TrumpCare Revealed Today

[somarco]

Most of the practices have business managers. The ones owned by hospitals have centralized billing, budgets, quota's, etc.

Dr Welby doesn't exist any more.

If you think docs have bankers hours you are wrong, especially if they have admitting privileges.

That's like thinking preachers only work on Sunday.

 

[taterpeeler]

Most of the practices have business managers. The ones owned by hospitals have centralized billing, budgets, quota's, etc.

Dr Welby doesn't exist any more.

If you think docs have bankers hours you are wrong, especially if they have admitting privileges.

That's like thinking preachers only work on Sunday.

Joe's only work on Fridays.....

 

[sshafran]

Most of the practices have business managers. The ones owned by hospitals have centralized billing, budgets, quota's, etc.

Dr Welby doesn't exist any more.

If you think docs have bankers hours you are wrong, especially if they have admitting privileges.

That's like thinking preachers only work on Sunday.

My brother is a preacher... and I'm pretty sure he only works Sundays. At least that's what I keep telling him...

 

[newt103]

My 2 cents...I agree with Somarco...we need a free market, no control on provider pricing. Its Un-American and in the end the consumer loses. Let insurers fight with providers on price per service. Let insurance companies control provider costs. They know it and are good at it. Let consumers choose their insurance company based on price and benefits. Sound familiar.

I believe underwriting needs to come back. Politically tough but it needs to be explained. And really not hard to explain to most grown-ups. Can you buy car insurance after an accident and expect insurance company to pay that claim? Obviously, you get insurance before something happens. Also, no pre-x clause. If the insurance company excepts you they except you 100%...everything. No fine print. Create competition and put the insurance company into the decision making process. You take the applicant or you don't.
If you have a chronic condition and nobody will take you, have a GI high risk pool and based on your income you get a subsidy to offset premiums. For the poor we have Medicaid.
Kind of sounds like the old system we had before Obamacare. I know costs were going up with old system but compared to Obamacare its not close. Not to mention comparing old system to Obamacare on deductible, coinsurance and copay costs its not close.

I believe the old system before Obamacare was actually starting to drive costs down. You could hear the complaining from employees on employer plans when they started complaining that their plans started having higher deductibles and copays. Nothing compared to the Obamacare fiasco. Obviously, Employers started reacting to premium increases climbing very rapidly and had to change what they offered their employees.
So the free market was correcting itself before Obamacare blew it up. Free market corrections are slower for a reason. Its because they are 100% right all the time. No bubble, no debt, no agenda. I think the insurance companies knew the correction was happening and it started putting the consumer and their advocates(agents) in the driving seat. They did not like it.

Also, in our 21st century economy that is always rapidly changing, people that would find themselves between jobs whether voluntarily or involuntarily, would find the premiums in the underwritten individual market were affordable even though they were paying 100% of premium. I started seeing individual premiums that were considerably less than the contribution part of their former employer's premiums. Some clients started to keep their individual plans instead of picking up new employer insurance with no worry of losing their coverage being between jobs.

Bottom line: I don't think you can control costs without underwriting and making it easier for insurance companies to sell in all 50 states.

 

[junkman]

I like free market pricing. The problem is that is that people think of insurance as paying and don't care about price except as it relates to their out-o-pocket. I have had instances where I knew that I'd hit my max OOP. Of course I postponed until 1/1 and got as much done as possible for 1 money.

I really like how Trump (and Cruze and Rubio) want to do away with the individual mandate and foster insurance competition across state lines - (un Amerikan to force people to have coverage) and still have no pre-x. How much competition do we have with zero carriers offering coverage?

Remember Trump is going to save all that money with Mexico paying for the wall. (Perhaps he only intends to pay for bus fuel to ship the illegals back. I'm not sure what will pay for the jails to hold them until the buses or even the buses themselves.) Cruz is going to stimulate the economy by replacing all of the bombs after carpet bombing the Middle East.

 

[scagnt83]

I really like how Trump (and Cruze and Rubio) want to do away with the individual mandate and foster insurance competition across state lines - (un Amerikan to force people to have coverage) and still have no pre-x. How much competition do we have with zero carriers offering coverage?

Selling across state lines would do nothing to increase competition and it would do everything to increase costs for the carriers.

Why is a policy in SC cheaper than one in NYC?
Because the cost of care is higher in NYC.

Why would someone in SC want to buy a higher priced NY policy? We wouldnt.
But all of NY would want to buy cheap SC policies...

But once the higher cost of care in NY hits the SC blocks of business, suddenly the SC insurers will have to raise rates to compensate for the higher cost of care in NY.

