SeaWorld Parks doesn't pay any corporate income taxes after record year

Hospitals have oligopoly and oligopsony power - they can pay what they like (nursing shortage, anyone?) and charge what they like (uninsured patients who are not being treated as "indigent care")....when negotiating with a buyer or seller that has less market clout. Medicaid rates for services are set by the Government (CMS) because as the single largest buyer, they have significant off-setting clout. Insurance companies have considerable power too, as they account for roughly 35-40% of hospital payments....so they also get to negotiate for lower prices  - hence your "negotitated payment". Who has NO power in the market? Individuals. So get yourself into an insurance group to get better prices, be directly covered BY the Goverment (Medicare), or be prepared to pay thousands out-of-pocket for even a couple hours in an ER.

All of this creates incredible expense in billing and payments-processing...my salary for the last 15 years has been covered by the money I "re-claim" from Medicaid (and to a way lesser degree, private insurance). America doesn't need to spend so much money passing the buck along - it's wasteful and highly inflates the cost of health care. Other developed countries (OECD) spend roughly half what we do, and they get health outcomes AT LEAST as good as ours (so much for "the best healthcare system money can buy).

Seriously, put me and all my co-workers out of work...you'll have a better economy.

What other good or service is purchased/delivered with neither the seller/provider nor the buyer knowing the price at the time of purchase/delivery?

Hehe. Aamilj would gladly say, "democratic legislation."

" Other developed countries (OECD) spend roughly half what we do, and they get health outcomes AT LEAST as good as ours..."

Actually, this article says they don't.

http://online.wsj.com/article/SB10001424052702304444604577337920091158442.html?mod=googlenews_wsj

To the item at hand:
The Patient Protection and Affordable Care Act seems to lack meaningful provisions for actually protecting patients, and does pretty much nothing to actually reduce the cost of care. It's really more about the protection of insurance companies, more than anything else.

So let's look at the sorry state that we're in, and ask a few questions...questions that, in my opinion, could actually make a difference on the cost side of things...

o Why do we have a health care delivery system carefully engineered to *maximize* cost? Providers want to get paid, so they maximize what they bill in an effort to get the insurance providers (or Medicare; for this purpose they're basically equivalent) to cover the cost. Meanwhile, nobody actually involved with the process is sensitive to pricing. Neither the patient nor the provider can tell you what the procedure costs, and even the final compensation is not based in any way on reality.

o Why do individuals not receive the same tax benefits that employers do? If my employer buys my medical insurance, the premiums are tax free. If I contribute to those premiums, that contribution is also tax free. If I go out and buy my own insurance, those premiums are only tax deductible to the extent that they exceed 7.5% of my gross income. Likewise, any medical expenses (including prescription medication) that are paid for by insurance do not qualify as income for tax purposes. But any medical service or product that I buy myself is only tax deductible to the extent that it exceeds 7.5% of my gross income.

o Why can individuals not buy their own medical insurance plan? Again, there is the tax difference...if I pay 100% of an employer-provided plan, I can use pre-tax money, but if I pay for it myself using post-tax money I can't deduct it. But in addition, my insurance plan is tied to my job. If I get a different job, I probably end up with different insurance, and if I don't have a job, insurance is very difficult and extremely expensive to obtain.

o Why is the entire medical industry based on an insurance payment model? I don't use my automobile insurance to buy gas or get my oil changed; why is medical insurance involved with routine medical care...what should be the lowest cost, highest volume form of care? Not only low cost, high volume...but because it is routine, this is also where the costs and the fees should be well-established. A routine office visit with lab tests doesn't cost $350. The physician knows that the insurance company is going to knock the price down to about $75 and pay about $25. Why aren't the physicians encouraged to hand the patient a $60 invoice and skip the claim?

Just some thoughts...weren't we talking about amusement parks?

--Dave Althoff, Jr.

Lankster said:

" Other developed countries (OECD) spend roughly half what we do, and they get health outcomes AT LEAST as good as ours..."

