Why (health) insurance companies must go

[SparkyJJO]

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

Wow you got ripped off. I think they gave you the wrong brain

 

[KeithTalent]

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.

We do? Thanks for letting me know.

KT

 

[xeemzor]

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.

Right now the plan structure does not take away any benefits. If you could see the same doctor before you would still be able to see him after the switch. This simply gives employees skin in the game and incentive to shop around and chose value based care. It isn't the solution for everyone but it goes a long way in reducing costs.

There will always be a need for insurance in the healthcare marketplace but it should be limited to catastrophic and emergency care.

 

[smackababy]

Well, she can always pay cash for medical care.

But, then she would have to pay the bulk of her medical costs, and that is something she (and most people) are unwilling to do. She'd rather pay a company some money every month who then pledges to pay a significant portion of her medical costs should she incur them. And, the OP thinks we should have the government subsidize health care because some doctors don't take the insurance she has.

 

[SunnyD]

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

Wow, that's great!*

*The fine print include:

A list of what is NOT included in the fee is as follows:
Any diagnostic studies necessary prior to the surgery such as lab, MRI, X-rays, consultations with specialists to determine medical risk/management, physical therapy and rehabilitation.
Any hardware or implants necessary for completion of the procedure (plates and screws, e.g. for orthopedic procedures). This price information will be provided prior to surgery but subsequent to the surgical consultation. Our experienced surgical staff knows with almost certainty what will be needed to complete your surgery and this hardware or implants will be provided to you at invoice cost without any markup whatsoever. Copies of the invoices will be provided to you.
Any overnight stay at our facility can be arranged on a case-by-case basis for an additional charge. Lodging and travel expenses are not included in the price of the procedures.
Expenses or fees resulting from complications subsequent to the completion of the surgery and discharge from the facility are also not included.

And what, pray tell, happens when you don't have that $10k they want up front for your cardiovascular surgery (not including the aforementioned fine print) that your insurance and in-patient co-pays cover in a traditional medical environment?

Yeah, this model is a non-option for the vast majority of Americans who can't even afford to pay for a used car outright let alone necessary medical care out of pocket.

 

[glenn1]

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

This, OP friend isn't some special snowflake and neither taxpayers or anyone else owes her shit, much less her choice of doctor.

 

[xeemzor]

Wow, that's great!*

*The fine print include:

A list of what is NOT included in the fee is as follows:
Any diagnostic studies necessary prior to the surgery such as lab, MRI, X-rays, consultations with specialists to determine medical risk/management, physical therapy and rehabilitation.
Any hardware or implants necessary for completion of the procedure (plates and screws, e.g. for orthopedic procedures). This price information will be provided prior to surgery but subsequent to the surgical consultation. Our experienced surgical staff knows with almost certainty what will be needed to complete your surgery and this hardware or implants will be provided to you at invoice cost without any markup whatsoever. Copies of the invoices will be provided to you.
Any overnight stay at our facility can be arranged on a case-by-case basis for an additional charge. Lodging and travel expenses are not included in the price of the procedures.
Expenses or fees resulting from complications subsequent to the completion of the surgery and discharge from the facility are also not included.

And what, pray tell, happens when you don't have that $10k they want up front for your cardiovascular surgery (not including the aforementioned fine print) that your insurance and in-patient co-pays cover in a traditional medical environment?

Yeah, this model is a non-option for the vast majority of Americans who can't even afford to pay for a used car outright let alone necessary medical care out of pocket.

And what's wrong with any of the terms of conditions? Nothing there seems unreasonable at all and the total cost of surgery is still 1/8th of the market rate. It's also far less egregious than what you agree to when getting a procedure done at a traditional hospital.

Keep in mind that even if patients don't pay the true cost of care self-funded employers do. Because employers are able to save a huge amount of money with this model they are able to pass on enormous savings to employees. From the employee perspective they have cheaper deductibles, "free" care, and better coverage. It's not like the average patient is paying $10,000 out of pocket most of the time. Oklahoma county has already saved thousands.

