Affordable Care Act Scene 2 - Insurance Premiums

Cardinal_Fang · April 21, 2014, 12:56am

Like calmom, I think that concierge medicine is a luxury good. There is money in luxury goods, but the luxury market is necessarily a smaller market: it won’t support a concierge doctor on every corner. Regular non-wealthy people can’t afford to pay for health insurance and for their own personal doctor as well.

In order to get market penetration, a group of doctors has to set up an entire health coverage plan. And as I said before, I think that will happen. If a group of doctors, with some arrangement with a hospital or two, is the entire health system for someone, then they don’t have to worry about billing and all that stupid stuff. If the patient is a member, then the patient can go to their facility. It’s easy.

lookingforward · April 21, 2014, 1:18am

We have a nifty low cost service here, operating like what we call concierge, but making big deal of saying they are not. (Actualy, it’s under the same large umbrella as my own doc.) 
“What services are not included? Services provided outside of our two office locations; medical services falling outside of usual and customary definitions of Primary Health Care; emergency medical services; mental health & counseling services; medications; hospital, laboratory, radiology, and other specialty services; and medical equipment or supplies.”

Actingmgt, you and others need to run some numbers on the catastrophic premiums, deductible and co-ins- for a guy like GP (no subsidies) and for a blue collar income person. And may as well check into the recurring concierge subscription costs in CA. And remember, GP wants Cedars.

catahoula · April 21, 2014, 1:59am

Can’t help but agree with both but why don’t you mention the racial disparities? Saw others but here’s the 2007 breakdown of US maternal deaths will do:

You’re probably guessing, right now, correctly, as to why I inquired for your racial stats for Sweden. :">

Cardinal_Fang · April 21, 2014, 2:05am

GP, you’re the kind of person concierge medicine is aimed at: you’re willing to pay more for better service.

But I’m not clear on how a concierge doctor will solve the issues you say you have. You’ve said that you don’t worry so much about routine care, but you want some certain high-end providers if the worst happens. Thing is, the concierge doctor is only for routine care. For specialized care, the concierge will send you to a specialist, like any primary care doctor would do. The concierge will send you to an oncologist (not included in the concierge service) if you get cancer, for example. So a concierge won’t get you what you say is important to you.

Cardinal_Fang · April 21, 2014, 2:07am

catahoula, it’s because I don’t think racial disparities in maternal health are an excuse. We’re not talking about sunburn here, or cystic fibrosis or sickle-cell, something that inevitably differs by race. If maternal health stats differ in the United States by race (as they certainly do) that’s a culpable failure, not an excuse.

catahoula · April 21, 2014, 2:40am

That it exists is pretty plain, CF. That correcting it’s probably out of reach of whatever health spending you or me might envision is strongly indicated.

That: if Sweden, or Canada, or whatever country with whatever universal healthcare system had the same demographics as the US, their maternal mortality would look a whole lot like ours is just about a given.

Not that pointing it out will make any difference at all, whether here or at a spot like HuffPo.

Cardinal_Fang · April 21, 2014, 4:35am

Poor women who don’t get prenatal care have bad outcomes. But that is clearly something amenable to health spending, as we can see in countries that have wonderful prenatal care for everyone, such as the Netherlands.

bclintonk · April 21, 2014, 5:50am

I really don’t understand what your racial explanation is, catahoula, if it’s not somehow related to racial disparities in access to care or quality of care. As Cardinal Fang has pointed out, there’s no racial disparity in incidence of the underlying conditions that cause maternal mortality. So if it’s not that, then a racial disparity in access to care and/or quality of care seems like a logical candidate. If you’re saying it’s not that, then what exactly is your explanation?

Here’s a pretty big clue that access to care and quality of care are the big determinants here. Tables I’ve seen indicate that Russia, Ukraine, and Latvia–all pretty darned white countries, all much whiter than the U.S.–have rates of maternal mortality higher than the U.S. Set aside Russia and Ukraine for the moment and consider Latvia, a small Baltic country that as best I can tell is nearly 100% white (or Caucasian, if you prefer). I’m looking at figures that show a maternal mortality rate in Latvia of 32 maternal deaths per 100,000 live births in 2010. But if you look at the other nearly 100% white countries in its immediate vicinity, their maternal death rates are all much lower–Estonia 2 per 100,000, Sweden and Belarus each 4 per 100,000, Poland and Finland both 5 per 100,000, Lithuania 8 per 100,000. Some of these countries are richer, some poorer; none appreciably whiter. But then Latvia also shares a border with Russia, and the two countries also share an identical maternal mortality rate of 34 per 100,000, many multiples of the other countries immediately on their borders.

