Questions about Obamacare

[flintlock]

Re: Questions about Obamacare

Nobody else in the world has Obamacare. Obamacare is not nationalized healthcare. It takes the worst of both worlds approach we have now and makes it even worse.


Because our system is one which is partially socialized and heavily regulated but has few of the advantages of full scale socialized medicine or free market healthcare. Also our population is terribly unhealthy. Obesity is out of control, smoking is still a big problem and there's probably several other contributing factors such as the type of food we eat, attitudes towards health, etc.



What does "it" refer to? Obamacare? Nationalized Healthcare? Something else?

+2

[charliebrown]

Re: Questions about Obamacare

Before the breakup of Ma Bell, equipment for it was overpriced as well. The reason, the regulated monopoly was allowed to charge a perctage of fixed capital costs to the customers. Higher capital costs means higher revenue and profits. Same in health care????

My son had a ekg run. Equipment except the multi-lead cable looked just like a p.c. and monitor. The procedure was run by a nurse and took 15 minutes most of which was taping the pickups to him. Cost $600.00

[shiny!]

Re: Questions about Obamacare

Before the breakup of Ma Bell, equipment for it was overpriced as well. The reason, the regulated monopoly was allowed to charge a perctage of fixed capital costs to the customers. Higher capital costs means higher revenue and profits. Same in health care????

My son had a ekg run. Equipment except the multi-lead cable looked just like a p.c. and monitor. The procedure was run by a nurse and took 15 minutes most of which was taping the pickups to him. Cost $600.00

It probably would have cost $25 in Mexico or Thailand. Sheesh.

[jk]

Re: Questions about Obamacare

Before the breakup of Ma Bell, equipment for it was overpriced as well. The reason, the regulated monopoly was allowed to charge a perctage of fixed capital costs to the customers. Higher capital costs means higher revenue and profits. Same in health care????

My son had a ekg run. Equipment except the multi-lead cable looked just like a p.c. and monitor. The procedure was run by a nurse and took 15 minutes most of which was taping the pickups to him. Cost $600.00

real cost or fake cost? what was billed to the insurance company, what was paid by the insurance company, or what you paid? all different numbers. the incentive is to make "posted" costs high, so that it's above the "allowable" which is set by contract with the insurers. otherwise the provider doesn't get the full allowable.

[shiny!]

Re: Questions about Obamacare

real cost or fake cost? what was billed to the insurance company, what was paid by the insurance company, or what you paid? all different numbers. the incentive is to make "posted" costs high, so that it's above the "allowable" which is set by contract with the insurers. otherwise the provider doesn't get the full allowable.

This is frikkin INSANE!

[Ellen Z]

Re: Questions about Obamacare

real cost or fake cost? what was billed to the insurance company, what was paid by the insurance company, or what you paid? all different numbers. the incentive is to make "posted" costs high, so that it's above the "allowable" which is set by contract with the insurers. otherwise the provider doesn't get the full allowable.

People earlier in this thread said they'd prefer a free market in healthcare.

One reason we're so far from that is, there is no "price list" for health care services. I'm looking at a recent bill for a routine visit with my doctor for a minor health problem. The billed amount is $244. However, my insurer has negotiated a contract with this clinic, so the "allowed amount" (the amount they've negotiated) is $111. My insurer paid $96 of that, and I paid a $15 copayment. If someone is paying out of pocket, with their own money, they get charged $244 for the same service....

Another reason it's hard to "shop" in the healthcare market is, they don't know what they'll find before they start an operation. For major procedures, any prices will be at best rough estimates... you find a doctor and hospital you trust, and then you take your chances.

This is from 2005, but it is really good:
___ http://www.chcf.org/publications/200...spital-pricing
It explains more about why it is so hard to find healthcare pricing information.
During the three-month study, the mystery shoppers contacted hospitals both in person and by telephone to obtain answers about the price of one of 25 elective procedures or tests....
The report found that... Obtaining a price depended primarily upon luck and persistence. Experiences varied greatly — even at the same hospital. While 76% of the mystery shoppers' overall price inquiries were ultimately answered with a firm or estimated price, more than a third had to make three or more calls to obtain the answer.
..... When pricing information was provided, there were inconsistencies. For example, prices could be estimates, firm price quotes, or discounts. Some hospitals gave a range of prices because of the complexity of the procedure or the number of variables involved.

On the positive side, there is more "shopping" information available about healthcare nowadays than there was five years ago. Here are two web sites with information about home health services and nursing homes:
___ http://www.medicare.gov/homehealthcompare/
___ http://www.medicare.gov/NursingHomeC...ch.aspx?bhcp=1
Save these web addresses in case you or a family member needs these services ... they are a good place to start.

There is a federal web site with information about hospitals:
___ http://www.medicare.gov/hospitalcompare/

And there are some state web sites with hospital data that look interesting. These web sites say they include data about charges.... I haven’t had a chance to explore them in detail...
___ http://ohiohospitalcompare.ohio.gov/
___ http://www.calhospitalcompare.org/?v=2

How come there is no Trip Advisor for hospitals?

If anyone finds websites with better information about comparative price/quality data for standard hospital procedures, please post those websites.

[Ghent12]

Re: Questions about Obamacare

How come there is no Trip Advisor for hospitals?

If anyone finds websites with better information about comparative price/quality data for standard hospital procedures, please post those websites.

That sounds like a good business idea to me! Lots of people will opt out of coverage or be forced out of insurance coverage due to Obamacare, and they might make use of such a website. Truly an underserved market, that of health market information.

[charliebrown]

Re: Questions about Obamacare

that was the amount billed to insurance. I think insurance paid about 250. However ... in a similar situation where the insurance reneged on coverage, the doc would not back down on the over inflated price.

