Health Care

[wirehairman]

+1

 

The quickest way to get costs down is to remove the disconnect currently shielding consumers from the cost of their HC. Right now they have absolutely no incentive to save, since they only have an $X co-pay and their insurance pays for the rest. Give Joe Public the same tax break that business gets and soon the link between employers and med insurance is gone. Once people have to see it/take care of it themselves they'll become cost conscious.

 

Spot on, but it will never happen. There is no warm fuzzy or stick it to the man sentiment with this solution.

[Yukon Cornelius]

Just trying to show how asinine the statists continual attacks on the insurance companies are. Yes some reforms are needed, but to try to lay to cost at the feet of the insurance companies are laughable.

kinda like blaming lawsuits on rising costs

[Perchoutofwater]

kinda like blaming lawsuits on rising costs

 

You are right they have absolutely no effect.

[Yukon Cornelius]

You are right they have absolutely no effect.

jebuss i didnt say that but thanks for jumping to conclusions.

[Perchoutofwater]

jebuss i didnt say that but thanks for jumping to conclusions.

 

No, but you act like that is the only thing I suggest doing to right the system, which is just as big of a jump.

[yo mama]

+1

 

The quickest way to get costs down is to remove the disconnect currently shielding consumers from the cost of their HC. Right now they have absolutely no incentive to save, since they only have an $X co-pay and their insurance pays for the rest. Give Joe Public the same tax break that business gets and soon the link between employers and med insurance is gone. Once people have to see it/take care of it themselves they'll become cost conscious.

I agree. So why aren't insurance companies changing the way they do business?

[CaP'N GRuNGe]

Selling insurance across state lines: A terrible, no good, very bad health-care idea

[bpwallace49]

I agree. So why aren't insurance companies changing the way they do business?

 

Why should they? They make money hand over fist no matter what system is in place . . . people still need insurance, and business still get squeezed to absorb the huge increases the insurance companies levy every year.

 

But I still blame tort reform . . . that HAS to be the main issue . . right?

[bpwallace49]

Selling insurance across state lines: A terrible, no good, very bad health-care idea

 

That article is worth printing in its entirety . . . nice find.

 

Selling insurance across state lines: A terrible, no good, very bad health-care idea

 

 

The big Republican idea to bring down health-care costs is to "let families and businesses buy health insurance across state lines." Jon Chait has some commentary here, but I want to simplify a little bit.

 

Insurance is currently regulated by states. California, for instance, says all insurers have to cover treatments for lead poisoning, while other states let insurers decide whether to cover lead poisoning, and leaves lead poisoning coverage -- or its absence -- as a surprise for customers who find that they have lead poisoning. Here's a list (pdf) of which states mandate which treatments.

 

The result of this is that an Alabama plan can't be sold in, say, Oregon, because the Alabama plan doesn't conform to Oregon's regulations. A lot of liberals want that to change: It makes more sense, they say, for insurance to be regulated by the federal government. That way the product is standard across all the states.

 

Conservatives want the opposite: They want insurers to be able to cluster in one state, follow that state's regulations and sell the product to everyone in the country. In practice, that means we will have a single national insurance standard. But that standard will be decided by South Dakota. Or, if South Dakota doesn't give the insurers the freedom they want, it'll be decided by Wyoming. Or whoever.

 

This is exactly what happened in the credit card industry, which is regulated in accordance with conservative wishes. In 1980, Bill Janklow, the governor of South Dakota, made a deal with Citibank: If Citibank would move its credit card business to South Dakota, the governor would literally let Citibank write South Dakota's credit card regulations. You can read Janklow's recollections of the pact here.

 

Citibank wrote an absurdly pro-credit card law, the legislature passed it, and soon all the credit card companies were heading to South Dakota. And that's exactly what would happen with health-care insurance. The industry would put its money into buying the legislature of a small, conservative, economically depressed state. The deal would be simple: Let us write the regulations and we'll bring thousands of jobs and lots of tax dollars to you. Someone will take it. The result will be an uncommonly tiny legislature in an uncommonly small state that answers to an uncommonly conservative electorate that will decide what insurance will look like for the rest of the nation.

 

As it happens, the Congressional Budget Office looked at a bill along these lines back in 2005. They found that the legislation wouldn't change the number of the uninsured and would save the federal government about $12 billion between 2007 and 2015. That is to say, it would do very little in the aggregate.

 

But those top-line numbers hid a more depressing story. The legislation "would reduce the price of individual health insurance coverage for people expected to have relatively low health care costs, while increasing the price of coverage for those expected to have relatively high health care costs," CBO said. "Therefore, CBO expects that there would be an increase in the number of relatively healthy individuals, and a decrease in the number of individuals expected to have relatively high cost, who buy individual coverage."

