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Health Savings Accounts to the Rescue . . . not

BaliBabyDoc

Lifer
Jan 20, 2001
10,737
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yahoo
Forty-eight percent of individuals in families earnings between $35,000 and $49,999 said they had either a somewhat serious or very serious problem paying their medical bills in the last two years, according to a study by The Commonwealth Fund. Meanwhile, 50 percent of adults in that income bracket said they had difficulties affording their health insurance.
I assume most in the former group have health insurance, yet still have trouble paying their bills. They would really be in trouble if they were saddled with a high-deductible healthcare plan (HDHP).

33% of the 50-75k families and 21% of families over 75k reported problems with healthcare costs. Similar % had issues with insurance cost.

The study also found that while people are having difficulties paying for their health services, they are also unsatisfied with them. Forty-two percent of people surveyed said they had experienced poorly coordinated, inefficient or unsafe care at some points during the past two years. Their experiences included a medical error, a duplicate test or the failure to provide important test results to doctors or nurses.

Three-quarters of the adults surveyed said the health care system needs fundamental change or a complete rebuilding.
This is actually the most important finding. The common man is finally coming to terms with our horribly flawed 'health'care system. It's a shame the politicians don't have a clue. They are busy focusing on the various lobbyists lining their pockets to realize the primary problem isn't how we finance it (granted that needs serious reform). The primary problem is our approach to healthcare in general and how we choose to execute it . . .

don't you dare be po . . . and expect healthcare . . . at least from doctors
Overall, the percentage of physicians not accepting new Medicaid patients has risen from about 19.5 in the mid-1990s to about 21 over the past few years. The change was much more pronounced among solo and small group practices.
 

LunarRay

Diamond Member
Mar 2, 2003
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What good is Medicare or Medicaid if no MD's or clinics or what not will take it..

I know a person who is retired on SSDI and receives SSI and Medicare (california) and can't find a dentist, doctor or any usual health care outlet.. sure University Hospital will take this person but the wait to see a PCP and then on to a specialist is forever.. "go to emergency if you've a problem.. " another 10 hour wait..
This is insane..

IMO..

I can't imagine not having health care insurance but that is impossible to afford anymore for the folks under 75K$ a yr... Guess we should all just give up.. and be sick.. and when real sick go to emergency.. it is depressing..

Edit: I'm quite thankful for the VA ... in La Jolla the entire set up is great
 

BaliBabyDoc

Lifer
Jan 20, 2001
10,737
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Well when the majority of American households . . . which make under $75k . . . start voting as if healthcare matters . . . things may get a little better.

Then again we may just wind up with a 'different' crop of idiot politicians . . . beholden to special interests with deep pockets.
 

zendari

Banned
May 27, 2005
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People want 21st century healthcare for 19th century prices, and they treat the entire industry as subservent to the rest of us.

No wonder they have problems.
 

TheSlamma

Diamond Member
Sep 6, 2005
7,628
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And the Zentrolls of the world are cool with the current 22nd century price gouges.
 

senseamp

Lifer
Feb 5, 2006
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4,602
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US healthcare system is broken. It does not really serve a huge percentage of people, or serves them very poorly. And it's overpriced for what you are getting.
 

spidey07

No Lifer
Aug 4, 2000
65,481
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Originally posted by: senseamp
US healthcare system is broken. It does not really serve a huge percentage of people, or serves them very poorly. And it's overpriced for what you are getting.
WHAT!!!!!!!!!!!!

Do you have a job? I've always had great healthcare. Heck, I've known many employers to fully cover the employees healthcare insurance and only have a 10 dollar co-pay.
 

zendari

Banned
May 27, 2005
6,558
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You think MRIs, catscan machines, and intensive care units build themselves?

Graphics card hardware has grown tremendously in power over the last 3 years, and so have prices as well. You have to pay for technological progress.

Originally posted by: senseamp
US healthcare system is broken. It does not really serve a huge percentage of people, or serves them very poorly. And it's overpriced for what you are getting.
Well, the people decided to demand that the healthcare system fix their baldness, give them boners, and lower their cholesterol so they could eat more fatty foods, and tons of other increased services. They just didn't want to pay for any of it.

Then they drop the lawsuit card and everyone pays for it.
 

senseamp

Lifer
Feb 5, 2006
34,739
4,602
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Originally posted by: spidey07
Originally posted by: senseamp
US healthcare system is broken. It does not really serve a huge percentage of people, or serves them very poorly. And it's overpriced for what you are getting.
WHAT!!!!!!!!!!!!

