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Old 11-01-2014, 10:33 AM   #101
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Do you drive finish nails with a sledge hammer?
I think that's a ridiculously naive view. Costs won't come down for everyone unless money stops going to someone.

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I guess it is a good idea if you want to stifle innovation.
And I agree that some of those things would stifle innovation - that wasn't what we were talking about... we were talking about why the insistence that everyone's costs go down is naive.

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I don't get it. How does publishing a price for services generate slave healthcare workers?
Publishing a price for services doesn't reduce costs for everyone, which is what we were talking about. Please try to reply to comments with replies relevant to what the person you are replying to was talking about.
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Old 11-01-2014, 10:44 AM   #102
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Not sure if this was common knowledge as I always paid my portion of the bill without negotiation because I did not know what to negotiate other than to say " I believe this bill is too high and I'm not paying it" and risk my account going to collection which may affect my credit rating and being denied services by the provider.

Count me in the single payer system camp
This isn't a negotiation.
You just don't pay the first bill you get. You wait and then in a few weeks/months, you get another bill with the second insurance adjustment.

Generally, you don't pay the final bill until maybe 2-3 months later after all the submissions, re-submissions, coding corrections, re-coding corrections are done with.

They'll gladly take your money earlier because it is less work for the doctor's office, but if you wait, you end up paying 10 cents on the dollar.

If the doctor's office is a good one, they'll say something like: "oh, don't pay it now...let us go round and round with insurance first"
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Old 11-01-2014, 10:54 AM   #103
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Thou doth protest too much. IMO rack rates are not really much of an issue since nobody really pays the rack rates. Besides, there are emerging tools where one can compare prices and that functionality will only get better over time.

Banning profit making healthcare? Nationalizing health care providers? Do you drive finish nails with a sledge hammer? I guess it is a good idea if you want to stifle innovation.
I'm a big believer in free markets, but there must be a balance.

Free markets must be free, transparent, and open to meaningful competition. Rack rates, IMHO, are functionally monopolistic since they are not transparent and those affected really have no marketplace freedom to take their business elsewhere. And there are plenty of reports of those rack rates actually being assessed on some unfortunate folks. Few providers/facilities/drug makers/medical suppliers/etc. have rack rates anywhere near their in-network insured rates any more. Kinda makes me wonder if at least some of the US HC industry is getting close to violating the old Sherman Act (anti-trust/price fixing)

OTOH- Single payer does NOT mean an end to provider/facility/supplier price negotiations which affect patient care. These have been going on in European HC systems for years.
http://www.chcf.org/~/media/MEDIA%20...ontainment.pdf
http://www.mckinsey.com/insights/hea...h_franz_knieps
And sometimes these single-payer negotiations lead to denial of service, like access to potentially life-saving (but expensive) drugs according to British gov't agency report on NHS.
http://www.telegraph.co.uk/health/nh...the-dying.html
And the Swiss, being well aware of the single-payer experiences of other nations, have consistently & overwhelmingly voted against adopting a change from their private HI system to single payer.
http://www.hngn.com/articles/44104/2...healthcare.htm

As in most things, there is a financial Yin/Yang to the financial aspect of HC. There must be money to support HC to provide care, but as HC becomes too expensive fewer will have access to that care.
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Old 11-01-2014, 11:43 AM   #104
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And that's the crux of the issue: Practically no one really supports any mechanism for doing what you're implying here. We all support bringing about the impact, but there isn't support for any of the mechanisms that would be necessary to bring that impact about, i.e., effectively turning healthcare workers into slaves, effectively nationalizing healthcare providers, effectively banning profit-making healthcare industries, etc.
One idea I heard is to regulate HC as a utility. Similar to regulating a large electric company. An independent commission sets rates after considering costs and allowing for reasonable profit margin. Not a perfect system for sure, but utility workers are not slaves and some profit motive is still present to incentivize innovation.
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Old 11-01-2014, 12:42 PM   #105
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This isn't a negotiation.
You just don't pay the first bill you get. You wait and then in a few weeks/months, you get another bill with the second insurance adjustment.

Generally, you don't pay the final bill until maybe 2-3 months later after all the submissions, re-submissions, coding corrections, re-coding corrections are done with.

They'll gladly take your money earlier because it is less work for the doctor's office, but if you wait, you end up paying 10 cents on the dollar.

If the doctor's office is a good one, they'll say something like: "oh, don't pay it now...let us go round and round with insurance first"

I forgot to pay a medical bill once but a couple of months later I received another bill for the same amount.

