No health care for you! Come back one year...

[ERD50]

I wouldn't lose any sleep if someone neglected to mention their cancerous growth to get medical coverage. In fact, some doctors have been known to assist their patients in doing so.

I understand. Desperate people will take desperate measures. I think that is why so many of us are in favor of universal coverage. Just gotta find a reasonable way to do it.


-ERD50

 

[Martha]

I dunno, my "moral compass" says that legalities and fraud are not a one-way street. At any rate, the cost of fraud will be passed onto the customer....



Here's an excerpt from the application to get my son some catastrophic coverage ($5K deductible). Have you ever applied for coverage? This looks pretty specific to me. (edit/add) In fact, every single question you listed, without exception, is specifically included (apnea, headache, acne, muscular disorder, chest pain, anxiety)



-ERD50

Note how the specific is followed by the open ended and ambiguous. For example, "any breathing difficulty," "any other digestive disorder or condition," "enlarged lymph nodes," etc.
Obviously ambiguous and could easily include symptoms long forgotten or insignificant. Even the requirement to list any abnormal pap smears is problematic. You could have had one when you were 18 and never again. You might forget when applying for insurance at age 55. Innocent mistakes and immaterial omissions should not be grounds for cancellation of a policy.

In some ways I am glad I am on the risk pool.

 

[Martha]

The numbers in wiki get ref'd back to:

Overview National Health Expenditure Data

I guess I wouldn't be surprised at differences, the methodology might not be the same, and they might not be apples-to-apples at all.

But in a more general sense, whatever number we use, I am having trouble with the "conclusion", which seems to be (paraphrasing) - Canada has lower admin costs, Canada has single payer, so if US had single payer, the US would have lower costs.

I think that the reasons that the US has higher costs are much more complex than that. You know, what we really need is a document like the "energy conservation without the hot air".

David MacKay: Sustainable Energy - without the hot air: Industry leaders

Something that would line up all these costs and show the relative amounts and what can be clipped and what cannot. When we talk about changing one, it might just shift the cost somewhere else. We need the big picture.

-ERD50

Those figures don't jibe with the huge amount of data I have read on admin costs. I think that they are omitting the admin costs of the providers and put each provider in a separate category. It is impossible to trace back their data.

What we do know and is supported by significant research is that the US is very high on admin costs at about 1/3 of the health care dollar, and as compared with single payer systems. Now the question is whether we can reduce those costs without single payer.

 

[samclem]

One issue with the CBO analysis is that it does not take into account any savings from use of best practices as they are too hard to quantify. At least Obama is emphasizing the need to get cost down through better practices.

Martha, do you happen to know if the new CBO analysis mentioned below captures the cost savings you referenced?

Underscoring the challenge, the Congressional Budget Office on Saturday issued a report finding that relatively little savings would be realized by one of the few deals reached between party leaders and moderate Democrats who want to change the health bill: an agreement to create a panel to find cost savings in Medicare. The report said the proposal, which the White House is pushing as a crucial, cost-saving change to the legislation, would save $2 billion over 10 years.

Link (Might require subscription):
Idea to Tax Insurers Gaining Traction(WSJ)

 

[Martha]

Martha, do you happen to know if the new CBO analysis mentioned below captures the cost savings you referenced?


Link (Might require subscription):
Idea to Tax Insurers Gaining Traction(WSJ)

I don't know. I'll see what I can find out. Though it does seem unlikely as they said the savings from best practices are too hard to quantify.

 

[ERD50]

Those figures don't jibe with the huge amount of data I have read on admin costs. ...

What we do know and is supported by significant research is that the US is very high on admin costs at about 1/3 of the health care dollar, and as compared with single payer systems.

I have no idea which, if any, of those numbers are correct.

Now the question is whether we can reduce those costs without single payer.

But as I stated before, whichever numbers we use.... it is also a legitimate question to ask whether the US can reduce those costs with single payer. You seem to keep pushing single payer on what appears to me to be an 'a priori' argument.

Note how the specific is followed by the open ended and ambiguous. ... Innocent mistakes and immaterial omissions should not be grounds for cancellation of a policy.

In some ways I am glad I am on the risk pool.

I agree, it is a minefield. I was very nervous as we filled it out, trying to remember everthing that occured. Since we had ins all the time he was a child, and I could not deduct medical, my records are not that great. To us, if an event was over, it was over.

