Congress price fixing our "free market" healthcare

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steross

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#1
Congress is working on a bill to require doctors to accept in-network insurance rates so that patients avoid surprise bills. Think about it, as a doctor, you are forced to accept the price that a third party decides to pay you even if you have never contracted with that party. With all the cries of "socialism" about universal health care, this is real socialism. Not government run, but even worse government controlling price and picking the winning industry in a private negotiation. And, of course, is the the dems doing this government overreach, right? Nah, dems and republicans both with their principles up for sale to the highest bidder.


Want to solve surprise medical bills? Listen to patients

Americans are fed up. Health insurance is increasingly costing more but covering less. According to a new Morning Consult poll, 59 percent of Americans say they wish their insurance company provided plans with lower deductibles so they could better afford the health care they need. Over the last 12 years deductibles in job-based health plans have nearly quadrupled. Such higher deductible plans can lead to surprise medical bills, leaving patients who suffer an emergency on the hook to pay for care out of their own pocket that they thought their insurance covered.

An overwhelming 81 percent of Americans believe the majority of costs associated with surprise medical bills are the responsibility of insurance companies. Unfortunately, the cost of care is increasingly being pushed back on patients

Among the solutions to surprise medical bills Congress has been considering are capping rates for out-of-network providers or staying out of price-setting by providing an independent dispute resolution (IDR) process to serve as a backstop when insurers and providers are unable to resolve disagreements on payment. On the Senate side, Sen. Lamar Alexander (R-Tenn.) and the Health, Education, Labor & Pensions (HELP) Committee want to cap physician reimbursement. If enacted, the “Lower Health Care Costs Act” would allow insurers to undercompensate for services provided to patients both in- and out-of-network, straining physician and hospital resources and limiting the ability to improve clinical quality, attract top physicians and keep hospitals open.

If the government steps in to set payment rates, it could significantly reduce the ability of local health professionals to provide timely and quality care, especially in rural communities. In fact, 63 percent of Americans are worried about the impact rate setting could have on small communities, and even more (67 percent) believe it is Congress’s responsibility to protect access to health care for the millions of Americans living in rural communities.

Instead of such an untested approach that strongly favors insurers, Congress should look to what has already been proven to protect patients without raising costs. Recently, Reps. Raul Ruiz (D-Calif.) and Phil Roe (R-Tenn.) introduced the “Protecting People From Surprise Medical Bills Act,” which goes further than any other surprise billing legislative proposals to encourage transparency from insurance providers and make sure that patients understand the limitations of their insurance.

This legislation uses an independent resolution process to take patients out of the middle of disputes between insurers and medical providers. This efficient, market-based process has worked in a number of states, without added bureaucracy or cost. In New York, independent dispute resolution (IDR) has almost eliminated surprise bills, yet rarely even needs to be invoked, instead providing a strong incentive for both insurers and providers to set fair payments and prices from the start. As a result, insurance premiums and health care costs in the state have grown more slowly than the rest of the nation. Because it does not disrupt broader market dynamics, IDR also takes into account the increased costs associated with rural health care and ensures rural Americans’ access to health services continue to be protected.

Health care providers and patients agree IDR is to best way to take patients out of the middle and establish a fair process to resolve differences between insurers and providers. In fact, 69 percent of Americans prefer a third-party resolution process over allowing the government to set doctors’ rates.

For years, insurers have been manipulating the health care system to reap excess profits. And now they are using those profits to lobby Congress to interfere with the free market and increase insurers’ advantage over physicians without concern about what that could mean for patients. As Congress works to protect patients from surprise bills, it should listen to the American people and not swing the scales further in favor of the insurance industry.

