Face Shields..

[Creekwood]

Sorry guys, but there is nothing wrong with profits in healthcare. You want to reduce healthcare profits and costs, then make it uber competitive. The more competition, the lower the pricing. Then take the lawyers out of the malpractice business.

That works where the consumer has access to choose what product they buy and where they buy it. Don't like the pricing of that BMW, you can go buy a Benz. Get three quotes for that new kitchen and decide who to give the work to.

Get cancer and need treatment, where is the consumer choice? Do you look for the cheapest oncology clinic? Get in a car accident and go to emergency for urgent care surgery - how can you comparison shop? Medical care is not a free open market where people have the same choice. Yes you can choose your insurance provider, but they just price in the costs from the for-profit hospitals.

 

[skibum]

That works where the consumer has access to choose what product they buy and where they buy it. Don't like the pricing of that BMW, you can go buy a Benz. Get three quotes for that new kitchen and decide who to give the work to.

Get cancer and need treatment, where is the consumer choice? Do you look for the cheapest oncology clinic? Get in a car accident and go to emergency for urgent care surgery - how can you comparison shop? Medical care is not a free open market where people have the same choice. Yes you can choose your insurance provider, but they just price in the costs from the for-profit hospitals.

Obviously in an emergency, you go to the nearest facility, wherever that is. Once you are stabilized, you can request a transfer to a different facility. Big ticket items like cancer are an obvious go where you gotta go situation. You really can't shop for the whole thing. You could shop for the common things that you have time to decide on, like imaging, lab tests, chemo treatments, or radiation treatments. Ideally, health care providers should price there services like every other retail business. They've done unknown thousands of tonsillectomies. They know what it costs them on average, and can come up with a price that would cover all of the routine ones. You couldn't cost compare complications because like accidents, they aren't something you plan. Hospitals and doctors know exactly what certain procedures cost. I think having them publish their prices so that we could shop for them just like everything else would be wonderful. Competition is the basis of capitalism. The current system puts the insurance company (or government) in between the customer and the provider, and makes it impossible to do so for the reasons I mentioned. Governments and insurance companies only care about how much they have to pay, so they are not always working in your best interest. I want to get people who only care about cost out from in between me and my medical needs. Let me shop for it. I might decide to pay more because of a doctor's or facility's reputation. For mundane procedures, I might be willing to pay less because there is low risk going with a lesser known physician or facility. Putting the prices "on the menu" and letting consumers decide would improve the services and prices.

 

[Blueone]

I shopped hard core for cancer treatment. Went to the guy with the best reputation in the US.... he was in Florida The top two were in Florida. Interviewed them both.... cost obviously wasn’t an issue. Rented a condo for a few weeks.... walking and talking today. You won’t do that in a free health care systems like Canada

 

[alnav]

Obviously in an emergency, you go to the nearest facility, wherever that is. Once you are stabilized, you can request a transfer to a different facility. Big ticket items like cancer are an obvious go where you gotta go situation. You really can't shop for the whole thing. You could shop for the common things that you have time to decide on, like imaging, lab tests, chemo treatments, or radiation treatments. Ideally, health care providers should price there services like every other retail business. They've done unknown thousands of tonsillectomies. They know what it costs them on average, and can come up with a price that would cover all of the routine ones. You couldn't cost compare complications because like accidents, they aren't something you plan. Hospitals and doctors know exactly what certain procedures cost. I think having them publish their prices so that we could shop for them just like everything else would be wonderful. Competition is the basis of capitalism. The current system puts the insurance company (or government) in between the customer and the provider, and makes it impossible to do so for the reasons I mentioned. Governments and insurance companies only care about how much they have to pay, so they are not always working in your best interest. I want to get people who only care about cost out from in between me and my medical needs. Let me shop for it. I might decide to pay more because of a doctor's or facility's reputation. For mundane procedures, I might be willing to pay less because there is low risk going with a lesser known physician or facility. Putting the prices "on the menu" and letting consumers decide would improve the services and prices.

The dream of competition in health care has been around a long time but nobody has proposed a workable or passable means of doing it. The step I think would have to come first is to get employers completely out of the health insurance business. The fact that they provide the money for some or all coverage distorts the system up front before individuals even get involved. Tax and compensation strategy considerations serve to compound the distortion. Why should employers be involved? After all, we don't interfere with house or car insurance and the system would be better off without us. I mostly hire retired military and government people so it's less of a problem for me but still a PITA.

