No, I get that. That's why I pay my car insurance. But that doesn't change the fact that if I'm involved in a single car accident and "total" my car I'd barely receive enough to put a down payment on a new vehicle, despite having paid them enough for an entire vehicle (I'm not talking brand new, but I shouldn't be limited to buying a piece of **** either). I get that I'm also paying for the service they provide - it's not a savings account that I can withdraw from. It's just a terrible service that needs an overhaul.

That 2.2% is a nice, tidy statistic but out of how many visits? What is the dollar figure? How many of those 2.2% have insurance? How many are poor and can't afford the bills? I'm not trying to argue that there's an epidemic of people rushing to the ER for bloody noses but that nice, low statistic doesn't tell the whole story.

If your full coverage auto insurance is that high shop around or drop it and save the difference for your next vehicle. I'm pretty happy with mine but full coverage on two and liability only on one cost me less than $100 a month.

That's not the point. I can afford my $45/month premium but it's the collective amount I've given them over time including when the cost wasn't as affordable.

The 2.2% rate of non-urgent visits by people who did not seek primary care pretty much does tell the whole story because it means their overhead is at most 2.2%, and probably less because they are triaged down below everybody else. Even if the hospital has to eat the cost of dealing with them it is a drop in the bucket compared to doctor salaries.

But that's a silly point. You bought the optional insurance to avoid risk. It's actually the best example of what insurance is supposed to be.

Only it's not optional where I live; it is a legal requirement to have at least liability and if payments are being made to a dealership/bank full coverage is (understandably) required. The point is should something happen - say, sliding off an icy road and into a tree - the payout I would receive is criminally low and usually won't even cover the full cost of repairs let alone allow a substantial amount to be put down for a new vehicle. Let's say, for argument's sake, that you've paid an insurance company $10,000 over the lifetime of your policy (roughly a decade, maybe a little more). If you were to wreck your car I wouldn't expect them to pay out a full $10,000. That would be ridiculous and not profitable for them. But on the flip side, I sure as **** would expect them to give you more than $1000. And the longer you've had your vehicle, the less it's worth so they give you less despite continuing to receive more and more money from you.

It's a racket.

So then don't get collision?

The problem with healthcare isn't so much the paying for insurance part of it, as it is the fact that doctors and hospitals are profit-mad and well aware that most of the people who get medical help can afford infinity dollars of care through privatized for-profit socialism-only-worse.

As soon as my car is paid off I'm downgrading to liability.

Roger Spruce FWIW there are hundreds of insurance companies to choose from and there are many different ways they choose or choose not to pay out if you get in an accident. You can pay more for insurance that will "more fully" cover your losses. It's a complete crapshoot but it is possible to eventually find a company that will treat you fairly and pay out fairly in case of a claim. You may will have to pay more for it. In addition, if you do get in an accident you don't have to accept their first, second, or even "final" offer; you always have the choice to hire a lawyer to help you "negotiate" with your insurance company for a fair settlement. When my Jeep got totaled decades ago GEICO offered me $1050.00 for it based on "comparables" they found for sale 300 miles away that weren't actually comparable. Instead of just accepting the offer I wrote them a letter and told them that their list of comparable vehicles was invalid and provided a better list. I asked for $5500 (which is exactly what the vehicle was worth before it was wrecked). The guy called me on the phone, we talked about it for 5 minutes, he subtracted my $500 deductible and I got a check for $5k in the mail a few days later.

On the other hand, my sister was rear-ended by an inattentive (negligent?) driver and the other drivers insurance offered a settlement of ~$2k. My sister eventually ended up needing brain surgery which was awful but the only way the insurance company would budge was after we hired a lawyer. My sister would probably have settled for her out-of-pocket expenses because she was young and didn't know any better but after she was forced to hire a lawyer this guy got hundreds of thousands out of that company. (not like my sister just got to keep it but you know... it's money they never would have had to pay if they would have been reasonable at the outset)

Anyway, if you ever end up making a ton of cash you can also put money equal to your states required minimum liability limits into a trust fund and then you don't have to pay the insurance companies anymore. But most people at that point I think opt to pay for insurance anyway. Obviously check your local laws. Insurance sucks, I agree, but if you ever get wrecked by someone without insurance you'll be pissed that they aren't more strict about it

I'm sorry, I thought we already acknowledged liability isn't a part of this conversation and I would think a lien holder requiring insurance would be common sense as well. So really any complaint about choosing to pay another entity to absorb the risks associated with your driving and vehicle, with clearly defined terms, limits, and cost still seems silly. It's also pretty silly to drop collision if you don't know that you can absorb the replacement cost.

I think you are misunderstanding his complaint. It sounds like he's complaining about a low payout for an accident based on the amount of money that he's paid in. But the payout is generally based on the amount the wrecked car is worth, or maybe the replacement value, or maybe the depreciated value, or maybe the agreed-upon value, depending on your policy. You have to be a careful insurance shopper and know what you are buying ahead of time to make sure you don't get screwed.

You realize that most hospitals are not for profit, right? And the ones that are for profit have pretty pitiful margins.

