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Started By
Message
How to fix Healthcare, in one regular guy's opinion
Posted on 5/24/17 at 1:00 pm
Posted on 5/24/17 at 1:00 pm
To be fair, I do get a chance to discuss the issue with my brother who is a physical assistant, so he has more direct information in regards to the issues that occur.
My steps would be:
1.) Open up insurance to compete across state lines.
** I work in Virginia, but my company has offices in Mississippi, Virginia, Canada, etc. Turns out the best healthcare for us was BC/BS of Mississippi. Oddly enough, my Virginia doctors still took it - even though in regular circumstances, I could not have purchased it on my own.
2.) Tort reform
** Malpractice insurance is a huge cost. Yes, there should be SOME recompense if a doctor does something terrible to you. You should not get to sue the doctor, however, if you go against his medical opinion or if you're going to die anyway, etc.
CATO Institute Do's and Don'ts of Tort Reform
The Hill - Why we need tort reform in the US
3.) Billing reform
** Example: At Duke University Hospital, they have 900 beds... and 1300 billing clerks. Why? Because the billing system is complex to the point that the IRS looks at it and says, "Daaayyyuuummm."
4.) Drug costs - Bring in negotiating power
** Unlike other industries, where combined bargaining power can help drive down costs, no such capitalist defense mechanism exists for pharmaceuticals. The VA and Medicaid can get drugs much cheaper using this, but insurance companies don't work together to accomplish the same. Individuals without healthcare have no capacity to do so either. I'm against government oversight in a lot of things, but there has to be something (be it from a government or other organization) that gives negotiating power to citizens. Your TV isn't astronomical because of competition...
This thing would cost the equivalent of over $10,000 today. I can get an 85" 4k resolution smart TV today for that.
5.) Get the costs down, and require insurers to pay what is billed
** Insurance companies have their own algorithms for paying your bills. It doesn't matter what the doctor charges - if your insurer thinks that your $15,000 colonoscopy should cost $1500, then that's what gets paid and the hospital/doctor/etc is required to "forgive" the rest. Of course, this means that if you don't have insurance, you'll get a bill for the full $15,000. Here's good article on what you truly run into: LINK
The main reason costs are so high in this country isn't because of the advanced technology (that has actually REDUCED costs as what would have required you to stay in the hospital for DAYS can now be a simple outpatient surgery), but because of bureaucracy, lack of negotiating power, broken legal systems, and a billing system designed to inflate costs because of non-payment from insurance companies that has a devastating impact on non-covered patients.
You should not be required to have health insurance from a legal standpoint. That said, if the government really wants to help those in need of healthcare, it needs to sit all the responsible parties down and get them to work together instead of in opposition to each other.
It's a three-way war between insurance companies, health care organizations, and pharmaceutical companies. Patients are the "acceptable losses" in a war of attrition.
My steps would be:
1.) Open up insurance to compete across state lines.
** I work in Virginia, but my company has offices in Mississippi, Virginia, Canada, etc. Turns out the best healthcare for us was BC/BS of Mississippi. Oddly enough, my Virginia doctors still took it - even though in regular circumstances, I could not have purchased it on my own.
2.) Tort reform
** Malpractice insurance is a huge cost. Yes, there should be SOME recompense if a doctor does something terrible to you. You should not get to sue the doctor, however, if you go against his medical opinion or if you're going to die anyway, etc.
CATO Institute Do's and Don'ts of Tort Reform
The Hill - Why we need tort reform in the US
3.) Billing reform
** Example: At Duke University Hospital, they have 900 beds... and 1300 billing clerks. Why? Because the billing system is complex to the point that the IRS looks at it and says, "Daaayyyuuummm."
4.) Drug costs - Bring in negotiating power
** Unlike other industries, where combined bargaining power can help drive down costs, no such capitalist defense mechanism exists for pharmaceuticals. The VA and Medicaid can get drugs much cheaper using this, but insurance companies don't work together to accomplish the same. Individuals without healthcare have no capacity to do so either. I'm against government oversight in a lot of things, but there has to be something (be it from a government or other organization) that gives negotiating power to citizens. Your TV isn't astronomical because of competition...
This thing would cost the equivalent of over $10,000 today. I can get an 85" 4k resolution smart TV today for that.
5.) Get the costs down, and require insurers to pay what is billed
** Insurance companies have their own algorithms for paying your bills. It doesn't matter what the doctor charges - if your insurer thinks that your $15,000 colonoscopy should cost $1500, then that's what gets paid and the hospital/doctor/etc is required to "forgive" the rest. Of course, this means that if you don't have insurance, you'll get a bill for the full $15,000. Here's good article on what you truly run into: LINK
The main reason costs are so high in this country isn't because of the advanced technology (that has actually REDUCED costs as what would have required you to stay in the hospital for DAYS can now be a simple outpatient surgery), but because of bureaucracy, lack of negotiating power, broken legal systems, and a billing system designed to inflate costs because of non-payment from insurance companies that has a devastating impact on non-covered patients.
You should not be required to have health insurance from a legal standpoint. That said, if the government really wants to help those in need of healthcare, it needs to sit all the responsible parties down and get them to work together instead of in opposition to each other.