Actually, this article says they don't.

http://online.wsj.com/article/SB10001424052702304444604577337920091158442.html?mod=googlenews_wsj

I'm reading from articles in public health magazines (professional, peer-reviewed journals). Just can't see how WSJ stacks up...

Briefly, here's a snippet from Health Affairs, 2003. Granted, the article is a bit dated, but more recent analyses show the same pattern - the vast majority. "Ein an annual series, uses the most recent OECD data to present a series of snapshots of the health systems in the thirty OECD countries in 2000. Together these snapshots show that the United States spends more on health care than any of the other OECD countries spend, without providing more services than the other countries do. This suggests that the difference in spending is mostly attributable to higher prices of goods and services."

Lord Gonchar said:

On top of that, I don't feel health care is a right.

Therein lies the fundamental difference in opinions in all of this. I find most conservatives believe that, whereas most liberals believe healthcare is a right. My argument has always been if we can waste money on all the stupid crap we waste money on, there's no excuse for not taking care of our citizens when they get sick.

Do you believe if someone needs medical treatment (we'll say anything from a broken finger to a heart attack to cancer) and can't prove they can pay before receiving any services, we should refuse to treat them? If the answer is anything but yes, how do we make sure the costs get covered? Currently they're getting covered by passing higher costs along to the people who do have insurance/can afford to pay.

The only way to provide any medical service to anybody, including emergency services, without burdening everyone else is to make everyone contribute to the system. Isn't that what conservatives believe about taxes? The alternative is to refuse treatment to anyone who shows up at an emergency room without an insurance card/wad of cash in their pocket. That's not a country I'd want to live in.

rollergator said:
Together these snapshots show that the United States spends more on health care than any of the other OECD countries spend, without providing more services than the other countries do. This suggests that the difference in spending is mostly attributable to higher prices of goods and services."

A country's healthcare costs would be higher, and its results worse, if it has a higher obesity rate than another country. Same is true with teen pregnancy rates. Do those studies make any adjustments for those types of factors?

"Just can't see how WSJ stacks up..."

So when they reference a study (they're reporters, not researchers after all) that study is suspect?

What's really funny is that the study is in Health Affairs, the same outfit you used!

Here's a link that doesn't have that evil WSJ in it...

http://healthaffairs.org/blog/2012/04/10/new-health-affairs-on-cancer-care-u-s-spends-more-and-gets-more/

GoBucks89 touches on the issue of using lifespan as a judge of the quality of the system--that's usually the reason I see given as to why our system is inferior.

Two items: WSJ is strictly financial in emphasis (my undergrad was Econ) - I didn't, and wouldn't, use the word evil...merely pointing out their area of expertise. The idea from their perspective, which is not invalid but necessarily stresses the cost factors, is to consider the costs.

From the strict healthcare perspective, the emphasis is always going to be on "health outcomes". This means they're going to do scientific analyses of health inputs consumed vs. results in terms of mortality, morbidity and other quality-of-life data. As GoBucks89 was getting at, this also means you have to utilize accepted biostatistical practices in terms of gathering data that accounts for other demographic data to ensure valid results not skewed by selection bias (i.e., the idea that we're more obese in the US, etc.).

My area of study combines the two disciplines - the idea being that we can hopefully become a healthier nation without spending more by implementing methods that have proven effective, and cost-effective, in our own country and elsewhere. One of the more successful initiatives in the US recently involves smoking prevention/cessation...public-private partnerships that have greatly reduced teen smoking, encouraged millions to quit, and has seen dramatic reductions in the costs of treating smoking-related illness. Some may decry the "nanny-state tactics" employed - smoking is now forbidden in many bars and restaurants nationwide...I understand their concern.

