Medical Costs Bankrupt Patients; It's the Computer's Fault 637
nbauman writes "Don't get cancer until 2015. The Obama health reform is supposed to limit out-of-pocket costs to $12,700. But the Obama Administration has delayed its implementation until 2015. The insurance companies told them that their computers weren't able to add up all their customers' out-of-pocket costs to see whether they had reached the limit. For some common diseases, such as cancer or heart failure, treatment can cost over $100,000, and patients will be responsible for the balance. Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs? 'A senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: "We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person's out-of-pocket costs. They asked for more time to comply."'"
A cynic's view (Score:5, Insightful)
The rollout is being delayed until after the 2014 congressional elections. The problem is political, not technical.
Re:A cynic's view (Score:5, Insightful)
A cynic would also know that billing system software is some of the most byzantine crapware on the face of the planet. It's hacking on this kind of software--plus payroll, HR, accounting, etc--that sustains both Oracle and IBM, plus thousands of smaller consulting firms.
So, the administration's excuse is both plausible and fortuitous. In other words, I doubt the insurance companies had to twist the administration's arm to postpone the mandate and cap.
Re:A cynic's view (Score:5, Interesting)
The mess is deep and wide, and likely still has some duct tape applied to cover up the Y2K transition. Many/most of these systems are ancient, and creaking under their own mass.
Re:A cynic's view (Score:5, Interesting)
Re:A cynic's view (Score:5, Interesting)
Burning the place to the ground and starting over would be cheaper. The problem is they never figure that out until after the first hundred billion dollars are spent. And the bigger problem is when they do burn it all down and start over, the never remember to lock the politicians in first.
Re:A cynic's view (Score:5, Insightful)
Re:A cynic's view (Score:5, Informative)
Part of the reason for the resistance is lost institutional knowledge. These are old systems, probably poorly commented and poorly documented. They've been modified and patched a thousand times over to handle corner cases, odd hardware based bugs, new interfaces, new regulations and new laws, as well as mashing with new insurance companies, new plans, old plans, outdated data and new data and 50 states worth of independent regulations. How much money and how much time do you suppose it would take to rewrite that entire 30 year history, including refactoring all of the data such that is accessible back to the beginning, in a modern language, with modern technologies and can guarantee that it is 99.99% exactly the same functionality for all possible input combinations?
For reference, the state of North Carolina recently overhauled their Medicaid billing system. They are months and billions of dollars behind in payments from this change over, and the project was already over due and over budget.
Re:A cynic's view (Score:5, Insightful)
Most projects are overdue and over budget because of two reasons: mission creep, and poor systems analysis in the first place. When have you heard of one that was on-time and under-budget? People would look at it with furrowed eyebrows, like-- what's wrong with it? When's it going to break? Are we throwing good money after bad?
Who's to blame? We are. We as coders and analysts let people get their way, rather than making them pay for 20-20 hindsight. We do poor QA, and things break and require fixing. We make things complex and hard to sustain workloads, while other teams sit on their thumbs and play online.
But this mission is about your health and mine. The date will continue to sag until someone says (probably a Federal judge): this date or $100,000/day. Until then, each date is squishy, and the code is squishy, and everyone will wring their hands about what to do. No one wants to report a bad couple of quarters while they burned serious money on systems upgrades. But eventually, everyone has to do it. Will it make cloud brokerage better? Someone designs a killer app and OEMs it to insurance companies so they can comply?
Nah, no one's that smart.
Hey Benioff-- ya listening?
Re:A cynic's view (Score:4, Insightful)
Let me address your thoughts:
Coders working on teams have a responsibility to themselves and their teams to interact with others in such a way that the job gets done. There are lots of management problems, PHBs, and others that can get in the way, but ultimately, code is crafted by coders. If you can't do a resonable job, get out and keep your integrity. Yeah, you have to eat. I'd rather eat sparsely and sleep at night than the reverse.
If you don't interact successfully with analysts, the same problem occurs. If you're a coder with reasonable skills, and you understand your code's place within infrastructure, than you have the nexus to tell analysts where they're wrong or need improvement. Lacking that, it's also irresponsible to, having warned, to render the expectation that results will work.
And you might be wrong. But without voicing this legitimately, projects become blackholes, code doesn't fit the efforts of others, QA gets testing roadblocks, and the timeline creeps ever more.
There are big differences between solo efforts and team efforts. Team efforts require a lot of flexibility, but importantly, keeping an eye on the goal. Do that, and the end result is more easily calculated and executed by all, rather the mercurial results often achieved-- if they are, at all.
I'll concede that management expectations can be ludicrous. But if you tell the truth, you'll also achieve it.
Re: (Score:3)
Re:A cynic's view (Score:4, Insightful)
50 states worth of independent regulations
Honestly, I'm a big fan of federalism, but it really does create MAJOR problems for automation. I'm working on a software application that deals with international shipments and you have the exact same problem but on a national scale.
At any time some small African nation can issue a regulation, perhaps by sticking it in the classified section of the national newspaper or putting it on display in the national library or something, and make it effective in a week. The regulation can specify anything that you can communicate in the local written language. Now your fancy automated system will be out of compliance unless the logic is changed and deployed to production within a week.
Sure, there are better ways of solving the problem and worse ways of solving it, but no matter how you slice it there are a bazillion inconsistent rules that you need to follow. State sales tax is a great example of this. If it were just a matter of having a DB of 9-digit zip code vs tax rate it would just be a huge pile of work. However, in addition to the rate varying by location, the kinds of items it applies to also varies. So that means a zip code table for every item in your catalog, and then some means to update all those tables every time some local town council changes their mind on whether an umbrella is an article of clothing or a household good, and what exactly is and isn't an umbrella.
Re:A cynic's view (Score:5, Insightful)
Not cynical enough. In large, old companies there's software running key parts of the company that they don't have source code any more, or that they can't recompile because even with source they don't have the ancient compilers, etc., or if they have source and tools, nobody remembers the code and it's undocumented, etc. - all of which means that there's tons of code that's "frozen in time" and all they can do is write layers on top of it.
