How Big Data Is Destroying the US Healthcare System 507
KindMind writes "Robert Cringely writes on the idea that technological advances have changed the health care system, and not for the better. The idea is that companies now rate individuals instead of groups, and so move to a mode of simply avoiding policies that might lose money, instead of the traditional way that insurance costs were spread over a group. From the article: 'Then in the 1990s something happened: the cost of computing came down to the point where it was cost-effective to calculate likely health outcomes on an individual basis. This moved the health insurance business from being based on setting rates to denying coverage. In the U.S. the health insurance business model switched from covering as many people as possible to covering as few people as possible — selling insurance only to healthy people who didn't much need the healthcare system.'"
so... (Score:3, Interesting)
Re:so... (Score:4, Insightful)
Radical libertarian playbook step 1: Try to make the story about the government.
Re: (Score:3)
There's nothing particularly radical about that. The underlying philosophy of libertarianism is one such that all incorrect decisions come from a lack of freedom(usually caused by the government).
I would call such a statement extremely radical. Basicly it exculpates every individual and blames all his incapabilities, errors, misdeeds and outright crimes to a lack of freedom caused by the government. It's pretty close to a marxist viewpoint, which states, that in social production, individuals are forced into objective relationships independent of their free will.
As an Asshole, I support this (Score:5, Funny)
Insurance companies can do what they like - who are we to tell them what policies they can and cannot agree to? Furthermore, by keeping the future-sick out of the pool, they lower costs for the patriotically healthy.
Down with Statism! Towards a Individualist Future for All!
Re:As an Asshole, I support this (Score:4, Insightful)
Yes, it is a parody, and yet... (Score:2, Insightful)
If one provider takes on coverage for "suspected losing cases", then they will go out of business, especially if their competitor is always only taking "profitable cases".
Really, doesn't it all boil down to charity and one's lot in life? As a society, it would be nice to provide the basics, such as trauma care, like a few sutures to stop some bleeding, fixing broken bones, toss in some antibiotics, etc. because that is cheap.
How
Re:Yes, it is a parody, and yet... (Score:4, Insightful)
So it is the classic problem of "behavior B is best for everyone, but behavior A is best if others are doing B or A", so unless some force changes the payouts (i.e. regulation) to make B more attractive and A less.
Re:Yes, it is a parody, and yet... (Score:5, Insightful)
The whole free market angle on health insurance is complicated by the fact that the people who require the most expensive medical care can't work. This isn't like shopping for night classes, maids, smart phones, cars, or new housing - in all of those cases you have an income while you search for a deal on new service. With health insurance, if you desperately need expensive medical treatment there's a good chance you aren't able to work to pay for it.
In addition to that, while some people with expensive medical costs will never recover fully and will always be a net financial drain on the system and the economy, others can. If your cancer treatment fails or prolongs your life slightly but you still die of cancer, then that is tragic and expensive. But increasingly people do go into remission and live and work another ten, twenty, or forty years after their cancer diagnosis. Likewise surgery and care to recover from an accident, assault, etc... might take years but you could emerge at the other end a fully functioning member of society again.
Re: (Score:3)
If one provider takes on coverage for "suspected losing cases", then they will go out of business, especially if their competitor is always only taking "profitable cases".
Try reading TFA. Pay attention to the part where (as in the summary) they explain the shift away from an all risks pool to a preferred risk pool.
Next, learn something about why healthcare is so expensive, because you clearly have no fucking idea. Hint: it is related to the business model of the insurers, not the actual cost of the delivering the care. If it were, all those other countries who are delivering better healthcare for far less money would not be doing so.
Re: (Score:3)
The business model of American insurance companies (as if they all have the same model anyway) has little to do with the cost of health care. The high cost of health care in this country is due to an almost total lack of regulation over health care prices.
As an example, if there are price controls for drugs, the cost of drugs will come down, whether there's an evil capitalist insurance company involved or not.
Re:As an Asshole, I support this (Score:5, Insightful)
Yep, that's why we should have a single payer system of health care coverage. The hell with the insurance company middle men.
Re:Yeah, beacuse... (Score:5, Informative)
As a Canadian, here's the thing I don't get about the American "fear" of single-payer health care system : "Oh my god, the paperwork! And the bureaucrats that deny care!"
Now here's how it works for a Canadian : You go see a doctor, you give them your single-payer card and... That's it. There's no additional charges or paperwork to fill out, no administrative useless bullcrap. Heck I got surgery done a few years back and all I had to do was to show up at the hospital on time and show them my little card. No cash needed, no bill, just care.
Re: (Score:3)
Re:As an Asshole, I support this (Score:5, Insightful)
I know it's parody, but there is a really good point in it:
Yes, in a free market, companies are free to do what they want. (policy and contract wise)
But... if they do what they want, who is doing what should be done? Namely providing health insurance to the ones who need it (which may be anyone here at some point)
And that's the point where the state had to step in, because the insurance companies didn't do what they were supposed to do.
Re:As an Asshole, I support this (Score:5, Insightful)
This is the difference between Insurance and Insurance Companies.
Insurance is a bet between the insurer and the insured that the insured will not need to cash in. By setting appropriate odds, the insured pays less for benefits than if he/she covered them directly and the insurer makes a profit.
This scheme can be extended in 2 ways. First, the insurer can take some of the premiums and invest them, insuring more profit, since the invested money helps reduce the amount of reserve cash that has to be held in order to meet obligations.
