Stossel's stating the obvious, but the obvious never gets said without people like Stossel.
I'd be curious about the microeconomics of some of this; that doctor who hired 4 people to do the paperwork (all the expenses of which - salaries, benefits, office space, etc. - are a deductible expense)- what's the net to him after expenses on insurance company reimbursements? Usually, doctors reduce their fees for procedures billed to insurance companies because they pay to their schedule, not the doctor's. That means a $100 bill to the cash customer gets reimbursed at $55 from the insurance company, less the $5-15 it costs the doctor to do the paperwork, less the time value of the $55 because the insurance company takes 8 weeks to pay. Net to the doc might be the equivalent of $40 cash at the time of service.
There's no way to reverse the process because the customer (the patient) frequently suffers only a $10-20 co-pay expense, sometimes nothing, which is much less than the $40 cash cost, and reducing the cost burden to the insurance company doesn't show up as a line item cost benefit to the patient because the patient doesn't think he pays for insurance, despite the hidden cost burden on his employer negatively affecting his paycheck.
And, unless all billings from the doctor benefit from a cash pay arrangement, he still has to maintain 3 of those 4 people for the billings to the other other insurance companies, so he can't afford to offer the $40 cash payment for a visit.
This may be something that can't be fixed with an incremental solution, but only the nuclear one.
Well, Stossel makes some interesting points here. I think, though, that he places too much of the blame on the insurance industry when the HMOs are equally to blame.
The key to understanding what went wrong really starts with the February 17, 1971 meeting between Richard Nixon and John Ehrlichman to discuss the Vice President's position on health maintenance organizations. The next day, Nixon announced a new national health strategy for expanding HMOs. It was from there that Nixon started us down the path of being up to our eyeballs in bullshit.
As a yoon-yun member, I get to hear ALL the doom and gloom bullshit from the clowns "selected", (you think Bush stole elections? Try a Union election sometime for a ful taste of Soviet Democracy!), to "represent" me.
Dem bums are all sphincters a-puckered to have Der UberFrauFuehrer's Reich come and rescue us from the high cost of health care.
It's mostly bullshit of the most odoriferous transparency.
And here's the proof:
Most health insurance, and Medicare does not cover cosmetic breast augmentation surgery.
Result?
You can get a pair of "bolt-ons" installed for about 5-7 grand, financed.
"Usually, doctors reduce their fees for procedures billed to insurance companies because they pay to their schedule, not the doctor's."
Yup, and there is a mechanism you won't see unless you're a provider or you work for an insurance company.
I saw it. My wife was a provider, a clinical psychologist in private practice, and her sister is an RN, an auditor for a major health insurance company.
The mechanism is that health care providers must bill patients at a rate that is higher than the insurance companies pay, such that the insurance companies can then state to their stockholders and clients, truthfully, that they have forced the providers to bill them at lower rates. The providers are audited by the insurance companies to prove that they comply with the rules, and refusing to submit to the audit results in the insurance companies refusing all claims.
Her primary reason for retiring early was that she was simply fed up with dealing with insurance companies. It's easy to see why.
My dentist gives us a 10% break because we write him a check up front for the full amount. One of the local HMOs lets non-members in and bills us at a "hardship rate" that is less than the official charge.
Several doctors in Florida have opened up new practices - that refuse to take Insurance.
They post their prices, you pay 'em, and then if you have insurance, you go wrangle with them for reimbursement.
They get paid, so they don't have to float for months - in some cases exceeding 6 for getting paid.
They don't have to have staffs devoted to constantly battling and wrangling with insurance companies.
An office visit starts at $30, IIRC. According to their math, they were losing more money with how many staff and time they were devoting to insurance.
One said in an interview I saw on a local TV station that the tipping point for him was when he realised that he had 3 nurses and a tech working for him, and 8 "billing specialists".
he places too much of the blame on the insurance industry when the HMOs are equally to blame.
