Second installment on ACA for those that like to read tea leaves...

[Youngster]

Call me selfish; but, all I want is a high deductible (up to $10,000) plan for under $300.00 per month, and I will be satisfied. I need something to tide me over until medicare, about 5 years.

[Ian S]

It's stupid to start over from scratch with the ACA. We've had a few years experience and know what the issues are. It would seem best to make some changes to address those issues rather than start out with something totally new which is bound to have its own completely different set of problems.

The same applies to Medicare. That system - a combination of government and private coverage - works well and folks seem to satisfied with it judging by all those around here commenting that they can't wait until they are eligible for it. If there are funding issues a decade off then let's deal with them. Already there are plans to eliminate "F" type plans in 2020 and that's probably warranted. It does make sense for most of us to have some kind of deductible/co-pay instead of first dollar coverage. Plus Medicare should be able to negotiate lower drug prices: why should Americans pay several times as much for prescription drugs as folks in other countries?

[Fermion]

Perhaps they could negotiate lower drug prices with the carrot of reform in the judicial system for drug lawsuits. I am not sure other countries have 24/7 commercials about how to sue drug companies if you feel you are harmed by their FDA approved treatment.

[LARS]

Quote:

Originally Posted by NW-Bound I don't think decamillionaires and centimillionaires, let alone billionaires, want to go to the same hospitals as everyone else. They will have their own private healthcare, while the rest of us share the same semi-public facilities. I wonder how it all works in other countries. The devil is always in the details.

It is my understanding in Britain, with National Health, this is exactly what is happening. Those that can afford to pay, go the route of private pay to get procedures done, avoiding the wait of National Health...

[NW-Bound]

And this is understandable. Here's an analogy. Public transportation means buses, trams, metros, etc... If you want speed and convenience, you take a taxi. The rich will have limousines. Everybody gets to move around, but with different methods according to what they want to pay. It would be nice if the state can provide a taxi to anyone, whenever he wants or needs it, but it is not going to happen.

[sengsational]

Quote:

Originally Posted by Letj It's for the simple fact they health care in the US is profit driven.

As implemented, I think most people can agree that profit driven healthcare system is not serving as efficiently as it could be. If we knew what we were buying (quality and outcomes), we had a complete range of choices (use any doctor, any facility we want), and we knew beforehand what the pricing was (nothing hidden, no surprises, not getting bills from 6 different entities for one encounter), then the profit driven system has a better chance of working. That would mean getting rid of the secret pricing contracts between insurance companies and providers, and their limited networks. If all the prices were public and "real", health insurance might provide customers with a defined payment for each service. If you want to go to Wal-Mart Medical, you might only pay 2% more than the defined payment. If you want to go to Maserati-Medical, you might need to pay 50% more than the defined payment. Of course setting the defined payment is a challenge, but it's done for Medicare, and it's done in all of those secret contracts between providers and insurance companies. If pricing secrecy was abolished and we could really "shop", that would go a long way to keep health care costs in check.

[explanade]

They have no incentive for price transparency.

Many hospitals and doctors have a lucrative business.

If they published prices, they'd have to defend why provider A charges more than provider B or why provider C raised prices every year for 5 years at much greater than the rate of inflation, etc.

So why would they bother?

[NW-Bound]

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Originally Posted by explanade They have no incentive for price transparency...

No, they don't. Not right now. We will just have to beat it out of them.

[explanade]

Quote:

Originally Posted by Senator It's pretty simple. If you want to take medicare, medicaid, any federal health insurance, or this new plan, you take the rate provided by the Government. If you used Government guaranteed student loans for your education which lead to a medical license, you take the rate. You could even require a Doctor to take that rate as a pre-condition to get any medical license.

I'd like to see that but it would be a pretty radical move, especially with the politicians in charge of govt. now.

Private insurance can't get anywhere near medicare rates. Some would argue that expanding medicare rates to all patients, among all providers, would be an even greater govt. intervention than the ACA, whose critics are against govt. role in health care.