 

[brianmanahan]

Wow you got ripped off. I think they gave you the wrong brain

they took a baseball-sized piece out and didnt even give me anything to replace it with!

unfortunately it was word memory too... my pomes would probably be twice as good if i still had a whole brain :\

 

[bradly1101]

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.

She's not in the right age range for one and her supplemental deductible is too high for the other.

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

It's the insurance companies that set these restrictions.

 

[bradly1101]

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.

Yes, the insurance lobby is most powerful.

She's changing to a doctor that the insurance company approves of, but she really liked that doctor.

 

[bradly1101]

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.

Because we live in a society.

 

[cabri]

Yes, the insurance lobby is most powerful.

She's changing to a doctor that the insurance company approves of, but she really liked that doctor.

Insurance company has rules/restrictions that the MD office refuses to work with.

So either change insurance to what the MD office will work with, pay cash or switch MDs.

Looks like she has decided on the last option.

 

[Jeff7]

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.

Replace "healthcare" with <government service of choice>. I pay for lots of roads I don't use. I pay a lot for bailouts of wealthy, corrupt banks that I don't use. I pay for bridges I've never even seen. I pay for warheads and aircraft that have never been used against an enemy military force.
But I draw the line at paying anything to help ensure the long-term health of other human beings. That's just bullshit.

If you were stupid enough to be involved in an accident that someone else caused, or were born with a genetic predisposition for heart problems or cancer, or end up with a chronic illness from a pathogen you're unable to see, you had better be able to afford care on your own. If not, you should have done a better job of avoiding unfortunate circumstances you have no control over, and you deserve the early death you may well face.









What certainly makes the situation difficult is that we are very tolerant of corruption in the US, in politics, medicine, commodities, and elsewhere. Organizations and individuals with billions of dollars to spare mean that it's easy to buy your own politician, and also easy to buy the public's approval.

For example, WellPoint, one of the largest private payers for health care, recently outlined designated treatment pathways for cancer and announced that it would pay physicians an incentive of $350 per month per patient treated on the designated pathway.

Act in the best interest of the cash incentive. It'll help pay for the lofty burden of malpractice insurance.

God our system's screwed up.




.

 

[JMapleton]

Everyone wants top tier healthcare. I do too. But there is only so much to go around.

We need different tiers of healthcare. Different tiers of quality so that everyone can afford some healthcare because some is better than none.

If you're poor, maybe you'll have to share a room with someone. An older building. Longer wait lines, etc.

This notion that we can give literally every human in the US top top notch healthcare is not logical. We need a "value" level of healthcare that can service the masses for a reasonable price.

It is economically impossible to give everyone the same healthcare a king or president would receive.

 

[xeemzor]

Everyone wants top tier healthcare. I do too. But there is only so much to go around.

We need different tiers of healthcare. Different tiers of quality so that everyone can afford some healthcare because some is better than none.

If you're poor, maybe you'll have to share a room with someone. An older building. Longer wait lines, etc.

This notion that we can give literally every human in the US top top notch healthcare is not logical. We need a "value" level of healthcare that can service the masses for a reasonable price.

It is economically impossible to give everyone the same healthcare a king or president would receive.

Or maybe healthcare shouldn't have artificially inflated prices, insane regulations, and dumb business structures? The average doctor spends 22% of their time on useless paperwork when they should be focusing on patient care. Cut out the middlemen and you increase access for all.

 

[Nocturnal]

Or make it so that it's cross country like Statefarm can sell in all 50 states same for a single insurance company.

 

[Slew Foot]

i would absolutely LOVE to put a price list out and charge people my rate. unfortunately, people dont want to pay for healthcare, theyd rather pay into some mysterious fund and then have that fund give them "free" care.

 

[xeemzor]

i would absolutely LOVE to put a price list out and charge people my rate. unfortunately, people dont want to pay for healthcare, theyd rather pay into some mysterious fund and then have that fund give them "free" care.

It's not random people you should be targeting. Self-funded employers absolutely do care about the cost of care and have been incentivizing their employees to shop around. The case studies have proven that employees/patients absolutely will modify their behavior when they have skin in the game.

