Off-topic: Government healthcare proposals

Bill- a well thought out post

Cost control could be cost reduction it could also be cost elimination it could come in different forms as well

Costs can be eliminated. Transportation fees, lab fees, billing fees... the doctor's offices create fees to bill insurance companies for, so they have more billing codes and because the fees are small, they will not get the attention from the insurance company that "large claims" get. My MIL works in large claims at a health insurance company- her job is to track the high cost patients and the bills they receive, and work to pay less on these large claims. Small claims have similar markups, but because its OK for you and me to each pay an extra $35 for this, or $75 fot that, those costs do not get removed or eliminated, where as if the bill is large, those costs are often removed.

In a similar example, In my experience, I had health coverage with an employer in 2007. Call it company A. In 2008 company A was bought by company B and new health care was provided. In 2009 I received a Bill for services which were incurred in 2007. The fees totaled about $500. The insurance decided to change what was covered in 2007 2 years later. This is after my company let all its benefits people go when the 2008 buyout happened- I had no where to go but pay the extra $500 in fees which were covered on the original Bill, but the insurance company audit close to 18 months later decided we had to pay the fees. That type of insurance company bullying needs to stop as a way to eliminate or control costs.

Reply to
jIM
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My opinion would be let free market drive how many treatments exist for something. There are numerous antihistamines. Allegra works best for me, but I stopped using it because my insurance would not cover it, and they told me to use claritin or similar instead. To this day I have yet to find an antihistamine which works better for me than allegra.

Bill had a point which debated this too, and my take is remove the insurance companies from telling me what drug to use for a given problem- let my body and free market decide which treatments work best and determine the costs of the treatment too.

Reply to
jIM

Similarly, for those without insurance who pay cash, there should be a discount from your aforementioned 'set price,' because the billing source does not have to spend time on the administration of insurance company policies, insurance company billing procedures, etc. A few years ago my local paper reported that the local university hospital charged those without insurance, whether they paid in cash or not, a premium of some 30%.

Then too those with insurance are far less likely to question the prescription of ineffective procedures and drugs. Many with insurance have the attitude that they should get back what they pay for, and that more is always better in medicine. (Not so.) What this does is push up prices for all.

My point is there is justified disgruntlement on the sides of those without insurance as well. In fact I think our problems today are due mostly to consumers with insurance.

Lastly, with all due respect, I am doubtful that a level playing field and free market can go hand-in-hand in the ways you suggest. That is, you seem to be suggesting cost controls, which would be socialized medicine and not a free market.

Reply to
Elle

If I understand you correctly you are advocating a system where your insurer must pay any claim for any treatment regardless or price. That is going to remove the microscopic amount of cost control that exists in the system now and increase the cost of insurance. The result of that will be fewer people with insurance.

Remember that both private insurance companies, drug companies, privately owned hospitals, etc. are for profit businesses. The sole purpose of any business is to increase the wealth of its owner(s) and all business will act in a way that management believes will further that goal.

It is a given that demand for healthcare will always exceed supply. Therefore, healthcare will always be rationed in some way just as it is now. If you espouse a free market approach what you are saying is that you favor a system where access to healthcare is rationed based on ability to pay. If that is really the kind of system you want to see in this country that's fine as long as you clearly understand all of the implications of the system you advocate.

Reply to
Bill

Level playing field relates primarily to how people obtain insurance. Meaning you have the "right" or ability to get the same insurance I do, and have that insurance cover the same things for the same price. That environment does not exist today.

The "free market" is about obtaining insurance- make sure BCBS competes with medicare and competes with UHC and all other insurance providers compete for my insurance dollar.

I believe if this happens, the inefficiencies of costs can be squeezed out of the system.

I am not suggesting the cost of an MRI be fixed, I am suggesting it be the same for all who want to get an MRI. You without insurance should pay the same as me with insurance (you should not get a discount).

The anti thesis to your comment is that the insurance cost should be lower because they negotiated a bulk group rate. Your thesis was your rate without insurance should be lower because its less paperwork. My thought is the price for a given service should be the same (remove the inefficiency and just list a standard price which all pay like a restaurant menu). I don't care if the doctor sets the price, the government does, the insurance companies do, but my point is the price for a given service needs to be equal, to extent that if I find out my Dr charged you less, I have the right to sue or recover the difference in treatment costs.

Reply to
jIM

Bill- My point is a level playing field on price. I am not advocating price controls. I am suggesting if you get an MRI and I show up later that day, I pay the same amount for an MRI as you do.

I have NO IDEA how to set the price, or who "controls" or "makes sure" we set the price. Kind of like going to a restaurant and ordering from a menu- the price for a given procedure is listed on a menu, and all people at that location pay the same amount for the same service.

My logic behind this is the basic premise that "everyone wants good healthcare, no one wants to pay for good healthcare".

At minimum my reform wishlist is that we all start paying the same price for things. Level that, fix that, and see where it takes us (change in baby steps in better than complete reform IMO).

What I would "expect" to see is people now understanding that to get an MRI it costs about $500 for the MRI tech and similar to get that done. If a doctor orders an MRI, they could then logically ask "do I need that test"?