Vidor Friedman, MD, FACEP, is president of American College of Emergency Physicians.
https://thehill.com/blogs/congress-...lve-surprise-medical-bills-listen-to-patients
 

CaliforniaCowboy

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#3
maybe the damned doctors should stop referring us to specialists that are not "in network"

and...

either bill at "in network rates" for emergencies, or require hospitals to keep a doctor on duty for every "network" in that geographic area. (concept similar to reciprocity)

The doctors and health providers must play a role in this mess and must come up with solutions or "solutions" will be dictated by government.
 

steross

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#4
maybe the damned doctors should stop referring us to specialists that are not "in network"

and...

either bill at "in network rates" for emergencies, or require hospitals to keep a doctor on duty for every "network" in that geographic area. (concept similar to reciprocity)

The doctors and health providers must play a role in this mess and must come up with solutions or "solutions" will be dictated by government.
If you want to avoid looking damn clueless, probably better to read the article in the post you are responding to when it addresses your only suggestion that isn't pure nonsense. Hey, hospital struggling to get one radiologist to cover weekends, now you need to have 10 because there are 10 insurance networks in the area.:derp:
 

steross

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Your "whole point" is something you didn't even say. Right.

Read the article is your first option then you would not look quite as much like an idiot.

But, since you don't seem to have that ability. I'll see if I can simplify it enough for you to understand. Although I admit it is unlikely that I am that damn good at simplifying:
1. Doctor or hospital bills what they bill.
2. The insurance company pays what they pay.
3. If those two entities are not in agreement, goes to baseball-style arbitration through IDR.
Solved. Patient isn't even involved.
 

CaliforniaCowboy

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#6
Your "whole point" is something you didn't even say. Right.

Read the article is your first option then you would not look quite as much like an idiot.

But, since you don't seem to have that ability. I'll see if I can simplify it enough for you to understand. Although I admit it is unlikely that I am that damn good at simplifying:
1. Doctor or hospital bills what they bill.
2. The insurance company pays what they pay.
3. If those two entities are not in agreement, goes to baseball-style arbitration through IDR.
Solved. Patient isn't even involved.

Dude, it's an advertisement from a freaking Doctor pleading with the public to choose his (your) side and get the government involved, but only if it help the Dr's.

Quote: As Congress works to protect patients from surprise bills, it should listen to the American people and not swing the scales further in favor of the insurance industry.

How about the Dr's. bill what it costs, not what "they will", and the insurance companies pay what it's "worth", then those 2 entities are in agreement and the Patient is not involved either.

procedures not covered by insurance have dropped dramatically when left to free-market conditions, and the same would happen with ALL medical procedures. Lasik is very affordable even without insurance (it wasn't originally), most plastic surgery is affordable even without insurance (it wasn't originally), etc.

There is only one problem and that is Dr's are gouging the population simply because they can.

face the facts Dr Jekyll
 

CaliforniaCowboy

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#8
This is a brilliant plan! Government price fixing has always worked to bring down costs. [/sarcasm]
exactly... this crap can't cost that much or companies like Kaiser would not be able to offer complete services for practically nothing.

I'm all for capitalism and Dr's making as much as they can in the free market... IMHO, the real problems lie with the Hospital systems, who's rates are set and established based on government intervention (Medicare, and illegals).

It's the same effect as government interference in education. The professors are paid too much, but they can demand what they want because most of the money comes from the government.

If the goverment would get completely out of education and medicine, then we might be able to create a true system that is affordable.
 

steross

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#9
Dude, it's an advertisement from a freaking Doctor pleading with the public to choose his (your) side and get the government involved, but only if it help the Dr's.

Quote: As Congress works to protect patients from surprise bills, it should listen to the American people and not swing the scales further in favor of the insurance industry.

How about the Dr's. bill what it costs, not what "they will", and the insurance companies pay what it's "worth", then those 2 entities are in agreement and the Patient is not involved either.

procedures not covered by insurance have dropped dramatically when left to free-market conditions, and the same would happen with ALL medical procedures. Lasik is very affordable even without insurance (it wasn't originally), most plastic surgery is affordable even without insurance (it wasn't originally), etc.

There is only one problem and that is Dr's are gouging the population simply because they can.

face the facts Dr Jekyll
So you said doctors should be forced by the government to accept a rate from an insurance company that they have no contract with but arbitration would be involving the government too much. That it too stupid for words.

