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Old 05-06-2010, 03:05 PM   #41
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"Fast" or "Not so fast." are our only choices for the future.
I've always said I have two speeds

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Old 05-06-2010, 03:10 PM   #42
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When cost-cutting backfires | Harvard Gazette Online
Though the copayment increases were counterproductive for elderly patients with a chronic disease like diabetes or hypertension, the study showed that copayments worked as desired for those not chronically ill. Those patients reduced office visits and prescription drug utilization with no negative effects on their health.

Thanks for the link... what I did not see is what the copays were before and after... where is the 'sweet spot'?

I can say that if copays were raised to say $75, I would not have gone to the doctor any more or any less.. nor my family...

But I can see where this would change the behavior of many... so, this does seem like a cost cutting way to go... with an exception for 'cronic illnesses' where you might have to pay one copay a month or whatever...
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Old 05-06-2010, 03:16 PM   #43
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BTW. I might as well respond to the OP...

I think that there are going to be a number of companies dropping their health care insurance...


And another comment... and someone from the UK now might be able to shed some light on what has happened since I was there....

Private insurance provided by companies were the big thing that was happening in the UK in 2000... yes, PRIVATE INSURANCE... it was becoming a perk to not have to deal with the national health system...

When I was there... I had seasonal allergies... and was trying to get to a doctor to get a prescription... I found out that I could have a doctor come to my house and check me out... for a fee... I decided not to... then to my surprise... I went to the drug store and found all the drugs I needed without prescriptions!!! What a concept... sell drugs that are not that dangerous to people without them having to go to the doc just to get the script... saved me a lot of money...
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Old 05-06-2010, 03:24 PM   #44
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Also to the point of the original post:
Small companies have been doing this for years.
As for the rest of the thread, kudos for people offering suggestions on improvements instead of just throwing stones.
I concur with many of you when it is said that cost controls is one of the most important things in any cost care bill. It will help with stop (or at least slow down) both the large and small companies from dropping health care.
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Old 05-06-2010, 03:32 PM   #45
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I agree that copays are an absolute requirement. Research I've seen in other areas show less overall usage and higher levels of satisfaction when people pay something rather than nothing per activity.
I think if deductibles are copays are high enough, health care consumers can demand transparency in cost structures. One hospital in the area charges $2500, while a new MRI clinic in town boats $699 MRI's. Hard to justify why one is almost 4 times the other..........
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Old 05-06-2010, 03:52 PM   #46
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I concur with many of you when it is said that cost controls is one of the most important things in any cost care bill..
How do you control the costs?
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Old 05-06-2010, 04:32 PM   #47
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Also to the point of the original post:
Small companies have been doing this for years.
As for the rest of the thread, kudos for people offering suggestions on improvements instead of just throwing stones.
I concur with many of you when it is said that cost controls is one of the most important things in any cost care bill. It will help with stop (or at least slow down) both the large and small companies from dropping health care.
I was in a debate on another board a while back and was waiting for others to hijack this one before I started my rant opinions facts.


There are 3 main problems with health care

1) costs spiraling out of control
2) availability to everyone (almost everyone?)
3) everyone wants health care and no one wants to pay for all of it, most of it, any of it.

I have yet to see a compelling case made for if it is available to everyone, then the other 2 dominos fall easier or are improved.

The reverse thesis might have some free market principles applied- if you force people to pay for what they receive, its possible free market prices insurance to where people can pay for it. There would be some suffering by people which need it and could not pay (is this bad?).

The other reverse thesis also has merit- control costs and its possible people can afford it.

But I still don't think giving everyone insurance fixes anything, and I believe it will make problems worse.

a) companies will stop offering insurance (because it saves them money)
b) doctors will have less time with patients (because more patients can now afford healthcare they were not getting before)
**this may lead to lots of other problems (waiting lists, lower quality of care) IMO**
c) creates more levels of insurance than we already have
**IMO the insurance industry is causing more problems than solutions in today's current system**


So you want a solution?

Try this...
A level playing field with a patients bill of rights. This is all patient centric. Add rights as I leave them off...

1) you cannot be denied treatment or coverage with a pre-existing condition
2) any health care provider must be 100% up front with fees (either on web site, in office or something similar)
3) all people using the same healthcare provider pay the same price regardless of insurance or not, and regardless of which insurance carrier they have

2) and 3) are my big ones, and I think these both fix lots of things. First, my employer paid for coverage now costs my employer less, because medicare and medicaid are required to pay equal amounts as my insurance carrier for the same procedure.

Second, If this bankrupts medicaid, then fix that program and that funding. The average family of 4 spends $2500 in premiums and co-pays each year to cover the medicare and medicaid lack of pay to health care providers. I can link to study, but need to go to another site to find it.

