Originally Posted by ziggyX65

It doesn't *have* to be on the patient but someone paying the bills needs to care. Right now it's too easy for all the insurers to just pass on the 20% annual inflation to the insureds (or their employers).

We also have a problem with different pricing depending on your insurance (or lack of it). If a procedure costs $500, it should cost $500 -- not $1,100 if you are uninsured, $350 if you have private insurance and $300 if you're on Medicare. Again, this transparency in pricing doesn't need to be at the consumer level, but should be in place for those paying the bills at a minimum.

Example:

http://noir.bloomberg.com/apps/news?...d=aUovUYMjKBNs

Down the road in Silicon Valley, when obstetrician Sarah Azad, a solo practitioner, delivers a baby for a patient covered by Aetna, the insurer pays her $2,052. When Nicole Wilcox of Sutter’s Palo Alto Medical Foundation does the same job, Aetna pays Sutter $5,890.
The doctors practice blocks apart in Mountain View, California. Performance isn’t an issue -- Azad has Aetna’s top rating for quality of care and trained Wilcox during residency.

What incentive does Dr. Wilcox have to lower her rates under the current system to be competitive with Dr. Azad when insurance will pay the higher rate anyway and merrily pass the costs on to policyholders and employers? And what incentives do patients have to use the lower-cost provider if they pay the same co-pay and/or deductible in either case?

Originally Posted by ziggyX65

Example:

http://noir.bloomberg.com/apps/news?...d=aUovUYMjKBNs

What incentive does Dr. Wilcox have to lower her rates under the current system to be competitive with Dr. Azad when insurance will pay the higher rate anyway and merrily pass the costs on to policyholders and employers?

Why would the insurance company be willing to pay Dr. Wilcox's rate when they need to compete with other insurance plans which don't pay Dr. Wilcox's rate?

"Primary care physicians spend on average around $70,000.00 per year on dealing with the maze of multiple insurers in order to get paid for their work. It doesn't have to be this way. Even without changing reimbursemet rates, physicians would see a raise in payment with single payer/Medicare for all."

Doctor Margaret Flowers

Originally Posted by scotths

Why would the insurance company be willing to pay Dr. Wilcox's rate when they need to compete with other insurance plans which don't pay Dr. Wilcox's rate?

Its like a Cafeteria plan, each insurance company has a a limit of a service or procedure they will pay or per visit. The Doctor's rate is the same, no matter what the patient insurance plan is. That's why cost of procedures, not price of insurance should have been Obamacares primary challenge. Now all 300,000,000 get the health insurance monopolies prices.

Originally Posted by scotths

Why would the insurance company be willing to pay Dr. Wilcox's rate when they need to compete with other insurance plans which don't pay Dr. Wilcox's rate?

Who says that the health insurance companies compete? They can force competition by others while they load costs onto everyone else.

A single-payer system would effectively require the federal government to buy out the industry.

While I have to digest his ideas, this is one of the most honest pieces I have read in regards to the so called reform.

And for some who continue to push the "but it's a start" excuse, may want to consider that we have been working for real 'Healthcare Reform' for 40 years.

Healthcare Fiasco
By Brent Budowsky

It is no secret that I have vehemently disagreed with much of the current political strategy of Democrats. In public columns and private memos to senior Democrats I wrote that it was absurd and out of touch with main-street America to hail "recovery summer" when for so many Americans the recession continues in their real-life worlds.

Similarly the healthcare bill was not a great progressive or money-saving achievement. It was a hodge-podge bill, largely written by lobbyists and insiders, with key points usually negotiated behind closed doors. The "product" is filled with Rube Goldberg contraptions, most of which do not go into effect until after the next election, and until after the next election after that.

Who ever heard of a bill that does not go into effect until after the next two elections?

The healthcare bill was eerily and factually reminiscent of the healthcare bill proposed by President Richard Nixon in the early 1970s, with refinements added by the lobbyist-dominated culture of Washington today.