BTW, I'm OK with trying single payer as I see it as the only way to get us out of the current mess. Put it in place gradually with defined exit ramps up front if it doesn't work. I've actually been covered by government health systems literally my entire life and it has worked out fine for me.

As was famously said once: "Nobody knew that health care could be so complicated".

 

[Creekwood]

I shopped hard core for cancer treatment. Went to the guy with the best reputation in the US.... he was in Florida The top two were in Florida. Interviewed them both.... cost obviously wasn’t an issue. Rented a condo for a few weeks.... walking and talking today. You won’t do that in a free health care systems like Canada

Right, but you are a wealthy individual that can afford to do that. That is a major difference. The other 90% of american’s cannot afford to do that. Yes, in Canada we cannot “shop” around, but I can choose where I get my treatment. Thankfully fI have not (yet?) had to deal with cancer. But like all of us, cancer is all around me. My wife picked her thyroid cancer surgeon based on reputation and beautiful technique (literally no scar). I knew about a guru knee replacement surgeon at a hospital in Toronto and told a friend that was due for one. He got his GP to refer him to that Doc and got it done there. Anyone that gets cancer in the Ontario and many from outside of Ontario go to Princess Margaret in Toronto. My BIL has a rare form of leukemia. He did some reasearch and found out where the best Doc was in Canada and has been under his care for years. They can use their local hospital if they want or get referred to whoever they want.

Common denominator - they don’t pay one cent for any of it.

Yes, if you have money or a gold plated HC plan that allows you to shop and buy the best you can buy, then your system allows you that luxury. As the obnoxious will say “If you have the means......”

And actually, we in Canada, “if we have the means”, can go see the same doctor you can and pay the same fee you can. Just with a few more teeny tiny $0.75 Canadian dollars

 

[Blueone]

Common denominator - they don’t pay one cent for any of it.

Creek.... Don’t ever say health care is free in Canada... you pay for it in insane income tax, insane gas tax, insane purchase tax.. insane business tax.
And the killer is it’s government run ... so you know there is a ton of waste .... when has the government ever run something better than a private enterprise ?

 

[El Capitan]

Creek.... Don’t ever say health care is free in Canada... you pay for it in insane income tax, insane gas tax, insane purchase tax.. insane business tax.
And the killer is it’s government run ... so you know there is a ton of waste .... when has the government ever run something better than a private enterprise ?

In the UK, the NHS contracts out 15% of their volume back to the private sector. Why? No capacity, lack of doctors, little resources, so they sub it out.

In Canada, they have what is called a “wait list”. You wait for your appointment. Single payer may be ok for a small country the size of Texas but not for 350M citizens and about 40M illegal aliens.

 

[Golfman25]

My cousin Jackie who is a CPA for a world famous hospital very close to where I live. I asked her how they could sustain the business after dropping the prices so much from the initial price after I had some questions about the bill for my hernia surgery. Maybe I got the details a little wrong, but she assured me that the initial inflated price that I didn't pay was there just for that reason. I put discount in quotes because it is coded as something that indicates it was somehow a loss of revenue. She finished the conversation saying "The whole thing is a sham, and I could tell you about things that would make your head spin.". I asked her how her brother was instead since I hit my out of pocket maximum for the year and the insurance company took care of the rest. Thank God for my HSA that I make regular contributions to.

IDK. I think you probably misunderstood or she explained it weird. There is no question the medical providers have tiered pricing. The ends are the full pay price and the medicare price. Sandwiched between are the contract prices they have with the insurance companies. But at the end of the day, revenue is revenue. Revenue minus expenses is profit. Unless there is a special tax provision that I am unfamiliar with, there is no tax break for "lost revenue" due to the discounts from full pay. Now if the discounts cause them to loose money, then they show a loss and can carry that forward to shelter taxes for years.

 

[Golfman25]

That works where the consumer has access to choose what product they buy and where they buy it. Don't like the pricing of that BMW, you can go buy a Benz. Get three quotes for that new kitchen and decide who to give the work to.

Get cancer and need treatment, where is the consumer choice? Do you look for the cheapest oncology clinic? Get in a car accident and go to emergency for urgent care surgery - how can you comparison shop? Medical care is not a free open market where people have the same choice. Yes you can choose your insurance provider, but they just price in the costs from the for-profit hospitals.