Can you give me an industry that bills “ what it costs” Do you even read the nonsense you write?

“The doctors should be forced to pay the insurance network rates”
“Procedures not covered by insurance drop dramatically”
You are like a multiple personality patient arguing with yourself.

Sure, as long as all people need is vision correction or bigger boobs we should be just fine.
 

Donnyboy

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So you said doctors should be forced by the government to accept a rate from an insurance company that they have no contract with but arbitration would be involving the government too much. That it too stupid for words.

Can you give me an industry that bills “ what it costs” Do you even read the nonsense you write?

“The doctors should be forced to pay the insurance network rates”
“Procedures not covered by insurance drop dramatically”
You are like a multiple personality patient arguing with yourself.

Sure, as long as all people need is vision correction or bigger boobs we should be just fine.
I like to see big boobs clearly.
 

CaliforniaCowboy

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#11
So you said doctors should be forced by the government to accept a rate from an insurance company that they have no contract with but arbitration would be involving the government too much. That it too stupid for words.

Can you give me an industry that bills “ what it costs” Do you even read the nonsense you write?

“The doctors should be forced to pay the insurance network rates”
“Procedures not covered by insurance drop dramatically”
You are like a multiple personality patient arguing with yourself.

Sure, as long as all people need is vision correction or bigger boobs we should be just fine.
that's right dodge the subject with stupid semantics... your posting and ridicule of others is simply pathetic.

"what is costs", would include making a profit, dipshit. I'm a capitalist. I'm pretty sure I said without "gouging".

the only thing nonsensical that I have done is try to converse with you.

we could have a good discussion on the subject if you weren't constantly being a jerk.

good luck to you
 

Donnyboy

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that's right dodge the subject with stupid semantics... your posting and ridicule of others is simply pathetic.

"what is costs", would include making a profit, dipshit. I'm a capitalist. I'm pretty sure I said without "gouging".

the only thing nonsensical that I have done is try to converse with you.

we could have a good discussion on the subject if you weren't constantly being a jerk.

good luck to you
So who sets the margin? What two entities establish profit because "what it cost" including a profit makes you your math completely arbitrary. Is margin 10%....50%.....100% is it different for different people on different plans....what is gouging? Is gouging 125% but not 124% of time and materials? Oh wait you missed the point of the article.
 
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Jostate

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#14
maybe the damned doctors should stop referring us to specialists that are not "in network"

.
When my wife was going through Chemo she was referred for some testing to someone out of network, which we didn't realize until we got a bill for $18k. I called to discuss this matter and we ended up paying $400. I don't fully understand the pricing structure and all the variables involved but apparently it has a lot to do with the emotional instability of a patient's husband when he calls to "discuss" price.
 
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Jostate

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I'm over my head on the whole healthcare debate, but I know any time government and business get mixed to an extent most of us don't even understand (Fannie Mae) we end up with the incompetence of government, mixed with the greed of corporations and the accountability of NASA.
 

CaliforniaCowboy

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I'm over my head on the whole healthcare debate, but I know any time government and business get mixed to an extent most of us don't even understand (Fannie Mae) we end up with the incompetence of government, mixed with the greed of corporations and the accountability of NASA.
of course we do, that's why the article was offensive, because the clown MD who wrote it, his whole purpose was to promote legislation that favored the Doctor's rather than favoring the Insurance Companies. (he even said so)

(rather than him proposing ideas and solutions that would not involve government intervention at all)

I don't believe that there can be any meaningful solution until and unless Medicare is privatized. Give people vouchers to purchase their own insurance. Just imagine, for example, if the Government simply paid the Kaiser premiums for all the people on Medicare and let that company tend to medicare's health needs. No more "billing". No more long lines of uninsured in the ER. No more Medicare fraud. Everyone gets the care they need. (or any other HMO, or similar programs)

Currently, Medicare = 702 Billion, for 44 million recipients = 16,000/person annually.