The second way to extend this is to broaden the pool. Take lots of people. It's possible to compute over a statistical population how many people will cash in and set rates, reserves, and investments accordingly. This is what actuaries are for. You also deepen this pool by extending it through time, since the claims rates for many insurable conditions vary with age.
That was the original idea. Insurance companies were early and enthusiastic adopters of computer technology since computers helped with the bookkeeping of the large pools of insured people as well as being able to assist with actuarial computations.
More recently, however, 2 things have distorted that plan. One the one hand, advances in technology have skewed the original actuarial computations. Car crashes are more survivable, cancer isn't a guaranteed death sentence, and so forth. You have people paying in longer, but the expense of the payouts has also risen, and the likelihood that multiple payout events later in an otherwise curtailed life will occur likewise.
The other distortion has been that really cheap computing has led to the development of sophisticated data mining. This, in turn has led to the processes of "cherry picking" (favoring those who will pay in but not make a claim) and "lemon dropping" (dropping the policies of people most likely to prove unprofitable). All of which makes the process more efficient.
The problem is, this efficiency is gained at the expense of one of the primary benefits originally accorded to organized insurance. The pools become shallower and narrower. The insurance companies get more profit, but the outliers in the insured base pay for it. The more likely you are to truly need insurance, the less likely you'll get it. If not from outright denial, simply because in order to support these extra profits, you'll pay a higher premium rate. If you can afford it at all.
Re:As an Asshole, I support this (Score:5, Insightful)
"Inelastic demand."
A "free market" (supposedly) works by normalizing prices to the point where profit is maximized and no higher.
In the case of "healthcare," the good for sale is "not dying", so a moment's consideration should be all it takes to realize why it is entirely a sellers' market.
Sounds like a problem... (Score:5, Insightful)
That will require a government solution. Either laws preventing health insurance companies from turning down coverage on individuals in that manner, or an actual heath care system for all and an end to regular private insurance.
Or we can go full capitalist and just get rid of health insurance, then the cost of heathcare will have no choice but come down because almost no one will be able to afford the service (causing the providers to go out of business).
Why the PPACA was necessary (Score:5, Insightful)
A business that makes money by turning customers away does not lend itself to "free market solutions".
So Obamacare prevents companies from refusing coverage or dropping it when the customer gets sick.
Re:Why the PPACA was necessary (Score:4, Insightful)
So Obamacare prevents companies from refusing coverage or dropping it when the customer gets sick.
hmm, I now see why the republicans hate this idea. its bad for Big Business and good for the little guy.
Re:Why the PPACA was necessary (Score:5, Insightful)
Health insurance companies couldn't drop people when the customer gets sick prior to the ACA. The change is that they now can't deny coverage for previously existing conditions.
Its good for some little guys, however its bad for the majority of little guys. Some people will get coverage who otherwise would not have. The rest of us will have higher premiums.
That's pretty much the definition of insurance. Yes, you pay more than you likely would have to, but you don't get catastrophicaly screwed if you are 'that guy'. When you write 'the rest of us', you are assuming that you are the heathly person, and not the one with the previously existing condition. You don't know that. It might be true right now, but that could change tomorrow, based on some test or event.
Further, your analysis assumese that the costs for a person without an existing condition just disappear. They don't. That person, who possibly can't get insurance, ends up in the hospital anyway, and then costs are shared by everybody else because your insurance pays for it in higher hospital costs. When you go to the hospital, it costs $100 rather than $50 because there is $50 added for uninsured people. It's even worse than that because it's a hidden cost. You don't know what percent of that $100 is cost of treatment and how much is overhead cost by uninsured. Better to have everybody covered, your insurance go up by a little and then the hospital costing $50.
Not really (Score:5, Insightful)
At the risk of being modded troll, let me say that that's the trouble with Capitalism. The real world doesn't fit into it's principles and ideas. Health care is too complex and purchased too rarely to make Capitalism a good fit for acquiring it. The classic example is that it's tough to comparison shop on a heart transplant....
Re: (Score:3)
Re: (Score:2, Funny)
I agree, even though I am a free market advocate. The long-term solution to healthcare is completely free market: your parents buy you a health insurance plan before you're born (similar to how parents know they have to pay for their kids' college and braces). In the meantime, for those of us already born, Medicare should be expanded to cover everyone born before (e.g.) 2015, and no one else -- ever. A 100-year phase out of Medicare similar to the phase-out Ron Paul h
Re: (Score:2, Insightful)
I like it!!!! I am going to register a corporation tomorrow to get ready for this. I will then offer by far the cheapest option available. For getting such a huge piece of the market I will of course pay myself tens of millions per year in salary. In 15 years, when it turns out I cannot actually cover their health care, I'll simply have to close the company and leave the poor saps who bought my insurance dangling in the wind. I'm going to have my hundreds of millions though, so whatever.
Re: (Score:2)
Re: (Score:2)
That would be fraud, which is in the purview of the government to prosecute. Prevention of such a calamity is in the purview of the private sector, where private ratings agencies would conduct audits on the financial solvency of insurance companies.
If we replace the term 'private insurance companies' with 'banks' we can see just how disastrously naive that notion can be.
Re: (Score:2)
Re:Sounds like a problem... (Score:5, Insightful)
Re: (Score:2)
as the least centralized authority is the individual, it seems you are either trying to outlaw insurance companies, or legalize and new form of robbery. It is hard to distinguish your policy from pure individual responsibility for payment and possibly replace any insurance with a line of credit.