They'd love to blow the code up and rewrite it. The problem is the work required to reverse engineer whatever the code does. Keep in mind that they're heavily regulated, and whatever they're running now is approved. So if they blow it up and rewrite, they have to spend years figuring out what it all does well enough to recode it, then do so, then validate it as supporting every line of business under every ancient contract they've ever signed, then re-certify it with whoever approves their SOX/HIPPA/etc., stuff. And they have to do all of that while continuing to run the business, so both systems have to run in parallel, creating huge piles of extra work for everyone in the business, doing double entry, reconciling differences, etc. At infinite cost and business risk that nobody will sign off on.
So instead, they keep running ancient software, and writing layers on top of layers. It's horrible, but it's that way for a reason.
Re:A cynic's view (Score:5, Informative)
Just so you know, every time you write a check in the united states, the format that it needs to get converted into follows the x937 spec. Each record is in ebcidic but requires a big-endian record header except for the records with image data in them, where the image data is required to be little-endian. The medical systems running our nations hospitals make banking look sane.
There's your 10 minutes of terror for the day.
funny ebcidic story (Score:3, Interesting)
back in 1995 I was working for a larGe TElco when my director called me into her office and instructed me to go down to Hartsfield (ATL airport) & pay the walk-up fare to get on the next flight to Raleigh b/c they couldn't process commissions & the SE sales reps were revolting ("you ain't kiddin' - they stink on ice" - sorry, couldn't resist). I immediately knew what problem was (well, 99+%) but felt conflicted so called (then) girlfriend (now wife) and said: "${DIRECTOR} just told me to get on ne
Re: (Score:3)
Burning the place to the ground and starting over would be cheaper.
I see a grasshopper who prefers the fire to the pan. The (few) systems built in the seventies that are still in use today, are here for one reason only, the stability and predictability imparted by 40yrs of field testing and maintenance, it's the "if it ain't broke don't fix it" rule in action. Different interface standards are not the root problem (middleware exists to solve that maze), the root problem is the difficulty of extracting the currently embedded business rules from the existing code. Why would
Re:A cynic's view (Score:4, Interesting)
Because the customer's first requirement will be that the new system comes up with the "same numbers as the old system" (even if they are wrong).
That is the truth there. At one point in college I worked at a place where they had a legacy accounting system that ran on ancient mainframe that it was becoming incredibly expensive to keep running. They were unable to get it to function properly on any other hardware. So they finally gave up and reimplemented the system on what was then the latest and greatest hardware using modern programing techniques and languages. The software in question implemented an incredibly complicated set of rules to various transactions. They spent a fortune having people go through the old code, as well as the original source documents, to map what all these rules were. Just one problem, in some cases the new system would sometimes come out a few cents to a couple of bucks off from the old system. This on transactions frequently in the multiple, or even hundreds, of millions of dollars. The end result of that was that for the entire time I worked there they had to enter everything into both systems. Last time I talked to anybody from there they were still doing that. All the while the organization has spent a fortune trying to find out why the numbers are different. That is despite the fact that as far as they can tell everything is implemented exactly right in the new system. So there is every possibility that it is the old system that is wrong. Management just can't accept that and take the leap of faith to declare the new system right and move on.
Re:A cynic's view (Score:4, Interesting)
Re:A cynic's view (Score:5, Insightful)
What they are really saying is "We want to delay this for as long as possible so we can keep maximizing our profits".
Re:A cynic's view (Score:5, Informative)
You'd be amazed how difficult it actually is to track accumulated values (like out-of-pocket payments) in most insurance software. It's not just "SELECT SUM(claims.oop) WHERE claims.member = X" -- it should be, but it's not. And the process in place is so fragile that any change at all might well break the whole thing.
There's also the problem of the system not being able to accommodate things like a legislative limit that's different from the contract limit, or a contract that changes after initial implementation -- if you don't assign a new group number to the members you can't apply new limits to them. And you can't assign a new group number without a new contract entry. And there is no new contract because the change was legislative not contractual. And you can't just update the old policy entry because it would apply retroactively to all old claims.
It's all stuff that any one with 2 credits in database administration could fix in like 4 minutes, but it's all baked in to 40 years of COBOL, intermixed with business logic, writing fixed-width data to ASCII "tables", and no one is willing to risk changing anything unless God and his wife both sign off on it.
Oooo, ooo. Pick me teacher. I can solve this one (Score:5, Insightful)
Face it, health 'insurance' made since when the only thing a doctor could do was a) amputate and b) give out aspirin. It didn't matter that they only did a few big things that were mostly comfort before you died. Now we want to _use_ insurance. Insurance can't be profitable if we're all going to use it. The entire _point_ of insurance is that most of us aren't going to use it.
It's like hurricane insurance in Florida. Good luck buying it.
Re: (Score:3)
What do you mean switch? We already have Medicare/Medicaid, and 1/3 of the uninsured go into those programs under Obamacare.
Depends on which state (Score:3)
Re:Depends on which state (Score:4, Interesting)
Most of those people are idiots looking for a reason to hate Medicare/Medicaid/Any-Service-That-Doesn't-Help-Them.
The truth is that the abusers are a tiny minority, and the amount of money they scam from the system is utterly dwarfed by the amount of money scammed from the government/other-citizens by our national heroes in the finance industry. Suggest policing healthcare programs and you're a responsible citizen fighting corruption. Suggest policing the Fed or investment companies and you're a filthy hippie who hates freedom.
Re: (Score:3)
On the contrary, health insurance only "made sense" because during World War 2 businesses were prohibited from increasing wages to attract workers (because it would increase costs of material for the war effort), so they started offering employer-sponsored health insurance instead. Once the war ended, the idea stopped making sense again (but stuck around anyway).
That's the beuaty of it (Score:5, Insightful)
But far be it from me to let a little thing like facts and the failures of the US healthcare system get in thy way of irrational fear mongering perpetuated by a multi-billion dollar insurance industry. Viva la death panels (well, the private ones anyway)
Re:That's the beuaty of it (Score:5, Informative)
Tell me more about how great this works and procedures aren't rationed or wait listed.
It's worked well for me in Australia so far.
Last time I needed it, I went to the hospital (severe abdominal pains), they admitted me immediately. Within 20 minutes I was in a bed and being checked over. Within half an hour, I was on pain relief and monitoring. Overnight, I had a diagnosis and initial treatment so I could leave the hospital. The following week I was given a schedule for follow-up surgery, which I duly attended and which solved the problem.
The sole bureaucratic action I had to make was to present my Medicare card when I first attended the hospital, and even that was optional, if I didn't have it with me. I paid nothing, was treated promptly and got well.
