Rant (healthcare costs)

@alnav
My solution, at least partially, .... Then, every employed individual would be on their own to select insurance or pay for the care they consume. It's the only way in my mind to create a true marketplace and competition. I think the only other way to solve it is Single Payer, government-managed cost control (i.e., the Democrat solution).

@FootballFan
What is the solution?

Ask yourselves, where is the true advocate, financially, for the patient? Where in the system that you are paying for, does someone have your financial interests aligned? Anywhere? Is your insurance company containing prices to save you money or are they squeezing the providers so they can simply make more money? Do you think "gov't-managed will be your advocate?

The system is designed to be confusing and burdensome. The most horrible thing about it is, people are usually to stressed dealing with their medical issue to deal with the crap, bills, and paperwork to fight it...

It should be embarrassing to members of Congress that the number one reason people file for bankruptcy in this country is due to healthcare costs....In my opinion it's disgusting and criminal and I hold Congress accountable.

Where are our advocates?

Yes, I've thought about it, and yes I have a solution.....Personally, I think it solves all the issues but might need to be tweaked...

1. Create a non-profit "Co-op" style National Health Care insurer....Non of this state by state BS they hide under....Not Gov't run, but non-profit "co-ops"... The co-op acts as an advocate for their members and negotiates the best prices with providers nationwide.

2. The healthcare professionals can still earn in a capitalists system and compete. They still have the opportunity to be successful, but this over-watch from the "co-ops" will likely require the hospitals to run efficiently or fail and remove some layers of administration.

3. Providers do not send bills to the patient, but to the "co-op" that consolidates and corrects any issues and you pay any co-pays, etc. direct to the "co-op" so you receive one consolidated bill for care instead of 10 for all the diff.BS things they did. (Labs, ER, Doc, Hospital, Scans, etc.)

4. So you don't receive 10 confusing "Statement of Benefits" that don't match up with bills, you simply log into your "co-op" account and check the complete statement and running totals.

5. If you can't pay your co-pays the "co-op" can (doesn't have to) provide financing or you deal with it yourself.

So, insurers of today would become dinosaurs and the "entities" that replace them are more all encompassing advocates that consolidate patient advocacy at the bedside, financially, and management.

Think about it....We pay premiums to companies that don't care at all about us...It is in their best interests to deny medical procedures and contain costs. Not so premiums go down, but so the CEO can claim $.01 EPS and get his/her $5M bonus....

F'em.....

Why is this so hard to figure out? I could fix this in a day....

Go ahead, tear it apart.....
 
@alnav

@FootballFan

Ask yourselves, where is the true advocate, financially, for the patient? Where in the system that you are paying for, does someone have your financial interests aligned? Anywhere? Is your insurance company containing prices to save you money or are they squeezing the providers so they can simply make more money? Do you think "gov't-managed will be your advocate?

The system is designed to be confusing and burdensome. The most horrible thing about it is, people are usually to stressed dealing with their medical issue to deal with the crap, bills, and paperwork to fight it...

It should be embarrassing to members of Congress that the number one reason people file for bankruptcy in this country is due to healthcare costs....In my opinion it's disgusting and criminal and I hold Congress accountable.

Where are our advocates?

Yes, I've thought about it, and yes I have a solution.....Personally, I think it solves all the issues but might need to be tweaked...

1. Create a non-profit "Co-op" style National Health Care insurer....Non of this state by state BS they hide under....Not Gov't run, but non-profit "co-ops"... The co-op acts as an advocate for their members and negotiates the best prices with providers nationwide.

2. The healthcare professionals can still earn in a capitalists system and compete. They still have the opportunity to be successful, but this over-watch from the "co-ops" will likely require the hospitals to run efficiently or fail and remove some layers of administration.

3. Providers do not send bills to the patient, but to the "co-op" that consolidates and corrects any issues and you pay any co-pays, etc. direct to the "co-op" so you receive one consolidated bill for care instead of 10 for all the diff.BS things they did. (Labs, ER, Doc, Hospital, Scans, etc.)

