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Creating a healthcare market that works

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WATU2

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May 29, 2001
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For a market to work effectively, consumers need pricing information, but that's often impossible when it comes to healthcare. Massachusetts and a few other states are implementing laws that require providers and insurers provide enough information to enable consumers to make informed decisions.

Competition requires open markets and open markets require access to information.






This post was edited on 11/10 6:54 PM by WATU2

Mass makes health insurers/providers cough it up
 
The problem with revealing medical prices, which I am not against, is that the most expensive bills are also the most complicated. Lets say that I have chest pains and go check St.F, St.J, and Hill. ER is cheaper at say SJ. They decide I need a heart cath to find out the exact problem. Hill his cheaper on heart caths but I'm at SJ. The heart lab decides I need a bypass. Now we bring in a surgeon and some intensive care after the surgery. Another hospital is cheaper depending on how long I am in ICU. But wait, maybe I am lucky and only need stints like last time. I like the doctor at St. F who did them maybe I'll just go there. Then maybe it's adjusting the meds and that's it.

I can see where if I have an uncomplicated urinary tract infection it would be nice to know which place is cheaper. But what if they find blood in the urine. That means tests. It turns out just to be from by blood thinner. But now I have to worry about who would have charged less for the tests.

Most insurance pays back to Unusal and Customary on most of this. So even if H is cheaper, I will be liable only my part of the UC. I'm doing the math for all of this in my head while on morphine.

I'm not against prices be made available. I think it would be helpful in some cases. A torn meniscus in my knee, little Johnny's tonsils, uncomplicated pneumonia, etc. But those, while not cheap, are not the mega bills. Cancer, kidney failure, major heart problems bring the big bills. You pretty well need to think this out before you have them. Add to this that many have insurance with network and out of network. Hospital A's prices do me little good if the they are cheaper but out of network and I have to pay 40 percent instead of 20 percent.

And finally, on big ticket items along with the price it would be a good idea to have them provide survival rates and what they can do and the cost of transporting me to a top flight [pun] trama center or isolation center. At last check St. F had the highest rated trama center in Tulsa. But not as high as the one in OKC which is the only top level one in OK. The injured Tulane player was going to St. J which was the closest but was diverted to St. F because they were higher level on spinal injuries.
This post was edited on 11/16 2:08 PM by TUMe
 
Agree with what many have said about our ability to price shop. There are so many moving parts to an operation and extended hospital stay. Many of your choices are limited to your choice of hospitals or surgeons. The only way I see this as a major benefit would be to get a lump sum out of pocket after insurance from several options. Most of us have no idea all the services involved in say a hip replacement.


Obamacare has placed the burden on an already struggling middle class to foot the bill for sicker and older enrollees through skyrocketing premiums. The law eliminated many of the small business group exchanges which enabled small businesses to pool their coverages and take advantage of less expensive group rates. They completely misstated the demographics of new enrollees when selling the bill to the public. In short, it's a mess which has placed it's hefty price tag squarely on the backs of the middle class.
 
What do you expect when the health care/big pharma lobby owns Congress? Single payer eliminated, Medicare can't negotiate drug prices, no pricing information, and obvious sign of collusion between insurance companies.

Until we get the big money out of politics, neither party will fix anything but they will tell you that they have all the answers.
 
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WATU2 said:
What do you expect when the health care/big pharma lobby owns Congress? Single payer eliminated, Medicare can't negotiate drug prices, no pricing information, and obvious sign of collusion between insurance companies.

Until we get the big money out of politics, neither party will fix anything but they will tell you that they have all the answers.
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Pretty much sums it up.
 
There's just no way to get progressive and quality health care reform without removing medical and pharmacutical lobbying interests from the conversation.

Bottom-line, we need to make sure Doctors, nurses, technicians etc. are adequately compensated for their work and the effort it takes to break into the profession. We need to make sure investment in reasonably priced pharmacutical keeps moving research forward.

Anything beyond that is an after thought.

I personally think the medical and automotive insurance industries are rackets. The looming development of automated vehicles should make auto insurance obsolete. Hopefully we can move to a system that does the same to medical insurance.
 
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astonmartin708 said:
There's just no way to get progressive and quality health care reform without removing medical and pharmacutical lobbying interests from the conversation.

Bottom-line, we need to make sure Doctors, nurses, technicians etc. are adequately compensated for their work and the effort it takes to break into the profession. We need to make sure investment in reasonably priced pharmacutical keeps moving research forward.

Anything beyond that is an after thought.

I personally think the medical and automotive insurance industries are rackets. The looming development of automated vehicles should make auto insurance obsolete. Hopefully we can move to a system that does the same to medical insurance.
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Agreed. Just got a lecture from PT who owns multiple locations. Absolutely convinced that the insurance companies have zero interest in lowering healthcare costs as they earn a % of the total expenditures. Another interesting notion was that the average person sticks with a health plan for 5.3 years, so the health plan has reduced incentive to look after their long term health. And once they make it to 65, it is Medicare or Medicaid's problem.
 
