Health Care and the alternative point of view

[irmanator]

A step which accompanies this is also price disclosure to consumer. Once this is known, its very possible that consumers get smarter with more information. Right now the health care industry (doctors and insurance companies and hospitals) have little communication with the consumer in regards to cost. If this is corrected with some level of TEMPORARY price controls and price disclosures, I think reform can happen by the providers without much intervention from the government in terms of trillion dollar legislation.

Maybe not controls so much but disclosure..... (maybe a menuboard like the fast food places )

[irmanator]

What I see as the problems

1) NO ONE knows what most health care costs.
2) Even if you put 1 insurance company with 1 doctor, 1 Nurse and 1 billing specialist you could not put together a true cost for a given service- there needs to be mass data available for trending.
A great example would be whether a "transportation fee" is assessed to move a lab sample from one floor to the next- I saw this on a bill once, even though the lab was 2 doors down from where the procedure occured. If I had same procedure done at a different provider, would they assess the same fee? This is level of standardization I am looking for (who is allowed to assess that fee?)
3) The government health care agencies (Medicare/Medicaid) do not pay at same rates aa private insurance companies- this is unfair to those which carry private insurance (savings of 2k per year for a family of 4 if this inefficiency is removed).
4) Doctor's should be allowed to charge what is reasonable for a procedure without any entity talking them down on price- provided there is full price disclosure before the procedure. If full price is not known, see point #1.
5) Based on item #4 and #1, it is clear its an endless cycle until it is well documented what the price of a procedure is. My line of thinking on keeping prices consistent is temporary until the cycle of #4 is removed from the system (if price is disclosed before procedure Dr should be able to set price at anything they want).

So are you saying that (gov't or someone else like ins) should set all the prices of similar services the same? Or are you saying the Dr. or tech should set the price and make it very publicized for comparison purposes?

An idea I have (I don't work in anyway in health care so am kinda uniformed of the minute details) The insurance covers XXX for the orthodontist, so then I know I am liable for the difference. The orthodontist gave a exam to see what was needed to straiten the teeth. But I was free to go to get several quotes with being able to have the same dollar amount from ins no matter which Orthodontist I chose. I was thinking with this example on MRI (since that is everyone example) you would know that ins only covers say 200 and you pay the difference. You would then be able to decide if you want to use the one in the hospital, dr office, or the clinic accross town, based on your ability to pay. Idk if this will ever happen but it might help ???

[jIM_Ohio]

So are you saying that (gov't or someone else like ins) should set all the prices of similar services the same? Or are you saying the Dr. or tech should set the price and make it very publicized for comparison purposes?

An idea I have (I don't work in anyway in health care so am kinda uniformed of the minute details) The insurance covers XXX for the orthodontist, so then I know I am liable for the difference. The orthodontist gave a exam to see what was needed to straiten the teeth. But I was free to go to get several quotes with being able to have the same dollar amount from ins no matter which Orthodontist I chose. I was thinking with this example on MRI (since that is everyone example) you would know that ins only covers say 200 and you pay the difference. You would then be able to decide if you want to use the one in the hospital, dr office, or the clinic accross town, based on your ability to pay. Idk if this will ever happen but it might help ???

Insurance should not set the prices without an oversight board (like a regulatory agency)
government should not set anything

I can distinguish between a regulatory board and government, but do agree that is muddy, thick water.

I outlined some of my ideas earlier in thread.
Not all MRIs are created equal (is machine 1 year old or 10 years old, how much is the resolution of the MRI? Lots of questions)

I do like price disclosure, but that is not enough.

My suggestion initially was "fix" prices for a given procedure within a given radius to squeeze out anyone which is inefficient. For example I hear of doctors knocking price up 25% because they know insurance is going to try to negotiate 25% off the top, or not pay for certain fees.

My goal is to remove that competition from the system- that competition is inefficiency, and that is waste. I put most of that on the insurance companies (all doctors should be able to charge and make a profit).

Once the inefficiencies are out of the system, price disclosure should be the watchdog on that inefficiency creeping back in.

