Congress price fixing our "free market" healthcare

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steross

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#21
If anyone really wants to get into the weeds of why this issue has gone from simmering for decades to a full blown war, here it is.
But, if you think that handing victory to the insurance companies is the best plan because the private equity companies that have purchased docs, it is basically ripping the meat out of the mouths of wolves and handing it to grizzly bears.
And, it isn't just Emcare. When I returned from Aus I was shocked to find the penetrance of these companies in Oklahoma. It is nearly every hospital. Which is why I am trying to work at the VA. I hate the bureaucracy, but I like veterans. I don't like gouging Oklahomans so that an exec can make $21.7 million a year completely off of doctor billings ("Envision" is the new name of "Emcare" as listed in the article below)

https://www.nytimes.com/2017/07/24/...XRva2L1hWFyx03KjILNrdBLp-tlZMDjpf4xTgQAbmGDy8

The Company Behind Many Surprise Emergency Room Bills
By Julie Creswell, Reed Abelson and Margot Sanger-Katz
July 24, 2017


Early last year, executives at a small hospital an hour north of Spokane, Wash., started using a company called EmCare to staff and run their emergency room. The hospital had been struggling to find doctors to work in its E.R., and turning to EmCare was something hundreds of other hospitals across the country had done.

That’s when the trouble began.

Before EmCare, about 6 percent of patient visits in the hospital’s emergency room were billed for the most complex, expensive level of care. After EmCare arrived, nearly 28 percent got the highest-level billing code.

On top of that, the hospital, Newport Hospital and Health Services, was getting calls from confused patients who had received surprisingly large bills from the emergency room doctors. Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks and were sending high bills directly to the patients. For a patient needing care with the highest-level billing code, the hospital’s previous physicians had been charging $467; EmCare’s charged $1,649.

More at link

‘Like a Light Switch’
In several hospital emergency rooms, out-of-network rates for customers of one large insurer jumped to nearly 100 percent after EmCare took over. Below, the year before and the year after a switch.
Screen Shot 2019-07-16 at 10.59.56 PM.png
 

wrenhal

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Aug 11, 2011
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#24
And, it isn't just Emcare.
The same thing has happened with PBMs and prescription meds. It is the result of Obamacare, it has encouraged the growth of insurance middlemen.
Would allowing insurance companies to compete with packages across state lines help? I've heard that that could help bring down the coat of medicine.

Sent from my Moto Z (2) using Tapatalk
 

oks10

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#25
If anyone really wants to get into the weeds of why this issue has gone from simmering for decades to a full blown war, here it is.
But, if you think that handing victory to the insurance companies is the best plan because the private equity companies that have purchased docs, it is basically ripping the meat out of the mouths of wolves and handing it to grizzly bears.
And, it isn't just Emcare. When I returned from Aus I was shocked to find the penetrance of these companies in Oklahoma. It is nearly every hospital. Which is why I am trying to work at the VA. I hate the bureaucracy, but I like veterans. I don't like gouging Oklahomans so that an exec can make $21.7 million a year completely off of doctor billings ("Envision" is the new name of "Emcare" as listed in the article below)

https://www.nytimes.com/2017/07/24/...XRva2L1hWFyx03KjILNrdBLp-tlZMDjpf4xTgQAbmGDy8

The Company Behind Many Surprise Emergency Room Bills
By Julie Creswell, Reed Abelson and Margot Sanger-Katz
July 24, 2017


Early last year, executives at a small hospital an hour north of Spokane, Wash., started using a company called EmCare to staff and run their emergency room. The hospital had been struggling to find doctors to work in its E.R., and turning to EmCare was something hundreds of other hospitals across the country had done.

That’s when the trouble began.

Before EmCare, about 6 percent of patient visits in the hospital’s emergency room were billed for the most complex, expensive level of care. After EmCare arrived, nearly 28 percent got the highest-level billing code.