This has been explained to you. Twice, if I recall correctly. Perhaps more. You don't know what an HMO is, so assigning blame is ridiculous for you. (No, ignoring that you've been pulled up short in knowledge is not forgivable when you spout the same, incorrect nonsense later.)
(Or: Explain the difference between "insurance industry" and "HMOs".)
(Bonus points for explaining the differences in "HMO's" and John Edward's plan/comments)
(Note, both require explanation.)
And I didn't feel like filling up Haloscan explaining the difference between traditonal indemnity insurance and HMOs as well as adding links that Unix would never go and read to explain the difference between the current system and the ones proposed by Edwards/Clinton/Obama (i.e. why they could work beter).
It wouldn't seem so, no. (That you were sarcastic.)
By all means, fill up Haloscan. Give me some links, but I will insist on some quality ones. Health Care's an area where I've argued with some people who really know what they're talking about, so I've seen the good arguments. (I don't think you'll provide them, but go ahead, go for it.)
Part of the reason I asked, is that what is called an "HMO" plan today is not what HMO's were proposed to be. It would be instructive, and illuminative, if you were aware of that, and could discourse on that. As well as what's different with Edwards "Plan".
Note that the vast majority of "HMO Plans" aren't actually, Health Maintenance Organizations. (The one my employer offers is BCBS "HMO".)
Part of the problem with the "Universal" or "Governmental Health", when you're heading down a path that's already been traversed, to know the history.
So, since most "HMO's" aren't, and Edwards plan, for a really good example, is pretty damn close to the original HMO proposals.... The next, logical step is to ask "How will this succeed when it failed in the past?"
Do you have an answer to that? I can promise you most of us know what the real answer is to Edwards and his staff. "Do it again, but this time, harder!" But I've heard actual arguments (that tended to still ignore history/human nature) that did take the HMO failure into account.
Unix, Yes, I can. But I won't because it would be a fruitless excersise. The way I see things at present is that I would like to see a system that is healthy balance of socialized medecine and what we have here. I have stated repeatedly that we can't have a Canadian or French type system here. We have to take into consideration the system we currently have in place. In addition, I think that funds re-allocation NOT more taxes will pay for any health care plan.
You would like the current system to remain in place, citing faults yes but not enough to change things because you think that any government run system would a) thieve from your wallet and b). be mismanged. There is absolutely nothing I can say to convince you otherwise so it would be a waste of my time.
"I just wish people would move back toward indemnity plans, i.e. where you get a cash payout upon diagnosis of a malady to do with as you wish."
I reckon that that was the first step on the journey that ends up with where we are now.
So...you get diagnosed with bleeding 'rhoids, and here's your payout.
Congratulations, (I think), but when you go to get treated,(and I'm assuming that you WOULD), you'd find that the base price of rectal repair to be exactly what your payout amount is.
Well, you could say, that's groovy!
But now the base price of the procedure has been established predicated on an insurance benefit.
And here comes all those who cannot or will not buy an anal maintenance plan, but who are getting cranky because their butts are itching and burning and bleeding regardless of their uninsured status, and they want to know why the cost of blessed medical relief is so unaffordable.
Medical insurance should be like auto insurance, to be used only for truly catastrophic treatments, and your risk factors can be mitigated by your deductible to determine your premium and its' affordability.
But I won't because it would be a fruitless exercise.
Not at all. This is why you fail.
It would be very fruitful.
Because you wouldn't be able to say "fluffy", non-specific things like: The way I see things at present is that I would like to see a system that is healthy balance of socialized medicine and what we have here.
So, you can't actually tell us how you'll achieve that, but we're wrong when we tell you that you're telling us that your plan has been well-stereotyped as "Do it again! HARDER!"
It would be very fruitful, and not just for us, but for you to try and explain how you'd manage that, and how it would work.
Since you can't tell me how the last time didn't work, I'm pretty sure your plan is.. "We'll try something, and I HOPE, hope! It will work!"
