2016 Health Care costs, surprises...

[Mr. Deez]

My point is that lots of people outside of healthcare think it is perfectly fine for patients to get free healthcare. However, few seem to want their industry providing large quantities of uncompensated services.

I don't think most people outside of healthcare think uncompensated care is a good thing any more than shoplifting is. However, unless everybody in the country is insured, I think most people accept that it's going to happen. We don't want people dying in the streets and hospitals aren't going to stop taking Medicare, so EMTALA isn't going away anytime soon. Furthermore, though we can improve healthcare providers' power as a creditor, that wouldn't eliminate uncompensated care, and for big ticket procedures, it wouldn't even make a serious dent. Finally, if that's done, it's also going to invite scrutiny of the providers' billing practices, and they probably won't want to go there. They know how messy that is.

County hospitals are constantly lobbying for new revenue from taxpayers due to uncompensated care. Smaller county hospitals across the country are closing their doors due to uncompensated care and reimbursement from Medicare and Medicaid which do not cover their costs.

Medicare and Medicaid reimbursement rates are terrible. I don't see how doctors that accept them can make a living. Frankly, the fact that they accept Medicare and Medicaid makes me a little suspicious.

I am glad you were able to recover for everyone and got paid as well. Our revenue rates for legal cases are much higher than that received from Medicare and Medicaid or even third party insurance.

Not at all surprised. First, we actually have a disincentive to try to negotiate cheaper rates for care, at least to a point.

Second, though not all lawyers do this, many (myself included) are willing to reduce their own fees in proportion to any reduction they ask for from providers. I can't very well justify a 40 percent contingent fee if I'm asking my client's doctors to cut their bills. The bottom line is that if everybody shares in any reductions, then nobody has to reduce as much.

Third, we know that doctors can make excellent referral sources for lawyers. They can't pay the doctor a finder's fee to go hustle cases for them. That's illegal, though many lawyers do it, even though it can get them thrown in the slammer. However, there's nothing illegal about a doctor referring a patient to a lawyer, and there's nothing illegal about the lawyer protecting his bill if the client consents. If you have a reputation of paying doctors consistently and in full, many of them will remember that when a patient needs a lawyer.

Finally, though doctors offices can't do this, hospitals can pretty easily secure a statutory lien against third-party recoveries, which means the lawyer can't just distribute funds to the client if the hospital won't play ball with him. That gives them leverage and less incentive to reduce from their chargemaster rates.

And your final point is correct. However, if people like the Crocodile Hunter above are not held accountable, the healthcare system will continue to collapse financially. Don't even get me started on new drug development or medical devices if the government removes or limits the return on investment.

You're right, but I don't see an easy solution.

 

[NJlonghorn]

He was rushed to Brackenridge Hospital in Austin, and performed two surgeries on his leg.

That's an impressive feat for a construction worker.

 

[Crockett]

I am all for health insurance or health care provided to those who truly cannot afford it. However, I am not for subsidizing or providing insurance to those who can afford it, but choose to spend their money elsewhere. Just don't ask me to provide free services.

That's the argument that won me over for Obamacare. Of course I hadn't imagined how Republicans would sabotage efforts to get the truly needy on Medicaid.

 

[Mr. Deez]

That's an impressive feat for a construction worker.

LOL. He wasn't your average construction worker. Not many can perform leg surgery, and even fewer can performer surgery on their own legs. Trump would want to think twice before deporting a guy with that kind of skill.

 

[Mr. Deez]

That's the argument that won me over for Obamacare. Of course I hadn't imagined how Republicans would sabotage efforts to get the truly needy on Medicaid.

I don't doubt that partisan politics was the biggest driver in refusing to expand Medicaid. However, there was a pretty defensible policy reason not to. Specifically, for most states Medicaid is a fiscal dumpster fire, and it is what keeps the states' fiscal managers awake at night - not education, not prisons, etc. Why would a state pour gasoline on it? True, it came with federal money, but accepting it meant accepting federal rules and regulations, and the states don't know how long the federal money is really going to last, particularly in light of the fact that there was nothing in the bill to actually control costs. If they ever pull the money (or more likely reduce the money), huge political pressure will fall on states to come up with the difference.

Making people Medicaid eligible isn't healthcare reform. It's welfare. Doing something to meaningfully control costs is healthcare reform. Like I've said earlier, single payer would have been better than Obamacare, because it would have at least created a mechanism with the ability to control costs. I'm not saying it would have controlled them, because our government's track record simply doesn't warrant giving it that kind of benefit of the doubt. However, it at least theoretically could have as other single payer systems throughout the world have.

 

[ProdigalHorn]

People want security when they get sick, and that means they're not going to want a true free market approach to healthcare. They're always going to want a third-party payer who will cover the bills - certainly the big bills.

I would say that IS a free-market solution, since insurance is part of the free market. Ultimately, someone is paying for that procedure, and I think most people understand that, which is why the most affordable options are the ones where you are a low-risk person who gets grouped with other low-risk people. That's one reason (maybe the main one) why health insurance costs are skyrocketing under Obamacare. The nature of the plan demands that the low risk people pay for the high risk people.

I'm sure there is a rhyme and reason to how stuff is priced, but it is not orderly. I've been billed $120 for blood tests. Then when I had insurance and a health savings plan it cost $12, even prior to exhausting my deductible, which by the way takes some doing. By contrast, services my physician billed insurance $180 for, she would do for $60 cash (out of kindness I suppose.)

It's always been explained to me that hospitals basically spread costs all over the place to cover all the things they don't collect on (i.e. delinquency, shortfalls in reimbursement, free services). Someone in the industry could comment on this, but my assumption has always been that individual hospitals handle that by their own procedures, so each one might handle his pricing differently - or is there an actual uniform process and model?

If so, let's argue over that standard not whether one should exist.

I think the issue is that the standard under Obamacare was set so broadly as to bring in a number of different risk groups, causing some to have to buy insurance which covers things they do not need.

I don't doubt that partisan politics was the biggest driver in refusing to expand Medicaid. However, there was a pretty defensible policy reason not to. Specifically, for most states Medicaid is a fiscal dumpster fire, and it is what keeps the states' fiscal managers awake at night - not education, not prisons, etc. Why would a state pour gasoline on it? True, it came with federal money, but accepting it meant accepting federal rules and regulations, and the states don't know how long the federal money is really going to last, particularly in light of the fact that there was nothing in the bill to actually control costs. If they ever pull the money (or more likely reduce the money), huge political pressure will fall on states to come up with the difference.

This.

 

[Mr. Deez]

I would say that IS a free-market solution, since insurance is part of the free market.

It is, but it effectively isn't. When a third party payer is involved, the patient loses almost all sensitivity to cost, which is fundamental to an effective market. The same phenomenon happens with the student loan program and tuition costs.

 

[oilburner]

My BCBSTX goes up 12.99% next month.
Trying to keep it below 13% was the goal?