How about you tell me what you think is wrong with it?
Re: (Score:3)
When the government decides not to pay for it you go private. Even in the UK we have BUPA providing treatments the NHS doesn't view as effective. (E.g. cancer drugs that extend life for a decade, but cost millions per survivor over that time period; you get better survival by putting that money into a few hundred cancer surgeons).
Re:That's the beuaty of it (Score:5, Insightful)
Re:That's the beuaty of it (Score:5, Funny)
And my appendices were taken out within 3 hours of diagnosis.
How many did you have?
Re: (Score:3)
Re: (Score:3, Insightful)
When there is only one payer, they control absolutely what things they will choose to pay for.
And you honestly don't think this happens today? Seriously?
Make no mistake: There are death panels in existence right now, this very moment. They work for the private insurance companies, doing their damned best to figure out how to kick people off of insurance rolls and rescind coverage for whatever reason will legally scrape by. Or even illegally, if they think that it would be cheaper to fight the battle until you die than to pay out your claim. The big difference is that today, you frequently don't
Re:Oooo, ooo. Pick me teacher. I can solve this on (Score:5, Insightful)
Yeah, ever so much better to let a vastly overpaid CEO make that decision.
No so much (Score:5, Interesting)
Anyway, I started asking him what he was gonna do. How would he use private insurance. Wouldn't they insurer just keep raising his rates. He said that would be wrong, and so somebody should do something 'bout that. I asked who, and how and he said there should be a law that the insurance companies could only charge so much.
Basically he, like most Americans, deep down want single payer health care. But we're been taught from cradle to grave that socialism is bad. We're indoctrinated. It's called cognitive dissonance. He knows he needs socialism to live. He knows he needs help, and he knows it's his right (as a human) to live. Not just to have some blind dumb chance at good luck, but to actually have a life. But he's been taught, over and over, lied to and lied to. So he breaks down.
Obama recognized that there's lots of people like that. So he's giving them what they need (socialized health care) but doing it in the only way he can. He's letting the devil have it's due, and he's going to give billions and billions to parasitic insurance companies who's only purpose is to make us feel better about getting something that's a basic human right.
or not (Score:4, Interesting)
Obamacare is a compromise forced by unions and large corporations that want to maintain their tax deductible "cushy" medical plans whilst the rest of the populous get forced into a command-economy style health care industry.
If Obamacare was actually single payer, or socialist, the cushy medical plans couldn't really exist (because the infrastructure that would have supported them meaning the insurance companies and the pay-for-service medical providers would have evaporated) and there would have been no support for it. Regardless if the that is what Obama wanted, his support base wanted to be able to keep their plans, so this is what came out of the backroom deal.
If you want some evidence of this, I suggest you start with the sad fact that congress needed to hastily pass a law [reuters.com] to allow their staffers to get a federal subsidy to help pay for getting their insurance through Obamacare since they feared "brain-drain" of people fleeing public service to get better health coverage from the private sector. No, the people in charge of Obamacare don't want the same coverage for everyone, they just want to change the way healthcare is funded for the masses, not the elite.
Tiered coverage often doesn't work with single payer very well, because of economies of scale limit the availability of competition for supplemental insurance resulting in a very have and have-not price points. As an example of this, you can start by looking into the fact that in the US medicare supplemental insurance needs to be subsidized by the government to keep providers in the market. If that seems like an inherently unfair use of government resources to give health benefits to some people over other people, well, you are probably looking at a preview of Obamacare in a few years if they want to keep private insurers in the market as costs rise, but premiums are capped due to political pressure.
On the other hand, if you are a cynic, you probably think that this design was an intentional long-term policy to drive out all insurers so that the system has to convert to single payer. If you want to see some evidence of this, look at what Obamacare is doing to Medicare Advantage programs (alternate Medicare-like insurance provided by private insurers).
Re:No so much (Score:5, Interesting)
I get your point if we were talking about a million dollars a year to keep them alive.
But in many cases it's as simple as getting a colonoscopy now if you have money vs in january if you don't (true story - and yes in america).
It may be as simple as $6000 worth of pills a year to stay alive and healthy.
In a country as wealthy as america is, you have to ask how we can let people die.
It's not about suckers- it's about if you are willing to chip in a couple grand a year to make sure everyone in the country does well vs letting 40% of the country die an average of five years sooner. It's really appalling.
I guess if it were 60%- we'd already have decent health care. But talk radio has done a lot of damage. I listened to a guy on the local conservative talk radio.
He was 59-- his unemployment was about to run out- he wouldn't be eligable for social security until he was 62. He was going to lose his house-- his wife was divorcing him.
He couldn't get a job. And being conservative- you know he tried. And he was railing against unemployment. Saying we shouldn't extend it to 99 weeks.
He was literally slitting his own throat- he was so brainwashed.
Re:No so much (Score:5, Insightful)
BTW, what was this basic "human right" again? I can't seem to place it from what you're saying. You've just been yacking about "socialized health care".
Question: Do you believe that someone without insurance, or who otherwise has no ability to pay, who is suffering from an acute medical emergency, should be turned away from a hospital emergency room and left to die on the sidewalk?
If the answer is "Yes," then you're some kind of barbarian, and we're done here.
If the answer is "No," then I've got some even worse news for you: we already have "socialized medicine." The patient will, in fact, be treated, and you and I will, in fact, pick up the tab. It just costs us several times more than it would in any other civilized nation on Earth, because unlike those nations, we insist on kidding ourselves.
Re:No so much (Score:5, Funny)
If the answer is "Yes," then you're some kind of barbarian, and we're done here.
You misspelled libertarian.
Re:Oooo, ooo. Pick me teacher. I can solve this on (Score:5, Interesting)
As a Canadian I have yet to see the very interference of the government into my health. I have never had any government official stop me getting an x-ray, stomp on my doctor when he ordered an ECG, or any of the other numerous tests and prescriptions he has ordered for me.
It's true that there are flaws, but when my wife was diagnoses with a life threatening cancer, no time wastes in diagnostics and in the two surgeries that followed. Better still, I was unemployed by the second surgery and we didn't have to bankrupt ourselves to save her life.
Re:Oooo, ooo. Pick me teacher. I can solve this on (Score:4, Funny)
Hey, quit injecting your facts and experience into their wild speculation.