Should I have requested that they re-submitted to the insurance company?
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Old 11-01-2014, 12:57 PM   #106
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............
Publishing a price for services doesn't reduce costs for everyone, which is what we were talking about.
Publishing a price for services most certainly does reduce prices for everyone, that is the basis of a free market. I'm still waiting for you to back up your assertions that publishing prices would be "effectively turning healthcare workers into slaves, effectively nationalizing healthcare providers, effectively banning profit-making healthcare industries"

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Please try to reply to comments with replies relevant to what the person you are replying to was talking about.
To be honest, I'm not sure what you are talking about and that is why I asked for clarification.
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Old 11-01-2014, 01:17 PM   #107
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Going back to the subject of mid-year drop off of ACA enrollment it is possible that some of that is the result of the insured finding a job with employer sponsored health insurance. As unemployment drops that may be an even bigger factor.
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Old 11-01-2014, 01:21 PM   #108
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I wonder what would happen to one's credit rating if there were some late / unpaid medical bills. My car insurance uses my credit rating among other things to determine my rate.

Recently I was considering simply not paying for a $75 medical bill I received. Fortunately, when I called the provider, they said it was their mistake, and to not pay it.

But it seems the ""take to it collections, I don't ever need credit again anyways" tactic may be what many of us will be forced to use against the "gotchas" that are so prevalent in healthcare billing.
Interesting thought. I just saw an article on that exact topic:

"Fair Isaac Corp. (FICO) – the country’s most widely used credit score – announced plans to reduce the impact of medical debt on its credit-scoring model. This is great news for consumers. The changes to FICO scoring will help millions, raising scores an average of 25 points for people who have medical debt but otherwise good history of paying bills. "

Medical Debts Will Soon Weigh Less On Your Credit Score, But They're Still A Problem - Forbes
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Old 11-01-2014, 01:26 PM   #109
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While I am not currently on an ACA plan, I am very happy that they exist because it means that I can continue planning to start my own business and leave my job without losing health coverage. That is absolutely priceless.


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Not sure it has yet...
Old 11-01-2014, 01:35 PM   #110
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Not sure it has yet...

I early retired in 2012 (age 56) and had Cobra coverage that lasted until 12/30/2013, so I was hopeful that the ACA would assist in finding reasonable priced coverage starting in Jan 2014, but the most reasonable coverage I could find on Healthcare website (when it finally worked) was about 35% more than my Cobra for equivalent (High Deductible HSA type)coverage (for just me). Fortunately I also remarried in 2013 and was able to switch to my wife's coverage for both of us in 2014 which is what we did. When my wife finally also retires in a year or two, I will need to re-evaluate it at that time, and hopefully it will be affordable at that time.
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Old 11-01-2014, 01:35 PM   #111
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This isn't a negotiation.
You just don't pay the first bill you get. You wait and then in a few weeks/months, you get another bill with the second insurance adjustment.

Generally, you don't pay the final bill until maybe 2-3 months later after all the submissions, re-submissions, coding corrections, re-coding corrections are done with.

They'll gladly take your money earlier because it is less work for the doctor's office, but if you wait, you end up paying 10 cents on the dollar.

If the doctor's office is a good one, they'll say something like: "oh, don't pay it now...let us go round and round with insurance first"
Do you have a source for your ten cents on the dollar? Is that a research or survey based figure or just your personal experience?

This is what I have been reading:

"The number one cause of personal bankruptcy has less to do with spendthrift habits and a great deal more to do with bad luck when it comes to your health: medical bills are the leading reason that Americans file for bankruptcy.
When patients can’t pay their bills, their credit scores suffer. This affects their ability to get credit in other parts of their lives.

Over 64 million consumers have a medical collection on their credit report, according to the credit bureau Experian."

Source:
Medical Debts Will Soon Weigh Less On Your Credit Score, But They're Still A Problem - Forbes

I don't think your personal experiences are indicative of what happens in the population as a whole. Are you saying the 64 million people with medical collections on their reports have those because they have poor negotiation skills? And not because of all the reasons listed in the widely praised article from Time magazine, called Bitter Pill, about our flawed system, greed and arbitrary pricing:

Bitter Pill: Why Medical Bills Are Killing Us
http://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDemandAndGreed.pdf

Note that in this article the professional medical billing advocate charges $97 an hour to get maybe 30% to 50% discounts, and sometimes no adjustments at all (ambulance companies.).
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Old 11-01-2014, 05:32 PM   #112
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One idea I heard is to regulate HC as a utility. Similar to regulating a large electric company. An independent commission sets rates after considering costs and allowing for reasonable profit margin.
Undercutting the value of many of the existing for-profit healthcare enterprises. I suspect that there would be a significant number of Americans who would threaten to take up arms against the government if that suggestion was operationalized.