Is it any wonder that the American people do not understand it? The bill is incomprehensible, in fact. Instead of having a real debate between a liberal vision of healthcare and a conservative vision of healthcare, the debate surrounding the bill became a warped distortion of true liberalism, for a proposal that was not even remotely truly liberal, versus a distortion of true conservatism, with opponents who never offered anything remotely resembling a comprehensive healthcare proposal based on true conservativism.

http://thehill.com/blogs/pundits-blo...lthcare-fiasco

In today's Albuquerque Journal there was a story about St. Vincent's Hospital in Santa Fe, NM, cancelling their contract with the Lovelace Health Plan, a New Mexico health insurance company that was bought a few years ago by Ardent, a for-profit hospital ownership company. Ardent also bought the Lovelace integrated healthcare system that at one time was a world class group-health kind of operation similar to Kaiser.

Business decision making at the old Lovelace was largely by the medical staff. CIGNA eventually bought out the insurance company side of Lovelace and the healthcare provision was continued pretty much as before. Then Ardent came to town, bought all of Lovelace including the insurance company side and integrated the old Albuquerque St. Joseph hospitals into the operation.

Since then Ardent has downsized, shutting down the original Lovelace hospital, and has pissed off multitudes of nurses and physicians, many of whom left and went off to practice elsewhere.

Back to Santa Fe: North of Albuquerque, healthcare access gets pretty dicey in New Mexico. There are a few very small, very limited institutions in northern NM. Santa Fe has St. Vincents, and Los Alamos has a small hospital. The other northern NM hospitals are pretty much POS's.

Now, thousands of people who are insured under Lovelace and live north have no place to go. St. Vincent's is a not-for-profit hospital and I would imagine that the reason they gave notice to Lovelace to stop serving their patients is that they could no longer afford to accept inadequate reimbursement in order for Ardent to continue paying bonuses to their executives.

Long live "free enterprise" eh? Socialism for the rich bastards; free enterprise for the northern NM working stiffs.

I read that. I have Lovelace Senior Plan and didn't like it when Ardent bought them out. But down at the old hospital we now have Albuquerque Health Partners, and that is doctor-run. In fact, my primary care physician designed the intake forms. (Gee - I wish he'd let an experienced admin do it! Try and squeeze your name in that teeny-tiny half-line-high space!)

Yeah. Northern New Mexico is overripe for some comprehensive medical clinics. Perhaps everyone up at UNMH, Financial Aid, the Med School, and the Dental School should be forced to watch the complete set (how many seasons?) of Northern Exposure as part of their training; the slogan can be "Go thou and do likewise."

Albuquerque Health Partners are all the old Lovelace docs. They jumped ship when Ardent came in. Ardent had to have healthcare providers, so they pretty much had to contract with AHP to do that for them or they wouldn't have had anyone to send them patients.

The trouble is that Presbyterian is now overrun with demand vs their infrastructure, but at the same time has not increased their revenue sufficiently. I hope that the gamble on the westside Pres hospital works out; that could take some pressure off the downtown infrastructure.

Right now, when we have a broken hip for Lovelace, we call from the ambulance to find out "where the orthopedic surgeon is" - at the downtown hospital or the westside hospital - and then take the patient wherever the surgeon is.

Insurers Begin Blaming Health Law For Premiums Increases

On Friday, the News & Observer in North Carolina reported that Blue Cross Blue Shield of North Carolina — the largest insurer in the state — would be increasing premiums to keep up with medical inflation and the requirements of the new health care law:

“With everything that’s been added, you can’t really expect costs to go down,” he said.

The situation isn’t likely to improve any time soon. As more provisions of the health overhaul law take affect in 2014, Blue Cross officials said they expect rates to rise further.

“We do expect significant premium volatility in 2014 as the industry moves to an entirely new rating structure,” said Patrick Getzen, Blue Cross’ chief actuary.

For More:

http://wonkroom.thinkprogress.org/20...emiums-bcbsnc/

http://www.nytimes.com/2010/08/25/bu...N1SzQ4hpssATeA

U.S. Rejected Hen Vaccine Despite British Success By

WILLIAM NEUMAN

Faced with a crisis more than a decade ago in which thousands of people were sickened from salmonella in infected eggs, farmers in Britain began vaccinating their hens against the bacteria. That simple but decisive step virtually wiped out the health threat.