And what if it doesn't? You've not thought about how we'll handle failure of your system.
But we have.
I have stated repeatedly that we can't have a Canadian or French type system here.
Um. Yes, you stated that about the Canadian system. But you've lauded the French previously. (Again, you're contradicting yourself.)
But that's all you're doing. and you're not demonstrating that you know enough about the current system and it's history to be judged competent to describe it, much less plan a replacement!
This is why actually arguing something non-fluffy would be very fruitful - for you.
In addition, I think that funds re-allocation NOT more taxes will pay for any health care plan.
Mark, it's Monday morning. You can't give me my weekly dose of Meaningless Political Promises this early in the week and expect me not to get grouchy.
Medical insurance should be like auto insurance, to be used only for truly catastrophic treatments, and your risk factors can be mitigated by your deductible to determine your premium and its' affordability.
Bilgeman, I like that idea.
I would like to see something where you can take that payout and go anywhere, not just those pre-approved buy the policy.
How do you think something like this would affect standard office visits, child checkups, and immunizations?
"Medical insurance should be like auto insurance, to be used only for truly catastrophic treatments, and your risk factors can be mitigated by your deductible to determine your premium and its' affordability."
That's what I've looked for, and it isn't available. Well, at least it isn't available here, and, thanks to the feddle gubmint, it doesn't matter if it is available elsewhere, because I can't buy it if it isn't available here.
"Medical insurance should be like auto insurance, to be used only for truly catastrophic treatments, and your risk factors can be mitigated by your deductible to determine your premium and its' affordability."
That sounds suspiciously like how a Medical Savings Account plan is supposed to work. Unfortunately, like DJ, I can't find such a beast. In fact, with two diabetics in my family and me being self employed, I can't buy insurance. Period.
I have discovered that paying cash for our supplies is usually significantly cheaper than the premiums for insurance. I would still like to find catastrophic coverage, though.
Methinks there might be a market opportunity for a health care marketing professional.
I started to comment, then aborted, that in the cases I've researched, those sorts of health care plans aren't allowed... by the government.
(New York came up in one discussion - they're specifically disallowed in any and all cases. Sorry, this was years ago, no idea where in the ether those bits went.)
"I have discovered that paying cash for our supplies is usually significantly cheaper than the premiums for insurance. I would still like to find catastrophic coverage, though."
The total of my medical expenses, for supplies, drugs, doctors, and so on, would be about half what they currently are if I didn't have insurance. I pay the additional amount to have the insurance as a hedge against the cost of the catastrophes that it covers.
"It's why health insurance is not a good idea for anything but serious illnesses and accidents that could bankrupt you. For the rest, we should pay out of our savings."
This is exactly the problem. As a nation we don't save. If everybody had $10-15k (or more) in a savings account (medical or generic) that would be a lot more realistic of a solution. But, since the typical American is saddled with high levels of consumer debt and little or no savings they'd react to such a proposal by saing something to the effect of "You want me to do what!? That's what my gilded insurance is for!"
If you have no debt except a modest mortgage, and $15k in a savings account that'll put you well into the top 10%, maybe even the top 5% of Americans in terms of wealth. Until that kind of financial picture becomes at least a lot closer to the norm rather than the exceptional, the health insurance system is not likely to change significantly.
Andrew, I submit that we've been going at this the wrong way around. If we don't fix the underlying societal illness that drives people towards government intrusion, we'll always be playing defense.
Said illness being that people sacrifice long-term safety for the sake of short term hedonic pleasure, thereby making their own positions precarious, thereby creating the need for systemwide risk mitigation of the type that governments claim to provide.
But, but that means the subj--er, citizens have to take responsibility!
Why should they do that when big papa (or mama, don't want to be sexist) government can take care of it all?
We are, after all, rich.