Or consider that Granada, a small and not wealthy Caribbean nation (2012 GDP per capita $7,485) that is 82% black and 13% mixed black and European, has a maternal mortality rate (24%) very similar to that of the United States as a whole (21%) and much lower than that for African-American women in the U.S. (35 per 100,000). This certainly seems to suggest that race is not destiny when it comes to maternal mortality rates,

Or again, consider Chile (95% white) and Argentina (97% white), yet Argentina’s rate of maternal mortality (77 per 100,000) is triple that of Chile (25 per 100,000) despite roughly comparable GDP per capita. Or that North Korea’s rate (81 per 100,000) is 5 times that of South Korea (16 per 100,000) despite sharing a single ethnicity.

Goldenpooch · April 21, 2014, 6:33am

CF, I am not sure how a concierge system will work in the future but I think some entrepreneurial fellows and/or gals will figure it out.

If you have enough excellent doctors who don’t want to deal with the low reimbursement rates under Obamacare and sufficient wealthy or upper middle income people who don’t want to be constrained by limited networks, an alternative system will be conceived to meet the demand from the providers and the consumers. It could be a supplemental policy you will have to pay for in addition to an Obamacare-compliant policy. I think the only thing you can say for sure at this point - is it will not be for those who are receiving subsidies.

Cardinal_Fang · April 21, 2014, 6:43am

But that’s what I’ve been saying: doctors are going to get together to form a provider network themselves, and offer it as a health plan that qualifies under the ACA. And if there’s a market for it, some doctors will make a high-end health plan with high-end hospitals.

But also, if you have enough wealthy people right now for a high end health insurance policy, one will emerge in 2015 or 2016. Why wouldn’t it? If the market demand is there, the supply is going to be there.

Goldenpooch · April 21, 2014, 6:51am

I was thinking what could be done to make Obamacare more palatable to me so that I wouldn’t insist on its repeal. Actually, it wouldn’t require huge changes. If the mandated benefits were made voluntary and if plans were sold across state lines so consumers had more choices and greater flexibility to mix and match their policies to customize it to their needs and individual circumstances, I could become far more supportive of the law. I also think if the law was restructured to be more consumer friendly and allow for wider networks, it could garner more support from a very reluctant American people.

For instance, I would happily sacrifice some of the mandated benefits for better network coverage.

Goldenpooch · April 21, 2014, 6:58am

“offer it as a health plan that qualifies under the ACA.”

Could be but could also be a supplemental policy you will have to buy in addition to owning an Obamacare policy, although that could get pretty expensive. I think that’s how the Swiss do it but their primary policy does not have all the bells and whistles of an Obamacare policy.

kmcmom13 · April 21, 2014, 10:32am

GP, who knew what you really wanted was a single payer system ;)

(Base coverage for all, no network restriction at all, and pharma/elective handled by supplemental insurance :))

tom1944 · April 21, 2014, 10:43am

GP are on the same page with that

catahoula · April 21, 2014, 1:33pm

For the purpose of comparing US medical care (unfavorably) to Sweden, it doesn’t matter what the causes of black mortality are. Well, not entirely… I suppose if you’d like to advance the idea that black mothers in the US are somehow intentionally denied the same access that poor Hispanics appear to find both easily and sufficient, you’d at least have a theory. A crackpot one, to be true, but it would hardly die for lack of company in some circles.

That white and hispanic maternal mortality rates for the US aren’t that far off Sweden’s is the only real point.

Of course, I could me missing yours - not Fang’s, since she doesn’t do paragraph posts - and buried somewhere in there is the notion that: if every black US mother emigrated to Sweden, 4/100,000 would die in childbirth?

bluebayou · April 21, 2014, 2:50pm

Poor pregnant women qualified from Medicaid prior to ACA…

actingmt · April 21, 2014, 2:52pm

The majority of the poor are white, btw. Do people not know this?

TatinG · April 21, 2014, 3:02pm

Re: Concierge care. One of the articles said that ACA has a provision allowing for a catastrophic insurance plan if one were signed up with a concierge practice. That could work out to be more affordable than any of the silver, bronze, etc. plans.

Cardinal_Fang · April 21, 2014, 3:10pm

Intention doesn’t enter into it. Black women in the US are in fact denied the same access to care that Hispanic women get.

Cardinal_Fang · April 21, 2014, 3:29pm

Can you point us to a link? In previous discussions, we’ve concluded that people can buy catastrophic care in only two situations: (1) they are under 30 or (2) no other policy is “affordable” by the metrics of the ACA.

OTOH, I played around with the numbers for catastrophic care. I sampled various areas of the country, comparing Catastrophic plans to the cheapest Bronze plans in the same area. Both the mean and the median savings for buying a Catastrophic plan over a Bronze plan were about 14%. In other words, you can save a little buying a Catastrophic plan, but not as much as you’d hope. Catastrophes are expensive.

Affordable Care Act Scene 2 - Insurance Premiums

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