4. So you don't receive 10 confusing "Statement of Benefits" that don't match up with bills, you simply log into your "co-op" account and check the complete statement and running totals.

5. If you can't pay your co-pays the "co-op" can (doesn't have to) provide financing or you deal with it yourself.

So, insurers of today would become dinosaurs and the "entities" that replace them are more all encompassing advocates that consolidate patient advocacy at the bedside, financially, and management.

Think about it....We pay premiums to companies that don't care at all about us...It is in their best interests to deny medical procedures and contain costs. Not so premiums go down, but so the CEO can claim $.01 EPS and get his/her $5M bonus....

F'em.....

Why is this so hard to figure out? I could fix this in a day....

Go ahead, tear it apart.....
The idea of having such an advocate is appealing but I don't see how it would work in the real world based on history. Some of the biggest players in health insurance today are "non-profit" and that doesn't seem to have made much of a difference. The non-profit Blue Cross/Blue Shield companies, I believe, service more than half of the insured population today (106 million). The problem with the non-profits becomes that the leadership convinces itself that they are doing such a great job that they deserve huge salaries. See the story here of the CEO of Michigan Blue Cross being the second-highest paid executive in the state. This behavior tends to permeate the organization, so, even though the entity is not making a profit, it's still incurring huge overhead costs, perhaps higher than a for-profit entity which has an incentive to minimize indirect costs.

Given that the lack of a profit incentive doesn't seem to work in this domain, how would the behaviors we want be made to happen? It seems to me the only way would be extensive regulation, and that means the government is actually running the entities with all that brings.
 
We need to fight for it....

The problem so far, as I have researched a bit, is insurance is State by State... This is a fail, IMO. It needs to be at the federal level to scale.

The co-op model is being tested in some states, and it's been good and bad. Some have gone under and others done well.

But, IMO, you can't use it as ref. because they can't scale well, and they can be attacked by the legacy industry.

It's likely not going to be a cost savings until there is a tipping point and legacy insurers fail. (No love lost)

Trump talked about national health plans...So I think he gets it. When co-ops can scale and have the buying power, that's a game changer.

The co-ops today are nice, but they don't have the power position they need. In fact, some that failed, failed because they were actually using the infrastructure of the legacy insurance companies and not building out their own....How stupid is that? Relying on the industry that wants you to fail...

I know one of the co-ops actually lowered their premiums this year. Did your insurance co. lower their premiums?

Also, I will point out that "co-ops" don't seem to be getting premiums down as much as I would expect. But, in fairness to them, I don't think it's attainable until it reaches the tipping point...

When that happens, I think you could have close to 50% reduction in premiums with better quality of care. When you have a system like that, then you are likely to have the populous want to join in. Imagine that, a system where people want to join and it's not mandated.

I further want to add one caveat. The system has to have co-pays. Perhaps a percentage, perhaps not....My point is, a system where everyone has skin in the game so they are not just simply milking it....
 
The idea of having such an advocate is appealing but I don't see how it would work in the real world based on history. Some of the biggest players in health insurance today are "non-profit" .....

I am deeply involved in the non-profit space....Probably looked over 1000 990's... I understand fully the profitability focus of non-profits...Please don't get me started on my disgust for the "non-profit" industry....I know clear well that it's easy for a company to call themselves non-profit to create the optics that they are charitable and nothing could be further than the truth.

This is not the same as a non-profit "co-op" where the members are the owners. That is the fundamental difference and the key to it all. Interests have to be aligned....The only way.

This is not a BCBS model and while a CEO of a leading co-op might still make a seven figure salary, it will be justified by premium levels, not by EPS.

But I welcome the feedback....Keep shooting it up. It's the only way to work out the kinks.
 
The "non-profit" idea sounds interesting, but they still have to make a profit (they just don't distribute it to shareholders). And non-profits don't necessarily keep a check on executive salaries.

