TrumpCare Revealed Today

[scagnt83]

Letting HSA contributions transfer tax free is a joke, a few thousand dollars doesn't make much of a difference on a $5.4M+ estate (if the estate is worth less than that, no tax in the first place). People like being told they won't be taxed, even if they wouldn't be taxed in the first place...
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If they expand the limits then people could put a lot more into them. Grandma could put her CD into it and then pass $50k down to her grandson. As someone who works the retirement planning market I can tell you that would be very popular. It would not be an estate planning tool as far as estate taxes are concerned. But it would be a good tool for middle america. Putting the money in tax free, and then receiving it tax free and letting it continue growing tax free. Nothing else out there does that. And since it is for healthcare related expenses it is actually for a good use. Grandma would much rather help Johnny with his future medical bills than his future car payments.

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"Remove barriers from importing medication overseas" will basically mean "invalidate the FDA and DEA". Not going to happen. The issue isn't that we can't import the medication, it's that it's not FDA/DEA approved. It hasn't mattered where the approved medication is manufactured. A huge portion of the medication available here is imported from overseas. Ever get a drug made by Bayer? It's probably from Germany. Cipro, for example, is made in Germany and Italy, as noted on the last page of the FDA's guidance on it: http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019537s701984744198575120780282147325l.pdf. Yaz (the birth control pill)? Xarelto? Nexavar? All produced in Germany. There's thousands of other common drugs imported from overseas.

I dont really know what the hell he means by that ... it sounds good but wtf?
I do know that overseas often you can find the exact same drug for half of what we pay here in the US. Not always obviously but it does happen. I think it had something to do with how long the patents stay active for the original brand name or something. I do think that prescriptions have gotten expensive and very abundant.

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Tyler, my blogging partner and I have gone back and forth on the transparency issue for years and we are still at a standstill.

If you have a brain tumor do you want the cheapest oncologist or the best? Are you really going to call around and price shop?

Transparency is fine for cash and routine procedures but not for the more complex items.

Its a very complex issue with no good answer. In general, I think that transparency is a good thing when it comes to exchanges of services.

If someone is cutting into my brain, I care a lot more about his success rate than I do how much he charges. Show me that statistic first and price second.

For routine procedures there is no excuse not to have price transparency. Obviously more complex stuff has more complex issues and would require more complex solutions.

But what happens when the most expensive doctor has the worst track record with operations? Maybe he is most expensive because of the hospital he works at and not just for his specific surgeon charge? Do you still want the most expensive then? The best is not always the most expensive. Way too many factors that go into the billing of major procedures imo.

 

[somarco]

control what providers can charge...

Smells like NHS to me.

Limiting what providers can charge is un-American. It also assumes the MCO contracts are ineffective.

What drives claims more than anything are low dollar, copay plans with little skin in the game (except for big claims). That fuels utilization.

HMO type copay plans is what spiked claims in the late 80's and triggered managed care as a way of policing claims. You have to eliminate all copays for everyone and have a minimum front end deductible of $500 before you will see much reduction in utilization.

The other driver is DTC advertising for Rx. Drug claims have steadily risen over the last 30 yrs from less than 10% of claims to 25% (dollar volume).

 

[walthamny]

I don't see how Trump's plan will lower costs. Also taking away the guaranteed coverage won't win him any votes( It is the best part of Obamacare). If I have an ear infection over the weekend, the emergency visit costs over a $1000. We either pay for this through deductible or higher insurance premiums. There is not much incentive in the old or current system to deliver service at a lower cost/value. Obamacare was supposed to lower costs by forcing everyone to enroll and have access to preventive care. We will see if that happens when it is fully implemented.

Drug companies wont allow imports without a fight. They can now produce a pill for 28 cents a pill, sell in the USA for $1,000 a pill, $5 in Canada and 35 cents in the third world and get away with it. Now you can force the companies to just charge one price globally, but that would mean many counterfeit operations in the third world and eventually some of those would also make it into the US system.

 

[Ann H]

I am a fan of price transparency. I understand the other side of the argument, and the fear of "price fixing". However, in what other industry do you purchase something, yet have no idea of the cost until you get the bill? Usually, you know the exact cost up front or are given an estimate.

Anytime that you give control to the consumer and/or private enterprise, it's better than control in the hands of government and/or large corporations. Right now, large corporations (hospitals, insurance companies, healthcare corporations) control the pricing, without consumer involvement. I think that needs to change or we will never reverse the drivers of spiraling health care costs.

Price transparency would not be hard to institute. The government could go to Medicare, ask for their huge list of procedure codes and reimbursement schedules, then demand that the insurers use that as a basis. One plan could reimburse 120% of Medicare, another 160% of Medicare, but nobody could go lower than Medicare. Using Somarco's Labwork example, you could go online, select the lab tests that your doctor ordered, and find out the Medicare allowance. Then, pick a couple of Labs and see the difference in prices.

