<p>“I’m curious if anyone has seen their premiums go down for next year (without a corresponding loss of benefits or networks). Specifically I mean for those whose premiums aren’t going down because of subsidies”</p>
<p>As I’ve said upthread, I’m going from expensive and crummy catastrophic coverage with giant exclusions to more or less the same comprehensive BCBS I had from my last employer, and my premium is going down, sans subsidy.</p>
<p>However, I’m still going in circles trying to verify my identity on healthcare.gov so I can actually enroll in the products I see. Grrr!</p>
<p>“Hospitals buy each other. Insurance companies buy each other. Economies of scale do not apply. After mergers, prices rise.”</p>
<p>Same in every business. After deregulation of airlines, competition rose, prices dropped and 30 years later they are going back up because the competition is disappearing. I was complaining to a friend about fares from Houston to SFO always being about 500 and he said it will get worse. He was saying there were 8 or so major airlines only 4 years ago and now they are down to 4 (United, Southwest, Delta (American and US Air)) and with the latest merger it will only get worse.</p>
<p>It’s not as though there has ever really been a free market in health care, though. Due to insurance no-one has a clue or a care how much anything costs.</p>
<p>The detractors call it price fixing and moan about it philosophically. It is not perfect of course, although one of the benefits has been that inner city hospitals thrive rather than shutter and go into the suburbs. The rural parts of the state are still underrepresented but we are a small state so traveling to an urban area for care is not too burdensome. There is a big challenge as to how things will go forward in Maryland. The state has submitted its proposal to the feds to keep the Medicare waiver and it involves new models for cost containment. Because more and more healthcare is being provided on an outpatient model, it no longer makes sense to just look at cost per hospital admission. In fact, it makes more sense to look at limiting hospital readmission. Here is what one article has to say on Maryland’s new proposal to keep the waiver. The hospitals are on board with it. If you really want to know the details, the entire proposal is contained in this link. </p>
<p>Kmc, I wasn’t worried about bcbs being accepted, I was looking for whether or not they took Medicaid and found that handy link. </p>
<p>To be fair, my surgery wasn’t routine because of complications but I don’t think it was 35k worth of not routine lol. 20k of it was the hospital stay (plus meds and all that). The other 15k was the first er I went to, the surgery, the anesthesia, the doctors fees, etc. I was in the hospital for three days (two nights). Ridiculous.</p>
<p>romani, I think you had the right idea to be sure to call the insurer and make sure your enrollment was successful. WaPo and ABC News are reporting that there is a significant number of people who have enrolled via the government website but whose information hasn’t been communicated to the insurers, so people believe they have completed the process, but haven’t and will be uninsured as of January 1 if they don’t contact the insurers directly.</p>
<p>As I understand the situation, state regulators set the prices at hospitals. But they don’t set the SAME price for every hospital.</p>
<p>So there are two issues of concern. First is the process of setting prices, which is by its nature p*litical. We can worry about regulatory capture, which in this case might result from the people who want the prices high (the hospitals) caring more about prices being high than the people who want prices low (us). We have lots of other issues that we care about, but hospitals care only about their few issues including making sure they get a lot of money, so they end up exerting more pressure on regulators than we do.</p>
<p>But also, not all prices at all hospitals are the same. We might agree that Forest Resort Hospital and Casino’s high prices are “justified” in the sense that it does cost a lot to provide the marble hallways, the original museum-quality paintings, the piano player in the lobby and the massage therapist for every room. But nevertheless, we might not think the prices are worth paying.</p>
<p>This is why I think insurers are right to play hardball with ridiculously inflated hospital charges. We can’t afford to keep paying these stratospheric bills.</p>
<p>“In a highly competitive field, patients sometimes now referred to as guests appreciate amenities. The tactic works. We found that patient demand correlates much better to amenities than quality of care” </p>
<p>In some ways, the astronomical costs of healthcare are our fault.</p>
<p>You have a odd definition of free market. These medical facilities are choosing to offer better customer service and better amenities in order to attract patients. And it is working. </p>
<p>People dont want to be in a 20 bed ward anymore. They dont want their visitors restricted to narrow visiting hours. They dont want to be kept up by a room mate making noises.</p>
I think in all ways. Whether one agrees with certain aspects or not, things that exist in the healthcare sphere didn’t spring up by accident. Someone liked them, provided them, asked for them. We could all divide up the entire thing and choose or not choose each option or priority, be it end of life care, premie care, amenities, innovation, convenience, whatever, but we didn’t get here by accident.</p>
But that doesn’t mean that there aren’t other people who did. In some places maternity care is all about amenities and a spa-like experience. Expensive as all get out. People asked for those things. Just probably not folks like you!</p>
<p>argybargy, I suggest you take another look at the article, before suggesting that patient preferences are the cause of California Pacific’s eye-popping prices for their emergency room. It’s not as if the Roche family planned a visit to the emergency room as a part of their family vacation in San Francisco. Their toddler fell off a couch, and they rushed her to the emergency room to get stitches, like anybody would. It wasn’t like</p>
<p>Where should we go on vacation, honey?</p>
<p>How about Florida?</p>
<p>No, no. That emergency room in Miami was a dump. They only had a selection of two DVDs. Let’s go to San Francisco!</p>
<p>Argbargy, I am not going to argue with you. I was a “market” maker. My prices for bids and offers for stocks, options and etfs were disseminated across the United States a BILLION times. </p>
<p>If hospitals are choosing to compete on amenities and patient service they are going to succeed or fail on their ability to attract customers willing to pay. Thats a free market.</p>
<p>So, it’s a free market when insurers pay Cal Pacific their extortionate emergency room rates. Then it must also be a free market when insurers say, we’re not paying Cedars Sinai their extortionate rates. Right?</p>