Im not saying your wrong, but I am saying that you are not discussing insurance.
Re: (Score:3)
Re: (Score:2)
You mean like the McCarran-Ferguson act of 1945?
Re: (Score:3)
If you eliminated the entire DOD budget, you would have a slight budget surplus, all else being equal (I know it would not be equal, because of the huge negative effect of lost spending, but please bear with me). However, you still have >3T in spending to account for. Where on earth would that money come from? Some of it is SS tax, some is business tax, but federal income tax is the biggest piece.
Re:Sounds like a problem... (Score:5, Insightful)
I'm generally not a "government solutions" kind of person, but I do wonder how private insurance is allowed to exist for essential things like health care. How does the profit motive not create an inherent, unethical conflict of interest?
Also, insurance spreads risk and expense over a pool of policy holders. Pretty much everyone needs health care. Coverage-wise, it would seem like one large, central pool would be the best case. And, if the insurer isn't out to make money, it could instead focus on, say, reducing premiums.
Re:Sounds like a problem... (Score:5, Insightful)
That's why in sane countries they've gone Single Payer, as opposed to the USA which is run by lunatics who still think laissez-faire anarcho-libertarian economic theory does anything but cause monopolism and boom/bust depression cycles.
Re:Sounds like a problem... (Score:5, Informative)
If you think the US is "laissez-faire anarcho-libertarian" you're stupider than you are a troll.
Read Moryath's post again, Gothmolly.
... the USA which is run by lunatics who still think laissez-faire anarcho-libertarian economic theory does anything ...
I suspect Moryath is quite aware of what the US really is, but is also aware that our elected representatives live in a fantasy world that reflects the reality they wish they could live in, not the reality they impose on those they "represent".
Re: (Score:3)
He didn't say the USA is "laissez-faire anarcho-libertarian". He said it's "un by lunatics who still think laissez-faire anarcho-libertarian economic theory does anything but cause monopolism and boom/bust depression cycles."
Which gets us the worst of both worlds: It gets the government meddling of socialist systems, and the corporate meddling of capitalist systems, without the controls either provide. (Instead we socialize the controls of the capitalist systems, and capitalize the controls of the sociali
Re:Sounds like a problem... (Score:5, Interesting)
I'm generally not a "government solutions" kind of person, but I do wonder how private insurance is allowed to exist for essential things like health care.
How is essential defined here? Which of the following goods and services are essential?
Every single one of these things could save lives or drastically improve one's quality of life. Some of these are commercially available, some are available in hospitals, some are neither. Is it the presence of a doctor that turns some of these things into "essentials" and others into goods? Which of these should we allow profits on? If a government system does not cover any of these things, is it unethical?
If profits are unethical, should we allow profits on anything? Why?
I know this is a smarmy post—I'm not trolling, honestly. But I find people come into these conversations with a pre-existing mental framework that "health = essential" and therefore "profiting on health is unethical" without much exploration. Not everything offered in the health care industry is essential or life-saving, and many goods and services which are absolutely essential and life-saving are offered privately with no objections from anybody (e.g., refrigerators). What makes "health care" exist outside of the framework of goods and services in general? Most health care spending is dedicated to gradually improving quality of life, not saving people from axe wounds. If allowing profit and unrestricted competition is a bad way to improve people's quality of life, why are we even talking about health? Shouldn't we jump to the conclusion that anything that improves people's lives should be strictly non-profit and centrally planned?
Re: (Score:3)
I think that most people don't have a problem with *reasonable* profit earned by providing essential things, as hard as reasonable is to define. They have a problem with "gouging you for as much as they can take from you because you need it and have no choice but to die or live a life of suffering". That's no longer profit, that's just plain exploitation.
Re: (Score:3)
I don't think people from the other side (like me) who are sane think capitalism is bad. The issue is capitalism isn't the point of society, instead, it should be a tool to promote common good, to increase the utility of society.
So, profit isn't bad, as it increases utility in society. Whoever, when capitalism becomes the point, the motivation, that is when we draw the line. It's like a CS instructor focusing on teaching C or C++ but not teaching how to program with any tool they can find. Some tools are be
Re:Sounds like a problem... (Score:4, Insightful)
LIfe, liberty, property, pursuit of happiness and all that.
Still, I don't know why we get all hung up in debate. National health care works. There is proof everywhere. The question you ask really is irrelevant. There are models that work well we can simply copy.
When a broken limb doesn't carry the threat of crippling debt and care of a chronic but treatable illness isn't a severe financial burden life is simply better. Getting injured and having a many-nights stay in a hospital in Europe might cost you all of 20 dollars, not tens or hundreds of thousands. No years-long fight with medical providers and insurance companies afterward either. If you're an American, this is probably really shocking to you.
Does this hurt some companies business models? Sure does.
Are we going to have to kick a bunch of crooked politicians out of office? Yep.
Are we going to have to tell a bunch of ignorant conservatives to sit down and shut the fuck up? Yes. (Yes. They are the problem. It's time to grow up and talk like adults.)
Re: (Score:3)
Still, I don't know why we get all hung up in debate. National health care works. There is proof everywhere. The question you ask really is irrelevant. There are models that work well we can simply copy.
My problem is less with Single Payer, but more with who will be in charge of it all.
There have been 18 government shut-downs since 1976 (http://en.wikipedia.org/wiki/Government_shutdown_in_the_United_States).
