Why (health) insurance companies must go

[bradly1101]

I'm helping a friend navigate her healthcare, and the obstacles that keep getting in the way are the insurance companies. Short version: her doctor only accepts two insurance plans. We've been trying to apply, but she doesn't meet the requirements of either plan, which will force her to lose her doc.

I understand their requirements are to keep costs down in deference to the shareholders but in doing so they have created a system of 'locked down' providers and facilities. In universal healthcare systems you can go to any doctor anywhere and be fully covered. Those systems are paid for via taxes which have the ability to capture enough money from everyone and if you can afford more expensive things, you pay more into the system.

Insurance companies only exist to make money, they have no other function in the process of providing healthcare, and they rake it in. Why do we put up with these middlemen? And why is 'taxes' such a dirty word? We all saw how the creators of Obamacare avoided naming any of it 'taxation.'

Obamacare wasn't universal coverage, it just forced people to get insurance plans, making them provide permanent profitability for these useless and costly (in many ways) companies.

We failed.

Edit: added '(health)' to title

 

[smackababy]

No, her doctor needs to go, not insurance companies.

 

[sactoking]

1) What requirements doesn't she meet? It's a guaranteed availability, guaranteed issue, guaranteed renewability world now, so she shouldn't be being denied.

2) "Short version: her doctor only accepts two insurance plans." Is that the insurers' fault?

 

[nickbits]

UHC isn't perfect either. I've had better service using insurance in the US than when I was covered by UHC.
All people do in Canada is complain how expensive goods are compared to the US. Hmm I wonder why.

 

[Jimzz]

UHC isn't perfect either. I've had better service using insurance in the US than when I was covered by UHC.
All people do in Canada is complain how expensive goods are compared to the US. Hmm I wonder why.

Such as?

 

[minendo]

Get a new doctor or pay cash. Negotiate a rate with her current doctor if she must stay with him.

 

[xeemzor]

The model of the future can be found at http://www.surgerycenterok.com. Clear transparent pricing at 1/8th the current market rate.

 

[poofyhairguy]

Why do we put up with these middlemen?

Because SOMEONE has to be the adult, aka be the "bad guy," and ration care.

Simply put we have too many sick people and not enough top tier doctors, and that shortage in certain specialties will get worse as the baby boomers age. The insurance company acts as a barrier to entry for services for these doctors, plus acts as the "death panel" for patients when further care is a waste.

If we had politicians we could trust who could setup a system we would trust to fairly ration care it would be better, but in America that is a pipe dream. Any system would benefit whoever could donate the most to political campaigns (like our justice system), or whatever demographic swings elections (hello 50+ years of Cuba policy). So the middle ground of insurance companies becomes an unwanted necessity.

The problem in this situation is that your friend's doctor has set a higher standard than she can meet, which means in practical terms she needs to find another doctor. She is lucky this doctor even has any insurance company contracts, so many of the best doctors are going cash only.

Once everyone has to pay cash out of pocket for every piece of decent medical care you will miss insurance companies.

 

[xeemzor]

Once everyone has to pay cash out of pocket for every piece of decent medical care you will miss insurance companies.

Cash pay medical specialties have been forced to innovate rather than stagnate. Look how much it costs for for laser eye surgery vs orthopedics. Not only has the cost come down dramatically but the outcomes have also improved. We need similar market forces to impact other areas of healthcare.

 

[nickbits]

Such as?

Cars, gas, electronics--most consumer goods

 

[boomerang]

I'm helping a friend navigate her healthcare, and the obstacles that keep getting in the way are the insurance companies. Short version: her doctor only accepts two insurance plans. We've been trying to apply, but she doesn't meet the requirements of either plan, which will force her to lose her doc.

I understand their requirements are to keep costs down in deference to the shareholders but in doing so they have created a system of 'locked down' providers and facilities. In universal healthcare systems you can go to any doctor anywhere and be fully covered. Those systems are paid for via taxes which have the ability to capture enough money from everyone and if you can afford more expensive things, you pay more into the system.

