During the health care reform debate, we wrote that most people’s attitudes to it were “confused, conflicted, clueless and cranky.” A major reason was that the American health care “system” is fiendishly complicated and few people really understand it. As a result hardly anyone knows much about what is actually in the reform bill (but that does not prevent them from having strong opinions about it). Sadly, the reforms, whatever their merits, will make the system even more complicated, the administration more Byzantine and the regulatory burden more onerous.
System complexity.
The American healthcare system is already by far the most complex and bureaucratic in the world. We were once asked to spend ninety minutes explaining American health care to a group of foreign health care executives. Ninety minutes? We probably needed a few weeks. Most other countries have relatively simple systems, whether insurance coverage is provided by a government plan or by private insurance or some combination of these. But in the United States insurance coverage, for those who have it, may be provided by Medicare Parts A, B, C, and D, 50 different state Medicaid programs (or MediCal in California), Medicare Advantage, Medigap plans, the Children’s Health Insurance Plan, the Women, Infants and Children Program, the Veterans Administration, the Federal Employees Health Benefits Program, the military, the hundreds of thousands of employer-provided plans and their insurance companies, or by the individual insurance market. This insurance may be paid for by the federal or state governments, by employers, labor unions or individuals. Some employers’ plans cover retirees, others do not. The result is that the system is pluralistic, mysterious, capricious and impossible for most patients and providers to understand.
Administrative complexity
The administrative complexity is amplified by the multiplicity of insurance plans. About half of all Americans with private health insurance are covered by self-insured plans, each with its own plan design. Employers customize their plan documents, led by consultants who make a good living designing their plans and tailoring their contracts. As one prominent consultant told us recently, if all the self-insured plan documents were piled on a table they would not just exceed the 2,700 pages of Obamacare, they would probably reach the moon. For the rest of the commercially insured population, health plans may be traditional indemnity plans, Preferred Provider Organizations or Health Maintenance Organizations.
The coverage provided by different plans varies dramatically. They may or may not include large or small deductibles, co-pays or co-insurance. Beneficiaries may pay a large, small or no part of their health insurance premiums. Some plans cover dependent family members and children, others do not. The Medicare Part D pharmaceutical benefit plan involves a “doughnut hole,” which will disappear as health reforms are implemented. Surveys have found that few people fully understand their own insurance plans let alone the bigger picture. While health reform takes some steps toward standardization of insurance offerings and improving transparency, overall it is likely to increase complexity.
Physicians may be paid by salary, fee-for-service, or capitation, with “pay for performance” bonuses based on complicated metrics. In order to get paid, most doctors and hospitals have to use many thousands of codes to describe the care they have delivered. Doctors can spend hours a day doing this; hospitals employ tens of thousands of coders; insurance companies and government programs spend a small fortune entering and checking this coding. A substantial proportion of payment claims are disputed, further increasing administrative costs and the “hassle factor.”
Some insurance companies are for-profit, some are not-for-profit. Hospitals may be for-profit, not-for-profit charities or be run by federal government agencies such as the VA or the DOD or by cities.
The administrative complexity exists in the private and public sectors and in both for-profit and non-profit organizations. Medicare is relatively efficient because it has a simple criterion for eligibility – your age (although it also covers people with disabilities). But for many of us administrative complexity is rampant because health insurance is a function of our jobs or our income (or lack of it). Our insurance changes often (because our employers change their plans, because we change jobs or because our income changes), far more often than it does in other countries. As a result we have armies of people who sell insurance, keep track of who is eligible for what, chase, authorize or deny payments, and lob faxes, emails and assorted missives at us and each other. In Los Angeles County, 1,900 people work on nothing but MediCal eligibility with a union-mandated productivity target of completing two forms a day. There are an estimated 150,000 such eligibility workers across the country. The health reform bill proposes to expand Medicaid by 16 million so the number and cost of these workers will surely increase.
Regulatory complexity
Different parts of the health care system are managed or regulated by dozens of Federal government and state agencies, including the Department of Health and Human Services, the Center for Medicare and Medicaid Services, the Centers for Disease Control, the Veterans Administration, the Food and Drug Administration, and the Agency for Healthcare Research and Quality. One report claims that the health care reform bill will create 183 new agencies, including state insurance exchanges and a Medicare Independent Payment Advisory Board (IPAB) and the Center for Medicare and Medicaid Innovation.
And then there are the acronyms. If you don’t know them you will not understand much of the health policy debate: PPACA, DHSS, FDA, CMS, VA, CDC, AHRQ, SRG, MLR, HMO, PPO, PBM, COBRA, P4P, CER, EMR, HIT, DRG, FEHBP, WIC, CHIP, DSH, MMA, and many more.
We believe that this complexity is a major reason why we have (and this is very well documented) the most expensive, inequitable, inefficient and unpopular health care system of any developed country, with poor to mediocre outcomes. The problem is not the doctors or the hospitals but the system. Reimbursement, with its many thousands of points of public and private sector payment and the mindboggling payment rules, creates a bow wave of administrative costs and many perverse incentives. And these costs are the incomes of powerful interests who fight to preserve them.
The American “system” is exponentially more complicated than the systems in other countries – and the reforms will make it even more complicated. Unfortunately reform that would simplify the system is probably not politically feasible. A benign dictator might scrap the system and start over with a much simpler system. But in a democracy, with powerful interests and 17% of our economy involved, “you can’t get there from here.” We have to build on what we have, heaping complexity on complexity.
It is therefore no wonder that surveys find most people (including, it would appear, many members of Congress) understand very little about the health care system let alone health care reform. A recent Harris poll asked people which of 18 items are or are not in the reform bill. Modest majorities were able to give the right answer for only 4 of the items. And pluralities got the answer wrong on nine of the items. For example pluralities believed that the bill includes higher income taxes for the middle class, new ways to ration care, a new government run health plan, cuts in Medicare benefits, increased payroll taxes and “death panels”.
Of course, many millions of people followed the reform debate with interest and passion, but because the issues were so complicated, very few of them understood them. Which is why rhetoric often trumped substance, and misinformation often fuelled strong opinions. And why American health care is likely to be extraordinarily inefficient and expensive far into the future.
Humphrey Taylor is Chairman of the Harris Poll.
Ian Morrison is a healthcare consultant in Menlo Park, California.
Filed Under: OP-ED, Pharma, THCB
Tagged: Complexity, Doughnut Hole, Harris Poll, IPAB, Regulation, US Healthcare system Mar 24, 2011
comic relief can be of great value and service. There could be someone right now having an epiphany, made possible by the clear mind of a good laugh. They won’t give you or I any credit of course but we will know.
In regards to the quote do you believe it holds true more often then not? It does pretty well sum up most religious and popular movements. I would be much harder to come up with leaders who countered the argument then those that did. I don’t know when it was written but Pol Pot, Moa, Hitler, Stalin all had millions die under their….ideology? or what ever you want to refer to it.