Do you have a job? I've always had great healthcare. Heck, I've known many employers to fully cover the employees healthcare insurance and only have a 10 dollar co-pay.
I have a job and insurance, but I wouldn't say service is all that great, and it's overpriced. Face time with the doctor is minimum, charges are maximum. If you are going to charge the patient $300 for a visit, at least have the descency to spend more than 10 mins with him. Just because insurance pays most of it doesn't mean its not overpriced. It's like whne you are in a minor fender bender, and then you find out the body shop billed your insurance $5K. Sure it's not out of your pocket at the time, but eventually it all does come out of your pocket. That's why companies are dropping insurance or moving jobs overseas.
 

senseamp

Lifer
Feb 5, 2006
34,739
4,602
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Originally posted by: zendari
You think MRIs, catscan machines, and intensive care units build themselves?

Graphics card hardware has grown tremendously in power over the last 3 years, and so have prices as well. You have to pay for technological progress.

Originally posted by: senseamp
US healthcare system is broken. It does not really serve a huge percentage of people, or serves them very poorly. And it's overpriced for what you are getting.
Well, the people decided to demand that the healthcare system fix their baldness, give them boners, and lower their cholesterol so they could eat more fatty foods, and tons of other increased services. They just didn't want to pay for any of it.

Then they drop the lawsuit card and everyone pays for it.
Technological progress is all great, but when I am paying for healthcare, I am paying for outcomes, not technology for the sake of technology. And even with no technology, just plain doctor visits are getting more expensive and rushed. Technology is just a tool, but ultimately it's the doctor providing the care, not a machine.
 

BaliBabyDoc

Lifer
Jan 20, 2001
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MRI scanners are used b/c they are available. It's cool technology but of questionable utility and certainly not an efficient use of limited resources. Retail scan charge is over a grand per body part . . . typically closer to 2k.

CAT scan . . . a little different. A lot of use is indeed driven by availability but it often has a significant impact on treatment decisions.

PET . . . worst aspects of both. The government tried to intervene by setting rules prohibiting 'me too' applications. In essence, trying to limit the number of facilities with a PET scanner within a certain area. I assume it didn't work out since Duke got a PET scanner and then my hospital (10 miles away) got one a few years later after petitioning for it.

ICU bed runs $1k/day roughly the same rate as a bed in our inpatient adolescent psych ward. An intelligent use of resources would be to keep people OUT of those places. Instead we have a system that rewards the USE of those places.

No one demanded their baldness be fixed. Minoxidil was a blood pressure medication . . . it just happened to grow hair better than it lowered BP.

Guys were getting rigid implants and inflatable bladders, when Pfizer tripped over a failed heart failure drug . . . that just happen to have a peculiar side effect.

High utilization of prescription drugs does indeed affect our healthcare costs. Curiously, the costs really took off after it became standard practice to advertise medications as if they were just another consumer product. Maybe we should start by ending or curtailing that practice?! When FDA/FTC have tried in the past, the first response from industry . . .
Then they drop the lawsuit card and everyone pays for it.
 

BlancoNino

Diamond Member
Oct 31, 2005
5,695
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Medical Savings accounts are a good idea.

The healthcare industry also needs some deregulation...actually a lot of deregulation
 

DurocShark

Lifer
Apr 18, 2001
15,708
5
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I have outstanding insurance, with only a $5 copay for everything except name brand drugs that are $10.

But I've had periods of my life where my insurance sucked donkey butt.

My mom right now has Kaiser. If she has an emergency (happens once a month or so due to her health issues), and can't convince the ambulance to take her to a "Kaiser hospital" then she gets slapped with a $250 copay. But the nearest Kaiser hospital is 20 miles away, and there are 8 (yes, eight) other hospitals closer. But she doesn't have a choice since it's her employer's insurance. (Well, ex-employer. She's permanently disabled and is using COBRA to keep her insurance for now.)

To me that's just offensive. And the stories about poor service are absolutely frightening (almost as bad as my near death crap)! I can't wait until she arranges Medicare. It may not be better, but it surely can't be worse!
 

senseamp

Lifer
Feb 5, 2006
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The problem with medical savings accounts is one illness can wipe them out, and then you got nothing.
The other problem is hospitals and doctors don't advertise what their fees are so you can shop around, instead they just bill you whatever they want later, which is not a recipe for the markets to work since you can't compare prices upfront. And thirdly, insurance companies will get huge discounts because they can bargain for them, while billing department will rape and pillage your HSA until it's empty.
 

BaliBabyDoc

Lifer
Jan 20, 2001
10,737
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Originally posted by: BlancoNino
Medical Savings accounts are a good idea.