First thing that needs to be done is to actually talk about costs and reduce that which drives up cost. Things like malpractice, administrative costs, regulations, etc. Probably could move more towards a workers compensation type system for medical malpractice claims. Streamline regulations. We need to attack these extraneous costs so more money is put towards care.

Get employers out of the selection of health insurance. Your insurance should't be tied to your job. Allow employers to subsidize employees for premiums tax free like they do now. Just have the employees responsible for their own selection and management of their insurance products. At the same time, move towards more consumer oriented options. This will lead towards healthier lifestyles as people realize the connection.

Simplify plans. Reduce mandates for young, healthy people. Open up competition to drive pricing down.

Shield people from healthcare bankruptcy. Make it easier for providers to provide charitable care.

Etc. etc.
 
Actually, only Medicare Part A is funded by the employee/employer medicare payroll tax. The other parts are funded by our premiums (about 25%) and the remainder by General Revenue just like most other ongoing federal programs. See https://fas.org/sgp/crs/misc/R40082.pdf for a good explanation of how Part B works, including projections of future costs to your point.

Semantics!
Bottom line is that Medicare, no matter how you slice it, ain’t free.
 
Regardless of which side wins out, it helps to remember what Reagan called the nine scariest words in the English language.

"I'm with the government, and I'm here to help".

Amen!
I’ve got no problem with the government providing healthcare for the truly poor and needy. In fact, I think it’s something we should do as a society.
But I wish the government would stay out of the healthcare business for the rest of us.
I’d much rather see private corporations compete in an open marketplace than let career politicians and career bureaucrats (among the lowest life forms in our society), who have proven over and over again how they can screw things up, take it over for the whole country.
 
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At the risk of enduring a lot of screaming and complaining from some of you, the solution has to include consideration for what it costs to become a doctor. My surgical residents are piling on some serious debt over many many years of undergraduate and medical education, followed by many years of internship, residency and fellowship training. These kids are only starting to become productive workers after 16 to 20 years of educating themselves! In many cases 300 to 400 thousand dollars in debt.....WTF? Look, I'm an NOT suggesting reducing the indebtedness of medical students is the answer to our healthcare problems but between that and the expenses to fend off the "sharks" waiting to sue us for every little thing certainly has to be considered if you're gonna have a balanced approach to our healthcare crisis. And absolutely no one on the evening news, idiotic talk shows or those dopey presidential debates ever talks about that aspect of things!

Considering the investment that they make in time, money and the sacrifice of time during the young parts of their lives, Doctors deserve to make money just like everyone else.
 
I just don't see this... I know the cost of education is there but around me friends and neighbors in $1-$3M homes and all have cabins and or vacation homes and they are all in their early 40's..

God Bless them. They deserve it just as much as the Wall Street guys and crooked politicians who line their pockets while flying around the country and sometimes the world do.
 
The "non-profit" idea sounds interesting, but they still have to make a profit (they just don't distribute it to shareholders). And non-profits don't necessarily keep a check on executive salaries.
First thing that needs to be done is to actually talk about costs and reduce that which drives up cost. Things like malpractice, administrative costs, regulations, etc. Probably could move more towards a workers compensation type system for medical malpractice claims. Streamline regulations. We need to attack these extraneous costs so more money is put towards care.

Get employers out of the selection of health insurance. Your insurance should't be tied to your job. Allow employers to subsidize employees for premiums tax free like they do now. Just have the employees responsible for their own selection and management of their insurance products. At the same time, move towards more consumer oriented options. This will lead towards healthier lifestyles as people realize the connection.

Simplify plans. Reduce mandates for young, healthy people. Open up competition to drive pricing down.

Shield people from healthcare bankruptcy. Make it easier for providers to provide charitable care.

Etc. etc.

