TrumpCare Revealed Today

[junkman]

@ newt: underwriting does NOTHING to control the costs that underlie procedure costs. The dollar cost for a given procedure and utilization of more expensive procedures continues to out pace inflation. Underwriting only excludes some people from having coverage or results in higher premiums for those with health issues (ie higher EXPECTED claims).

I have a friend that had a stroke 15 yrs ago at age 48. He has good stats (BP, weight, exercises hard multiple times /week (weights, bicycle, swimming, yoga)). I wrote a husband/wife group contract under the old rules because he couldn't pass individual underwriting. He has had almost $0 claims in the last 15 yrs.

He has money and is currently paying annual premiums of $12,000 for the lowest premium plan available. I checked BCBST, UHC, Humana, Cigna & Aetna. Ded is $5,200, OOP is $6,400 x2 family.

So far, I've seen absolutely Zero suggestions anywhere that would control underlying claims costs, only some proposals that shift costs from the carrier and ultimatey premiums to the insured.

@SCagnt, I hope you understood the sarcasm. I like nothing about Cruze. I've heard nothing of value come from him and he is what my Yiddish speaking friends call a Bermal Pischer who wears his religion on his sleeve with many people voting for him for that reason alone. Bermal is "holy water". You can get the rest from context.

 

[Ann H]

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

Agreed, Somarco. However price transparency is not price control.

"Price controls" rule price because the government mandates a set amount.

"Transparency" controls price because the consumer makes decisions based on facts.

The first one is governmental over-reach that always ends in prices remaining set, but all other features blowing out in every direction.

The second one is the free enterprise system that results in the betterment of both price and quality.

 

[somarco]

Price transparency works for services not covered by insurance. Cosmetic surgery and laser eye surgery (cosmetic, not for disease) come to mind.

When you have a procedure covered by insurance price transparency is meaningless when you are dealing with something with a pre-negotiated price.

Before 2014 I had people looking for maternity coverage and most plans had eliminated maternity by 2012 or so. I helped couples set up an HSA and gave them information on how to negotiate prices for a normal delivery. Most of them ended up paying close to what they would have under an insured delivery.

 

[sshafran]

Price transparency works for services not covered by insurance. Cosmetic surgery and laser eye surgery (cosmetic, not for disease) come to mind. When you have a procedure covered by insurance price transparency is meaningless when you are dealing with something with a pre-negotiated price. Before 2014 I had people looking for maternity coverage and most plans had eliminated maternity by 2012 or so. I helped couples set up an HSA and gave them information on how to negotiate prices for a normal delivery. Most of them ended up paying close to what they would have under an insured delivery.

Side note...

My first son was born 5.5 yrs ago. We had insurance with maternity coverage. All in all it cost us just about 6k out of pocket.

My 2nd son was born 3 yrs ago. New insurance, no maternity (we moved and had to change carriers). All in all cost about $6-7k out of pocket... (The premium to get ins with maternity was ridiculous).


Both times, when the bills came, I asked the hospitals for discounts if we could pay in full... And they were good to work with.

Even though our ins didn't cover maternity, it still got re-priced to insurance pricing for some reason.


We were initially concerned with no maternity coverage, but when I found out that complications were covered, I was ok with it.

Sent from my iPad using InsForums

 

[houcoogster]

Price transparency works for services not covered by insurance. Cosmetic surgery and laser eye surgery (cosmetic, not for disease) come to mind.

When you have a procedure covered by insurance price transparency is meaningless when you are dealing with something with a pre-negotiated price.

You make the perfect case for Gov setting the reimbursement rate. The only other option is to outlaw insurance, and we know that ain't happening.

 

[scagnt83]

Price transparency works for services not covered by insurance. Cosmetic surgery and laser eye surgery (cosmetic, not for disease) come to mind.

When you have a procedure covered by insurance price transparency is meaningless when you are dealing with something with a pre-negotiated price.

I wouldnt agree with that. Right now insurance does not allow the cost of healthcare to operate under a true free market system. The lack of transparency combined with the fact that the end consumer's role in the transaction is greatly masked by the carriers because costs are largely bundled up into premiums. And essentially the consumer is beholden to the carrier and is forced to trust that the carrier will act in the consumers best interest and control costs (which is not in the best interest of the carriers).

Price transparency would work, even at pre-negotiated carrier prices, if the consumer is forced to have real skin in the transaction.

If the consumer has a $5k deductible HDHP, and they have to choose between one provider that charges $3k and another that charges $4k; suddenly that transparency creates true competition because the consumer is actually paying for it in hard dollars.

Under that same scenario of a cost of $3k vs. $4k. If they have a Co-Pay Plan that picks up 80% of the bill, suddenly that decreases the amount of skin the consumer has in the transaction by 80%. Instead of a $1k difference in cost it is only a $200 difference in cost.

Most people would care more about a $1k difference in cost than a $200 difference in cost. And many people would choose to save that $1k if the procedure was not something life threatening. This is why HDHPs and HSAs are the way to save this countries healthcare system.

 

[healther]

When you have a procedure covered by insurance price transparency is meaningless when you are dealing with something with a pre-negotiated price.

I'm not tracking you on this... price transparency would be a very useful tool not only from a budgetary stand point but also during open enrollment when shopping plans.

 

[Ann H]

Price transparency works for services not covered by insurance... When you have a procedure covered by insurance price transparency is meaningless when you are dealing with something with a pre-negotiated price.

Bingo. And there you nailed the full point. Price transparency when the consumer has "skin in the game" reins in over-utilization.

 

[somarco]

Tyler, before managed care there was free market pricing. Carriers paid what they considered reasonable and customary, insured's paid the balance without a cap.

That system didn't work so well for consumers or carriers. The result was managed care with pre-negotiated pricing.

This idea of price transparency isn't new, it's old. Consumers were free to negotiate pricing on anything.

When you have been around long enough you see there are really no new ideas, just rehashed old ones.

 

[AboutThatLife]

I like the idea of having a single statewide network (or a few regional networks) for each carrier. Either the doctor takes that carrier or they dont, period.

This sounds like H.R 676. I read the 2008 version, it is probably what Bernie would do and it's what Kucinich wanted in 2008 instead of UHC. However, UHC probably would have been more effective with the public option. That was killed, so it was really just a backdoor subsidy to health insurers.

Here