<p>Why wouldn’t any government agency get in the business of law interpretation, if they are charged with administering laws, from the Treasury Department down to the Planning Department at your local city hall? That’s what an agency that administers laws has to do.</p>
<p>I can think of another agency that is part of the Treasury Department that considers whether people are acting in ways that are contrary to the intent of the law. Try declaring your Caribbean vacation or your cat’s medical care as business expenses and see how the IRS likes it. </p>
That’s an enormously interesting sentence but it’s opaqueness makes it very hard to refute. That the government ends up playing whack-a-mole every time it attempts to counter economics or human behavior doesn’t cast much of a flattering light on this last swing.</p>
dstark’s a big-picture guy, no doubt about it, but… pushing the insurers out removes the profit motive of zealous billing, how, exactly? I might believe there were great economies in there somewhere, if the government hadn’t shown how good it could be, with their handling of the Medicaid/Medicare billing. True market pricing and almost no overhead, along with so little fraud.</p>
<p>When dstark figures that out, he might want to revisit some of his past schemes and see how they’re working out. I keep seeing reports of double-digit increase in premiums for 2015, which most definitely wasn’t part of the sales pitch for this last one. That, and very little news about ACA being on path to ‘not cost us a dime’.</p>
<p>I don’t doubt there exists enough data, right at this moment, to verify some of the opinions around here, LF. Sadly, it seems to have been round-filed or embargoed to a later date. Before someone asks what I’m referring to, I’ll point to: </p>
<ul>
<li>CBO saying it can no longer score the effects of the law due to all the extemporaneous changes.</li>
<li>Changes to Census regarding year to year uninsured.</li>
<li>Enrollment and price signaling, beginning November 15th. (Like I said earlier, that seems a happy coincidence.)</li>
</ul>
<p>The biggest ones that come to mind at the moment.</p>
<p>It should be obvious why an accountable care organization will result in economies, though not necessarily to the patient. Let’s say you for some reason want a recreational knee replacement. If you go to a surgeon, they might be willing to do the surgery even though you don’t need it, because they get paid to do surgery. And then your insurer would have to pay.</p>
<p>But let’s say you’re a Kaiser subscriber. Kaiser isn’t going to do the knee surgery, because they’d have to pay for it. Once you’ve bought a policy from Kaiser, they’re on the hook for your medical care, and they don’t want to be offering you unnecessary care.</p>
<p>For the same reason, if your insurer is also your doctor, as in these accountable care organization schemes, they’re going to want to cut down on unnecessary or expensive care, because they’d have to pay for it.</p>
<p>There are all sorts of oligopolistic schemes these accountable care organizations can devise to screw more money out of subscribers, but they are undoubtedly in the position to save money (for themselves, if not you) by coordinating care and eliminating unnecessary care.</p>
<p>I’ve participated in enough of these discussions to safely say: the patient’s always the only dependably non-greedy player in the system, CF… trading the old insurers for doctor’s staff performing the exact function (likely with ex-insurer workers comfortably plying their old jobs under new management) seems musical chairs.</p>
<p>Did dstark say he’d really thought this through, or was he just scribbling on a cocktail napkin?</p>
<p>‘recreational knee placement’, since you brought it up, is going to be a pretty slippery definition is my best guess. The doctor’s (insurer’s) bottom line is going to place a lot of pressure on interpretation, mostly because they’d have to pay for it. The profit motive predicts recreational replacements might very well outnumber medical necessary ones, depending on how many they’d had to spring for that insurance cycle. Maybe the same people that have zeroed out Medicare/Medicaid fraud would be available to render a judgement as to necessity?</p>
<p>Not knocking the new ideas, they may turn into something special eventually, but once bitten twice shy is an apt description of how I’m feeling about healthcare schemes:
<p>I agree that the insurer is not going to want to pay for a recreational knee replacement, but the point is, if a doctor recommends the knee replacement, it’s difficult for the insurer to get out of paying for it. But if the doctor refuses to recommend the knee replacement because the doctor has to pay for it, then the patient isn’t going to get it.</p>
