Halt In Subsidies For Health Insurers Expected To Drive Up Costs For Middle Class

[CaliCat 3,957]

1 minute ago, IDWAF said:

Ummm, no one said that, did they?

 

When it comes to health insurance I am very much a conservative. Everyone should take care of theirs. 

[spookyturtle 9,465]

Who cares if people have to pay more when subsidies end. #MAGA

[Voice of Reason 10,298]

19 hours ago, CaliCat said:

 

When it comes to health insurance I am very much a conservative. Everyone should take care of theirs. 

I agree.  Same with buying a car, paying for college, paying my mortgage and bills on time, buying my groceries...  I think everyone should take care of their own.

[Voice of Reason 10,298]

19 hours ago, spookyturtle said:

Who cares if people have to pay more when subsidies end. #MAGA

Who do you think should be subsidizing health care? Our government who is so deep in debt?

 

Why not pass laws that lower the cost of health care to reasonable levels?  Why not restrict the amount that hospitals can charge patients?

 

Instead of asking for money from a broke entity to subsidize those who don't earn enough to pay for their own care, couldn't we regulate the upper limits of health care?

[CaliCat 3,957]

1 minute ago, IDWAF said:

I agree.  Same with buying a car, paying for college, paying my mortgage and bills on time, buying my groceries...  I think everyone should take care of their own.

 

One way to resolve this issue is to create a hospital bond. Before being admitted for care, you should have to post bond commensurable with the service you're expected to receive. If you choose not to have health coverage, the bond would take care of the bills, and the hospital should have the right to discharge you at the moment when the funds run out. It would lower insurance premiums for everyone. 

[Voice of Reason 10,298]

1 minute ago, CaliCat said:

 

One way to resolve this issue is to create a hospital bond. Before being admitted for care, you should have to post bond commensurable with the service you're expected to receive. If you choose not to have health coverage, the bond would take care of the bills, and the hospital should have the right to discharge you at the moment when the funds run out. It would lower insurance premiums for everyone. 

Yup.  But see my other post just above yours.   In addition to yours, I mean.

 

When I was younger, that's exactly how I financed having a kid... asked the hospital how much it would cost for delivery, and made payments until the time had come.  Ended up walking out of the hospital only paying about $75.  Worked 70 hours a week at a "part time" job that didn't provide insurance.  But I was beholden to NO ONE.

Edited October 17, 2017 by IDWAF

[CaliCat 3,957]

1 minute ago, IDWAF said:

Who do you think should be subsidizing health care? Our government who is so deep in debt?

 

Why not pass laws that lower the cost of health care to reasonable levels?  Why not restrict the amount that hospitals can charge patients?

 

Instead of asking for money from a broke entity to subsidize those who don't earn enough to pay for their own care, couldn't we regulate the upper limits of health care?

 

Fire or frying pan. The moment you start talking about "regulations" you will get push back from all sides. The truth is that nobody likes regulations, but also, what people don't realize is that health coverage is never going to be a zero sum game. 

One way to regulate would be taking care of the upper and lower limits. Regulate the price of medical services, in addition to going into a single-payer system. Is it pretty? No, it's not, but in the end, you'll have decent coverage to everyone. Does this mean that private clinics and hospitals will close? Absolutely not. If you want to go to a private clinic, you're free to do so, on your own dole. 

 

[spookyturtle 9,465]

45 minutes ago, IDWAF said:

Who do you think should be subsidizing health care? Our government who is so deep in debt?

 

Why not pass laws that lower the cost of health care to reasonable levels?  Why not restrict the amount that hospitals can charge patients?

 

Instead of asking for money from a broke entity to subsidize those who don't earn enough to pay for their own care, couldn't we regulate the upper limits of health care?

I'm sure that's exactly what Trump will do. He's all about helping the poor. He's quite the humanitarian.

 

[ThomReilly 0]

A ton of misinformation in this thread.

 

First of all you need to understand the difference between APTC(Advanced Premium Tax Credits) and CSR(Cost Sharing Reduction).  Trump is only ending the CSR's and not the APTC.

 

Previously if your income was below 400% of the poverty level you were eligible for an APTC to offset some of costs of insurance.  However if you chose a silver plan you could potentially get a lower deducitble/out of pocket because of the CSR's.  So Trump ending the CSR's won't effect individuals from getting an APTC if they qualify.  

 

What is going to happen this year is that individuals will be getting such large APTC"s that without the CSR's they have little reason to get a silver plan now when they could get a bronze plan for little to no money.  So your going to have a lot of poor people on $7000 deductible plans.

 

The middle to upper class are going to go to short term medical or International if they qualify.  

