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History (health insurance, government spending). Also more Crypto.

Updated: May 5, 2021

Thinking about health insurance and also government spending and the current debt - what are the histories of these things? To gain a better understanding and more clear picture...we forget things so quickly or easily as times change.


https://www.healthforcalifornia.com/blog/history-of-health-insurance


What stands out to me (bold font):


"Eventually, the idea caught on with the local media and spread through the north Texas area until three million people were members of Blue Cross in 1939. The plans would cover a $5 a day, 21-day hospital stay, which today would cost $525. The insurance allowed teachers and other earners of modest incomes a means of avoiding bankruptcy if they required medical care. Unlike today’s health coverage, Blue Cross started as a not-for-profit organization to keep hospitals open and help protect people’s finances."


Even back before health insurance was a large entity, healthcare costs could still bankrupt people; but it did start out as a non-profit organization. That could, in my opinion, be an answer to fixing the healthcare costs of today. Surely we've advanced and come a long way scientifically and technologically but I feel, costs today might be even higher for the average person than they were even back in those days. - Is that due to ever-rising income inequality, is policy to blame?, or is the for-profit healthcare industry to blame? (or, most likely, a combination of all these things is most true).


Could policy that limits healthcare insurance provider's profits to say, the inflation rate +, (say) 5-10% be a solution? (companies need profits but in healthcare, I believe, that shouldn't be THE priority).


Continuing on...


"During the 1930s, innovations in medicine meant hospitals could save lives that would have been lost in the past. These discoveries, such as intravenous anesthetic also increased the costs of care. Insurers offering $5 a day coverage for a hospital stay would no longer cover the required expenses. The demand for insurance that would pay for the higher costs was soon to increase dramatically.


During the Great Depression, people scrimped any way they could, including by cutting out pricey hospital stays. Despite the widespread availability of Blue Cross in most states in the country, it remained unpopular in an economy where people cut out extra costs as much as possible. When World War II broke out, American men flocked to enlist in droves, but those who stayed behind needed jobs, mainly to fuel the manufacturing machine of the war.


To encourage people in the smaller workforce to come work for certain factories, the owners began offering incentives, such as health insurance with the jobs. A law passed in 1942 froze wages, preventing companies from using higher salaries to attract workers.


In 1943, the Internal Revenue Service changes how it treated health insurance benefits from employers. Now, they were tax-free. Later, in 1954, additional laws made getting health insurance from an employer even better on tax rolls. In fact, the numbers showed how many people took advantage of the new regulations. In 1940, only nine percent of those in the United States had health coverage, but by 1953, this number ballooned up to 63 percent of the country.


Another leap in medical advancements during the 1950s, such as the Polio vaccine, doubled the cost of care from a hospital. The higher prices made insurance even more of a requirement, but those who did not have employer-provided insurance found themselves in positions where affording coverage was difficult. To help the elderly and indigent afford health care, President Johnson signed Medicaid and Medicare into law in the 1960s."


Under President Nixon, health maintenance organizations (HMOs) became the new name for group health plans. PPOs weren’t created until the early 1970s to give consumers more freedom in their choice for physicians. Both of these plan types are still available today, in addition to variations on them.


Today, many Americans expect health insurance benefits with their jobs. The United States is the sole country on Earth with such a reliance on employer-provided health coverage.


How Has It Changed Over Time?


Initially, health insurance was designed to cover only major problems. If you needed to go to the hospital or to get surgery, that was what the insurance would help pay for. It was not intended to pay for doctor visits or preventative care. Those things were up to the individual.

Over time, health insurance evolved to cover the increasing costs of health care. Finally, by 1994, the original Blue Cross organization, which had grown significantly, allowed for subsidiaries to become for-profit insurers. The change was significant. When still not-for-profit, 95 cents per dollar of paid premiums went toward covering medical care. After the company’s policy shift, that amount dropped to an average of 80 cents per dollar, with some even less.