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Publishing a price for services most certainly does reduce prices for everyone
Publishing a price for services doesn't reduce costs for everyone. Money doesn't simply come into existence. If there are going to be winners, there are going to be losers. Address yourself to the losers your ideas would create.
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Old 11-01-2014, 05:42 PM   #113
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.............
Publishing a price for services doesn't reduce costs for everyone. Money doesn't simply come into existence. If there are going to be winners, there are going to be losers. Address yourself to the losers your ideas would create.
Sure there would be losers. Hospital CEOs might not be able to pay themselves multimillion dollar salaries. Assistant surgeons might not be able to charge 10x the cost of the primary surgeon because they are "out of network" and "deserve" that level of compensation. Drug companies / hospitals might not be able to charge $100 for a Tylenol tablet.

On the whole, I think that the country would be the winner and the opportunist bandits would be the losers if medical service prices were transparent.
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Old 11-01-2014, 05:43 PM   #114
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So don't ignore the fact that what you're aiming for isn't practicable given the political realities.
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Old 11-01-2014, 05:56 PM   #115
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So don't ignore the fact that what you're aiming for isn't practicable given the political realities.
That is not the spirit of what has moved this country forward. What were the "political realities" when the Civil Rights Act was signed? Sometimes enough is enough.
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Old 11-01-2014, 05:57 PM   #116
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A sense of practicality and reasonableness actually was what moved this country forward.
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Old 11-01-2014, 06:41 PM   #117
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Nothing impractical or unreasonable about a $100 fee for a Tylenol tablet? Or not being able to find out what you'll actually pay for a procedure?

Market opacity and complexity are the enemy of market efficiency. They promote rent-seeking and unproductive use of talent/skills.
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Old 11-01-2014, 06:45 PM   #118
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Sure there would be losers. Hospital CEOs might not be able to pay themselves multimillion dollar salaries. Assistant surgeons might not be able to charge 10x the cost of the primary surgeon because they are "out of network" and "deserve" that level of compensation. Drug companies / hospitals might not be able to charge $100 for a Tylenol tablet.

On the whole, I think that the country would be the winner and the opportunist bandits would be the losers if medical service prices were transparent.
I think your ideal is how healthcare actually does work in almost of the developed world. We're the outliers with the highest healthcare costs by far and no universal insurance coverage.
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Old 11-01-2014, 07:32 PM   #119
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...I would agree that the rack rates are ridiculous and should be abolished.....
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And that's the crux of the issue: Practically no one really supports any mechanism for doing what you're implying here. We all support bringing about the impact, but there isn't support for any of the mechanisms that would be necessary to bring that impact about, i.e., effectively turning healthcare workers into slaves, effectively nationalizing healthcare providers, effectively banning profit-making healthcare industries, etc.
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Originally Posted by pb4uski View Post
Thou doth protest too much. IMO rack rates are not really much of an issue since nobody really pays the rack rates. Besides, there are emerging tools where one can compare prices and that functionality will only get better over time.

Banning profit making healthcare? Nationalizing health care providers? Do you drive finish nails with a sledge hammer? I guess it is a good idea if you want to stifle innovation.
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I think that's a ridiculously naive view. Costs won't come down for everyone unless money stops going to someone.

And I agree that some of those things would stifle innovation - that wasn't what we were talking about... we were talking about why the insistence that everyone's costs go down is naive.

Publishing a price for services doesn't reduce costs for everyone, which is what we were talking about. Please try to reply to comments with replies relevant to what the person you are replying to was talking about.
So let's see here.... you suggest that we should nationalize healthcare providers and ban profit-making healthcare providers. I respond that your proposals are extreme and will stifle innovation and you respond that I'm naive. What is naive is to even think that there is a snowball's chance in hell that the US would ever nationalize healthcare providers or ban profit-making healthcare industries. Now that is the ultimate in naivety.
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Old 11-01-2014, 08:42 PM   #120
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Let's all try to stay on topic and avoid the minefields, folks.

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