Which providers?

The problem isn't the providers, it's systemic.

10/14/2013 11:43:56 PM

The prices charged by the providers. Although the insurance companies don't negotiate on those prices so they are complicit. Probably because the higher prices are, the greater profit they make on the same percent margin they charge for the services they sell. So yes, it's systemic. But if providers were more honest in what they charged the patient, things would be a lot better.

10/14/2013 11:51:24 PM

It seems the unpredictable prices are due to gaps in coverage. People who don't have any coverage will still get cared for by our society, so the providers charge who they can what they can to make up for this.

An individual mandate helps solve this problem, as well as gov. Stipends to providers for the outliers who don't choose coverage.

10/14/2013 11:59:43 PM

all of them. and yes. the problem is a systemic one within every healthcare provider from small docs on up to the largest hospital systems. it ranges from racketeering on stuff like imaging to waste on unnecessary procedures to lack of controls leading to mistakes in care.

anyone who blames insurance is basically an idiot who has no idea how healthcare in the us works. The problem is 90% providers 10% insurance and like 9% of the insurance problems would go away with better insurance reforms (national regulation instead of state, national exchanges, standard billing codes, etc...)

anyone who brings up concerns about fixing care for outliers is also an idiot. Proper controls on the most common procedures will bring down costs and improve care more than anything else. Its about saving $10 on a procedure done a million times a week instead of saving $100000 on one done a dozen times a year. You start with the biggest savings that improve care the most and then you move on from there.

Saying "oh, heres a blank check to do whatever, have fun doc!" doesn't help anyone

10/15/2013 12:03:26 AM

You're talking about micromanaging legislatively the day-day work days of doctors it seems, which I don't think is the right thing to do, for various reasons.

I'd think that the threat of lawsuits is the best force to keep those factors in check. Let doctors do their jobs, but if they happen to mess up, punish them.

ACA already sets payouts for some procedures which acts as a price control. If this is really a problem (I don't know, have never looked into it), they might could expand that.

10/15/2013 9:44:04 AM

threat of law suit is half the reason healthcare costs balloon to what they are currently. Don't be obtuse.

The new american dream of getting rich through law suit causes so many unnecessary
bullshit tests to be run daily it's mindboggling.


hell I do EKG's on 18 year olds with known history of asthma because "shortness of breath" can be an indicator of cardiac issues, and we have to rule out the 1 in 5 million chance someone has Brugada's syndrome, or WPW.


threat of law suit is helping nothing. the problem is nothing in our healthcare system is run with any common sense

10/15/2013 8:29:11 PM

Quote :

"The prices charged by the providers. Although the insurance companies don't negotiate on those prices so they are complicit. Probably because the higher prices are, the greater profit they make on the same percent margin they charge for the services they sell. So yes, it's systemic. But if providers were more honest in what they charged the patient, things would be a lot better."

Are you smoking something? What the hell do you mean insurance companies "don't negotiate on the prices". Such a statement shows a fundamental lack of understanding about what health insurers are doing! Providers CAN'T be honest with the patient about what they want to be paid, because the insurers will fuck them hard for it! Insurers pay a set pct of your "reasonable & customary". Provider's can't charge cash patients differently because that changes their "reasonable & customary", or the insurers will fucking SUE the providers for lying. Because cash payers can't (or won't) afford the higher charges, the end result is that everyone who is "paying" is likely using insurance, and is essentially getting the "discount" off of a price which has been inflated to take into account the "discount." Put simply, if you give everyone a 50% discount, then you will eventually have to almost double your prices in order to stay in business. Oh, and did I mention that there's a ton of extra expenses involved in processing that "discount"?

Quote :

"I wouldn't be surprised in 2 years time to see headlines of record profits for insurance companies and massive bonus payouts. "

Then you surely don't understand how bad this is going to fuck the industry. This law essentially says insurance companies can no longer use actuarial tables when calculating someone premiums, nor can they deny coverage to someone based on something the person is going to immediately file extensive claims on. That's madness. It's like requiring that homeowner's insurance companies have to accept all applications, even when the person's house is on fire.