Here's my healthcare story of the day. My six year old daughter has separation anxiety. The problem is now to the point where her school as well as her pediatrician has recommended counseling. Call the Dr for a referral. The only place in Tulsa which our insurance will cover is Laureate. Call Laureate....the only option would be to send her there on a three day hold for evaluation and then subsequent counseling. Yep....send a 6 year old girl with separation anxiety to stay at Laureate for three days. Called my insurance company....no other options.

There's is absolutely no way for the average person to ever know their coverage when they buy a policy much like shopping for costs.
 
Seems like 95% of auto insurance premiums must go toward marketing and a little compensation.

The remaining 5% might go to claims.
 
lawpoke87 said:
Huge health insurance premium increases appear to be on the way. Pretty sobering news for the middle class whose feeling the effects of this economy. Will someone be held accountable for this mess?

http://thehill.com/policy/healthcare/276366-insurers-warn-losses-from-obamacare-are-unsustainable
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I love when insurance companies complain about 'losses'. To them 'losses' just means the ROI fell from 10% to 9%. Take Health Service Corp. for example: They are the parent company of Blue Cross + Blue Shield branches in Oklahoma, Texas, Illinois, Montana, and New Mexico. They enjoy plenty of tax brakes from the government, and from 09-13 they posted billion dollar profits every year. Yet these are the same people with lobbyists in Washington trying to get them a better deal through the government, and the same people that are going to jack up your premiums because their CEO has to buy the Gulfstream 4 instead of the Gulfstream 5.
 
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TUBballJunkie said:
Seems like 95% of auto insurance premiums must go toward marketing and a little compensation.

The remaining 5% might go to claims.
Click to expand...

Don't let Flo hear you say that!

Seriously, is there a contest among auto insurance companies to spend the most on on silly adds? Flo, the geicho, State Farm taking you away from a lion, The midnight call to Jake, the old man with a dollar on the fishing line. One sponsors almost every TV sports broadcast.
 
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Surely they knew this would be the result of the law when it was being written and passed....right? There were plenty of people out there telling them that there projections were flawed.
 
astonmartin708 said:
I love when insurance companies complain about 'losses'. To them 'losses' just means the ROI fell from 10% to 9%. Take Health Service Corp. for example: They are the parent company of Blue Cross + Blue Shield branches in Oklahoma, Texas, Illinois, Montana, and New Mexico. They enjoy plenty of tax brakes from the government, and from 09-13 they posted billion dollar profits every year. Yet these are the same people with lobbyists in Washington trying to get them a better deal through the government, and the same people that are going to jack up your premiums because their CEO has to buy the Gulfstream 4 instead of the Gulfstream 5.
Click to expand...

So is your theory that when they say they have taken year over year losses, they're lying and are actually doing great and can continue to fund current salaries and liabilities at that income level?
 
URedskin54 said:
So is your theory that when they say they have taken year over year losses, they're lying and are actually doing great and can continue to fund current salaries and liabilities at that income level?
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Maybe they should cut salaries, or save some of those record surpluses they had in previous years.
 
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lawpoke87 said:
Agree with what many have said about our ability to price shop. There are so many moving parts to an operation and extended hospital stay. Many of your choices are limited to your choice of hospitals or surgeons. The only way I see this as a major benefit would be to get a lump sum out of pocket after insurance from several options. Most of us have no idea all the services involved in say a hip replacement.
Click to expand...

Problem here is the differential in knowledge between the provider and the purchaser. Who would be sophisticated enough to assess the total price vs quality vs. etc etc?


lawpoke87 said:
Obamacare has placed the burden on an already struggling middle class to foot the bill for sicker and older enrollees through skyrocketing premiums. The law eliminated many of the small business group exchanges which enabled small businesses to pool their coverages and take advantage of less expensive group rates. They completely misstated the demographics of new enrollees when selling the bill to the public. In short, it's a mess which has placed it's hefty price tag squarely on the backs of the middle class.
Click to expand...

IT also required that insurance companies spend at least 85% of their revenues on providing care vs. sales/marketing. Employer insurance pools can cherry pick healthy, working younger people who by definition are well enough to work. Mandated participation in an insurance pool which increases the pool to include young, healthy participants should achieve better results. That's what makes single payer work in other countries: large pool, no marketing costs, and preventive care reduces overall costs.

