The Dismantling of ObamaCare - Ongoing Updates.

[ARus]

It will be simple if we go and ask for the price, pay to this provider or shop around, and after that make a claim to our carrier. For small things it should work (my latest experience with 2 dentists showed me exactly how well it works).
If they can consult by phone (nurse hot line), it means they can have their price list hanging in the provider's offices and hospitals (computers with info), also accessible financial department people. I want to say, it is not so big deal everything to be transparent, as all of you are saying above. People will ask for more services if they know what to expect.

And of course all preventive care should not be a problem even for cash. Bad things start from missing it. If we have affordable prevention, it means people should do not be afraid from it also (finding out that they have some preexisting condition). So, underwriting should be excluded. Everybody should be able to purchase insurance if needed it. As we commented before, the insurance carriers are making their money from their large groups. The individual market is worsening of their conditions for good bonuses at the end of each year.

If all this can't work, sorry, but the health care system is totally wrong and everybody should look for his own variation of survival.

 

[junkman]

I agree price transparency would help.......if we didn't have insurance. Insurance causes those with large, non-emergency procedures to shop only considering out of pocket. Once you hit OOP, all else is covered.

I know 1 person who fell and cracked his pelvis. Ambulance, ER put him close to OOP. He stayed 4 days and only used the hospital as a high priced hotel. No significant health care was given. He would have been out day 1 had he been self pay. It hurt to walk and was paid for so he stayed.

Medical trend has been 8-10% for years. Premiums are function of price AND utilization. Both have no form of control with our current system. Published procedure prices would help but not as much as the rest of the economy because Healthcare isn't self pay.

There are also few alternatives to Healthcare. You can buy a used car, walk ,ride a bike, grow a garden, rent a house, live in a tent etc. There are no such options when you need a new hip or even a flu shot.

Finally, it is the large claims that really drive rates. 5% of the people will have 40% of total claims and those will all be serious and expensive procedures.

 

[RayNY]

Medical trend has been 8-10% for years. Premiums are function of price AND utilization. Both have no form of control with our current system.

This is the important fact everyone seems to forget. We saw a slight bend in the cost curve from 2011-2015, but that was mostly due to an abnormally large increase for 2011 due to pricing in uncertainty/risk and the cost of covering the essential health benefits throwing off the following years.

We're still right on trend.

 

[yorkriver1]

ARus it is quite clear you have no clue about the meaning of underwriting. And yes, I am quite serious, that health insurance premiums for the masses will not decline until medical underwriting is allowed.

Underwriting is risk assessment and evaluation.

As long as we don't go with a true coverage for all government plan, with strict price controls--which will never happen--and I am not rooting for it--I believe you are right, Somarco.

Local PCP's have told clients of mine they have never had it so good. Volume, I guess, + not having to write off care that's not reimbursed.

 

[workerscomp1]

Congrats to this forum on talking about costs! At the end of the day that is what this whole debate and National debt crisis is about. How do we control medical inflation when providers(Docs, ICU SIUs, Hospitals, DME vendors, Skilled nursing, Imaging centers, Rehab pros, on and on) all in some way have investors, stockholders, owners to answer to who expect a maximum profit from their investment?? The above mentioned providers naturally make more$$ the more procedures and services they do soooooooooooooooooo up goes the costs$$$.
As a lifelong Commercial P&C producer IMO I have read positions on this forum that are pure Bulls###t
1.TORT REFORM(over treat because they don't want to get sued)--Really?? We have had Gold Seal Tort Reform in several states and now have record low Malpractice premiums, lawsuits yet those areas still have some of the highest Medical inflation rates in those very tort reform states!!! West Texas great example!! Sorry talk show experts and fellow Repubs this won't work!!!
2.Selling across state lines--L&H sorry again guys-- you don't have the markets(companies) we P&C folks are constantly faced with this stone wall-- you would need hundreds of players(companies) to even give this approach a try.
3. Risk Pools--ha ha ha- sorry to be a downer Risk pools have flopped in several lines of insurance Health, Liability, W&C Malpractice they always become too expensive, to labor intensive for both insureds and claimant's doubt you could get any real players interested
So how about we stop calling each other names (Libertards-- racists wingnuts you know who you are) and start talking about real reform that might get costs$$$ down!!