Re:A cynic's view (Score:5, Interesting)
Which is funny, because my health policy company (whatever BCBS in Florida is called this month - FloridaBlue I think?) sends me a statement every month of what was charged, what was paid, what I paid. And at the end of the year they send a nice summary for tax filing purposes. Heck, hte pharmacy the family uses - Publix - has a "year to date" on each receipt we get for prescriptions.... so, it obviously isn't impossible, or even too hard....
Re: (Score:3, Insightful)
Re:A cynic's view (Score:5, Informative)
http://www.leadertelegram.com/blogs/tom_giffey/article_c9f1fa54-d041-11e1-9d01-0019bb2963f4.html [leadertelegram.com]
I was curious to know how the length of the Affordable Care Act compared with other major pieces of legislation. Take, for example, the Wisconsin state budget (officially known as Act 32) signed into law last July by Gov. Scott Walker. The PDF of the budget, as approved, is 532 pages long. I cut and pasted the text into my word processor, and learned the budget ran to 409,629 words (give or take -- the figure includes some page headers and other extraneous verbiage). How long is the Affordable Care Act? By my count, it’s 418,779 words (again, that’s approximate).
In other words (pardon the pun), a law refashioning one of the major sectors of the U.S. economy is only slightly longer than a law setting the two-year budget for one of the 50 states.
http://www.fourmilab.ch/uscode/26usc/ [fourmilab.ch]
The complete Internal Revenue Code is more than 24 megabytes in length, and contains more than 3.4 million words; printed 60 lines to the page, it would fill more than 7500 letter-size pages.
Part of The Big Lie strategy is repeating a lie over and over again till it's common enough people start to believe it. Don't fall for that type of dishonest stupidity.
Re:A cynic's view (Score:4, Interesting)
It's totally obvious that you have not read the law. I have. You have no clue where it's strong or weak. Instead of learning for yourself, you get your opinions from your favorite vending machine. You said Obamacare, "requires dozens or hundreds of executive offices to add tens of thousands more pages of regulations and other rule-making on top of the legislative part of the law."
Bullshit. Try reading this tiny Voter ID law passed yesterday in my state (which, yes, I've read). It's 35,000 words, or about 1/12th the size of Obamacare. The NC voter ID law commands tons of county and municipal governments to take various actions to comply with the new law. Obamacare is light in comparison. Our state agencies will be much more laden with additional red tape due to the voter ID law compared to Obamacare. Why don't you try and point out some concrete examples of why I'm wrong? Or... are you just a stupid bag of hot air?
Re: (Score:3)
(its longer than the IRS code)
My response to that lie was just that... a response to that point.
..but now, like many uneducated fucking morons, some total fucking dipshit wants to change the point to show how I was wrong when i was simply pointing out facts. Guess what, Entrope... you're a fucking idiot.
The poster i responded to said the quoted line, which is incorrect. What it is is a stupid fucking talking point by mental fucking midgets who's only capacity is to lie like worthless pieces of shit to try to make their point.
Re: (Score:3, Interesting)
I hate to post AC, but I've modded this thread already.
As somebody who doesn't rate Obama too badly as presidents go, I still agree with you, that Constitutionally, he does not really have the power to delay any part of it. But who would challenge his actions in this case? The opposition party is full of people who are heavily beholden to the insurance companies and various medium sized business groups that tend to have just enough employees they aren't sure if the law will hurt them or not, and are working
Re: (Score:3)
The executives power to delay implementation rests in the interpretation of the Administrative Procedure Act (1946).
So the ACA can be delayed through APA. I recognize "agencies" tasked with implementing law creates an extra-Governmental body that bleeds into both the legislative and executive branches, which is problematic.
Re:A cynic's view (Score:4, Informative)
I completely agree. That said, the billing systems already have this function built in. Hospitals and other health care providers want to track what they're owed and by whom.
Stating their systems don't have this functionality is a bald faced lie. Congress should try some due diligence.
Re:A cynic's view (Score:5, Funny)
Oh, come on.
Do you really think insurance executives know how to add?!?!?!?
Re:A cynic's view (Score:5, Insightful)
A cap on out of pocket expenses means the insurance company has to pay more.
Where will they get that money? They'll get it from higher premiums.
Forcing people to pay higher premiums just before the election would look bad, hence the delay.
Re: (Score:3, Informative)
All you need to know is that's not true [politifact.com].
Re:A cynic's view (Score:5, Informative)
Ezra Klein of the Washington Post says THIS:
There’s a Politico story making the rounds that says that members of Congress are engaged in secret, sensitive negotiations to exempt themselves and their staffs from Obamacare.
Well, they were secret, anyway.
The story has blown up on Twitter. “Unbelievable,” tweetsTPM’s Brian Beutler. “Flat out incredible,” says Politico’s Ben White. “Obamacare for thee, but not for me,” snarks Ben Domenech. “Two thumbs way, way down,” says Richard Roeper. (Okay, I made the last one up).
If this sounds unbelievable, it’s because it is. There’s no effort to “exempt” Congress from Obamacare. No matter how this shakes out, Congress will have to follow the law, just like everyone else does.
Based on conversations I’ve had with a number of the staffs involved in these talks, the actual issue here is far less interesting, and far less explosive, than an exemption. Rather, a Republican amendment meant to embarrass Democrats and a too-clever-by-half Democratic response has possibly created a problem in which the federal government can’t make its normal contribution to the insurance premiums of congressional staffers.
Maybe.
See? This is getting boring already.
Here’s how it happened: Back during the Affordable Care Act negotiations, Sen. Chuck Grassley (R-Iowa) proposed an amendment forcing all members of Congress and all of their staffs to enter the exchanges. The purpose of the amendment was to embarrass the Democrats. But in a bit of jujitsu of which they were inordinately proud, Democrats instead embraced the amendment and added it to the law. Here’s the relevant text:
The only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are — (I) created under this Act (or an amendment made by this Act); or (II) offered through an Exchange established under this Act (or an amendment made by this Act).
(Snip)
But no one is discussing “exempting” congressional staffers from Obamacare. They’re discussing creating some method through which the federal government can keep making its current contribution to the health insurance of congressional staffers.
“Even if OPM rules against us,” one staffer said, “it’s inaccurate to imply that any talks are aimed at exempting federal employees from routine mandates of ACA since any talks are about resolving the unique bind that the Grassley amendment puts federal employees in.”
This isn’t, in other words, an effort to flee Obamacare. It’s an effort to fix a drafting error that prevents the federal government from paying into insurance exchanges on behalf of congressional staffers who got caught up in a political controversy.
All you really need to know about Obamacare is: republicans lie, republicans lie, republicans lie.
Re:A cynic's view (Score:5, Informative)
A board that reviews health care expenses and recommends cuts in specific areas isn't new with or unique to Obamacare. Every insurance company has one, and they feed off of an existing, independent board that recommends prices for the entire medical industry (and which is sometimes wildly off the mark in terms of current costs).
Unlike Obamacare, every insurance company also has employees (doctors, yes, but not the ones treating the patient) who can decide that a given treatment isn't worth the cost associated with it and deny its coverage, thereby in some cases sentencing the patient to death. That nearly happened to my then-86-year-old grandfather who was denied coverage for a triple bypass because he was already beyond his life expectancy. It wasn't until it was pointed out--twice--to the insurance company that he was still working 40 hours per week that the surgery was approved, by which time he was in the ICU on oxygen. It was his employer-provided insurance that tried to nix the surgery. This was about 2005. He lived another five years or so after the surgery.
I'm not entirely certain how the insurance-company doctors making such decisions will fare under Obamacare, but I expect that they'll still be around.
Re:A cynic's view (Score:4)
Annnnd the fact that every time this sort of article gets posted there is this fundamental and extremely naive assumption that you are still in control of your government, it is still supposed to work for the people and that the politicians (and their masters) are not fully aware of what they are doing.
Remove that and this faux surprise and outrage goes away and the real work can begin...fixing the ACTUAL problem...
Re: (Score:3)
Annnnd the fact that every time this sort of article gets posted there is this fundamental and extremely naive assumption that you are still in control of your government, it is still supposed to work for the people and that the politicians (and their masters) are not fully aware of what they are doing.
Remove that and this faux surprise and outrage goes away and the real work can begin...fixing the ACTUAL problem...
In this case I actually buy the explanation that they can't get the IT side of things done in time.
While I have no insight into this here are my assumptions based on 15 years of dealing with this BS professionally. I expect:
A hairball of a mess of interconnected subsytems that were developed independently. Compatibility propably wasn't high on the requirements list.
Subsystems that got adapted for each and every policy change since the 1980ies. Even the subsystems propably aren't consistent anymore.
Load
Re:A cynic's view (Score:5, Interesting)
For who's benefit, though?
As far as I can tell, Republican partisans believe that everyone will hate Obamacare once it actually exists, which would mean that the Democrats are trying to avoid having it exist. The Democrats could have cut a deal with the insurance companies to prevent things from rolling out on schedule so they wouldn't have to deal with the negative campaign ads about their support of it.
On the other hand, Democratic partisans believe that everyone will love Obamacare once it actually exists, which would mean that the Republicans are trying to avoid having it exist. The Republicans could have cut a deal with the insurance companies to prevent things from rolling out on schedule so they wouldn't have to deal with the negative campaign ads about their opposition to it.
Or, alternately, gerrymandering has made it almost guaranteed that the House will be controlled by the GOP, and Obama is not up for reelection, so no matter what happens in November of next year nothing will get done. And don't think waiting 2016 will help, because the staunch Republican voters are slowly dying off making the president likely to be a Democrat, but still have a majority in enough congressional districts to keep the House Republican. So there's a good chance that absolutely nothing useful will come out of Washington D.C. for at least another decade.
Re: (Score:3)
Actually, Republicans have been well documented (in their own writing) as knowing that if Americans ever got decent healthcare reform they'd vote for the party that gave it to them forever, dooming the Republicans to losing forever. That's why Republicans fought to hard to prevent health care reform, then negotiated like crazy to make it as complicated and ineffective as possible, and made sure that the major benefits were deferred until after the 2012 election (hoping to win the election and kill health ca
Re: (Score:3)
Re:A cynic's view (Score:5, Interesting)
In most polls on the subject, including some internal studies by the Republican Party, younger voters don't exactly like the Democrats, but think the more prominent Republicans are so insanely dangerous that they won't even consider them. I mean, running down the list of everyone who has made it onto the Republican presidential ticket in the last decade:
- George W Bush: Flat-out incompetent, with policies that: bankrupted the US treasury, gutted FEMA and then stood by while a major American city was destroyed, started 2 wars on false pretenses, willfully broke at least 5 of the 10 amendments in the Bill of Rights, ignored counterterrorism until it smacked him in the face with the biggest intelligence failure in US history, and caused the greatest economic mess since the Great Depression. The Republican Party has done its best to minimize his influence on the current campaigns.
- Dick Cheney: Admitted war criminal, and the architect of many of the bad policies of George W Bush.
- John McCain: In his first key decision as a would-be president, chose Sarah Palin. If he'd wanted a woman, he could have gotten someone at least competent like Christine Todd Whitman.
- Sarah Palin: She was stumped by the question "What magazines and newspapers do you read?" Enough said.
- Mitt Romney: Didn't know where Iran is, which I would think is kinda important if you're president. Announced that he didn't care about the fate of half of the citizens of the country.
- Paul Ryan: Produced budget after budget where the numbers, based on ludicrous assumptions (like 20% economic growth), fail to add up. And that's his area of expertise.
As for the last round of Republican primary candidates:
- Rick Perry and Newt Gingrich: Both at least appear to be racists, whether intentionally or not. That's a big deal to the growing percentage of young people who aren't white, and also to the significant percentage of white young people who oppose racism.
- Rick Santorum and Michelle Bachmann: Both have made it quite clear that their religious beliefs will trump scientific or statistical or factual evidence where the two conflict.
- Herman Cain: Had no actual factual understanding of any of the issues, as anyone who listened to an extended interview figured out pretty quickly.
- Ron Paul: Insightful about some stuff, also nuts about some other stuff. By all appearances, he believes the US government should not be in the business of issuing money.
So who is this Republican that is not going to be seen as incompetent, corrupt, or crazy?
Defining out-of-pocket (Score:3)
Wouldn't that be a different plan?