Besides mid evil heros riding back and forth on their horses in movies who ever has asked for sacrafice and given it?
Just wanted to add a perspective to the mix. Complexity is a symptom, not a diagnosis. The diagnosis as to why we have so much complexity can be found in the insurance concept of “float.” Investing float (monies held by the insurance company that is not paid out immediately) is how an insurance company makes its profits. It behooves an insurance company to make a complex system so that claims are not billed efficiently (how many coding errors are made in billing?) or paid efficiently. The government does a different variant of this by spending today’s healthcare tax dollars into other immediate priorities (like creating loopholes so that GE does not have to pay any corporate taxes) and deferring payments for healthcare (by accruing more debt, raising the debt ceiling, etc).
Investors know and utilize the concept of float very well. It’s why Warren Buffett is one of the richest men in the world (Berkshire Hathaway owns GEICO. Mr. Buffett has the privilege of investing billions of dollars of float). Automatic Data Processing (ADP) makes it’s money off of investing the float from their HR operations. The point is that insurance companies will make money for the advantage of their shareholders; complexity will reign because it allows them to make more money. The government will also use healthcare tax dollars for their own political purposes and complexity allows them to fund their projects instead of efficiently paying claims; they also cannot be trusted with float.
To reduce complexity in the system, float has to be controlled and limited. The only long-term solution to reduce healthcare complexity is for patients and providers to have a more direct financial relationship that limits the ability for third parties to control larger and larger sums of money (float).
“oh…thats right, we can’t look at the rules becuase they don’t exist ANYWHERE but in the Obama Administration.”
Since I can’t post a link without get a “waiting for moderation” notice I’ll have to post the contents of the link for you Nate, if you bother to read it, as I can see you didn’t read the above “Waiver Criteria”.
Testimony
Statement by
Steven B. Larsen, J.D.,
Deputy Administrator and Director
Center for Consumer Information and Insurance Oversight
Centers For Medicare and Medicaid Services
on
Obamacare: Why the need for Waivers? (Annual Limits Bridge Program)
before
U. S. House Committee on Oversight & Government Reform
Subcommittee on Health Care, District of Columbia, Census, and The National Archives
U.S. House of Representatives
Tuesday, March 15, 2011
“Chairman Gowdy, Ranking Member Davis, and Members of the Subcommittee, thank you for the opportunity to discuss the Department of Health and Human Services’ work implementing the Affordable Care Act. I serve as Deputy Administrator and Director of the Center for Consumer Information & Insurance Oversight (CCIIO) within the Centers for Medicare & Medicaid Services (CMS). Since taking on this role, I have been involved in CCIIO’s implementation of many of the provisions of the Affordable Care Act, including overseeing private health insurance reforms, assisting States to implement Health Insurance Exchanges (Exchanges), and ensuring that consumers have access to information about their rights and coverage options. Prior to becoming the Director of CCIIO, I served as the Director of the Office of Oversight within CCIIO, which is charged with working with the States to ensure compliance with the new insurance market rules, such as the prohibitions on rescissions and pre-existing condition exclusions for children, as well as ensuring consumer value for premium payments through the medical loss ratio standards and the enforcement of the new restrictions on annual dollar limits on benefits.
As a former State Insurance Commissioner, I understand the key role that States play in the regulation of insurance and insurance markets. I have seen first-hand the importance of holding insurance companies accountable, and understand the need to make quality, affordable coverage more accessible to all health care consumers. I have also served as an executive in a for-profit, publicly-traded managed care company, and understand the need for competitive and robust markets as well reasonable regulations. The Affordable Care Act appropriately balances these objectives.
At this time last year, Congress passed and the President signed into law the Affordable Care Act, which expands access to affordable, quality coverage to over 30 million Americans and strengthens consumer protections to ensure individuals have coverage when they need it most. Immediate reforms include a critical foundation of patients’ rights in the private health insurance market that help put Americans in charge of their own health care. Over the past year, we have already implemented historic private market reforms including eliminating pre-existing condition exclusions of children, prohibiting insurance companies from rescinding coverage absent fraud or intentional misrepresentation of material fact and from imposing lifetime dollar limits on coverage, and enabling many dependent young adult children to stay on their parent’s insurance plan up to age 26. The Affordable Care Act also established new programs to expand and support coverage options, including the Pre-Existing Condition Insurance Plan (PCIP) and the Early Retiree Reinsurance Program (ERRP).
Beginning in 2014, State-based health insurance Exchanges will improve access to affordable, quality insurance options for Americans who previously had no health insurance coverage or inadequate coverage. The Exchanges will make purchasing private health insurance coverage easier by providing individuals, families, and small businesses with “one-stop shopping” on a single, easy-to-use website. On the website, American consumers, businesses, and other organizations will be able to compare a range of plans. Eligible individuals will also have new premium tax credits and cost-sharing reductions available to them to make coverage more affordable. By increasing competition between insurance companies and allowing individuals and small businesses to band together to purchase insurance, Exchanges will help to lower health care costs for consumers.
Today, millions of Americans are already benefiting from the Affordable Care Act. Many parents across the country are able to protect their dependent young adult children by allowing them to stay on a parent’s plan until they are 26 years old. We estimate that, in 2011, more than 1.2 million young adults will be able to maintain insurance coverage through their parent’s health plans because of this new policy. This is an important protection for these young adults and a huge relief for their parents.
We estimate that more than 31 million Americans will benefit from the preventive services provision of the Affordable Care Act, which requires that important early detection services like mammograms and colonoscopies be available to Americans enrolling in new plans without expensive co-pays or deductibles. Furthermore, insurers are no longer permitted to rescind insurance policies simply because a consumer made an inadvertent error on a form. These changes are putting consumers back in charge of their health care and getting insurers out from between patients and their doctors.
Consumers can also use an important new tool to gain access to an unprecedented amount of information about insurance options and public programs available to them by zip code. In eight months, http://www.HealthCare.gov has had more than 4 million visitors and the number of insurance options listed continues to grow rapidly. Visitors can get information in plain English – and Spanish – about the coverage options available to them, their protections, and their rights as health care consumers.
As mentioned previously, States play a crucial role in the implementation of the Affordable Care Act. Since enactment, we have worked actively with the Governors, insurance commissioners, Medicaid directors, and other stakeholders to implement programs that are helping consumers and businesses with coverage. It has been our priority to work collaboratively with our State partners as the provisions of the Affordable Care Act go into effect.
States were critical to our efforts to write regulations implementing the new medical loss ratio provisions of the Act. The National Association of Insurance Commissioners (NAIC) worked for nearly six months to develop uniform definitions and methodologies for calculating MLR. Their process included significant input from the public, States, and other key stakeholders, and was approved unanimously by the NAIC Commissioners. HHS certified and adopted the NAIC recommendations and the reaction from consumers and insurers has been very positive. Starting this year, insurers must spend at least 80 or 85 percent of premium dollars, depending on the market, on health care and quality improvement efforts instead of CEO bonuses, profits, or marketing. And those that do not meet this standard will be required to reduce their rates or provide rebates to their customers. In addition, the Department recognizes State flexibility. The law allows for a temporary adjustment to the individual market MLR standard if the State requests it and demonstrates that the 80 percent MLR standard may destabilize their individual insurance market.