 

That is to say, the legislation would not change the number of insured Americans or save much money, but it would make insurance more expensive for the sick and cheaper for the healthy, and lead to more healthy people with insurance and fewer sick people with insurance. It's a great proposal if you don't ever plan to be sick, and if you don't mind finding out that your insurer doesn't cover your illness. And it's the Republican plan for health-care reform.

[yo mama]

You are right they have absolutely no effect.

It has *some* effect. But lawsuits aren't even in the top 6 reasons why rising health care costs are out of control. Indirectly, it can be argued that fear of litigation causes medical providers to order tests that are unnecessary (which is a top 6 reason). But it is equally true that, because medical providers get PAID for running unnecessary tests, that fear of litigation is a partly pre-textual excuse, and that profit motive is just as much to blame for unnecessary tests and procedures.

[Piles]

I straight up asked if that was why and was told no it wasn't....I was also told that my drug isn't that expensive ($140ish I think)...it is a generic called Mercaptopurine (50mg tablets)....I am waiting for them to get back to me tomm. because I am not giving up without a fight...i cant remember the name of the online pharmacy but it isn't the one you listed....I wouldn't have as much of a problem with it if I was at least given a couple of choices of online pharmacies to use but that isn't the case and I think it absolutely sucks.

 

Mandating specialty pharmacy on generic mercaptopurine is a joke. I am really quite shocked. It's common on drugs that are pushing 40k/yr or more. I've seen mandatory mail order for mercaptopurine for some benefits but never have heard of it as mandatory specialty. And your insurance is straight up lying to you. It has everything to do with reimbursement. I checked and in our area the average pharmacist is being reimbursed about $1.40 per tablet for mercaptopurine.

[Piles]

I agree. So why aren't insurance companies changing the way they do business?

 

Change is slow but it is coming. We are seeing it now with Medicare D. There are 4-Tier benefits with the 4th Tier being a 25% copay for high cost drugs over $600/month. The problem with this is there are drugs that can change people's lives but nobody can afford to pay the 25% copay. I am thinking of drugs like Humira (20k/yr) for Rheumatoid Arthritis or Crohn's Disease. It is a tragedy really.

 

Inevitably the change will be driven by the employer groups. Self-Insured employers don't want to pay 60k for a drug when they are only paying the employee 40k per year. The standard 3-Tier benefit isn't working because every brand name drug manufacturer is offering coupons that essentially makes these drugs free for the patient. The way to really drive cost savings from drug is to 1) Eliminate direct to consumer ads 2) Eliminate coupons 3)Eliminate samples 4) Allow biogenerics like they do in Europe 5) Comparative efficacy trials so we know what drugs are the best 6) Go to percent copays except for select high cost drugs where no alternative exists and the evidence strongly supports efficacy and safety

 

There also is talk of a reverse 3-Tier plan. Right now patients maybe responsible for $10/$25/$40 copays. In the future we may see it where that is what the insurer pays and the patient is responsible for the rest. It would definitely drive utilization of lower cost alternatives but doesn't address the issue of affordability for those good drugs that really make a difference but cost more than a new luxury car. I don't see this coming to fruition anytime soon.

[Chavez]

+1

 

The quickest way to get costs down is to remove the disconnect currently shielding consumers from the cost of their HC. Right now they have absolutely no incentive to save, since they only have an $X co-pay and their insurance pays for the rest. Give Joe Public the same tax break that business gets and soon the link between employers and med insurance is gone. Once people have to see it/take care of it themselves they'll become cost conscious.

The one problem with that is that health care pricing isn't transparent. Ask you doctor how much a procedure is going to cost and I bet you'll get a sh*t-ton of "fum fuh"s.

[Chavez]

You are right they have absolutely no effect.

Maybe one of these days you'll actually read this article...

 

Post #80

http://www.slate.com/id/2145400/

 

The most impressive and comprehensive study is by the Harvard Medical Practice released in 1990. The Harvard researchers took a huge sample of 31,000 medical records, dating from the mid-1980s, and had them evaluated by practicing doctors and nurses, the professionals most likely to be sympathetic to the demands of the doctor's office and operating room. The records went through multiple rounds of evaluation, and a finding of negligence was made only if two doctors, working independently, separately reached that conclusion. Even with this conservative methodology, the study found that doctors were injuring one out of every 25 patients—and that only 4 percent of these injured patients sued.

