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Old 12-07-2015, 10:04 AM   #21
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I think there is some penny wise pound foolish danger in getting a bronze plan over a silver plan.

Fictional example:

"Maybe that lump isn't too big yet. It is November and if I wait until January the money for the test will go on that year's deductible since I haven't filled much deductible this year."

Wow that one hit home.

Found a lump on side of neck in November of 2013. Fortunately I had it checked out as it turned out to be Hodgkin's lymphoma. I have no idea if the outcome (complete remission) would have been worse if I had waited 2 months but sure glad I didn't risk it.


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Old 12-07-2015, 10:34 AM   #22
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But we're talking about people making $50k or less mostly. There are probably a lot of people in that category who don't understand what HDHP are.
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I think the deductibles are too high.
The cost sharing provision goes a long way to reducing the deductible and max OOP. On covered CA at 200% of FPL the individual deductible is only $550 and max OOP at $2250.

So a single person making $20k would be on the hook for roughly 10% of income for their max OOP. A family of 4 making $48k (falls just under 200% threshold) would also be eligible for an individual $550/$2250 deductible/maxOOP. At lower incomes, the cost sharing drops deductible to as low as $75 (but the max individual OOP is still at $2250). At this level the deductible/max OOP may be painful financially but I don't think it's unmanageable.

However a problem I see with CoveredCA is that there is a big jump in the deductible/max OOP going from 200% of FPL to 200% + $1 of FPL. I.e. the individual deductible jumps from $550 -> $1900 and the max OOP from $2240 -> $5450. I think having a sliding scale as with the premium assistance would make a lot more sense.
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Old 12-07-2015, 08:59 PM   #23
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I switched from a Silver plan to a Bronze plan for 2016, and will save more than $4000 in premium relative to 2015. The new deductible is $5,500, but I had $10K deductible before in the pre-ACA plan.
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Old 12-07-2015, 09:18 PM   #24
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It seems to me that cost-sharing is a necessary >component< of reducing costs (by encouraging more prudent use), but it's not sufficient.

We also need more transparency in the costs of procedures, drugs, etc (so people can compare prices). This will help lower costs in exchange-sold plans and employer plans.

And we need comprehensive and well-presented information on the quality and availability of care in the exchange-sold health insurance plans. Customer satisfaction rates, waiting times and other metrics on availability of care, etc. This will allow people to better compare value (rather than just price for coverage--which might be hollow coverage if they can't get service). That would help put market forces to work more effectively to lower medical costs and improve care.
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Old 12-07-2015, 09:21 PM   #25
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The providers and the insurers have no incentive to publish that information.

The providers especially are doing very well financially, especially many "non profit" hospitals.

What's in it for them to make it easier for patients to compare shop their services against other competitors, or for that matter, risk public outcry where their prices are perceived as unjustifiable?
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Old 12-07-2015, 09:45 PM   #26
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The providers and the insurers have no incentive to publish that information.
Of course. Well, there are some exceptions, but not enough to matter.
So . . .

The present setup was engineered by the government. The government can compel provision of the necessary information, or collect it directly. If it matters anymore, that seems far less of an intrusion and more in keeping with the traditional role of government (encouraging free trade and competitiveness) than some other things which have been done.

Information regarding price and quality is needed in any competitive market to improve value, reduce margins. Information on both price and quality remains relatively unavailable.

As a practical matter and based on experience, I expect the government would do a good job of collecting and compiling the information, and a terrible job of making it useful to ordinary people, But if they did the first two parts, public interest groups, nonprofit entities, or even for-profit companies could do a good job of making tools available for people to seek the best value. >That< will result in some reductions in costs over time.
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Old 12-07-2015, 09:54 PM   #27
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Well the govt sets Medicare reimbursement rates and a lot of providers can't simply refuse that business.

I'm sure they would lobby not to have to publish that info.

I've been looking at dental plans. Dentists don't publish their prices on their web sites, obviously works against their interests.

But you can tell by which ones are in HMOs and which ones are in PPOs that some are more willing to take lower prices for their services than others.


As for quality, there are reviews on Yelp and other sites but you can't take a review from say half a dozen or a dozen users as reflective of that practice. If it was like TripAdvisor reviews where there are hundreds of reviews, then you have less likelihood of the review being gamed.
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Old 12-07-2015, 10:02 PM   #28
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As for quality, there are reviews on Yelp and other sites but you can't take a review from say half a dozen or a dozen users as reflective of that practice. If it was like TripAdvisor reviews where there are hundreds of reviews, then you have less likelihood of the review being gamed.
That's not the scale I'm talking about. And we'll never get meaningful, actionable information on waiting times, etc, like that. This is going to take a big effort to shine a light on a very intricate and opaque activity, but it is worth it because we spend so much on this.
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Well the govt sets Medicare reimbursement rates and a lot of providers can't simply refuse that business.
We shouldn't be interested in having the government set prices--that's not a formula for driving prices down and improving quality, it's a road to scarcity or to stagnation of prices at an artificially high level (the efficacy and history of price controls isn't worth repeating here). If we want more value, then let people shop (for insurance as well as for the services themselves) and arm them with actionable information they can use. When the medical results, waiting times, customer satisfaction and other measures of quality are used by consumers to make buying decisions (of insurance and medical services), we'll see better medical services and lower prices. Until then, there's not much downward pressure on prices and zero upward pressure on quality/availability.
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Old 12-16-2015, 12:52 PM   #29
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Some economists believed that high deductible plans would push down costs as patients, bearing more costs, would shop for better prices.

But as indicated broadly, people may just be forgoing care and risking long-term health, which would raise long-term health care costs. Meanwhile, it's not easy to shop for better prices:

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One study a few years ago, from the Altarum Institute, showed that Americans tend to spend more time shopping for dishwashers than for doctors — despite the latter being a rather more consequential decision.