Third, level playing field means price competition, and that should drive prices down (eventually).

Fourth- overhead for any health insurance company goes down and any doctor's office goes down- there is less negotiation for the cost of coverage after the treatment is given, so the people which do this for a living need to find new jobs and the companies they work for have now spent less money.
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Old 05-06-2010, 04:38 PM   #48
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I think if deductibles are copays are high enough, health care consumers can demand transparency in cost structures. One hospital in the area charges $2500, while a new MRI clinic in town boats $699 MRI's. Hard to justify why one is almost 4 times the other..........
Agree
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Old 05-06-2010, 04:42 PM   #49
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I think if deductibles are copays are high enough, health care consumers can demand transparency in cost structures. One hospital in the area charges $2500, while a new MRI clinic in town boats $699 MRI's. Hard to justify why one is almost 4 times the other..........
Historically "insurance paid it" so we didn't care about the price. With the combination of higher deductibles and transparency in pricing, that would help the cost control issue.
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Old 05-06-2010, 04:47 PM   #50
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Try this...
A level playing field with a patients bill of rights. This is all patient centric. Add rights as I leave them off...

1) you cannot be denied treatment or coverage with a pre-existing condition
2) any health care provider must be 100% up front with fees (either on web site, in office or something similar)
3) all people using the same healthcare provider pay the same price regardless of insurance or not, and regardless of which insurance carrier they have

2) and 3) are my big ones, and I think these both fix lots of things. First, my employer paid for coverage now costs my employer less, because medicare and medicaid are required to pay equal amounts as my insurance carrier for the same procedure.

Second, If this bankrupts medicaid, then fix that program and that funding. The average family of 4 spends $2500 in premiums and co-pays each year to cover the medicare and medicaid lack of pay to health care providers. I can link to study, but need to go to another site to find it.

Third, level playing field means price competition, and that should drive prices down (eventually).

Fourth- overhead for any health insurance company goes down and any doctor's office goes down- there is less negotiation for the cost of coverage after the treatment is given, so the people which do this for a living need to find new jobs and the companies they work for have now spent less money.
These are all reasonable.

Quote:
I have yet to see a compelling case made for if it is available to everyone, then the other 2 dominos fall easier or are improved.
If everyone is not insured the other problems cannot be fixed. So much cost shifting is going on due to mandatory treatment regardless of payment capability that it becomes impossible to identify and deal with abusive pricing and exploitation. Guaranteeing payment doesn’t fix the problems but it enables other measures.

Quote:
Historically "insurance paid it" so we didn't care about the price. With the combination of higher deductibles and transparency in pricing, that would help the cost control issue.
It would probably help deal with "use control", an important component of cost control.
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Old 05-06-2010, 04:53 PM   #51
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Jimoh...

Some good ideas in your post... and I will give examples..

Go to any doctor or even their front desk people and ASK... how much does this cost I have not had a single person be albe to tell me...

(as an aside, I can ask this in my dentist's office and they will tell me what any and everything costs... they also will say 'this is not covered by your insurance, do you want to pay for it yourself... it is $25)...


One of the other problems is the cost of some of the medicine that is out there... why can we not have some negotiation with the companies... why does it cost us 25X here and only X in Canada or England....

My mother is trying to get approved for some bone medication... the one recommended by the doc cost over $10K per year for two years... she was denied by her insurance company... no reason given...
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Old 05-06-2010, 04:55 PM   #52
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It would probably help deal with "use control", an important component of cost control.
It's both. In FD's example, I don't care whether the full price of an MRI is $2500 or $699 if I pay a $50 co-pay either way. If the $2500 place has more impressive facilities, a more convenient location or appointment times, has prettier nurses or whatever else, I may choose it since I'm only out $50 either way.

But subject this to coinsurance and deductibles, and suddenly I pay a LOT more for it at the $2500 place, and I go elsewhere. I pay less, insurance pays less and (in theory) premium increases are held down.

And in some cases ("use control" as you say), I might not go in at all for elective visits or really minor stuff if I had to pay more than a $20 co-pay office visit for it.

Health care isn't an area where "free market economics" are a cure-all (pun intended), but I do believe that they should be used where they make sense -- and IMO, here they do. But again, this requires both transparency in fee structure AND a switch from low fixed co-pays to deductibles and co-insurance.
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Old 05-06-2010, 05:03 PM   #53
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It's both. In FD's example, I don't care whether the full price of an MRI is $2500 or $699 if I pay a $50 co-pay either way. If the $2500 place has more impressive facilities, a more convenient location or appointment times, has prettier nurses or whatever else, I may choose it since I'm only out $50 either way.

