health care gone nuts!

[NYEXPAT]

We pay $933.00/year for a family of 3 (59/31/7) which is up a wee bit. It does not have drug coverage although the doctors give free samples (most of the time) and generics are crazy cheap.

 

[tjscott0]

Let's look at it from the insurance company's viewpoint.

Rise of health care vs CPI
Percent Annual Increase in National Health Expenditures (NHE) per Capita vs. Increase in Consumer Price Index (CPI), 1980-2009 - Kaiser Slides
You will note the cost of health care is double CPI.

In the olden days [1960]<grin>, doctor's bils were paid roughly 50% by insurers & 50% by the patient. Now it's about 90% insurers & 10% by patient.

CARPE DIEM: The Real Health Care Problem: Spending Other People's Money; From 50% to 90% in 60 Years

Could be it that once a third payer is responsible for paying the patient has little incentive to hold the cost down.

see Roemer's law
http://www.ahpanet.org/files/TheDartmouthAtlasonRoemer'sLaw b.pdf

Roemer's Law states that there is a direct correlation between capacity and utilization. With
the availability of third-party reimbursement, oversupply of resources, especially hospital beds and
specialist physicians, induces its own demand for their overusage.

As Pogo said:"We have met the enemy & it is us".

 

[mpeirce]

We're paying $3700/year for a family of 3 (51/60/18) for a HDHP+HSA with a large deductible: $11,000. We budget for the deductible, but have never come close to it.

We view it as real "insurance" were we pay directly for our own health spending, but have the HDHP if something major comes up. Since we have few health issues, this has worked out very well for us.

 

[MichaelB]

I thought that in 2014 that insurers could no longer deny coverage for preexisting conditions and that would be a biggie. Already adopted in my state, but could be a cause for premium increases elsewhere. Is that right?

Well, that might be a reason premiums rise in 2014, but we're talking about 2013 premiums. Besides, premiums have been rising at this pace for the past decade. The only thing "new" is the reason given.

 

[Midpack]

I can confidently predict that the so called reforms of the past few years will increase costs. Microeconomics 101-increase demand, and make no change in supply, prices can only go up.

Here's a chart that shows how the US stacks up internationally.

Healthcare Spending As A Share Of GDP - Business Insider

So far "reform" has consisted of trying to stick the other guy with the bill. Some day, likely when it is too late, we will figure out that the size of the bill must be decreased.

Look where Japan is on this chart. Japanese people live longer than anyone else on earth, and they like their health care system, their access to doctors, and their relationships with their doctors.

How many of us can say the same, and how many will be even as satisfied as we are today 5 years from now?

Ha

Good info ha. I've posted this kind of thing here until I was 'blue in the face.'

Per Wikipedia:

"The health care system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Payment for personal medical services is offered through a universal health care insurance system that provides relative equality of access, with fees set by a government committee. People without insurance through employers can participate in a national health insurance programme administered by local governments. Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profit and be managed by physicians. For-profit corporations are not allowed to own or operate hospitals. Clinics must be owned and operated by physicians."

Sounds like a good system to me. However, the degree of government control and exclusion of for profit institutions might be a bit hard to implement here in the USA.

If it was just Japan that would be one thing. But it's every other country, we'll have to find another way. Switzerland might be a good example for us to examine, they came from a system more like ours, only 20 years ago IIRC.

 

[sheehs1]

Anyone see the 60 Minutes segment last Sunday.? Investigation of
Health Management Associates one of many hospital chains forcing doctors to admit patients to increase profitability with a large percentage of their revenues coming from Medicare and Medicaid. Doctors admitting they are forced to find reasons for admittance or face termination.

There is fraud at every level in our system. Hence the escalation of costs.
There will be a breaking point. Just don't know when.

 

[Midpack]

Anyone see the 60 Minutes segment last Sunday.? Investigation of
Health Management Associates one of many hospital chains forcing doctors to admit patients to increase profitability with a large percentage of their revenues coming from Medicare and Medicaid. Doctors admitting they are forced to find reasons for admittance or face termination.

There is fraud at every level in our system. Hence the escalation of costs.
There will be a breaking point. Just don't know when.

See post #7.

 

[M Paquette]

Healthcare Spending As A Share Of GDP - Business Insider
...
Look where Japan is on this chart. Japanese people live longer than anyone else on earth, and they like their health care system, their access to doctors, and their relationships with their doctors.

Ideally we will successfully roll back all these pesky changes introduced by the so-called Enlightenment, and we can get back to that North Africa style expense level for the bulk of the population.

 

[haha]

Per Wikipedia:

"The health care system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Payment for personal medical services is offered through a universal health care insurance system that provides relative equality of access, with fees set by a government committee. People without insurance through employers can participate in a national health insurance programme administered by local governments. Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profit and be managed by physicians. For-profit corporations are not allowed to own or operate hospitals. Clinics must be owned and operated by physicians."

