I think that another thing that needs to be addressed is medical waste and fraud. I know that some places like Florida are RAMPANT in healthcare faud for medicare, prescriptions, medical equipment, and things of that nature. I think that if we reduce costs purely from the fraud aspect that the country we see an overall reduction in problems.
ObamaCare Must Die
- Thread starter Mark from WI
- Start date
- Thread starter
- #12
Great analogy. It's the entitlement mentality. For so many years people have just been "covered" by their employers without cost. And now, for so many reasons, costs have escalated to the point where that model is no longer sustainable by employers or by individuals/families.
It's time to get real about BOTH the costs and the reasons they are so high. It's also time, as you say, to realize that we must all accept the accountability for our own health.
Part of it is also to realize that doctors are not magicians, and drugs are not magic. With some notable exceptions, you don't get something for nothing. Most "cures" come with downsides. Sometimes living with the condition (and whining to friends and family) is the best option.
- 14,808
I've touched on this many times before.
Say the average cost of a MRI is $1,000. Why. Why's it $1,000. The answer? Because it can be $1,000.
With a pure open market an MRI could cost $100.
People say costs have gone through the ceiling - but NOT when there's direct competition.
As an example, the price of an office visit, adjusting for inflation, has barely budged in 50 years.
- 3,384
The problem is that "we" understand these concepts but the general public does not.
Insurance should be for catastrophic costs
Provider rates should be transparent and shop-able
NFR should not constrict true cash pricing for services
The private system we have now hides too much information in their little game between insurers and providers. If a person is going to be subject to NFR best pricing, they should be able to go online and shop the NFR rates with their carrier for that particular service. Right now it's all but impossible, even with the CPT-4 codes, to get a price for a service.
The public wants either someone else to pay for it or they want to pay the lowest premium and get the most upfront first-dollar benefit.
I feel that until the public perception changes away from "just a co-pay" mentality, the idea of shopping for services and catastrophic health insurance are a tough sell.
Insurance should be for catastrophic costs
Provider rates should be transparent and shop-able
NFR should not constrict true cash pricing for services
The private system we have now hides too much information in their little game between insurers and providers. If a person is going to be subject to NFR best pricing, they should be able to go online and shop the NFR rates with their carrier for that particular service. Right now it's all but impossible, even with the CPT-4 codes, to get a price for a service.
The public wants either someone else to pay for it or they want to pay the lowest premium and get the most upfront first-dollar benefit.
I feel that until the public perception changes away from "just a co-pay" mentality, the idea of shopping for services and catastrophic health insurance are a tough sell.
Last edited:
From personal experience I can tell you that when someone is in the hospital for 18 days and the bill is over $270,000 something is not right. Take out $40,000 for Rx, $15,000 for surgeons, $5,000 for MRI and CAT Scans and you still have almost $12,000 a day for room and board.
Then when you get out and go to a specialist their statement shows that they charge $250 to $350 for an office visit that lasts five minutes while they have their hand on the door knob and order several more thousands in additional tests to cover their butts.
Also, prescriptions that cost $300 a month that you can order from Canada for $25 a month.
Nobody bothers to look at their statements because it's covered by insurance and there's nothing we can do about it anyway.
Insurance premiums for someone 50+ can be more than a house payment and some still have $10,000 or more in max OOP.
Nothing that I have seen in the healthcare reform addresses cost and I don't think there is anybody in government that is smart enough to fix it.
After seeing a hospital bill like this I firmly believe the big hospitals and big pharma are more to blame than the insurance companies. Oh, I forgot it's the agents fault because our commissions were so lavish.
Then when you get out and go to a specialist their statement shows that they charge $250 to $350 for an office visit that lasts five minutes while they have their hand on the door knob and order several more thousands in additional tests to cover their butts.
Also, prescriptions that cost $300 a month that you can order from Canada for $25 a month.
Nobody bothers to look at their statements because it's covered by insurance and there's nothing we can do about it anyway.
Insurance premiums for someone 50+ can be more than a house payment and some still have $10,000 or more in max OOP.
Nothing that I have seen in the healthcare reform addresses cost and I don't think there is anybody in government that is smart enough to fix it.
After seeing a hospital bill like this I firmly believe the big hospitals and big pharma are more to blame than the insurance companies. Oh, I forgot it's the agents fault because our commissions were so lavish.
- 14,808
Exactly. They also want us to bite down on "but new medical technology increases costs."
There are few examples of technology increasing costs in the free market.
15 years ago it would cost $5,000 for a big screen TV. Now, due to technology, you can throw on in your shopping cart at Walmart.
Medical technology should be lowing the cost of care.
There are few examples of technology increasing costs in the free market.
15 years ago it would cost $5,000 for a big screen TV. Now, due to technology, you can throw on in your shopping cart at Walmart.
Medical technology should be lowing the cost of care.
Last edited by a moderator:
I have written a few of these plans while they were still paying brokers. The biggest challenge in getting people covered is that they have to go without any health insurance coverage for 6 months to qualify. That is ridiculous. I was trying to help clients that had major health risks and that couldn't afford Cobra and needed medical care, but had no other options. PCIP is not effective with a 6 month waiting period for people that have had coverage in the last 6 months.
I understand that doctors offices are crunched as much as we are in this health care reform, but I must say that transparency and efficiency would go a long way to lowering costs. The health care business is more inefficient than any industry I know. Where else do you arrive for an appointment at 10:00 and you finally are seated in the exam room at 10:30 to see the doctor at 11:00 for a 5-minute appointment? Going out for tests, getting the results, and seeing your doctor for follow-up is another round of ridiculous. The 3rd party billing system is inefficient. I've gone to hospitals to visit, and watched medical personnel just hanging around - a lot. We take care of my 84-year-old mother-in-law, and the inefficiencies and errors that doctor's offices and care homes make are shocking. Lack of efficiency in the health care industry, and lack of transparency in costs are major factors.
- - - - - - - - - - - - - - - - - -
I, likewise, know people who need the PCIP but are hanging onto their current coverage and therefore won't satisfy the 6-month go-bare clause for the PCIP.
However, the 6 month go-bare clause was put in there to avoid an adverse selection migration of business from the IFP and Group market to high risk pool. Without it, there's little motivation to keep insurance in force. Go without insurance, hop on the PCIP when sick, hop off again when well. This is bad for our tax dollars, and also bad for the IFP and Group insurance market.
An alternative to the 6-month go-bare clause might be for an applicant to prove that they have no other insurance options, and that they were declined at least 3 times in the IFP market. Still another fix is to have specific open enrollment windows.
- - - - - - - - - - - - - - - - - -
I, likewise, know people who need the PCIP but are hanging onto their current coverage and therefore won't satisfy the 6-month go-bare clause for the PCIP.
However, the 6 month go-bare clause was put in there to avoid an adverse selection migration of business from the IFP and Group market to high risk pool. Without it, there's little motivation to keep insurance in force. Go without insurance, hop on the PCIP when sick, hop off again when well. This is bad for our tax dollars, and also bad for the IFP and Group insurance market.
An alternative to the 6-month go-bare clause might be for an applicant to prove that they have no other insurance options, and that they were declined at least 3 times in the IFP market. Still another fix is to have specific open enrollment windows.
Last edited:
