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Yeah, that's a major problem. There are so many, many things at which the government is incompetent - but this isn't one of them. One thing government at all levels is expert at is stifling competition. Governments love to carve out protected monopolies and auction them to the highest campaign contributor. This is an interesting twist on the phrase "privatize profits but socialize costs." The "profit" in this case is to the elected official in the form of legalized bribery called campaign contributions. The costs are borne by the public in the form of higher prices -- anyone with cable TV knows this very well. In fact, research into this area of economics is one of the things that earned George Stigler the Nobel Prize in Economics in 1982 (and I admit I'm a bit biased, as I took classes from him in the area of the economics of regulation when I was in grad school). Stigler wrote extensively that governmental regulation is an "economic good" in the same sense as wheat or corn in that it has a supply curve and a demand curve, and indeed much governmental regulation occurs as a result of demand from the industry being regulated -- to protect incumbent companies from competition. It is a big problem, and a difficult one to solve - the people in governmental entities tend to start out serving the public good but end up serving others instead.
The right questions is "why do labs charge prices off-the-charts for simple blood tests absent insurance negotiating prices"? Could it be that labs list off-the-charts retail prices because insurance companies negotiate X% off retail? Why do two people get charged vastly different prices? It is because of insurance companies being the "customer" instead of patients being the customer.
Imagine we all paid for gasoline via some system. You drive up to the pump & pay, say, $3.29 for a gallon of regular while I pay $2.09 for that same gallon - simply because we use different gasoline insurance companies who negotiate differently. Clearly, that's nuts. Why do we allow this for simple blood tests? It is BECAUSE of the existence of the vast network of insurance companies that the lab work's retail price is off the charts -- and few pay retail.
One of my personal pet peeves is airline pricing. I certainly understand why, but it pisses me off that I sit in a seat on a 737 and pay $400 while the passenger next to me pays $200. It pisses me off that the web price at 9:00 am 5 weeks before the flight is different from the price at 2:00 pm that same day, which in turn is different from the price at 9:00 am 2 days later -- but the price 3 days after that is back to the original. Thank goodness paying for health care isn't like that.
Let's be clear: that "little three hour stint" did NOT cost over $14K. The PRICE was $14K but he COST to the hospital was trivial, as I'm sure you would agree - at most a few bucks. So -- why does the hospital CHARGE $14K for care that costs at most a hundred bucks?
In this case, many pundits agree it is about hospitals purposefully switching fixed cost allocations to the ER just so they can then report back to the community at large "we provided $X Millions of free ER services."
In the real world, they did no such thing. Those $X Millions represent bogus charges just so they can issue press releases.
This points out one of the oft-reported untruths - repeated so much that it has become "true" even though it is false. "ER visits are the most expensive way to treat many things that should be treated in urgent care or in a doctor's offices instead," goes the mantra.
That is just not true. It does not COST anymore to treat someone who comes to the ER with, say, flu symptoms in an ER than it does to treat that person in an urgent care clinic or in a doctor's office. The ER CHARGES more for it, but the COST is the same: a few minutes of a nurse, a few minutes of a doctor, and an admonition to go home & get bed rest & drink plenty of fluids. Those costs are the same.
One of the most misguided proposals I've seen is to set up urgent care clinics inside the ER, and people mostly go the the urgent care clinic while the true emergencies go the the ER. The person proposing this again mistakes prices for costs.
The ER is the front door to the hospital . The hospitals actively encourage misuse of the ER. Have you noticed the billboards around town with "average wait time , 9 minutes" promoting an ER ? The ER is where they generate their revenue.
I've worked on both sides of this equation.
Medicare for everyone is the only viable long term solution .
The ER is the front door to the hospital . The hospitals actively encourage misuse of the ER. Have you noticed the billboards around town with "average wait time , 9 minutes" promoting an ER ? The ER is where they generate their revenue.
I've worked on both sides of this equation.
Medicare for everyone is the only viable long term solution .
I agree, as far as the ER, sometimes there is no where else to go. In my son's case, it was 11 PM at night, all Urgent Care facilities were closed and we had no idea what was wrong with him. It could have been a burst appendix, or a staff infection among other more serious things.
One tid bit that really upset me that I will pass on. I took him to St. Rose on Eastern, as it was on his plan when he enrolled last year, and it is the closest hospital to our home. But after getting there I decided I should double check and be sure his plan and the relationship with the hospital had not changed since enrollment last November, so I went over to the registration desk and asked them. The girl told me "They can not verify this information. Theyare not allowed to." She told me to call my insurance company, which I did and got a recording to call back during regular business hours. So no way to verify with anyone, before going or during.
Not that I would have removed him, as at this point I still didn't know what was wrong. But, when insurance companies tell you to verify the relationship, and obtaining the information off of their web site is not adequate, and you can't reach anyone by phone, it kind of leaves you wide open.