I’m with you!
My wife (turning 63 this year) has spent her life working for non profits and specializing in the mentally ill.
Great concept in theory but the problem is that other than the executives, it seems that most everyone else gets paid peanuts.
Example: Her present agency, located in an immediate suburb of NYC, a kid coming out of school with a Masters would be lucky to start in the mid 30’s and it doesn’t go up much after that. You can barely live in your parent’s basement around here with that kind of money.
They’d do better driving for Uber.
Real shame too. They ask a lot of those kids.
The big jump is if and when they get up to the department director level. That usually takes many years.
 
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You guys are misdirecting what I've said and putting in your personal biases. I never said setup a non-profit and problem solved. Trust me, I know a great deal about the non-profit space and ED salaries...

Stop wasting your keyboard strokes on it.... Focus on non-profit "co-ops", a much different game. If you want to discuss non-profits/ charities, throw it into another thread, and I'll give you more than you want to know.
 
Let me throw this out there. One major cost factor driving insurance is having babies. That cost is born by all insureds -- even 60 year old men. Is that really "healthcare?" Could/should the government carve that cost out and subsidize it? Instead of medicare, call it "babycare."
 
You guys are misdirecting what I've said and putting in your personal biases. I never said setup a non-profit and problem solved. Trust me, I know a great deal about the non-profit space and ED salaries...

Stop wasting your keyboard strokes on it.... Focus on non-profit "co-ops", a much different game. If you want to discuss non-profits/ charities, throw it into another thread, and I'll give you more than you want to know.
You haven't shown how a "co-op" would be any less corrupt than the government or other organizations. A co-op without competition would just be a quasi governmental agency. The thing that will level the playing field is more and more competition. Right now most states are monopolized by 1 or 2 companies.
 
@Boat Guy - How does this lower the cost of cataract surgery - to just grab one of thousands of examples?

Some cost savings in reimbursement - a few percentage points.

Less hassle for the consumer.

If the standard cost for a single eye cataract surgery with a standard lens is $4,000 - is there a way to reduce the 4K.

How much of those dollars are related costs due to insurance? My uncle when he was still practicing was paying several hundreds of thousands dollars for Malpractice, E&O, etc.

The amount of tests for CYA related activities?

This is where I think the ACA failed. It was focused on reimbursement process and guidelines - not on the underlying costs.
 
United Health Care one of the larges health care insurers just released their 4th quarter profits, 13.1 Billion!! This is why health care costs so much, 13.1 billion in 3 months!!
 
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United Health Care one of the larges health care insurers just released their 4th quarter profits, 13.1 Billion!! This is why health care costs so much, 13.1 billion in 3 months!!

Is that the cost of services provided my medical providers? Or is that cost of Insurance?

We can look at ways to reduce insurance costs - but to me - what can be done about the cost at the physician, clinic level, hospital, etc level?
 
@FootballFan, with all due respect, think it through....

As @atrick states, and I haven't verified, "United Health Care one of the larges health care insurers just released their 4th quarter profits, 13.1 Billion".... That's just one insurer...

You fix the middleman issue of profit and scale, and you can, in turn, fix the cost structure in the industry.

I can't go item by item, but I imagine the cost you see listed isn't the true cost.

I'm not saying there isn't fat from the providers. I'm just saying that's not the best starting point.
 
United healthcare full year 2019 earnings:
Revenue $242 billion
Profit $19 billion
Profit margin. 5.7%
 
United Health Care one of the larges health care insurers just released their 4th quarter profits, 13.1 Billion!! This is why health care costs so much, 13.1 billion in 3 months!!
So got an email today that UHC was going to increase our premiums by 34% this year. I guess 13.1 billion wasn't enough for them? So now they are going with Cigna but haven't heard the rates yet.

As far as Dr's being in debt, I would think if they are the reason for high healthcare costs that they might make more with lower rates. I don't go to the Dr unless I have to because it costs so much. I'd probably see the Dr a few more times a year more than I do now. If even a small % of the population feels the same then I'd guess Dr's might actually make more.
 

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