Paul of Covington I can't talk about insurance companies without getting all worked up, so I'll just tell something my mother told me back in the 70's. The dollar amounts seem outrageously low now, but this is what I remember. Before medicare she and my father used to get flu shots every year for one dollar each. After medicare, the price was ten dollars, medicare paid 80% ($8). Their auxillary insurance paid half of the remainder, and they paid one dollar out of pocket. (Edit): On reflection, I realize that this is more of an indictment of the healthcare industry, but that's OK. I'm not a fan of them either.
(Edit): On reflection, I realize that this is more of an indictment of the healthcare industry, but that's OK. I'm not a fan of them either.
In today's world, it is practically impossible to separate the health care and insurance industries - when it comes to money.
Never too old to have a happy childhood!
The basic problem in healthcare is the price which is rising out of control for these four reasons:
The administrative cost imposed by the insurance companies as a third party to the patient/provider transaction.
The administrative cost of government regulations.
The separation of the patient from consideration of direct cost awareness.
The lack of cost containment pressure on the medical provider and products industry, the insurance companies, and the regulators that results from separating the patient from direct cost awareness.
For a while, the rising costs could be somewhat contained by group rates and pooling risk which was a natural function of insurance, but the limit is now being reached, and the cost is becoming impossible to cope with.
The only solution is to fix all four of the above listed items by introducing competition for the patients’ business. Neither the insurance companies, the medical business, nor the government regulators have any interest in this solution. They all benefit from the lack of competition for the patients' business. Only the patient has an interest in this solution, and they have no idea how to exercise their will in the matter.
So the solution can only happen at the political level, and only by those politicians who see a greater political benefit serving the public rather than serving their self-interests.
Euclid, you forgot Number 5:
The Shkreli Profit factor, which is rife throughout the Health Care Industry.
Tom
Tom,
If we fix #1-4, that will take care of the Shkreli problem.
Euclid Tom, If we fix #1-4, that will take care of the Shkreli problem.
The Shkreli Factor is the real facilitator of 1-4.
BaltACDAnd how much is the Insurance industry gouging on health care, while being in a conspiracy with health care providers of both services and medicines to jack up prices 100%, 200% 1000% and then blame it on the Affordable Care Act. Two years ago I broke the radius on my left arm. It had to be surgically repaired through an 'outpatient' surgery center. I arrived at the facility at Noon and spent an hour filling out forms. Taken into per-op at 1 PM. Procedure performed, installed a plate and 6 screws, into recovery and released at 5 PM. Bill $25,000 to insurance (through my employer/union - not the ACA). Insurance settled the bill for $17,000 + $1300 for anathesia + 2400 for the surgeon. Later my doctor prescribed a 'bone stimulator' to enhance the healing process. Insurance billed $4200 and insurance settled for $2500 for what appeared to be a $200 piece of electronic equipment. In total I was billed $40K, Insurance settled on $25K and I had to pick up $1500 out of pocket. I don't begrudge any business to make a profit - it is obvious the 'billings' were Insurance prices - I don't know what prices would have been if I had said I didn't have insurance, only money - maybe less, maybe more. The fact that insurance setteled at the prices they did by default means that the providers are making a profit at the settled price. The reality is there is no effective control on health care prices and people are hit with these bills when they are in the most stressed periods of their lives - just wanting to feel 'normal' again and having no basis to 'comparison shop' for any of the procedures to know if they and/or their insurance carriers are being taken. I suspect the ACA Insurers aren't challenging what they are being billed so they can claim losses on the business and jack the rates out of sight and say 'we told you so'
The two different rates are what you would pay without insurance and what the insurance company negotiated to pay for the procedures. The reason for the difference is the negotiated rate represents a GROUP of people that may or maynot seek the same care from the same medical system for the same rate versus an individual.
Now for the restaurant analogy to please ACY:
If you eat at a restaurant as a individual you typically pay higher rates on a per person basis than if you eat at a restaurant as a group and pay group rates for the food. That doesn't mean the restaurant is run by evil people out to gouge. It is what is called an "Economy of Scale".