One obvious argument against this kind of move would be that doctors would stop taking Medicare or any kind of govt.-paid insurance or quit their practice altogether.

And a lot of potential doctors would decided not to enter the field because it would be a lot less remunerative, relative to other professions.

[Texas Proud]

Quote:

Originally Posted by Katsmeow Well, often, the issue is that you don't really know in advance what is end of life costs and what isn't. When my father many years ago had surgery for cancer, he had a complication that resulted in a wound that didn't heal and prevented him from eating food. He had been released from the hospital but had to go back and had to be fed through an IV. This went on for months, hospitalized the entire time. He kept deteriorating (he was 75 at the time) and eventually they decided on a last ditch surgery to try tor repair the area that wouldn't heal so he could eat. In the meantime, he couldn't have the radiation that would ordinarily have occurred after his cancer surgery. Before they took him in for the surgery so he could perhaps be able to eat, they did a scan and found that his cancer had metasized to his liver. So, doing the surgery was no longer indicated and he died 48 hours later. But, here's the thing. Until the last little bit of it, it wasn't really known this was end of life care. Until then there was the hope that eventually this place would heal and he could eat and then he could have the radiation. Yes, of course, the cancer might come back but on the other hand it might not have. So, in retrospect, it is easy to think it was all a waste of money (and it certainly wasn't pleasant for my dad), but at the time it wasn't clear early on that he was destined to die. I remember my husband's mother had a stroke and ended up in a nursing home. She deteriorated and was literally put into hospice. But, she rallied and lived several more years. So, what is end of life and what isn't is not always clear at the time.

Yes, I have read a bit and your stmt is an important one.... there is a good amount of spending that is in the last year of life where they do not know it is the last year until after the patient is dead.... but I still read that 40% or last year spending is to people who they do not think will live...

As an example... I had a women who worked for me... had stage 4 pancreatic cancer.... but did an operation on her stomach for some reason... she had to recover from this major surgery which took 2 to 3 months... and that was out of less than 6 months of the rest of her life...


Then there is my mom... she is 97 and had 'something' happen to her a month or so ago... she went to her regular doc and we said the hospital doc suggested she do some testing on this and that.... her doc said 'why?'.... if we find something wrong with her heart are you going to put her through open heart surgery We said 'no'.... he said it was not worth doing invasive procedures to try and find out what happened.... it went away... we are going to do a few tests, but nothing major...

[ShokWaveRider]

Quote:

Originally Posted by Youngster Call me selfish; but, all I want is a high deductible (up to $10,000) plan for under $300.00 per month, and I will be satisfied. I need something to tide me over until medicare, about 5 years.

If Medicare is still there as we know it....

[Texas Proud]

Here is an interesting article on the cost of healthcare of the US vs other countries...


If you look, the % of GDP had a bit over 8% in 1980 to the 17% plus we have today....

We were close to Denmark and Germany at the time, but our costs have skyrocketed over the years... if we got down to where they are today (11%) we would not have as big of discussion as we now have...

The problem is the costs, not who is going to pay for them...


Edit... article.... http://www.commonwealthfund.org/publ...al-perspective

[Youngster]

Quote:

Originally Posted by ShokWaveRider If Medicare is still there as we know it....

I like to think it will still be there, as we know it or better.

[samclem]

s

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Originally Posted by sengsational If all the prices were public and "real", health insurance might provide customers with a defined payment for each service. If you want to go to Wal-Mart Medical, you might only pay 2% more than the defined payment. If you want to go to Maserati-Medical, you might need to pay 50% more than the defined payment. Of course setting the defined payment is a challenge, but it's done for Medicare, and it's done in all of those secret contracts between providers and insurance companies. If pricing secrecy was abolished and we could really "shop", that would go a long way to keep health care costs in check.