In 2018, Kaiser Family Foundation (KFF) found the average premium for single coverage was $575 per month, or $6,896 per year (for a Kaiser plan)

Sure, many of those on Medicare are older (more expensive), or have pre-existing conditions, so up the payment somewhere beyond the "average premium" to maybe DOUBLE like 12,000/yr (family plans are less)... and we'd still come out better than Medicare's $16k / person.

Just saying....

as for the accountability of NASA, they can at least demonstrate that their results were at least stratospheric and beyond. (big grin)
 

#1 Pokes Fan

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#18
When my wife was going through Chemo she was referred for some testing to someone out of network, which we didn't realize until we got a bill for $18k. I called to discuss this matter and we ended up paying $400. I don't fully understand the pricing structure and all the variables involved but apparently it has a lot to do with the emotional instability of a patient's husband we he calls to "discuss" price.
There is an urgent care facility my wife isn't allowed to go to in any capacity due to "discussing" prices. :lol:
 

oks10

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#19
If you want to avoid looking damn clueless, probably better to read the article in the post you are responding to when it addresses your only suggestion that isn't pure nonsense. Hey, hospital struggling to get one radiologist to cover weekends, now you need to have 10 because there are 10 insurance networks in the area.:derp:
Personally I wouldn't mind if they were at least required to have ER docs that are in-network for at least the MAJOR insurance providers. (That or have some way of people knowing before hand if the doctor is in or out of network since it's not like people "shop" for ER doctors...) For example, (as I discovered the hard way) the hospital near us in network but the ER doctor we saw was not in-network. I have CIGNA which is the 4th largest health insurance provider in the US... I get not having agreements with every regional insurance out there but I would think that assuming they're with the top 5 isnt' some outrageous expectation... Although, I guess if you're an ER doctor you don't really care if you're in a popular network because your main pool of patients aren't going to have a clue if you are or aren't in network until you foot them the bill and by then it's already done. It's not like people check out which in-network hospitals have in-network and out-of-network ER docs on the drive in...

BTW, my comments may be completely ignorant to how it actually works but I'm ok with that. :D I just know now not to screw with going to an ER unless I want some absurd bill from my insurance not covering due to being given an out-of-network ER doc when I go to my in-network hospital. Though it does make my insurance seem like a complete waste of money when I can only use it for illnesses I can schedule...
 
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steross

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#20
Personally I wouldn't mind if they were at least required to have ER docs that are in-network for at least the MAJOR insurance providers. (That or have some way of people knowing before hand if the doctor is in or out of network since it's not like people "shop" for ER doctors...) For example, (as I discovered the hard way) the hospital near us in network but the ER doctor we saw was not in-network. I have CIGNA which is the 4th largest health insurance provider in the US... I get not having agreements with every regional insurance out there but I would think that assuming they're with the top 5 isnt' some outrageous expectation... Although, I guess if you're an ER doctor you don't really care if you're in a popular network because your main pool of patients aren't going to have a clue if you are or aren't in network until you foot them the bill and by then it's already done. It's not like people check out which in-network hospitals have in-network and out-of-network ER docs on the drive in...

BTW, my comments may be completely ignorant to how it actually works but I'm ok with that. :D I just know now not to screw with going to an ER unless I want some absurd bill from my insurance not covering due to being given an out-of-network ER doc when I go to my in-network hospital. Though it does make my insurance seem like a complete waste of money when I can only use it for illnesses I can schedule...
Well, I agree with you that our system of "insurance" is insane which is why I wonder why so many people defend it so strongly.
I guess the counter point to "requiring" the ER doctor to take what the insurer chooses to pay in-network is to "require" the insurer to pay what the doctor charges.
And, ER doctors definitely care if they are in-networks. But, insurers are aware of this therefore contract the hospital network first then low-ball the doctors. Also, "ER doctors" is really a thing of the past as in Oklahoma nearly every doctor is really just an employee or 1099 contractor of a private equity company that has bought a CMG who forces the doctor to reassign payment to them. These companies, like insurance companies, are out for pure profit. Which is why this was in the past a minor issue and is now a major one.