[bcking 3,157]

On 10/17/2017 at 4:42 PM, IDWAF said:

Who do you think should be subsidizing health care? Our government who is so deep in debt?

 

Why not pass laws that lower the cost of health care to reasonable levels?  Why not restrict the amount that hospitals can charge patients?

 

Instead of asking for money from a broke entity to subsidize those who don't earn enough to pay for their own care, couldn't we regulate the upper limits of health care?

This is all my opinion, so keep that in mind:

 

1) I think a government needs to make priorities, and in my opinion the health of its people should be very high on that list. We may be in debt, but I can think of a lot of other things (mostly in the explosive category) that we could cut back on in favour of keeping our people healthy

 

2) That sounds great. Much harder in practice. Hospitals are not the primary source of our excess health care costs. It's a little old now, but the IOM held a roundtable discussion on this topic and published a report in 2011 (http://www.nationalacademies.org/hmd/Reports/2011/The-Healthcare-Imperative-Lowering-Costs-and-Improving-Outcomes.aspx)

 

They summarize excess healthcare costs into 6 categories:

1) Unnecessary services

2) Inefficiently delivered services

3) Prices that are too high

4) Excess administrative costs

5) Missed prevention opportunities

6) Medical fraud

 

A similar list published by Dr. Berwick (A former CMS) administrator estimated that the 6 categories combined accounts for about 910 billion dollars per year of waste (In 2011)

 

Just "lowering the cost of health care" would really only take 1 of them (#3). Part of it is changing the culture of medicine to target #1 (Doctors over order tests/interventions), part of it is alligning incentives effectively to target #2 and #5. Hospitals definitely play a role in #4, but so do insurance companies. The "Doctor to Administrative" ratio (Comparing the number of doctors to the number of "administrators" ie non-medical employees) has risen sharply over the last couple of decades.

 

3) What do you mean by "regulate the upper limits of health care"? Do you mean death panels? In this country politicians have decided it isn't appropriate to discussed money/cost when it comes to prolonging life, no matter how what the cost effectiveness ratio is.

 

In the UK, and other places, they use ICERs (Incremental Cost Effectiveness Ratios) to determine whether a new intervention is cost effective. They set limits in terms of what they are willing to spend for each "quality adjusted life year" that they gain. That sort of behavior is generally frowned upon in the USA. In fact when the ACA created a government body to fund evidence based medicine research (The Patient Centered Outcomes Research Institute, PCORI), they specifically had to include language banning funding for studies that included types of comparative effectiveness ratios.

Just like there is limited funding to study gun violence in the USA, there is also limited funding to to do proper cost effective analyses to determine how we can provide care more efficiently while still maximizing outcomes.

Edited October 20, 2017 by bcking

[bcking 3,157]

12 minutes ago, ThomReilly said:

A ton of misinformation in this thread.

 

First of all you need to understand the difference between APTC(Advanced Premium Tax Credits) and CSR(Cost Sharing Reduction).  Trump is only ending the CSR's and not the APTC.

 

Previously if your income was below 400% of the poverty level you were eligible for an APTC to offset some of costs of insurance.  However if you chose a silver plan you could potentially get a lower deducitble/out of pocket because of the CSR's.  So Trump ending the CSR's won't effect individuals from getting an APTC if they qualify.  

 

What is going to happen this year is that individuals will be getting such large APTC"s that without the CSR's they have little reason to get a silver plan now when they could get a bronze plan for little to no money.  So your going to have a lot of poor people on $7000 deductible plans.

 

The middle to upper class are going to go to short term medical or International if they qualify.  

I don't know about this thread, but there were plenty of reports in the news that correctly distinguished between the two.

 

THe people who are getting subsidized from the government because they are near poverty will continue to get that help. This is going to have a bigger impact on those that don't qualify for that, but find plans continue to be unaffordable for them.

 

It doesn't mean they weren't affordable before this. We all have to recognize that premiums of risen sharply. It's just that this change is not going to make it any easier. He did it in hopes of "forcing change" to fully repeal the whole system. That may work, but in the mean time middle class people will be paying more. I doubt may of them have the ability to seek international care.

[Voice of Reason 10,298]

bcking, I meant the upper limits of the cost of health care, not the care itself.  I remember a couple or so year back when I received a series of bills for an ER visit for a family member... two acetaminophen were billed to me (well, insurance first) at $25 for two 500mg tablets.  