The Us government has a track-record of grasping for more and more power, regardless of the cost.(Income tax was originally a 'wartime' thing, and taxes are currently used to manipulate every sector of the economy)
The US government has a track record of poor management and blatant cronyism(Copyright ref
Re: (Score:3)
The problem is that human nature being what it is, we are all addicted to life, and it is a well known fact that nearly all of us will do whatever it takes to preserve our own life and health if we think that is required.
So since this is a known fa
Re: (Score:3)
The problem with fixing prices and killing profit motive is that it prevents
No. No, it doesn't.
Only if you assume that only selfish bastards exist and if you design a system that in no way whatsoever rewards progress or punishes regress or stagnation.
Stop thinking that money can be the only motivation for humans. Just stop.
Re: (Score:3)
You speak of this like it's a bad thing. If our choices are:
1) have everyone pay exorbitant
Re: (Score:2)
Insurance companies price insurance based upon an individual's risk. The fact that some people can not afford the price of their insurance either because they are poor or because they are high risk is not the insurance company's problem.... it is the government's problem. The government could leave the insurance market alone, but provide medicaid to the poor and high-risk pools to those who are of high risk.
Re:Sounds like a problem... (Score:4)
or, the government could kick the companies' ass and force them to abandon the concept of PROFIT when it comes to human life.
we don't have a profit motive for giving us roads, clean water, electricity. well, there is some, but its mostly an infrastructure INVESTMENT in our own people.
if those things (roads, water, etc) were left entirely to companies, the rich would have them and no one else would.
is this the kind of world you want to live in? not me!
we (the US) is one of the richest countries in the world, if not the richest. the fact that people lose their houses over being sick and unlucky enough to be poor enough to not afford insurance (or to have insurance and the greedy bastard company cancelling you!) is an insult. a damned shame and a preventable problem. we have the money here. but the wealth distribution is skewed so that the uber rich who can afford to get sick don't actually care about insurance. the rest of us do care and we are only a few paychecks away from being homeless if we get unlucky and very sick.
some things should not be capitalistic. providing care for sick people is one of them.
unless you are a monster, that is. and we clearly have quite a few of those running around and running things, here.
Re: (Score:3)
How does the profit motive not create an inherent, unethical conflict of interest?
it does!
but that's beside the point. if you disagree, I'll invoke the danger word: SOCIALISM! you're programmed to hate anything that is even close to being attached to this word.
Re: (Score:3)
Re: (Score:2)
What do you think the Affordable Care Act does?
Re: (Score:2)
That will require a government solution.
Why?
Re:Sounds like a problem... (Score:4, Insightful)
because spoiled brat rich guys don't want to contribute their fair share to the society that made them rich.
that's why.
they won't act good on their own.
Re:Sounds like a problem... (Score:4, Interesting)
Re:Sounds like a problem... (Score:5, Informative)
Before people go apoplectic keep in mind the concept of medical tourism, where people go overseas to places like India for heart or other major surgeries for ten cents on the dollar or less, with success rates that are only marginally worse than that in the US.
There's more to competition than just nominal competitors. Hampering, even due to well-meaning regulations, transparently occurs, and to our detriment.
Go watch the Tucker film, about the guy trying to start a competitor to the big car companies in the 1950s. The big companies used every manner of regulation, requiring expensive development and lawyers and nitpicking, just to satisfy, and used it to effectively bar entry into the market.
All done 100% "in the name of the people's safety".
Fair enough, if you still wanna defend utterly massive regulation, but you pay for it in increased costs. Apparently about 5-10x in increased costs in medicine in the US.
Re:Sounds like a problem... (Score:5, Insightful)
Funny how medical tourism turns out to only be available to the wealthy...
Comment removed (Score:5, Interesting)
Re: (Score:3)
Yes, I'm from central Europe, and I went to the neighbor country by driving for 45mins, getting my laser eye surgery for half the price and most likely better quality.
However, cosmetic treatments usually are not covered by the insurance at all (unless it's from severe burns to the face or similar), and that includes my surgery as well.
Re:Sounds like a problem... (Score:5, Insightful)
Funny how medical tourism turns out to only be available to the wealthy...
No, it's not - the reverse really. If the treatment or surgery is expensive enough in the US, then a flight to Thailand and inpatient hospital care there is cheaper than care in the US. If you're wealthy, you don't go to a country with no medical liability and take your chances for the best care, you just write the check.
OTOH, single payer in the US with certainly create a 2-tier healthcare system, with doctors either working as employees of the hospital system, or working on a cash-only basis for far more money catering to wealthy clients. This has already started happening as doctor compensation is falling within the system. Long waits and second-tier care for the many, immediate boutique care for the few. But apparently that's the system people want.
Re:Sounds like a problem... (Score:5, Informative)
Long waits and second-tier care for the many, immediate boutique care for the few.
As someone who's taught many pre-med students and has family who've taught med students, I'll take a moment to dispute that point.
Almost all of the student's I've had whose primary interest was money and status were, without a doubt, the worst students in the class. They had no real interest in the subject matter and no passion for what they'd be expected to do. The idea of abandoning patients in need to give liposuction to old rich women is repulsive (in many ways) to genuinely passionate doctors. As long as normal doctors in a single payer system are making a decent salary, I would put my trust in them and not the greedy sociopaths that are so attracted to medicine today.