[LorenS]

Re: Questions about Obamacare

How come there is no Trip Advisor for hospitals?

If anyone finds websites with better information about comparative price/quality data for standard hospital procedures, please post those websites.

Our company gives us access to a website with cost information.

We have a 4k deductible, we now ask a lot more questions and do more up front negotiating. The old co-pay model was an unintended consequence that had it's roots in executive pay freezes from long ago.

When I lived in the dorm we had "free" heat, we left the windows wide open in the middle of winter. The heat really was free - it was waste heat from a power plant.

Price matters.

[charliebrown]

Re: Questions about Obamacare

The whole thing just stinks ...

Call a provider and half the time you will get the run around, and they will say call your insurance company. Call the insurance company and you will get it depends upon what codes the doctor uses, if the doctor is in network etc. etc, and then their is the creepy recorded voice that says "any quotes given are not necessarily binding or proof of insurability ..." or some such gobbley gook. With diagnostic codes I have had misquotes from the provider and I have to eat the mistake.

When my son went to surgery in an outpatient surgical center, the insurance company said "some outpatient clincs the doc's office in is network but it does not necesarily mean the surgical center is in network". Call the center and nobody really knows. So now I am playing lottery with a 10K bill. Will I get in network coverage 20% copay, or out of network coverage 50%.

I think a good gvt healthcare first step would be to set up a bunch of gvt run, low cost clincs. Pricing would be a-la-cart on the web site. You could check availability on-line. They would be staffed with medical people who would be willing to get less pay but not have to deal with all the crap a doctor has too like billing, scheduling, staffing, law suits, long hours etc. They would charge cost + some reasonable margin as to not drive non-gouging private providers out of business. The profit of the center would go into the medicare trust fund.

Now you have a choice, low cost transparent care, or obscure high priced care. Perhaps private care might be better and faster. This might put pressure on providers to provide lower costs and transparency.

[jk]

Re: Questions about Obamacare

it's just as bad from the other side. i got paid for a service that was explicitly approved by the health insurance company, but months later was retro-actively denied [and the money seized from other payments] because someone's employer stopped paying premiums. i.e. the service was explicitly approved and delivered in may, retroactively denied in august and refund seized in september. i was then supposed to bill the patient directly for the service that he, too, thought was covered by his insurance since he was unaware that his employer wasn't paying their bills. by that time the employer had shut its doors and the patient was unemployed.

[charliebrown]

Re: Questions about Obamacare

been there too. My former employer went chapter 7, 6 days after my son was born. I technically had insurance during the process, but the payments were stopped 6 days later. Providers came looking for their cash directly from me. I had to file a bankruptcy claim against my former employer. I did get some money from it. But it took 18 months, meanwhile I was floating 15K in payments and bankruptcy is a very opaque process. In order to view the court proceedings you had to have some crazy membership in a bar association ??? or something like that. Some providers were very nice and reduced their fees to just cover costs. A few stuck it to me for the full retail amount.

[Ellen Z]

Re: Questions about Obamacare

They would be staffed with medical people who would be willing to get less pay but not have to deal with all the crap a doctor has too like billing, scheduling, staffing, law suits, long hours etc.

Kaiser Permanente uses salaried physicians. So does the Mayo Clinic. Physicians are attracted to this model if, as you say, they value fixed hours and don't want to deal with all the hassle of managing a small business, in addition to practicing medicine.

Here's a link to a 2010 post on the Health Affairs blog, looking at a dozen large group practices (including Mayo and Kaiser) and how they determine payments for physicians.
____ http://healthaffairs.org/blog/2010/1...oup-practices/

Lawsuits.... I don't think the model you're picturing could prevent potential lawsuits. That's a whole separate issue.

[charliebrown]

Re: Questions about Obamacare

if said clinic where gvt run, the bar regarding what constitutes negligence/malpractice would be raised. Damages would be limited. That would be agreed upon at the time of service.

[lektrode]

Re: Questions about Obamacare

Kaiser Permanente uses salaried physicians. So does the Mayo Clinic. Physicians are attracted to this model if, as you say, they value fixed hours and don't want to deal with all the hassle of managing a small business, in addition to practicing medicine.

....
Lawsuits.... I don't think the model you're picturing could prevent potential lawsuits. That's a whole separate issue.

a couple of my clients are or were kaiser docs - this is PRECISELY the reason why they went to work for K-P.
the out-of-control liability insurance price is what drove them to it

if said clinic where gvt run, the bar regarding what constitutes negligence/malpractice would be raised. Damages would be limited. That would be agreed upon at the time of service.

again - this is what would allow gov run/staffed clinics to give the private sector quasi-monopoly a real run for its money - remove the threat of unlimited liability for stuff like 'emotional' damages along with pain and 'suffering' - never mind 33% contingency-fee-based settlements - by making the use of said public clinics an 'at your own risk' in exchange for reasonable assurance that one wont end up crippled by simple proceedures - not sure exactly how that would work, but anything is better than the current legal-insurance extortion-racket that most med service providers have to knuckle-under to. (and why, IHMO, obamascare should be scrapped in its entirety, since BAD policy is WORSE THAN NONE AT ALL)

and yeah, ok - there's always going to be the risk that ONE person in 10000 (or whatevah the acutarials are) is going to suffer some sort of mal-practice error or another - but should the other 9999 get stuck paying the price for this?
(and i say this even after considering what happened to my poor mother, RIP, for want of an assist to goto the toilet)

since thats whats happening now, is it not?

i for one, would be willing to take that chance, in exchange for reasonably priced - that is COSTS-BASED-priced med services. (vs insurance company profits-based priced)

it would be kinda like downhill skiing - in CO, for instance - where there is codified assumption of risk by the participant, but this doesnt let the ski area operators off the liability hook completely.