This MLR provision ensures consumers receive value for their premium dollars and encourages insurers to invest in the health of their policyholders, while maintaining insurance market stability. There are signs that this provision has already helped to moderate premium increases.
Rising insurance costs have made it difficult for American employers to provide quality, affordable coverage for their workers and retirees while also remaining competitive in the global economy. The Early Retiree Reinsurance Program serves as one bridge to the new Exchanges that will become available in 2014. Many Americans who retire before they are eligible for Medicare and without employer-sponsored insurance see their life savings disappear because of the high cost of insurance in the individual market. Millions more see their insurance disappear, leaving them vulnerable to high costs and poor quality care. The ERRP provides much-needed financial relief for employers so early retirees and their families can continue to have quality, affordable insurance. More than 5,000 employers – including many State and local governments – have been accepted into the program from all 50 States and the District of Columbia.
The Pre-Existing Condition Insurance Plan program is another bridge to 2014, when all Americans, regardless of health status, will have access to affordable coverage. PCIP provides a lifeline to uninsured Americans who private insurers have refused to insure because of a pre-existing condition. These Americans can now receive health coverage without limitation on benefits or higher premiums because of their condition. Thousands of Americans who were locked out of accessible private insurance coverage before the passage of the law now have this valuable and needed coverage. I’m pleased that enrollment has increased by 50 percent in the last few months, and we expect it to grow. The Department is actively working with States, consumer groups, chronic disease organizations, health care providers, social workers, other Federal agencies, and the insurance industry to promote the program, including holding meetings with State officials, consumer groups, and others.
Finally, for Americans who receive insurance in the individual and small group markets, the Affordable Care Act should result in more protections from unreasonable rate increases. The law provides $250 million to strengthen States and Territories’ ability to review proposals by private health insurance companies to raise their rates for small businesses, individuals, and families. Since enactment, $45 million has been distributed to 44 States and the District of Columbia, and, in February, $205 million in additional funding was made available to States, the District of Columbia, and Territories to continue such efforts. We are committed to working with States, the District of Columbia, and Territories, who are the primary regulator of insurance rates and solvency.
The Bridge to 2014
As Director of CCIIO, I am committed to continued improvement of the health insurance system so that it works for consumers both now and with the additional reforms that start in 2014. It is essential that we make sure that Americans who have insurance today – even if that insurance is highly limited – can keep that coverage until reforms take effect that will increase their ability to choose among comprehensive, affordable insurance options in 2014.
As part of our package of consumer protections called the Patient’s Bill of Rights, we began implementing the Affordable Care Act’s phase-out of limited benefit insurance products – a subject area that you have asked me to discuss. When consumers are covered under health plans with limited benefits, consumers do not always have access to coverage when they need it. In some cases, policies have “lifetime” dollar limits on benefits, and in some cases, insurers have “annual” limits or dollar-amount caps on what the policies will pay during a single year for the benefits that they cover. In 2009, over 100 million Americans were in private health insurance plans with a lifetime limit, and roughly 18 million Americans were enrolled in a plan with an annual limit.
The Affordable Care Act prohibits lifetime limits in all health insurance plans starting in new plan years on or after September 23, 2010. It also provides that, as of January 1, 2014, no group health plan or any individual market plan that is not a “grandfathered” plan may have annual limits on coverage. However, Congress recognized that there should be a transition period between now and 2014, when the Exchanges will be up and running, during which annual limits would be phased out. Section 2711 of the Public Health Service Act provides that group health plans and issuers may continue to impose a “restricted” annual limit with respect to essential health benefits until the consumer protections take effect in 2014. More importantly, the statute directs the Secretary to define “restricted annual limit” during the interim period in a way that will “ensure that access to needed services is made available with a minimal impact on premiums.” This statutory directive recognizes that, for some health plans, an immediate transition to high or no annual limits could significantly raise premiums or reduce coverage with adverse consequences. Therefore, the Secretary must address this concern in implementing the provision during the transition years between passage of the Affordable Care Act and the availability of new quality, affordable options in 2014.
In June of last year, we issued regulations providing that the “restricted annual limit” is $750,000 for group and non-grandfathered individual plans with plan and policy years starting between September 23, 2010 and September 22, 2011. In other words, plans must provide at least $750,000 in coverage for essential benefits such as hospital, physician and pharmacy benefits. The limit will be $1.25 million for plan and policy years starting between September 23, 2011 and September 22, 2012, and $2 million for plan and policy years starting between September 23, 2012 and December 31, 2013. The rising restricted annual limits will increasingly ensure that consumers have coverage when they really need it.
Most group health plans either already exceeded the new restricted annual limits or could comply with the new restricted annual limits with a negligible or minimal impact on premiums or coverage. However, a very small percentage of the market provides coverage below the new annual limits. It is this small percentage of policies in particular that, without an accommodation, would sustain more than a “minimal” impact on premiums or coverage if they were required to provide coverage at or above the annual limits provided for in the regulation.
To be sure, limited benefit plans (also known as “mini-med” plans) can leave consumers with unexpected medical bills in the event of hospitalization or chronic disease. Unfortunately they are the only option that some employers offer to their employees and some individuals can afford in some States. In order to protect coverage for these workers, pursuant to the statutory requirement, CCIIO established a process whereby those plans with annual limits below $750,000 could apply for a one-year waiver from the restricted annual limits. The waiver process, which is grounded in our regulation and fleshed out in subsequent guidance, allows employers and insurers to continue offering limited coverage if they can show that complying with the regulation would cause their enrollees to experience a significant increase in premiums or decrease in access to benefits.
The waiver procedure is administered fairly based on each application’s merits without regard to the type of applicant or size of business, with the goal of minimizing market disruption and maintaining coverage. Guidance on how to apply for a waiver was posted on our website on September 3, 2010. Applicants must submit: 1) the terms of the plan; 2) the number of enrollees; 3) a description of the annual limits; 4) a narrative describing how compliance would lead to a significant increase in premiums or a significant decrease in access to benefits; and 5) an attestation of the facts of the application by the CEO or plan administrator.
We have posted additional guidance detailing the criteria CCIIO uses to determine if the premium increase or access decrease would be significant. Further guidance also lays out specific disclosure requirements that approved applicants must meet. Approved applicants must notify enrollees and potential enrollees of the plan’s annual limits and the fact that the plan does not meet the standards of most plans covered by the Affordable Care Act. This notice is designed to ensure that consumers are aware that their coverage may be inadequate in the event of a catastrophic event or chronic disease.