For one thing, for existing insureds with an out-of-pocket limit higher than permissible under the Affordable Care Act, the insurance company would have to cancel the remainder of the old policy and enroll the insured in a new policy with the lower limit as of the effective date of the Affordable Care Act. Recording this cancellation and enrollment would take some coding. For another, what a policy defines as an out-of-pocket cost and what the Affordable Care Act defines as an out-of-pocket cost may differ.
Balance :) (Score:4, Interesting)
We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person's out-of-pocket costs.
So what's on the other side of this "balanced" solution?
That's funny (Score:3)
My current plan already does this and I'm certain it's a basic tenet of all medical insurance plans. After all, most people choose a plan by balancing the up front premium costs with the out of pocket costs on the backend. Der, someone is fibbing. X-/
Re:That's funny (Score:5, Informative)
Having worked firsthand in the medical data field, I'm actually more inclined to believe them. It's pretty easy for a billing system to say "You haven't met your deductible" or "You've paid about enough"... but as I understand it, the legislation requires that each patientis cost be tracked on a per-patient basis - not per-policy or even per-insurer. That means the records have to be combined from every participating hospital, correlated with information from every other insurance provider, and deduplicated accurately, before they can be added.
There are many people with multiple health insurance policies, who go to several healthcare systems, or have incorrect identification data in their records. What's being asked is not simply adding a few numbers in a bill, but rather merging trillions of records with few errors, across hundreds of formats from thousands of providers.
I wish them luck, and I'm glad I'm not in that field any more.
Re: (Score:3)
My policy has an out of pocket maximum for individuals and for family. If an individual reaches the max, they don't pay for the rest of the year. If the family combines to reach the family max, no one pays for the rest of the year. How is that any different than the 12.7K max per person?
Computers can't add? (Score:2)
How the heck does this happen?
Re: (Score:2, Insightful)
How the heck does this happen?
Technical people don't understand politics.
Re:Computers can't add? (Score:5, Interesting)
Well damn, better go tell Microsoft to stop making Excel... *facedesk*
Go ahead and try to put health data into Excel without violating HIPPAA and going to jail. The same medical procedure can be billed at hundreds of different rates, depending on numerous criteria, many of which are covered by privacy laws, or are calculated by third party labs or testing facilities. If you really think this is easy, then you don't have a clue. There is a reason that we spend 2 trillion a year on health care, and if you compare America's longevity, infant mortality, etc. to other countries, it is pretty obvious that all that money isn't being spent on actual effective medicine. My family doctor's office has one doctor, two nurses, and four people in the billing department.
Re:Computers can't add? (Score:4, Interesting)
Actual payouts due to litigation is around 0.5% of medical spending. The money wasted by Doctors on malpractice insurance is far more, but you'd have to ask them why they agree to pay so much more than the expected cost of settling. I suppose it's a risk management issue - you're extremely unlikely to have a $10M settlement, but if you did you'd be happy to have paid $100K/year for insurance, even though if you averaged the settlements it'd be $5K/year/doctor. That kind of thinking is probably how the insurance companies are making so much money. :-)
Computer? (Score:2)
Who said you had to use a computer?
Yeah.. (Score:3)
Today your government is brought to you by PepsiCo and Corrections Corporations of America [wikipedia.org], Low on regulation and high on regulatory capture.
Re:Yeah.. (Score:4, Informative)
Re:Yeah.. (Score:4, Interesting)
Re: (Score:3)
Uhhhh, what? Then how come every other western country can provide better average healthcare for lower pricing than US? Just because the potential expense is big doesnt mean that this scenario will play out for half, 1/3, 1/20 or even 1/1000 of the cas
The "death panels" set arbitrary limits on a per-person basis. It's no longer a set arbitrary limit, but set based on quality of life and personalized metrics. The Death Panels existed for long before Obama Care was first proposed by and passed by Mitt Romney. Got a failing liver and still drink? No liver for you. The drug that will save you life is called "experimental"? No drug or you.
The only difference in the death panels is that now, they aren't run by for-profit companies who have a financial
Re: (Score:3)
For what it's worth, the states that set up exchanges (i.e. that aren't incompetently run) are seeing huge drops in premiums, as much as 50% lower. And in Massachusetts where the exchanges have been running, health care costs have gone down for four years in a row now, while costs went up for everyone else.
The exchanges can't happen soon enough. If some states are stupid enough to force people to pay 2x as much for healthcare, people will figure it out soon enough and either move or elect competent leadersh
What a sick system (Score:5, Insightful)
It's just another example of bought and paid for politicians sucking the dick of corporations. The famous words "of the people, by the people, for the people" are such a sick joke if you look at the USA government. Coming from a country that covers 100% of such common procedures, I just can't imagine how people can live like that. And Americans still think they have the most superior country in the world. America! Fuck Yeah! Please stop spreading your ideas of freedom to the world and try spreading those ideas at home instead.
Q&A (Score:5, Funny)
Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs?
That depends entirely on whether the insurance company wants to remain in business or not. Next question.
Alternatives... (Score:2)
Paver Stones on the Road to Single-Payer (Score:3, Insightful)
Which is what Obama has wanted since day one.
1) Pass a bunch of rules with an unreasonable compliance schedule that no insurance company on Earth could hope to meet
2) Blame insurance companies when the new "free healthcare for all" law fails miserably
3) Use it as an excuse to ram single-payer down everyones' throats
4) Government now has the power to decide who lives and dies, based on political ideology, which is what leftist despots like Obama want.
Re:Paver Stones on the Road to Single-Payer (Score:5, Insightful)
6) Having someone in the family get a very nasty, expensive disease no longer ends in bankruptcy. Which means the rest of us continue to pay for it, but the afflicted family isn't ruined. As we live longer and eat more crap, this begins to affect almost everyone.
7) We quit talking about health care as though it should be less important than police or roads or a standing army - things we already care enough about to devote tax dollars to.
Re:Paver Stones on the Road to Single-Payer (Score:5, Insightful)
It's not such a great idea to remove personal accountability.
You get cancer, it's your responsibility. Can't pay the bills? Then don't get cancer.
You get crippled by a drunk driver who speeds off and is never caught? It's your responsibility. Can't pay the bills? Then don't get hit by a drunk driver.
Leg blown off in a terrorist attack? It's your responsibility. Can't pay the bills? Then don't go to spots that terrorists want to blow up.
Oh, that happened to you? So sorry, here's a bailout because you had personal accountability. Enjoy your long life!