 

[scagnt83]

They can if you don't use your insurance card and pay cash. Have you ever tried?

Incorrect (in a general sense at least). And YES, I am speaking from personal experience.
I have lived without insurance multiple times in my adult life. So I am extremely familiar with the difficulties of getting a straight answer on prices from doctors.

My kid was on a short term plan for 3 months last year. I went super high deductible, which means she was just "self-pay" for 3 months. Never used the insurance card or ever told the Dr about it since it was all minor issues. But she needed a strep test...

....Even the urgent care/quick clinics cant even give you a hard number on a strep test. Most will give you a "base rate", which are all about the same. And when pressed hard, 3 out of 5 did gave me some type of range on labwork... there was a 1000% difference in the ranges for the possible cost on labwork.

But heres the thing, the people manning the phone had none of that info ready to provide. Only 1 place was able to give me the info without putting me on hold forever and talking to multiple other people. THAT is why things are so effed up. That is not the free market at work. For simple issues, a person should be able to call or go on a website and have at least an estimate or range on how much the visit will cost. It is possible to do.... just not in the best financial interest of the Dr office.

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Also, in a f*cked up twist of irony, the people with insurance are able to have more price transparency than the ones without. As you like to point out, most providers have online systems to show you the negotiated cost at a certain provider. BUT INSUREDS HAVE NO INCENTIVE TO DO SO BASED ON POLICY DESIGN! If I have a $20 copay and nothing else, why do I care?

The ones who have access to transparency are the ones who need it the least! (unless everyone was on HSAs)

 

[Yagents]

Put everyone on 5-10k deductible HSA plans.
HSA penetration is about 30% of market I believe, time to make it 100%.
Fund the HSA account for the lower income up to certain dollar amount.
Same model for medicaid.
Tell them the money is theirs the rest of their life.
Tax deductible higher contribution limits for everyone else.
Require price transparency on the internet and on facility arrival.
Watch behavior change.
Consumerism........catch the fever.

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Or, you have all payer system like Alan Katz blogged about:
Is All Payer Ready for a Comeback? | The Alan Katz Blog

 

[scagnt83]

The problem is that Paul Ryan's grand idea is to give people the choice of going uncovered. History has proven that does not work out well for anyone involved... and every US citizen is involved in this... in one way or another, we are all interconnected on the health care issue.

Unless we start denying ER access to those who deny coverage, we are all in this together. That is why the current plan will fail.

 

[Yagents]

Fiction or non fiction?

CBO says millions lose health insurance under GOP Obamacare replacement


Fourteen million people would become uninsured next year if the top Republican proposal to repeal and replace Obamacare is signed into law, the Congressional Budget Office estimated Monday. Fopu1

That equals about 70 percent of the 20 million or so people who have gained insurance coverage as a result of the Affordable Care Act, as Obamacare is more formally known.

The Republican bill also would reduce the federal deficit by $337 billion over the next decade, the CBO estimated in an analysis of the embattled proposal, which is currently working its way through the House of Representatives.

 

[kgmom219]

T

How did you get it?

I called my carrier rep and asked. Then she (this was last year, Tater) was told I couldn't have the information. It was "priviledged".

So I sent it to my VP and he got it for me, with the promise that I couldn't name the hospital or carrier.

A family member needs an endo/colonscopy. The doc I want has privledges at 3 hopsitals. 1 gave me the number. 2 others said "they weren't allowed under the carrier contracts". That didn't go well for them and I got the number.

But how many people are really going to push that hard to get the info?

(And the difference between the 3 was miniscule. The RAP claims is where the huge cost variation was. And how many people know to ask for that info, too?)

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Fiction or non fiction?

CBO says millions lose health insurance under GOP Obamacare replacement


Fourteen million people would become uninsured next year if the top Republican proposal to repeal and replace Obamacare is signed into law, the Congressional Budget Office estimated Monday. Fopu1

That equals about 70 percent of the 20 million or so people who have gained insurance coverage as a result of the Affordable Care Act, as Obamacare is more formally known.

The Republican bill also would reduce the federal deficit by $337 billion over the next decade, the CBO estimated in an analysis of the embattled proposal, which is currently working its way through the House of Representatives.

It also says rate relief won't come until 2020 or 2021. Can't win the midterms with that!