The annual limit waiver process has been carried out in a way that reflects a commitment to transparency and responsible implementation. CCIIO regularly posts a list of approved annual limit waivers. The list includes the name of the company, the date their application was received, the plan effective date, the number of enrollees covered, the date the application was completed, and the date the waiver was approved.
After we initiated the process in September, applications were received at a relatively steady rate. However, we experienced an expected increase in applications in December, due to the fact that employers and insurers must submit their applications 30 days before the start of their plan year. Many plan years begin on January 1; for that reason we received a large number of applications at the beginning of December. CCIIO worked very hard to ensure that we could process those applications and make timely decisions with respect to these applicants.
As of late February, CCIIO has approved 94 percent of waiver applications received from employers, insurers, and other applicants. The vast majority of waivers, more than 95 percent, were granted to health plans that are job-related. These include self-insured employer health plans, health reimbursement arrangements, collectively-bargained multiemployer plans, and health plans sold by issuers to fully-insured employers.
It is important to note that these limited benefit plans that have received waivers cover an extremely small proportion of the people covered by private health plans in the United States. Since setting up this program, CCIIO has granted waivers to plans covering approximately 2.6 million people, out of the 160 million people who have employer-sponsored health coverage.[1] This figure is less than 2 percent of all covered lives in the private insurance market.
Moving Forward
Until now, very little data were available about these limited benefit plans. We are now analyzing the data we have received through the waiver process and have begun determining what approach we should take for plan years beginning September 23, 2011 and beyond to 2014. We will continue to work in a manner that minimizes market disruption and ensures Americans have health coverage. The overriding purpose of this waiver program is to ensure that Americans do not lose their health coverage before better health insurance options become available in 2014.
As we lay the groundwork for 2014, it is our intention to continue implementing vital consumer protections while offering enough flexibility to ensure that the market is not disrupted. We are proud of all that we have accomplished over the past year and look forward to 2014 when Americans will have access to more affordable, comprehensive health insurance plans without annual limits that cap their benefits. When the insurance market reforms in the Affordable Care Act are fully implemented, limited benefit plans will be a thing of the past.
In the meantime, I look forward to continuing to work on our bridge toward 2014, year after year, strengthening CCIIO’s partnership with Congress, the States, consumers, and other stakeholders across the country. Thank you for the opportunity to discuss the work that CCIIO has been doing to implement the Affordable Care Act.”
You see Nate, the administration is working with states (at their request) and companies, (at their request) to implement this law. As stated before (it seems in your old age you have impaired short term memory) If the administration was rigid you’d be flailing away at them for that. Take a pill Nate.
Yanga, MD I hope you know more about medicine then you do insurance. Where do you doctors come up with this crazy BS?
“. It behooves an insurance company to make a complex system so that claims are not billed efficiently ”
Claims are paid in 7-14 days by most major insurers and most pay electronically now so you lose the float from the mailman. Lets be generous, and keep the math simple, and say they get 30 days float. These days carriers aren’t making anywhere close to 6% but it keeps the math simple. On a monthly basis they might make .005% interest. If the average claim is $200 that means they are making $1. In reality your probably closer to a quarter if that. Every time you deny a claim by law you have to send an EOB, that’s $0.40 to $0.50 alone. I’ll be generous and say the doctor gets their responce electronically and pretend that doesn’t cost anything. Then when the claim is processed a second time they need to mail another EOB so they just lost money.
Then what happens if a doctor or member calls to discuss the denied claim, you can’t answer a call for under a $1. There is no money to be made by delaying payment of claims. In fact it is common knowledge in the industry paying claims promplty saves money. Once claims get close to 30 days doctors start to bill, people call for status. Its very expensive to have a back log or deny claims.
The NYSE processes billions of transactions on a daily basis. I would use that market place as a better model of efficiency. If insurers wanted to become more efficient, they could give all their patients debit cards that can clear in 1 day. Then we can skip all mail carriers and phone personnel costs. There is a reason this does not happen.
Float is not simple pass-through money with only bank interest being accrued. United Healthcare (this is from their latest 10K, pg 49) had $14.9 billion in cash sources from their 2010 operations. They used $7.8 billion to buy new investments (typically high grade debt securities – not sitting in the bank), $2.3 billion for acquisitions (new business investment), $2.5 billion in stock repurchases (equity investment), $1.58 billion in retiring corporate debt, $878 million in property, equipment and software (real estate and asset investment), and $449 in dividends to shareholders. They use float to expand their business, fund investment, buy real estate and buy equity. After these activities, UNH continues to hold $25.7 billion in cash and cash equivalents (and will like get another $10 billion this year to invest while maintaining these reserves). There is a reason their stock is up 12% annualized over the last 15 years. It’s not from being the most efficient payer of claims. (BTW, this is better than Berkshire Hathaway’s 15 year return of 9% annualized.)
I appreciate peer-review. My numbers are from UNH’s 10-K and Morningstar’s total return for UNH and BRK.A. If you have better actual numbers to explain United Healthcare’s float or the float from another major insurer like Aetna or Wellpoint, I would like to review your work and understanding on the subject.
“The NYSE processes billions of transactions on a daily basis. I would use that market place as a better model of efficiency.”
Any idea how big of a data set a stock trade is compared to an 837? With a stock trade you also have two interested parties making sure it is right. With 837 only the provider and insurer cares, so the insurer needs to collect enough additional information to validate the legitimacy. If it was just transactions between patients with their own money and the provider it would work, i.e. HSA accounts.
“If insurers wanted to become more efficient, they could give all their patients debit cards that can clear in 1 day.”
We are currently suffering a small problem with fraud. It’s already running around 100 billion a year. You’re proposing we do away with all fraud prevention and auditing so doctors can get paid in 24 hours instead of 10 days. What exactly do you think is going to happen with the rate of fraud if providers can swipe a card, collect the money, and be out of country before the payor even knows about the charge? People are more protective of their own money then the insurance companies. If they had debit cards that would just pay for everything in 24 hours you would bankrupt the system in a year or two. You really need to consider the real would response to such a change and the consequences.
Are you aware United Health sells more than just health insurance? Health Insurance has a much shorter hold time then other insurance. For example, life insurance you need to reserve for and invest the premium for decades. LTD is long term. STD is medium. Annuities are also long term investments. After you build your regulatory reserves your not holding health insurance premium for even a year. The portion allocated to large claims might sit for a few months but that’s it.
If you wanted to make a killing on float you would not be in first dollar health coverage. The reinsurance market use to be very sensitive to market returns. Their where carriers targeting 90%+ loss ratios in the late 90s because they could make enough money on the float until the large claim was paid to be profitable. Its been over a decade since we have seen that. Life insurance is obviously a market when you get to sit on large sums of cash for long periods of time. The other is P&C risk like home owners or some environmental liabilities.
I can guarantee you payors don’t deny or delay claims chasing extra float, the numbers don’t work.
Peter, if Obama told you in order to stop global warming we are all going to trade our cars for Unicorns you would be the first in line wouldn’t you?