I love the "personal accountability" line. It's simply a nice way of saying "not my problem - fuck you".
Re:Paver Stones on the Road to Single-Payer (Score:5, Interesting)
It's not such a great idea to remove personal accountability. When nobody cares about being healthy because "someone else" will pay the bill, then nobody will be healthy, and the amount of money required to pay the bill every year will exceed all of our production (although we already do not produce enough to pay our bills).
This has been disproven by 40 years of research, starting with the Rand Health Insurance Experiment http://en.wikipedia.org/wiki/RAND_Health_Insurance_Experiment [wikipedia.org] and confirmed with studies by insurance companies and big corporations that self-insure their employees. The reason people believe it, when the data contradicts it, is that they're following an irrational free-market ideology. The rich conservatives figure that they can easily afford copayments themselves, and they can save money by not having to pay for the poor. It's a way of making the poor pay more for worse health care. Copayments result in worse health outcomes, and higher health costs. Companies have tried copayments and gone back when it wound up costing more. In health care, the free market fails, and we know the reasons why. If a doctor tells you to go to the hospital immediately because you could die, you can't start researching it on the Internet and comparing prices. If you want to discourage people from spending money on needless health care, you should put pressure on the doctors, who actually make the big purchasing decisions. That's what they do in countries like Canada and England, that spend half as much as we do. This is part of the Republican war on science. They try a free-market solution, it doesn't work, and instead of accepting failure, they ignore the facts and make excuses.
The Rand study was a controlled study that randomly divided people into different groups, with different levels of copay among them. That's the strongest evidence you can get.
The goal of the Rand study was to find out whether people who must pay copayments would be more likely to use appropriate treatments, and less likely to use inappropriate treatments.
-- The people with copayments were less likely to use inappropriate treatments, but they were also less likely to use appropriate treatments -- like drugs to control blood pressure, asthma, diabetes, etc. As a result, they wound up in the hospital more.
-- With copayments, people with asthma would save $100 by not taking their asthma controller medication, have an asthma crisis, go to the emergency room, and run up a $1,000 hospital bill that they couldn't afford to pay anyway.
The Rand study didn't have the statistical power to tell whether people with higher copayments were more likely to die, but they did find that the secondary outcomes like high blood pressure and high blood sugar were worse.
Studies of copayments have been done ever since, by insurance companies and big employers that were looking for ways to save money. They consistently found that copayments cost them more money in the long run.
-- Copayments raised costs. http://www.nejm.org/doi/full/10.1056/NEJMsa0904533 [nejm.org] Increased Ambulatory Care Copayments and Hospitalizations among the Elderly. People made worse health care decisions.
-- When Medicare managed care companies imposed a small copayment for mammograms -- in over-65yo women, one group in which mammograms are cost-effective -- the rate of mammograms went down significantly. http://www.nejm.org/doi/full/10.1056/NEJMsa070929 [nejm.org] Effect of Cost Sharing on Screening Mammography in Medicare Health Plans
-- IBM tried a copayment scheme with their employees. It wound up costing them more money, so they dropped it.
The reason it doesn't work is that the free market doesn't work in health care. The Nobel prize-winning economist Kenneth Arrow explained why in an article seve
Re: (Score:3)
Paver Stones on the Road to Single-Payer ... Which is what Obama has wanted since day one.
How I wish that were true.
Just curious (Score:5, Interesting)
By what legal authority did Obama delay this implementation?
Re:Just curious (Score:5, Informative)
Wrong on so many counts.
The executive branch has the authority (granted by Congress) of delaying implementation of laws if there are implementation issues that require a delay to work out. It happens fairly often, though usually without the whining that's accompanying this instance. Which is odd, because it was Republicans asking for the delays, and causing the problems that lead to the delays, so it's nonsensical for them to complain about having been given the delay they asked for.
The waivers are a part of the ACA, to give states flexibility in how they implement healthcare reform, as long as they meet or exceed the targets for cost and coverage. And since Republicans were asking for the waivers via the mechanism defined in the ACA, I'm not sure how they'd justify complaining that they were given the waivers that they asked for. Or that it's somehow an exception to the ACA.
And the price support that Congressional staff is receiving for healthcare bought through the exchange is exactly the same as the price support that they are receiving for their current healthcare. Surely you're not arguing that people should lose their existing healthcare benefits from their employer.
So all of your examples of illegal acts are legal.
Care to try again? Perhaps after some more research...
Not as fast as one would hope. (Score:5, Informative)
So what is the opposition party alternative? Repeal.
That will limit the out of pocket costs when? Never.
Plus it will eliminate the various positive effects that the ACA is already having.
Basically the people that are screwing up here are the beneficiaries of the higher out of pocket costs, our Medical Insurance Overlords.
How would I? (Score:2)
while(true) {
DontBeBastards();
RememberYoureDealingWithHumanBeings();
}
Re: (Score:2)
refactored:
while(true) {
DontBeADick();
BeExcellentToEachOther();
}
Insurance Systems Suck (Score:3, Informative)
Easy answer on this one from someone who has worked in the insurance industry for a few years... the systems suck.
I am not defining 'suck' from the standpoint of performing because they do what they need to... however they become so bloated with complexities that even minor changes seem daunting. No person or team in my organization knows how the systems work from end-to-end and even the vendors need to use reverse engineering to resolve issues because of the complexities.
Not unusual for an insurance company to build a new system to support new plans because integration of the benefit rules into an existing system is not worth the pain. In the end the company ends up with several systems and IT silos built up around them.
The system at my current work will not be able to handle tracking co-payments over any period of time. The jobs that run overnight to price claims and track this sort of thing are already running at capacity.
On top of all this the executive management in this industry tend to be incredibly conservative and avoid risks like the plague.
Compliance time linked to the punishment (Score:5, Insightful)
Businesses exist to maximise profits, all profits, even those derived from delaying compliance activities. It becomes a simple cost benefit case. Is it cheaper to pay some politician's wage and go moan about how hard it is for your one programmer to re-write the software within a timeframe, or is it cheaper to simply hire the right number of people to do the job properly and quickly.
The answer is nearly universally the former. Major companies (not just healthcare) will rather moan about how hard done they are by the government than actually step up to comply with the new regulations. If a large fine is linked with non-compliance they'd have the software modified by the end of the month.
