Everybody would be better off depositing the money they’d otherwise pay in premiums into a “disaster account” , like the healthcare savings accounts. When you think how much you’ve paid these companies o over the years, which you will never get back, or if you do you’ll only have to repay it, you can see it is a total boondoggle.
I remember when this really got started: I think sometime in the 80s? The insurance industry decided to declare a “crisis”! You got a crisis, you can get away with anything! I was on the board of our local library during that period. Because I’m a lawyer, they asked me to get us E&O insurance. No problem, it cost around $300/yr as I recall. Oh but the NEXT year, after the “crisis” was in full swing, the premium became exorbitant. And, as I wrote above, the industry is now moving to”claims made” policies which, really, don’t provide any protection. But as a doctor or lawyer, you are mandated to buy the illusory protection. It sux.
Hypatia – that is the nature of insurance. Instead of facing the low probability of a huge loss, we accept the certainty of a small loss.
Yes, the majority of people will (fortunately) never face that huge loss and will get back nothing from their insurance payments; instead, they will have paid a lifetime’s worth of small losses, just to protect themselves from the massive loss which never happened. On the other side of the equation, a few people will have suffered a major loss, and been recompensed; they will have got back much more than they ever paid in.
This all started with ship owners who never knew if their ship was the unfortunate one which would go on the rocks. Because of probabilities, mutual insurance made sense for them. Then government got involved!
There is a fascinating book on the subject: “Against the Gods – the remarkable story of risk”, by Peter Bernstein (1996).
Thanks @Gavin I’ll check out the book. But the thing is, now, insurance is very expensive and mandatory in many situations. I don’t think the insurance companies are keeping up their part of the bargain in assuming risk.
To call Medicaid “coverage” is a big stretch. Last I knew - maybe 25 years ago - Medicaid paid anesthesiologists about $15.00 (fifteen dollars) for the 4am epidural for its “covered” patients. These were disproportionately morbidly obese, high-risk patients with minimal or no pre-natal care. Now, since then, Medicaid payments have not only not increased - they have been cut! Back then, the nominal $15 (cringe when you factor in the sharp decrease in purchasing power of the USD) didn’t even cover the pro-rata portion of my malpractice premium. In other words, Medicaid payments often do not even cover the fixed costs of providing the services and, of course, they purport to “cover” everything.
LOL, indeed, when it comes to ChatGPT. I’m not going to waste precious time chasing down Medicaid payments, but I would bet good money nobody receives $9K - almost surely not even the total payment to everyone involved.
That said, I just happened to have asked ChatrGPT why Russia hasn’t the same interest in Ukraine that the US claims for itself as to the ENTIRE Western Hemisphere via the Monroe Doctrine. The answer was jaw-droppingly biased and untruthful (by both commission and omission) to such an extent that it has solidified my fear that the State will be concocting LLM’s which will blare only the “party line” and which will be legally deemed to be the final arbiter of truth; all else will be legally actionable “misinformation”. The live-fire practice round was held during the Covid plandemic. Get ready.
Agree about Chat GPT, useless for political and foreign policy questions
I understand that no hospital or doctor gets full amount from Medicaid.
Hypothetical example: doctor sends bill to Medicaid for $9000. Doctor receives $3000 from Medicaid. What happens to $6000 deficit?
I understand most doctors don’t accept Medicaid. Which doctors accept Medicaid and why? Is it financial desperation? I’m shocked any OB/GYN would accept Medicaid patients.
Accounting-wise, it is an “adjustment” or a “write down” for the billing party. Medicaid just ignores it, unless it exceeds some statutory or regulatory maximum allowed billing; then they prosecute and excise someone’s license. That’s part of why so few physicians accept Medicaid. Of course, there is a movement to force doctors to participate as a condition of state licensure. Some states do that with Medicare - here, in the “land of the free”.
The hospital costs for childbirth and how much Medicaid reimburses doctors vary depending on the state, hospital, and the specifics of care provided. Here’s a breakdown:
Hospital Costs for Childbirth:
• Average Costs Without Insurance:
• Vaginal delivery: $10,000–$15,000.
• C-section delivery: $15,000–$30,000.
• These costs include hospital stays, medications, anesthesia, and newborn care.
• What Medicaid Covers:
• If you’re eligible for Medicaid, most or all hospital costs are fully covered, including labor and delivery, room charges, and newborn care.
Medicaid Reimbursement to Doctors and Hospitals:
• Medicaid reimburses healthcare providers at rates that are lower than private insurance or Medicare.
• Reimbursement depends on:
• State Medicaid policies (rates vary widely by state).
• Type of service provided.
Examples of Medicaid Reimbursement Rates:
• Vaginal delivery: Around $1,000–$2,000 to the doctor.
• C-section delivery: Around $2,000–$3,500 to the doctor.
• Hospital reimbursement: Depends on the length of stay and services provided but often averages $6,000–$10,000 for a delivery.
• Reimbursement for prenatal and postpartum visits is typically bundled into a global fee that covers the entire pregnancy.
Why Reimbursement Rates Are Lower:
Medicaid payments are set by state governments and are designed to control costs for public healthcare programs. While lower, these rates ensure access to care for low-income individuals.
The US effectively already has socialized medicine. Medicare represents 22% of US healthcare spending. Medicaid is a further 18%, bringing the total to 40%. Given that the underpayment to providers, documented above, shifts some of the costs incurred by federal programs to other payers, the true total share of government-provided healthcare likely exceeds 50%. Furthermore, these government programs affect rates and coverage in the so-called private sector. The ironically-named Affordable Care Act (ACA) affects virtually all US healthcare.
Doctors are already coerced in various ways by Medicare, Medicaid, and ACA. This sort of coercion incompatible with the ideals of a free society. What’s worse is that it doesn’t even result in cost savings. As I’ve pointed out elsewhere, US performance (measured by outcomes) is comparable to, or worse than, other developed countries at about double the cost.
If there’s going to be de facto socialized medicine, at least let it deliver good results at lower cost. It’s about 18% of US GDP now and rising. How much farther can it rise? Imagine what could be done if that 18% were cut in half: erase the federal budget deficit, for one thing.