But when American regulators created new egg safety rules that went into effect last month, they declared that there was not enough evidence to conclude that vaccinating hens against salmonella would prevent people from getting sick. The Food and Drug Administration decided not to mandate vaccination of hens — a precaution that would cost less than a penny per a dozen eggs.

Anecdotal but an interesting story about how the healthcare insurers are putting the screws on providers (Mish is very anti the healthcare reform BTW):

http://globaleconomicanalysis.blogsp...ealthcare.html

"Therapist CEO" writes ....

Hello Mish,

I’m a long time reader of you blog. Thanks for keeping some sanity in an otherwise economically insane world.

I’m writing in response to your post regarding small business owners, specifically the letter from “Healthcare CEO”.

I am also a small business owner. I share many of the same difficulties that he discussed. One point he made did surprise me though, when he mentioned that he didn’t “blame the insurers too much”. On that point I couldn’t disagree more.

As a small business owner, I have been feeling the pinch of ever rising healthcare premiums; our premiums went up 26% last November and I can’t imagine what they will be this year when we renew. I have another perspective though. The small business that I am in is physical therapy; I own two outpatient clinics in New York. Over the past year while health insurance premiums have been going through the roof, I have watched insurers do one more thing to help their bottom line. They have shifted payment for healthcare to the patient, in some cases entirely.

As an example, here in New York, there are some Oxford and Blue Cross Blue Shield plans that by contract “reimburse” $50 per physical therapy visit. Here’s the kicker. The patients co-pay has been raised from $15-$25 per therapy visit to $50 per therapy visit, so what the patient pays is all we get. The insurance companies pay nothing additionally.

This is what insurance companies “sell” as insurance for these elevated premiums and I don’t know how that’s even legal. It’s a joke when patients come in and present their insurance card like that provides them any benefit at all. The insurance companies also still have the audacity to require us to submit continued requests for them to authorize care, and in many cases they won’t give us that authorization even though they aren’t paying a dime for the service (yes, we are currently in the process of exiting some of these contracts).

The way I see it, the insurance industry has taken advantage of the turmoil in Washington to stick it to patients and healthcare providers. While we still can’t buy drugs from overseas, and we still can’t buy insurance across states lines, at least we can stick it to healthcare providers to “cut healthcare costs”. Providers don’t share the same strength in lobbyists so we’re doomed to be the goats.

This shift to high co-pays ($50/visit three times per week is high) coming on during a depression has taken a toll on patient volume. Furthermore, many private insurers have been decreasing what they pay us overall. In New York, workers comp and no fault cases have paid us the same rate for care since 1996. The only other avenue for us to make money is Medicare, and CMS (the body who controls Medicare/Medicaid) is proposing cuts of over 40% by January. If these cuts go through I’m out of business and so are many other ancillary healthcare providers and primary care physicians throughout this country of ours. I know these things happen to businesses during times like these, but these changes to providers of healthcare are being jammed down our throats by the unrestrained insurance industry. The whole thing is a mess and while I do place blame on the idiots in Washington, I also blame the opportunistic insurance industry.

We’ll try to survive be transitioning to a more cash based model (good luck in this economy) and diversifying our business, but I’m aware that unless someone reigns in the insurance industry, I’ll probably be flipping pizzas this time next year. The bigger question is what happens if the network of private healthcare delivery simply collapses from an inability to remain solvent? This as we bring on board an additional 35 million newly “insured”. Good luck with that one.

Keep up the good work. We can’t get accurate news assessments from the mainstream press anymore, so thanks again.

Signed,
Therapist in New York

So Who's To Blame?

* Obama
* Congressional Republicans
* Democrats
* Insurers
* Public Unions
* State Government


President Obama just wanted a bill. He did not really give a damn what was in it, as long as it did not upset public unions. Moreover, Obama sold the youth vote right down the river. There is nothing but pain for them.

Public unions do not give a damn about healthcare costs because they and their families pay next to nothing with deductibles that are next to nothing. Taxpayers pick up the cost.

