Good article on health care costs in Washington Post

[samclem]

Quote:

Originally Posted by Helen I have tried to examine my insurance bills to look for errors but the information is not clear at all. They don't list doctors names and they use codes for treatment/test descriptions.

If health insurance were competitively sold to consumers, you can bet the statements would get better. Nobody would stand for being billed hundreds of dollars for services they can't decipher. I'm sure "clarity of statements and billing" would be among the criteria we would consider, as well as quality of medical care, waiting times, price of the policy, etc.

We'll get there, because it's better than the alternatives ("better" for customers and for most of the current (monied) vested interest groups). It will be painful in the meantime

[Gone4Good]

Quote:

Originally Posted by samclem If health insurance were competitively sold to consumers, you can bet the statements would get better.

I have an individual health insurance policy and it isn't any more user friendly than what I had working for Mega Corp. Meanwhile it comes with a bunch of significant downsides that I didn't have to worry about with the Mega Corp policy.

I'm in favor of adding competitive forces where we can to our health care system, but there are so many natural market failures in providing health care that competition alone (or even mostly) can't get the job done.

[samclem]

Quote:

Originally Posted by Gone4Good I have an individual health insurance policy and it isn't any more user friendly than what I had working for Mega Corp.

Did you find that it was easy to shop for an individual policy? Were there many competitive vendors selling policies with standardized features and were there easy-to-use tools to help buyers choose (e.g. a site with examples of billing statements from all insurers for the same few procedures? The same site maybe giving consumer satisfaction ratings? Snapshots of typical wait times for various procedures, etc)? I haven't shopped for individual health insurance, maybe the market is very competitive and efficient, but my impression was that there were few vendors and that there was a lot of "friction" involved in getting information to make a buying decision.

[Gone4Good]

Quote:

Originally Posted by samclem Did you find that it was easy to shop for an individual policy?

I probably had as many insurance companies to choose from as I do airlines between any two destinations.

Was it easy to shop? Some required 5 years of medical history others required 10. No, it wasn't easy. Shopping for health insurance was an excercise in prostration all the while hoping that you haven't forgotten something in your history that will later allow the insurance company to revoke your coverage when you need it most.

[ERhoosier]

Quote:

Originally Posted by Gone4Good Doctors get paid more because nobody shops for a lower cost doctor. As the return to being a doctor increases, the demand for medical school increases. Medical schools, seeing the value of a medical degree, increase tuition prices. Would-be doctors are willing to borrow to pay for school because the field is so lucrative. ......

While it can indeed be difficult for the consumer to compare doctor prices, the financial luster of a medical career is clearly in decline.
Here's a very interesting & well-referenced analysis of ROI (Return on Investment) for medical education:
The Deceptive Income of Physicians
Physician bankruptcy, previously rare, is now not unusual-
Small Business: Doctors going broke - Jan. 5, 2012
And the "cost" of being a physician is not measured just in $$, but in a toll on personal health inc. increased rates of suicide, divorce, and cardiovascular disease compared to the general population.
Physician wellness: a missing quality indicator : The Lancet
FWIW- Medical schools are increasing tuition not out of greed but in an effort to stay afloat-
AAMC Study: Recession Forced U.S. Medical Schools to Take New Tack -- AAFP News Now -- American Academy of Family Physicians
Interestingly, the number of med school applicants in US has NOT been steadily increasing over past 20yrs but has waxed and waned with economic conditions.
https://www.aamc.org/data/facts/

[samclem]

Quote:

Originally Posted by Gone4Good Was it easy to shop? Some required 5 years of medical history others required 10. No, it wasn't easy.

Thanks. That's what I'd heard from others. This is definitely "low hanging fruit" if we're looking for a way to reduce costs and improve the quality of care. Maybe when "the exchanges" get here we'll see some progress in building an efficient marketplace for individual policies.

[ERhoosier]

Quote:

Originally Posted by samclem Thanks. That's what I'd heard from others. This is definitely "low hanging fruit" if we're looking for a way to reduce costs and improve the quality of care. Maybe when "the exchanges" get here we'll see some progress in building an efficient marketplace for individual policies.