I did question the girl more about it, as she handled the insurance aspect of things. I asked her why she could not look on the computer and verify it with me, and she just said, she was not allowed to. I asked her if the information was available for her to see, and she stated it was, but they were still not allowed to "devulge that information." Needless to say, I was incensed by this type of response. Perhaps more so, since I was so worried about my son. They know patients are over a barrel in cases like this, and they could care less (not the girl's fault obviously), what it might cost you. This system is so flawed on so many levels, I don't know where to begin sometimes. (me ranting about health insurance in this country )
Last edited by modhatter; 10-10-2015 at 07:11 PM..
So I just received a notice BCBS telling me for the second time since the "Affordable Care Act" (ACA) has gone into effect that my plan is no longer available. Didn't someone say on national TV that I'd be able to keep my current plan?
Anyway the new plan is 28% higher than my last plan. My last was 30% (I think that's the figure) higher than the plan I had prior to the ACA which I was told I"d be able to keep. So in a year my health insurance premiums have gone up close to 60%. Funny, this doesn't feel so affordable to me.
Anyway, anyone have a lead on affordable health insurance? Personally I feel my agent is worthless. I'd be willing to combine auto, home and health if it would save me a few bucks.
It's only affordable care for those who don't work. Their care is paid for by you and me and others like us while they breed like rabbits.
It's only affordable care for those who don't work. Their care is paid for by you and me and others like us while they breed like rabbits.
Stereotypical comment in many ways. For many working people the affordable care act doesn't provide affordable care and "breed like rabbits" isn't factual.
The ER is the front door to the hospital . The hospitals actively encourage misuse of the ER. Have you noticed the billboards around town with "average wait time , 9 minutes" promoting an ER ? The ER is where they generate their revenue.
I've worked on both sides of this equation.
Medicare for everyone is the only viable long term solution .
I share your sense of frustration. Everyone on this thread is frustrated.
Part of the problem is identifying exactly which problem we're trying to solve. Is it:
Health insurance costs too much
We spend too much on health care
There are too many uninsured people
We consume too much health care
etc
Depending on which problem we're trying to solve, we end up with different prescriptions.
"Medicare for everyone" does not fix any of the problems - it just rearranges the deck chairs on the Titanic. A "single payer system" just rearranges the deck chairs.
But first we have to agree on the problem statement.
I share your sense of frustration. Everyone on this thread is frustrated.
Part of the problem is identifying exactly which problem we're trying to solve. Is it:
Health insurance costs too much
We spend too much on health care
There are too many uninsured people
We consume too much health care
etc
Depending on which problem we're trying to solve, we end up with different prescriptions.
"Medicare for everyone" does not fix any of the problems - it just rearranges the deck chairs on the Titanic. A "single payer system" just rearranges the deck chairs.
But first we have to agree on the problem statement.
I've been inside it for decades. You can trust my opinion, or not.
If Medicare was opened up to all enrollees, it would solve 65% of the problems with the healthcare delivery system.
Doctors have had to hire people like me to climb through the morass that private insurance has created. We employ people whose entire job is getting prior authorization to send our patients to a specialist, or for a test.
Does that improve outcomes? No. It improves bottom lines because if you neglected a step, you don't get paid for the services you just provided.
I worked for the docs, and for the insurance companies. You want to know which one had more money to waste?
Thank you for that. If people had an inside look at the workings of the insurance companies and doctors office, or they were well read on the subject, they would have a very different perspective.
based on the MLR specified by ACA, for insurance companies 80% of revenue must be paid out in claims, the remaining 20% is administrative, IT, marketing and profit - not much room. The providers (hospitals) on the other hand, are the ones that need to streamline and cut the fat
...Doctors have had to hire people like me to climb through the morass that private insurance has created...
Yes, the problem is insurance isn't insurance; it is pre-paid health care. If it were really just insurance, everything would be more efficient. Not perfect -- but at least as efficient as, say, automobile repair.
Quote:
Originally Posted by NLVgal
...We employ people whose entire job is getting prior authorization to send our patients to a specialist, or for a test.
Yes, pure dead weight in the system precisely because of the existence of insurance. If instead of pre-paid health care, if our system were actually insurance there would be no need for the dead weight.
Quote:
Originally Posted by NLVgal
...I worked for the docs, and for the insurance companies. You want to know which one had more money to waste?
A better comparison would be to compare insurance companies with the Federal Government's Health and Human Services bureaucracy. Which one would you guess has more money to waste? Which one cares the least about efficiency? Which one is staffed with people who get lifetime employment, gold-plated pensions & Cadillac health-care regardless of their performance or level of competence?
Too bad that the only options for all this inefficiency are:
1) Expect the sick and the dying to curl up somewhere and die in a financially-responsible manner.
2) Encourage doctors and hospitals to deny treatment to the sick and dying unless the patient can prove he or she has the means to pay.
Basically, cancer goes back to being a financial killer in addition to just being a killer. It wouldn't even take cancer or a coronary. Most major surgery would send the average patient straight to bankruptcy. I don't want to live in such a callous society. I'll take the inefficiencies of society paying for this inelastic demand.
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