Quote :

"Setting minimums standards for coverage and predictable payouts to health providers"

Setting minimum standards for coverage is effectively equivalent to setting price floors. Economics basically tells you how that will work out.

Quote :

"focusing on payment is retarded when the problem is the providers."

Forest ------------> trees.

^^^ Shaggy, the problems you are citing in your 12am post are correct, but you aren't seeing the reason for those things happening. All of them stem from a system where the consumer of the service is heavily insulated from the actual price of the service he is consuming, with added pressure from other areas on providers to oversupply some services.

Quote :

"anyone who blames insurance is basically an idiot who has no idea how healthcare in the us works."

The irony here is that the truth is exactly the opposite. If you don't look at how insurance operates, how it has been completely changed into something else via gov't regulations, and how it insulates consumers from too much of medical expenses, you'll never see how to fix the system, and you won't understand what is wrong. You can't dismiss a major part of the payment system of a service completely when you are trying to understand why that service has high costs.

10/15/2013 9:03:46 PM

Quote :

"The new american dream of getting rich through law suit causes so many unnecessary bullshit tests to be run daily it's mindboggling."

This is a myth. There's no evidence for this. Companies have been successfully pushing for laws to limit their liabilities because it makes business easier. Just look at BP and deep water. Their cap on what they could be sued for was like $300k. The insurance companies and doctors want the same thing in their industry. Doing tests to cover your ass isn't a bad thing.

Quote :

"Then you surely don't understand how bad this is going to fuck the industry. This law essentially says insurance companies can no longer use actuarial tables when calculating someone premiums, nor can they deny coverage to someone based on something the person is going to immediately file extensive claims on. That's madness. It's like requiring that homeowner's insurance companies have to accept all applications, even when the person's house is on fire."

Lol you have just described it ducking insurance companies, not "the industry". It's going to be painful for some insurance companies that are for profit and that don't adapt. This is part of the goal. Private health companies shouldn't be making profit for shareholders by denying paying for care. But you have to remember, ACA was a conservative idea, heavily influenced by insurance company lobbyists. It's dumping a massive amount of money into the insurance company system, this money is either going to go to hospitals or it's going to insurance companies. Someone is getting really rich from this.

[Edited on October 16, 2013 at 9:30 AM. Reason : ]

10/16/2013 9:25:27 AM

I'd like to see a graph of insurance costs and healthcare costs over time. Then I'd like to figure out when health insurance went from something relatively cheap that covered you for major disasters (car wreck, cancer, etc) rather than paying out for every single sick visit for you and your entire family. I'd like to see if those two things overlap.

I think when insurance became a safety net for all medical procedures, from the mundane to the spectacular, that is when costs started skyrocketing. I mean, why is it so much to ask for someone to pay a doctor's visit in full when they go, but still walk around with the piece of mind that if in that dr's visit, they find malignant tumors, you won't go bankrupt? If we could get back to such a system (and I know we can't at this point) I think costs would come back down. Also, try to suppress the whole "test your ass till the cows come home" mentality. Testing to prevent litigation is a problem. I had a gastrointestinal problem, and after a colonoscopy, and endoscopy, and blood tests, they found nothing wrong. Anybody wanna guess what all those tests cost? That is an expensive piece of mind - for me and my doctor.

10/16/2013 12:32:14 PM

Quote :

"I had a gastrointestinal problem, and after a colonoscopy, and endoscopy, and blood tests, they found nothing wrong. Anybody wanna guess what all those tests cost? That is an expensive piece of mind - for me and my doctor."

If they didn't do those tests and something WAS wrong, you'd be pissed. I'm not sure why you're complaining. If you don't want tests done to you, don't go to the doctor.

That seems like a good reason for you to have the option for litigation.

