Skip to comments.Forget the website crashes: The real $1 trillion problem with Obamacare yet to emerge
Posted on 11/03/2013 1:06:12 PM PST by Cincinatus' Wife
In an exclusive interview with The Daily Caller, Dr. Robert Nirschl a practicing orthopedic surgeon, former faculty member of Georgetown and a former member of the legislative committee of the American Academy of Orthopedic surgery dismissed the recent issues suffered by HealthCare.gov and the media feeding frenzy surrounding it, arguing that the systemic flaws within the law had not yet surfaced, and that when they do, it will be catastrophic.
Nirschl took apart the concept of health insurance arguing that its an inaccurate buzzword. What is being legislated is not insurance at all, Nirschl said. By its very nature, insurance is a way of protecting against an unforeseen, catastrophic incident. It works by having large groups of people paying premiums into a central fund with the understanding that if they were to suffer an unlikely incident, they will be compensated. The likelyhood of people claiming out of the central fund is a calculated through a risk assessment, and the riskier the bet, the higher the premium. Nirschl points out that since the 1950ss true health insurance has not existed.
The facts of the matter are that the product we have had has, since the UAW (United Auto Workers) negotiated with General Motors in 1959 to do first dollar coverage, we destroyed the concept of insurance, Nirschl said. The product we have had since 1959 has been a hybrid of a service maintenance contract plus insurance. If youre going to buy true insurance, you want to buy it for a catastrophic event, example, auto insurance. If I go to my auto insurer, I dont want to be covered for oil changes and lube jobs. I want to be covered for a car crash and so when we went to first dollar coverage thats when it [health insurance] became a service maintenance contract.
Nirschl explained the consequences of including supplementary services on premiums using his auto insurance analogy: One hundred percent of folks are going to use the service. One hundred percent of people who want cars are going to get oil changes and lube jobs, so it doesnt lower the premium. It increases the premium, and at the same time it adds an enormous administrative cost We squander 35 percent in administrative costs by this form of insurance For maintenance services, oil changes and lube job, you want to pay out of your own pocket, and you want to basically have insurance for a car crash, for catastrophic things. So we have destroyed true insurance.
Nirschl says that that destruction of true insurance and the wide scale implementation of service maintenance has come at a cost. By his calculations, it likely runs as high as $1 trillion dollars annually on useless costs, administrative costs which deliver absolutely no service.
When asked about the future of the law, and if it is now sacrosanct in American minds and unable to be repealed, Nirschl said no.
As the law unfolds and as people are seeing the derogatory effects of it I mean, the granddaddy of that situation was Prohibition. That was not sacrosanct and for that matter, all of the Jim Crow laws from way back when were the law of the land, so when ever I hear some of our politicians say: Well, this is the law of the land, and so we cant do anything about it. Well, as an example, Martin Luther King did a lot about it. I think that when the people really see what its all about it should go the way of Jim Crow laws. It should go the way of Prohibition.
Yes! I've been saying this for ages. As much as I like my doctor's visits covered it is akin to auto insurance that covers getting your oil changed. I am not sure the doctor's visits is the real problem though ... not when compared to the cost of an any operation. Some of my medical friends have told me a major reason for the high hospital costs is cost shifting to cover the gaps by medicare, medicaid and uninsured.
However, I believe that we need to trust the American people to do the simple things like keep track of their blood pressure, have yearly check-ups, have their teeth cleaned twice a year, etc.
A better way to go would be to lower premiums for those people who can prove they have done the little stuff themselves, i.e. show receipts for having had their teeth cleaned, had a recent check-up, got a flu shot, etc.
Just like drivers who get discounts for not having tickets.
I agree. We need to go back to paying for our medical expenses and getting insurance for big emergencies. Health "insurance" has driven up costs, complicated the process and become unnecessarily tied up in red-tape.
Well, predictably, everyone who saw a particular chiropractor in the area had an "accident" every three months or so. They fell in holes, tripped on steps, bumped heads, and on and on and on. We knew that the members were abusing their benefits, but there was nothing we could do about it.
Yes. And if they don't, what business is it of anyone else?
New York's Medicaid costs are skyrocket-high and much of that is the bureaucracy which keeps tabs on your file and the extras like free rides to the doctor which the liberals put in place to make sure the irresponsible take care of themselves.
No study has ever shown that such preventatives result in better medical outcomes for the population or reduced medical costs to
the government "society". But, just like pre-K, it sounds like it should work, so we do it.
Been sayin’ the same thing here every chance I get. And oh boy, doesn’t it make the creatures come out!
The same groups keep complaining “but my doctor visits cost too much. . .” or “what about my receipts for un-reimbursed expenses?” or some other nonsense. Yes that’s right NONSENSE.
Insure against catastrophic or unanticipated financial loss and PAY for your healthcare.
How about . . . if you don’t cost the insurance pool a lot of money, you get a discount or a refund off your premium?
Prices WILL drop.
That’s why God invented “consequences”. Do stupid sh!t and you get bad consequences. Most people will associate stupid sh!t with bad consequences and avoid repeating them. However, there is a certain percentage that will never learn .... the hammer to the head group (why are you hitting yourself in the head with a hammer ..... I like the way it feels when I stop).
Good post - that has to be the most succinct explanation of how we got where we are and why this won’t work that I’ve read in this entire debacle. Unfortunately, the Dem numbskulls in Congress, like Pelosi, Can’t Understand Normal Thinking and this goes right over their heads.
Since I was born in 1955, I have no direct recollection of the UAW 1959 contract but I can remember the 1960s when my dad spoke of our family insurance as “hospitalization” as that was the event that would cause economic harm and merited true insurance. I didn’t experience anything more than that until I entered my civilian career in 1981 after military service. It’s been nowhere but downhill since then.
I would not want discounts in a world of insurance that offered them for showing a dime, a health card and a note from my mother-that is still paying for nanny to tell you what to eat and do. What you do with your teeth or any other part of your person is your business and responsibility-and the same goes for me and everyone else.
Tickets are gotten for doing something dumb-that is why they cost money and raise your rates-they are not the same as oil changes. If I’m not ailing, I’m not going to go pay for someone to try to find a reason to charge me more money-don’t you want this newest little test for only a few hundred?-I’ll go if I need stitches, or am otherwise injured, etc-I don’t ask the mechanic to run a diagnostic on my truck when I get the oil changed-I’m sure he’d find something to test further and charge for just to pay him for his trouble, and that isn’t “maintenance”-the truck doesn’t go to the shop unless it needs a repair/part...
Just my two cents worth-I was a workers comp case manager until I was smart enough to go to work for myself...
How about . . . if you dont cost the insurance pool a lot of money, you get a discount or a refund off your premium?
The premium cost on an individual basis is not individually risk-based under group insurance which is definitely insane. We all pay the same amount for the same coverage regardless of age, even salary or other demographics. Only perhaps in the case of employee wellness programs would it be legal to charge differently to different employees for not meeting their health care goals.
Log on in mass and let’s see what happens.
Bingo! Probably half my clients had engineered their work related “injuries” to get a little paid vacation time-once, a client’s co-worker called to drop the dime on him-seems he’d said he needed some money, so it was time for a comp claim, as he threw a half-full soda down some stairs then proceeded to “slip” in it and fall...
Since you seem to be the one making up the arbitrary compliance schedule how about you get a colonoscopy every 10 days and then we'll give you a discount on your proctology premiums.
BTW, medical coverage and dental coverage are entirely unrelated in my state except when dental injury occurs as a result of an accident or malignant disease or concerning a child on Medicaid.
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