 

When baseless medical malpractice suits were brought, the study further found, the courts efficiently threw them out. Only six of the cases in which the researchers couldn't detect injury received even token compensation. Of those in which an injury resulted from treatment, but evidence of error was uncertain, 145 out of 515 received compensation. Indeed, a bigger problem was that 236 cases were thrown out of court despite evidence of injury and error to patients by physicians

 

The cost of all malpractice suits (including legal fees, payouts, and insurance costs) is less than 1/2 of 1% of all health-care spending. It's tough to use THAT sliver to argue that people exercising their 7th Amendment Rights are the reason medical costs are spiraling out of control.

 

Maybe we could just make it illegal for patients to sue doctors that injure them, that would solve the problem.

[millerx]

The one problem with that is that health care pricing isn't transparent. Ask you doctor how much a procedure is going to cost and I bet you'll get a sh*t-ton of "fum fuh"s.

Very true comment here.

[bpwallace49]

Maybe one of these days you'll actually read this article...

 

Post #80

 

 

When baseless medical malpractice suits were brought, the study further found, the courts efficiently threw them out. Only six of the cases in which the researchers couldn't detect injury received even token compensation. Of those in which an injury resulted from treatment, but evidence of error was uncertain, 145 out of 515 received compensation. Indeed, a bigger problem was that 236 cases were thrown out of court despite evidence of injury and error to patients by physicians

 

The cost of all malpractice suits (including legal fees, payouts, and insurance costs) is less than 1/2 of 1% of all health-care spending. It's tough to use THAT sliver to argue that people exercising their 7th Amendment Rights are the reason medical costs are spiraling out of control.

 

Maybe we could just make it illegal for patients to sue doctors that injure them, that would solve the problem.

 

Y'know Chavez . . you have posted this very legitimate and relevant post before. I wonder why people that tend to drift right never acknowledge it? It is almost like they cant stray from their talking points . . . .

[westvirginia]

I agree. So why aren't insurance companies changing the way they do business?

 

 

Why should they? They make money hand over fist no matter what system is in place . . . people still need insurance, and business still get squeezed to absorb the huge increases the insurance companies levy every year.

 

But I still blame tort reform . . . that HAS to be the main issue . . right?

 

Because they can't right now. Because of the tax deduction available to businesses that isn't available to consumers at large. When you have that significant of a cost difference on something that is a large cost already, people will seek to avoid as much of that cost as they can.

 

BP - the insurance companies only make about 4% profit margin IIRC. That's not "hand over fist".

[CaP'N GRuNGe]

Because they can't right now. Because of the tax deduction available to businesses that isn't available to consumers at large. When you have that significant of a cost difference on something that is a large cost already, people will seek to avoid as much of that cost as they can.

 

BP - the insurance companies only make about 4% profit margin IIRC. That's not "hand over fist".

 

I can do a poor job at managing my costs (executive bonuses, etc etc) and through other creative adjustments make my bottom line anything I want as well.

[Yukon Cornelius]

a bigger problem was that 236 cases were thrown out of court despite evidence of injury and error to patients by physicians No that cant be true

[wirehairman]

The one problem with that is that health care pricing isn't transparent. Ask you doctor how much a procedure is going to cost and I bet you'll get a sh*t-ton of "fum fuh"s.

 

Health care pricing will be forced to become more transparent if people start questioning costs and shopping around. As it is now, the majority of folks look at their copay or portion they are responsible for and never even ask for an itemized invoice.

[Perchoutofwater]

Maybe one of these days you'll actually read this article...

 

Post #80

 

 

When baseless medical malpractice suits were brought, the study further found, the courts efficiently threw them out. Only six of the cases in which the researchers couldn't detect injury received even token compensation. Of those in which an injury resulted from treatment, but evidence of error was uncertain, 145 out of 515 received compensation. Indeed, a bigger problem was that 236 cases were thrown out of court despite evidence of injury and error to patients by physicians

 

The cost of all malpractice suits (including legal fees, payouts, and insurance costs) is less than 1/2 of 1% of all health-care spending. It's tough to use THAT sliver to argue that people exercising their 7th Amendment Rights are the reason medical costs are spiraling out of control.

 

Maybe we could just make it illegal for patients to sue doctors that injure them, that would solve the problem.

 

The 1/2 to 1% does not include the cost of defensive medicine. Again while I support tort reform, specifically capping punitive type awards, I do think it is a silver bullet. I do think it is a cog in the wheel though. I also support portability, less state regulation (not sure if that is constitutional),. and tougher enforcement of our existing immigration laws, all of which will help bring our cost down. There are a number of other issues I've mentioned previously as well. Tort reform is not the only thing I think we need contrary to the way you, BP, Ursa, and Grunge would like to paint me. However the fact that you and others feel like it is some sacred cow and refuse to even consider it is ridiculous.