+1
Never understood why sales of health insurance across state lines has been severely restricted. Limited competition means consumers can get treated like dirt. Health insurers get away with junk that would never be tolerated by car insurance companies (e.g. incomplete bills/statements, delayed benefits, unjustified denials, etc.).

[M Paquette]

Quote:

Originally Posted by ERhoosier +1 Never understood why sales of health insurance across state lines has been severely restricted. Limited competition means consumers can get treated like dirt. Health insurers get away with junk that would never be tolerated by car insurance companies (e.g. incomplete bills/statements, delayed benefits, unjustified denials, etc.).

What health insurers 'get away with' is largely determined by state insurance regulators. Allowing insurers to register under one state while selling policies in other states has interesting consequences. Insurer operating expenses drop, as there is only one state regulatory board to manage, in their 'home' state. States can compete to become the home state for insurers by suitably adjusting their regulatory regime.

I believe this is commonly called a 'race to the bottom'. I don't see any path that would have a net benefit for the consumer, as any drop in rates is likely to be matched by improvements in loss mitigation (that funny thing where your claims are denied).

[samclem]

Quote:

Originally Posted by M Paquette I don't see any path that would have a net benefit for the consumer, as any drop in rates is likely to be matched by improvements in loss mitigation (that funny thing where your claims are denied).

There's no doubt that insurers would gravitate to states with fewer mandates (i.e. no mandatory insurance covering erectile dysfunction for 90 year olds, etc). And then people would buy the types of policies they'd like to have from those companies.

An article in Reason makes the point: is "the bottom" such a bad place if state mandates are adding 30-50% to the price of health insurance?

I do see the problem with the money/political dynamic of a huge health insurance industry being located in a tiny state and having tremendous influence on that state's economy, politics, and regulatory oversight (like Delaware and credit cards). And I also see that having 50 state markets would continue an inefficiency that bedevils us today. But right now we've got the most expensive possible combination, and it shows.

[explanade]

Race to the bottom is seen with credit card companies located in some small state with lax regulatory standards.

It's associated with predatory lending and usurious interest rates.

May not be the best way to improve health care availability or costs to people but it's probably great for the insurers.

[Gone4Good]

Quote:

Originally Posted by samclem An article in Reason makes the point: is "the bottom" such a bad place if state mandates are adding 30-50% to the price of health insurance?

It's strange how these articles never consider people who are sick or old. So they end up coming to conclusions like this:

Quote:

Purchasers will avoid states whose regulations prove inadequate, and ultimately, so will insurers.

So we're to believe that healthy people aren't going to flock to the low cost policies of a state where insurers can cherry pick customers.

The reason state mandates cost so much is because insuring the sick and elderly is expensive. It's true that we can lower insurance costs by ignoring the needs of these people, which is what Cato implicitly suggests. But if that is the idea, why not say so explicitly?

Edit to add:
The reason I was required to submit 5 and 10 years of medical history to get an individual insurance policy isn't because of a lack of competition, but because I'm in a low regulation state where insurers are allowed to deny coverage to sick people.

[samclem]

Quote:

Originally Posted by Gone4Good The reason state mandates cost so much is because insuring the sick and elderly is expensive. It's true that we can lower insurance costs by ignoring the needs of these people, which is what Cato implicitly suggests. But if that is the idea, why not say so explicitly?

When 2014 rolls around and the "exchanges" are in place, private insurers will have to take all comers. But unless something changes, we still won't have the ability to buy insurance across state lines, leading to lots of inefficiencies. With the "what about the sick" problem gone, maybe we can start solving the rest of it.

[Gone4Good]

Quote:

Originally Posted by samclem When 2014 rolls around and the "exchanges" are in place, private insurers will have to take all comers. But unless something changes, we still won't have the ability to buy insurance across state lines, leading to lots of inefficiencies. With the "what about the sick" problem gone, maybe we can start solving the rest of it.

That's a switch. I thought we were repealing ACA.

If Cato et. al. are now on board with mandatory issue of proscribed minimum coverage health insurance, I'm on board with a national health insurance market. But I strongly suspect that is not what they mean.