The Affordable Care Act (ACA) was designed to make the insurers pay more of premiums toward care, up to 85 cents per dollar. Another change the ACA brought was making health insurance no longer optional. Today’s insurance plans cover everything from preventative care and therapy to major medical expenses. Policies now are vastly different from the original plans that only covered hospital stays. The prohibitive cost of all types of care contributes to this and makes carrying insurance a requirement in life now rather than an option.


Why Do We Need Health Insurance?


Insurance makes it possible for the average American to afford medical care without going bankrupt. Among those without insurance, 20 percent went without care because they couldn’t afford to pay out of pocket. Even more of uninsured, 24 percent, put off looking for care. A full 50 percent of those without health insurance did not have a place to turn to if something did happen to their health.


Carrying health insurance makes it possible to seek treatment when something is wrong. You also don’t have to worry about the cost of finding preventative care when you’re insured. Taking charge of your health by visiting your doctor for checkups can help you spot problems early while they’re still treatable. Purchasing health insurance is a step toward protecting both your health and finances."


It seems like, health insurance isn't really to blame but the rising cost of healthcare coverage is - but do the two go hand-in-hand and work together somewhat? Could it then be seen as a bit of a scam? I feel like, yes, a bit or quite a bit.


"Options for Coverage


When selecting health plans, you will have many options. Knowing the differences between HMO, PPO and other choices will help you make a more informed decision. Here’s what those acronyms mean:

  • HMO: Health maintenance organizations are those plans that typically cost the least, but you have a limited number of providers and facilities to choose from. Also, your primary care doctor must give you a referral for any specialist visits or tests you need.

  • Managed Care Plans: With a managed care plan, facilities and doctors have worked out deals with the insurance company to provide lower rates for members plan. If you choose a doctor or hospital that is not in-network, it may not be covered, leaving you to pay the full cost.

  • PPO: Preferred provider organization is a health plan that lets you select any doctor and facility you want, but the premiums tend to be higher in return for the choice you have. You don’t need referrals to go to any specialist, and if you visit an out-of-network doctor or facility, you may still get a discount from your insurer."

Obviously, there are deals between insurers and providers. Would it be better for a government insurance program like the one initially proposed by Obama? I definitely thought so back then and maybe, yes, even now I think that could be right and a good option.


Continuing on.


"Changes occur to the health insurance field each year, and 2019 is no different. For the coming year, expect a rise in premiums. The LA Times reports a 16 to 30 percent rise in premium costs. These increases in the cost of insurance are tied to both a seven percent increase in the cost of care in addition to the costs of federal policies. Luckily, those covered by federal subsidies will not be severely affected by the rise in premiums. Those who don’t qualify for subsidies are most likely to bear the burden.


Another major change seen in 2019 is the abolition of the mandate to carry health insurance. The order required proof of health coverage when filing taxes or paying the penalty. Without the penalty to enforce coverage, many people may drop their insurance. But, as seen, not carrying insurance is a bad idea, especially in light of how expensive paying for medical care is.


Does this mean you should avoid getting health coverage in 2019? Of course not. Despite the higher premiums, it will still cost you less money to pay for insurance than for the ever-increasing cost of medical care out of pocket. Health insurance can protect you from devastating bills that may come if you’re not covered and have a medical emergency.


What Changes Can We Look Forward to in the Coming Years?


Beyond 2019, predictions are far from being set in stone. But looking into the crystal ball, some possibilities in the insurance field seem highly likely for the future based on current trends.


Some states and even cities are taking the reins in providing health coverage and incentives to their residents. States with their marketplaces and Medicaid expansions have the option to offer their residents the most insurance options. Also, states with state-supported markets tend to have fewer uninsured. For instance, Texas has the highest percentage of uninsured, at 18.8 percent in 2014. The only marketplace available was the federal one with no Medicaid expansions in the state. California, Washington and New York all expanded Medicaid and offer state marketplaces. In these states, uninsured levels are below 12.5 percent.


Federal funding of health insurance will affect the change in premiums. If the national government funds health insurance pools to reduce the impact of having a higher percentage of high-risk individuals, premiums could decrease. Estimates suggest federal spending on healthcare of $15 billion during 2019 and 2020 could cut rates by nine to 16 percent. With the number of uninsured likely to rise due to the repealed penalty, without federal money, premiums could increase even more.