It's a three-way war between insurance companies, health care organizations, and pharmaceutical companies. Patients are the "acceptable losses" in a war of attrition.
13
Posted on 5/24/17 at 1:03 pm to skrayper
quote:
Turns out the best healthcare for us was BC/BS of Mississippi. Oddly enough, my Virginia doctors still took it - even though in regular circumstances, I could not have purchased it on my own.
You have an Administrative Services Only (ASO or self-insured) "plan". It's not actually insurance as there is no risk transfer to a carrier. All BCBS is doing is paying claims (with your company's money, mailing cards and plan docs and doing customer service (there are obviously network tasks they do too).
BCBS entities all share their networks nationally so that they can compete with Aetna, Cigna, UHC, etc. That's why you have access to the VA blue network. You actually have access to BCBS docs across the country.
Your comment about not being able to buy a MS BCBS contract in VA is strange. No, you can't buy a MS BCBS fully insured contract in VA because they aren't licensed in VA to sell fully insured contracts. Because you don't have a fully insured policy now VA doesn't need to license BCBS of MS. They may have a TPA license but that's different I hope this helps.
quote:
Insurance companies have their own algorithms for paying your bills. It doesn't matter what the doctor charges - if your insurer thinks that your $15,000 colonoscopy should cost $1500, then that's what gets paid and the hospital/doctor/etc is required to "forgive" the rest.
Well, not exactly. There aren't algorithms that pay your bills there are actually fee schedules usually down to the three digit zip code and sometime drilled down to 5 digit. Those fees are negotiated with providers and hospitals and contracts are signed. Contracted providers cannot charge more than the agreed upon fee schedule. That would be balance billing and it's illegal. Don't get me wrong, providers do it all the time and some people pay those bills when they should not. If they get caught, they just claim administrative error and write off the balance and refund the money with no repercussions.
You touched on some of the smallest pieces of the puzzle and not touched on the biggest piece. That's claims. In order to affect "cost" the most, we have to get healthier as a nation so that claim costs come down. Claims are claims and have to be paid. The goal is to get those claims as low as possible.
Duke: you serious about 1300 admin staff dedicated to billing? I'd be shocked.
quote:
The main reason costs are so high in this country isn't because of the advanced technology (that has actually REDUCED costs as what would have required you to stay in the hospital for DAYS can now be a simple outpatient surgery), but because of bureaucracy, lack of negotiating power, broken legal systems, and a billing system designed to inflate costs because of non-payment from insurance companies that has a devastating impact on non-covered patients.
Well, that's not true. Admin costs are about 15% of the puzzle. That other 85% is your biggest problem.
Drug costs: There are entities that negotiate lower drug prices from the mfgs. They are TPAs known as PBMs. They help insurance companies and government entities negotiate drug prices. So yeah, that's happening.
Open up across state lines:
Insurance companies are free to file for licenses in each state of the union and in fact many do just that.
This post was edited on 5/24/17 at 1:37 pm
Posted on 5/24/17 at 1:08 pm to skrayper
quote:
4.) Drug costs - Bring in negotiating power
How can you negotiate with companies that may have a patent on a certain needed medicine?
What happen when all the companies combine and get gobbled up by the large conglomerates?
Posted on 5/24/17 at 1:14 pm to skrayper
I'll be honest. I opened this thread, saw the chick in the old television advertisement, and decided to go look for NSFW threads on the OT.
There aren't any right now, so I decided to come back and post this.
There aren't any right now, so I decided to come back and post this.
Posted on 5/24/17 at 1:19 pm to skrayper
I agree with everything you said, but here are 2 more provisions I'd add:
1. 11 million people were added to Medicaid (these were people who are above the poverty line, but not more than 138% above the poverty line). Kick them off of Medicaid and make them prioritize their spending in life to afford heath insurance.
2. Give the $ you were giving to those 11 million you'll be kicking off of Medicaid to people with pre-existing conditions in the form of Medicare, however get very limited in what you call pre-existing conditions. Being diagnosed ADHD doesn't deem you worthy of recieving Medicade because you had a "pre-existing condition".
3. Tell ERs that do not have to take people without insurance or a form of payment and if they choose to that they have to eat the cost.
1. 11 million people were added to Medicaid (these were people who are above the poverty line, but not more than 138% above the poverty line). Kick them off of Medicaid and make them prioritize their spending in life to afford heath insurance.
2. Give the $ you were giving to those 11 million you'll be kicking off of Medicaid to people with pre-existing conditions in the form of Medicare, however get very limited in what you call pre-existing conditions. Being diagnosed ADHD doesn't deem you worthy of recieving Medicade because you had a "pre-existing condition".
3. Tell ERs that do not have to take people without insurance or a form of payment and if they choose to that they have to eat the cost.
Posted on 5/24/17 at 1:28 pm to skrayper
I would add a couple of things....
Get rid of mandates. If I don't want pregnancy coverage I can go without.
Allow people to join a group for the sole purpose of buying health insurance.
