<p>Change is coming. The healthcare industry is going to become more efficient. It is going to take time. Some people are going to freak out but change is coming. Change is already happening behind the scenes. </p>
<p>The way people access entertainment has changed dramatically and that will happen in the health insurance industry. </p>
<p>Sutter knows. Kaiser knows. Looks like Stanford knows.</p>
<p>"The time spent dealing with insurance intermediaries costs money and aggravates physicians and their patients. As one doctor lamented in a column in The Wall Street Journal, “U.S. doctors spend almost an hour on average each day, and $83,000 a year … with the paperwork of insurance companies.” And for every call coming from a doctor’s office or hospital to an insurance company, there is someone at that insurance company on the other end of the line to process the call.</p>
<p>In 2012, more than 460,000 people were working in the health insurance industry, and employment growth in health insurance is much higher than for the providers of actual health care. Of course, managing all these people is expensive—very expensive. In 2011, the CEO of Blue Shield of California made $4.6 million and the organization’s top 10 executives earned $14 million in total, although of course none of them did any medical research or delivered any care to real patients. The Affordable Care Act mandated that health insurers had to spend at least 80% of their collected premiums on medical care. The very inclusion of that provision implies that at least some health insurers had overhead rates in excess of 20%. All of this seems expensive and wasteful, and it is."</p>
<p>Even if all of the insurance company overhead were cut out, wouldn’t US medical care would still be the most expensive in the world? Insurance company overhead is certainly part of the cost problem, but it seems like far from the only cause of the cost problem.</p>
<p>“The Sutter group’s conclusion: if they are to compete, they have to offer their own health plan and get out from under the health insurers so they can reduce overhead costs. They have such a plan—Sutter Health Plus, which began as an offering just for Sutter Health employees but now includes 1,800 physicians and a multi-hospital network serving employers and patients in the Sacramento and San Joaquin Valley area. Sutter needs to expand this offering throughout Northern California, and many Sutter employees know it. To take one example of why, a person from their Palo Alto Medical Foundation, a doctor’s group serving the South Bay, reported that Blue Shield negotiated lower prices from PAMF and then did not fully pass those reduced prices on to employers, leaving Sutter disadvantaged in its pricing during open enrollment.”</p>
<p>Take a look at the difference between the original bill and the allowed amount on your EOB some time. Insurance companies are very successful at negotiating reductions in costs from in-network providers.</p>
<p>My doc is no fan of insurance companies, but his biggest gripe is the current situation where the government and insurers are not able to negotiate rates with the pharmaceutical companies. Drug prices, especially chemo drugs, are obscene, according to my oncologist who probably sees many patients who struggle to afford their necessary medications- especially since it’s hard to work while undergoing treatment, which for many will be indefinitely. I don’t know if the drug companies or the insurance companies are the hardest on patients.<br>
When I look at my bill, the drugs and the hospital scans are the biggest expenses. The doctors fees aren’t really that bad.
My Dh’s large company self-insures, so no middleman, and I do think our rates have been pretty stable compared to what I hear others complaining about. </p>
<p>This is a game. Providers charge multiple times what they expect to get from insurance companies. Then insurance companies cut the bill. Providers get what they expect. </p>
<p>On the other hand, when patients don’t have insurance, doctors can charge anything they want. And they do. Emergency room doctors have worked out a scam where they don’t take any insurance, but they get hired as contractors at hospitals. Then unwary patients go to the emergency room, get treated by these emergency room doctors-- and the doctors send the patients obscenely large bills. That’s how emergency room doctors have raised their income 20% on average in the last five years, when doctors’ incomes as a whole are staying flat.</p>
<p>However, the result is no price transparency to the user. Providers are unwilling to tell you how much something costs beforehand (and probably to do a trial run through insurance billing to even find out themselves). Self-pay patients will be told the normally fictitious exaggerated list price that is used only as a starting point in negotiations with insurance companies.</p>
<p>So the argument is not to have insurance but I thought on other thread some posters mentioned without insurance they have to pay millions. You can’t have it both ways.</p>
<p>That sounds similar to how anesthesiologists work, where surgical patients often have little ability to choose an anesthesiologist, and may incorrectly assume that surgery at an in-network hospital with an in-network surgeon will be completely in-network, when the anesthesiologist may not be.</p>
<p>But it’s not fictitious to them! That’s what self-pay patients get billed.</p>
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<p>I thought self-insured plans were cheaper just because the company that self-insures is taking on more risk. Companies that self-insure still have insurance companies negotiate rates and administer the plans, don’t they?</p>
<p>You have to replace the insurance industry with something else. </p>
<p>I am dealing with insurance companies and a doctor today. </p>
<p>My wife and I have called Anthem more than a dozen times in the last 3 weeks on a different issue. </p>
<p>I know all about the out of network issues. </p>
<p>I am affected by the network issues. Right now.</p>
<p>What the writer wrote is going to happen. It is already happening. We are going to end up with oligopolies of providers. They are going to insure the public themselves.
Cedars has joined a bunch of hospitals in LA to form a network. Then these hospitals will eventually tell the insurance companies to take a hike and issue their own insurance. </p>
<p>The Kaiser model is going to become prevalent. We can argue all we want. It is going to happen. </p>
<p>This will save a lot of money. The question is how is the savings doled out. </p>
<p>My guess is the oligopolies will get most of the savings. :)</p>
<p>When a company self-insures, my understanding is that they take on the risk of paying the bills for their employees, up to some predetermined amount (like a quarter of a million dollars). But they don’t normally negotiate with care providers or set up a network. They hire an insurance company to run their plan, and the insurance company provides the network to them, together with negotiated prices.</p>