Meaning if we saw the price, we could either a) shop around for a lower price (and then free market might change how much an MRI costs) b) opt to not have the test c) get the MRI done because it is needed and needed now

The list price for the MRI might be $500 as I suggested if we have the same insurance, we should pay the same amount (whether a 20% copay, the whole $500 or something else). If you choose to not have insurance, then you pay the full $500, but you know the "end result" is that the office received the same revenue from me as it did from you.

This is the only form of cost control I am suggesting- menu pricing so to speak.

Reply to
jIM

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Non -profits are also in the business of making money so that they can expand, have fancier rooms, subsidize the poor etc. They also must compete for doctors, patients etc.

Reply to
Avrum Lapin

I agree. This is part of the larger issue of transparency. The consumer needs to understand not only pricing but all other aspects of how the system works in order to make good decisions.

Only true if the consumer has to pay part of the cost directly from his/her pocket. For those that have first dollar coverage (for example, myself on traditional medicare with a medigape policy) there is no incentive whatever to conserve resources. Any plan that offers first dollar coverage will be abused and is a bad idea because resources will be wasted that could be used to server others.

Again, I agree but it will only work if, as Warren Buffedt says, the consumer has some skin in the game.

Reply to
Bill

I agree that non-profits need money to operate but making as much money as possible is not usually their primary stated goal.

Reply to
Bill

I don't think you meant what you said. I think your intent is that any single provider or MRI exams much charge the same price to all regardless of whether or not they have insurance or what insurance they have. If provider A charges everyone $500 and provider B can provide the same service charging everyone $450 that is fine.

Reply to
Bill

Sorry. That should be "provider of MRI exams".

Reply to
Bill

The above is not what I call a free market.

My thesis is that when it comes to assigning blame for health care costs, the insured are as much at fault as the uninsured.

I am not seeing it. Bargaining is usual for many products outside of health care. For example, should we have a standard price for new cars?

My objection is your claim that what you are proposing goes toward a 'free market.' I think what you are proposing is in some respects a freer market, but in other respects it is a less free market.

Reply to
Elle

My thought is I need to see the cost of the procedure before the procedure and everyone getting a procedure from the same location be charged the same amount (transparency). You are correct in stating if the office down the road wants to charge $50 less, they should be allowed to do so.

As long as all costs are known for a given procedure ahead of time.

Reply to
jIM

It has to be said that along with the transparency in amounts there needs to be transparency as to quality and safeguards. Not all MRIs or Radiologists are of the same quality. It is sometimes the case where serious problems are not apparent on imaging but discovered later with a different radiologist or different type of machine. It could be strictly a matter of quality or, perhaps, of payment but these more sophisticated areas of health care difficulties have to be worked out also.

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Reply to
Lowrie

I keep hearing that one of the ways the government intends to pay for whatever national health insurance passes is by cutting Medicare. Does anyone know the specifics of the cuts?

Reply to
HW "Skip" Weldon

My disappointment in the past week is the clauses that would be helpful to the 50-65 age group have been mostly removed. These include the public option, medicare buy-in, and federal employee plan buy-in. I dont not know if the clause restricting the maximum premium to be 5x the minimum premium is still in the bill. Just having a no-refusal clause for private plans may help a lot. Though it may cost a fortune.

Reply to
rick++

True, and people who compare two countries are often selective to the USA's advantage. That is, they compare the medical care the more affluent Americans receive with what everybody in Canada receives.

Reply to
Don

It is interesting that those provisions were removed at the insistence of Joe Lieberman of Connecticut, home to more insurance companies than any other state in the U.S.

I don't think that making all insurance plans guaranteed issue will increase premiums much. All group plans for employers with over 10 to

15 employees are guaranteed issue and the premiums are lower than individual policies for the same group of people. When you look at adding those who can afford to buy insurance and would buy it if they were not prevented from doing so by a pre-existing condition I think you are looking at a very small percentage of the total number of people now insured. It would be interesting to see some accurate statistics on this .
Reply to
Bill

It will. A PPO under the California HIPPA plan (those who use up Cobra and can't buy insurance because of pre-existing) pay about $750/mo with a high deductible and a 30% co-pay

Reply to
Avrum Lapin

Everyone seems to accept that as a given, but, in the case of Canada, I don't think it's necessarily true. Check out the latest OECD economic outlook:

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Specifically, the spreadsheet on government outlays:

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They measure total government outlays (federal, state and local) as a percent of GDP. Admittedly, this is a pretty crude way of measuring "taxes". But it's probably a lot better than anecdotal evidence. In

2009, government outlays in Canada were 43.6% of GDP. In the US, it was 41.5%. Canada is only about 5% higher than the US.

However, the UK IS significantly higher, at 52.1%. That makes me wonder where the disparity between Canada and the UK comes from. At first blush, I thought it was military spending (the UK has things like nuclear weapons, ballistic missile submarines and aircraft carriers that I don't believe the Canadians do), but that doesn't appear to be the case. According to Wikipedia:

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Canada spends 1.1% of its GDP on its military while the UK spends

2.4%. That accounts for some of the disparity, but certainly not all of it. Maybe the UK has more non-medical social spending that Canada? Don't know.

--Bill

Reply to
Bill Woessner

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