more. One set of my lenses this year cost over $800 and my insurance laughed and refused to touch it. ONE SET OF LENSES.

And I am not buying frames. I am buying lenses, and for clarification, I am an effective -8/-9. My vision is a handicap. This is not a question of fashion frames. I'd cheerfully pay for frames out of pocket. The lenses are a life necessity. That the hell is the point of vision insurance that won't even buy a set of lenses??

And this sort of philosophy of course carries over to all insurance...

/burn it down and start over

You should really at least try Zenni. They make glasses for most prescriptions. I have -5/-6 and the high index is like $30 upcharge and they do HSA receipts. My glasses with high index are better than the cheap plastic coak bottle my insurance almost pays for. I paid as much for high index with blue light and anti-reflection coating as the plastic base lenese with no coating after insurance. $60 for my zenni pair and the vision is better with thinner lenses and anti-glare.


I have a -9 and I get glasses from zenni too. They still run around $150, but way better then the optometrist and a but better then sam's club. Quality is as good.
 
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