I did a bit of research and learned that IL has a risk pool somewhat similar to Minn (125-150% of group rates, no cancellation). There are 43 pages of details to slog through, it looks like you need to be covered by some plan for 18 months prior to qualify. I'll review this with my son, there may be a few things he would want to do just to stay eligible, just in case.

-ERD50

 

[Martha]

I have no idea which, if any, of those numbers are correct.




But as I stated before, whichever numbers we use.... it is also a legitimate question to ask whether the US can reduce those costs with single payer. You seem to keep pushing single payer on what appears to me to be an 'a priori' argument.



I agree, it is a minefield. I was very nervous as we filled it out, trying to remember everthing that occured. Since we had ins all the time he was a child, and I could not deduct medical, my records are not that great. To us, if an event was over, it was over.

I did a bit of research and learned that IL has a risk pool somewhat similar to Minn (125-150% of group rates, no cancellation). There are 43 pages of details to slog through, it looks like you need to be covered by some plan for 18 months prior to qualify. I'll review this with my son, there may be a few things he would want to do just to stay eligible, just in case.

-ERD50

Well, you can do your own research but I am comfortable that we know that admin costs of single payer are much less than our admin costs. That is the only thing that I am pushing about single payer. This isn't battles of the researchers. Researchers agree that our admin costs run at over 30%. I guess it is time for me to work on editing the wiki article with the misleading information. But the real question is how can we reduce admin costs without single payer as we are not going to get single payer. That is why I keep pressing the issue. If we can't reduce admin costs we will continue to be in big trouble.

My argument is not a priori, it is based on comparison of other countries with ours and what makes up our higher admin costs. For example, the size of billing departments in Canadian hospitals are a tiny percentage of the size of billing departments in US hospitals. (Sorry, can't remember exact numbers). We know that we spend a lot of money dealing with different payment mechanisms. We would save that money if there was only one payer. That doesn't mean that there wouldn't be other worries from single payer, but admin costs are very likely to be reduced.

Yes, Illinois like Minnesota uses a risk pool if you are HIPAA eligible, that is covered by a group plan on the last day of your current insurance and have 18 months of continuous coverage. My health care FAQ covers HIPAA eligibility requirements.

 

[samclem]

For example, the size of billing departments in Canadian hospitals are a tiny percentage of the size of billing departments in US hospitals. (Sorry, can't remember exact numbers). We know that we spend a lot of money dealing with different payment mechanisms. We would save that money if there was only one payer. That doesn't mean that there wouldn't be other worries from single payer, but admin costs are very likely to be reduced.

Maybe this is another area that is amenable to government standardization with private sector implementation (just as standardization of private insurance policy types could be). If the government established a standardized billing format for use by all insurers and providers, the admin costs would be reduced considerably. Better yet--the govt could threaten such a thing (after what we've seen to date, is there anyone who wouldn't believe this government would do it?) and the private insurers and HC providers could instead for a voluntary industry group to set and enforce the standards.

It seems to me that the high admin costs are likely due to the number of different insurance billing systems, not the existence of private (vs public) insurers.

 

[Martha]

Maybe this is another area that is amenable to government standardization with private sector implementation (just as standardization of private insurance policy types could be). If the government established a standardized billing format for use by all insurers and providers, the admin costs would be reduced considerably. Better yet--the govt could threaten such a thing (after what we've seen to date, is there anyone who wouldn't believe this government would do it?) and the private insurers and HC providers could instead for a voluntary industry group to set and enforce the standards.

It seems to me that the high admin costs are likely due to the number of different insurance billing systems, not the existence of private (vs public) insurers.

I just read that in Seattle there are 755 insurance plans out there insuring Seattle residents. It isn't just a billing system, it is the differences in these policies, such as different coverages, different reimbursement amounts, and different referral networks. It is also the high overhead of insurance companies. To fully resolve you would need each plan to be the same. I hope we can do something to help with this issue.

 

[lets-retire]

Though it does seem unlikely as they said the savings from best practices are too hard to quantify.