The healthcare industry also needs some deregulation...actually a lot of deregulation
For the former, you're right. They are a good idea. My wife and I both have HSAs. But our employers also pay for comprehensive (low deductible healthcare). Oh yeah we each make far more than the median FAMILY income for my state. Oh and we don't actually use much healthcare . . . as long as the UPS guy leaves her alone this year.

The problem with HSAs is that the people getting the greatest benefit out of them are people like me. It's a tax thing . . . it has almost nothing to do with health.

Your latter statement makes it clear you don't understand much about healthcare. A lot of activities are scarcely regulated at all: fertility services, plastic surgery, prices (nonMedicare/Medicaid). Others are regulated to the extent of having different rules for almost every state; abortion, age of consent for procedures (varies by procedure), what must be covered by health plans.

My broad theme is that there's nothing inherently wrong with HSAs. They just have no real bearing on healthcare costs or healthcare quality.
 

BlancoNino

Diamond Member
Oct 31, 2005
5,695
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The things you listed as non-regulated are great examples that you don't need regulation. I've had nothing but great experiences with plastic surgeons. There are a few that don't do a good job, and they are quick to find themselves out of business. They must do a good job, it's how they stay advertised, and when word-of-mouth spreads, the customers start to pour in.
 

senseamp

Lifer
Feb 5, 2006
34,739
4,602
126
Originally posted by: BlancoNino
The things you listed as non-regulated are great examples that you don't need regulation. I've had nothing but great experiences with plastic surgeons.
I bet you have :laugh:
 

BlancoNino

Diamond Member
Oct 31, 2005
5,695
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0
Originally posted by: senseamp
Originally posted by: BlancoNino
The things you listed as non-regulated are great examples that you don't need regulation. I've had nothing but great experiences with plastic surgeons.
I bet you have :laugh:
? I have...I had some minor scarring on my left temple, and they did a great job. Also, if you read reviews, people for the most part are very happy with the procedures. These horror story mess-ups are quite rare.
 

BaliBabyDoc

Lifer
Jan 20, 2001
10,737
0
0
Originally posted by: BlancoNino
The things you listed as non-regulated are great examples that you don't need regulation. I've had nothing but great experiences with plastic surgeons.
You do realize that unregulated prices have contributed to healthcare cost inflation? Check out how much Medicare and Medicaid are paying for Erbitux . . . at a discount.

A common distortion in the marketplace is that Medicare, Medicaid, and private insurers impose certain fee schedules on providers. In response, providers jack up the costs on everybody else. Naturally, everybody else is anybody that's too young for Medicare, makes too much money for Medicaid, or cannot afford private insurance (or just chooses not to buy it).
 

LunarRay

Diamond Member
Mar 2, 2003
9,993
1
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Everything is in code regarding the medi etc.. payment scheme..
But on average what is the difference, if you know, between some normal office visit charge to a cash payer, a typical insurance reimbursement and medicaid or medicare.. I know there are varying additional co-pay involved but I wondered if the medi stuff was significantly lower.
 

shira

Diamond Member
Jan 12, 2005
9,574
5
81
Originally posted by: zendari
People want 21st century healthcare for 19th century prices, and they treat the entire industry as subservent to the rest of us.
If the poor are treating the health care industry as "subservient to the REST of us", that means NOT subservient to themselves. So according to you, the poor are treating the health care system with respect (it's not subservient to them).

So what's your beef?

Edit: Oh silly me. I get it. This is just one more example of a random string of words assembled by Zendari, filled with sound and fury, signifying nothing.
 

BaliBabyDoc

Lifer
Jan 20, 2001
10,737
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Originally posted by: LunarRay
Everything is in code regarding the medi etc.. payment scheme..
But on average what is the difference, if you know, between some normal office visit charge to a cash payer, a typical insurance reimbursement and medicaid or medicare.. I know there are varying additional co-pay involved but I wondered if the medi stuff was significantly lower.
I haven't seen office practices since med school but I can give some ballparks about my hospital.

My research group typically runs safety labs on a patients (all children and adolescents) . . . usually standard blood counts, electrolytes, liver/kidney fx . . . but these days we also do endocrine and lipid panels b/c our drugs have some ugly side effects.

Anyway, I needed some lab costs to produce a budget for a study . . . to be funded by a member of the evil empire (Bristol Myers Squibb). The administrative assistant brought back a list of charges that I scanned and then told her that most of them were way too high. She said, "those are the prices!" I had her call back and she was then quoted a different set of rates . . . 50-80% LOWER. The first set was regular billing. The second set was research. I did a little digging and found out the research rate was a lower than what Medicare/Medicaid paid but A LOT lower than what patients without insurance are billed.