10/16/2013 2:03:42 PM

Quote :

"Setting minimum standards for coverage is effectively equivalent to setting price floors. Economics basically tells you how that will work out."

I must say, aaronburro is posting better than usual today. I only quote this sentence because it's the most contentious point I see quickly.

Usually, I consider the arguments that health care is "different" to be a good amount of BS. But I'm conflicted, myself, when it comes to our price "floor" here. AFAIK, such "floors" are a major part of Obamacare, although they haven't staked out a solid place in the talking points. I mean, it's more often in the talking points against Obamacare.

But what about the Hippocratic oath? It would be inconsistent to not set price floors for health insurance, while still maintaining legislation that obligates hospitals to treat people. At least a minimum coverage standard would guarantee some degree of partial payment in these cases. As long as we ascribe to the Hippocratic oath, it should also follow that we can obligate hospitals to treat people for things that fall under their insurance coverage. If people are going to buy 10% cost coverage, then that's not going to cut it.

10/16/2013 2:24:40 PM

Minimum standards are very different that price floors.

Just read "The Jungle" if you want to know what setting minimum standards can do.

10/16/2013 2:35:23 PM

I feel like the food industry was more of an issue of asymmetric information than standards. Sure, we solved the problem with standards, but it doesn't necessarily follow from that that the consumer wanted standards over information.

Legally, you don't really have a right to produce a book like "The Jungle". As journalism, it enjoys some protections in publication, but the act of taking the footage to begin with can be legally prohibited by the producer, even from their own customers. If you want something to attack the philosophical libertarian ground with, that's a pretty good shot. We can engage in voluntary transactions, but what if someone won't voluntarily tell me what the transaction they're selling you is?

I do have some sense that the ACA will simplify the product in a way that buyers actually have a chance to understand. This point was made well here:



Sorry if I already posted that video. But it's quite convincing. The way insurers set up the system before the ACA made it nigh impossible to honestly buy health insurance. The product was just so intractably complicated...

10/16/2013 3:19:25 PM

[Edited on October 16, 2013 at 3:21 PM. Reason : .]

10/16/2013 3:20:52 PM

^^ amusing and interesting.

10/16/2013 4:06:49 PM

I just got a bill in the mail for $206 for a visit I made to urgent care back in May when I paid $123 up front. I had separated my shoulder and got an x-ray, a very brief doctor's exam, and a sling. How am I getting charged twice as much now as I was informed it would cost at the time I was there? How is this even a fucking thing?

Fuck current healthcare, that shit is broken as shit. Obamacare cannot possibly get here soon enough.

10/16/2013 10:36:48 PM

ACA in tact
boehner loses
T party dead?

10/16/2013 11:04:59 PM

R Party dead

10/17/2013 12:03:50 AM

Quote :

"boehner loses T party dead?"

You know, this should affect our predictions. I wouldn't be surprised to see some legislative tweaks to the ACA law, but they're quickly losing momentum to have deleterious changes. I wonder if we'll change to "single payer" eventually. The current ACA isn't the ideal for either party. A change in the political balance should push it in one direction or the other.

10/17/2013 9:51:08 AM

Quote :

" How am I getting charged twice as much now as I was informed it would cost at the time I was there? How is this even a fucking thing?"

You just got the bill from the radiologist

10/17/2013 10:14:57 AM

[Edited on October 17, 2013 at 10:18 AM. Reason : .]

10/17/2013 10:16:32 AM

^^ yeah your initial charge was just for the doctor visit. Your new bill should specify exactly what the charges are for, and likely they're from the radiologist. That's how I was billed when I had x-rays done during a visit, two separate bills. Took them forever to send the bill for the x-ray.

10/17/2013 10:22:57 AM

Ya that's not changing.

10/17/2013 11:01:18 AM

Quote :

"This is a myth. There's no evidence for this. Companies have been successfully pushing for laws to limit their liabilities because it makes business easier. Just look at BP and deep water. Their cap on what they could be sued for was like $300k. The insurance companies and doctors want the same thing in their industry. Doing tests to cover your ass isn't a bad thing."