As for the insurance companies being evil. I've yet to hear one complaint about workmans comp insurance and how that works. Everyone is happy with that. You know why right? Because someone else picks up the tab (the employer). Yet still if the employers and insurance companies were really in cohoots they could screw you on workmans comp but guess what? They don't. You can pick any doctor and any hospital to resolve a workmans comp claim. You can also take off as long as the Doctor instructs from work and your work hours salary or just salary is protected by Workmans Comp. The only requirement is the Workmans Comp Insurance company reviews the Doctors instructions and requests both employer and emploee to sign off on the amount of work missed. That was my experience with workmans comp insurance. Everyone happy and everyone made whole again. Worker didn't pay a penny for medical care nor the time missed from work.
And guess what else, Workmans Comp is not part of the ACA. Imagine that. How did those evil companies and evil insurance companies work out such a deal?
I had a employee that claimed Workers Comp for a twisted knee (whatever that is) I sent him to top of the line (for Dallas) Baylor Hospital in Plano for Medical Care. He was treated like royalty and recovered just fine.
Euclid The basic problem in healthcare is the price which is rising out of control for these four reasons: The administrative cost imposed by the insurance companies as a third party to the patient/provider transaction. The administrative cost of government regulations. The separation of the patient from consideration of direct cost awareness. The lack of cost containment pressure on the medical provider and products industry, the insurance companies, and the regulators that results from separating the patient from direct cost awareness. For a while, the rising costs could be somewhat contained by group rates and pooling risk which was a natural function of insurance, but the limit is now being reached, and the cost is becoming impossible to cope with. The only solution is to fix all four of the above listed items by introducing competition for the patients’ business. Neither the insurance companies, the medical business, nor the government regulators have any interest in this solution. They all benefit from the lack of competition for the patients' business. Only the patient has an interest in this solution, and they have no idea how to exercise their will in the matter. So the solution can only happen at the political level, and only by those politicians who see a greater political benefit serving the public rather than serving their self-interests.
The rising costs in medical care are also largely attributable to unfunded mandates passed by Congress each year which drives the medical costs higher and higher.
One big way to reduce pharmacutical prices in my view would be for government to pick up the cost of medical research on drugs that are successful in treating ailments as well as partially sponsoring research in other areas. Stripped of the claim they have to recover the research monies spent. The price of some drugs would be significantly cheaper.
BaltACD Euclid Tom, If we fix #1-4, that will take care of the Shkreli problem. The Shkreli Factor is the real facilitator of 1-4.
How so? If you believe that to be the case, how would you fix it?
Euclid BaltACD Euclid Tom, If we fix #1-4, that will take care of the Shkreli problem. The Shkreli Factor is the real facilitator of 1-4. How so? If you believe that to be the case, how would you fix it?
Everybody pushes the limit on their billing - try $10 and get paid 7; next time try $15 and get paid 10; next try $20 and get paid 15 and the march is on time after time increment after increment. Shkreli only made the increments beyond belief - doctors are doing it, drug companies are doing it, hospitals are doing it, doctor owned 'surgery centers' are doing it - anybody and everybody connected with providing health care are doing it and with each 'increment' so raises 'reasonable & customary' in what gets paid - and everybody in health care laughs all the way to the bank, including the insurance providers.
BaltACD Euclid BaltACD Euclid Tom, If we fix #1-4, that will take care of the Shkreli problem. The Shkreli Factor is the real facilitator of 1-4. How so? If you believe that to be the case, how would you fix it? Everybody pushes the limit on their billing - try $10 and get paid 7; next time try $15 and get paid 10; next try $20 and get paid 15 and the march is on time after time increment after increment. Shkreli only made the increments beyond belief - doctors are doing it, drug companies are doing it, hospitals are doing it, doctor owned 'surgery centers' are doing it - anybody and everybody connected with providing health care are doing it and with each 'increment' so raises 'reasonable & customary' in what gets paid - and everybody in health care laughs all the way to the bank, including the insurance providers.
I understand what you mean. Everyone will take as much money as they can. With healthcare, there is no free market. The final payer is the consumer, and he/she is frozen out of any influence on the price. If this same system were applied to food, a gallon of milk would cost $889.57.
The only solution is to put the consumer back into the normal position of shopping for the best price. That forces the providers to compete with each other, and they will feel the pressure to lower their prices to get the business. Right now, these providers are free to take whatever price they want. Competition will end this free lunch to providers. It works every time.