Current models typically offer a fee-for-service, which means you may get multiple bills for a hospital stay to pay separately for your doctor, a specialist, the hospital itself and diagnostic tests. The future could move toward bundling these fees together with Accountable Care Organizations (ACOs). In 2014, the number of ACOs was more than 500 in the United States, with predictions for an increase. Future insurance payments with ACOs are more straightforward, based on the value the patient receives rather than breaking down the individual costs.


These future changes are far from guarantees. Many factors influence the health insurance field, including federal and state politics, economics and the health care industry."


Nice ending.


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Google Search: why do health care costs keep rising


"One reason for rising healthcare costs is government policy. Since the inception of Medicare and Medicaid—programs that help people without health insurance—providers have been able to increase prices. Still, there's more to rising healthcare costs than government policy."

Why Do Healthcare Costs Keep Rising? - Investopedia


Geez (we spend so, so much on healthcare). Starting at the source - that is, healthy food and lifestyle choices, is so important to health. I hope our congress can pass the No Surprises Act and do things to support, truly well, inequality and healthy food (including access to at prices every one can afford).


Great article:

https://www.peoplekeep.com/blog/8-reasons-health-insurance-costs-continue-to-rise


Another:

https://www.thebalance.com/causes-of-rising-healthcare-costs-4064878


"In 2018, U.S. health care costs were $3.6 trillion. That makes health care one of the country's largest industries. It equals 17.7% of gross domestic product.1 In comparison, health care cost $27.2 billion in 1960, just 5% of GDP.2 That translates to an annual health care cost of $11,172 per person in 2018 versus just $147 per person in 1960. Health care costs have risen faster than the median annual income."


It seems most all of these web articles on a Google search say, about the same thing (good to read a few of them still).


What about more actual science (peer reviewed and researched) sources say?:


A good one: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394555/


"No sector of the healthcare economy wants to accept blame for skyrocketing costs, and so far, none has had to. With everyone adding to the cost of healthcare, a myriad of scapegoats exist. Politicians point fingers at pharmaceutical manufacturers, who in turn blame health insurers and pharmacy benefit managers (PBMs). Doctors complain about regulations and protocols enforced by payers and health system administrators, while patients remain unsatisfied with the quality and cost of their care. It seems that no one is satisfied, yet everyone (except the patient) goes home with their share of the profit at the end of the day.


The central challenge facing the US healthcare system is not the motivation of stakeholders to earn a profit, but rather the misaligned incentives among healthcare stakeholders as outlined in Table 1, which drive up costs unnecessarily. Although at their core all healthcare stakeholders agree that enabling quality, cost-effective care for patients should be their primary concern, other factors often interfere. These misaligned incentives do not apply universally to every stakeholder, which adds more complexity to the system. Each stakeholder has different profit motivations that drive up the overall costs of healthcare."



"Patients are the central figures in any healthcare system, and although they are often the victim of misaligned incentives, they also bear some responsibility for rising costs. Typically, patients are motivated to spend as little as possible out of pocket. They are conditioned to expect healthcare to be inexpensive or free, because the majority of their expenses are covered by a third-party payer (a commercial health insurance company or the government). Because patients may not value healthcare as a service in which they are willing to invest their own money upfront, they have little incentive to actively participate in reducing costs. Patients may be reluctant, for example, to make a dietary change to reduce cholesterol levels when a once-daily pill can achieve the same results.


And yet, compounding the problem, the opposite may also be true. This dynamic, which does not reward patients for being accountable for their health, and insulates them from the true cost of healthcare, is beginning to change, but without the anticipated positive results. Employers and health insurers have begun pushing patients toward high-deductible health plans that require patients to pay more for their care upfront.2 Although these plans reduce spending in the short-term, they may discourage patients from seeking necessary care, leading to costly complications down the road.1 According to a patient survey conducted by the Physicians Foundation in 2016, patients are increasingly fearful that they will not be able to afford necessary care as medical costs continue to grow.3 The survey respondents overwhelmingly pointed to prescription drugs as a primary cause for increased spending, with 59% selecting drugs as a key cost driver. By comparison, physicians were associated with increased medical spending by only 20% of the respondents.3"


..."The government has a lot at stake and has taken this responsibility seriously; in addition to playing the role of payer, it also serves as a regulator. This is a fairly recent stronghold linked to the ACA and its supporting regulations. Medicare, for example, has more pages of regulations than the Internal Revenue Service's tax code,10 and is considerably more complex."