Another obstacle will be the doctor's offices. They are so used to billing the insurance company, I doubt they'd be all over the idea of pricing out services a la a mechanic. Or, gasp!, competing.
"Another obstacle will be the doctor's offices. They are so used to billing the insurance company, I doubt they'd be all over the idea of pricing out services a la a mechanic. Or, gasp!, competing."
Been thinkin' 'bout that, and I don't agree. Doctor's offices have to specify in considerable detail what they bill for. Every billable item has to have a proper code to describe it, and every code has several prices, including one for those who actually pay, and one for each different insurance company (because they negotiate their own rates and aren't allowed to collude with each other to do so).
Such was the case when my wife had to bill insurance companies. She made use of a woman who operated a very helpful service out of her home. My wife would hand over her bills to the insurance companie, in ready-to-file form, and this woman would file them, track them to completion, including the inevitable hounding of the insurance companies to get off their collective asses, and then turn over the proceeds to my wife when she collected them. Her fee was three dollars per bill. She was invaluable.
I think simply pricing their services as a supermarket does would be a considerable relief to them.
Doctor's offices have to specify in considerable detail what they bill for. Every billable item has to have a proper code to describe it, and every code has several prices, including one for those who actually pay, and one for each different insurance company (because they negotiate their own rates and aren't allowed to collude with each other to do so).
I didn't know that.
I wonder, though, if the doctor has any idea of the cost of the services and materials?
Any good mechanic knows how much things cost and how to cut costs. Does that apply to say, a G.P.? Should the doctor even know? Maybe just the staff should know.
I think simply pricing their services as a supermarket does would be a considerable relief to them.
Given that they are being dinged $3 a bill, I would think so, too.
But now we are talking about bureaucratic inertia.
It would have be attractive to the office to make the switch, or at least support it in parallel.
The latter might not be a big deal, since they already have mechanisms in place for different billing.
My experience is that the typical doctor's office has a staff to file and pursue their billings with insurance companies. My wife used the services I described because she ran a one-person-office, she being the doc, the secretary, the accountant, and the floor sweeper.
A case in point from today is interesting. A week or two ago, I visited my doctor to get my routine prescriptions updated. My deductible is really high, and they know it, so they billed me $62.98 for the visit and filed a routine claim with the insurance company. In today's mail, I received, direct from the the insurance company, my copy of the claim they filed. The claim shows:
The doctor's staff knew 'xactly what to expect, and billed me before I left the office for what they knew I would have to pay. But, the insurance company can say, "See! We got you a discount!"
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Stossel's stating the obvious, but the obvious never gets said without people like Stossel.
I'd be curious about the microeconomics of some of this; that doctor who hired 4 people to do the paperwork (all the expenses of which - salaries, benefits, office space, etc. - are a deductible expense)- what's the net to him after expenses on insurance company reimbursements? Usually, doctors reduce their fees for procedures billed to insurance companies because they pay to their schedule, not the doctor's. That means a $100 bill to the cash customer gets reimbursed at $55 from the insurance company, less the $5-15 it costs the doctor to do the paperwork, less the time value of the $55 because the insurance company takes 8 weeks to pay. Net to the doc might be the equivalent of $40 cash at the time of service.
There's no way to reverse the process because the customer (the patient) frequently suffers only a $10-20 co-pay expense, sometimes nothing, which is much less than the $40 cash cost, and reducing the cost burden to the insurance company doesn't show up as a line item cost benefit to the patient because the patient doesn't think he pays for insurance, despite the hidden cost burden on his employer negatively affecting his paycheck.
And, unless all billings from the doctor benefit from a cash pay arrangement, he still has to maintain 3 of those 4 people for the billings to the other other insurance companies, so he can't afford to offer the $40 cash payment for a visit.
This may be something that can't be fixed with an incremental solution, but only the nuclear one.
This may be something that can't be fixed with an incremental solution, but only the nuclear one.
Entropy's a bitch, isn't it?