I agree, in general, that the concern over lawsuits is overblown, and I certainly am not one normally to favour limited liability for a fuckup, but defensive medicine absolutely has a role in explaining skyrocketing healthcare costs and consumption. Doing a bunch if expensive tests to cover your ass from a lawsuit is not a symptom of a good system, especially when there are better explanations for what the patient is exhibiting. it'd be akin to me running seismic studies on a building to diagnose energy losses from inefficient windows on the off chance that maybe an earthquake opened a few cracks that led to drafts. Yes, it is a bad thing, especially if it's not adding any value while driving up costs at the same time.

Quote :

"Lol you have just described it ducking insurance companies, not "the industry". It's going to be painful for some insurance companies that are for profit and that don't adapt. This is part of the goal. Private health companies shouldn't be making profit for shareholders by denying paying for care. But you have to remember, ACA was a conservative idea, heavily influenced by insurance company lobbyists. It's dumping a massive amount of money into the insurance company system, this money is either going to go to hospitals or it's going to insurance companies. Someone is getting really rich from this. "

What I've described is that health insurance companies effectively can no longer operate the way every other sector in the insurance operates: they can't price based on risk! How does an insurance company "adapt" to that? The fact is they can't! I completely agree that companies shouldn't be denying payment when someone legitimately gets sick, but increased insurance coverage mandates make it easier for companies to hide such denials. They can hide behind inflated numbers of approved claims whenever someone complains, and it looks legit. "Hey, we approve 99.9% of our claims, this guy's complaint is just sour grapes!" is a lot easier to say when you've got a huge mass of menial approved claims for things that could have been easily paid out of pocket. I think the insurance companies are initially going to make some money, but when people figure out how to game the preexisting conditions clauses, you're going to see it become almost impossible to run an insurance program without pricing by risk.

Quote :

"But what about the Hippocratic oath? It would be inconsistent to not set price floors for health insurance, while still maintaining legislation that obligates hospitals to treat people. At least a minimum coverage standard would guarantee some degree of partial payment in these cases."

This is an argument against requiring hospitals to treat every single person who comes in the door, not in favour of minimum standards. The problem comes when a hospital has to devote time and resources to every single person who comes through the door, despite knowing that the person probably isn't sick enough to warrant a hospital visit and, even worse, won't pay anyway. It's a perverse system; hospitals have to waste time on people who don't need it! I think if you took away the triage requirement, you'd see hospitals denying services for those who aren't really sick and instead referring them to a local doctor while still treating those who actually need it, and they will do this precisely because of their oaths. You get someone who comes in twice a week looking for pills, and you have to triage them. That's a waste of the hospital's time, yet they have to do it. The price floors just make things worse. In this case, you're trying to address the fallout from one bad law by introducing more laws instead of removing the law that caused the problem in the first place and replacing it with something that actually works and makes sense.

Quote :

"Minimum standards are very different that price floors. Just read "The Jungle" if you want to know what setting minimum standards can do."

I beg to disagree. It might be more accurate to describe minimum coverage standards as "cost floors," because that's what they do. Every procedure covered by insurance is going to add an expense to the plan. Insurance companies are damned good at estimating the expected expense, and they aren't stupid; they're going to include that expense in calculating how much they need to charge for the plan. The more covered procedures, the more expenses for which they must account, and the more the plan must charge in premiums in order to cover those expenses. This effectively sets a price floor (or cost floor, which must be covered by the premium). You can't get around this. Sure, you can try to remove inefficiencies in networks or payment systems, but if you are increasing the average amount that plans must pay out, then you are going to increase the premiums which must be paid to support these plans.