Something I'm having difficulty with, is the government is saying they will save hundreds of billions of dollars from implementing best practices. Going from where we are now that would mean they would be able to lower the cost of Medicare/caid so that instead of spending more than they take in, those programs would start throwing money off. Since that hasn't happened in the past I don't see how they are going to do it in the future, without a complete take over of the system. Most of the savings from requiring the implementation of best practices would go to the private insurance industry, since they provide most of the coverage. The government is expecting to cause trillions of dollars in savings throughout the industry?

 

[M Paquette]

Anyway, the application for individual/family coverage with a high deductible and HSA was just one branch in a decision tree. I've got lots of options left.

In this case, DD now has the HSA plan, so her rates drop. DW and I continue on COBRA on into 2011, and can try again for a HSA plan, falling back to 'conversion' to a HIPAA plan with no medical review (a bit more than COBRA, but with DD on the HSA, we are still in budget).

Just a quick followup.

DD is now on the HSA plan, at 1,488/year (including a minimal dental option)

We are moving onto a COBRA extension, where we continue on our group medical coverage, paying the full cost, plus a 10% administrative fee. That costs 8,742/year for DW and I.

We are also paying for another daughter away at college, outside our HMO coverage area, at 1,788/year.

That puts our current annual rate at 11,748/year.

In about a year and a half, we go off COBRA and onto a HIPAA continuation plan that covers pre-existing conditions like being over 55. That one will cost DW and I 21,600/year. (This is essentially an unsubsidized version of the high risk pool, with better lifetime maximums and overall coverage.)

With any luck the college student will graduate and get a job with coverage, so our annual insurance cost will only be 23,088/year.

 

[M Paquette]

I think this is unconstitutional as well as impractical. Is there some reason that this particular industry should not be allowed free speech?

Buckley v. Valeo found that shoveling piles of cash at politicians (purely in support of the election of candidates, of course) was protected free speech.

Sadly, the auctioning of votes to the highest bidder is a privilege reserved to our distinguished politicians.

 

[ziggy29]

Buckley v. Valeo found that shoveling piles of cash at politicians (purely in support of the election of candidates, of course) was protected free speech.

I believe the decision was a correct one. Having said that, I don't know that the framers of the Constitution could foresee just how much "money = speech" would [-]buy[/-] influence elections a couple centuries hence.

I believe campaign finance reform such as McCain-Feingold is unconstitutional for that reason, though I wouldn't mind seeing a Constitutional amendment placing some restrictions on lobbying and "money as free speech" (depending on the details). I don't think elections being bought and paid for by well-heeled special interests is in the best interests of the people. For sure I think the health care debate is one of those where the big-time moneyed interests can thwart the will of the people.

There are plenty of other examples in other issues, too, whether it be trial lawyers, unions, drugmakers, insurance companies, big business or others.

 

[youbet]

I don't think elections being bought and paid for by well-heeled special interests is in the best interests of the people.

How about the reverse? Say a candidate promises a special interest group that controls significant votes that he'll spend lots of public money on their focused situation if they vote for him/her? Perhaps promising a large union that he'll bail out their employer and help them keep high paying jobs if they vote for him and work hard to get him elected? The money flows from the taxpayers to the public domain to the special interest group. Is that direction of money flow OK?

We have a lot of that here in Illinois. But I guess everyone knows that.........

 

[nwsteve]

Just a quick followup.

We are also paying for another daughter away at college, outside our HMO coverage area, at 1,788/year.
quote]
MP
You have probably checked on this but I found I could cover my college kid's health risk by buying the policy issued through the University. It is my understanding that most schools offer their students coverage programs at what are pretty attractive rates. It is several years ago but I think a 12 month policy was around $700 for the year. It did require the full amount to paid up front.
Nwsteve

 

[quietman]

so our annual insurance cost will only be 23,088/year.

So, is the new "Health Plan" going to require people buy private insurance like this? This is insanely expensive, unless you have very expensive chronic health problems. I got some quotes for private insurance a few months ago, and nothing was this expensive.

 

[M Paquette]

Just a quick followup.

We are also paying for another daughter away at college, outside our HMO coverage area, at 1,788/year.
quote]
MP
You have probably checked on this but I found I could cover my college kid's health risk by buying the policy issued through the University. It is my understanding that most schools offer their students coverage programs at what are pretty attractive rates. It is several years ago but I think a 12 month policy was around $700 for the year. It did require the full amount to paid up front.