If you look back though history, traveling quacks were always eager to feed upon the stupid rich. It still happens in our time, too. There is no shortage of witch doctors and alternative healers. Ask Jobs... he saw it firsthand and he could afford the best medicine we have to offer.
Re: (Score:2)
Re: Sounds like a problem... (Score:3, Interesting)
No, the problem is that the first pill costs $4.5 billion, then every pill after that costs 5 cents.
Re:Sounds like a problem... (Score:4, Interesting)
Governments are ideally suited to provide this kind of service. They can still contract out to provate suppliers if they wish.
I don't see the same people suggesting that the road networks should be privatised so they'd have to negotiate a price for each stretch of road they used.
Ideology trumping experience. If you can't look at Europe > Universal cover even for the homeless coupled with Lower costs, and admit it is better then you are an idiot.
Re: (Score:2, Interesting)
If you are on an ambulance speeding towards the nearest hospital, you are hardly in a position to ask for prices (particularly if unconscious), and you couldn't get the EMTs to re-route to a different hospital even if you tried.
In cases where a patient is in need of non-critical care, it's highly unlikely that he o
Re:Sounds like a problem... (Score:4)
Not only that - if the drug company tells you that'll be $7 per month to buy the pill that will save your life, you pay the $7 and go on living. If the same drug company tells you that the pill is $100 per week or you die, then guess what - you'd better find that extra $100 per week or you die.
Free market economics doesn't work with healthcare because you are not free to make those choices. This doesn't happen anywhere else in the free market.
Re:Sounds like a problem... (Score:5, Insightful)
This is a struggle for me. It seems reasonable to me that there should be access to basic medical care for all citizens with as little standing in the way of this care as possible. No one should die from Dysentery in the United States. On the other hand, if Pyro_Peter's Nuclear Anti-cancer Medicines, Inc. spends $10,000 to make each Fermium Armed Genetically Tailored Smart Bomb Anti-Cancer Pill then I completely understand that if we want more FAGTSBAC Pills (*whew* that was close to being a really baaaad acronym) then Pyro_Peter's Nuke Pills, Inc. must charge more than $10,000 for that pill.
I think the tough part here is that the line for "reasonable access to basic care" is in different places for different societies. I'd also be concerned that the act of drawing that line would be sufficient force to prevent it from naturally rising with time. What if that line was drawn in the 1920's US? Where would medicine be today? Would we have some metric like the Consumer Price Index but for medical care to keep moving that line up?
Finally, and I know this is diverging from the actual topic of this thread, it is clear to me that your right to health care is a different sort of right than your right to free speech or your right to be free from unreasonable searches. No one else has to do anything for you to speak or for you to not be searched. Health care is different. Someone else has to do something for you to have a right to health care. What if they don't want to? Can you (or a government agent working on your behalf) compel someone else to provide you care?
It is a complex issue and the more closely I look at it the more complex it seems to get.
Peter
Re:Everybody pays (Score:5, Insightful)
No, looking at it from the outside [I'm not in/from the US, and rarely visit], the Republican's seems entirely against it because Obama is for it. They can only win if Obama and the Democrats lose. How it affects the American public is a distant second.
For example, way back, the Democrats tried to start healthcare reform with "Lets start with the proposal John McCain publicly came forward with during his run for the Presidency." Republicans response "No".
They are unable in any way, shape or form of publicly saying ANY aspect of the ACA is good, simply because it was put forward by a Democrat.
Re: (Score:3)
You might have a point, if health insurance were something your parents bought and maintained for you as a child until you became a self-supporting adult, and expensive chronic conditions that emerged during childhood were primarily the responsibility of your childhood insurance company to pay in perpetuity. Kind of like homeowners insurance. If your policy runs from January 1 through December 31, and your house gets destroyed by a hurricane on October 17th, you don't have to embark upon a mad rush to get i
Re: (Score:3)
If no one decides to become a lawyer or judge how can the government provide for protection of constitutional rights?
If no one decides to become a soldier how can the government provide for national defence?
Is it possible, just maybe, that all government is 'at the point of a gun'? Constitutional rights, basic requirements of government and law & order, etc?
Or perhaps economics rules the day, and if
Re: (Score:3, Informative)
Positive rights such as public safety and national defense are different from the classical (negative) rights that the parent referred to. Classical rights (e.g. the negative rights listed in the US Bill of Rights such as freedom from censorship, cruel punishment, illegal search and seizure) do not need a government to enforce them, since without a government you wouldn't need those rights.
Of course, the negative rights that protect you from the government are worth an awful lot without a bunch of positive
Re:Sounds like a problem... (Score:4, Informative)
You are wiser than most to realize that there is a distinction between Constitutionally granted rights and what many people are now declaring is a right.
You are right in a sense, but I think you are seeing "rights" too narrowly. The distinction that is generally made is between classical, negative rights (the ones in your 'bill of rights') and the positive, modern, or social rights (such as in your "equal protection" clause and in many european constitutions and also in some articles of the universal and European declarations of human rights.