If there were ever a time when *everyone* agreed on a certain course of public policy, health-related or otherwise....then you'd have a clear signal that you were doing something wrong. Governance is a delicate balancing act in which many players have considerable influence - hopefully the 300+million citizens have enough representation to consider their health and well-being (as well as our federal budget) first and foremost. Right now, "public health" accounts for 3% of our national health care expenditures (public and private payers). Countries that have more cost-effective health systems....typically spend almost twice that.

" WSJ is strictly financial in emphasis .."

I guess you'd argue that all the articles having *nothing* to do with finance are simply not emphasized? Whatever--have you ever read the WSJ?

But you totally missed the point, anyway. The WSJ has nothing to do with the study!

"From the strict healthcare perspective, the emphasis is always going to be on "health outcomes". "

No kidding? Maybe you should actually read the article I linked to--it actually compares the outcomes and the additional costs. Plus, it comes from a source you've already labeled "credible." It's win-win, really.

Or you could continue educating us all on how smoking is bad for us.

The only way to provide any medical service to anybody, including emergency services, without burdening everyone else is to make everyone contribute to the system.

How do you "make everyone contribute to the system?" The poor are unable to. Obamacare merely moves the subsidy to the poor to a different location--it still exists. The only way to get rid of it is to get rid of the poor.

I believe the idea that insurance is synonymous with health care is the number one problem we have. In fact, I think it is the problem with the health care system in this country.

Which answers about all the other questions/comments that follow in one form or another. But we are consistent as a country. The government passes a bill without knowing its costs (most bills). The populace gets its health care without knowing the costs. It seems to be that the basic bad behavior is making decisions without knowing the costs? No?

Why do we have a health care delivery system carefully engineered to *maximize* cost?

Because our government gave us a system specifically designed so the end consumer does not bear the costs. Companies maximizing profits off the system is entirely predictable human behavior. Companies getting into the lobbying business to get their slice of the Trillion's is a direct result of the fact the individual has no skin in the game.

Why do individuals not receive the same tax benefits that employers do?

Lobbying is expensive. Had the system be set up appropriately, where the individual more than the insurance company bears the market forces of health care costs...the tax inequities would not have happened.

This is more of a secondary result to the initial FDR/Johnson boondoggle's. Interestingly, in many text books and political circles these two are viewed in high esteem... I think there is a very good argument that their actions were the catalyst of the country's decline. We are nearing 50 years of data that easily demonstrate that NONE of the social ills they purported to alleviate have done anything but worsen...exponentially.

Why can individuals not buy their own medical insurance plan?

Simple answer...Johnson!

When he signed Medicare it effectively ruined legitimate market forces (the stuff gator is talking about now). No private company can compete with the government. They can take Trillions in losses and stay standing long after a traditional market-based company goes out of business. I believe they knew this and it was purposeful...but that discussion is more than you asked for. But the reality is that from 65-67 on the entire health system is government funded with nary a private enterprise capable of competing.

Moment to note that this is exactly what Obama is doing with this bill. We couldn't afford the original promises from 1965. He is doubling down and applying the same concepts to cover EVERYBODY circa 2012 that we have had for the elderly since 1965. That system is financially insolvent...possibly the PRIMARY cause of our un-mountable deficit.

He has not hidden ANY of this. He wanted a single payer (i.e. government)...remember that debate? He lost that argument for now to get the current form of the bill passed. But this is just a step to get to "single payer." That is a dream that has been the golden grail since the 60's.

When the conglomerate of pseudo-private government-mandated insurance companies FAIL under Obamacare...and they will... The next step is Captain Government and Single-Payer-Boy to save the day.

It would be a lot easier and more in line with our founding principals to just let one buy their own medical insurance plan in a minimal, but reasonably monitored market. But apparently 2000 plus pages of nonsense and Trillions more of unfunded liabilities to the coffers is preferable to some.

My argument has always been if we can waste money on all the stupid crap we waste money on, there's no excuse for not taking care of our citizens when they get sick.

I sincerely admire your consistency. I even mostly agree with what your saying. But it sure would be nice if more people voted based upon the first part of your quote rather than the latter. If we would take care of the first, there might have been some money left over for the latter.