That's what we are using. There are three tiers to the coverage, with the better (higher priced) tiers offering lower copays and better percentage coverage. For example, the base level in-network benefit covers 50% of hospital costs, and a maximum policy benefit (lifetime) of $2,500.

That's not so good. For a bit more, the lifetime max goes up to $100,000, and for a little bit more the in-network benefit goes up to 90% coverage and a $250,000 lifetime.

The devil is in the details on these things. The base policy would be totally exhausted on one trip to the ER.

 

[M Paquette]

So, is the new "Health Plan" going to require people buy private insurance like this? This is insanely expensive, unless you have very expensive chronic health problems. I got some quotes for private insurance a few months ago, and nothing was this expensive.

Well, there are at least five versions of healthcare bills rolling around now. The more recent ones seem to favor no government insurance competition, and the nearest thing to that would be health care co-ops. The idea that all persons must have health care coverage of some form still seems to be going strong, but they'll likely have to buy coverage from an insurer. This appears to be acceptable to insurers. ("You yielded in the past. You shall do so again.")

That rate is expensive because the HIPAA continuation plan allows pre-existing conditions, and is not subsidized. It's similar to the state-subsidized high risk pools, but with a better lifetime cap and coverage terms. If I had qualified for a high deductible plan with HSA, I would have gone that route, costing me $5340/year.

Entry conditions are pretty strict. I have to have had 18 months of continuous coverage without breaks, last insurance under a group plan, not eligible for another group plan, group coverage not terminated due to non-payment or fraud, not eligible for Medicare/Medicaid, and purchased and exhausted COBRA or similar temporary continuation coverage.

HIPAA does not limit the premiums individual healthcare plans can charge. If qualified, an application won't be rejected, but you will pay. Shopping for different plans with significant rate savings involves investigating different state limits, and being willing to relocate to obtain the desired benefits and rates.

 

[ERD50]

I don't think elections being bought and paid for by well-heeled special interests is in the best interests of the people.

How about the reverse? Say a candidate promises a special interest group that controls significant votes that he'll spend lots of public money on their focused situation if they vote for him/her?

Yep. I hate abuse by lobbyists as much as the next guy, but consider something - If the "rich" represent only a few % of the total population, their vote does not count for much. So how do they get representation? They buy it (lobbyists being one way).

I'm not defending it, just saying that it is a reality.

And when Congress has set it up such that ~ 50% of the wage earners pay no/little Federal Income Tax, we shouldn't be surprised by it.

-ERD50

 

[quietman]

The idea that all persons must have health care coverage of some form still seems to be going strong, but they'll likely have to buy coverage from an insurer. This appears to be acceptable to insurers.

No surprise at that. Once we are REQUIRED to buy it, I can easily imagine that plans will be getting more expensive.

 

[ERD50]

No surprise at that. Once we are REQUIRED to buy it, I can easily imagine that plans will be getting more expensive.

Yes, but in theory at least, we are paying for a lot of this in our taxes and through adjustments in billing (hospitals charge extra to 'make up' for those who do/cannot pay).

And if ins cos are required to take all, they don't need to spend money on screening out your risk. I don't know if that is big bucks in %, but it's something.

My fear is the reality will not be anywhere close to the theory. I don't trust tnat Congreess is cablale of dealing with this. I don't even think Congress is the right place to be dealing with this (at least not at the level of detail that they seem to be trying).

I am not alone. I'm not even in the minority:

Congressional Approval Hits Record-Low 14%

whoops, old data (2008, not 2009), still looking bad though:

http://www.gallup.com/poll/118318/Approval-Congress-Remains-Steady.aspx

edit/add: even if we are required to buy ins, *if* there is competition for our $, that should help control costs.

-ERD50

 

[samclem]

No surprise at that. Once we are REQUIRED to buy it, I can easily imagine that plans will be getting more expensive.

I'm not sure. We're all required to buy food and it is cheap. All drivers are required to buy insurance, and we have a healthy, competitive marketplace. We don't have a healthy, efficient marketplace now for health insurance because the folks using the insurance (the patients) are not the ones buying it (employers). And, even in the individual insurance market, pricing and content information is very hard to get (differs by health status, complexities in coverage, legalese in the contracts, satisfaction of customers with various insurers and policy types, etc). The best use of government power is to institute changes that make this market more efficient, this would drive down costs of both medical care and insurance.