The right to free speech is a "classic" (human) right. It is something between you and the government, and it acts as a prohibition on the government. It is a 'negative right' in that the government isn't forced to *do* anything, they're forced to not do stuff, like putting you in prison if you say stuff. The bill of rights used the phrase "congress shall pass no law" for a reason. The right doesn't mean that the government has to pay publishing cost for your newspaper, and it also doesn't mean that other citizens are forced to listen to you or banned from telling you that you're a twit if you 'exercise' your basic right. These rights can be "absolute" in the sense that they allow no exceptions, although it often isn't (the classical example being yelling 'fire!' in a crowded cinema) and in principle they cannot clash, since every negative right bans the government from doing something. The right to the freedom of the press and the freedom of religion do not clash: if you exercise your press freedom to say that not all Catholics are holy, there is no clash of rights, since the freedom of religion never prohibited you from saying that, it simply prohibits the government from establishing, favoring, regulating, or banning any religion.
The right to healthcare (and education, housing, property non-discrimination, etc) are all "social" (human) rights. They are generally positive rights, where the government has to provide something for the citizen. These rights are never absolute, in the sense that it is obvious that no one can receive all the education, health care, etc that money can buy. Also, these rights can clash with each other and with the classical rights: my right to self-expression can clash with your right to non-discrimination.
Sometimes, a right can be both 'positive' and 'negative'. For example, the right to "life" in the universal and European declaration of human rights (and implied in your declaration of independence) is mainly negative, in prohibiting the government of killing you in most circumstances, but can (and is) also interpreted positively as a positive duty to prevent certain loss of life and/or to investigate suspicious death. Similarly, the right to own property (e.g. article 17 UDHR but see also the 3d-5th amendment in the US Bill of Rights) is a negative right in prohibiting the government from taking your stuff (except through taxes, eminent domain etc.). However, it also implies a duty for the government to protect your property by banning and investigating theft etc, although the US Bill of Rights is phrased to exclude those duties by listing prohibitions against search, seizure, and quartering by the government, and does no list a "right to property".
Sources:
- http://en.wikipedia.org/wiki/United_States_Bill_of_Rights [wikipedia.org]
- http://en.wikipedia.org/wiki/Positive_obligations [wikipedia.org]
- http://www.un.org/en/documents/udhr/ [un.org]
- www.echr.coe.int/Documents/Convention_ENG.pdf
Re: (Score:3)
I think you're on to something here. Paying $100 per week is a price point that has become acceptable based upon the available amount of funds in the system.
What if health service providers were required by law to provide you with services regardless of your ability to pay for the services? In that case the service provider may actually devise a price and payment model that both you and he can accept. This is the current model that is in place today. Both hospitals and drug companies have programs to pr
Re:Sounds like a problem... (Score:5, Informative)
Paying $100 per week is a price point that has become acceptable
And that's the problem in a nutshell, Americans think it's acceptable to be ripped of by big business if the alternative is a government scheme has a that whiff of socialism about it.
US/AU dollars have been close to parity for a while. Currently in Australia a single man on $100K/yr pays ~$30 for UHC, a family of four with a single bread winner on $50K/yr pays ~$15/pw. And yes we are near the top of the list for "health outcomes", in fact our hard working death panels would have to work overtime to kill the extra 20K people per year it would take to catch up with the US. And yes, the government encourages you to buy private insurance if you want first dibs on a private bed, plastic tits, etc. Private insurance won't buy you better doctors, nor will it get you to the front of the queue for anything except cosmetics and a private bed. Nobody pays more that $1200/yr for medicine, once you hit that limit they are free.
For zero extra cost I get the same treatment anywhere in the EU should I fall ill while on vacation, as I did a few years back in the UK. I offered to pay the bill but the doctor just laughed and said - We have a deal with Australia to look after each other's citizens, it's only the silly Yanks who have to pay.
Re: (Score:2)
It is easy to price compare and to save a lot money if you want to. Most people are too lazy to be bothered.
I have had no problem obtaining price quotes from every medical provider I have used and I have saved a substantial amount of money by doing price comparisons. For those who are too meek to do their own price negotiation, there are companies who will negotiate price discounts for you at the cost of a percentage of the discount obtained. Here is an example: http://www.medicalcostadvocate.com/defaul [medicalcostadvocate.com]
Re: (Score:3)
How do free market solutions address your bleeding chest wound?
How do they address the young couple with no money and a kid on the way?
How do they address the situation where you need a drug and only one company makes it?
Insurance is not the health system... (Score:5, Insightful)
It's to their credit that we as a culture see them as the gateway to health care, and they have done many, many things to insure that people don't interact directly with providers, but in the end, they are middlemen. Nothing more. They do not provide care. Doctors, nurses, clinics and hospitals do. And, given the current state of things, they have done nothing to control costs.
Big Data isn't destroying the US health system. It's the lack of coverage, for-profit insurance protecting their margins by charging everyone more and more to do less and less, to deny payment (and therefore care) so that people get so sick that they lose their jobs and their coverage, passing on the burden to providers and taxpayers that, by law, can not deny essential care. It's a system that only pays up when absolutely necessary, that does not to help people stay off of the doctor's office.
It's a culture that insists that chronic illness or disability is a moral failing and that it is the fault of the person for merely being ill. It's the insistence that health is a privilege, not a right. It's not some computing trend that insurance companies are using to discriminate. Insurance companies have been doing that forever.
Re: (Score:2)
s/off/out/g. I can't brain today.
Healthcare vs. Insurance (Score:5, Insightful)
This is not destroying the healthcare system - it is (potentially) destroying the health insurance industry. The two are different things.
The auto insurance industry has had very fine grained data on drivers and their habits for many, many years. That hasn't affected the auto industry at all, and it doesn't seem to have materially affected the auto insurance industry either.