26 states are suing to repeal the bill, if Obama wants to work with them he can start by repealing it.
None of what your posting has anything to do with the mistakes you made anyways.
Well, Nate, maybe not much longer for this thing to be settled. Virginia has petitioned the US Supreme Court to look at their case before it goes to appeal,
http://www.oag.state.va.us/PRESS_RELEASES/Cuccinelli/24454%20pdf%20McCullough.pdf
and it seems that the Court will be reviewing that request on April 15.
http://www.supremecourt.gov/Search.aspx?FileName=/docketfiles/10-1014.htm
Well, Nate, maybe not much longer for this thing to be settled. Virginia has petitioned the US Supreme Court to look at their case before it goes to appeal, and it seems that the Court will be reviewing that request on April 15.
I have the same problem as Peter so I cannot post the links, but it’s Case No. 10-1014, so you can search the docket and see the last entry on March 23.
I tried to read the thread for the past 24 plus hours and have come to again realize that people who just pontificate and regurgitate the same rhetoric in 30 separate statements are not interested in debate, but just decapitate. The pro PPACA speakers are ingrained in their legislative zeal to demand we all capitulate to this purely partisan agenda, while the equally overzealous and intolerant right that now runs the House are just focused on the status quo, except their status quo is that of the 1950s, so us in the middle who are living in 2011 and wanting to work on a middle ground to reel in health care expenses and interventions just get blasted and trampled.
You all suck! And to Bobby G, to spew your repetitious link of the Pelosi sound bite and then tell me you don’t favor the Democrats and the legislation is so hypocritical, but whatever reality you live in, I am glad I am not there with you.
There will be no efficacious resolution to this crisis that is health care and it’s real puny efforts for relief and control of costs ,as offered by corrupt and uncaring politicians, as long as the current leadership and extremist followers, or more realistically the covert operatives who control the alleged leadership of both parties, just pontificate and gesticulate away. And we read their sound bites here every freakin’ day!
When both parties address Social Security and Medicare entitlements, and that is what they both are, then we will see some chance of change for the better. Face it, you want to extend the lifespans of people beyond what is the natural order of our species, and expect the young to literally sacrifice for this unnatural extension of life, the costs are multifactorial.
And don’t look for the majority of boomers to think differently and redirect the nation’s outlook. They are, and unfortunately I am in this pathetic generation, as selfish, narrow minded, and so devoid and blantant examples of lack of vision, it will probably destroy what is the society of the U.S.
But, what do I know, having listened to this lame B.S. dialogue for the past 30 years as an adult, US citizen, doctor, and reader of current events.
Hey, at the end of the day, we’ll just keep having to learn what is in the bill so we can all appreciate the lack of vision and concern for the public’s well being, solely brought to you by Democrats, the most recent example of power without balance that shows you corruption does not bias by party, gender, or age!
http://cheaptherapy.net/sitebuildercontent/sitebuilderpictures/WHINE2.jpg
“You all suck!”
This person purports to be a physician.
This a response from someone who alleges to work with physicians and claims to be interested in the welfare of the public, who only defends in the end the agenda of PPACA and attacks anyone who deters from his agenda.
Yes, I am a physician, and I think you suck! Gee, you think doctors can’t have harsh feelings about those who are focused on ruining health care?
That is how you come across to me. Your retort, sir?
Grow up.
“There will be no efficacious resolution to this crisis that is health care and it’s real puny efforts for relief and control of costs ,as offered by corrupt and uncaring politicians, as long as the current leadership and extremist followers, or more realistically the covert operatives who control the alleged leadership of both parties, just pontificate and gesticulate away.”
Actually, there will be no efficacious resolution to the crisis in health care costs as long as
1) the average age of the population continues to rise
2) older people have more ailments than younger people
3) medicine continues to make advances converting quickly fatal diseases to chronic ones (e.g. diabetes, HIV infection, etc.)
4) people who have such diseases prefer to survive rather than die
5) big mutual funds etc. who invest in drug companies and medical equipment companies demand a healthy profit every quarter
6) people who have their retirement money in big mutual funds demand a healthy profit every quarter
“And to Bobby G, to spew your repetitious link of the Pelosi sound bite”
Just correcting you. Deal with it. You misquoted her. I corrected you. End of debate.
Doctor.
And, no, to correct you yet again, I am on record as not being a fan of the corporate welfare + outright welfare that largely comprises the PPACA. Unlike YOU, I am personally traceable, as are my writings
Have you tired posting as text instead of a hyperlink? I think/hope we all know how to cut and paste
Text turns it into a hyperlink if it’s a valid one…. I guess, it’s because I posted 2 links. I’m trying now with just one – the docket
http://www.supremecourt.gov/Search.aspx?FileName=/docketfiles/10-1014.htm
There you go Peter. One link at a time….
Not a bad idea…
Margalit it appears it doesn’t matter if we have laws or not, non elected career washintonians can just pass the bills themselves.
http://www.nypost.com/p/news/opinion/opedcolumnists/entitled_to_chains_tqyOh9TXW49SLG5xwS3kvJ
“ObamaCare. That 2,000-plus-page law”
906 pages, to be exact (I know, so what if you’re off by more than double?).
H.R. 3590. Look it up. Here, let me help:
http://democrats.senate.gov/reform/patient-protection-affordable-care-act-as-passed.pdf
The PPACA, as amended, spans 2,409 pages. Approximately 1,000 of these pages apply to Medicare, Medicaid, transparency or program integrity. The number of pages created during the regulatory process now beginning will easily expand to ten times this amount.
BobbyG I think the Democrats in the Senate would be the last people to count on to know.
The passed bill is what it is. 906 pages.
Which one? There is the original bill and the fix. One is 906 and the other is 2310, like you say, they are what they are
3590
4872
http://www.mdnews.com/news/2010_11/05788_octnov2010_one-bite-at-a-time
This legislative behemoth, consisting of nearly 3,000 pages, will grow exponentially over the years, nourished by a constant crop of regulations, which some pundits have estimated could reach 3-million, by the last phase-in period in 2018.
http://www.mbnlaw.com/our-thoughts/tag/ppaca
The key provisions of the new laws include insurance coverage reforms, individual health plan mandates, and employer “play or pay” mandates. The two bills total over 2,300 pages and the regulations that will be issued to govern enforcement of the laws will likely be voluminous.
http://docs.house.gov/rules/hr4872/111_hr4872_reported.pdf
WOW 4872 is 2310 pages all by itself. LOL if it takes 2310 pages to fix 906 pages should we worry about that?
Nate, take us to 100 comments here (irrespective of whether they will provide anything of constructive utility). C’mon, bro’, Illuminate for us. Tell us exactly how “page count” is instructive.
I suppose if the bill was only 2 pages long because it didn’t spell anything out, then there would be no complaints that there was so much “hidden agenda” or that “nobody knows what was in it”. The CBO managed to publish plenty of analyses on the various iterations of the Bill between fall of 2009 and March of 2010 when it was passed.