I really don't not understand his complaint. It's more that I find his complaint rather irrational. You purchase car insurance for a term. Typically six months. It sounds like his total insurance coverage costs him around $300 and that's rather cheap for the amount of service and money available should the need arise. There is no cumulative aspect to car insurance. It's almost like he's pining for some sort of crappy whole life coverage for his car. Considering that he is financing his vehicle and likely paying much more in interest over the life of the loan than the coverage his financing agency requires it appears that he's annoyed at the wrong thing.

I had dropped my collision on one car so I would have more money in my account each month a long time ago. When I realized that I couldn't afford to replace the car and that the extra coverage was really affordable I picked it back up and even took the lowest deductible. Granted, the car is a 2000 model but it's not easy to find Trans Ams of that vintage in such nice condition. And I haven't bought a new car since 1991. And I won't finance one ever again. Live and learn.

I really do understand the notion of being annoyed that you have to purchase a product that you hope to never use but at least that is the case with automotive insurance and why it is relatively affordable.

That's because administrators and directors use their position to disburse their profits to themselves and other employees. Most hospitals are "not for profit" where "" means "airquotes". It's a tax dodge and an accounting scheme and maybe just a little bit of an extra bonus at the end of the year. The fact that they call themselves non-profit, and their profit seeking is for the sole benefit of the managers and doctors, and not the hospital corporation itself, doesn't mean it literally conducts itself as a non-profit.

****in' Scientology is a non-profit. Chrissakes.

By those very same stats you quoted, this doesn't add up. A few CEOs and hospital admins making half a million a year isn't the driving cost behind a 2.7 Trillion dollar industry. If rent seekers really were contributing significantly to these costs, you'd see numbers far higher than that. You'd also see hospitals doing a lot better financially. I mean, hell, Aetna is a 60 billion dollar a year company. A 36 million dollar compensation package for their CEO isn't what's breaking the bank here.

Hospital administrative costs make up 30% of all US healthcare expenses. For perspective, doctor pay is 8.6% and even that is grossly inflated in the US. Malpractice is less than 1%. FTA, US hospitals invent whole layers of management and clerical positions that simply do not exist in other countries and are completely unnecessary other than to pad headcount and get their buddies paid.

When I went to the dentist, doctor, etc. in France, they didn't even have secretaries or anything. You'd speak directly with the doctor when making your appointment, he'd buzz you in when you arrived for your appointment, he'd run your Carte Vitale & bank card himself, & then he'd schedule your follow-up. The wait was always better than what I'd experienced in the states, I never felt rushed, I was never dumped onto a nurse practitioner, & I always felt like I was getting my money's worth. In fact, I rarely even needed to go to the doctor because they would usually just come to my apartment, & that was essentially the same as just calling for a taxi (on my end at least). I really don't feel like we're getting the best bang for our buck in the states. I think that many Americans find masochism romantic.

I haven't finished catching up on the thread, so I'm sorry if someone's already gotten to this. There'll be a lot more I want to respond to, I'm sure, but this jumped out at me as something I could try to clear up right away.



This will probably apply exclusively to administrative lawmaking, rather than to actual legislation, since that first thing is the one that Trump's administration will have (theoretically) complete control over. As such, an agency that wants to make a new rule will only have its own rules to choose from, since it doesn't have any authority over any other agency's. (It's possible to imagine interagency deals to game this, I suppose, either negotiated bilaterally or brokered by the President, depending on how much Trump can be bothered to care.) As an extremely facile example, the Trump FDA might kill two food safety regulations it doesn't believe are necessary in order to implement a rule that pharmaceutical companies wanting to bring hair loss treatments to market must first offer free samples to the President.

You're right, of course, that what constitutes "one regulation" is not inherently obvious and probably won't ever be well-defined under a President who gives no ****s about the details of his proposals. If the Trump FCC removes the words "dick" and "piss" from its list of punishable fleeting expletives, is that two regulations? In the absence of specific top-down guidance from the guy issuing the edict (which is not going to happen), I expect each and every agency will interpret this directive in a manner that maximizes its freedom to issue new regulations and blunts the directive's intended effect.

What on earth makes you think that? Hospital administration has a massive amount of regulative and bureaucratic churn. Billing in particular is awful. Why on earth would an insurance company put up with a hospital that for some reason decided to create a bunch of unnecessary overhead for a jobs program? Why would they even do that? If that money was there to be made, you can bet that the capital holders would concentrate it, not bleed it off into millions of mid level job for buddies of managers.

Median pay for healthcare executives is $14.5 million, but $10.8 million for all S&P 500 companies. Executive pay increased 7% for healthcare executives in 2015, but only 4.5% for S&P 500 executives. I'm not sure what capital can be concentrated in healthcare (other than financial derivatives) but in terms of profit and total compensation, it is tightly concentrated. More so than other industries, even.

Managers have strong social and personal profit motives to unnecessarily inflate their number of direct reports. Manager prestige is based on your direct reports, it influences compensation and your control over the organization. Over hiring is a huge problem for all businesses in all industries, as is nepotism. The fact that it's a waste of money doesn't even enter into consideration. (Was this really news to you? It's why companies have to do layoffs every time the economy takes a hit, they're employing far above efficiency.)