10/17/2013 9:33:47 PM

it's amazing how badly the 'pubs fucked themselves on the ACA showdown/gov't shutdown. Now the dems are wanting to do exactly what the 'pubs shut the gov't down over: delay the individual mandate. Only, the 'pubs didn't get any other concessions for it, AND they made the entire country fucking hate them at the same time. That's an impressive level of political incompetence

10/27/2013 12:06:44 AM

It's interesting how many people who have enrolled in medicaid vs. a private health plan under ACA.

http://www.cbsnews.com/8301-505267_162-57609254/medicaid-enrollment-spike-a-threat-to-obamacare-structure/

10/27/2013 5:32:08 PM

Sounds like insurance companies don't want to lower their prices.

10/27/2013 6:27:43 PM

Why would they?

10/27/2013 6:48:12 PM

Sounds like insurance companies don't want to lower their prices go bankrupt.

10/27/2013 9:20:03 PM

Businesses will be businesses; much to the lefts supreme shock.

Oh hey, IMStoned420, try not to blow a gasket this time you crazy bastard.

10/27/2013 11:32:23 PM

Well, let's see. A basic review of supply and demand determines that if they want to increase demand, they should lower their prices. A competitor has come along and undercut those artificially inflated prices. They're fucking themselves in the ass by not lowering them. It's almost as if everything with the ACA is going to plan except for the insurance companies reacting to the new market.

Something is extremely wrong with our capitalistic system when even supply and demand is broken.

10/28/2013 4:35:50 AM

Quote :

"Something is extremely wrong with our capitalistic system when even supply and demand is broken."

How so? Thanks to the combination of the myriad of previous regulations, plus the new regulations imposed by the ACA, the suppliers of health insurance are extremely constrained, both from the ability to enter the market in the first place, and then based on what they're allowed to sell. That means supply is unlikely to increase. Additionally, the ACA now mandates that the entire nation must now under penalty of law purchase insurance from one of these suppliers, without regard to cost. Even better, the costs for those that would otherwise have decided the insurance is too expensive with now subsidized which means between employee sponsored care and the ACA, a large segment (I would argue the vast majority) of the health insurance consumers are disconnected from the actual costs of that health insurance, reducing their price sensitivity. Combine all of these factors and you have a scenario in which at best, the insurance prices remain the same, and at worst they increase at a rate faster than they previously were. In fact if you go dig up the old giant health care thread when this was all still being proposed, I'm sure you'll find quite a few people predicting this.

Edit:

And just for gits and shiggles, none of this does anything to actually address the real problem which is the cost of health care (not insurance), which itself is badly distorted thanks to the way modern health insurance works, and will likely only get worse now that there are theoretically no cash customers.

[Edited on October 28, 2013 at 8:08 AM. Reason : Sdft]

10/28/2013 8:05:19 AM

They capped profits, and have forced them to accept people how are going to be massive expenses that they wouldn't have previously had to take. Cost doesn't automatically decrease because of volume, there are other factors.

10/28/2013 3:08:34 PM

Economists have always known that supply and demand has been broken, except in a tiny set of circumstances.

It's like when you learn about Newton's laws of motion, but they don't tell you about all the exceptions to when it doesn't REALLY work.

10/28/2013 3:10:49 PM

http://money.cnn.com/2013/10/29/technology/obamacare-security/index.html?iid=Lead

Glad I haven't had to use this site and never got to successfully create an account.

10/29/2013 4:42:48 PM

There's no way it's actually running on 1 server blade...

edit: appears that part of the "article" is false.

[Edited on October 29, 2013 at 5:15 PM. Reason : ]

10/29/2013 5:12:40 PM

Quote :

"A competitor has come along and undercut those artificially inflated prices."

the competitor's prices are artificially low. they're subsidized by the taxpayer.

no matter how hard politicians try, it is still impossible to pay peter without robbing paul.

[Edited on October 29, 2013 at 7:16 PM. Reason : zd]

[Edited on October 29, 2013 at 7:17 PM. Reason : they're pissing down your back and telling you it's raining]

10/29/2013 7:16:12 PM

I predict the next administration lie about Obamacare to fall will be the "it will reduce the deficit" whopper

10/29/2013 8:07:59 PM

"If you like your current plan, you can keep your current plan"

Lol.