And when participation drops for the NY carriers, they will lower rates until they are in line with SC rates. So what happens is that both states end up meeting in the middle on rates... which is what would happen all across the country.

Buying across state lines would essentially socialize the cost of care (as it is priced into insurance premiums) across the nation. Premiums from states with lower costs of care would end up subsidizing premiums from the states with the higher cost of care.

 

[houcoogster]

In some situations you MAY be able to negotiate a lower cash price for your procedure but a provider can get in trouble with the carrier if the carrier finds out they are accepting a lower price than the negotiated fee.

This is exactly correct. If bcbs hears of a patient getting a cash price lower than what their negotiated rate is, guess what??? That "cash price" becomes the NEW bcbs reimbursement rate, I believe that wording is in their contract.

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Only way to control the health care problems is to follow the Peeler Plan...

You can only control the health care problems is to control the health care cost... control the spending... hence, control what providers can charge...

Next, provide high deductible blanket policy to ALL and allow the masses to select a supplement policy if they so choose..... those with the cash can select a medicare supplement type policy.... those below a FPL point can elect a MAPD style offering with copays and such so they have skin in the game. If you term you supplement mid cycle(enrollment year) then you can get back in with full underwriting or wait till your birthday month of primary tax payer. If you are getting in without coverage you are burdened with a 6 month pre existing clause..

There, The Peeler Plan... same basic plan I proposed back in 2008

I pretty much agree with this.....


Just give everybody Medicare part A that includes zero co pay for preventative check ups, everything else is subject to the deductible and co insurance 80/20. They can buy into Part B and buy into Part D and get a supp or mapd if they have both A and B.


Allow Medicare to set the reimbursement rates based on Area.
Prohibit all Rx medication advertising.
Medicare Part D sets the price for all RX medication. Nobody will pay more than that price with or without Part D coverage.
Doctors and hospitals do not have to accept this plan but if they chose not to then they will be kicked out of billing medicare for all patients.
Failure to enroll in Part B and or D will result in penalties and waiting periods when one does enroll.
Medicare payroll taxes will be higher.
Insurance premiums will be $0 or much lower than current depending what coverage is elected.

So there you have it, the Coogster Plan. It's a little bit socialism and a little bit capitalism.

 

[Yagents]

Avik shares his 2 cents:

"It has the look and feel of something that a 22-year-old congressional staffer would write for a backbencher based on a cursory review of Wikipedia," wrote Avik Roy, the opinion editor at Forbes who has advised several GOP presidential candidates on health policy, including Mitt Romney in 2012.

Or this one:

"Trump's actual health care plan is a series of ignorant, incoherent, and self-contradictory verbal spasms," Cannon wrote on Forbes' website. "He doesn't have a plan. He has paroxysms."

TrumpCare Takes It On The Chin | Kaiser Health News

 

[cornelius322]

As someone with Crohn's/Colitis I find this "free-market" idea laughable. My Humira's actual cost for two pens a month went from $3,461.97 to $3,804.69. I'm pretty happy with how my Humana plan plus Abbott's co-pay card covers it. It's not like those of us with chronic conditions that are pretty much in remission with one surgery and a biologic have an elastic demand curve, and you just don't go change biologics on a whim if one is working for you and your side effects are minimal. The only exception to that would be a biosimilar for Humira which AFIK won't be available in the US until 2019, I think India has already developed one for a quarter of the cost.

Another thing is prior to a pre-existing say someone has a bronze plan, when they get sick with a chronic condition they up to a gold or platinum the next OEP if that makes the most sense for them financially. True enforcement of making it more like "insurance" (if you keep the metal tiers) would be like in tightening the SEPs, would you have some kind of underwriting annually that prevents someone from upping their coverage option (even if changing carriers) during an OEP if the policy holders developed a condition that year? That would sorta being like a subset of underwriting within GI, you are only GI in the same or below metal tier if you develop a condition.

 

[somarco]

So what you are saying is, if the govt decided to decree that henceforth and forevermore pharmaceutical companies would be limited in what they can charge for a biologic and that limit will be no more than $100 per dose (to grab a figure out of the air).

How long before the companies stop making that drug?

I don't recall seeing any platinum plans in 2016 and gold plans are nearly extinct. Exception is via the exchange. Can't think of a single carrier offering gold off exchange.

When the govt steps in to write the rules of commerce the market reacts by shrinking down and raising prices.

Price controls don't work. Never have. Never will.

And GI isn't working very well either. That's why so many carriers are toying with sitting out 2017.