Affordable Care Act Supreme Court Hearings this week

[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?

[justplugit]

$3700 ?

[TheSpecialist]

Originally Posted by justplugit

$3700 ?

nope...

[JohnnyD]

Originally Posted by TheSpecialist

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?

Probably about 65-75%, so about $8500. In the end, why does it matter? It still doesn't change the whole bit about leverage I discussed above.

Even with BCBS paying a reduced rate, health care costs are still increasing. With that in mind, even enacting your "government regulated pricing", how would it decrease costs? Like I said above, it seems like you want the government to regulate pricing because you don't think it's fair.

[scottw]

Originally Posted by JohnnyD

? Like I said above, it seems like you want the government to regulate pricing because you don't think it's fair.

Bingo!...wants the govt to make it fair(er) regardless of whether or not it is the proper role of the federal government....

interesting comparisons...

Why The Supreme Court Should Uphold the Health Care Law 9-0 | TIME Ideas | TIME.com

RealClearPolitics - Back to the Future?

also interesting that I've read proffered cause for all but Thomas* of "the 5" as having reason or potential to uphold Obamacare but on the other side there is absolutely no question apparently, that "the 4" will ignore the Constitution and vote in lock step to uphold it........

*despite his obvious distaste for Justice Thomas’s views, Jeffrey Toobin takes him seriously as a judicial thinker and pathfinder.
“In several of the most important areas of constitutional law, Thomas has emerged as an intellectual leader of the Supreme Court,” Toobin writes. “Rarely has a Supreme Court Justice enjoyed such broad or significant vindication.”

[TheSpecialist]

Originally Posted by JohnnyD

Probably about 65-75%, so about $8500. In the end, why does it matter? It still doesn't change the whole bit about leverage I discussed above.

Even with BCBS paying a reduced rate, health care costs are still increasing. With that in mind, even enacting your "government regulated pricing", how would it decrease costs? Like I said above, it seems like you want the government to regulate pricing because you don't think it's fair.

nope

[TheSpecialist]

It would decrease costs because the American public is being price gouged.

BCBS payed a grand total of 2159.14 The rest was written off, and they still had room for a profit.


So tell me they are not price gouging, and if there was a commission that set rates at this point healthcare cost would be no cheaper across the board?
It's not about fairness as much as about being price gouged.