Sure, it gets more complicated with doctor, etc. You might go in for surgery to cost $12,000, then the doctor finds complications and it winds up costing $20,000. But even then, you made a selection of doctor and price initially, yet you understood that it could cost more. That's the same concept as the plumber who just replaced my sink's faucet, then charged me for other parts that were so corroded I shuddered at seeing them. Yes, I was glad to pay for those other replacement parts, and the price didn't bother me, because I had already selected the plumber by quality of service as well as his fair base prices.

Price transparency actually helps you select quality. When you want the best cardiologist you can see that he doesn't participate in networks at 101% of Medicare! He's worth the higher price.

I'm pretty sure the Provider community would not like the disruption to their current model. There is comfort in their hidden fee schedules. They can shift costs. Perhaps they make nearly nothing on procedure A, but make 700% mark-up on procedure B. Every industry does that. However, every other industry does that with price transparency. You walk into Macy's department store and find Shirt A costs $50 but is on sale for $19.99, which is a loss-leader for the store. But then you buy Silk Tie B and Leather Belt C at a mark up of 65% each, plus you bought Jeans which you didn't realize are one of the biggest mark-ups in retail clothing at about 300%. Meanwhile, your wife is shopping in the women's department and sinks you with purchases at a higher mark-up. That's business. Cost shifting isn't new, and doesn't happen just to health care. But at Macy's Department store, you know the price of every item, and select it based on need (or desire), price and quality.

Sometimes you need a professional's advice on your purchase decisions, which would be true in the healthcare example. That professional can comment on why you need this, why you should select quality over price, etc. Actually, the doctors do that right now. The only difference is that "price" is unknown to the customer (and usually to the Doctor). The Doctor tells you that you need this medication, then recommends medicine A. But they allow generics. Or they will change to medicine B if your insurance company says to (which was a price decision on the insurance company's part, by the way). The only difference between this and other industries is that neither the Doctor nor the Customer knew the price.

Price transparency, paired with "more skin in the game" can drive better consumer decisions. I really like expanded HSA ideas (although the tax talking points are just political). I like consumer choices when it's "their money". We need to turn back the clock on 3rd party payer for first dollar items. To do that, the consumer must know the price.

 

[SENIORCHIEF]

1. Make all medical care prices transparent.
2. Expand Medicare coverage to everyone with a buy in based upon your age. Will also include restricted enrollment periods and late enrollment penalties to guard against adverse selection. Provide subsidies for the low income and industry will provide supplements for the gaps.
Basic medicare will give excellent coverage if it is priced right. The system is already in place and works.

 

[taterpeeler]

Smells like NHS to me.

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Any federal controls to you sounds like NHS.... I know you all to well....

 

[somarco]

If I have an ear infection over the weekend, the emergency visit costs over a $1000.

Guess you don't have urgent care facilities where you can get in and out in less than an hour and under $100.

Can't recall having anyone declined health insurance for an ear ache.

GI drove up premiums more than anything and was completely unnecessary.

They can now produce a pill for 28 cents a pill, sell in the USA for $1,000 a pill, $5 in Canada and 35 cents in the third world and get away with it.

You have examples or is this just exaggerated bravado?

Right now, large corporations (hospitals, insurance companies, healthcare corporations) control the pricing, without consumer involvement. I think that needs to change or we will never reverse the drivers of spiraling health care costs.

Before managed care no one was controlling costs and consumers were still dumb.

Many of the carriers have online pricing tools but most consumers are too lazy or dumb to use them. Transparency sounds good but there is very little practical application unless it is widely used.

Consumers will shop cell phone pricing and go with the lowest price then complain when they exceed their data limit. Much easier to complain after the fact and hope to gain an audience than it is to take the time to look at what you are buying before hand.

I don't have a lot of faith in consumers taking advantage of health care price transparency.

https://healthcarebluebook.com/

Southeastern Marketing Concepts > Home

Any federal controls to you sounds like NHS.... I know you all to well....

How do you feel about govt mandated commissions of 1% and an overall annual earning cap of $40,000?

I mean, at some point you have to agree you have earned too much, right?

 

[taterpeeler]

Bob... Now you know all to well that's not true.... comeon man stop the negative nancy stuff..... Im not saying cut providers by 2000% and you know dang good and well that's not what I mean but it plays into your narrative. We went from 20-26% to 6%... the providers need a hair cut too

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BYW... I stand by my excellent position as its the only one that works... your way failed, Obamas way failed... now lets try my way

 

[somarco]

"My way" was never implemented. Obama's plan was never meant to work.

I am opposed to the govt dictating pricing and wages on anything.

Obviously you are out of touch with provider earnings. They have been taking a haircut (to use your term) for years. That's why there has been so much consolidation, closing of hospitals, vertical integration, etc.

No one is getting rich under Obamacare.

Well, no one except you and Joe

 

[taterpeeler]

I would dispute the getting rich part.... I work xtra hard with 20 hour days 7 days a week during enrollment period and then a normal work week so to speak after AEP..... unlike doctors working 4 days a week and hitting it 8-5... that would be N..I..C..E.

Providers are simply mismanaged due to these clowns having no business skills.

Again, control the money flow and control health insurance cost... Insurance is nothing more than a line of credit, you the consumer spend it and the insurance companies pay it....