<p>There must be people who choose hospitals, or the hospitals wouldn’t be advertising so much.</p>
<p>In my view this is not a choice between the current dysfunctional system and the even more dysfunctional ACA law. </p>
<p>I have said in an earlier post that there is a role for govt but it is not limiting choices or setting prices. How come Govt hasn’t used their antitrust powers to stop the incredible number of mergers and acquisitions in the medical care industry in the last two decades. Many hospitals have monopoly franchises in their communities. BTW, the answer is because of the political lobbying and financial influence of these medical providers. Another reason to distrust having govt involved in our health care.</p>
<p>Most importantly the govt can have a major role in ensuring the transparency that is currently lacking in the marketplace. The govt should have a website where every medical provider in the United States has to publish all their prices for every procedure. These prices should also be posted by the provider for their patients. Cost shifting should be banned, so one category of people are not charged more than another.</p>
<p>The answer is not restricting who can go where but creating a system where people can make rational decisions based on price and quality. In this type of system I favor high deductible plans so people will become careful shoppers. Also, don’t force everyone to have the same level of benefits. People should be able to choose which benefits they want in their insurance policy and which they want to pay out of their own pocket.</p>
<p>Competition can drive down prices if it was allowed. To that end, insurance should be allowed to be sold across state lines, giving the consumer the widest number of choices possible. Lastly, I would abolish employer-based insurance and the massive tax subsidies for this anachronistic practice. It is a relic of WW 2 and has outlived its usefulness.</p>
<p>Having said the above, I still think the very problematic system we have today is eons better than the mess which is called Obamacare.</p>
<p>“Here is the list of places with plush amenities from the article. They all seem to be in competitive markets.”</p>
<p>There’s one hospital on that list that I know well – Lurie Children’s in Chicago. It is the creation of a generous local philanthropist who relied on the latest research about how to reduce stress for critically ill children and families. The physical spaces were charity donations, not investments from hospital funds.</p>
<p>We’re still a federal system of govt and, in may cases, specific oversight falls to the states. A lot of these sorts of questions can be googled. Eg, how Medicaid differs or various processes. Or the roadblocks in implementing PCIP.</p>
<p>We have different ideas and opinions here on “free lunch.” If the govt is in charge of publishing each and every procedure’s costs, some team is doing that. For Medicare, aiui, they don’t break down each line item in their publications. I believe (not going back to check,) that HBB (Healthcare Blue Book) is based on this Medicare sort of bundling of charges, by zip code. AND, who checks HBB? </p>
<p>The answer is not restricting who can go where but creating a system where people can make rational decisions based on price and quality.</p>
<p>How effective is it to release info and have the general public responsible for line item decisions? One hosp charges more for that titanium implant, but less for anesthesia. I don’t know that the great mass of us is able or willing to go to those lengths, to decide.</p>
<p>ps. you can go to Cedars. Your insurer will treat it as OON, right? But you can choose it. If you advocate “rational decisions,” perhaps the problem is that, rationally, you don’t need to go to Cedars and pay the excess.</p>
<p>And, of course, perhaps Cedars needs to shave costs. To make you and the insurers happier.</p>
<p>To be frank, if I were in the same pool as GP, I wouldn’t want him/her to rack up high bills at Cedars that impact the group, when an effective alternative facility is available and a perfectly reasonable choice. We have different opinions on free lunch. I would accept that the ill child needs the particular advantages at a children’s hospital or that cancer is often best treated at a specialty facility. But these more discretionary choices…?</p>
<p>GP, there’s such a thing as a banhammer. I’m just sayin’.</p>
<p>“Reading some of these posts … Well they are disturbing.
I have to be careful. I don’t want to become as negative as busdriver11”</p>
<p>Some of these posts are really disturbing. They sound almost unbelievable, though I’m sure they are true.</p>
<p>And I’d be far less negative if I could lounge around drinking coffee, going on long walks and arguing about health insurance today. Instead, I have to make sure you people are taken care of after Cyber Monday. So enjoy your positivity before I ruin it…</p>
<p>:D There you go.</p>
<p>cf, I’d like to know what a banhammer is. A good joke would help.</p>
<p>Of course people choose their hospitals. One would be crazy to let a doctor choose one that isn’t on their insurance plan. </p>
<p>And it is very common around here for providers to require clearance from your insurance company in advance before performing any relatively expensive procedure, including routine ones like colonoscopies, and cash payment up front of your portion of the bill.</p>
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</p>
<p>10 years ago when H was set for his first colonoscopy I forced Sutter to give me a price quote for the room. I say forced because they gave me the run around for days until I quoted the CA law which required them to provide the info. In short, the facility fee (charger rate) was $3800. It was also the insurance negotiated fee. So, I shopped around. The stand alone surgery center down the street which utilized the SAME dr. had a charger rate of $1200. Our insurance negotiated rate gave us a 33% discount. I called Sutter back to ask why the difference and what else was provided for the rather hefty price. Of course there was no good answer. I asked if maybe the probe was 18K plated and there would be a string quartet playing Mozart during the procedure. Only one of us thought that was funny.</p>