On top of that, the hospital, Newport Hospital and Health Services, was getting calls from confused patients who had received surprisingly large bills from the emergency room doctors. Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks and were sending high bills directly to the patients. For a patient needing care with the highest-level billing code, the hospital’s previous physicians had been charging $467; EmCare’s charged $1,649.

More at link

‘Like a Light Switch’
In several hospital emergency rooms, out-of-network rates for customers of one large insurer jumped to nearly 100 percent after EmCare took over. Below, the year before and the year after a switch.
View attachment 71784
Yep. Sounds like exactly what I ran into with my ER visit but with an even higher bill than that... I think my ER bill was about $2100 IIRC (just the doctor portion, in addition to the hospital bill which wasn't anything outrageous. Was definitely less than $1000, I just don't remember how much it actually was because the doctor bill overshadows that memory...)
 

steross

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#26
Would allowing insurance companies to compete with packages across state lines help? I've heard that that could help bring down the coat of medicine.

Sent from my Moto Z (2) using Tapatalk
My honest opinion is that it would make marginal differences.

Third-party payment for routine services with no price transparency because it is the payer, not the consumer, that contracts will never be an efficient method of obtaining goods or services. Adding more insurers to the mix to make it even easier for them to say "we can't tell you how much this costs because it depends on your insurance" will not make it better.

We will see if the president's order for price transparency has an effect.
 

osupsycho

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#27
My honest opinion is that it would make marginal differences.

Third-party payment for routine services with no price transparency because it is the payer, not the consumer, that contracts will never be an efficient method of obtaining goods or services. Adding more insurers to the mix to make it even easier for them to say "we can't tell you how much this costs because it depends on your insurance" will not make it better.

We will see if the president's order for price transparency has an effect.
So since I have very little knowledge in this area I am truly curious what you think will help things?
 

wrenhal

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Would allowing insurance companies to compete with packages across state lines help? I've heard that that could help bring down the coat of medicine.

Sent from my Moto Z (2) using Tapatalk
My honest opinion is that it would make marginal differences.

Third-party payment for routine services with no price transparency because it is the payer, not the consumer, that contracts will never be an efficient method of obtaining goods or services. Adding more insurers to the mix to make it even easier for them to say "we can't tell you how much this costs because it depends on your insurance" will not make it better.

We will see if the president's order for price transparency has an effect.
I just feel that if more insurers can compete nationwide it would eventually bring down the cost of insurance, as well as we put some of the insurers out of business. Less insurers would make it easier on the hospitals and doctors eventually?

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CaliforniaCowboy

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I just feel that if more insurers can compete nationwide it would eventually bring down the cost of insurance, as well as we put some of the insurers out of business. Less insurers would make it easier on the hospitals and doctors eventually?

Sent from my Moto Z (2) using Tapatalk
Nationwide (or cross-State) insurance would eliminate the State Insurance agencies, that are designed (in theory) to protect consumers, and on a national level represents separation of powers and State rights to govern themselves.

The Federal government really should not have any say-so in how a State conducts their business. (that's one thing to consider).

The Federal government does have jurisdiction in inter-State commerce (States selling stuff to each other and competing with each other), but I'm not sure that Insurance meets that criteria.

Regardless of those "Constitutional" issues, the only purpose to open policies/programs across State borders would be to STIMULATE competition, NOT put some companies out of business.

More competition means lower prices, not less competition.

Many companies already have employees in multiple States, so they have to offer plans that will accommodate those employees. (I'm not up on those policies, because my employer only has CA employees and CA plans).

With that said, if I need to see a doctor or visit a hospital or urgent care when I'm not in California, then those local providers seem to have to take extra steps to ensure Blue Cross of California is going to cover me in Oklahoma (for example).

From a consumer perspective, it seems as if there are at least 3 parties all pointing fingers at the others (Hospitals, Insurers and Doctors). Regardless of the parties involved, they should be able to tell us what a procedure is going to cost before we agree, or in the case of an emergency, a Hospital that accepts the insurance should ensure that any bill that comes from procedures at their facility are according to the agreement (i.e., no separate bill from some random Doctors that you have no idea what they performed).