 

I got into it with another member when he basically called me a liar when I said my bills were settled with the insurance company for around 12-15%.  I was told there was NO WAY insurance got away with paying that little.  So I redacted some statements from the insurance company and posted them here.  I had no reason to make it up, but had to prove my statements that hospitals over-inflate the billing, insurance limits what it will pay.  It’s a game, and I am sure you know more about it than I.  But if I didn’t know any better, and didn’t have insurance, I would still be paying down a $50K ER bill that the insurance company negotiated down to a bit over $5K. 

 

That’s the sort of thing I am referring to when I talk about limiting upper costs on health care.  I get it that an MRI is an expensive thing.  But 3 sutures in a cut should NOT cost $500 or more.  Ridiculous.

Edited October 20, 2017 by IDWAF

[ThomReilly 0]

9 minutes ago, bcking said:

I don't know about this thread, but there were plenty of reports in the news that correctly distinguished between the two.

 

THe people who are getting subsidized from the government because they are near poverty will continue to get that help. This is going to have a bigger impact on those that don't qualify for that, but find plans continue to be unaffordable for them.

 

It doesn't mean they weren't affordable before this. We all have to recognize that premiums of risen sharply. It's just that this change is not going to make it any easier. He did it in hopes of "forcing change" to fully repeal the whole system. That may work, but in the mean time middle class people will be paying more. I doubt may of them have the ability to seek international care.

Correct anyone who is not getting a subsidy is getting screwed.  Increases for plans written before the ACA(pre-2014) are averaging an 18% increase.  Plans from Florida Blue and AvMed here in Florida are close to 70% increase from last year.  Not a Trump fan but AvMed isn't on the marketplace.  The CSR's have no effect on them.    

[bcking 3,157]

4 minutes ago, IDWAF said:

bcking, I meant the upper limits of the cost of health care, not the care itself.  I remember a couple or so year back when I received a series of bills for an ER visit for a family member... two acetaminophen were billed to me (well, insurance first) at $25 for two 500mg tablets.  

 

I got into it with another member when he basically called me a liar when I said my bills were settled with the insurance company for around 12-15%.  I was told there was NO WAY insurance got away with paying that little.  So I redacted some statements from the insurance company and posted them here.  I had no reason to make it up, but had to prove my statements that hospitals over-inflate the billing, insurance limits what it will pay.  It’s a game, and I am sure you know more about it than I.  But if I didn’t know any better, and didn’t have insurance, I would still be paying down a $50K ER bill that the insurance company negotiated down to a bit over $5K. 

 

That’s the sort of thing I am referring to when I talk about limiting upper costs on health care.  I get it that an MRI is an expensive thing.  But 3 sutures in a cut should NOT cost $500 or more.  Ridiculous.

I think I remember that discussion actually.

 

Cost-to-charge ratios tend to be around the 10-1 mark in a lot of situations. So charging $25 and then receiving $2.5 isn't that off the mark. If a person doesn't have insurance, they can often get a large reduction as well, though typically not to the same degree. If you call up the hospital's billing department when paying out of pocket you can negotiate down because they honestly don't expect anyone to pay what they are charging.

 

When we are talking about "costs" there are really three numbers:

 

1) Actual cost - What is actually costs for the hospital to provide that service. This is by far the most difficult one to calculate for most things

2) Charge - What the hospital charges to provide the service

3) Reimbursement - What the hospital will receive

 

Most hospital systems aren't running around with billions of dollars in profits. Their charges end up being high mostly due to such a wide range of payers. Ratios are different throughout the country, and hospital to hospital, because their payer mix is different but they are trying to receive the same net outcome (Being reimbursed enough to cover the costs).

 

I would love to talk more in terms of actual healthcare costs, but as someone who makes this topic the sole focus on my non-clinical work, even I find it difficult. Even something as simple as acetaminophen isn't straight forward. If you wanted to consider what it "costs" to give you those pills you would have to think about:

 

1. Purchasing the acetaminophen

2. Storage of acetaminophen

3. Distribution of the acetaminophen when it was ordered

4. Administration of the acetaminophen

5. Decision to administer the acetaminophen

 

So there is a doctor and a nurse involved. For something like acetaminophen fortunately it is likely stored in "Omnicell" type device (where the nurse can obtain it without getting it from pharmacy). Those have limited space, and the devices themselves are quite expensive so you have to factor that in (but obviously they store a lot more than just acetaminophen). THe hospital buys in bulk of course, but they also have to make sure they aren't overbuying and ending up with expired medications. They have to maintain a proper "par" level (I forget what it stands for) based on the usage for each department and hospital wide.

 

I'm on a committee that reviews our supply chain and I can tell you - something as menial as gloves costs our department $15,000 to $20,000 per month. Not sure what we charge, or what we are reimbursed.