"Conclusion


This complex and convoluted mess caused by misaligned incentives has led many experts to declare the failure of the capitalist experiment in healthcare and to call for a public option or a single-payer system. In fact, President Barack Obama recently encouraged Congress to add a public option to improve his signature legislation, the ACA. “Public programs like Medicare often deliver care more cost-effectively by curtailing administrative overhead and securing better prices from providers,” President Obama wrote in a July 2016 special communication in the Journal of the American Medical Association.11


Although we do not advocate for a government-run solution to America's healthcare-spending crisis, we understand the frustration that motivates supporters of this proposed solution. Instead, however, we would prefer to see the US healthcare system work as it was intended: with uninhibited consumer choices; with competition for business among providers, pharmacies, pharmaceutical manufacturers, and payers; and with taxpayer-funded and charitable financial support for those in need. It is the responsibility of all stakeholders to stop looking for a scapegoat and to begin participating in the solution."


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Interesting. I agree with their take (last paragraph) but upon further reflection, disagree in reality. Government policy, which is super important, I think, does need to be simplified and also be a regulating force that reduces complexity and transparency of the system as a whole and encourages a more free and fair system (for the people, by the people). But what does that truly entail? ->


A more authoritarian (controlling) approach with much regulation could be the best option I believe. One where health care isn't totally free - as people then would have no responsibility for ourselves/themselves and our health but in this arena, I think it might be very questionable to trust in a free market approach - especially when it's for-profit (it doesn't seem to be working anyway but it's not truly free - but even if free, due to how hard the job and degree of doctors and health care professionals is, and there being a shortage of doctors and nurses as is, that in itself can lead to very high costs because of supply and demand - we can't truly separate government from healthcare). I think it would be better to let people vote on issues that can arise, from the starting point of a government top-down approach to health care that isn't totally free. I think we could also probably more easily adopt simpler systems from other countries (take what works best from the best - study).


Also, within this system and the online voting system, we the people could also vote on federal spending towards healthcare and all that it encompasses (including funding education and training for healthcare professionals) within the budget and can include expected percentages of everything based on the GDP. One can also make the jump then, towards a less personally powerful government, because the people ultimately are in charge.


Of course, in a perfect world without war and competition (mostly economic nowadays and informational) and perfect democracy and voting rights, we could then have free health care for all without any problems. Everything could be perfected.


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Will post about federal spending history tomorrow.


Some crypto news I saw:


https://www.bbc.com/news/technology-56844813


I think, even though I like Elon Musk and a lot of what he does for the planet and admire him as a very bright, hardworking guy; that no matter how they spin it, crypto as is, is unhealthy for the planet. It takes tons of power. Even if all the profits one or an organization, made from crypto mining where spent on, say, solar panels, those are just solar panels going towards funding power for crypto mining. Is taking energy and resources away from elsewhere. The solar panels could have gone nearly anywhere, or even if donated, that money that bought the solar panels itself is dirty because it comes from having to spend tons of energy for hashing. Until hashing itself becomes totally useful and wasteless, it's dirty. Even then, it's unfair because it's favoring those with capital to be to invest in all that's required for hashing operations and for the building itself and to sustainably power the operations - which favors them in making lots of money off that system created by some guy.


They just made up a new crypto I guess in honor of Elon:


https://www.hitc.com/en-gb/2021/04/20/elongate-crypto/


Some things just don't make sense to me, given reality. It's like some people are living through their computer screens and internet. When it takes a computer a fraction of a second to calculate simple math problems and hardly much to encrypt and send money over the internet, do we really have to make it more compute intensive just because computers are powerful now? Everything takes energy.




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