[Winstonm]

blackshoe, on 2013-November-22, 01:29, said:

What exactly is it that caused all these existing policies to suffer such huge cost increases overnight?

What percentage of your income goes for healthcare premiums now, Winston? What percentage before ACA?

Those percentages really are not important statistics (and a little too personal of information for me to be comfortable with sharing) as the pre-ACA policies did not cover all things the ACA requires and had deductibles higher than is allowed by the ACA, so it is truly an apples-to-oranges comparison. I live in Oklahoma, a red state that refused to start a state exchange and refused the Medicaid expansion, so I had to go through the federal healthcare.gov website that is the subject of so much controversy.

It took me about 10 days to get my account straight, and then another week to get the side-by-side comparisons and ability to choose a plan - this may have been slowed because navigational directions within the website are quite unclear. (you have to figure out without prompting that to get the comparison you click on your name).

Once in, though, the site was quite easy to use - every plan available to me in my state was shown by type (bronze, silver, gold, platinum), along with the pertinent details (deductibles, co-pays, etc.), and the site automatically figured any tax credit available and automatically sends it to the plan-operator chosen.

In my case, I was able to chose a plan which I believe is better from a company that did not operate in Oklahoma prior to the ACA - and even the Blue Cross plans on the website were less costly that the one I had previously, although Blue Cross neglected to inform me of those policy choices when they notified me of the rate increase for my old plan.

[onoway]

Seems to me that health care around the world would improve dramatically AND go down in cost if doctors were paid when their patients got better instead of no matter what happens. Has to be one of the few businesses (veterinarians are another) when what the people you are paying actually accomplish is totally irrelevant to their financial success.

Can you imagine paying someone to fix a leaky roof and it got worse instead of better but you still had to pay the full amount that you would have paid if he had actually fixed it?

Supposedly paying only when a successful outcome was once the practice in China and possibly elsewhere but tended to be accompanied with people literally losing their heads if they lost an "important" patient which is admittedly a tad drastic.

Somewhere, though, there ought to be some sort of difference between a good outcome and a bad one. It might also make people look a little harder at some of the drugs and their side effects being peddled to a naive public. Now it sometimes seems as though at least some of them deal with one issue but cause another. Good for business, not so much for people.

[kenberg]

It's not practical, Pam. Example: In 1977 my 77 year old father was suffering from an aneurism. The surgeons went in to repair it, my father died. I paid them, it would never cross my mind to do otherwise. As I age, I have seen many similar examples.

[Winstonm]

onoway, on 2013-November-22, 08:32, said:

Seems to me that health care around the world would improve dramatically AND go down in cost if doctors were paid when their patients got better instead of no matter what happens. Has to be one of the few businesses (veterinarians are another) when what the people you are paying actually accomplish is totally irrelevant to their financial success.

Can you imagine paying someone to fix a leaky roof and it got worse instead of better but you still had to pay the full amount that you would have paid if he had actually fixed it?

Supposedly paying only when a successful outcome was once the practice in China and possibly elsewhere but tended to be accompanied with people literally losing their heads if they lost an "important" patient which is admittedly a tad drastic.

Somewhere, though, there ought to be some sort of difference between a good outcome and a bad one. It might also make people look a little harder at some of the drugs and their side effects being peddled to a naive public. Now it sometimes seems as though at least some of them deal with one issue but cause another. Good for business, not so much for people.

Actually, addressing outcomes is part of the ACA/hospital payment structure - some payments are withheld based on readmission rates for certain problems, i.e., the better the outcome for the patients, the more the hospital earns.

Quote

In fiscal year (FY) 2013, the Hospital Readmissions Reductions Program withheld up to 1% of regular reimbursements for hospitals that had too many patient readmissions within 30 days of discharge because of three medical conditions: heart attack, heart failure and pneumonia. Under the ACA, the maximum penalty will increase to 3% by 2015 and be expanded to include readmissions for other medical conditions.