Sounds like a good system to me. However, the degree of government control and exclusion of for profit institutions might be a bit hard to implement here in the USA.

That 30% cost sharing might sound tough, but prices are strictly controlled, so I am told it isn't too bad. It certainly does not keep Japanese people from freely accessing health services.

Ha

 

[haha]

Ideally we will successfully roll back all these pesky changes introduced by the so-called Enlightenment, and we can get back to that North Africa style expense level for the bulk of the population.

So you think Japan is a medieval society?

Ha

 

[sheehs1]

See post #7.

Yep. Hard to go back and read thru 25 + posts. Usually I try but I missed that one.

 

[LOL!]

Our health care premiums have dropped considerably. We used to pay about $6,000 a year for a family of four. In 2012, we will pay about $1500 for the year for an HDHP with free in-network well-care (physicals, that first colonoscopy, etc), plus we were able to put about $6250 into an HSA that is so-far untouched. Add in some contact lenses and less than $100 of dental co-pays and we've had a good cheap healthcare year.

 

[imoldernu]

The cost doesn't all go away when Medicare kicks in... Been on Medicare for 12 years. Total cost for two of us, including supplement and prescription drug part D, about $10K. That does not include dental or optical.

Re: the "why so high"... My guess is that almost everyone has at least one horror story of costs that were outrageous. Like... DW went in for a operation. After it was over, the time in the recovery room which should have been about 1/2 hour ended up being 7 hours... because the ICU was unavailable due to remodeling. Difference in cost? $12,000... Only found that out by accident. Who cares?... Medicare pays.

There is no incentive for members to question bills, as the patient doesn't receive the bill. Only the total shows on the statements and often, before the final bill comes in the mail, two, three or four months may pass, as the paperwork goes back and forth. IMHO... much room for increases in efficiency and economies of scale.

Two more things...
The mandatory hospital admittance for indigents is a tax balancing act. Some multi million dollar operations pay minimal or no taxes.
Equipment design is often standardized to benefit manufacturers, as in approved hospital beds selling for as much as$100,000 versus top of the line home adjustable hospital bed selling for $2,000.

 

[tjscott0]

Another reason for soaring medical cost is the end of private practice physicians. They are selling out to hospitals & becoming employees. Thus reducing competition.

The High Price of Nickel-and-Diming Doctors - Businessweek

Dr. Thomas Lewandowski, a Wisconsin cardiologist, had a tough choice to make in 2010 after the federal government yet again reduced the payments he received for treating Medicare patients: He could fire half his staff to keep his practice open, or sell it to a local hospital. He sold

Under Medicare’s tangled payment system, hospitals get higher reimbursements than individual doctors for cardiology treatment and other specialty services—in some cases a lot higher.

Large hospital chains also have more power than individual doctors to negotiate reimbursements from insurers such as UnitedHealth Group (UNH) and WellPoint (WLP). The result: Instead of controlling costs by keeping payments to doctors down, the federal government may be driving them higher.

http://www.nytimes.com/2012/12/01/business/a-hospital-war-reflects-a-tightening-bind-for-doctors-nationwide.html?pagewanted=all

For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments.

But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons.

Today, Boise is a medical battleground.

A little over half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or its smaller competitor, St. Alphonsus Regional Medical Center.

Many of the independent doctors complain that both hospitals, but especially St. Luke’s, have too much power over every aspect of the medical pipeline, dictating which tests and procedures to perform, how much to charge and which patients to admit.

In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment.

 

[Gatordoc50]

Some premiums here are quoted at 4k, some at 8k, some at 20k, etc. Doesn't make sense to me.

 

[Mulligan]

Some premiums here are quoted at 4k, some at 8k, some at 20k, etc. Doesn't make sense to me.

I agree. The various threads on this topic always amaze me. My premium is $76 a month with a $5500 deductible on an individual BCBS policy. I am 48 and it has only went up $4 a month in 2.5 years that I have been on it. Factor in my HSA, and my policy actual nets me a small profit. I don't see health insurance as a real cost at this point. If I was paying some of these outrageous premiums, I don't know if I would feel comfortable being retired. I probably would still be employed full time afraid to let go of my company insurance plan.

 

[MichaelB]

Some premiums here are quoted at 4k, some at 8k, some at 20k, etc. Doesn't make sense to me.

Some of that is underwriting, some is subsidy. It doesn't make sense to anyone and the true cost of health care is hidden to most of us.

 

[MichaelB]

I can confidently predict that the so called reforms of the past few years will increase costs. Microeconomics 101-increase demand, and make no change in supply, prices can only go up.

That same economics class also says demand will fall if price goes up and there is lots of evidence this has happened in the US.