Well, Stossel makes some interesting points here. I think, though, that he places too much of the blame on the insurance industry when the HMOs are equally to blame.
The key to understanding what went wrong really starts with the February 17, 1971 meeting between Richard Nixon and John Ehrlichman to discuss the Vice President's position on health maintenance organizations. The next day, Nixon announced a new national health strategy for expanding HMOs. It was from there that Nixon started us down the path of being up to our eyeballs in bullshit.
Ahhh, health care.
As a yoon-yun member, I get to hear ALL the doom and gloom bullshit from the clowns "selected", (you think Bush stole elections? Try a Union election sometime for a ful taste of Soviet Democracy!), to "represent" me.
Dem bums are all sphincters a-puckered to have Der UberFrauFuehrer's Reich come and rescue us from the high cost of health care.
It's mostly bullshit of the most odoriferous transparency.
And here's the proof:
Most health insurance, and Medicare does not cover cosmetic breast augmentation surgery.
Result?
You can get a pair of "bolt-ons" installed for about 5-7 grand, financed.
http://www.docshop.com/education/cosmetic/breast/augmentation/cost/
Most health insurance doesn't,(yet), cover laser vision correction.
Result?
With coupons, you can get your blinkies zapped 20-20 for about 2 grand.
http://www.allaboutvision.com/visionsurgery/cost.htm
Same with dentistry.
Without an artificial price support, the providers MUST charge what the market can afford to pay, (or they go bankrupt).
That's why new Hyundais aren't priced at 100,000 dollars, kids.
Sure, they would LOVE to charge that much, but they know that nobody SANE would drop 100 grand on a fuckin' Hyundai.
Thanks to government agreeing to be our "doctor", and with Clinton's "Ministry of Volkisch Health", we indeed WILL be paying 100k for that Hyundai...
...and a used one, at that.
Regards;
"Usually, doctors reduce their fees for procedures billed to insurance companies because they pay to their schedule, not the doctor's."
Yup, and there is a mechanism you won't see unless you're a provider or you work for an insurance company.
I saw it. My wife was a provider, a clinical psychologist in private practice, and her sister is an RN, an auditor for a major health insurance company.
The mechanism is that health care providers must bill patients at a rate that is higher than the insurance companies pay, such that the insurance companies can then state to their stockholders and clients, truthfully, that they have forced the providers to bill them at lower rates. The providers are audited by the insurance companies to prove that they comply with the rules, and refusing to submit to the audit results in the insurance companies refusing all claims.
Her primary reason for retiring early was that she was simply fed up with dealing with insurance companies. It's easy to see why.
My dentist gives us a 10% break because we write him a check up front for the full amount. One of the local HMOs lets non-members in and bills us at a "hardship rate" that is less than the official charge.
Several doctors in Florida have opened up new practices - that refuse to take Insurance.
They post their prices, you pay 'em, and then if you have insurance, you go wrangle with them for reimbursement.
They get paid, so they don't have to float for months - in some cases exceeding 6 for getting paid.
They don't have to have staffs devoted to constantly battling and wrangling with insurance companies.
An office visit starts at $30, IIRC. According to their math, they were losing more money with how many staff and time they were devoting to insurance.
One said in an interview I saw on a local TV station that the tipping point for him was when he realised that he had 3 nurses and a tech working for him, and 8 "billing specialists".
Mark:
he places too much of the blame on the insurance industry when the HMOs are equally to blame.
This has been explained to you. Twice, if I recall correctly. Perhaps more. You don't know what an HMO is, so assigning blame is ridiculous for you. (No, ignoring that you've been pulled up short in knowledge is not forgivable when you spout the same, incorrect nonsense later.)
(Or: Explain the difference between "insurance industry" and "HMOs".)
(Bonus points for explaining the differences in "HMO's" and John Edward's plan/comments)
(Note, both require explanation.)
Unix, you know what? You're right, I have no idea what an HMO is.