[kenberg]

Winstonm, on 2013-November-22, 08:09, said:

Once in, though, the site was quite easy to use - every plan available to me in my state was shown by type (bronze, silver, gold, platinum), along with the pertinent details (deductibles, co-pays, etc.), and the site automatically figured any tax credit available and automatically sends it to the plan-operator chosen.

In my case, I was able to chose a plan which I believe is better from a company that did not operate in Oklahoma prior to the ACA - and even the Blue Cross plans on the website were less costly that the one I had previously, although Blue Cross neglected to inform me of those policy choices when they notified me of the rate increase for my old plan.

This is really good to hear. It's good for you, of course, but it is also good to hear that it actually seems to be working out at least for some.


I can see why the high deductible plans would not fit well into this scheme. Those with few or no issues would take them until they had issues, and then htey would switch. It would be a soft version of not carrying insurance (which is an infinity deductible approach) until they got ill, and then signing up for the benefits.

[Winstonm]

kenberg, on 2013-November-22, 09:18, said:

This is really good to hear. It's good for you, of course, but it is also good to hear that it actually seems to be working out at least for some.


I can see why the high deductible plans would not fit well into this scheme. Those with few or no issues would take them until they had issues, and then htey would switch. It would be a soft version of not carrying insurance (which is an infinity deductible approach) until they got ill, and then signing up for the benefits.

Although your idea is valid, my understanding is that is not the reason behind the high deductible policies - those were instituted by the insurance companies as a way to offload accumulated smaller costs to the consumer, a profit-protection motivation. Profit of this sort is not of itself a bad thing, but is it the best and most affordable way to offer healthcare protection?

The other part of the ACA that has altered pricing is the forced abandonment of lifetime policy limits - my understanding is that insurance companies can no longer offer policies that cap their lifetime risk, so it pretty much is useless to compare previous policies to current policies.

Both of these look to me to be geared toward protecting consumers while forcing insurance and business to look to other means to hold down costs.

[Winstonm]

kenberg, on 2013-November-22, 09:18, said:

This is really good to hear. It's good for you, of course, but it is also good to hear that it actually seems to be working out at least for some.


I can see why the high deductible plans would not fit well into this scheme. Those with few or no issues would take them until they had issues, and then htey would switch. It would be a soft version of not carrying insurance (which is an infinity deductible approach) until they got ill, and then signing up for the benefits.

Although your idea is valid, my understanding is that is not the reason behind the high deductible policies - those were instituted by the insurance companies as a way to offload accumulated smaller costs to the consumer, a profit-protection motivation. Profit of this sort is not of itself a bad thing, but is it the best and most affordable way to offer healthcare protection?

The other part of the ACA that has altered pricing is the forced abandonment of lifetime policy limits - my understanding is that insurance companies can no longer offer policies that cap their lifetime risk, so it pretty much is useless to compare previous policies to current policies.

Both of these look to me to be geared toward protecting consumers while forcing insurance and business to look to other means to hold down costs.

Quote

Just after I wrote this I noticed this:
The 2010 health-care law itself doesn't include any requirements limiting physicians' payments or restricting insurers' arrangements with doctors. But in order to keep prices low for exchange plans, many health insurers cobbled together narrow networks of doctors who agreed to lower their fees.

....Experts worry that a stratified system could emerge for the insured, where people who get health insurance through their jobs can go to a broad slate of doctors, while those newly covered in the exchanges get fewer choices. Depending on their plan, people may be able to see an out-of-network doctor and get some level of reimbursement. But many plans on the exchanges are HMO-style closed networks.

Once again it is hard to imagine why there is so much resistance to reducing the administrative costs and profitability needs of the present system in favor of a simple expansion of Medicare that covers everyone. From what I have read, those savings alone would pay for the expanded system.

[Winstonm]

kenberg, on 2013-November-22, 09:18, said:

This is really good to hear. It's good for you, of course, but it is also good to hear that it actually seems to be working out at least for some.


I can see why the high deductible plans would not fit well into this scheme. Those with few or no issues would take them until they had issues, and then htey would switch. It would be a soft version of not carrying insurance (which is an infinity deductible approach) until they got ill, and then signing up for the benefits.