Again, check out T.R. Reid's The Healing of America. Easy, fun read that shows how other nations do it. The US has first world medicine and third world medical administration.
 
lawpoke87 said:
Here's my healthcare story of the day. My six year old daughter has separation anxiety. The problem is now to the point where her school as well as her pediatrician has recommended counseling. Call the Dr for a referral. The only place in Tulsa which our insurance will cover is Laureate. Call Laureate....the only option would be to send her there on a three day hold for evaluation and then subsequent counseling. Yep....send a 6 year old girl with separation anxiety to stay at Laureate for three days. Called my insurance company....no other options.

There's is absolutely no way for the average person to ever know their coverage when they buy a policy much like shopping for costs.
Click to expand...

Sorry to learn that you are going through all this. Bummer.

Your situation does put the concern about 'government death panels" in perspective. A for profit insurance company focused on making its shareholders happy will be under even more pressure to keep its costs down by limiting care.
 
astonmartin708 said:
Maybe they should cut salaries, or save some of those record surpluses they had in previous years.
Click to expand...

Cutting salaries and jobs are at least partial solutions rather than a conspiracy theory, though it would likely cause criticism from the same people who think rate increases happen for sinister reasons. But do you not think that record surpluses are typically re-invested in other things or kept as a hedge against a natural disaster, or do you think they're just dispersed among a few officers/unused?
 
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WATU2 said:
Sorry to learn that you are going through all this. Bummer.

Your situation does put the concern about 'government death panels" in perspective. A for profit insurance company focused on making its shareholders happy will be under even more pressure to keep its costs down by limiting care.
Click to expand...

My reply to that is Obama needs to keep his hands off and out of the healthcare business and quit trying to expand his power with new taxation in the guise of single payer which would expand future costs and the national debt.

And then there is this. One of my renters went from full time employee to part time (I assume it was because of the Obamacare mandates) and in the process lost his insurance only a couple of weeks before his wife was to have a baby. In the process, he had to pay out of pocket for the procedure and it was so expensive he couldn't afford to keep up the payments on his pickup and it was repossessed. Then he called me and said he needed to break the lease and move back in with his parents. Both he and his wife are early 30's and now with two children.

Read into that what you will. BTW, he now wants to vote for Trump and I can't talk him out of it.
 
WATU2 said:
Unfortunately doing anything about these problems is 'socialism".
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One might argue that "socialism" in part is the reason Obamacare isn't working for the middle class. Prior to the law, many small business owners and those who worked for small businesses were able to pool their resources and enroll in group plans comprised of like companies and individuals. Obamacare basically wiped this alternative out and many in the middle class are now grouped in the general population pool. As this pool has an unusually high number of sick the premiums have increased at an accelerated rate causing those who are actually paying their full premiums to suffer. Being a nation full of fats and sedentary people is now costing the healthy and fit.
 
lawpoke87 said:
One might argue that "socialism" in part is the reason Obamacare isn't working for the middle class. Prior to the law, many small business owners and those who worked for small businesses were able to pool their resources and enroll in group plans comprised of like companies and individuals. Obamacare basically wiped this alternative out and many in the middle class are now grouped in the general population pool. As this pool has an unusually high number of sick the premiums have increased at an accelerated rate causing those who are actually paying their full premiums to suffer. Being a nation full of fats and sedentary people is now costing the healthy and fit.
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Poor people aren't the only ones who are overweight. They just don't have the money to provide correct nutrition, and after decades of having ZERO medical care of course they're going to be sick at a higher rate. If we had implemented public health when the countries of Europe did (in the 50's / 60's / 70's) we wouldn't have a decrepit poor population.

Getting angry that the poor are sicker than the middle class and the middle class is having to pay for it is kind of the entire argument for socialized medicine. I don't think the trend will continue for decades as eventually even the poor should be in moderate health.
 
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Did I link the poor to the overweight? While I assume there's certainly a correlation that wasn't the intent of my post. The pool of new Obamacare insures ( I have no idea if the poor which have joined are the majority of the sick which somehow wasn't accounted for in the initial planning) are sicker and costlier than the population as a whole. Thus, the healthy which are paying full premiums are bearing the brunt of these additional costs.
 
Yeah I thought it was the elderly that were the group more likely to be sick.
 
lawpoke87 said:
Did I link the poor to the overweight? While I assume there's certainly a correlation that wasn't the intent of my post. The pool of new Obamacare insures ( I have no idea if the poor which have joined are the majority of the sick which somehow wasn't accounted for in the initial planning) are sicker and costlier than the population as a whole. Thus, the healthy which are paying full premiums are bearing the brunt of these additional costs.
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I get your logic (which is correct) I'm just saying that it's imperative that we change the fact that the impoverished masses are in poorer health. Simply from an epidemic standpoint. If the nation sees an outbreak of an Ebola-esque virus we now know that a large portion of our population is susceptible to such a virus which puts even the healthy portion of our populous at risk.
 
URedskin....the explanation we have received for the losses being suffered by the exchanges are that the pool is older and sicker than what was projected. So I think it's likely a combination of both.

