Economic pain train's a coming (Boston, Newton: 2015, houses, purchasing)

[porterhouse]

Originally Posted by AtkinsonDan

The goal should be to lower healthcare costs, not to simply provide more insurance to cover escalating healthcare costs. Letting costs escalate is unsustainable.

Agreed. Our premiums are more than double what they were 10 years ago, the coverage is a shadow of what it was, and out of pocket costs out of hand. I did some analysis last year and it likely would be cheaper to self insure given that most providers will negotiate out of pocket costs at a far lower rate than what they bill insurance companies.

[bugelrex]

Originally Posted by porterhouse

Agreed. Our premiums are more than double what they were 10 years ago, the coverage is a shadow of what it was, and out of pocket costs out of hand. I did some analysis last year and it likely would be cheaper to self insure given that most providers will negotiate out of pocket costs at a far lower rate than what they bill insurance companies.

Its bizarre that ppl can be prosecuted for price gouging(eg masks) while hosiptals can charge $100 for a aspirin or $50 for a bandaid all day long...

I still dont understand why there hasn't been enough outrage to fix the crazy prices in hospital billing

[AtkinsonDan]

Originally Posted by bugelrex

Its bizarre that ppl can be prosecuted for price gouging(eg masks) while hosiptals can charge $100 for a aspirin or $50 for a bandaid all day long...

I still dont understand why there hasn't been enough outrage to fix the crazy prices in hospital billing

Many people don't see those outrageous prices because they get buried in the insurance. People only see their portion of the insurance premiums. It is the same principle with ESPN charging the cable companies outrageous carriage fees. The true cost of ESPN is hidden in the cable bundled price and most cable customers never see what ESPN charges. The more complicated a system becomes the easier it is to hide costs. We see it with colleges. We see it with cable TV. We see it with health insurance and government too... bundle services and obscure their actual prices.

[chicagoliz]

Originally Posted by porterhouse

This was not the case prior to the Affordable Care Act. As a small business owner who provided their employees health insurance before and after, I can say that things weren't perfect beforehand but they are much much worse now. Many of us (small business owners) supported ACA, however what was delivered was not what was promised, and the results have been disastrous. And no, socialized health care is certainly not the answer.

I heard lots of small businesses complaining about it back in 1994-95, and I experienced having no insurance at times, and I had plenty of friends who had no health insurance because their employers said it was too expensive. We need beyond what the ACA provided -- that was just a starting point. But too many people want to go backward rather than forward. Our healthcare system payment method needs a complete overhaul. It is beyond f-ed up.

[bugelrex]

Originally Posted by AtkinsonDan

Many people don't see those outrageous prices because they get buried in the insurance..

If you have a high deductable plan or accidentally go out of network, you get to see outrageous prices really quickly.

[BostonMike7]

Originally Posted by bugelrex

If you have a high deductable plan or accidentally go out of network, you get to see outrageous prices really quickly.

We had an ER trip early this year when my 7 year old impaled his foot on a hot wheels car axle shaft that broke. They gave him some Tylenol on the way out for pain. I told my wife I bet that was a $20 dose.

Sure enough, when we got the bill I went digging for it and saw it was in fact $15.xx for 5ml or so of Tylenol.

I’d say I wonder why most people aren’t outraged, but I guess I’m partly to blame as I shrugged it off too

[mdovell]

It might be on a tangent but healthcare and overall health are two different things just as the blue cross of mass isn't the same thing as blue cross of alabama. A few things to keep in mind is much of the medical profession is licensed on the state level. Crossing state lines for care is still a pretty new thing. There are areas where frankly healthcare will not be cheaper simply because of the population and the specific needs. Say a pediatric dentist in Vermont or a OBG/YN in Montana. Some of those areas have one major urban area and then drops off. If you can't get a job in that spot the chances of economically surviving are low. I have a friend that loves Burlington VT but outside of Burlington there just isn't that much of an economy.
Look at Montana after #6 https://www.montana-demographics.com..._by_population

Much of the midwest does have cities but they are spaced out to the point where you are more apt to drive there (hours and hours) vs fly and there's little in the way of trains. Chicago to Detroit is about 290 miles 4.5 hours driving or an hour flying each way.