Although your idea is valid, my understanding is that is not the reason behind the high deductible policies - those were instituted by the insurance companies as a way to offload accumulated smaller costs to the consumer, a profit-protection motivation. Profit of this sort is not of itself a bad thing, but is it the best and most affordable way to offer healthcare protection?

The other part of the ACA that has altered pricing is the forced abandonment of lifetime policy limits - my understanding is that insurance companies can no longer offer policies that cap their lifetime risk, so it pretty much is useless to compare previous policies to current policies.

Both of these look to me to be geared toward protecting consumers while forcing insurance and business to look to other means to hold down costs.

Quote

Just after I wrote this I noticed this:
The 2010 health-care law itself doesn't include any requirements limiting physicians' payments or restricting insurers' arrangements with doctors. But in order to keep prices low for exchange plans, many health insurers cobbled together narrow networks of doctors who agreed to lower their fees.

....Experts worry that a stratified system could emerge for the insured, where people who get health insurance through their jobs can go to a broad slate of doctors, while those newly covered in the exchanges get fewer choices. Depending on their plan, people may be able to see an out-of-network doctor and get some level of reimbursement. But many plans on the exchanges are HMO-style closed networks.

Once again it is hard to imagine why there is so much resistance to reducing the administrative costs and profitability needs of the present system in favor of a simple expansion of Medicare that covers everyone. From what I have read, those savings alone would pay for the expanded system.

[kenberg]

Winstonm, on 2013-November-22, 10:50, said:

Once again it is hard to imagine why there is so much resistance to reducing the administrative costs and profitability needs of the present system in favor of a simple expansion of Medicare that covers everyone. From what I have read, those savings alone would pay for the expanded system.

This could be tricky. See
http://www.washingto...ed81_story.html

For example:

Quote

A number of the nation’s top hospitals — including the Mayo Clinic in Minnesota, Cedars-Sinai in Los Angeles, and children’s hospitals in Seattle, Houston and St. Louis — are cut out of most plans sold on the exchange.

I could understand a person not being happy about this. We were very, very pleased with the hospital where Becky had her knee replacements done. At the other end of the scale, one place where I was at, mercifully not for long, when I was having my issues was such that if I have a heart attack on their doorstep it is my plan to insist that an ambulance be called to take me elsewhere.

The fact that a hospital or a doctor is adequately competent, or can fake it, to avoid revocation of a license is not enough,.

[Winstonm]

kenberg, on 2013-November-22, 15:56, said:

This could be tricky. See
http://www.washingto...ed81_story.html

For example:



I could understand a person not being happy about this. We were very, very pleased with the hospital where Becky had her knee replacements done. At the other end of the scale, one place where I was at, mercifully not for long, when I was having my issues was such that if I have a heart attack on their doorstep it is my plan to insist that an ambulance be called to take me elsewhere.

The fact that a hospital or a doctor is adequately competent, or can fake it, to avoid revocation of a license is not enough,.

I mean no insults to anyone but I am more and more convinced that unless one is out and about among the different states or working often with a large group of the public then there is a complete disconnect in grasping the magnitude of the income inequality in the U.S. For millions of Americans, living here has become a hand-to-mouth daily struggle to survive.

[mike777]

Winstonm, on 2013-November-22, 17:19, said:

I mean no insults to anyone but I am more and more convinced that unless one is out and about among the different states or working often with a large group of the public then there is a complete disconnect in grasping the magnitude of the income inequality in the U.S. For millions of Americans, living here has become a hand-to-mouth daily struggle to survive.

Winston as usual makes an excellent point. "For millions of Americans, living here has become a hand-to-mouth daily struggle to survive."

[kenberg]

There are many people in a precarious financial position, there are many people in a precarious medical position, and there are more than a few in a precarious position in both of these areas. Getting this right is not easy, and time will tell as to whether the ACA has accomplished it. The ACA was initially presented as sort of a miracale drug with great benefits and no serious side effects. With drugs or with programs, it is not realistic to expect such wonders. There is no benefit to rooting for failure, but there is also no benefit in pretending that it is working better than it is..

