Affordable Care Act Supreme Court Hearings this week

[JohnnyD]

Originally Posted by TheSpecialist

I saw that when I had surgery what was billed out by the hospital and doctors, and what was paid by the insurance was a big discrepancy. It also shows just how much the medical industry over charges if they can settle for the rates they agreed to with the insurance companies.

Insurance companies and hospitals agree to pricing terms before an insurance company say "yeah, we'll allow our customers to use your doctors." The insurance companies leverage the wide availability of doctors to strong-arm hospitals into agreeing on cheaper terms. In turn, the hospitals utilize the volume increase to justify taking tighter margins.

Essentially, large insurance companies are provided wholesale pricing because of the leverage they hold in their larger customer base.

[Jim in CT]

Originally Posted by JohnnyD

Essentially, large insurance companies are provided wholesale pricing because of the leverage they hold in their larger customer base.

What he said...

[TheSpecialist]

Originally Posted by Jim in CT

What he said...

Exactly now if the Federal Government did the same thing healthcare would be significantly lower. If they can take what the insurance companies are giving and still be profitable, then they should start by using those rates.

[Jim in CT]

Originally Posted by TheSpecialist

Exactly now if the Federal Government did the same thing healthcare would be significantly lower. If they can take what the insurance companies are giving and still be profitable, then they should start by using those rates.

Are you saying that government would act as a healthcare provider (like a doctor), or are you saying the government would act as a health insurance company (taking people's money and paying doctors with that money)...

If you are talking about the government actually providing healthcare, well, I don't see that the government does many things nearly as well or efficiently as what's done in the private scetor. The government has no incentive to save money, because they are spending other people's money.

If you're talking about the government acting as an insurance company, that's how Medicare works, and (1) it doesn't pay doctors enough for services provided, and (2) it's nearly bankrupt, and will be completely bankrupt when the baby boomers are all old and sick.

I don't pretend to have any answers...

[TheSpecialist]

Originally Posted by Jim in CT

Are you saying that government would act as a healthcare provider (like a doctor), or are you saying the government would act as a health insurance company (taking people's money and paying doctors with that money)...

If you are talking about the government actually providing healthcare, well, I don't see that the government does many things nearly as well or efficiently as what's done in the private scetor. The government has no incentive to save money, because they are spending other people's money.

If you're talking about the government acting as an insurance company, that's how Medicare works, and (1) it doesn't pay doctors enough for services provided, and (2) it's nearly bankrupt, and will be completely bankrupt when the baby boomers are all old and sick.

I don't pretend to have any answers...

I am saying the government would act like a public utility commission would. They would set the rate that each procedure should be payed. The insurance companies already do this , but if you have no insurance you pay almost double for the same procedure. This way there is a flat rate across the board for any and all procedures, it could be fine tuned by geographical area based on cost of living say. If hospitals want that rate to go up they would go in front of a board, and present evidence as to why the rate they get from anyone for a particular procedure should go up, then the board would decide on the increase.

as an example I go in for surgery and the anesthesiologist charges 2900.00 for general, 350 for a nerve block, and 400 to use an ultra sound machine for 3 minutes for a total of 3650. Now the insurance company agreement allows for 989 for general, 124 for nerve block, and 89 for the ultra sound. for a total of 2003.

Now if you have to pay cash you pay full price. Obviously the doctor and hospital are not going to be bankrupt charging the lower fees to the insurance companies, because those that pay cash probably offset it a little. Why not have the government regulate the amount the can charge and set the rate at:

1200 for general
147 for the nerve block
110 for the ultra sound

Now every individual pays that amount if the pay cash, or if they have insurance the insurance company pays the same.

That is the extent of the Government involvement, they just set the price for a procedure across the board.


I think this would significantly lower health care cost, or at least control any rise in cost.

[JohnnyD]

Originally Posted by TheSpecialist

Exactly now if the Federal Government did the same thing healthcare would be significantly lower. If they can take what the insurance companies are giving and still be profitable, then they should start by using those rates.

There's a reason many private practice doctors don't accept Medicaid (some won't event accept Medicare). The government sets pricing and then pays 60-75% of that actual price, if they pay at all. Also, medical offices that accept Medicare patients are subjected to significant increases in the amount of BS they have to deal with, including how they bill, manage records, operate their office and a ton of other things that increase overhead.

It is exactly the above reason that in some states Walgreens has stopped accepting Medicaid.

Again, it comes down to matter of leverage due to volume. The government has the leverage over many providers because of the volume of elderly patients on Medicare.

Some of the most successful private practice doctors that I know of have enough patients that they do not need to accept patients with Medicare/Medicaid. Not to mention they don't get stuck dealing with nearly as many people begging for pain pills, people that play the system to get disability checks and the other dregs of society.


Personally, I'd prefer the government to stay the hell out of setting prices. Make no mistake, government regulation is a major contributor to why health care costs are so high.

[TheSpecialist]

Originally Posted by JohnnyD

There's a reason many private practice doctors don't accept Medicaid (some won't event accept Medicare). The government sets pricing and then pays 60-75% of that actual price, if they pay at all. Also, medical offices that accept Medicare patients are subjected to significant increases in the amount of BS they have to deal with, including how they bill, manage records, operate their office and a ton of other things that increase overhead.

It is exactly the above reason that in some states Walgreens has stopped accepting Medicaid.

Again, it comes down to matter of leverage due to volume. The government has the leverage over many providers because of the volume of elderly patients on Medicare.