Metro areas transcend state borders so it might make more sense for regional licensing rather than by state. Maybe some articulation agreements to make it easier. The same goes with other jobs like the trades and education and legal. I know teachers and lawyers that would love to go to another state to have a lower cost of living but after a few decades who wants to pass another bar exam or entry test?

[robr2]

Originally Posted by bugelrex

Its bizarre that ppl can be prosecuted for price gouging(eg masks) while hosiptals can charge $100 for a aspirin or $50 for a bandaid all day long...

I still dont understand why there hasn't been enough outrage to fix the crazy prices in hospital billing

And that isn't the norm anymore. Hospitals are paid by the insurer for procedure or day/diagnosis, not by the supplies used. Hospitals do track that so they know what their costs are but they aren't billing for OTC doses as a line item.

If you are paying out of pocket, you might see a line item charge.

[GeoffD]

Originally Posted by mdovell

Crossing state lines for care is still a pretty new thing. There are areas where frankly healthcare will not be cheaper simply because of the population and the specific needs. Say a pediatric dentist in Vermont or a OBG/YN in Montana. Some of those areas have one major urban area and then drops off. If you can't get a job in that spot the chances of economically surviving are low. I have a friend that loves Burlington VT but outside of Burlington there just isn't that much of an economy.
Look at Montana after #6 https://www.montana-demographics.com..._by_population

Much of the midwest does have cities but they are spaced out to the point where you are more apt to drive there (hours and hours) vs fly and there's little in the way of trains. Chicago to Detroit is about 290 miles 4.5 hours driving or an hour flying each way.

Metro areas transcend state borders so it might make more sense for regional licensing rather than by state. Maybe some articulation agreements to make it easier. The same goes with other jobs like the trades and education and legal. I know teachers and lawyers that would love to go to another state to have a lower cost of living but after a few decades who wants to pass another bar exam or entry test?

Huh? Anyone with anything serious in southern New Hampshire heads straight to Boston. If you're Vermont upper valley, your hospital and specialists are Dartmouth-Hitchcock. In my corner of 3rd world West Portugal, I'm getting an ambulance ride to Rhode Island Hospital if I need a Level I trauma center.


A license in Massachusetts is $600. If you're licensed elsewhere, the Commonwealth does a license verification before granting a Massachusetts license. The point of all of this is to protect the public. It's a pretty minimal barrier to entry. All you need is a license in good standing elsewhere and $600.

[chicagoliz]

Originally Posted by mdovell

It might be on a tangent but healthcare and overall health are two different things just as the blue cross of mass isn't the same thing as blue cross of alabama. A few things to keep in mind is much of the medical profession is licensed on the state level. Crossing state lines for care is still a pretty new thing. There are areas where frankly healthcare will not be cheaper simply because of the population and the specific needs. Say a pediatric dentist in Vermont or a OBG/YN in Montana. Some of those areas have one major urban area and then drops off. If you can't get a job in that spot the chances of economically surviving are low. I have a friend that loves Burlington VT but outside of Burlington there just isn't that much of an economy.
Look at Montana after #6 https://www.montana-demographics.com..._by_population

Much of the midwest does have cities but they are spaced out to the point where you are more apt to drive there (hours and hours) vs fly and there's little in the way of trains. Chicago to Detroit is about 290 miles 4.5 hours driving or an hour flying each way.

Metro areas transcend state borders so it might make more sense for regional licensing rather than by state. Maybe some articulation agreements to make it easier. The same goes with other jobs like the trades and education and legal. I know teachers and lawyers that would love to go to another state to have a lower cost of living but after a few decades who wants to pass another bar exam or entry test?

This is a major tangent, and there are some valid issues here, but this is not among any of the primary reasons why our healthcare payment and delivery system is so f-ed up.

As far as other professionals, I'm not sure regional licensing would make any difference. It's usually not that hard to get licenses in neighboring states, especially when you're starting out. I have an IL law license and now live in MA. And yeah, I wish it were easier to get a MA license as I have very little desire to sit for a bar exam. But if you've been in active practice in one state, it generally isn't that hard to get a license in a new state. My issue is that I had a long break. If I were in IL, I could pick right back up at the drop of a hat. Being in MA, it is more complicated. But as far as, say MA lawyers who want to practice in NH or RI, there are lots of lawyers who have both of those licenses. Many don't need both, but those that do don't generally have a very hard time getting them.