<p>GP, the insurance companies should have high priced networks for those that want to pay the high prices. </p>
<p>I have been to Cal Pacific several times. There have several great doctors that I have known over the years. The hospital is too expensive. </p>
<p>If everybody wanted the plans you want, the price of those plans would increase dramatically. The system runs on a certain amount of revenue and that revenue is going to be achieved by what we are moving towards with ACA or it could be achieved by high priced high deductible plans. If we all switched to high deductible plans instead of them costing 500 a month, they would cost a 1,000 a month. </p>
<p>The healthcare system sucks up money.</p>
<p>I think transparency will help, but when I read that you see Cedars costs and you want to still be covered there…I wonder how well transparency will work. </p>
<p>Sometimes higher prices increase demand because people equate price with quality.</p>
<p>I can’t think of a joke, but Texaspg wields the ban-hammer. Texaspg has said repeatedly that we have to avoid discussing alternative health systems that we might prefer. People who disregard Texaspg’s instructions could get squashed under the ban-hammer (ouch!).</p>
<p>That’s close enough, cf!</p>
<p>It turns out that outpatient surgical centers are among the most profitable of all medical cost centers. Hospitals are so ridiculously expensive that an outpatient surgical center, which doesn’t have to provide all the facilities a hospital has, can charge way way over costs and still undercut the hospitals. We could wish that we had competition among surgical centers driving prices down, but we seem not to.</p>
<p>"Some of these posts are really disturbing. They sound almost unbelievable, though I’m sure they are true.</p>
<p>And I’d be far less negative if I could lounge around drinking coffee, going on long walks and arguing about health insurance today. Instead, I have to make sure you people are taken care of after Cyber Monday. So enjoy your positivity before I ruin it…"</p>
<p>Kind of like your post busdriver11. :)</p>
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<p>Tell me about it. Seven years ago my daughter had to have surgery to repair hernia. It was done in the outpatient center. The total time spent from entering the facility to exiting it was under 2 hours (including filling out forms, waiting for my daughter to wake up, etc.). I believe the total bill was around 5K (from everyone), of which I had to pay around 1K.</p>
<p>Lerkin, just to ask a question related to my own decisions: that looks like 20%. Was it after you had met deductible that year? Cuz it sure looks like, if I need a 5k procedure, I am I for the deductible first.</p>
<p>Lookingforward,</p>
<p>Since it was 7 years ago, I did not have a deductible. Office visits were 100% covered after a co-pay (about $20). But this was not an office visit, so it was covered at 80%, subject to out of pocket yearly maximum/procedure maximum.</p>
<p>I don’t remember what yearly maximum was, but procedure (or whatever the proper word for it) maximum was around $1000. However, since I was billed by more than one provider for this procedure, if the total bill was more than 5K, it would not mean that I would only pay 1K. It turned out the procedure out of pocket maximum was per provider maximum. </p>
<p>Two years prior to that I gave birth to my daughter - no complications. And I remember receiving bills from everywhere. I even received two bills from the hospital - one for me, one for my daughter. The total out of pocket was more than 1K, because each bill was considered in isolation by insurance company. </p>
<p>FWIW, I work for a large employer. One would think that 7 years ago I would have a Cadillac plan, but it was not really the case. Although I still got a better deal than those who had to buy their insurance on individual market.</p>
<p>The best insurance I had was in grad school. I was on fellowship. My premiums were $0 dollars and I had $0 out of pocket, no co-pays. I had my son while in grad school and I needed to buy him health insurance. To add him to my plan the premium for him was $800! I assume my premium was around the same. No wonder tuition is so high. That was 16 years ago.</p>
<p>I have a question on baby coverage. Dad is covered through work very cheaply. Mom on her parents’ plan. Baby arrives. Family coverage is available through dad’s employer, with employee paying the full premium. Premium would be far over 9,5% of income. Would be prohibitive. Income is too high for SCHIP.</p>
<p>What happens? I thought I read the 9.5% rule was based on single coverage. How does this come into play? Are they eligible to buy on the exchange for the baby? Eligible for a subsidy (assuming income merits it).</p>
<p>My head hurts. They needed useful story problems like this in school.</p>
<p>[Where</a> The World Comes To Get Well | Baltimore magazine](<a href=“http://www.baltimoremagazine.net/features/2010/11/where-the-world-comes-to-get-well]Where”>http://www.baltimoremagazine.net/features/2010/11/where-the-world-comes-to-get-well)</p>
<p>Here is an interesting article about Hopkins’ international healthcare unit and other businesses that have built up to support it. It is a little dated but still relevant. I have friends who have toured the international unit and say it is quite a sight.</p>
<p>Lerkin, I don’t think $5,000 for a hernia operation is all that bad, particularly since you only paid $1,000. People will spend $1,000 for a plasma TV without batting an eyelash but tell them that they have to pay for their health care and they throw a fit. We have spoiled the American public into thinking someone else will pay for the medical care they want, despite the very expensive technology, training and research it encompasses.</p>
<p>Regarding my last post, I was just attempting to deal with the problem of very expensive hospitals, which many of the supporters of ACA have been using to justify having the govt limit my choices.</p>
<p>GP, if you want Ceders so badly - why don’t you choose the HealthNet Bronze PPO plan -which was mentioned in the letter Samurai posted, as one of the 3 plans on Covered California where Ceders was included?</p>