So there are two areas of competition lacking in US healthcare. One is provider transparency of pricing. Like you said, it's hard to shop. However, most healthcare isn't emergency care, so you can shop around. There are several posts above where people did just that -- shopped based on quality as opposed to price, but shopped nonetheless.

The second area, and the area we hear the most complaints, is "insurance company profits." Some want to get rid of insurance companies because their profits are "bad." I say, if you want to reduce insurance company profits open up their markets to competition. Here in IL, one insurance company dominates the market with over 90% of the business. That's basically a monopoly. It's a proven fact -- more competition lowers profits.

 

[Golfman25]

Obviously in an emergency, you go to the nearest facility, wherever that is. Once you are stabilized, you can request a transfer to a different facility. Big ticket items like cancer are an obvious go where you gotta go situation. You really can't shop for the whole thing. You could shop for the common things that you have time to decide on, like imaging, lab tests, chemo treatments, or radiation treatments. Ideally, health care providers should price there services like every other retail business. They've done unknown thousands of tonsillectomies. They know what it costs them on average, and can come up with a price that would cover all of the routine ones. You couldn't cost compare complications because like accidents, they aren't something you plan. Hospitals and doctors know exactly what certain procedures cost. I think having them publish their prices so that we could shop for them just like everything else would be wonderful. Competition is the basis of capitalism. The current system puts the insurance company (or government) in between the customer and the provider, and makes it impossible to do so for the reasons I mentioned. Governments and insurance companies only care about how much they have to pay, so they are not always working in your best interest. I want to get people who only care about cost out from in between me and my medical needs. Let me shop for it. I might decide to pay more because of a doctor's or facility's reputation. For mundane procedures, I might be willing to pay less because there is low risk going with a lesser known physician or facility. Putting the prices "on the menu" and letting consumers decide would improve the services and prices.

So I have an HSA -- which mean a pay a boatload of the up front costs. My insurance company, Aetna, gives me the ability to shop their "preferred providers." So the admiral has to get an annual MRI. Her doc has an MRI, and it costs net about $2500. The preferred provider -- about $500. And the preferred provider is a nicer facility -- like a club atmosphere.

Here's another thing that is happening in my town. My Doc has opened his facility up in the AM for walk in visits. It's for all the coughs, colds and such that people would normally go to urgent care for. He only charges a normal doctors visit as opposed to the higher urgent care fees.

 

[El Capitan]

Agree. I know of two prices for every procedure (CPT Code) based on every diagnosis (ICD 10 codes).

Contracted rate. The agreed upon fee negotiated w the insurance companies and cash pay rate. The latter is much higher.

Here’s the scam. You pay your 20% co insurance based on the higher cash price but your deductible is credited based on the contracted price.

In addition if during a hospital stay a hospital physician attends to you who happens to be “ out of network “ guess who’s responsible for those fees?

Many hospitals also benefit as a non profit. They receive tax benefits, in return they’re supposed to provide free care to indigent populations up to a % of revenue. Why they can’t turn ER visits away.

Very high net worth individuals can act as a self insurer w doctors and hospitals. They negotiate cash rates just like an insurance company does.

State Medicare is subsidized by federal taxpayers. You pay for illegal alien healthcare.

Ever been in an ER during flu season. That’s where illegal aliens go for primary care. Free.

It’s a huge scam engineered by the most powerful lobby. Insurance industry.

 

[MonacoMike]

So there are two areas of competition lacking in US healthcare. One is provider transparency of pricing. Like you said, it's hard to shop. However, most healthcare isn't emergency care, so you can shop around. There are several posts above where people did just that -- shopped based on quality as opposed to price, but shopped nonetheless.

The second area, and the area we hear the most complaints, is "insurance company profits." Some want to get rid of insurance companies because their profits are "bad." I say, if you want to reduce insurance company profits open up their markets to competition. Here in IL, one insurance company dominates the market with over 90% of the business. That's basically a monopoly. It's a proven fact -- more competition lowers profits.

I agree that all that is problematic, but you miss the genesis of the problems. The fact that the vast majority of the people get their healthcare paid for by a third-party is the problem at its root.

Over regulation of the insurance markets stifles competition and creativity. That system in turn gives the consumer no reason to try to even save any money.

Mikes ideas for a better healthcare marketplace.

Eliminate employer provided insurance.

Since the consumer will then have to purchase their health insurance and healthcare with post tax dollars allow medical to be a full tax deduction for the individual.

