TrumpCare Revealed Today

[scagnt83]

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.

And the consumer was able to know what the price (or estimated price) would be on the front end and not after the fact??? Im pretty sure the answer to that is no.

Not knowing the cost when committing to the transaction is not the free market at work.

And price transparency or increased price competition among providers is not a cure all, its just a small part of the overall solution.

 

[AllenChicago]

There is an increasing urgency to have widespread price transparency, but in reality, only 7% of medical bills are paid by the patient. The rest is covered by health insurance. Therefore, patients really don't have much incentive to price shop. I think that's the point of this article?

Ref: Price Transparency May Lower $27 Billion in Healthcare

 

[mudhound]

What about tort reform?
If the lawers would stop getting rich over the loss of a pinky finger!
Or, make it where if they lose the case, they have to pay the other person! That would put a stop to most cases

 

[scagnt83]

There is an increasing urgency to have widespread price transparency, but in reality, only 7% of medical bills are paid by the patient. The rest is covered by health insurance. Therefore, patients really don't have much incentive to price shop. I think that's the point of this article?

Ref: Price Transparency May Lower $27 Billion in Healthcare

I didnt read the article. But I would agree that this is the problem. For it to work, price transparency must be combined with the consumer having more skin in the game.

I wouldnt mind seeing an end to all Co-Pay plans. HDHPs only combined with HSAs. If the gooberment wants to help the poor then give them a certain amount of cash per year in the HSA.

----------

What about tort reform?
If the lawers would stop getting rich over the loss of a pinky finger!
Or, make it where if they lose the case, they have to pay the other person! That would put a stop to most cases

Lots of studies have shown that the cost of lawsuits only accounts for around 1%-3% of the total premium. So it would help some but it would not be significant according to most studies.

I personally think that it would help more than just 1%-3% because I think it would reduce unnecessary procedures and tests that Doctors often perform just to "protect themselves" from potential liability. Few of the studies I have seen have taken those potential savings into account in a serious manner.

But no 1 thing by itself is the answer. It will take a combination of changes.

 

[Ann H]

I agree that a combination of solutions is embedded in the large solution. Another solution would be the reduction of unnecessary expenses.

The Exchange rakes in a commission (oops, I meant "fee") on every sale.

Expenses to insurers to implement the ACA is extraordinary, and they must pay those admin expenses despite the MLR.

Providers are still jumping through hoops and redefining themselves -- an expensive proposition.

The costs to states for Medicaid is very high.

The government takes money from insurers, skims admin costs off the top, then returns money to insurers.

The ACA was built like a shell game, with money shifting in every direction.

 

[somarco]

And the consumer was able to know what the price (or estimated price) would be on the front end and not after the fact???

They could if they asked.

Routine office visits, in office testing, surgery, hospital (for OB), delivery, etc. if you wanted to know how much you asked.

Both our kids were born before managed care was prevalent. We had insurance but wanted to know how much our OOP would be. Maternity was covered but the plan paid a flat amount. We were responsible for the difference. We asked the doc, and the hospital. We even got pricing for the type of anesthesia.

Tort reform, "market based pricing", etc have little if any effect. Until the consumer is willing to take responsibility for their HEALTH and HEALTH CARE not much is going to happen.

More cost sharing (no copay's, higher deductibles) will reduce utilization more than anything and utilization is the major driver of claims and, in turn, premiums.

HDHP's as a rule have better loss ratio's than the typical copay "HMO type" plan. That tells you something right there.

 

[scagnt83]

Until the consumer is willing to take responsibility for their HEALTH and HEALTH CARE not much is going to happen.

And there lies the problem. Too many people in this country will choose to do nothing and will take no responsibility for themselves. And like Trump says... "as a civilized nation we cant let people lay dying in the street"... so if we do nothing (or go back to the old system), then things only get worse and worse.

Which is why mandating HDHPs and HSAs might be the one single thing that could make a significant difference in reducing costs.

 

[yorkriver1]

Incentives to lose weight and lower blood sugar could work. Why not free gym membership on all health plans? A number of my clients on Medicare plans with Silver Sneakers are doing things they never thought they would do. Some of the MAPD plans have integrated gyms in their plan provider model, with trainers who develop treatment plans, social activities at the gym, and support groups on premises to reinforce weight loss/eating better.

Who doesn't like citizens to be healthier?

We have the food and pharmaceutical industries getting mega rich from making people fat then treating their Type II diabetes and heart problems. They must contribute millions to politicians.

http://www.npr.org/sections/thesalt...ry-manipulates-taste-buds-with-salt-sugar-fat Why you can't eat just one Cool Ranch Dorito, they are engineered to be addictive. Remarkably Dr. Evil, to keep shareholder value pumping.

There are many ways to rethink what we do.

 

[cadylou]

Incentives to lose weight and lower blood sugar could work. Why not free gym membership on all health plans? A number of my clients on Medicare plans with Silver Sneakers are doing things they never thought they would do. Some of the MAPD plans have integrated gyms in their plan provider model, with trainers who develop treatment plans, social activities at the gym, and support groups on premises to reinforce weight loss/eating better. Who doesn't like citizens to be healthier? We have the food and pharmaceutical industries getting mega rich from making people fat then treating their Type II diabetes and heart problems. They must contribute millions to politicians. http://www.npr.org/sections/thesalt/2013/02/26/172969363/how-the-food-industry-manipulates-taste-buds-with-salt-sugar-fat Why you can't eat just one Cool Ranch Dorito, they are engineered to be addictive. Remarkably Dr. Evil, to keep shareholder value pumping. There are many ways to rethink what we do.

In the Medicare advantage market those plans that include gym memberships are subsidized via the Medicare fund. Who would you suggest pays for these "free" gym memberships in the U65 market ? We'd all have to pay in the form of ithe premium and then there's no guarantee that the fat guy next door will ever go.

 

[somarco]

Wellness programs and incentives have been studied for at least 30 years and the conclusion is, they have no impact on overall claims and premiums.

At the individual level the numbers are different.

When individuals take responsibility for their personal health, regardless of the motivation, their health improves resulting in lower overall expenditures.