Astro....I'm not disagreeing that the poor need to be in better health. However, how does being fit or having money prevent one from catching an Ebola-like virus here in the states? The CDC would immediately be in charge of that outbreak including isolation and treatment. I don't see how income level would effect a patients as local health officials would be out of the decision making process.
 
lawpoke87 said:
URedskin....the explanation we have received for the losses being suffered by the exchanges are that the pool is older and sicker than what was projected. So I think it's likely a combination of both.

Astro....I'm not disagreeing that the poor need to be in better health. However, how does being fit or having money prevent one from catching an Ebola-like virus here in the states? The CDC would immediately be in charge of that outbreak including isolation and treatment. I don't see how income level would effect a patients as local health officials would be out of the decision making process.
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Basically I was just saying, the more people the country has who are in a state of good health, the better off the country will be when fighting large-scale epidemics. I know that there's a lot of other factors, but when you have a portion of the population that's clearly incredibly susceptible to a variety of maladies, it begins to put the healthy portion of the population at greater risk since there will be a larger number of people around them who are likely to catch / spread an illness.

It's the same reason metropolises like London, Paris, etc... had to invest heavily in sanitation infrastructure in their poorer communities in past centuries / decades. It's better to have everyone relatively healthy than just on group quite healthy and one group in squalor.
 
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After some thought, I guess I'm promoting some degree of social utilitarianism while still trying to defend some subconscious categorical imperatives that I must treat everyone as fairly as possible.
 
TUMe said:
Don't let Flo hear you say that!

Seriously, is there a contest among auto insurance companies to spend the most on on silly adds? Flo, the geicho, State Farm taking you away from a lion, The midnight call to Jake, the old man with a dollar on the fishing line. One sponsors almost every TV sports broadcast.
Click to expand...

The sports sponsorships are insane.
 
aTUfan said:
You want health insurance,

Pay for it!
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Nah....we'll lie about the plan, the costs, the coverage, etc... Then we'll stick the one group who has struggled the most over the last ten years with the bill. Brilliant!
 
astonmartin708 said:
I get your logic (which is correct) I'm just saying that it's imperative that we change the fact that the impoverished masses are in poorer health. Simply from an epidemic standpoint. If the nation sees an outbreak of an Ebola-esque virus we now know that a large portion of our population is susceptible to such a virus which puts even the healthy portion of our populous at risk.
Click to expand...

It is also cheaper to maintain a population in good health than to spend a lot more money curing or dealing with people beset with disease. We all know how expensive emergency room medicine is which a good health care system should reduce the cost of. Somehow other countries can spend less than we do to cover everyone and achieve better overall outcomes. It's not magic; there are multiple avenues for improving the healthcare system but too much money being made by the insurance companies, big hospitals and big pharma for them to give up without a fight.
 
We've always had free medical services in the U.S. The argument from the ACA supporters was that hospitals would no longer lose huge amounts of money treating the uninsured and those savings would then trickle down in the form of lower health insurance premiums (notice how Libs support the trickle down theory when it fits their argument). Well....with huge premium increases in store for 2017 on top of the increases already in place it's now pretty evident that those of us that argued this was fantasy were correct.

Those who have argued that big insurance, big pharma, and other health care private interest control the industry are absolutely correct. We missed an opportunity with the ACA to limit some of that influence. Instead, we not only gave them a seat at the table during the formation we allowed them to draft the damn law. It should surprise no one that this is now a disaster for the middle class and it's only going to get worse.
 
lawpoke87 said:
Those who have argued that big insurance, big pharma, and other health care private interest control the industry are absolutely correct. We missed an opportunity with the ACA to limit some of that influence. Instead, we not only gave them a seat at the table during the formation we allowed them to draft the damn law. It should surprise no one that this is now a disaster for the middle class and it's only going to get worse.
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Opportunity? Maybe in an ideal world, but not with the amount of influence, money, and lobbying thrown at Congress by big pharma, insurance companies, and big hospitals. The two Republicans and one Dem heading the Senate Finance Committee which was in charge of creating the bill were the three highest recipients of healthcare industry money.

Further insuring that there was no "opportunity" was the Republican Party's strategy not to pitch in (a better ACA would have been an Obama victory) so they had no interest in pushing for a better piece of legislation. Bitching about the ACA has been their core talking point and main legislative function since it was passed. There have been numerous opportunities to fix flaws that both sides of the aisle recognize, but instead all we get is meaningless votes to start over without offering an alternative.

Until we get the big money out of politics, expecting better results is crazy.
 
You're blaming Reps for a bad law which was written, passed and implemented soley by the Democratic Party? A party who not only invited those big special interest to the table but gave them a pen to write the damn thing.

Come on....do you hear yourself?
 
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