” I didn’t have time to do my homework, therefore I feel it shouldn’t count” never went very far when/where I went to school.
Wow- these comments are getting heated. Perhaps we can bring it back to the issue.
Taylor and Morrison identify the crux of the problem with our health care system. The layers upon layers of regulation, eligibility, and claims distances consumer and provider. It creates insurmountable obstacles to receipt of quality care and, while some interests do benefit greatly, the country itself suffers.
Perhaps providers can go out on a limb, or rather, take a step back and charge on a fee-for-service basis. . . no insurance required. What if providers advocated for catastrophic type insurance plans rather than complete coverage?
Certainly this will not work for all, but for the masses of healthy individuals shelling out thousands each year only to be seen once or twice by a provider it makes sense. This would require some changes within offices. Billing specialists would be unnecessary and costs of office visits would need to be decreased.
Now that many health Americans are taken out of the equation, those who do experience chronic or even transient, sever illness prior to being Medicare eligible may purchase coverage that appears similar to what the state-mediated exchanges are intended. Finally, those who cannot purchase coverage may be eligible for the same benefits as Medicare.
I am interested in simplifying the system as it restores what is lost on all of this complex parry of which we are all part. . .the patient-provider relationship that results in quality care.
Perhaps these ideas are not entirely possibly, but I believe them to be worthy of being explored. In particular, moving toward fee-for-service practices allows providers the freedom to determine necessary treatment not bound by what will or will not be covered.
As of the end of 2010, Berkshire Hathaway had roundly $60 billion of insurance float. Guess how much relates to health insurance. Answer: NONE. Reason: it’s not a very attractive business from a return on capital standpoint and will be even less attractive under health reform mainly because of the minimum MLR rules.
Did you know that Berkshire Hathaway invested its float capital in millions of shares of the common stocks of United Healthcare and Wellpoint up until around 2009-2010 when Mr. Buffet unloaded his stake? http://buswk.co/cOcDCC
I think that Mr. Buffett saw that healthcare reform bill provisions would crunch float profitability and sold the shares. But nonetheless, the master of float investing was definitively invested in healthcare insurers.
wow reading all your responses reinforces how impossible it is for the public to understand health care reform. What a great arguement for universal single payor supported only by a national value added tax. Cover everyone, tax everyone and don’t worry if they are legal or illegal, they still pay the tax. Meanwhile I advocate my transparency where is the money going publish on internet cost per patient per provider for all public, ie my taxes money.
Where is the defense of WashingtonState that is at least trying to control costs like all states who are being extolled by the right for cutting education and public services. Everyone supports that health care is breaking the budget without making or supporting any positive solutions.
Oh after reading the Wall Street Journal, just lying about attempting to limit diabetic testing from twice a day to 8 times a day. I would support letting someone test as often as they feel necessary or having a pump but again it requires monitoring to be sure the patients are indeed benefitting and not being pushed by equipment companies.
Hu,
“. I would support letting someone test as often as they feel necessary ”
This is the problem with people that don’t understand the system and how things actually work. You naively support providing people all the testing supplies they want unaware of all the fraud that is already going on. If you open a weekly or other small newspapers you will see adds from companies paying cash for diabetic supplies. So the insured fills orders for more then they need, pay nothing or next to nothing then sell the excess for cash.
“Claims are paid in 7-14 days by most major insurers and most pay electronically now so you lose the float from the mailman. Lets be generous, and keep the math simple, and say they get 30 days float.”
B*llsh*t! I wish that were true. As president of our corporation for many years and looking at bills for many years this may be a goal, but it is categorically untrue in Pennsylvania. Clean claims are denied less frequently, that has improved markedly.
Steve
It is disappointing that a blog discussing the shortfalls of a complex and inefficient health delivery system leads to argument of third party payment/ float.
Perhaps an examination of conscience and motivation may be in order here. Are you all providers to receive the 0.02 percent interest the insurance company may make off of your delayed payment or are you a provider that seeks to serve your patients?
Aren’t insurers required by law to pay claims within 45 days? Frankly, it usually takes me longer to pay bills from my “providers” for what the insurance doesn’t cover than it takes the insurance to pay for what it covers. And in this I don’t seem to be much different than everyone I know.
Berkshire Hathaway’s decision to buy stock in UnitedHealth Group and Wellpoint during 2009-2010 may have been made by Lou Simpson and not Buffett. However, even if Buffett made the decision, his intent was to make money in the stock, not to invest float. By contrast, when he made the decision to acquire General Re, the rest of GEICO that he didn’t already own and, much earlier, National Indemnity, he viewed them as fundamentally decent businesses where his people could control the premium setting process and he could personally make the capital allocation decisions that determined how to invest the insurance float.
In the health insurance business, individuals and small groups with full risk coverage probably pay their premiums either monthly or quarterly and thevast majority of premiums are paid out within the year they are earned. Moreover, more than half of people with employer provided health insurance are in self-insured plans. The employer controls the float on those, not the insurer. The insurer is paid a fee to administer the plan under an ASO contract.
The administrative complexity of our system is not entirely a bad thing because it gives people choices as opposed to what they would have under a monolithic one size fits all system. More importantly, it leaves room for innovation in both new medical therapies and in payment approaches that would be largely stifled under a single payer system. If we’re really interested in bending the medical cost growth curve, we would have payers stop paying for services, tests, procedures and drugs that are not cost-effective or are no better than less expensive alternatives. Disclosure of actual contract reimbursement rates, substantive tort reform and more high deductible plans would also be helpful.
I totally agree with your conclusions that transparency in reimbursement (“disclosure of actual contract reimbursement rates”), tort reform and “more high deductible plans” are the way forward. As deductibles rise, primary care is leaving the domain of insurance. When deductibles are commonly $1,500 or higher, most of primary care will be in cash medicine. This more direct relationship between patients and physicians can help reduce unnecessary costs and will reduce the complexity of the primary care portion of healthcare.
“More importantly, it leaves room for innovation in both new medical therapies and in payment approaches that would be largely stifled under a single payer system.”
I believe that was the McArdle argument a while back, but I dont see it. Innovators dont care who pays them, just that they get paid. Maybe it is just a coincidence, but we have had our big increase in medical advances since Medicare came along. Was it financially feasible to develop therapies like CABG procedures, stentings, etc. because people knew that they would actually get paid?
Steve
Steve –
I don’t think it’s easy for Medicare to alter the status quo except when faced with a crisis. The program was around for 41 years before it even offered a prescription drug benefit which private insurers had for decades. Private insurers developed tiered formularies which encouraged the use of lower cost generics. Private insurers are now experimenting with tiered networks to encourage patients and referring doctors to use the most cost-effective providers. There has been tremendous pressure from those who benefit from the status quo to preclude Medicare from using competitive bidding for durable medical equipment. Doctors resist allowing NP’s to practice at the top of their license including letting them write prescriptions without supervision. Radiologists were OK with remote reading of images during hard to staff nights and weekends but, somehow, to allow the same thing during the weekday risks compromising patient safety. A single payer system would make it easier to preserve the status quo for established interests and resist disruptive innovation that could reduce costs for the system and for payers. There is also far more fraud in the Medicare and Medicaid systems than private insurance.