Democrats also did not want to upset the unions.

Republicans refused to allow competition between states or cheaper drugs coming in from Canada.

State governments pander to unions and also act to restrict competition.

The insurers bribed both parties to get what they wanted out of the legislation.

Fresh Blood

In short, there was nothing in the bill to reduce costs.

It should not be surprising at all that costs are still going up, especially as the insurers have fresh blood from those Obama sold down the river to get the legislation passed.

Originally Posted by AnneZob

Anecdotal but an interesting story about how the healthcare insurers are putting the screws on providers

Insurers have been "putting the screw to providers" for a very long time.

When "HMOs" were begun in earnest in the 1980s, the insurance companies began to bid out their subscriber populations to the providers on what was called a "capitation" basis.

The way this worked is that the company paid the provider a fixed amount of money per month to do his kind of healthcare provision for the patient population, no matter whether the utilization of services was great or small.

For example, a blood-testing laboratory might bid on and get an exclusive contract to provide all the lab services for all of Blue-Cross Colorado's subscribers. The contract might be for $1.50 per subscriber per month for the term of the contract. If it happened that several of their subscribers had egregious luck and used megabucks worth of lab, tough cookies. The lab had to eat the cost.

They did the same thing with the doctors and other healthcare providers. They said that the providers "were taking risk." No shit.

In this way the insurance companies pitted the various regional groups of providers against each other. No longer was it possible for a patient to choose the provider they liked the best. They had to go to one that was "inside the network."

In the industry I worked in at that time, the blood-testing laboratory business, what happened is that the large corporate for-profit labs ultimately took over most of the outpatient lab testing by underbidding the smaller labs, locally owned usually by pathologists from the local hospitals. Guess what? The pathologists sold their businesses to the large corporate labs and now there are very few competing labs.

Big business DOES NOT WANT competition. They don't. They want monopoly. If they can't have that they'll settle for oligopoly until monopoly becomes possible.

56% Favor Repeal of Health Care Law; 54% Say Law Is Bad for Country

Whatever they come up with, I bet it'll be a nuissance. People will probably have to fill out a lot of paperwork and such to get healthcare

Originally Posted by Adina

People will probably have to fill out a lot of paperwork and such to get healthcare

In America, they already do.

A piece of advice: commenting on things about which you have zero direct experience is another one of those signs of not-yet-maturity that you seem to display fairly frequently. As the old saying goes, "better to be silent and thought a fool, than to open your mouth and remove all doubt".

The insurance industry wants to take away even the few crumbs of change. They are the definition of evil. The last paragraph is very telling. :{

Article:

Why Health Insurers Are Backing Republicans With Campaign Donations By 8:1 Margin
Insurers became the target of the White House’s attacks in the closing days of the health reform debate and so perhaps it’s no surprise that they’re “backing Republicans with campaign donations by an 8-to- 1 margin, favoring the party that’s promised to repeal President Barack Obama’s health-care overhaul if it wins back Congress.” Bloomberg’s Drew Armstrong has the scoop:

WellPoint, along with Coventry Health Care Inc. and Humana Inc., gave Republican candidates $315,000 from May through July, according to U.S. Federal Election Commission records. That compares with $41,000 given to Democrats by the three companies as the parties near November elections that will determine who controls the U.S. House and Senate next year.

While Republicans aren’t likely to win the large majorities necessary to override a presidential veto and repeal the health law Obama signed in March, they may be able to slow or stall its implementation, said James Morone, a political science professor at Brown University in Providence, Rhode Island. At the same time, the turn to strongly favor Republicans may anger Democrats who had been receptive to insurers’ concerns, he said.

Recall that after initially coming to the table and supporting Obama’s efforts, insurers turned against reform, even after the public option had been taken off the table. They criticized the weak individual mandate and argued that the bill would lead to higher premiums for average Americans.

