[whell]

Originally Posted by sheltiedave

And why are costs out of control? A large driver is because 40% of the people(those who have insurance, mainly) get to cover the other 50% to 60% who do not have adequate insurance coverage.

You're close on this, but you don't quite get there. A clarification of your term "adequate insurance coverage" needs to be cleaned up. The ACA essentially outlawed policies that didn't provided minimum essential coverage and minimum value. Some folks were allowed extensions to keep those policies, but these policies generally belong to the "young and healthy crowd", not to the folks who are frequent fliers in the medical system. So, when we talk about folks who "don't have adequate coverage" - particularly from your family's perspective, folks who are paid by that coverage - you have to look at reimbursements to hospitals and docs from those insurance programs. From that perspective, the 800 pound gorilla in the room is....

Medicare, the nations largest health insurer. In fact, its one of the largest health insurance programs in the world, with $540 Billion in spending for 2016. Medicare's budget growth has slowed. One big reason is that Medicare has been paying docs and hospitals less for services provided. The good news is that this has slowed the growth of inflation of medical costs in recent years. The bad news is that docs have been insulating themselves to some extent by increasing their bill rates to private insurance, thus inflating premiums for the rest of us.

Originally Posted by sheltiedave

Also, most hospitals are in competition with one another in urban areas, so they all line up and get the larger ticket items, like MRIs and CATs, and then they end up with 18 machines in an area that can readily be served with 8 machines. Many modern hospitals are in competition for services and prestige these days, and they end up pushing identical rather than complimentary services.

No doubt about this. I mentioned it in an earlier post.

Originally Posted by sheltiedave

When you duplicate services, and require the uninsured to be funneled into the most expensive of medical care to treat the most rudimentary of illnesses, you end up with underutilization, and cost tilting.

You still have the insured frequenting emergency rooms for non-critical illnesses as well. Yes, uninsured individuals seeking treatment in emergency rooms is a challenge but the expansion of Medicaid has had a significant impact on that. No one is talking about changing the new rules that expand access to Medicaid.

Originally Posted by sheltiedave

Please ignore my post here, Whell. I have just as many direct relatives who are intensive consumers of medical treatment as you, plus I have two brothers who are MDs, five first cousins who are MDs, a sister who is a pharmacist, a wife who is an MSN nurse informaticist, seven other first cousins who are regular BSN RNs, another first cousin who is an MSN RN psychiatric nurse manager, a first cousin who is a retired PhD nurse anesthetist(and the President emeritus of her professional society,) and another first cousin MD who runs the largest group doctor's practice in Illinois. And there also are two fathers-in-law who are the medical directors of major metropolitan Level One trauma hospitals, and a now deceased step great aunt who ran the SSM hospital chain here in Missouri for her religious sisters order.

We have been having these discussions about national medical insurance coverage within the family for longer than either of us have been alive, and it is a given that any current evolving system that makes the key stakeholders to be politicians, insurance companies, and actuarials is going to be a bastardized stew of epic proportions.

You may know stuff at the microecon level of medical care, but you don't know squat about macroeconomic medical care models, and it shows.

As usual, Dave shows us that he's rather full of himself.