Insurance companies only exist to make money, they have no other function in the process of providing healthcare, and they rake it in. Why do we put up with these middlemen? And why is 'taxes' such a dirty word? We all saw how the creators of Obamacare avoided naming any of it 'taxation.'

Obamacare wasn't universal coverage, it just forced people to get insurance plans, making them provide permanent profitability for these useless and costly (in many ways) companies.

We failed.

Maybe there is something wrong with the website? We were told repeatedly that we could all keep our Doctor. I suspect that the website is just having issues. Try back later today or tomorrow. There is no way she will have to give up her Doctor after all those promises.

 

[poofyhairguy]

Cash pay medical specialties have been forced to innovate rather than stagnate. Look how much it costs for for laser eye surgery vs orthopedics. Not only has the cost come down dramatically but the outcomes have also improved. We need similar market forces to impact other areas of healthcare.

Agreed. Transparency in pricing and the removal of the insurance layer does allow market forces to give competitive care to those who have cash. The issue is that the insurance companies often like to set reimbursement amounts for a region based upon the average local price, so if in a market many of the practices get competitive on the listed price they inadvertently take a haircut on their insurance checks.

In smaller markets I have seen the specialists collude with each other to keep prices high for this reason. The practical outcome is that if a procedure is not covered by insurance (say LASIK in your example) you get a competitive price, but in the exact same practice a covered procedure might have a list price 3 times what the doctor expects to get in cash. That is why places that do cash pay pretty much have to opt out of the entire insurance system completely, they can't afford a mixed clientele. Some basically just end up giving cash discounts on the backend- aka not turning people over to collections and cutting deals instead.

Mix this element with the entitlement of many people who expect health care to be free, and you have a situation where top tier care is going to be completely inaccessible for middle class America which is a shame. Already so many doctors don't take Medicaid that it is a major coverage problem in some states, so just cutting out the "middle man" of insurance may make things worse quickly.

 

[xeemzor]

Agreed. Transparency in pricing and the removal of the insurance layer does allow market forces to give competitive care to those who have cash. The issue is that the insurance companies often like to set reimbursement amounts for a region based upon the average local price, so if in a market many of the practices get competitive on the listed price they inadvertently take a haircut on their insurance checks.

In smaller markets I have seen the specialists collude with each other to keep prices high for this reason. The practical outcome is that if a procedure is not covered by insurance (say LASIK in your example) you get a competitive price, but in the exact same practice a covered procedure might have a list price 3 times what the doctor expects to get in cash. That is why places that do cash pay pretty much have to opt out of the entire insurance system completely, they can't afford a mixed clientele. Some basically just end up giving cash discounts on the backend- aka not turning people over to collections and cutting deals instead.

Mix this element with the entitlement of many people who expect health care to be free, and you have a situation where top tier care is going to be completely inaccessible for middle class America which is a shame. Already so many doctors don't take Medicaid that it is a major coverage problem in some states, so just cutting out the "middle man" of insurance may make things worse quickly.

The most successful route so far has been cash pay doctors take is cutting deals with self-funded employers to direct employees to their facilities in exchange for favorable rates. In real life case studies where companies have formed there relationships with the doctors the total surgical spend was cut 50%, total medical spend was cut 13%, and outcomes were improved. This even takes into consideration that the employer paid for travel costs and waived co-insurance, co-pays, and deductibles. I highly recommend that you check out the source material here: http://www.kemptongroup.com/KemptonMain/member-resources/kempton-premier-providers.php for more information.

It's a tough sell but if you can get all the stakeholders on the same page everyone wins(except useless insurance companies). Fortunately the savings are high enough that companies will eventually have to move to a similar model to remain competitive. Small companies are already moving towards healthcare co-ops as we speak because of much they are getting screwed in the current market.

 

[nickbits]

The model of the future can be found at http://www.surgerycenterok.com. Clear transparent pricing at 1/8th the current market rate.

No heart or brain surgery?!

 

[poofyhairguy]

The most successful route so far has been cash pay doctors take is cutting deals with self-funded employers to direct employees to their facilities in exchange for favorable rates.