"You're right, I have no idea what an HMO is."
A admission of ignorance is the first step to understanding. Congratulations, Grasshopper!
Mark:
Thanks. So what would that mean for your belief/statement when the HMOs are equally to blame?
Who's to blame, then?
"My dentist gives us a 10% break because we write him a check up front for the full amount."
So does mine.
Damn, but getting older sucks. I remember that filling a cavity cost seven dollars when I was in grade school.
Actually, I was being sarcastic.
And I didn't feel like filling up Haloscan explaining the difference between traditonal indemnity insurance and HMOs as well as adding links that Unix would never go and read to explain the difference between the current system and the ones proposed by Edwards/Clinton/Obama (i.e. why they could work beter).
Mark:
It wouldn't seem so, no. (That you were sarcastic.)
By all means, fill up Haloscan. Give me some links, but I will insist on some quality ones. Health Care's an area where I've argued with some people who really know what they're talking about, so I've seen the good arguments. (I don't think you'll provide them, but go ahead, go for it.)
Part of the reason I asked, is that what is called an "HMO" plan today is not what HMO's were proposed to be. It would be instructive, and illuminative, if you were aware of that, and could discourse on that. As well as what's different with Edwards "Plan".
Note that the vast majority of "HMO Plans" aren't actually, Health Maintenance Organizations. (The one my employer offers is BCBS "HMO".)
Part of the problem with the "Universal" or "Governmental Health", when you're heading down a path that's already been traversed, to know the history.
So, since most "HMO's" aren't, and Edwards plan, for a really good example, is pretty damn close to the original HMO proposals.... The next, logical step is to ask "How will this succeed when it failed in the past?"
Do you have an answer to that? I can promise you most of us know what the real answer is to Edwards and his staff. "Do it again, but this time, harder!" But I've heard actual arguments (that tended to still ignore history/human nature) that did take the HMO failure into account.
Can you, is the question.
I just wish people would move back toward indemnity plans, i.e. where you get a cash payout upon diagnosis of a malady to do with as you wish.
That would seem to be, if not the best of both worlds, a big step away from what we have now.
Err, I mean a REAL indemnity plan, not the bilge we have now.
Mastiff, agreed.
Unix, Yes, I can. But I won't because it would be a fruitless excersise. The way I see things at present is that I would like to see a system that is healthy balance of socialized medecine and what we have here. I have stated repeatedly that we can't have a Canadian or French type system here. We have to take into consideration the system we currently have in place. In addition, I think that funds re-allocation NOT more taxes will pay for any health care plan.
You would like the current system to remain in place, citing faults yes but not enough to change things because you think that any government run system would a) thieve from your wallet and b). be mismanged. There is absolutely nothing I can say to convince you otherwise so it would be a waste of my time.
Mastiff:
"I just wish people would move back toward indemnity plans, i.e. where you get a cash payout upon diagnosis of a malady to do with as you wish."
I reckon that that was the first step on the journey that ends up with where we are now.
So...you get diagnosed with bleeding 'rhoids, and here's your payout.
Congratulations, (I think), but when you go to get treated,(and I'm assuming that you WOULD), you'd find that the base price of rectal repair to be exactly what your payout amount is.
Well, you could say, that's groovy!
But now the base price of the procedure has been established predicated on an insurance benefit.
And here comes all those who cannot or will not buy an anal maintenance plan, but who are getting cranky because their butts are itching and burning and bleeding regardless of their uninsured status, and they want to know why the cost of blessed medical relief is so unaffordable.
Medical insurance should be like auto insurance, to be used only for truly catastrophic treatments, and your risk factors can be mitigated by your deductible to determine your premium and its' affordability.
Yes, I can.
The evidence would seem to indicate otherwise.
But I won't because it would be a fruitless exercise.
Not at all. This is why you fail.
It would be very fruitful.