<p>In the one case, we have the doctor who wants to do the surgery versus the insurer that wants to refuse it: power versus power. In the second case, we have the doctor not approving the surgery versus the patient who wants it: power versus no power. Insurers can be greedy. Doctors can be greedy. But if we get rid of the greedy insurers, and harness the doctors’ greed to limit treatment rather than expand it, we’ll end up with less unnecessary treatment. We’ll end up with less necessary treatment too, probably.</p>
<p>It might be a good thing or a bad thing. We don’t have a way to be perfect, and pay for all necessary care and no unnecessary care. So we have to find the best balance we can, knowing that we’ll still end up paying for some unnecessary care and denying some necessary care. </p>
<p>I’ll tell you what I’m positive is a bad idea, though: paying for everything a doctor recommends. That’s the road to huge amounts of overtreatment. Doctors are no more immune to financial incentives than anyone else. </p>
<p>Doctors are also not at all immune to lies by drug/device salespeople. I took Vioxx for years with the encouragement that it was likely to provide a heart benefit in addition to pain relief. Well, they flat out lied to doctors about that, and they’ve now been nailed for it. </p>
<p>That aspirin, and nothing else, is in all of our futures, CF. </p>
<p>There’s some merit to dstark’s proposal, though it seems to me that it runs counter to the entire premise of the last great rethinking. One detail I’d suggest needs working out is the percentage of the savings that is going to go to malpractice insurance and legal. </p>
<p>If I was a doctor practicing in this position, one where I had an immediate financial interest in denying treatment, I’d make sure to double… maybe quadruple… the insurance, and retain competent consul before I ever walked in an exam room.</p>
<p>Article about extra fees charged to patients. Do they charge all patients? Or only the ones they think will pay (the ones with private insurance)?</p>
<p>I have to tell you, I was pretty darn skeptical when I was admitted to the hospital feeling ok and then was wheeled into a beautiful, spacious, new…empty ward. They needed to fill that room. I have pretty good coverage for an extremely low premium, but there’s nothing I can do about a hospital running the bill into the stratosphere. I figured the room would be around $1000/night, which it was, but how they and their cronies justify charging another $13,000 on top for a two-night stay, I just can’t understand. Each bag of saline cost $38. You can buy them retail online for under $10, and you know the hospital isn’t paying retail.</p>
<p>@Hanna: the justification is called ‘cost shifting’. You are insured. Someone else who the hospital MUST treat is not insured. You are a guaranteed source of income/payment, the uninsured individual is a c*&P shoot at best. Regretfully, nothing in our new approach addresses this issue. In fact, it may make it worse since some reimbursement schedules for the newly insured are so low.</p>
<p>As for the saline, well…it needs to be bought, stored, tracked and inventoried. It needs to be administered by someone who is pulling in a very good salary. It needs to be monitored by that individual. And, it needs to cover the cost of potential lawsuits. Again, nothing in this has been changed with the new approach.</p>
<p>I thought the finance industry was bad. The health care industry leaves a lot to be desired. How can a consumer compare prices when the prices are hidden? All these bs charges that are levied…there is too much bloat in the health care industry. </p>
<p>It is going to be a big battle when so many people are feeding at the trough. </p>
<p>My wife is going to have cataract surgery. One hospital charges $10,000 to use their facilities (before insurance contract cuts). The insurance company won’t tell the consumer what the contracted cost is or what makes up the costs. How long does cataract surgery take? Prep time to leaving? Less than two hours? </p>
<p>This is what is reported to investors. </p>
<p>"Those trends have led to a brightening financial outlook for the companies, according to Bloomberg. Both HCA and LifePoint increased their fiscal forecast recently as the increase in paying customers became clear. LifePoint specifically estimated that Obamacare added $13 million to its total earnings in the second quarter, 40 percent above its expectations.</p>
<p>Hospitals were one of the key stakeholders backing health care reform during the legislative debate, and the law now seems to be paying dividends for them. These new uninsured figures track with some previous reports from hospitals which, particularly in the Medicaid expansion states, have seen a steady decline in their uninsured patient population since January."</p>
But at least they’re on the mound…</p>