Obamacare Exchanges Collapsing as Insurers Exit

I like China's system of paying in for catastrophic stuff and paying out of pocket for regular doctor's visits for colds and shit. France has something similar as well.

Nothing is actually free. Things cost money. The people who make the things want to make money like everyone else. This shouldn't be terribly difficult to understand. In other countries they don't have the high costs, but they do have waiting periods, and it can be difficult for anyone that has something out of the ordinary to be diagnosed and properly treated. Like say what happened with Mandy Morbid (a Canadian citizen) and her EDS not being diagnosed until she sought care in the US.

Good question. The thing I've always heard is that they don't have to take on the costs of development and testing, and that somehow the US is effectively subsidizing it. But I'd love to know myself why things cost what they do beyond the nebulous concept of the companies involved taking advantage of government regulation to establish what amount to monopolies or other forms of cronyism.

I'm sorry, I didn't explain that well. The international plan that I have is from a private insurer based in the US.

What system exists in China for Chinese is a bit confusing to me (like everything else in China). The government controls most facilities, and prices are low by Western standards, but my students claim that healthcare costs are a big issue domestically, and there is a substantial market for private insurance. It doesn't seem like China is a model for anything.

There may something to that, but I think it has more to do with economies of scale and market power. In a socialized system, the government is the one huge consumer of medical supplies. If companies won't sell to the government at a price favorable to the government, there isn't anyone else they're going to sell to.

But arguably that would simply mean we'd have something akin to the military industrial complex, only it would be with medical industry.

If you take away profits, investment money will stop flowing into medicine. It will become dependent on government money, and will be, at best, about as innovative as NASA, which is building a giant rocket to nowhere using engines designed in the late 1960's and early 1970's based on design work done by people who were born in the 1800's.

But that also wouldn't bring the costs down, because we pay our health-care providers a whole lot of money. We get tons of European nurses and doctors to work here because our hospitals throw money at them. If we went with socialized health care, they'd just be government employees and their salaries would be set accordingly, in line with other sectors like sanitation and forestry. So a lot of the best and brightest would quit going into the health professions.

And one of the drivers of health care costs is that it's a skilled craft trade, and everybody of course wants the most highly skilled people for their personal treatment. Unlike other economic sectors, automation and assembly line production are only of limited applicability. Yet the most obvious way to lower costs is to use cheaper labor, and less of it, which is what they do in many other countries.

Knowing America, I can't ignore this possibility, either.

I dunno what to do to convince American companies not to be greedy fucks.

Two things you're overlooking here.

Even in countries with socialized medicine, there is still a market for private services funded by private insurance. They are precisely the advanced, experimental services that government facilities may not provide. The same profit incentives for R&D exist there, just on a smaller scale.

Second, given the abysmal state of the labor market, what other sectors are US medical staff going to flock to? Government jobs in the US may not make you as wealthy as private medicine, but they're still highly secure, coveted, and provide for a high quality lifestyle.

It's not that medical staff will flock to other jobs, it's that the people who've always entered the medical field will instead major in something like advertising or finance. Do you think many people become X-ray technicians because they really love X-rays? No, they hear how much X-ray technicians make and it sounds a hell of a lot better than bartending.

Oh, please. Business degrees have flooded the market since the recession hit. No one in their right mind is jumping into that.

We have an aging population that is living considerably longer than previous generations. Few people outside of pharmacy techs are gonna go hungry in the medical field.

Unless you socialize it, and then it will be like Venezuela where you'd take your own toilet paper to the hospital.

I vote the candidate and the issue(s), not the party. Nice try, tho. Keep exercisin' that tiny little leftist brain. Maybe your premiums will go down.

I realize this may be a hard concept for a Trump supporter to grasp, but many people go into medicine or other human services fields because they actually enjoy helping others.

Yes, and those make great candy stripers. But you're looking for a thoracic surgeon who went to Harvard and whose brother probably makes a ton of money on Wall Street.