Because you wouldn't be able to say "fluffy", non-specific things like:
The way I see things at present is that I would like to see a system that is healthy balance of socialized medicine and what we have here.
So, you can't actually tell us how you'll achieve that, but we're wrong when we tell you that you're telling us that your plan has been well-stereotyped as "Do it again! HARDER!"
It would be very fruitful, and not just for us, but for you to try and explain how you'd manage that, and how it would work.
Since you can't tell me how the last time didn't work, I'm pretty sure your plan is.. "We'll try something, and I HOPE, hope! It will work!"
And what if it doesn't? You've not thought about how we'll handle failure of your system.
But we have.
I have stated repeatedly that we can't have a Canadian or French type system here.
Um. Yes, you stated that about the Canadian system. But you've lauded the French previously. (Again, you're contradicting yourself.)
But that's all you're doing. and you're not demonstrating that you know enough about the current system and it's history to be judged competent to describe it, much less plan a replacement!
This is why actually arguing something non-fluffy would be very fruitful - for you.
In addition, I think that funds re-allocation NOT more taxes will pay for any health care plan.
Mark, it's Monday morning. You can't give me my weekly dose of Meaningless Political Promises this early in the week and expect me not to get grouchy.
Mark:
Oh, and again, you're totally wrong.
You would like the current system to remain in place
Nope.
Medical insurance should be like auto insurance, to be used only for truly catastrophic treatments, and your risk factors can be mitigated by your deductible to determine your premium and its' affordability.
Bilgeman, I like that idea.
I would like to see something where you can take that payout and go anywhere, not just those pre-approved buy the policy.
How do you think something like this would affect standard office visits, child checkups, and immunizations?
Russel:
"How do you think something like this would affect standard office visits, child checkups, and immunizations?"
Normal maintenance, oil change and a tire rotation...get 'em at any walk-in clinic or school, buy 'em in bulk for a discount.
Open market unsubsidized by anyone, therefore, priced to where anyone can afford it.
And y'know, if you stick with the maintenance, your vehicle lasts a lot longer...
"Medical insurance should be like auto insurance, to be used only for truly catastrophic treatments, and your risk factors can be mitigated by your deductible to determine your premium and its' affordability."
That's what I've looked for, and it isn't available. Well, at least it isn't available here, and, thanks to the feddle gubmint, it doesn't matter if it is available elsewhere, because I can't buy it if it isn't available here.
"Medical insurance should be like auto insurance, to be used only for truly catastrophic treatments, and your risk factors can be mitigated by your deductible to determine your premium and its' affordability."
That sounds suspiciously like how a Medical Savings Account plan is supposed to work. Unfortunately, like DJ, I can't find such a beast. In fact, with two diabetics in my family and me being self employed, I can't buy insurance. Period.
I have discovered that paying cash for our supplies is usually significantly cheaper than the premiums for insurance. I would still like to find catastrophic coverage, though.
Huh;
Three potential customers in this wee small sample of folks reading and commenting on Kevin's blog.
Methinks there might be a market opportunity for a health care marketing professional.
BTW, y'all do know that Kaiser Permanente is the only vestige left of Kaiser's World War II shipbuilding empire, right?
K-P was the company clinics to keep Rosie a-rivetin' and Wendy a-weldin'.
Methinks there might be a market opportunity for a health care marketing professional.
I started to comment, then aborted, that in the cases I've researched, those sorts of health care plans aren't allowed... by the government.
(New York came up in one discussion - they're specifically disallowed in any and all cases. Sorry, this was years ago, no idea where in the ether those bits went.)
Funny thing, that...
"I have discovered that paying cash for our supplies is usually significantly cheaper than the premiums for insurance. I would still like to find catastrophic coverage, though."
The total of my medical expenses, for supplies, drugs, doctors, and so on, would be about half what they currently are if I didn't have insurance. I pay the additional amount to have the insurance as a hedge against the cost of the catastrophes that it covers.