Here's a decent article from 2004 (excerpts are out of order) USAToday
Charges are another ? and the one attracting the most controversy. Hospital charges are similar to the list price on a car. Few pay the full amount because insurers negotiate discounts, and Medicare tells hospitals what it will pay. Still, some insurers do pay full charges, such as when a policyholder goes to an out-of-network hospital with whom the insurer does not have a negotiated discount.
Some insurers, she says, pay less than Medicare, which she says also fails to meet overall hospital costs. Federal statistics show that Medicare in 2002 provided an overall margin of 1.7% to the hospital industry, more for inpatient care and less for outpatient.
---
Because most hospitals rely on government health payments for about 50% of their revenue, and private insurers who negotiate discounts for much of the rest, raising charges is one way hospitals can try to bring in additional money from individuals and insurers not covered by the discounts, Coyle says.
Hospitals are fighting back, saying they are only trying to counter rising labor and equipment costs, while faced with insufficient payments from government and private insurers.
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"These are hospitals that are basically told by insurers what their rates are going to be."
The article mentions wacky CA as one of the few states that mandates hospitals post price lists.

When Karen Hamers' teenage daughter Michele needed knee surgery, Hamers called several hospitals near her home in Vero Beach, Fla., and asked how much the surgery would cost. At the time, her family did not have health insurance. After choosing a hospital, Hamers paid the surgeon and then also paid the hospital what it said the surgery would cost: $4,200.

"Six days after surgery, we receive a letter from the hospital asking for an additional $21,000," Hamers says. She asked for an explanation and got an itemized bill.

"It was two pages of gobbledygook," Hamers says. "We could not understand it. They could not explain it. We showed it to our doctor, and he didn't understand it."

Hamers had kept a detailed log of her daughter's 20 hours in the hospital, including a list of all the staff who cared for her and what drugs she was given. After reviewing the log and its own records, the hospital reduced its additional billing to $610.


 

LunarRay

Diamond Member
Mar 2, 2003
9,993
1
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BBD,
The more I read the more I bolster my belief that in this country 'Universal' health care provided to each citizen with out direct (time of occurrence) cost is the answer.

Some form of scheme that all Private Md's, Clinics, Hospitals, Pharmacies, and etc. would be mandated to accept. All workers would be obliged to carry this 'scheme' just like they are mandated to belong to Social Security. Perhaps a central insurance agency...

The drug companies are the issue that can't easily be controlled... They spend more on advertisement than on research but yet claim they don't make enough as it is.. Me thinks the Drug companies should simply make the drugs the hospital and university research folks ask for.. In other words.. The drug companies create a better mouse trap or so they think.. may or may not do all the due diligence to insure the mice won't die from taking their drug... just suffer a bit from the side effects but that is OK.. it is a trap after all then induce everyone in the Medical profession to use their drug after the FDA blesses it and for Ten Years they make a killing... Well mainly cuz the formulary (spelling ?) won't list that drug for awhile.. so they get top dollar...

There is a way to control it all but we'd never ever ever be able to get the law passed..
A protection period equal to the actual research (audit-able) dollars spent times a multiplier until that drug is deemed generic... and factor in orphan drug development into that.. as well.. so that some tax scheme rewards a drug company who develops and makes drugs for very low use..
The key is the amount they can charge.. that is part of the factor.. 1$ a pill versus 5$ a pill will affect the length of time the Pill is protected..
edit: and yes I do realize that the expected volume sold would matter... to them... but also the competition would gear up too.. if the time was shorter.. there is a dynamic here that I'm not totally sure on.. but I think something has to be done.
 

BaliBabyDoc

Lifer
Jan 20, 2001
10,737
0
0
One of the interesting issues is that Universal healthcare would probably be worth $750-$1500 off each domestic automakers' list prices for vehicles. Granted, they would still have the problem of building autos that people don't want.


I'm gonna switch to the capitalist side on the drug industry issue . . . but a smart capitalist. Personally, I think we should keep current patent protections for industry and allow them to charge as much as we want. BUT . . .

1) NIH should get a new institute devoted to best healthcare practices from vaccines and meds to surgical procedures. Hospitals, MDs, and insurers would then be mandated to report compliance rates which would be posted at the NIH website. Not only would substandard care mark a provider as being deficient but they would also lose federal funding if they fail to come into compliance.

2) Medicare and Medicaid should be able to bargain for discounts just like the VA.

3) Medicare and Medicaid should automatically substitute cheapest option for a given med. Sometimes that will be the original agent but more often than not it will be a generic.