Restructure all insurance to function similarly to HSA that any money in that converts to retirement money.

Give people financial incentives to save money on their healthcare. Incentives to ask the doctor if this test is necessary. Incentives to look for a better price for the tests.

Break what we referred to as health insurance in two separate policies that may even be from separate companies. One would provide healthcare services and the other would provide catastrophic health care insurance.

I am sure there are other ideas that could be added to these that would make this all very effective and much more market-based.

 

[Golfman25]

Here’s the scam. You pay your 20% co insurance based on the higher cash price but your deductible is credited based on the contracted price.

That is not true. As an insured patient you get the contract rate. And providers are prohibited from balance billing - sending you a bill for the difference.

 

[Golfman25]

I agree that all that is problematic, but you miss the genesis of the problems. The fact that the vast majority of the people get their healthcare paid for by a third-party is the problem at its root.

Over regulation of the insurance markets stifles competition and creativity. That system in turn gives the consumer no reason to try to even save any money.

Mikes ideas for a better healthcare marketplace.

Eliminate employer provided insurance.

Since the consumer will then have to purchase their health insurance and healthcare with post tax dollars allow medical to be a full tax deduction for the individual.

Restructure all insurance to function similarly to HSA that any money in that converts to retirement money.

Give people financial incentives to save money on their healthcare. Incentives to ask the doctor if this test is necessary. Incentives to look for a better price for the tests.

Break what we referred to as health insurance in two separate policies that may even be from separate companies. One would provide healthcare services and the other would provide catastrophic health care insurance.

I am sure there are other ideas that could be added to these that would make this all very effective and much more market-based.

I agree. And as a small employer I would be first in line to get rid of providing insurance. I just don’t think we’ll ever get rid of employer provided insurance due to politics.

My idea is to allow the company to provide an amount to pay for premiums. Then individuals would go to an exchange and pick the policy for them. They can spend more or less than their employer stipend, their choice. Employees can choose from different insurers - one could choose blue cross, one Aetna, etc. The employer would handle payment via payroll deductions, etc.

 

[Carpediem44DB]

Back to the title of the thread..... We now are being hammered by PSA commercials imploring all Californians to do their part by ALL WAYS WEARING A MASK WHENEVER LEAVING YOUR HOUSE!!! For fuck sakes, It makes no sense to subject ourselves to the annoyance of wearing a face covering rebreathing what is supposed to be expelled unless and until one is in close proximity to another to protect each. Obviously the government is trying to enhance compliance by making it habitual, I get that. The morons that make up the masses can't be trusted to think logically and act accordingly. Instead they have to be conditioned like sheep. My ass is really getting worn out by these clowns trying to establish utopia. Life is messy, some get to live long and prosper, others struggle to survive for countless reasons. I really wish some times that CA wasn't such a beautiful place to live (environmentally), it really makes it hard to pull the plug over the taxes and politics. If it were not for my love of the year round boating I'd find my self residing in Montana.
Carpe Diem

 

[alnav]

I agree. And as a small employer I would be first in line to get rid of providing insurance. I just don’t think we’ll ever get rid of employer provided insurance due to politics.

My idea is to allow the company to provide an amount to pay for premiums. Then individuals would go to an exchange and pick the policy for them. They can spend more or less than their employer stipend, their choice. Employees can choose from different insurers - one could choose blue cross, one Aetna, etc. The employer would handle payment via payroll deductions, etc.

You've pretty much described exactly how the Federal Employee Health Benefit Plan works. Depending on the area they are located, Civil Servants can choose from around a dozen different carriers and then differing plans offered by the carriers for around 50 or so different choices of coverage levels and how much they pay. Who says government doesn't ever get anything right?

 

[BEH]

Right, but you are a wealthy individual that can afford to do that. That is a major difference. The other 90% of american’s cannot afford to do that. Yes, in Canada we cannot “shop” around, but I can choose where I get my treatment. Thankfully fI have not (yet?) had to deal with cancer. But like all of us, cancer is all around me. My wife picked her thyroid cancer surgeon based on reputation and beautiful technique (literally no scar). I knew about a guru knee replacement surgeon at a hospital in Toronto and told a friend that was due for one. He got his GP to refer him to that Doc and got it done there. Anyone that gets cancer in the Ontario and many from outside of Ontario go to Princess Margaret in Toronto. My BIL has a rare form of leukemia. He did some reasearch and found out where the best Doc was in Canada and has been under his care for years. They can use their local hospital if they want or get referred to whoever they want.