Since you are doctor I would highly recommend looking into the Free Market Medical Association. Their annual conference is August 21st-22nd and it's an amazing experience.

 

[Jeff7]

i would absolutely LOVE to put a price list out and charge people my rate. unfortunately, people dont want to pay for healthcare, theyd rather pay into some mysterious fund and then have that fund give them "free" care.

Psychology.
Same sort of thing with Amazon Prime. It's already paid for, so you'll go ahead and use it. And it means that you don't have to worry about shipping costs throughout the year, even though any extra costs are massaged into the whole price structure.


"Ow, my abdomen still hurts. I should probably get it checked out. Buuuuut that's also going to cost at least $50 for the doctor visit without even having any tests done. I guess it can wait."

"Damn, two weeks have passed and it hasn't gotten any better. I bet the doctor will need to send some blood out for lab testing. That'll definitely be another $300. Not worth it yet. I'll just use some aspirin and hope it helps."



Meanwhile, an abnormal mass of cells the size of a softball has quietly made itself comfortable just outside the winding neighborhood of your small intestine.


versus:


"Screw it, it's already paid for, I'll get this ache checked out. And I might as well see if they want to do anything about this mole that just showed up on my arm."





Then there are the really complicated and expensive procedures, which is where insurance can be a literal lifesaver.
Sort of like this: Life does crappy things sometimes. Bad things happen out of nowhere.
Life is a sniper atop a building, and everyone else just goes about their business. Then Life randomly selects someone and takes the shot. Without insurance, each person relies on the personal bulletproof vest that they can afford. If what that person has is not enough, they die on the spot.
But with insurance socializing risk, everyone in the group feels a small twinge of pain when the bullet hits, and the targeted individual survives one of Life's random acts.

 

[sactoking]

She's not in the right age range for one

So it's a Medicare Advantage plan? B/c that's the only thing I can think of off the top of my head that's private market and allows age restrictions.

It's the insurance companies that set these restrictions.

Insurers are not dictating to doctors that they can't accept other plans. That's an unfair trade practice subject to state regulation.

 

[waterjug]

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.

I'm in business school and we actually learned about insurance effects on pricing of medical procedures in my basic econ class. They used the example of appendectomies vs. breast augmentations (in non post-mastectomy cases). The latter's price has increased about 20% over the past twenty years. For appendectomies it was like a 120% increase.

 

[SparkyJJO]

Or maybe healthcare shouldn't have artificially inflated prices, insane regulations, and dumb business structures? The average doctor spends 22% of their time on useless paperwork when they should be focusing on patient care. Cut out the middlemen and you increase access for all.

You know who a big player is in all the excess crap that raises costs?

The government.

Seriously, the multiple levels of stupidity and excess crap that Medicare requires is mind-boggling. I didn't realize it at first until I got a job with a company that deals with Medicare regularly. Holy crap the rules they put in place are utterly retarded. For example, Medicare MUST be quoted the lowest price of anyone. No one can get a lower base price. HOWEVER, Medicare also will then just turn around and pay a fraction of that price anyway. We're talking half or less at times. This results in pricing having to be raised by a fair bit just to even cover actual costs.

This is one reason (of many others) that healthcare costs what it does. The government is part of the problem. They'll never "solve" it, so running to them as if they will is utter folly.

 

[KeithP]

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....

You are truly delusional if all you see is wine and roses with universal healthcare.

-KeithP

 

[JMapleton]

Or maybe healthcare shouldn't have artificially inflated prices, insane regulations, and dumb business structures? The average doctor spends 22% of their time on useless paperwork when they should be focusing on patient care. Cut out the middlemen and you increase access for all.

I agree with all that. But even with that, we need more "value" oriented healthcare for the masses.

 

[bradly1101]

I agree with all that. But even with that, we need more "value" oriented healthcare for the masses.

The thing is is that with insurance companies in control there's so much more unnecessary overhead. I think that's a big part of the reason health-care is so outrageous

Obama campaigned on having a 'government option' that would presumably bypass high profits, but he later lied and when it came down to negotiating the bill with the powerful insurance lobby he said he never campaigned on that. I saw it right there on his website during the Democratic primaries.