4) Medicare, Medicaid, and VA should stop paying for 'extreme' meds. Drugs like Erbitux (14k/mo) and Avastin (21k/mo) are of marginal benefit. It may sound cruel but giving someone a few more months shouldn't be a function of government. There's a clear public health benefit to giving everybody the flu vaccine but you can't make that argument for many biologics. Industry will either dramatically lower prices and/or stop making biologics. But since most biologics aren't all that impressive . . . the only pain will be felt in Genentech's and BMS/ImClone's bottomlines.

5) If #3 isn't an option, then after a drug goes off patent then government programs and private insurers should be allowed to cap medication cost at no more than 150% of the cost in any other OECD country. Technically that's price control but drug companies will benefit b/c they can stop bothering with the billions they are spending each year trying to figure out how to wring more cash out of off patent meds. They can spend that money on shareholders, R&D, or even . . . dare I say it . . . lower the cost of their drugs so people buy them anyways.
 

LunarRay

Diamond Member
Mar 2, 2003
9,993
1
76
Originally posted by: BaliBabyDoc
One of the interesting issues is that Universal healthcare would probably be worth $750-$1500 off each domestic automakers' list prices for vehicles. Granted, they would still have the problem of building autos that people don't want.

hehehehhe yes but that seems cheap and would allow amortization of assets cuz it seems more folks would use them.. lowers prices per use. I make an unfounded assumption but I think it is true

I'm gonna switch to the capitalist side on the drug industry issue . . . but a smart capitalist. Personally, I think we should keep current patent protections for industry and allow them to charge as much as we want. BUT . . .

OK.. :D

1) NIH should get a new institute devoted to best healthcare practices from vaccines and meds to surgical procedures. Hospitals, MDs, and insurers would then be mandated to report compliance rates which would be posted at the NIH website. Not only would substandard care mark a provider as being deficient but they would also lose federal funding if they fail to come into compliance.

What you suggest is a method of treatment for each diagnosed illness universally applied with out the side excursions and over treatment based on potential med/mal and inexperience... I think you are anyhow.. hehehe.. I'd go for that easily. Not too sure you could argue the compliance factor beyond them to the NIH so it would be "In some expert body's opinion.. etc.. and it carries the weight of opinion univerally.. I think

2) Medicare and Medicaid should be able to bargain for discounts just like the VA.

That I really can't understand.. that it don't already occur.... should be a no brainer but then those in Congress meet that test quite well..

3) Medicare and Medicaid should automatically substitute cheapest option for a given med. Sometimes that will be the original agent but more often than not it will be a generic.

Patients are Rx'd the 'good' stuff and walk away thinking that generic is not really the same or even close... My wife thinks you can eat microwaves so never uses a microwave... a Prof friend at UCSD mentioned it one day in jest... lots of folks don't quite understand that the color of the pill don't change the effect.. need education on that issue as well..

4) Medicare, Medicaid, and VA should stop paying for 'extreme' meds. Drugs like Erbitux (14k/mo) and Avastin (21k/mo) are of marginal benefit. It may sound cruel but giving someone a few more months shouldn't be a function of government. There's a clear public health benefit to giving everybody the flu vaccine but you can't make that argument for many biologics. Industry will either dramatically lower prices and/or stop making biologics. But since most biologics aren't all that impressive . . . the only pain will be felt in Genentech's and BMS/ImClone's bottomlines.

Well... that divides the rich from the poor and a day or a month is a lifetime to some... I think it might be handled better in a pool of Orphan drugs that are handled in some reasonable fashion but I tend to agree the Government (the people) don't need to pay for a small amount of added life span but the users are also some of them there people too... I've to think on that one a bit more.. And I edit: The really exotic and usually unproven drugs that you indicate really don't do much as far as I can tell.. least ways what I've heard in Congressional hearings is that tests are falsified or even the patient was cured or helped by another means and the 'wonder' drug had little efficacy in the event..

5) If #3 isn't an option, then after a drug goes off patent then government programs and private insurers should be allowed to cap medication cost at no more than 150% of the cost in any other OECD country. Technically that's price control but drug companies will benefit b/c they can stop bothering with the billions they are spending each year trying to figure out how to wring more cash out of off patent meds. They can spend that money on shareholders, R&D, or even . . . dare I say it . . . lower the cost of their drugs so people buy them anyways.

I think #3 is an option and #5 as well and both are not necessarily in conflict or agreement with each other all the time. But to lower the cost would be unique for the Drug Makers unless it increased volume versus the other options for similar treatment. I think using #3 is as much price control as anything. If there is a generic, that is.. and if not then it is (IMO) too new to use on humans..hehehhehehe... but I'll defer to your wisdom on that ... you and the (your) newly created division of the NIH.
 

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