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Thread: Irrational rise in Healthcare Costs

  1. #21
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    Re: Irrational rise in Healthcare Costs

    Quote Originally Posted by code1211 View Post
    In your explanation, the Insurance Companies and the Healthcare Providers are working against each other and the result is higher costs paid to each.

    In my understanding of this, they are partners and the result is higher costs paid to each.

    In either case, though, the result is a lot more cash flowing into the coffers of both.
    My understanding is that they are competitors as I have never met a healthcare provider who had anything nice to say about insurance companies, though there may be some circumstances where they are colluding for profit. If so, this should be illegal.

    I imagine there may be situations where they collude to collect as much government aid as possible. But the average citizen doesn't have enough money to be very profitable. So a healthcare provider attempts to charge a reasonable fee, but health insurance pushes back on certain high cost services in order to bolster their own profits, so healthcare workers raise their fees on other services to make up the difference. Then insurance providers push back on those and on it goes until the system breaks.
    Last edited by lwf; 04-07-20 at 09:47 AM.

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    Re: Irrational rise in Healthcare Costs

    Quote Originally Posted by Ikari View Post
    The healthcare system in America is far from some free-market capitalist system. It's oligarchy with price fixing.

    Healthcare debt is the #1 cause of bankruptcy in America.
    Just so you know.. healthcare debt is NOT the cause of bankruptcy. In fact.. studies of bankruptcy where medical reasons were listed as a cause... only a small percentage of the persons debt were medical bills.

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    Re: Irrational rise in Healthcare Costs

    Quote Originally Posted by code1211 View Post
    I would contend that a major factor in the increase of healthcare costs rises from urgency of the need coupled with the bills being paid by entities not getting the treatment.

    If I had "Car Purchase Insurance" allowing me to get the best car available, I'd have a Bentley parked in my garage instead of a Ford. Not a Rolls Royce- that's just TOO much...

    On the other hand, if all providers of medical care were charged to publish the "Out the door" cost of all procedures, a shopping process could occur the same way that guides car buying.

    Undoubtedly, there would be some folks who would buy the Rolls Royce or Bentley and others who would buy the Ford.

    Also undoubtedly, there would be providers that sold the Rolls Royce and providers that sold the Ford.

    As it is now, most of us go to the hospital in pain and ask to be fixed with no consideration of the costs involved until the day of discharge.
    Yeah.. pretty much not true.

    For one.. the idea that because of third party payers.. people decide to get " a bently".. is false. While you can decide to go out and get a bently.

    You cannot walk into a doctors office without a bad knee and say "give me a total knee". It just doesn't work that way. Particularly because of third party payers that ake things have to meet the "medically necessary".. criteria to be approved.

    Secondly.. providing charges in healthcare is largely meaningless since charges are pretty meaningless. So you go to me.. and you look at my charges.. and say "wow.. that's too high for that procedure"..

    And so you go to my competitor, whose posted price is lower.

    And what you don't know.. is that the actual cost to you.. if you had it done at my facility would be LOWER.. because of the negotiated rate of insurance vs my competitor... because I am a preferred provider.

    That posted charge is generally meaningless.

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    Re: Irrational rise in Healthcare Costs

    Quote Originally Posted by lwf View Post
    My understanding is that they are competitors as I have never met a healthcare provider who had anything nice to say about insurance companies, though there may be some circumstances where they are colluding for profit. If so, this should be illegal.

    I imagine there may be situations where they collude to collect as much government aid as possible. But the average citizen doesn't have enough money to be very profitable. So a healthcare provider attempts to charge a reasonable fee, but health insurance pushes back on certain high cost services in order to bolster their own profits, so healthcare workers raise their fees on other services to make up the difference. Then insurance providers push back on those and on it goes until the system breaks.
    After years of no pain to moderate pain to severe pain, root planing, a crown, another crown an oodles of money, I finally had a root canal on one of my molars. Seems okay now, but I'm waiting for time to pass.

    Anyway, the Humana-negotiated price for a new crown was set at a price lower than the price charged by the Dentist.

    Insurance calls the negotiated price, according to a person I knew in the business in the 80's, "normal and usual" costs.

    That knocked off about $300 or so and the insurance coverage was about $350 of the $1300 cost overall. The cost per pound on these things must be astronomical!

    Root Canals are not covered under the plan I have. X-rays, preliminary exam and all cleanings are covered 100%. Yipeee!

    Anyway, moral of the story: Extraction would have been much cheaper, but then I'd be without that tooth. I DID have the choice on whether or not to pay the money and the costs were explained to me prior to the procedures being completed.

    Without insurance, the costs of the various procedures in Dentistry and Medicine simply would not be affordable and, as we did before 1900, we'd simply die earlier.

    I was amazed when the Dentist noted that the first Root Canal was performed in the mid 1700's. Anesthesia came along in the next century. Probably invented by another victim of a root canal.
    We huh we'r we're it's it's a we're in the middle of a pandemic that has cost us more than 85,000 jobs as of today. Lives of billions of people. Millions of people. Millions of jobs. You know, we're in a position where, you know, we just got new unemployment insurance... -Joe Biden

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    Re: Irrational rise in Healthcare Costs

    Quote Originally Posted by jaeger19 View Post
    Yeah.. pretty much not true.