As someone directly involved with running an ambulance service - it's a problem. Most insurance companies won't pay even a reasonable fraction of what it costs to keep an ambulance available. We get a subsidy from the townships we serve and we still have to watch expenses and seek other sources of funding. The newer, and ever increasing, deductables are causing serious problems as well. We have had to resort to sending people to collections. This is not a pleasant solution, as these people are our neighbors.
It's not much different for doctors - if they want to keep their office open, they need money for direct and overhead costs.
That's not to say that there aren't those who are getting greedy, but what sometimes looks like greed is oftimes just an attempt to break even, somehow.
It has been said that those who supposedly are trying to help us get better are instead invested in keeping us where we are, so as to sell us more drugs and services...
But we're drifting off the rails here...
Larry Resident Microferroequinologist (at least at my house) Everyone goes home; Safety begins with you My Opinion. Standard Disclaimers Apply. No Expiration Date Come ride the rails with me! There's one thing about humility - the moment you think you've got it, you've lost it...
I;m reminded of the tale of the guy who challenged his doctor about his bill.
Doc, You billed me $250.00 for cutting this mole off and it only took you five minutes. The doc took the bill and issued him a new one. It said $10.00 for cutting of mole. $240.00 for knowing how to cut off mole.
Electroliner 1935 I;m reminded of the tale of the guy who challenged his doctor about his bill. Doc, You billed me $250.00 for cutting this mole off and it only took you five minutes. The doc took the bill and issued him a new one. It said $10.00 for cutting of mole. $240.00 for knowing how to cut off mole.
There you go!
tree68 As someone directly involved with running an ambulance service - it's a problem. Most insurance companies won't pay even a reasonable fraction of what it costs to keep an ambulance available. We get a subsidy from the townships we serve and we still have to watch expenses and seek other sources of funding. The newer, and ever increasing, deductables are causing serious problems as well. We have had to resort to sending people to collections. This is not a pleasant solution, as these people are our neighbors. It's not much different for doctors - if they want to keep their office open, they need money for direct and overhead costs. That's not to say that there aren't those who are getting greedy, but what sometimes looks like greed is oftimes just an attempt to break even, somehow. It has been said that those who supposedly are trying to help us get better are instead invested in keeping us where we are, so as to sell us more drugs and services... But we're drifting off the rails here...
I may be biased as a provider, but it seems to me that the insurance companies are the real bandits.
C&NW, CA&E, MILW, CGW and IC fan
First of all, Railroad Retirement is a two part system. Employees pay into Tier 1 RRR which is the equivilent of Social Security. Then they additionally pay into Tier 2 which is a private annuity for railway workers. Carriers hate Railroad Retirement because they have to pay 12.6 percent for each eligible employee earnings into Tier 2. In general, railroaders who are part of the Railroad Retirement program have more money deducted out of their paychecks than people who are only part of Social Security. In the end, Railroad Retirement is worth about 3 times what Social Security is worth after a 30 year career. Tier 2 is mostly self funded by the workers. To take this money and combine it with Social Security would be robbery. I see two major threats to Railroad Retirement: one person train crews and privitization of Amtrak.
One person train crews would significantly reduce the amount of railroad workers contributing into the Tier 2 portion of the benefit, not to mention the reduced amount of employees the carriers are having to pay 12.6 percent on.
Privitizing Amtrak where transportation companies like herzog take over the service as a "contractor" is also a threat. Despite Amtrak being a small Class 1 compared to other railroads, their employee contributions are a major factor in keeping Railroad Retirement solvent. As a norm, transportation companies like Herzog who have found a loophole as a contractor do not pay 12.6% per employee into the Railroad Retirement system nor are their employees part of the benefit.
cougarpinesOne person train crews would significantly reduce the amount of railroad workers contributing into the Tier 2 portion of the benefit, not to mention the reduced amount of employees the carriers are having to pay 12.6 percent on.
I know the Class I's are trying to push one person crews but I have to be honest here with the current automation technology still lacking..... I think a freight train with only one person in the cab is an accident waiting to happen and I would be personally opposed to any such thing comming anywhere near my home.
They won't even let you drive a tank in the Army without a second person to look over your shoulder or get off the tank and ground guide it around. Frieght Train can be far more damaging than a tank if it gets out of control.
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