I've seen similar cases in industry too. Companies will replace truly horrendous parts of their plant like-for-like because installing what they want is tied with meeting the new standards of the day rather than the easier standards of when the equipment was originally designed, and thus we have a plant basically half replaced as new with no gear that meets any modern emission standards.
There's simply no motivation to go down the more expensive route.
An old programmer... (Score:3)
Gigabytes of proprietary spaghetti code <<shudder>>
I'm not putting my hand up to fix that.
Real-time processing required (Score:5, Informative)
Step 2 is an immediate response, step 4 is handled in batch processing nightly. So far so good. Except that the Affordable Care Act makes it *illegal* to make a patient pay more than the annual limit. The authorizer and/or the pharmacy can be charged for forcing the patient to pay above the annual limit. This means that the authorizer must be aware of limit of each patient and be able to respond in real-time so that neither they nor the pharmacy will be sued. The insurance company doesn't have that information available real-time, nor do they make it available to the authorizer.
It is a computer issue, but as simple as everyone thinks. Putting individual insurance files on-line so that the out of pocket expenses can be tracked real-time isn't trivial. Now, maybe the Insurance companies were hoping the law wouldn't be implemented so they didn't do the hard work necessary to get set up, or maybe the rules were only written as to how to handle the annual limit must be handled.
Just remember, the last time companies put together a real-time on-line credit/debit system, the government decided that they charged too much to support the infrastructure, and started regulating it. That was the Durbin amendment to Dodd-Frank, which put a fixed limit on per swipe fees - regardless of what the infrastructure and support costs actually are.
jerry
Bad summary (Score:3)
Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs?
It's somewhat more difficult when you waste three years assuming the Republicans are going to win big in 2012 and repeal the whole ACA. You gamble, you lose.
Snark aside, the real answer seems to be in the article:
The health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another.
So insurance companies outsourced different parts of their work to different companies that don't talk to each other. It's not "the computer's fault", it's an administrative problem within the insurance company itself. That text was right above the paragraph quoted in the summary, but curiously the submitter felt the need to ask a rhetorical question instead of including the most important piece of explanation in the entire article.
(Also, have you ever heard a story about a giant years-old financial/billing system that was clean, well-implemented, and easy to maintain and modify? I sure haven't. Not sure why we'd expect anything to be a trivial change in one of those...)
Here's an Idea! (Score:3)
What? Too simple for you? I guaran-fucking-tee you that if you put this mechanism in place, the insurance companies would suddenly discover that they can, in fact, figure out how much you've been billed over the time period in question. "Oooh! THAT billing info! We just need to look in this computer for THAT!"
Captain Obvious here (Score:3)
Wow, what a coinidence (Score:4, Funny)
My computer isn't set up to pay the bills. It isn't set up to pay the penalties for not paying the bills either. I was too busy programming an interface to my asset protection plan. It's beautiful. You should see it. Rounded corners and everything, and the interest on my overseas accounts is lined up in formatted columns and everything. It doesn't do medical billing outlays though. So sorry. I'm sure you'll understand.
If politicians (Score:3)
What? Not ready by 01/01/2014 - it's going to cost you a million a day per case penalty and all the systems would be able to add up the numbers at deadline just fine.
This is laughable
An yes, the whole Obamascare show is political: http://www.dailykos.com/story/2013/08/11/1230529/-The-real-reason-for-the-GOP-s-all-out-war-on-Obamacare?detail=email [dailykos.com]
Just Sad (Score:4, Informative)
Re: (Score:3)
As long as the payers for service and consumers of it are different entities, this sort of nonsense will keep happening.
Does your scheme include room for the risk-pooling functions that people tend to like in situations with low-probability very-high-cost possibilities?
I'm not sure that there is a worse implementation of insurance than our present one; but a medical payment system without some provision for risk-pooling is DOA.
Re:Competition, not regulation (Score:5, Insightful)
The USA health care system has some of the worst possible perverse economic disincentives. At literally no point is there a clear economic incentive for you to be healthy and taken care of.
1) Consumers have no interest in keeping costs down. They pay the same deductible no matter what happens. Unfortunately, this is only up to a point (see #4 below) but that's not going to enter casual consideration.
2) Hospitals have no interest in keeping costs down. They blatantly inflate their costs knowing that the insurance companies will only pay a fraction anyway. They also have no incentive to keep supplies costs down since they are paid "cost +" by insurance companies. They'll tend to buy whatever sponge or soap dispenser is in "the catalog".
3) Providers of supplies to hospitals have no interest in keeping their costs down. Hospitals get paid on a "cost +" basis by the insurance companies so charging $35 for that "medical grade" sponge that cost them $0.35 wholesale has 99% profit margins as its incentive.
4) Insurance companies have some incentive to keep costs down, which they generally do by axing their most expensive customers with any of the myriad of technicalities written into their eye-gouging 10 page contracts full of inverted double negatives and exceptions. A good example is somebody with a job who gets cancer. Sure, he/she may have excellent health insurance, but what about when he/she loses his/her job because they didn't show for four months while undergoing chemo therapy? Even so, the myriad of regulations in place (and a legal department that ensures that one plan can't be compared to another) provides an opaque enough service offering that customers are unable to distinguish which plan is actually "cheaper".
5) Doctors had to just about kill their mother to get through medical school, and are saddled with enough debt to make anybody contract stress-related symptoms. Since they get paid for the work they actually perform, they have every incentive to declare a medical emergency and take you under the knife, regardless of whether or not it's necessary or even beneficial. I'm not saying every doctor will give you heart surgery when you come in with a rash, but I'm not alleging something that doesn't happen [nytimes.com]. Citation 2 [usatoday.com].
The majority of bankruptcies in the United States are for medical reasons [cnbc.com], and the majority of *those* are by people who had health insurance at the time they got sick. Anybody who says this ridiculous would-be-laughable-if-it-wasn't-true system is lying or misinformed.
Re: (Score:3)
Re: (Score:3)
No it's because the results of an unlikely occurrence are still far more catastrophic then the gain any single individual can obtain by not holding insurance.
The main thing for-profit insurance does is increase costs for consumers. It was pretty quickly recognized early on that the best possible insurance scheme for a country is single-payer, where everyone is part of the same risk pool since that's the greatest possible dilution of risk (it also means the government is strongly incentivised to keep its cit