Since passage of the law, the administration and the President have reached out to insurers, inviting them to meetings with Obama and HHS Secretary Sebelius and weighing their concerns about the forthcoming regulations and the implementation process. But through it all, issuers — while nominally agreeing to assist the administration with implementation — have understood which party has its interests in mind. Issuers have watched as Democrats — led, most recently by the six Democratic Committee chairman with jurisdiction over health care — argued that insurers should have to abide by a strict interpretation of the law and spend 80 to 85% of premium dollars on health care and contrasted that approach to the likes of conservatives like Douglas Holtz-Eakin, who have gone to the mat to weaken the regulations.

Therefore, this donation imbalance shouldn’t be interpreted as an industry endorsement of the GOP’s repeal efforts or its attack on the individual mandate — which could make the industry millions. The industry is turning to the Republican party not so that it could repeal the entire law — that seems highly unlikely — but so that it can push for favorable regulations that don’t cut into industry profits. The want to ensure that Republicans hold their line, like they always have

http://wonkroom.thinkprogress.org/20...rs-republicans

Originally Posted by Deb C

Insurers became the target of the White House’s attacks in the closing days of the health reform debate and so perhaps it’s no surprise that they’re “backing Republicans with campaign donations by an 8-to- 1 margin

Given how much the president has slammed insurance companies, why wouldn't they? That's just logical. Whatever we may think of the insurance companies, it's silly to think they would back a candidate who routinely maligns them and their motives, isn't it?

Originally Posted by Justin '77

In America, they already do.

A piece of advice: commenting on things about which you have zero direct experience is another one of those signs of not-yet-maturity that you seem to display fairly frequently. As the old saying goes, "better to be silent and thought a fool, than to open your mouth and remove all doubt".

Hey, that's mean.

Originally Posted by Adina

Hey, that's mean.

Reality isn't always nice. That's an important lesson to learn if you don't want to get burned again and again in adulthood.

Originally Posted by Adina

Hey, that's mean.

Not even remotely. You need to learn to recognize comments made in your own interest, kiddo. At least, if you ever want to be taken as a grownup.

Originally Posted by Deb C

"Primary care physicians spend on average around $70,000.00 per year on dealing with the maze of multiple insurers in order to get paid for their work. It doesn't have to be this way. Even without changing reimbursemet rates, physicians would see a raise in payment with single payer/Medicare for all."

Doctor Margaret Flowers

Would have to mandate that doctors accept Medicare. Some doctors now refusing to accept Medicare patients. I know of one that has stopped participation in Medicare and requries his former Medicare patients to pay $100/month to remain in his practice.
But, I would have preferred a simplication of payments as you suggested before we tried a massive change in the current Health Care 'System'.

Originally Posted by Justin '77

In America, they already do.

A piece of advice: commenting on things about which you have zero direct experience is another one of those signs of not-yet-maturity that you seem to display fairly frequently. As the old saying goes, "better to be silent and thought a fool, than to open your mouth and remove all doubt".

When my niece was 21, she was doing her Occupational Therapist practicum for her degree, she got what we think was meningitis. She recovered well, but she had insurance through her college and her father had her handling the bills. At one point she burst into tears and said, "How am I supposed to deal with this when I'm working all the time?"

My brother-in-law and I just looked at each other and said, "Welcome to the world."

Originally Posted by ziggyX65

Given how much the president has slammed insurance companies, why wouldn't they? That's just logical. Whatever we may think of the insurance companies, it's silly to think they would back a candidate who routinely maligns them and their motives, isn't it?

Considering that Obama caved in on the bill and his slamming the insurance companies was just a double speak. He wanted it both ways, give to the industry and make the people think he was really working for them. What came out of his mouth and what he actually did was apparent, unless one wanted to stay blind to his broken campaign pledge.

The transparency that he preached and promised during the campaign, was the opposite of his actions. Actions speak louder than mere words.

Originally Posted by Adina

Whatever they come up with, I bet it'll be a nuissance. People will probably have to fill out a lot of paperwork and such to get healthcare

Somehow I think that is the least of peoples worries with regards to the law.

Actually, perhaps with a push towards electronic medical records ultimately less paperwork will be needed.

List of current and future generations: * Lost * GI * Silent * Boomer * X * Millennial * Homelander * Renewal * New Nomad * New Civic * New Artist

So, a civic? wants to name the next generation of profits before they are even born!