"It's why health insurance is not a good idea for anything but serious illnesses and accidents that could bankrupt you. For the rest, we should pay out of our savings."
This is exactly the problem. As a nation we don't save. If everybody had $10-15k (or more) in a savings account (medical or generic) that would be a lot more realistic of a solution. But, since the typical American is saddled with high levels of consumer debt and little or no savings they'd react to such a proposal by saing something to the effect of "You want me to do what!? That's what my gilded insurance is for!"
If you have no debt except a modest mortgage, and $15k in a savings account that'll put you well into the top 10%, maybe even the top 5% of Americans in terms of wealth. Until that kind of financial picture becomes at least a lot closer to the norm rather than the exceptional, the health insurance system is not likely to change significantly.
Andrew, I submit that we've been going at this the wrong way around. If we don't fix the underlying societal illness that drives people towards government intrusion, we'll always be playing defense.
Said illness being that people sacrifice long-term safety for the sake of short term hedonic pleasure, thereby making their own positions precarious, thereby creating the need for systemwide risk mitigation of the type that governments claim to provide.
But, but that means the subj--er, citizens have to take responsibility!
Why should they do that when big papa (or mama, don't want to be sexist) government can take care of it all?
We are, after all, rich.
Another obstacle will be the doctor's offices. They are so used to billing the insurance company, I doubt they'd be all over the idea of pricing out services a la a mechanic. Or, gasp!, competing.
"Another obstacle will be the doctor's offices. They are so used to billing the insurance company, I doubt they'd be all over the idea of pricing out services a la a mechanic. Or, gasp!, competing."
Been thinkin' 'bout that, and I don't agree. Doctor's offices have to specify in considerable detail what they bill for. Every billable item has to have a proper code to describe it, and every code has several prices, including one for those who actually pay, and one for each different insurance company (because they negotiate their own rates and aren't allowed to collude with each other to do so).
Such was the case when my wife had to bill insurance companies. She made use of a woman who operated a very helpful service out of her home. My wife would hand over her bills to the insurance companie, in ready-to-file form, and this woman would file them, track them to completion, including the inevitable hounding of the insurance companies to get off their collective asses, and then turn over the proceeds to my wife when she collected them. Her fee was three dollars per bill. She was invaluable.
I think simply pricing their services as a supermarket does would be a considerable relief to them.
Doctor's offices have to specify in considerable detail what they bill for. Every billable item has to have a proper code to describe it, and every code has several prices, including one for those who actually pay, and one for each different insurance company (because they negotiate their own rates and aren't allowed to collude with each other to do so).
I didn't know that.
I wonder, though, if the doctor has any idea of the cost of the services and materials?
Any good mechanic knows how much things cost and how to cut costs. Does that apply to say, a G.P.? Should the doctor even know? Maybe just the staff should know.
I think simply pricing their services as a supermarket does would be a considerable relief to them.
Given that they are being dinged $3 a bill, I would think so, too.
But now we are talking about bureaucratic inertia.
It would have be attractive to the office to make the switch, or at least support it in parallel.
The latter might not be a big deal, since they already have mechanisms in place for different billing.
My experience is that the typical doctor's office has a staff to file and pursue their billings with insurance companies. My wife used the services I described because she ran a one-person-office, she being the doc, the secretary, the accountant, and the floor sweeper.
A case in point from today is interesting. A week or two ago, I visited my doctor to get my routine prescriptions updated. My deductible is really high, and they know it, so they billed me $62.98 for the visit and filed a routine claim with the insurance company. In today's mail, I received, direct from the the insurance company, my copy of the claim they filed. The claim shows:
charge submitted: $70.00
not covered / discount: $7.02
amount covered: $62.98
patient deductible / copay: $62.98
covered balance: $0.00
The doctor's staff knew 'xactly what to expect, and billed me before I left the office for what they knew I would have to pay. But, the insurance company can say, "See! We got you a discount!"
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