Great Article Bob !

[somarco]

Thanks for the shout out, Bill.

The MLR was designed to remove agents from the equation.

MLR was a salve to appease the voters, make them think the carriers were being squeezed.

In spite of what some agents believe, carriers cannot distribute effectively on a direct basis, even with a mandate.

Car insurance is mandated in almost every state yet there are still car insurance agents.

If agents weren't needed compensation for them would have gone out the window while Obama was attending college as a foreign exchange student.

fatness and pill poppers are not what is driving up health care cost.

Actually they are.

The large claims consume a fair amount of total health care spending but the routine stuff, most of which is preventable, is responsible for 60 - 70% of total claim dollars . . . and most of the items reimbursed for chronic illness are things that do not require insurance (if the patient simply paid out of pocket).

the doctors/hospitals/drug companies are the expenditures...... control the "expenditures" and you control health care premiums......

You sound like a Democrat.

The way to reduce Medicare spending is to pay the doctors and hospitals less money.

That doesn't work.

explain to me why there is even a ppo plan needed?

Reimbursement plans existed until 30 years ago or so. Claims were filed and the provider was paid R&C then balance billed the patient.

Providers set the prevailing rates, not carriers.

Managed care lowers the cost of care for insureds.

 

[russelltw]

I disagree with Peeler on that. I have clients with kids on 8+ meds...8 meds...and the kids is 12. I am in a rural area and any time we have a social gathering, it's soda/chips/cookies/etc.

I have friends who tell me they want to lose weight, had lypo suction, etc....yet go out to lunch and/or dinner 5 days a week. Last dinner with the friend above consisted of a salad, coke/ice cream float (32oz), and a kid's meal (all for them). And they wonder why they can't lose weight.

It's maddening to watch...They complain, yet turn around and grab some processed crap in a wrapper and eat it.

I have lost weight, not a ton (185 to 164) over year with no exercise, but just eating natural food. Watch what people eat today.

 

[taterpeeler]

glad you all disagree..... but the bottom line is to control the cost control the source...... that's just a fact

 

[somarco]

bottom line is to control the cost control the source

How do you propose doing that?

 

[kahlestyle]

I'll take a shot, but it will kill our group biz

get rid of incentive to offer employer based benefits (tax deductible)

get rid of fee for service

everyone knows their cost and has to spend their OWN money,
you know like a mattress or a tv which we'll spend hours on analyzing

then..... cause and effect sets in

throw in some european style end of life choices since something like 55% of our total health care costs come from the last 6 months of life

the obese, 2 packs a day, drugs, booze?
they dont pay more? REALLY?

ok, now im ranting....

medicare?
im tired of hearing this age group say "i deserve it, i paid into it all my life"
yeah? then quit taking out 3 times as much as you put in
or if this is your argument for not changing its structure, then cap it at the amount you put in, hell i'll even throw in interest and a cpi if you shut up after that

(no disrespect intended to all those here at the forum)

 

[RayNY]

Cutting reimbursement doesn't work obviously.

Singling out high-risk individuals is not nice, and since we have to be nice to everyone regardless of how stupid or self destructive they are, that won't work either.

You know what will work? Market forces.

Make doctors publish rates for procedures up front. Make insurance cover catastrophic events like it did in the beginning. Day-to-day routine stuff is out of pocket. Let people shop around and compare. Let them know that a visit to the ER for a sore throat is $4000 but a trip to a clinic is $90 IN ADVANCE SO THEY CAN MAKE AN INFORMED DECISION.

It works for everything else in this country, from houses to tic-tacs. I know it's a far fetched idea, but it just may work.

 

[Crabcake Johnny]

Kill all copays (except for "the poor") and put everyone on the hook for say...the first 5K to to 10K.

Then all of a sudden everyone will care about what they're paying and the market will force transparency.

 

[somarco]

get rid of incentive to offer employer based benefits (tax deductible)

Unions fought for that. Employees expect it. Won't happen but expect employees to be taxed on a portion of the employer paid premiums.

get rid of fee for service

Why?

And replace it with what?

medicare?
im tired of hearing this age group say "i deserve it, i paid into it all my life"
yeah? then quit taking out 3 times as much as you put in

They did pay all their life, or at least most did.

That is the way the system is set up. Don't blame seniors for what Congress designed and then screwed up by adding more and more benefits.

When Medicare was first set up seniors were expected to live about 6 years once they started collecting benefits. Now it is more like 10+ . . . mostly because of Medicare.

Make doctors publish rates for procedures up front.

Some do for routine care, especially in the doc-in-a-box clinics.

When it comes to surgery or treating a major illness or accident, what do you propose? Paying a flat amount and when you run out of money that's it?

(BTW, that is a proposal Medicare and Medicaid are considering).

 

[anonymous1]

Kill all copays (except for "the poor") and put everyone on the hook for say...the first 5K to to 10K.

Then all of a sudden everyone will care about what they're paying and the market will force transparency.

Sounds like a HSA. What a concept. If people actually took personally responsibility it would be great. But eventually you will have the govt tell us it isn't fair that the majority took the time to save money with a tax loop hole and we should get rid of them so those that didn't plan ahead have a fair chance. I personally would be ok with 10k

 

[Crabcake Johnny]

There's never gonna be a perfection solution because there's no good analogy.

Someone gets involved an a major car accident, is airlifted to shock trauma, spends the next 6 months in the hospital the the next few years in therapy is going to cost millions...and somehow the tab has to be picked up.

How? I wish it wasn't political because I'm sure the top minds in this country could put something together. If we get too strict on cost controls then innovation is stunted.