For one thing, most of us don't have access to tools that would let us shop for doctors. I can go on Amazon and pull up prices for dozens of different dishwashers. But there's no website I can hop on, right now, to find out what different radiologists around Washington, DC, would charge me for an X-ray.

This study tried giving workers both the tools to compare costs and a financial incentive to go with the less expensive option. And, at least in this instance, those nudges weren't enough to encourage patients to choose cheaper doctors. Instead of looking for a lower-cost option, workers simply decided not to go to the doctor at all.


For Kolstad, this makes him skeptical of "demand-side" interventions in health care — those that rely on consumer demands for lower health prices to ultimately lead to less medical spending.
This study is forcing economists to rethink high-deductible health insurance - Vox

In fact, the problem may be that health care prices are more the result of certain markets being uncompetitive, because a big hospital dominates the area:

Quote:
Many of the changes pioneered by the Affordable Care Act have been devised to reduce wasteful medical care, but few have been directly concerned about price.

Jonathan Skinner, a health economist who works on the Dartmouth Atlas, said that there were still lessons to be learned from places like Grand Junction, but he acknowledged that the new work showed the limitations of studying Medicare in isolation. “This idea that if the entire country turned into Grand Junction, that we’d suddenly save 20 percent on health spending, maybe that’s not totally true,” he said. “Prices are a real problem.”

Martin Gaynor, a health economist at Carnegie Mellon University and one of the authors of the paper, has spent many years studying how market competition influences the cost and quality of health care. He says the new data is strong evidence that the federal government needs to enforce antitrust laws vigorously to prevent health care markets from becoming monopolies.

Other experts say more aggressive price regulation may be necessary in markets that already have monopoly hospitals. Dr. Berenson suggested policy makers look to Maryland, where a government board sets standard prices for hospital services.
http://www.nytimes.com/interactive/2...=pl-share&_r=0
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Old 12-18-2015, 06:29 AM   #30
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I was waiting in the urologist's office a couple days ago talking to another 60 something year old guy who still thought *if you were on Obamacare everything was free*.
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Old 12-18-2015, 08:29 AM   #31
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If most 30-40 year old groups have average claims of $x per person, you can't magically sell a policy with an artificially low $500 deductible and expect to magically make a profit if your premiums don't cover the average claimant's costs. "consumers of healthcare" (i.e. more sicker people, on average) will sign up in droves if they expect higher medical costs and can get a low deducitble for just a little higher cost. Some healthier people might do this as well, but the scale will disproportionately be tiled towards the sick/consumers of healthcare so much so that profits will evaporate.
MooreBonds got it right- the fancy word the industry uses is "adverse selection". You can see it even in this discussion; those of us who generally have nothing more serious than a case of raging poison ivy are going to do the math and choose the higher deductible. Cancer survivors who need expensive maintenance meds and follow-ups will go for the lowest deductible they can find and likely still come out ahead.

The results of the study the OP posted don't surprise me at all. I'd like to think part of the decreased ER visits are people who should have just waited for symptoms to go away or who sought lower-tier care such as a PCP or a Doc-in-the-Box, but the increased hospitalization rates in males isn't a good sign. Lack of cost transparency, as others have pointed out, is another huge problem.

So far, since going to a very high deductible ($5K), I refused an X-ray that a doc said would probably be negative and the problem eventually went away. Probably a good example of cost savings. OTOH, I've postponed my colonoscopy, which should have been this past August, since I had virtually no OOP costs in 2015 so I may as well postpone it to January in case I have high costs in 2016. That's minor- I WILL get it done. (Previous history means it will be diagnostic, thus out of pocket.) Will be using colonoscopyassist.com and writing letters to both docs I consulted here who, as usual, gave me the runaround when I asked about the all-in cost of a colonoscopy and couldn't provide an answer, and I'm going to tell them why. I have $15K in an HSA, but that's beside the point. I won't write them a blank check.
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Old 12-18-2015, 02:59 PM   #32
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More and more employers are going to HDHP only as well. My megacorp financial industry) has always offered fantastic benefits, including several health care options - 2 different HMOs, 3 different PPOs and a HDHP for 2015.

They just announced that as of 2018, they will offer one plan - HDHP only. And I've heard several of my friends say they have heard the same thing from their corporations.

Now, I'm sure more things will change in the health care arena by then, so it will be interesting to see how that may change over the next few years.
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Old 12-26-2015, 08:04 PM   #33
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More and more employers are going to HDHP only as well. My megacorp financial industry) has always offered fantastic benefits, including several health care options - 2 different HMOs, 3 different PPOs and a HDHP for 2015.



They just announced that as of 2018, they will offer one plan - HDHP only. And I've heard several of my friends say they have heard the same thing from their corporations.



Now, I'm sure more things will change in the health care arena by then, so it will be interesting to see how that may change over the next few years.

As some on this thread have mentioned, HDHP do seem to be a way that employers force employees to have some skin in the game. Yet at the same time, I believe that they are also intended to force people to take better care of themselves. Unfortunately, this message is being drowned out by the cries that healthcare (and thus health insurance) is too expensive. It's not too expensive, as healthcare institutions are charging what the marketplace will bear. Costs will come down as people paying out of pocket begin to insist on lower prices. This will be achieved in part through shopping around for voluntary healthcare treatments, buying generic drugs, and perhaps even preventative care through healthier living.


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Old 12-26-2015, 09:25 PM   #34
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States regulate the rates charged by utilities (electric, gas, phone).

Presumably there was public support for these regulations. When rate hikes are proposed, you get consumer groups making noise about the hikes.

It's a wonder there isn't more uproar about health care prices.
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