Regarding new treatments, I’m quite confident they would have developed at a similar pace without Medicare. Currently, however, Congress specifically prohibits Medicare from taking cost into account in making its coverage and payment decisions. If a drug or device wins FDA approval, it’s generally covered no matter how much it costs even if the benefits are only marginal at best. I don’t think that’s a good thing. We might see private insurers start to push back on this before Medicare does. Or, we might see insurance offerings that cover services, tests, procedures and drugs that cost up to X per QALY at one price, 2X per QALY at a higher price, and 3X per QALY for a still higher price. One size fits all Medicare couldn’t and wouldn’t do that in all likelihood.
For an excellent and thorough review of this general topic, I recommend the 2009 book titled “The Innovator’s Prescription” by Clayton Christensen of Harvard Business School.
“Or, we might see insurance offerings that cover services, tests, procedures and drugs that cost up to X per QALY at one price, 2X per QALY at a higher price, and 3X per QALY for a still higher price. One size fits all ”
Does it? If you are poor, disabled and addicted to alcohol, your QALY is going to plummet through the floor. How is this particular form of discrimination any better than the current forms of care denial experienced by Medicaid “beneficiaries”?
Margalit –
I think you know better. First, I didn’t say “One size fits all.” I said “One size fits all Medicare probably couldn’t and wouldn’t do that” – offer policies with different QALY limits at different prices.
Second, if coverage decisions were ever based on QALY metrics or some other cost vs. benefits criteria, the judgment would be based on a population of people. So, if, say, a new cancer treatment were deemed cost-effective by Medicare and/or Medicaid, it would be available to you, We wouldn’t say to a poor, disabled alcoholic, your remaining life years are only worth 0.5 QALY each so you don’t get the treatment. On the other hand, many people facing end of life situations, if they had all of their options honestly explained to them, may not want the treatment anyway.
Obviously, the wealthy person could afford a policy with the higher limits and a poor person couldn’t. As long as the coverage available to the broad population is widely perceived as good enough, it doesn’t matter. You’re never going to achieve perfect equality as the wealthy will always be able to buy up. In Germany, for example, about 10% of the population opts out of the public health insurance system and nobody has a problem with it.
Nate I agree with your comment and was trying to cover that by suggesting we need much more oversight on what we are doing presently. That would involve proving you have better control when you test more than for instance 4 times a day, a distinct minority. So you are supporting the Washington State attempts to control costs, I applaud you.
Barry-
“The administrative complexity of our system is not entirely a bad thing because it gives people choices as opposed to what they would have under a monolithic one size fits all system.”
I agree , the prospect of a one-size fits all approach is frightening. However, the choices that do exist are not true to free market system that allows for the principles of competition to regulate both quality and cost. As I typically identify with libertarian ideals, I am starting to think these ideal cannot apply to healthcare. This massive industry is, one the one hand, a business. On the other hand, however, it is an need that must be met. Toying with cost and availability of services in this industry has far greater implications than in, say, the auto industry. People’s lives are literally at stake. What is so sad is you all who are so concerned with when you will get paid. Is that why you selected medicine as your profession? Isn’t the propose of this blog not to whine over dollars and cents, but to seek out solutions to these complex issues?
“If we’re really interested in bending the medical cost growth curve, we would have payers stop paying for services, tests, procedures and drugs that are not cost-effective or are no better than less expensive alternatives. Disclosure of actual contract reimbursement rates, substantive tort reform and more high deductible plans would also be helpful.”
Thank you, Barry. I agree with this.
I apologize for the misquote, Barry. But if we make tiers based on QALY, the question becomes whose QALY are we talking about.
For example, if treatment Z is shown to provide 2 QALY for person A, but only 0.5 QALY for person B, would it be priced at X based on a person A profile, or at 3X based on a person B profile, or tiered based on the person?
Margalit –
Let me try again using a specific example. Suppose the lowest tier (cheapest) insurance policy under my scenario would cover every service, test, procedure or drug that the experts determine would cost less than $150K per QALY when given to a population with the condition or the risk profile that the treatment is appropriate for. Specifically, let’s say a statin drug like the generic, Simvistatin, would cost $50K per QALY when given to people with CAD, high cholesterol or other appropriate risk factors. The drug is covered under this policy tier whether the individual patient is a billionaire or a poor person and the price that a given insurer negotiated for the drug is the same for every patient covered by the plan. At the same time, if the patient is dying of late stage cancer, advanced Alzheimer’s or dementia, or ESRD, etc. it probably would not make sense to prescribe the drug under those circumstances and the patient or the family may not even want it even though it’s deemed cost effective at the population level. By the way, a $150K per QALY threshold, combined with life expectancy of roundly 80 years, implicitly values a life at $12 million (80 years x $150K) which I think is more than reasonable in a real world of finite resources.
So you attach some sort of average utility measure to a therapy and decide how to tier it based on that. It could be QALY, but I am not sure that QALY is really, relevant since I thought the entire point of QALY was to prioritize who gets what. So for that statin example, a previously healthy 40 year old would get 1 QALY for the $50K, but a disabled person with other ailments would get maybe 0.5 QALY out of the same investment. I guess that is why, when you got to the terminally ill person, or very old person, the formula stopped working, because the real QALY math needs to be applied there (in lieu of common sense, which we seem to lack).
So now, I have another question. Regardless on how you make the tier decisions, how is this different than Nate’s lifetime maximum? And how do we apply a true lifetime maximum when we don’t have one payer, or a universal accounting, solution?
Margalit –
I think we’re talking past each other. The point of QALY is NOT to determine who gets what. It’s to determine what we cover and pay for and what we don’t cover and pay for. This is what the UK’s NICE attempts to do. If they decide to cover a service test, procedure or drug based on QALY metrics, they don’t care if the particular patient who gets it is young or old, rich or poor, disabled or healthy. Of course, they may also ration certain procedures like organ transplants based on age, among other factors, as well. We do that for organ transplants too. If insurers want to cover services for a higher price that adequately compensates them for the estimated additional cost that the basic plan doesn’t, they can. Anyone who wants to and can afford to buy such polices, they can. Or, they can self-pay.
The end of life care issue is a whole separate discussion. With appropriate tort reform, the default protocol in the absence of a living will or advance directive could change from “do everything” to apply common sense depending on circumstances. If we paid for palliative care and hospice counseling so patients and their families understood the options available to them, they could make informed choices regarding their end of life treatment preferences. Those preferences could then be stored on a registry so they are available to providers anywhere when needed. Right now, far too many patients have not indicated such preferences, so their families often don’t know what they would have wanted because the patient can no longer communicate at all or is not mentally competent. Doctors then feel that they have no choice but to do everything unless the healthcare proxy, if any, agrees on his or her own to do less than everything. This is an area where the conservative death panel crap does a disservice to us all.