At same time that prices are being frozen (temporarily), other concepts need to be reformed too... things like patients rights, the ability of people to find other insurance (availability and portability of policies). If insurance companies have to compete for business, they will quickly find ways to root out their own inefficiencies without price fixing, (the price fixing was designed to stick it to the insurance companies, not the doctors).

Your desire to have insurance cover a fixed amount per procedure sounds like an HDHP health plan. it fixes the amount I spend on my own care each year (max of $7000 give or take). First $1500 is on me, then its a 10%-90% split (meaning I have 10% copays after I pay $1500). The co pays stop once I hit the max of about $7000.

Makes it much easier to budget, and my premiums are cheap.

[irmanator]

Jim, I guess you could look at it that way. I guess I could but I wasn't at the time I wrote it. I haven't had the option of hdhp plan. So all I hear about them is on these boards. It sounds like something I would go for but my employer covers enough of the cost of my regular ins. to make it not worth switching at this time. (not that it matters cause i don't have the choice)

[jIM_Ohio]

Jim, I guess you could look at it that way. I guess I could but I wasn't at the time I wrote it. I haven't had the option of hdhp plan. So all I hear about them is on these boards. It sounds like something I would go for but my employer covers enough of the cost of my regular ins. to make it not worth switching at this time. (not that it matters cause i don't have the choice)

My company greased the skids on the HDHP

they contribute $750 for single people to an HSA
they contribute $1500 for families or married coupled to an HSA

My deductible is $1500
that means my employer is willing to pay my first $1500 each year in health expenses
then we split 10%/90% for next $7000 (I pay 10, they pay 90).

And my premiums are a fraction of the other plans. I pay $120/month ($60 per check) for the plan.

Most other plans are more expensive on premium side (like $400/mo??) and you still have to pay $20-$50 each time you visit.

My math says this- $5000 year in expenses on other plans are guaranteed, even if you NEVER visit a doctor (most pay $5000 in premiums for a family). My wife's old plan was about that cost...

so for same $5000 we can spend about $1500 in premiums and put $3500 into HSA
if we don't see doctor, we are ahead $3500
if we do see a doctor, $3500 is a decent number of visits before its used up.

[irmanator]

thats awesome that they pay that much. I don't know what my employer pays just that I pay 180 mo. for regular ins. If I had to pay the full amount I probably wouldn't do it unless I could get the hdhp, since the kids are healthy and I only go when my son does something stupid and needs stitches or tetanus. Thankfully that isn't often anymore.

[disneysteve]

This is really impressive; I really mean that. I am assuming you are talking about your primary care provider? I assure you, your experience is the exception, and not the rule. I bet specialist care will be a delay. Either your physician is very efficient, or he/she is not that busy for whatever reason.

Pediatrician for kids, primary care for me. The Pediatric practice is quite large (more than one pediatrician and more than one location in 50 mile radius).

My primary care is a smaller practice, but he can also see me on less than a 12 hour notice most of the time.

My wife has seen a specialist (neurologist) on less than 48 hours notice, and her second opinion was less than 48 hours after that as well.

I'm a pretty busy primary care doctor. I see 110-120 patients/week. If you call my office for a sick visit, you will be seen the same day. If you call really late in the work day, you'll be seen the next morning. Anything longer than that is unacceptable IMO.

Specialists are more difficult for a variety of reasons. There aren't as many of them. Many of them work out of multiple offices so, for example, the lung doctor I like might only be in his local office one day per week. If my patients have transportation, I can get them seen somewhere within a day or two. If they only want the local office, they may have to wait a week.

So maybe if non smokers and people who live healthy lifestyles could get discounts??? I don't know just an idea. It might motivate some to do better.

A lot of this is already happening either through insurance companies or through employers. Employers do it because it decreases their health care costs, decreases absenteeism and improves productivity. Smokers, obese people and those with poorly controlled chronic health problems miss work more often, take more sick time and cost more to insure which all costs the company money.