[samclem]

Quote:

Originally Posted by Gone4Good That's a switch. I thought we were repealing ACA.

We'll see. I'd like to make the best of whatever happens--repeal or not. How we respond to the enactment of ACA shouldn't have much to do with whether we favored it in the first place.

[Gone4Good]

Quote:

Originally Posted by samclem We'll see. I'd like to make the best of whatever happens--repeal or not. How we respond to the enactment of ACA shouldn't have much to do with whether we favored it in the first place.

And yet we never get a straight answer on whether when we say "state competition" we're actually talking about undermining no-underwriting laws. It's really remarkable how well people have learned to dance around this issue.

[samclem]

Quote:

Originally Posted by Gone4Good And yet we never get a straight answer on whether when we say "state competition" we're actually talking about undermining no-underwriting laws. It's really remarkable how well people have learned to dance around this issue.

The ACA will establish minimum standards for coverage. Starting in 2014 insurers will no longer be able to set policy rates based on pre-existing conditions. Doesn't this vitiate any reasonable state "no underwriting" laws? After all this is in place, if a state (or county, or hamlet for that matter) wants to enact further new laws mandating coverage for breast augmentation, height enhancement, or any other such thing, I think they should be able to do that provided their residents can vote with their wallets (and federal vouchers) to get coverage that meets the federal standard from some vendor not headquartered in their state.

It's the best of all worlds: the politicians can continue to vote for laws requiring bread and circuses out of thin air, but no one will have to buy them.

I guess some folks want the states to continue to set coverage minimums, but now that the feds are in the game these folks want residents of Idaho to be forced to pay (through funding of subsidies) for coverages mandated by the legislature of New York. That doesn't sound like a good system. This federal "empowerment" comes with a price.

[marko]

Quote:

Originally Posted by FinanceDude TORT REFORM. Our malpractice insurance premiums have to be one of the highest in the world............

Now THERE is the reason for high health care costs!!

Is getting 2,3, and 4 extra tests/procedures/opinions a matter of the doctor's greed or is he just trying to keep himself out of court?

Let's see: our costs are 3 times higher....but we need three times more 'tests' before the Dr will do anything. It's not health care cost...it's CYA costs!

[Gone4Good]

Quote:

Originally Posted by samclem The ACA will establish minimum standards for coverage. Starting in 2014 insurers will no longer be able to set policy rates based on pre-existing conditions. Doesn't this vitiate any reasonable state "no underwriting" laws? After all this is in place, if a state (or county, or hamlet for that matter) wants to enact further new laws mandating coverage for breast augmentation, height enhancement, or any other such thing, I think they should be able to do that provided their residents can vote with their wallets (and federal vouchers) to get coverage that meets the federal standard from some vendor not headquartered in their state. It's the best of all worlds: the politicians can continue to vote for laws requiring bread and circuses out of thin air, but no one will have to buy them.

Dancing, dancing, dancing.

It's very easy for me to say that I'm in favor of interstate competition for health insurance provided the insurers in each state are required to issue policies with Federally mandated minimum coverages at non-discriminatory prices.

It's not so hard to be direct. It's easy enough to say you agree in full, or you agree with the interstate competition part but not with the rest. What you're doing instead, is relying on the protections of a law you don't agree with to advance the idea of "state competition" without saying whether you actually support the protections that make state competition workable.

It's a good dodge, but I'm not sure why it's necessary. You're not running for office, are you?

[samclem]

Quote:

Originally Posted by marko Now THERE is the reason for high health care costs!!

Tort reform would help, but it's fairly small potatoes in the big scheme of things. IIRC even the most wide-ranging reform of the medical tort system would only cut our costs a few percent.

[samclem]

Quote:

Originally Posted by Gone4Good It's very easy for me to say that I'm in favor of interstate competition for health insurance provided the insurers in each state are required to issue policies with Federally mandated minimum coverages at non-discriminatory prices. It's not so hard to be direct.

I'm not following you. Isn't the situation you've described (set minimum coverage limits, no underwriting) exactly the situation that will be in place in 2014? If so, I think we'd both be in favor of cross-state insurance sales. That's not complicated or indirect.