When you're looking for a lawyer or a surgeon, do you look for someone who likes to help people or do you look for someone who knows their shit inside out?

Ideally both.

You really have trouble with the concept of people doing things out of empathy or compassion, don't you?

No, I don't, but a top student can go into international finance and indulge his compassion with charitable donations instead of becoming a doctor.

Or, look at the people who work at a food pantry. They love helping people. I wouldn't want them operating on me. For that, I want someone really smart, who forsook other lucrative career options because medicine also pays very well.

If you quit paying them very well, a whole lot of the brightest students will find other avenues for their talents. In part purely because of the money, and in part because low pay equates to us putting a low social value on being a doctor. We're going through that with lawyers right now, with law schools shutting down and cutting back because there aren't many lucrative jobs for lawyers these days, at least compared to the number of students the law schools were graduating.

And your contention is that in countries where insurance companies aren't allowed to rape people in the ass for fun and for profit, doctors make the same amount of money as people who work in soup kitchens?

No, you complete fool.

What happened with lawyers is a bunch of them jumped into law school or were in the middle of law school as the economy crashed and the demand for new lawyers plummeted. I assumed that's balanced out by now since only the truly passionate for law are applying, as anyone looking for a paycheck can find other avenues where they won't want to blow their brains out six months the after taking the bar exam

Insurers have to spend 90% of premiums on care, and since everyone has to buy health insurance, there's a guaranteed market. Providers, of course, want to set reimbursement rates (read: prices) as high as possible (which removes incentive for consumers to simply go uninsured), and can do so as there's no meaningful price comparison possible, with rare exceptions. All insurers have to do is not negotiate very hard with them, and they'll be able to raise premiums to cover the cost (making that 10% larger in absolute terms). If all the insurers in the area do the same, they can all raise premiums. And there's little to no risk of defection due to the structure of the the contracts they have with employers and the self-insured, both of which are sticky customers to begin with because of the provider networks for each insurer, so there's no guarantee that a defection would actually work. So it's easier to collude than compete, and there are secondary benefits like not having to advertise, the budget for which comes out of that last 10%. It's a win for everyone but the consumer.

A US general practitioner makes an average of $161,000. A Mexican GP makes an average of $21,000.

Which one do you go to?

Don't you work for the government? Go get a real job then you can maybe start throwing out the word leftist.

The one that does the best at his job.

Edit @gturner

Did this guy really just compare wages in Mexico to wages in the USA?

Maybe when I can get a bucket of cervezas for $2.50 delivered to the patio of my waterfront hotel room that I'm paying $85 a night for in America I'll start vacationing there.

The $21,000 is adjusted for purchasing power parity, and the Mexican GP's are paid only 2.1 times the average Mexican per capita GDP, less than half that of US doctors. Needless to say, a lot of them probably aren't Harvard Med School material.

Neither are a lot of US doctors.

A lot of them also aren't University of Iowa material.

Or you could be honest, and compare the United States to countries with similar economies, instead of reaching all the way to the bottom of the chart to make a comparison to a country with a developing economy.

But that would require you to note that the Netherlands, Belgium and Australia all have higher specialist salaries as a percentage of per capita GDP, and that for general practitioners, the United Kingdom, with its OMG teh socialism!!! NHS, is at 3.9 times per capita GDP versus the United States' 4.1 -- hardly a huge difference.

The evidence shows that even in countries that don't blindly prostrate themselves at the feet of the Almighty Free Market, doctors aren't exactly on food stamps.

And that's because if those countries slashed doctor's salaries, they'd soon find themselves without many doctors.

Do you think someone smart is really going to put themselves through 12 to 16 years of hell, doing an internship where they're working 100 to 120 hours a week, if they won't end up as well off as a guy who skipped all that schooling and got a job managing at Best Buy?

Defense department, Goober. You know, one of the few Constitutionally defined functions of government?