I think this could help, especially with routine procedures/products for "normal" things (pap smear, colonoscopy) or chronic care (diabetes maintenance care) but it won't get the very large cost savings we need in other areaas. If a patient if going down the normal "symptom>diagnosis.(rinse and repeat a lot> treatment > treatment> re-eval" route, it's just too much to ask the typical individual patient to shop around for all the services as though buying a toaster. They don't know what they need going in, the coding is too complex, etc. Instead, it is probably best for the patient to do the shipping at the macro level, for a medical care package that will provide the level of care they want, at a price they are willing to pay. Want unlimited access to diagnostic tests without getting approval? Want a room in the hospital by yourself? Want to get huge amounts of heroic care for untreatable cancers during your last 6 months of life? Then Maserati Medical has your policy. Okay with being 3 to a room, palliative care when the prognosis is truly dim, and seeing primarily PAs for routine care? Then ValueMed is your choice. But, all of this will work only if there is good quality information shoppers can readily use to see the true qualilty of care/outcomes each system is providing. I'd like to look past the expensive TV commercials, glossy brochures, and impressive chrome-and-glass hospital lobbies to see who is doing the best job in treating heart disease, cancer, providing care that keeps people healthy, info on wait times, and patient satisfaction, etc. That's a lot of hard-to-get data, and even harder to analyze (given the need to control for the initial health of patients, etc). Consumer Reports won't be able to do that, I think it would be a proper function of government. Virtually none of that is on the present ACA marketplace web pages, so people are just choosing by gut feel or the ads they see. It is no wonder that prices are continuing to rise.

Consumers who have good, well-presented information to use and who have a reason to shop wisely provides the best way to reduce costs (IMO).

[NW-Bound]

Quote:

Originally Posted by Texas Proud ...The problem is the costs, not who is going to pay for them...

+1
I have repeatedly said the same thing over many threads, and quite a few posters agreed with me. As a nation we have beaten around the bush for too long already.

I think we are all to blame. To use my analogy earlier, we want to ride a taxi while paying only bus fare. It comes to a rude awakening that the cost catches up with us, and some of us now on ACA are paying limousine price for that taxi.

[travelover]

Quote:

Originally Posted by samclem ........... Consumers who have good, well-presented information to use and who have a reason to shop wisely provides the best way to reduce costs (IMO).

Well said. My question is why don't we have this information now and what does it take to get it? It seems like pleas to Congress have fallen mostly on deaf ears, for even something as simple as competitive bidding on Medicare drug prices.

[explanade]

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Originally Posted by travelover Well said. My question is why don't we have this information now and what does it take to get it? It seems like pleas to Congress have fallen mostly on deaf ears, for even something as simple as competitive bidding on Medicare drug prices.

Because while voters may be making pleas to Congress, the lobbyists for various segments of the health care system are making donations and lavish dinner invitations.

[NW-Bound]

Quote:

Originally Posted by Youngster Call me selfish; but, all I want is a high deductible (up to $10,000) plan for under $300.00 per month, and I will be satisfied. I need something to tide me over until medicare, about 5 years.

Exactly what I had pre-ACA (the premium was closer to $700 for two, 3 years ago). However, the policy did not cover existing conditions, and had a lifetime benefit cap of $1M, so it is not a direct comparison with post-ACA policies.

Now, the deductible stays at $10K, but the premium is $2000/month for two. In return, it covers pre-existing conditions, with unlimited benefits.

[Senator]

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Originally Posted by explanade And a lot of potential doctors would decided not to enter the field because it would be a lot less remunerative, relative to other professions.

No problem. You create a free medical school program, for as many as can qualify to enter and flood the market with doctors.

You can create specialties and have non-doctors performing the work. Nurse Practitioners should be more prevalent. There are many medical procedures you do not need to be a Dr, but only Drs perform the work.

Allow patients to self prescribe medicine, and eliminate the Dr as the middleman. Then you need less Drs.

[Fermion]

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Originally Posted by Senator No problem. You create a free medical school program, for as many as can qualify to enter and flood the market with doctors. You can create specialties and have non-doctors performing the work. Nurse Practitioners should be more prevalent. There are many medical procedures you do not need to be a Dr, but only Drs perform the work. Allow patients to self prescribe medicine, and eliminate the Dr as the middleman. Then you need less Drs.

The malpractice lawsuits from all of this would end up being more than 20% GDP