[CaP'N GRuNGe]

I'm totally fine with tort reform to a point. At the same time, I think the threat of large financial losses if you screw somebody's life up as a doctor is a good incentive to do things carefully and correctly. As with anything, there needs to be a balance. You may not personally latch onto tort reform as the be all end all fix to the system, but it seems like alot of the people on the right do.

[Perchoutofwater]

I'm totally fine with tort reform to a point. At the same time, I think the threat of large financial losses if you screw somebody's life up as a doctor is a good incentive to do things carefully and correctly. As with anything, there needs to be a balance. You may not personally latch onto tort reform as the be all end all fix to the system, but it seems like alot of the people on the right do.

 

See, I think if a doctor totally screws someone up, rather than a punitive civil penalty, give him a criminal penalty. Yank his license which would also be a much more significant penalty to the actual offending party than would be punitive damages paid by a malpractice carrier. It would make the guy that screwed up pay the price, not the rest of us.

[Grimm74]

The headline is great politics but the reality is is that Health insurance companies are not that profitable. Wellpoints massive profits were due to the sale of one of its division and not raking over grandma and grandpa and small business. 3.4% profit margin is not much of a saving for the American people if the government decides to attack that industry.... The government take over of health insurance is purely a power grab and nothing more. We need REAL reform folks....I hope to god it takes place b/c I have a small business and a family.

 

 

http://seekingalpha.com/article/189285-hea...y-profit-margin

 

 

I've posted several times before about the profitability of the "Health Care Plans" industry, see posts here and here, and reported previously that the health insurance industry ranked #86 by profit margin out of 215 industries, at 3.3%.

 

Update data are now available for Q4 of 2009, and the Health Care Plan industry (includes Humana (HUM), Aetna (AET), WellPoint (WLP), Magellan (MGLN), Unitedhealth Group (UNH), etc.), and the health insurance industry slipped to #88 with a profit margin of 3.4%. Actually, that industry profit margin was boosted by WellPoint's 18% profit margin for Q4 2009, which was due largely to a one-time sale of its Pharmacy Benefit Management division. Without that sale, WellPoint's profit margin would have been only 3.9%, the industry average profit margin would have been closer to 3%, and the ranking for the industry would have fallen a few places down to #92.

 

America's Health Insurance Plans ((AHIP)), the industry's trade association representing 1,300 members, reported last October that annual health insurance premiums averaged $2,985 for individual coverage and $6,328 for family plans in 2009. Using the industry average profit margin of 3.4% means that insurance companies make about $100 per policy in profits for individual coverage, and a little more than $200 in profits for each family policy.

 

So even if we could strip away 100% of the health insurance industry's profits, it would only save patients between $100 and 200 per year in health insurance costs.

[CaP'N GRuNGe]

The headline is great politics but the reality is is that Health insurance companies are not that profitable. Wellpoints massive profits were due to the sale of one of its division and not raking over grandma and grandpa and small business. 3.4% profit margin is not much of a saving for the American people if the government decides to attack that industry.... The government take over of health insurance is purely a power grab and nothing more. We need REAL reform folks....I hope to god it takes place b/c I have a small business and a family.

 

 

http://seekingalpha.com/article/189285-hea...y-profit-margin

 

 

I've posted several times before about the profitability of the "Health Care Plans" industry, see posts here and here, and reported previously that the health insurance industry ranked #86 by profit margin out of 215 industries, at 3.3%.

 

Update data are now available for Q4 of 2009, and the Health Care Plan industry (includes Humana (HUM), Aetna (AET), WellPoint (WLP), Magellan (MGLN), Unitedhealth Group (UNH), etc.), and the health insurance industry slipped to #88 with a profit margin of 3.4%. Actually, that industry profit margin was boosted by WellPoint's 18% profit margin for Q4 2009, which was due largely to a one-time sale of its Pharmacy Benefit Management division. Without that sale, WellPoint's profit margin would have been only 3.9%, the industry average profit margin would have been closer to 3%, and the ranking for the industry would have fallen a few places down to #92.

 

America's Health Insurance Plans ((AHIP)), the industry's trade association representing 1,300 members, reported last October that annual health insurance premiums averaged $2,985 for individual coverage and $6,328 for family plans in 2009. Using the industry average profit margin of 3.4% means that insurance companies make about $100 per policy in profits for individual coverage, and a little more than $200 in profits for each family policy.

 

So even if we could strip away 100% of the health insurance industry's profits, it would only save patients between $100 and 200 per year in health insurance costs.

 

These numbers seem very low, given what I've seen just from people on this board.