So kinda like a HMO without the HMO middleman? That works fine for many people who don't care who their doctor is or where she is as long as the care is free. For people like OP who have a specific doctor, or people who commute into metro areas, it wouldn't be a good solution.

Also I would be wary about what would happen if you needed emergency care while on vacation in a place where that medical system has no footprint. It seems like for this to work there would have to be a MAJOR consolidation of medical practices and care facilities, which to be fair is happening anyway.

Thank you for the link, I will read into it and see if any of my questions are answered.

 

[xeemzor]

No heart or brain surgery?!

The focus has been on outpatient surgery to start but they have been partnering with local hospitals to provide transparent pricing on inpatient care.

A list of heart surgery procedures at the Oklahoma Heart Hospital can be found here: http://www.kemptongroup.com/Kempton...spital Qualified Procedures for Prem Prov.pdf. There are currently no prices on that PDF because they are in the process of working out some of the legal constraints BUT you can call them up and ask for a quote. Typically they can give you something in 24-48 hours. Hopefully they will be able to publish all pricing information shortly.

 

[brianmanahan]

The model of the future can be found at http://www.surgerycenterok.com. Clear transparent pricing at 1/8th the current market rate.

wow, it would be amazing if a system like this became commonplace!

 

[CPA]

Those systems are paid for via taxes which have the ability to capture enough money from everyone and if you can afford more expensive things, you pay more into the system.

Sorry, but Fuck that! Please explain how the ability to afford more expensive things should have anything to do with paying for someone else's healthcare.

 

[boomerang]

Color me a pessimist but you guys know where this is going to lead don't you? If enough healthcare providers start coloring outside of the lines, the feds are going to step in and put a stop to it. I know this is not P&N so I will make it short and sweet. If you think the primary goal of the ACA was healthcare reform, you haven't been paying enough attention to the changes occurring in the nation. Single payer will not accomplish the goal of the ACA either. Do some thinking. Why did we get the legislation we got? Think.

 

[brianmanahan]

No heart or brain surgery?!

my brain surgery ran well over 100$k, and that was 10 years ago

 

[Sho'Nuff]

I'm helping a friend navigate her healthcare, and the obstacles that keep getting in the way are the insurance companies. Short version: her doctor only accepts two insurance plans. We've been trying to apply, but she doesn't meet the requirements of either plan, which will force her to lose her doc.

I understand their requirements are to keep costs down in deference to the shareholders but in doing so they have created a system of 'locked down' providers and facilities. In universal healthcare systems you can go to any doctor anywhere and be fully covered. Those systems are paid for via taxes which have the ability to capture enough money from everyone and if you can afford more expensive things, you pay more into the system.

Insurance companies only exist to make money, they have no other function in the process of providing healthcare, and they rake it in. Why do we put up with these middlemen? And why is 'taxes' such a dirty word? We all saw how the creators of Obamacare avoided naming any of it 'taxation.'

Obamacare wasn't universal coverage, it just forced people to get insurance plans, making them provide permanent profitability for these useless and costly (in many ways) companies.

We failed.

Politics and News is that way ->>>>>>>>>>

Since you asked why taxes are a bad thing, the (likely correct) assumption is that you either do not have a job or you do not make a decent living. If it was any other scenario, you would understand why taxes are bad. I make a decent living and I take home exactly 49% of what I earn. So no. I don't want to give MORE of my money to a system that will just squander it.

Also - there are very few (if any) things that the federal government will do more efficiently than private industry. Healthcare is not an exception. Just look at the chumps who are backpedaling re: the ACA, saying it was "never meant" to make healthcare more affordable. Dipsh!t, its called the "affordable" care act.

 

[brianmanahan]

Politics and News is that way ->>>>>>>>>>

actually

<------------------- it's that way :whiste:

 

[xeemzor]

wow, it would be amazing if a system like this became commonplace!

I'm in the process of trying to make it more common in Illinois, Indiana, and Ohio. PM me if you want to know more.

 

[Sonikku]

Getting awfully tired of doctors getting in between patients and their insurance companies.

 

[Ns1]

Well, she can always pay cash for medical care.