No way Bush would've been able to get away with that. But hey, even NBC is starting to smell a rat. They published a pretty scathing article earlier, at least in NBC terms, of how so many people are losing the plan they like b/c the plan doesn't fit new regulations.

The White House knew this was going to happen, and kept saying time and time again that people would be able to keep the plan they have if they want to. Of the 19 million people who were already in the individual insurance market (non-employer sponsored insurance), up to 80% may lose their current plan. But

"If you like your current plan, you can keep your current plan"

Go ahead and repeat the current administrations spin...that they're "transitions not cancellations." If people are getting transitioned, they are getting sticker shock with the new plan they are "transitioned" to.

[Edited on October 29, 2013 at 9:11 PM. Reason : asdf]

10/29/2013 8:59:03 PM

Maybe if Republicans hadn't cried wolf so many damn times before now there would be some legitimate concern about this. But at this point lots of people who would otherwise care about this issue are dismissing it out of spite for Republicans.

10/29/2013 9:33:25 PM

Quote :

"No way Bush would've been able to get away with that"

He got away with worse, see: lies about Iraq's WMDs and the relationship between Saddam Hussein and Al-Qaida.
Dubya wasn't called out on it by the mainstream media for years after the plan to invade Iraq, supported by layers of lies, went into motion; in the end, despite having committed numerous impeachable offenses, he was let off with a slap on the wrist, even after the Democrats took over both houses of Congress.

so yeah, not only would he have gotten away with a lie on that scale, he did get away with greater lies

10/30/2013 7:08:56 AM

I'm really glad to hear that all of the higher premiums that Americans are being forced to pay are helping an outstanding segment of our society:

http://money.cnn.com/2013/11/01/smallbusiness/sex-workers-obamacare/index.html?source=cnn_bin

11/1/2013 9:58:04 AM

Actually I am glad to hear it. The safer we can make the sex industry the better.

11/1/2013 10:06:14 AM

Yes, at the great expense of thousands who don't make a living in breaking the law. To be fair, the article also cites erotic dancers and erotic massage therapists, and in two states prostitution isn't breaking the law, but still.

Its ok for Joe Middle Class's insurance to go from 400/month for his family to 1500, just to cover these folks? And I guarandamntee you that Joe Middle Class won't qualify for a subsidy, while Ms. Rottencrotch will probably be able to get subsidies.

11/1/2013 10:13:06 AM

Yes, it's OK for society to pay for the well-being of others. We can argue about what level of payment is reasonable but investments which improve society and reduce my (or someone I care about) chance of being mugged or getting an STD are investments worth making.

11/1/2013 10:37:49 AM

rjrmfuel is getting tripped up by lazy reporting

replace "sex worker" with any other low income person if you are having trouble with the story. who cares if some people are celebrating something, it's insignificant.

11/1/2013 10:40:24 AM

Not all low-income employees make a living by breaking their state's laws.

11/1/2013 10:49:17 AM

The law regarding sex work is unjust. I'm not compelled by this line of argument in the least. Prostitution should be legal in all states and regulated. If Obamacare makes it slightly more regulated then awesome.

11/1/2013 10:53:06 AM

i don't know how to better describe why that is just an inconsequential article and that the topic involved is unrelated in any way to ACA

11/1/2013 11:02:04 AM

The argument here isn't about the justification of the law. Its a law, some body, at some point deemed it illegal to sell your body for sex. Like weed, many people feel it shouldn't be a law, but it is, was, and people had to abide by it.

But I'm not sure what concerns me more...the fact that families are expected to come up with 1100 more out of pocket per month out of their budget to pay for someone else's potentially poor decisions, or the fact that people think thats 100% ok.

1100...for many people that is an extra mortgage payment. BAM! Just all of a sudden coming out of the budget. How many people do you know have 1100 dollars worth of disposable income they can just throw away.

11/1/2013 11:10:26 AM