Some of the most successful private practice doctors that I know of have enough patients that they do not need to accept patients with Medicare/Medicaid. Not to mention they don't get stuck dealing with nearly as many people begging for pain pills, people that play the system to get disability checks and the other dregs of society.


Personally, I'd prefer the government to stay the hell out of setting prices. Make no mistake, government regulation is a major contributor to why health care costs are so high.

Good points but not what I am saying.

We would not use medicare rates, and the paperwork would go to the health insurance company. Rather than 100 different insurers haggling over rates you could average the rates and that would be the max that any hospital or doctor could charge for that procedure whether the person has health insurance or pays cash. This way everyone is paying the same.

Right now if I have insurance and you do not we pay different amounts for the same quality of care:

My insurance might pay 200 for a checkup, and I pay my 10 copay

You might see the same doctor, get the same care but with no insurance and paying cash you pay 395.

That is not a good way to control or keep health care costs down.

The fed could say to the doctor you can charge 265 for the check up no matter what insurance someone has or doesn't have, because that is the average rate the 10 best insurers would pay you.

[JohnnyD]

Originally Posted by TheSpecialist

Good points but not what I am saying.

We would not use medicare rates, and the paperwork would go to the health insurance company. Rather than 100 different insurers haggling over rates you could average the rates and that would be the max that any hospital or doctor could charge for that procedure whether the person has health insurance or pays cash. This way everyone is paying the same.

Right now if I have insurance and you do not we pay different amounts for the same quality of care:

My insurance might pay 200 for a checkup, and I pay my 10 copay

You might see the same doctor, get the same care but with no insurance and paying cash you pay 395.

That is not a good way to control or keep health care costs down.

The fed could say to the doctor you can charge 265 for the check up no matter what insurance someone has or doesn't have, because that is the average rate the 10 best insurers would pay you.

I get what you're saying, but what you're suggesting is not sustainable.

Is it a matter of fairness or keeping down costs? From your description, it seems like you want Uncle Scam to further regulate things because "it's just not fair".

The strict regulation of charges that you suggesting is one baby step away from completely socialized medicine. Why not just completely nationalize health care?

[Jim in CT]

Originally Posted by TheSpecialist

Good points but not what I am saying.

We would not use medicare rates, and the paperwork would go to the health insurance company. Rather than 100 different insurers haggling over rates you could average the rates and that would be the max that any hospital or doctor could charge for that procedure whether the person has health insurance or pays cash. This way everyone is paying the same.

Right now if I have insurance and you do not we pay different amounts for the same quality of care:

My insurance might pay 200 for a checkup, and I pay my 10 copay

You might see the same doctor, get the same care but with no insurance and paying cash you pay 395.

That is not a good way to control or keep health care costs down.

The fed could say to the doctor you can charge 265 for the check up no matter what insurance someone has or doesn't have, because that is the average rate the 10 best insurers would pay you.

First, if everyone is paying the average of what we all pay today, I don't see how that lowers the cost, except for people who currently pay as they go without insurance. Second, while your idea controls the amount that doctors get paid for services, it doesn't address the costs of the care that the doctors provide.

We need to somehow address the underlying cost of the healthcare that docs provide. One way to do that is tort reform. Unfortunately, the American Trial Lawyers lobby gives big $$ to democrats, who consequently won't allow that reform.

That's just a very small piece. I don't know that there is a solution. It's a staggering problem even in a simple environment, but when you throw on top of it the looming tsunami of the baby boomers, and we are in for a real reckoning. A real reckoning.

[PaulS]

Originally Posted by Jim in CT

We need to somehow address the underlying cost of the healthcare that docs provide. One way to do that is tort reform. Unfortunately, the American Trial Lawyers lobby gives big $$ to democrats, who consequently won't allow that reform.

That's just a very small piece. I don't know that there is a solution. It's a staggering problem even in a simple environment, but when you throw on top of it the looming tsunami of the baby boomers, and we are in for a real reckoning. A real reckoning.

As you said, a small piece - but a piece.

The NE journal of medicine says about 7.4% of Drs. are sued each year and by age 65, even Drs. in low risk specialties (like pediatrics and dermatology) face a 75% chance they will have been sued. In 2009, the Congressional budget office said that going to a 250K cap on noneconomic damages and 500K on punitive damages and a 1 year statute of limitation would save about 11B/year - 40% of from reduced malpractice prem. and the rest from fewer tests/procedures.

Total cost/year are about 2.6Trillion. Thus 11B, is not even 1/2 of 1% of total costs. Cost are incr. about 100B/year.



In 2010, the 5 largest medical insur. had about 11.7B in profit.

[TheSpecialist]

Originally Posted by Jim in CT

First, if everyone is paying the average of what we all pay today, I don't see how that lowers the cost, except for people who currently pay as they go without insurance. Second, while your idea controls the amount that doctors get paid for services, it doesn't address the costs of the care that the doctors provide.

We need to somehow address the underlying cost of the healthcare that docs provide. One way to do that is tort reform. Unfortunately, the American Trial Lawyers lobby gives big $$ to democrats, who consequently won't allow that reform.

That's just a very small piece. I don't know that there is a solution. It's a staggering problem even in a simple environment, but when you throw on top of it the looming tsunami of the baby boomers, and we are in for a real reckoning. A real reckoning.

Well just in time, a bill came from our Orthopedist for my wife's shoulder surgery:

$11,800.00 billed for the ortho part not including anesthesia.

Anyone care to venture a guess how much Bluecross Blue Shield payed?