Easily the best book on how to reform the health care system is by Harvard Business School Professor Clay Christensen – The Innovator’s Prescription. http://davisliumd.blogspot.com/2010/12/best-book-on-healthcare-reform-or.html
Despite the complexity and challenges of the US health care system, Professor Christensen illustrates examples of why we should be optimistic that transformational change can occur and yet rightly cautions that too much regulation will stifle innovation and maintain the status quo. Let’s hope for the former and less of the latter.
Some states have a plan u can buy into…which isn’t cheap, but isn’t expensive either. For example, I had insurance through my employer. Got laid off, insurance ran out. Had to buy private insurance ar 112 bucks a month…not an option for just anyone but since I was insured before, I didn’t have to disclose pre existing conditions. Chiropractor Dunwoody GA
Last Word: Either Pay the High Prices for Sub Standard Care and Greedy Insurance underwriters or Go Without and Die Quickly.
This is the real choices of the Elitist Point of view. Either way Insurance and/or Provider can not be Held Accountable for any Negative Event . However, This does not apply to the intended target of their preditory and exploitive measures. Dead , Mangled,crippled, Medical Errors , Hospital Acquired Infections and longer stays from preventable events and gross negelgence. The Patient is expected to be accountable for services that end in their death.
Sadly, their is no Honor in this industry that only views consumers as a profit margin. A statistic or a number without as much showing a frailities of being Human. The Industry has saturated their belief system through out Government. Acting as lobbiest and Legislators to protect their profit making enterprises.
The industry has no shame in becoming 38th in Health Care among 40 industrialized Nations! Why? Profits are their primary focus and delivering statisfactory care has become a lesson of self protection;due to cuts in care givers and the absence of funds. Patients Suffer!
Although, Hospitals shed much of their responsibilities for providing proper care measures in order to satisfy investors. Hospitals expect full assurances from the State Legislature. Holding them Harmless, No Matter what the outcomes of Gross negelgence,Medical Error, and Preventable Staph Infection and death.
I do not know of any industry that has Mobb like Protections by our State Legislatures. The argument for greater and greater Profits have voices unmatched to the loss of Human Life. Which means our values have drifted away from core values of our founders. So , In order to keep these parisites from using you and charging your survivors . Is to die at home and overdose on drugs. If you find that objectionable ; Then you must realize what hospital staff are doing the same thing with Morphine. The hospitals are putting down people and Dieing quickly has nothing to do with the industry profiting from it. Save a survivor from Bankcruptcy:Die at Home!!!!!!!!!!!!!!!!
Oh after reading the Wall Street Journal, just lying about attempting to limit diabetic testing from twice a day to 8 times a day.
Here in Europe, Portugal, in the last few years the government made some reforms in the Public portuguese Healtcare system aiming to develop it.
We spend a lot of money on it, but everybody, also turists and foreigns, have the right to Health!
I hope this financial crise won´t destroy it.
All the governments should provide Free Health treatments for their citizens! That is one of the reasons taxes exist for.
http://hubpages.com/profile/JustaMendes
What other parts of our lives must you do, or have done (for basically fear of death) than “go to the doctor” ? And once there have a service preformed and then leave. 30 days later you get a bill/statement with the price. Basically, most of us go to the doctor and get services we need and find out 30 days later what it costs. Is there any other “industry” that works this way ?
Would you buy a car (which you actually have a choice, not a fear of death) and take it home and wait to get the bill 30 days later ? Would you buy a house only to find out later that the bank thinks 10% is a good rate ?
The system has built in enough time to guarentee a nice profit margin for all envolved.
Time to change. . . please
What about the rest of the equation chuck? What other parts of our lives do we walk in, expect to spend as much as we want, and have someone else pay the bill and not question our decision? In cases like this you need to look at the history. When insurance started you went to the doctor, received care, paid the bill, then submitted it yourself to insurance to get reimbursed. This worked pretty good for everyone, providers got paid right away, people knew what they were buying and exercised care, and insurance was protected from excessive treatment and wasteful spending.
If you want to see the bill the same day your treated don’t assign your benefits. That simple. Oddly all the people complaining about the system don’t want to take the easy step of solving it.
Yes, Nate it would be nice to have a clearer idea of what is charged and who is paying for it. I hate it when Dr. ‘s suggest a procedure and when asked how much would this cost they say they have no idea. But one thing is sure, insurance never cured anyone.
I think the industry started in Tx. because people couldn’t afford Dr. visits. Exactly how does hiring hundreds of thousands of people to be “go-betweens” for patients and Dr.’s decrease fees ?
Nate Ogden is right on. The immediacy of a check and balance by the patient is a powerful audit and control mechanism. No one knows better than the patient when he is charged $100 for an aspirin
Insurance was never meant to cure anyone. Before being bastardized it was meant to mitigate the risk of a large unforseen illness or accident. When it was reappropiated as a social tool and funding mechanism is when things started going wrong. Insurance actually started hundreds of years ago well before the idea of America even existed. Insurance has always been in america.
Insurance at first didn’t cover doctors visits then it only reimbursed a set amount, back when an office visit was just an office visit, they didn’t measure it 10 ways and then some. The go betweens got involved when government got involved. The government promised far more in benefits then they could afford, once they had to start cutting cost without admiting they couldn’t live up their promise they had to start measuring everything so they could slice and dice. That is how we got CPTs DRG RBRVS and everything else. The more government needs to manage the more complex it gets. Gary or one of the other doctors correct me but the government is taking us from 10,000 CPT codes to 40,000+? Now it is going to take even more middle people to figure out this even more complex system.
I am running for President in the 2012 elections as an Independent candidate.
These are my health care policies:
He says Obama Care does not go far enough, and proposes a completely new healthcare plan he calls “Americare,” which will provide government healthcare for everyone from cradle to grave.
“Americare will pay for the needs of all United States citizens and allow healthcare providers to be compensated according to their skill set. It will replace Medicare, Medicaid, and all private insurance. I believe that all private insurance companies are criminal organizations, because they make profits by delaying and denying care which could in many instances cause unnecessary deaths and suffering to people who rely on private insurance,” explained Abramson.
Abramson wants the liquidation of all private insurance companies, moving their administrative workers into Americare jobs. He wants to offer forgiveness of all medical indebtedness for anyone with debts resulting from the previous healthcare system. He said the cost of Americare will be paid from the savings obtained through military budget cuts.
Thanks for some other great article. Where else may anybody get that kind of information in such an ideal manner of writing? I have a presentation next week, and I’m on the look for such info.
Freat article, I found a chart that resembles a lot of the information presented, including how americans spend more than doble than other developed countries
http://synerchiflow.blogspot.com/2012/04/us-health-care-is-disaster-infogram.html
I meant “Great article” typo sorry