[Vampyr]

kenberg, on 2013-November-22, 15:56, said:

(From Washington Post)A number of the nation’s top hospitals — including the Mayo Clinic in Minnesota, Cedars-Sinai in Los Angeles, and children’s hospitals in Seattle, Houston and St. Louis — are cut out of most plans sold on the exchange.

Are these hospitals that are run on a for-profit basis?

[kenberg]

Vampyr, on 2013-November-23, 06:24, said:

Are these hospitals that are run on a for-profit basis?

I can't say that I know their finances, I was more concentrating on the reputation for excellence.

We have a difficult problem. Most of us, I think, are appalled at the chaotic nature of health care financing here. A couple of pages back I mentioned that I got this 89 page, pluse appendices, document in the mail about Medicare part D. I found it incomprehensible. I have been told I can ignore it., Whew. But not everyone can ignore it. It is more or less impossible to understand a lot of this. A year back, I had to try to understand what Medicare would or would not pay for. I couldn't. So I said what I wanted and agreed that I would pay for it if Medicare wouldn't. It did. So we are badly in need of a fix. The flip side is that places such as the Mayo Clinc (I grew up in Minnesota so I know more about Mayo than I do about other places mentioned in the article) have people come there from all over the world. No sane person wants to see such expertise dismantled. So where are we? Actually, I can't say with any confidence that I knw where we are or where we are headed in our efforts at reform. it may sound cynical, but over the years I have come to dread the word reform.

[Winstonm]

Ken brings up great points. Myself, I do not think healthcare under the present system can ever be properly fixed without first fixing this, wealth and income inequality changes since 1979.

[kenberg]

Winstonm, on 2013-November-23, 09:14, said:

Ken brings up great points. Myself, I do not think healthcare under the present system can ever be properly fixed without first fixing this, wealth and income inequality changes since 1979.

My guess is that you are right about this.

[kenberg]

While out for my morning walk, one more thing occurred to me. I mostl;y lack references but I am very sure that for a number of years the Mayo Clinic has been frequently cited as a leader in innovative ways of controlling costs. I found this somewhat skeptical story from 2009 at http://articles.wash...-public-option.
But even this skeptical article notes:

Quote

The emphasis on cost-effectiveness permeates the clinic. A single physician is assigned to coordinate each patient's care. A "clinical practices" committee preaches cooperation so that, for instance, vascular surgeons, neurosurgeons, cardiologists and radiologists agree on who would treat a carotid artery problem in the most cost-effective way.

The ethic is clear on the surgical floor, where schedules are organized so that patients spend as few days as possible waiting in Mayo hospital rooms. On a recent morning, colorectal surgeon Robert Cima assembled his 10-person team to review his four operations that day to ensure things would go smoothly. Nurses and other staff members tend to stay at Mayo for years, which also helps teamwork. "They know how I do it," Cima said. "Everybody knows what is going on."

This does not seem to me to be the sort of place we want to dis.

[PassedOut]

I can say from experience that the Mayo Clinic in Rochester provides far-and-away the best medical care I've ever encountered in a pretty long life. I'd never consider anywhere else for significant medical treatment for anyone in my family. Once you've been to Mayo, you see clearly how deficient other medical facilities are.

[Cthulhu D]

Mayo is very, very expensive, often for no discernible benefits (in terms of healthcare outcomes compared to other leading US hospitals). It is a pragmatic decision to cut it.

[kenberg]

Well, we seem to have a difference of opinion. From the Washington Post article quoted earlier:

Quote

"Look at what the Mayo Clinic is able to do. It's got the best quality and the lowest cost of just about any system in the country," Obama said in Minneapolis this month. "So what we want to do is we want to help the whole country learn from what Mayo is doing. . . . That will save everybody money."

So we have PassedOut and Obama on one side, Cthulhu D on the other.side. Me, I've never been there. But from what I have been told, I side with the Pres. on this one.