But subject this to coinsurance and deductibles, and suddenly I pay a LOT more for it at the $2500 place, and I go elsewhere. I pay less, insurance pays less and (in theory) premium increases are held down.

And in some cases ("use control" as you say), I might not go in at all for elective visits or really minor stuff if I had to pay more than a $20 co-pay office visit for it.

Health care isn't an area where "free market economics" are a cure-all (pun intended), but I do believe that they should be used where they make sense -- and IMO, here they do. But again, this requires both transparency in fee structure AND a switch from low fixed co-pays to deductibles and co-insurance.
Allow me to add that To make an informed decision, you also need information about the quality of care, and the medical profession has made this impossible to get.
Also, if you are a patient in the hospital, you don't have any choice of MRI providers.
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Old 05-06-2010, 05:07 PM   #54
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Allow me to add that To make an informed decision, you also need information about the quality of care, and the medical profession has made this impossible to get.
Agreed, but that's an issue regardless of whether you keep the "low co-pay" status quo or move to deductibles and co-insurance. Still it is an important part of becoming an informed consumer of health services.
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Old 05-06-2010, 05:10 PM   #55
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Agreed, but that's an issue regardless of whether you keep the "low co-pay" status quo or move to deductibles and co-insurance.
True
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Old 05-09-2010, 09:04 PM   #56
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Allow me to add that To make an informed decision, you also need information about the quality of care, and the medical profession has made this impossible to get.
Also, if you are a patient in the hospital, you don't have any choice of MRI providers.
Yes. I'm in favor of jIMOh's suggestions - medical providers should provide price lists, and they shouldn't give discounts to anyone (including Medicare).

Those are helpful steps, but they don't deal with people who can't afford care or insurance. And, they aren't enough to give us an efficient market. One of the requirements of an efficient market is that buyers are the sole judges of the value of what they are buying. In health care, most of us don't know what medication or procedure we need, and we can't judge the relative quality of various providers.

I don't know if I really need an MRI or if an ordinary X-ray is nearly as good. And if Dr. A charges 50% more than Dr. B for reading either, should I go with the cheaper Dr. B, or is this a case where the higher price signals better quality?
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Old 05-10-2010, 08:46 AM   #57
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Also, if you are a patient in the hospital, you don't have any choice of MRI providers.
True, but most MRIs done are outpatient in nature, or at least that's what my neighbor whose an MRI tech tells me............
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Old 05-10-2010, 08:50 AM   #58
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relative quality of various providers.

I don't know if I really need an MRI or if an ordinary X-ray is nearly as good. And if Dr. A charges 50% more than Dr. B for reading either, should I go with the cheaper Dr. B, or is this a case where the higher price signals better quality?
I heard this one somewhere.......... Guy goes to a doctor and says he's not feeling well. Doc does a bunch of tests and says he's fine, just some indigestion. Guy gets a bill and freaks. The tests were only $300 but the doctor charged $2500. Guy asks the doctor why the high fee. The doctor says: Anybody can give you a test, I'm the one who tells you WHAT THEY MEAN!!
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Old 05-10-2010, 02:42 PM   #59
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No first-dollar coverage except for preventive care (and perhaps those below the poverty level).

Stronger penalties for being uninsured so there can be no financial advantage for not buying at least the cheapest available (highest deductible) coverage.

Breaking the link between employment and health insurance so people can buy the coverage most suited for them. (If anything I think Obamacare *strengthens* the link by writing employer responsibilities/penalties into law.)
I agree with all of this stuff.

But none of this takes a radically different approach from the law that was recently passed. You'd think with all of the hollering, including from members on this board, about how truly awful this legislation was that someone would have a pretty significantly different idea about how to do this. But instead, everyone now apparently agrees that a very significant government takeover involvement is needed (in the way of mandating individual coverage, mandating minimum benefits, mandating that insurers provide coverage, regulating prices, etc.).

So if everyone mostly agrees, why do I keep seeing threads about how awful the legislation is? And if everyone doesn't agree, why can't anyone explain to me how chronically sick people get health care under an alternative system?
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Old 05-10-2010, 02:45 PM   #60
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Four simple rules to fix the healthcare system.
1. Prohibit exclusions for preexisting conditions.
2. Mandate universal minimum coverage (with subsidies for the truly poor).
3. Insurers may offer any policy features they wish above a required minimum set, and may set any price they wish for this optional coverage, but the prices charged must be the same for everybody.
4. Policies may be canceled only for non-payment or other breach of contract, not because the client was seriously injured or contracted an expensive disease.
In what way is this different from the law that was passed?
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