The preceding paragraph was tongue-in-cheek (in content...not personality) as I don't subscribe to the theory that we "don't take care of our citizens." I mostly see the "don't take care of our citizens" scare tactic as a tool used by those seeking the holy grail (single government payer).





Lankster said:

Or you could continue educating us all on how smoking is bad for us.

No, I think I'm done here...but thanks.

More rational discussions ended with the axe... ;)

Reading Aamilj's posts, I feel like I gave birth....to an attorney.

Why can individuals not buy their own medical insurance plan?

Um, I *do* buy my own medical insurance plan....(?)

And Gator, on that we can agree!

Yes, but I think (and I could be wrong) the issue is now you HAVE to buy one.

I think the issue is that the most affordable insurance options are provided through employment due to the group discounts. Plus there is the tax implication that RideMan spoke about.

If I don't care for insurance options I have through work, whether it's the provider, the coverage, or the "network" of covered doctors/hospitals, my alternatives are limited unless I'm willing to take on the expense of going my own way. And even if I did, it's not like forgoing the insurance benefit from my employer is going to equate to additional compensation in other ways. I would lose that part of my compensation package and then agree to use some of my wage/salary to cover the benefit on my own.

I certainly have that option, but it wouldn't make fiscal sense. So I have to go with the system in place.

In this case, the issue is that RideMan initially asked:

" Why can individuals not buy their own medical insurance plan?"

I'm not sure if he meant you *can't* do it, or that it has problems due to reasons he gives.

But Aamilj's post seems to agree you can't do it. I'm just saying you can do it!

(Obviously the mandate is a whole other issue.)

Edit to add: (Carrie's post beat mine...)

How much does the group discount really affect the rates? Paying the premium seems to be the main difference (one payer vs many). Isn't most of the rest the same? I'm thinking about other insurance I carry where the cost/year is $300-$500. Surely most of that is not due to the fact it's an individual policy? In any case, for the much larger cost of health insurance this must be a small percentage?

At any rate, how you'll do in the individual market vs group I'd guess mainly depends on your situation. Assuming the group is average, if you are "better than average" your individual policy could be much cheaper. (Doesn't change what Carrie said about no $$ for not using company provided benefit. Mainly applies to those of us with no co. provided benefit.)

That's the whole argument that the insurers make about building risk pools, using employers. Excuse me? Why does that necessarily make any sense at all? The only thing that all the people who work for my employer have in common is that they all work for the same employer. The institution employs healthy 22-year-olds, and it employs senior citizens. It employs athletes, and it employs cancer patients. The whole concept of a "group policy" to me makes very little sense.

In other areas, insurers do not have the luxury of being able to market themselves through corporate human resources departments, and instead exist in a competitive marketplace, where they compete with each other on coverage, customer service, and...yes...even on price. And yet these insurers are still somehow able to generate adequate risk pools from their entire base of insured clients. They even use real risk factors to affect premiums and even to create incentives to their clients for their habits and behavior (did you know that non-smokers get a discount on their homeowner's insurance? That non-drinkers get a discount on automobile insurance? That you get homeowners insurance discounts for smoke detectors and burglar alarms? That there are surcharges on automobile insurance for poor driving records, certain makes and models, and for being a 17-year-old male?). But the industry has been resistant to doing this for medical insurance. My guess is that it is more profitable to sell a group policy to a company with 14,000 employees than it is to sell 14,000 individual policies. But I don't see any reason why tax policy should make that the best way to do business.

I think health insurance reform should have started with some very minor tweaks to the tax code that would fundamentally change the whole environment of incentives surrounding medical insurance. That alone would, I think, start moving us in the right direction, towards a saner system of health care delivery.

--Dave Althoff, Jr.



Is there a call for a downward market force on costs in those minor tweaks? I'd say that ANY health care system that does not include a market mechanism to exert downward pressure on spiraling costs could never fit under the definition of sane.