Encourage health plans that allow for basic coverage ($100 and $50 per family member at a clinic) and then a high deductible plan for major problems.
Get rid of mandates. If I don't want pregnancy coverage I can go without.
Allow people to join a group for the sole purpose of buying health insurance.
Encourage health plans that allow for basic coverage ($100 and $50 per family member at a clinic) and then a high deductible plan for major problems.
Posted on 5/24/17 at 1:32 pm to roux
quote:
Allow people to join a group for the sole purpose of buying health insurance. Encourage health plans that allow for basic coverage ($100 and $50 per family member at a clinic) and then a high deductible plan for major problems.
Joining groups for the sole purpose of buying health insurance can lead to adverse risk selection (see ACA).
Some plans are indeed providing incentives to seek care at the lowest cost facility like Critical Care centers (doc in a box ERs) over actual ERs. Telemedicine is growing for colds, flu and other non-emergent needs. Those things are happening.
Posted on 5/24/17 at 1:32 pm to roux
The solution is to decouple health insurance from employment.
Posted on 5/24/17 at 1:33 pm to tigeralum06
quote:
The solution is to decouple health insurance from employment.
Explain the pitfall of coupling health insurance to your employer and the benefits of decoupling.
ETA: Decoupling does nothing to address claim costs.
This post was edited on 5/24/17 at 1:35 pm
Posted on 5/24/17 at 1:34 pm to skrayper
I would like to restore the right to not have healthcare.
Posted on 5/24/17 at 1:39 pm to roadGator
quote:
roadGator
This guy gets it. Sounds like you've worked in the industry for a while.
Posted on 5/24/17 at 1:40 pm to LSUcjb318
quote:Buy the identical medicine from an overseas distributor at 1/3rd the cost.
How can you negotiate with companies that may have a patent on a certain needed medicine?
Oh wait, BigPharma has lobbied to make that illegal.
Geaux figure.
Posted on 5/24/17 at 1:46 pm to AnonymousTiger
for over 20 years
I've heard all the evil insurance company BS. I see our profit margins and wonder why we do what we do when I know my plumber makes 40% profit and we'd be happy with 5%. Hell, we'd celebrate at 5 points.
I've heard all the evil insurance company BS. I see our profit margins and wonder why we do what we do when I know my plumber makes 40% profit and we'd be happy with 5%. Hell, we'd celebrate at 5 points.
Posted on 5/24/17 at 1:47 pm to tigeralum06
Healthcare should be similar to how social security is structured.
Everyone should have a very basis coverage with emphasis on prevention. Anything beyond the basic coverage should be similar to a 401k where you purchase insurance on the free market.
Anyone over a certain age should not be allowed doctors visits for common illnesses such a cold and so forth. These symptoms should be treated by a PA or NP.
I believe a hybrid health care system that includes a single pay and the availability of private insurance will work.
Everyone should have a very basis coverage with emphasis on prevention. Anything beyond the basic coverage should be similar to a 401k where you purchase insurance on the free market.
Anyone over a certain age should not be allowed doctors visits for common illnesses such a cold and so forth. These symptoms should be treated by a PA or NP.
I believe a hybrid health care system that includes a single pay and the availability of private insurance will work.
Posted on 5/24/17 at 1:47 pm to NC_Tigah
The pathetic thing is if you add up all the costs associated with the ACA and then add in what will be spent to repeal and replace it, it would have been cheaper for the government to just send every American family $1M tax free and told them to buy their own god damned insurance.
Posted on 5/24/17 at 1:50 pm to skrayper
lol, I can go to my Dr. in Idaho,have some blood tests done, be charged $46 for the Dr. visit and tests.
When I get the bill from Medicare it shows that Medicare thinks my Dr. charged too LITTLE and readjusts my bill to $94, pays the Dr. $42 and I get charged $54, which is more than my bill would have been if Medicare would have just stayed the hell out of it in the first place.
When I get the bill from Medicare it shows that Medicare thinks my Dr. charged too LITTLE and readjusts my bill to $94, pays the Dr. $42 and I get charged $54, which is more than my bill would have been if Medicare would have just stayed the hell out of it in the first place.
Posted on 5/24/17 at 1:51 pm to HeyHeyHogsAllTheWay
Just note that most people's ideas about how to fix health care never address the largest piece of the puzzle. The OP did mention pharmacy costs but that's it.
Our health care is expensive because of claims. You can trim admin here and there for insurers and providers but that still doesn't do anything for about 85-90% of the pie.
Our health care is expensive because of claims. You can trim admin here and there for insurers and providers but that still doesn't do anything for about 85-90% of the pie.
Posted on 5/24/17 at 1:56 pm to roadGator
quote:Right.
I've heard all the evil insurance company BS
Compared to the other variables, insurance is way down the list....especially true if interstate competition was allowed.
Posted on 5/24/17 at 1:58 pm to skrayper
1. If you can't pay you don't get healthcare
Posted on 5/24/17 at 1:58 pm to skrayper
As long as the philosophy regarding health care is that everyone has a "right" to the absolute best treatment available the second it's available..........all cost saving measures amount to re-arranging the deck chairs on the titanic.
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