I'm not on anybody's "side", but the existing practices are not consumer oriented.
 

steross

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#32
I just feel that if more insurers can compete nationwide it would eventually bring down the cost of insurance, as well as we put some of the insurers out of business. Less insurers would make it easier on the hospitals and doctors eventually?

Sent from my Moto Z (2) using Tapatalk
Here is what the insurers are trying to accomplish. Getting Congress to pass this law requiring doctors who have never contracted with an insurance company to accept the median rates of those companies is a huge step toward getting this accomplished:

https://www.vox.com/platform/amp/20...FNOwC6Ku1zNhy7kmaqS-YimmC_dXuhAAFiqC6aWInwZdM
All-payer rate setting: America’s back-door to single-payer?

Single-payer health care has long been the political pipe dream of the left, but there's a nearly identical system that could actually happen.

All-payer rate setting, as the system is known, shares the same goals of single-payer: it aims to increase efficiency and reduce insurer overhead in the health care system. Single payer does this by eliminating private plans for one government plan. All-payer rate setting gets there by setting one price that every health insurer pays for any given medical procedure.

"[All payer] has everything except the government-run plan," says Mark Pauly, a health economist at University of Pennsylvania. "In all-payer systems, the government uses Blue Cross and other insurers as their agent. For consumers its the exact same except for who they write their check for premiums to."

The big difference between the two systems is in the politics. Single payer has never gotten traction in Congress and even just failed in deep-blue Vermont. All payer has actually moved through state legislatures and is being road tested in Maryland. President Obama even said in a recent interview with Vox that he believes the central concept behind the system — giving insurers more bargaining power — "makes a lot of sense."

Here's a guide to where all payer is used, how it works, and whether it could be in America's future.
1) All-payer rate setting means one price for each medical procedure

Right now, there is huge variation in health care costs at different hospitals and doctor offices. The reason is different health-insurance plans pay different prices for medical care. That means the price of an MRI scan or knee replacement surgery, for example, can vary widely, depending on how good an insurance plan is at negotiating.

Bigger plans tend to negotiate deeper discounts. Most research shows that private insurance plans pay the most, Medicare pays slightly less, and Medicaid pays the lowest rates. And even between different private insurance plans, there can be huge variation — a bigger plan with more members might be able to ask hospitals for lower prices because it can promise lots of patients.
 
Oct 15, 2003
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So Cal
#33
Right now, there is huge variation in health care costs at different hospitals and doctor offices. The reason is different health-insurance plans pay different prices for medical care. That means the price of an MRI scan or knee replacement surgery, for example, can vary widely, depending on how good an insurance plan is at negotiating.

Bigger plans tend to negotiate deeper discounts. Most research shows that private insurance plans pay the most, Medicare pays slightly less, and Medicaid pays the lowest rates. And even between different private insurance plans, there can be huge variation — a bigger plan with more members might be able to ask hospitals for lower prices because it can promise lots of patients.
These approaches are always hair-brained, and are never fair or just (because, waa-laa, the government is involved).

There is a huge variation at different hospitals and doctors offices - BECAUSE they have different EXPENSES (and when considered nationally - different cost of living).

There has to be a solution, but one-size-fits-all does not seem to be that solution. Does it cost as much to perform procedures at Stillwater hospital as is does at, say, St. Francis in Tulsa? The Insurers want to pay the same rate, regardless of what it actually costs (apparently - unless I totally misread this).

In the 2nd paragraph, larger plans negotiate deeper discounts, BECAUSE, they represent more patients, hence they can offer a provider a larger number of patients at that negotiated rate. They are offering volume.

That's how all insurance works, the more people that they have in a plan, the lower their costs, and the greater the bargaining power. Everybody wins.

There have to be some solutions that do take into account real life and real economics - but the stuff presented by the insurers in this article don't seem to be practical nor realistic.