Re:Healthcare vs. Insurance (Score:4, Insightful)
The auto insurance industry has had very fine grained data on drivers and their habits for many, many years. That hasn't affected the auto industry at all, and it doesn't seem to have materially affected the auto insurance industry either.
If the government required auto insurance companies to insure people with pre-existing conditions (i.e. their car is already wrecked) then the situation would be different.
Re: (Score:2)
It still wouldn't affect the auto industry, only the insurance (and potentially auto-body and mechanic shops, which would stand to benefit). Though, as always, the analogy is horribly flawed. If you kill or injure yourself, you can go buy a new one.
In fact, auto insurance is nothing like health "insurance" because no auto insurer covers routine maintenance (checkups) or design flaws (existing conditions).
Re:Healthcare vs. Insurance (Score:5, Insightful)
In the auto insurance industry, if you can't get insured, you don't get to drive (legally). In the health insurance industry, if you can't get insured, you die. Slight difference. Also, if you can't get auto insurance, it's generally your own doing. If you can't get health insurance it's generally due to factors beyond your control (regardless of the statistically poorer health of people who take worse care of themselves).
Re: (Score:2)
This.
Re: (Score:2)
Get back to the shrill, hormonally-driven stuff, please.
Re:Healthcare vs. Insurance (Score:5, Insightful)
Health insurers are destroying themselves. Why do you think people like me don't have insurance? We've figured out the game. If they are willing to insure a person, it can only be because that person doesn't need health care. So those who need it are denied, and those who don't shouldn't buy insurance because it is a ripoff. Either way, no one should be a customer of a health insurance company.
If you get insurance anyway, should change insurers about every 2 years so you don't get charged a huge "inertia tax", the penalty they love to levy on loyal customers for being loyal and not changing. And changing is only if you haven't developed some problem they can claim is a pre-existing condition that they shouldn't have to cover. And be ready to get a lawyer to sue them if you are injured and actually need health care. They will deny half the claims on various technicalities. They're testing you, seeing if you'll roll over, play dead, and let them get away with it. If you have family and friends to help you fight back, or aren't too beat up to fight back yourself, then they try to walk the fine line of denying just enough that it's not quite worth suing them. They'll try to wear you down, bury you in paperwork. They'll occasionally take your side and save you from an outrageous bill here and there.
The medical community's outrageous prices are the only thing keeping insurance going. If not for that, it'd be better to deal directly with the doctors. You still can, so I've heard. Have to do a lot of haggling, but it can be done. You may also need the leverage of not having any money, to get them to cut you some deals. They'd rather get some money than no money, if you should go bankrupt and get all those medical debts erased. Of course if you're hurt or sick, haggling sessions are the last thing you need on your plate. Medical debt is the #1 cause of bankruptcy in the US. Medical debt is also quite peculiar-- it doesn't seem to count the same as other kinds of debt, and I've heard it is possible to defer paying it and still be able to buy the basic necessities and even have a credit card. For this reason, many doctors won't even see you if you don't have insurance. Too easy to stiff them entirely.
If auto insurance worked like health insurance (Score:3)
You go in for an oil change. It costs $5 no matter what. You get a statement from the auto insurance company that is "not a bill" which is a good thing, because it shows that you were charged $500/qt. for oil.
The $5 oil change would be great, except that your auto insurance bill is $3000/mo, up from $2700/mo last year. Your lucky though. You're a 40 year old driver who hasn't had a ticket in 15 years. Family man. You've heard the horror stories about the young people and seniors trying to get car insu
One advantage of Obamacare (Score:5, Insightful)
Beatuiful segue from the previous article (Score:2)
Great timing to have an article about insurance companies using big data to isolate individuals, when the previous article is about researchers putting together a database of people's family ties...
http://tech.slashdot.org/story/13/10/29/2223231/genome-hacker-uncovers-13-million-member-family-tree
Using Big Data to MAXIMIZE Healthcare Cost (Score:4, Informative)
Medicare Bills Rise As Records Turn Electronic [slashdot.org]: The goal was not only to improve efficiency and patient safety, but also to reduce health care costs. But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care. Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms, according to a NY Times analysis.
Re: (Score:2)
This is why the rest of the world uses ICD-10 coding.
Re: (Score:3)
I've worked in health care biling. Here's what's happening. EMR (electronic medical records) allow doctors to easily bill for all the services they should always have been billing. Before, with paper forms, it was a huge hassle and lots of things were just written off and not followed up on, or got lost in the shuffle. Now that it it's automatic, there's no reason not to take every dollar you're entitled to by law. Solution: change the law.
No, it's people (Score:2)
Makes Perfect Sense (Score:5, Interesting)
I didn't feel like pointing out the reason they were declining coverage on the one appliance was probably because it was the only one that needed to be repaired, and twice at that. As such, it would be the most likely to fail again. And it did.
Still don't make it right though.
Broken to begin with. (Score:2)
I thought this is what we wanted (Score:2, Interesting)
This is "evidence-based medicine", n'est-ce pas?
Re: (Score:3)
If you think... (Score:3)
this is banned starting next year (Score:3)
Kind of bizarre that this whole jeremiad seems to ignore the fact that the Obamacare reforms ban exactly this practice starting in 2014? This is responsible for a lot of the disruptions to the market we're seeing now -- some young healthy people are going to be paying more, and some older sicker people are going to be paying less. (The other disruptions are that some of the old policies had coverage caps that wouldn't have covered expensive catastrophic illnesses; that's also banned, and their replacements are more expensive.)