Common denominator - they don’t pay one cent for any of it.

Yes, if you have money or a gold plated HC plan that allows you to shop and buy the best you can buy, then your system allows you that luxury. As the obnoxious will say “If you have the means......”

And actually, we in Canada, “if we have the means”, can go see the same doctor you can and pay the same fee you can. Just with a few more teeny tiny $0.75 Canadian dollars

This is correct!

 

[Blueone]

Back to the title of the thread..... We now are being hammered by PSA commercials imploring all Californians to do their part by ALL WAYS WEARING A MASK WHENEVER LEAVING YOUR HOUSE!!! For fuck sakes, It makes no sense to subject ourselves to the annoyance of wearing a face covering rebreathing what is supposed to be expelled unless and until one is in close proximity to another to protect each. Obviously the government is trying to enhance compliance by making it habitual, I get that. The morons that make up the masses can't be trusted to think logically and act accordingly. Instead they have to be conditioned like sheep. My ass is really getting worn out by these clowns trying to establish utopia. Life is messy, some get to live long and prosper, others struggle to survive for countless reasons. I really wish some times that CA wasn't such a beautiful place to live (environmentally), it really makes it hard to pull the plug over the taxes and politics. If it were not for my love of the year round boating I'd find my self residing in Montana.
Carpe Diem

Masks apply to you unless you go to Lewis’ funeral

 

[Golfman25]

Since when?... this was a common occurrence a few years ago. I had employees complaining about how crappy our insurance plan was, when it was awesome. I started digging in to their problem and it turns out they were paying the doctors notice of the difference between what they billed and what insurance was paying. HR went back a year and got all their money back

My understanding is it's part of the insurance contract between the provider and insurance company. States have laws as well. Doesn't mean shady providers don't try it.

 

[skibum]

I agree that all that is problematic, but you miss the genesis of the problems. The fact that the vast majority of the people get their healthcare paid for by a third-party is the problem at its root.

Over regulation of the insurance markets stifles competition and creativity. That system in turn gives the consumer no reason to try to even save any money.

I 100% disagree with your 1st statement, but also 100% agree with the second.

My healthcare through my employer is not paid for by a 3rd party. It is a benefit that I choose from a list of options. One of which being, "None.". Our company gives us a certain number of credits based on salary that we can apply to our benefit package. If I choose to opt out of the company provided healthcare, those credits will be paid to me thought the year in my pay checks. I chose a plan, so I pay for it with those credits. Our company uses a total target compensating system so when we offer a position to a person we spell out how much of their compensation is actual salary and the number of credits that they get for other benefits. Some of the alternatives to health care that I could have chosen would be things like long term disability at a higher percentage of my base pay, extra weeks of vacation, etc... I get regular physicals and have no underlying concerns at the moment, so I chose a plan with a $3K out of pocket limit. If I don't get
(unusually) sick, I pretty much end up paying for everything myself (actually an 80/20 split oftheir negotiated rates). I'm single, so the company puts $1500 in my HSA every year. I contribute another $50 to it every month because my ex wife had some major surgeries before we divorced and the balance was low. My surgery last October was slightly over $11k after the plan negotiated discounts. My portion was $3k. All of that came out of my HSA, so the impact to my regular cash flow was zero. The company is really not paying for it, I am. I get the benefit of being in the risk pool that the company belongs to, which lowers my rate. There were other plans that pay out a lot more, but I would have had to contribute some money every paycheck to buy them. This arrangement in no way impedes anyone else's ability to get Health Care at a reasonable cost and is not part of the problem. Although I do disagree with the concept of needing to be part of a specific group in order to qualify for a risk pool. I think that is a little shady.

They really need to allow insurance companies to offer their services across state lines, so that no areas end up with only one choice as described above. Eliminating the monopolies is the way to drive the prices down.

Back on track for this thread. Governor Hogan has implemented a mask mandate for everywhere indoors or out where "social distancing is not possible". I needed to get out last night so I took a little ride around town and noticed that a lot of places had people drinking and dining outside. I noticed that the employees were wearing masks, but not most of the patrons even though most of them were less than 6 feet apart. It appears that folks are interpreting the order literally and saying "I don't have to wear a mask here, because social distancing is possible.". They are just not doing it. Unreal.