So far "reform" has consisted of trying to stick the other guy with the bill. Some day, likely when it is too late, we will figure out that the size of the bill must be decreased.

I respectfully disagree with your definition of reform. The bill is already being paid. It is about leveling the playing field and enabling or requiring everyone to play with the same rules. Decreasing the bill is critical, but the challenge is to do so without denying health care to people.

 

[zaqxsw]

I respectfully disagree with your definition of reform. The bill is already being paid. It is about leveling the playing field and enabling or requiring everyone to play with the same rules. Decreasing the bill is critical, but the challenge is to do so without denying health care to people.

Great summary! Amen. First, level the playing field, get all people health care in an equal fashion, then start reducing waste, costs, and the extreme pay differences in the medical fields. No more pay by procedure which leads to unbelievable pricing of everything related to it in the medical supply chain.

Oh, and fire all good looking drug reps under 30.........

 

[tjscott0]

Originally Posted by Gatordoc50
Some premiums here are quoted at 4k, some at 8k, some at 20k, etc. Doesn't make sense to me.

I don't think anyone would make this statement about housing. Housing costs varies by locale.

I expect the same applies to health care costs thus insurance premiums vary by locale [office rents, salaries] plus there are underwriting concerns [age, medical conditions] that apply individually to the insured.

 

[Gatordoc50]

I don't think anyone would make this statement about housing. Housing costs varies by locale.

I expect the same applies to health care costs thus insurance premiums vary by locale [office rents, salaries] plus there are underwriting concerns [age, medical conditions] that apply individually to the insured.

I can see that. My personal view is that all Insurance should pay the same for a specific procedure. Leaving it up to the healthcare provider to sift thru all the individual policies with their different deductibles, copays and reimbursement rates adds extreme costs to the delivery of care. Imagine standing in line at the grocery store with the cashier having to charge each customer differently. Let's see, this orange costs you 75 cents, and you 2 dollars and you 25.75 and for you it's free. lol. Or better yet, just let them all walk out paying next to nothing, figuring it out later, billing the food insurers, and then billing the customer for the difference. That would triple the cost of groceries, at least.

 

[nun]

our heath care goes up every year. with the next upage it will be just short of 20k.

thats nut. I am 60 and my wife is 57. both in good health. !y wife does take 3 different meds and I think they ding her for 50% add on. I do not even go to the doctor well not much.

We have a 1500 dollar deductable each. Here in CA anthem blue cross is about the only way to go. We have asked for quotes for higher deductable.

Just wondering what you all think about how high heath care is.

Bob

You'd pay around $1100/month in premiums for a $4k deductible plan in MA

https://www.mahealthconnector.org/p...x.portlet.endCacheTok=com.vignette.cachetoken

 

[eytonxav]

I can see that. My personal view is that all Insurance should pay the same for a specific procedure. Leaving it up to the healthcare provider to sift thru all the individual policies with their different deductibles, copays and reimbursement rates adds extreme costs to the delivery of care. Imagine standing in line at the grocery store with the cashier having to charge each customer differently. Let's see, this orange costs you 75 cents, and you 2 dollars and you 25.75 and for you it's free. lol. Or better yet, just let them all walk out paying next to nothing, figuring it out later, billing the food insurers, and then billing the customer for the difference. That would triple the cost of groceries, at least.

+1, if we are ever to get to reasonably priced healthcare, a standardized system will be needed.

 

[nun]

I can confidently predict that the so called reforms of the past few years will increase costs. Microeconomics 101-increase demand, and make no change in supply, prices can only go up.

Here's a chart that shows how the US stacks up internationally.

Healthcare Spending As A Share Of GDP - Business Insider

So far "reform" has consisted of trying to stick the other guy with the bill. Some day, likely when it is too late, we will figure out that the size of the bill must be decreased.

Look where Japan is on this chart. Japanese people live longer than anyone else on earth, and they like their health care system, their access to doctors, and their relationships with their doctors.

How many of us can say the same, and how many will be even as satisfied as we are today 5 years from now?

Ha

Other countries have strongly regulated health insurance systems and prices are often set by the government or the systems are run by the government. What factors actually lead to the cost of healthcare being half as much in other countries will be difficult to determine and implement in the US, basically because the ideas are not home grown and that is often reason enough to stay with the status quo.

 

[gerrym51]

I agree. The various threads on this topic always amaze me. My premium is $76 a month with a $5500 deductible on an individual BCBS policy. I am 48 and it has only went up $4 a month in 2.5 years that I have been on it. Factor in my HSA, and my policy actual nets me a small profit. I don't see health insurance as a real cost at this point. If I was paying some of these outrageous premiums, I don't know if I would feel comfortable being retired. I probably would still be employed full time afraid to let go of my company insurance plan.

i live in mass. the kind of policy you have is not allowed here.