Big Data Can Also Drive Positive Change (Score:2)
If you take out the ability of insurance companies to selectively deny coverage (which the ACA does), this ability to model outcomes can enable new more effective ways of paying doctors for care and hopefully improving outcomes. Given an expected outcome, an insurance company can pay for improving that outcome rather than just paying for every test run or treatment rendered.
The decline of the middle class (Score:4, Interesting)
This is slightly off topic, but I think it's not just the application of computing power to medical data, but the application of computing power to control and recover a lot of costs has generally been so successful that I think it's actually cutting the "slack" out of the economy and contributing to the decline of the middle class and growing economic inequality.
They're shaving the savings off the top and putting it in their own pockets, but the economic byproducts of the savings (cheaper goods) doesn't offset the economic loss of the savings not being spent on goods and labor, like additional inventory or additional workers.
Say a business sells a widget for $10. Their cost to make the widget is $4 and because of imperfect data/processing, sales forecasts, shipping, etc are all less accurate. They have to carry inventories to meet customer needs. Inventories require workers, facilities (which need construction...), they have to buy more raw materials. So $2 is added in overhead to the $4 and the profit on the widget is only $4.
With improved data/processing, they gain efficiencies. They carry as close to zero inventory as possible. They buy less raw materials. Need fewer workers. Smaller facilities (...less construction, fewer carptenters, less building materials, less ....) and so on. But the nominal cost of the widget doesn't go down, but the margin increases to $5 per widget because they save $1 in costs.
Since the price of the widget doesn't go down and at best rises slower, the consumer is only marginally benefitting, especially since the depressed employment resulting from greater operating efficiency results in lower wages, further mitigating any price declines or slowing price increases.
The $1 that was previously "lost" on administrative costs is now executive salaries, bonuses and benefits where it produces less economic impact than had it been spent on productive economic activity.
Re:Personalization (Score:5, Insightful)
We'd better get used to things being more "personalized," this is what we're moving to.
Various economic (and business) theorists have pointed out that this is part of a general pattern that's well understood: Insurance is based on spreading the cost of unpredictable events over a population, so that the victims of such events aren't bankrupt/homeless/dead/whatever if a disaster hits them. Insurance is basically a gambling game. If an event becomes predictable, insurance no longer works, since only those susceptible to a disaster will want insurance, but the insurance companies will refuse to sell policies to exactly those people.
A classical textbook example is flood insurance. There are many cases where the probability of a disastrous flood event has become predictable. The people and companies in the high-risk area want insurance, but the price is so high that a policy will bankrupt them. Such "insurance" can then only be provided by the government, but in reality, it's more in the nature of planned disaster prevention/recovery than insurance.
Various other theorists studying the medical field have been predicting that this will rapidly happen in medicine, too. Medical insurance made sense when most diseases were poorly understood, and it was impossible to predict with any accuracy who might be susceptible to which medial problems.
But we are getting more knowledgeable about such things. Medical problems are becoming much more predictable in general, and many major medical tests have much better accuracy than a few decades ago. Again, the inevitable result is that insurance companies will get access to the information, and will refuse to sell coverage (or will price it at bankruptcy levels) to people whose tests predict imminent medical problems. Eventually, this will mean all of us. This is how insurance has always worked, and medical insurance is not significantly different.
(Well, except for the fact that we know the exact probability that each of us will eventually have a major medical problem: 100% ;-)
Insurance isn't medical care. it's what insurance always is: a way of spreading the cost around in an unpredictable world. It only helps if the problems are unpredictable, but don't hit everyone. Medical problems are becoming more predictable, so medical insurance is slowly becoming irrelevant and unworkable.
In summary: The real problem here is using "insurance" to pay for health care. We don't need insurance; we need health care. As medical knowledge improves, the insurers will do what they always do: They'll collect premiums until just before you are likely to need something expensive, and then they'll refuse to renew your coverage. That's how their business works, when knowledge becomes available and the results of a gamble can be predicted. The "Free Market" system rewards companies that get good at this, and those that aren't as good go out of business.
Re: (Score:2)
I could be misinformed, but last I heard most of the single payer systems (UK, Australia, etc) were trying to wean people off into private health insurers because of unsustainable increases in costs. Not that the our private health system is a sparkling example of efficiency (OK its a dismal nightmare that more than doubles in cost every 10 years) but the answer does not seem to lie in either the single payer system or the private insurance system.
Re:What a load of BS (Score:5, Insightful)
The fact that a majority of Americans get no-questions-asked health insurance through their employers is exactly the problem and why we can't implement a sane system like the rest of the civilized world. Too many people think it's just fine the way it is.
And it is "just fine", until you decide you want to become self-employed and start your own business. Then all of a sudden, oops, you have a pre-existing condition? Sorry, no insurance for you. Or maybe you get laid off from work and can't find another job for a long time (hello, recession!). Sorry, no insurance for you. Or you're young and the only thing you qualify for is an entry-level job that doesn't offer health insurance as an employee benefit. Sorry, no insurance for you.
People who've worked stereotypical job-with-healthcare-benefits all their life can't fathom what it's like to not be in that position. And most importantly, they don't have a good understanding of how easily they could lose their nice job, along with their health insurance, in an instant and through no fault of their own.
The only reasonable health insurance system is to put absolutely everyone in in the same risk pool from birth until death. Anything else ends in having to tell some people, "Well, better hope you die quickly."