    For one.. the idea that because of third party payers.. people decide to get " a bently".. is false. While you can decide to go out and get a bently.

    You cannot walk into a doctors office without a bad knee and say "give me a total knee". It just doesn't work that way. Particularly because of third party payers that ake things have to meet the "medically necessary".. criteria to be approved.

    Secondly.. providing charges in healthcare is largely meaningless since charges are pretty meaningless. So you go to me.. and you look at my charges.. and say "wow.. that's too high for that procedure"..

    And so you go to my competitor, whose posted price is lower.

    And what you don't know.. is that the actual cost to you.. if you had it done at my facility would be LOWER.. because of the negotiated rate of insurance vs my competitor... because I am a preferred provider.

    That posted charge is generally meaningless.
    Are you asserting that if there were no insurance companies and that all medical costs were paid out of pocket that the healthcare industry would be enjoying the same cash flow as they do WITH insurance payments?
    We huh we'r we're it's it's a we're in the middle of a pandemic that has cost us more than 85,000 jobs as of today. Lives of billions of people. Millions of people. Millions of jobs. You know, we're in a position where, you know, we just got new unemployment insurance... -Joe Biden

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    Re: Irrational rise in Healthcare Costs

    Quote Originally Posted by code1211 View Post
    Are you asserting that if there were no insurance companies and that all medical costs were paid out of pocket that the healthcare industry would be enjoying the same cash flow as they do WITH insurance payments?
    No.. how they heck to you get that from my post? If we did without insurance.. most facilities would close and there would be very little in the way of technology and advanced medical care.

    We would go back to care in the late 1800's. Except for the rich. Who would fly to other countries that had insurance where they could get care.

    I was speaking to your assertion that prices were high because people who have health insurance CHOOSE.. to get expensive surgeries that they could otherwise do without.

    (getting that bently). That doesn't really happen.

    I also spoke to your assertion about "posting prices".. and having people shop. Shopping by "posted price".. is not very effective since depending on your insurance.. your cost may be lower than the posted price. And my be lower than another facility with a "posted price" that's lower.

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    Re: Irrational rise in Healthcare Costs

    Quote Originally Posted by jaeger19 View Post
    No.. how they heck to you get that from my post? If we did without insurance.. most facilities would close and there would be very little in the way of technology and advanced medical care.

    We would go back to care in the late 1800's. Except for the rich. Who would fly to other countries that had insurance where they could get care.

    I was speaking to your assertion that prices were high because people who have health insurance CHOOSE.. to get expensive surgeries that they could otherwise do without.

    (getting that bently). That doesn't really happen.

    I also spoke to your assertion about "posting prices".. and having people shop. Shopping by "posted price".. is not very effective since depending on your insurance.. your cost may be lower than the posted price. And my be lower than another facility with a "posted price" that's lower.
    My point about getting a Ford or a Bentley is pretty accurate.

    I have a given amount of money and buy a car that will serve my needs plus a small share of luxury, and select a car from that universe of choices that are in my price range.

    When I am suffering pain and go to a hospital, I seek relief of the pain and the treatment is purchased based ONLY on getting relief from the pain.

    I am never offered the Ford or the Bentley solution. I am told what the issue is and what the treatment should be to correct it. When I had a sigmoid colectomy, my choice was to get it or to die.

    As it happened, choosing to not die also included absolutely top shelf treatment, private room, a good recovery period and continued life. That is, a Bentley.

    I should think that a Ford would have been life, a bed in a ward, a shorter in-hospital stay and maybe no TV. There were only 6 channels on the TV, but with the Morphine, I wasn't really aware of the limited selection until the second day.

    Regarding the lower negotiated price, that cost used to be referred to by the insurance companies as costs that were "normal and usual".

    Why are these costs "normal and usual" for some folks, but not others? It's like the two guys in the commercial that are paying different rates for the same hotel room.

    I just don't understand that part of the healthcare pricing.
    Last edited by code1211; 04-10-20 at 09:32 AM.
    We huh we'r we're it's it's a we're in the middle of a pandemic that has cost us more than 85,000 jobs as of today. Lives of billions of people. Millions of people. Millions of jobs. You know, we're in a position where, you know, we just got new unemployment insurance... -Joe Biden

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    Re: Irrational rise in Healthcare Costs

    Quote Originally Posted by code1211 View Post
    I am never offered the Ford or the Bentley solution. I am told what the issue is and what the treatment should be to correct it. When I had a sigmoid colectomy, my choice was to get it or to die.

    As it happened, choosing to not die also included absolutely top shelf treatment, private room, a good recovery period and continued life. That is, a Bentley.

    I should think that a Ford would have been life, a bed in a ward, a shorter in-hospital stay and maybe no TV. There were only 6 channels on the TV, but with the Morphine, I wasn't really aware of the limited selection until the second day.
    With a functioning insurance market, you'd be making those decisions in advance of needing care, when you're shopping for insurance for the year. Insurers would market products featuring different provider networks at a range of price points. If you want a network limited to more Ford-like options (i.e., lower priced hospitals and other providers), you save on your monthly premium. And if you want a broader network with more Bentleys thrown in the mix, you buy a product that includes them and you pay the commensurately higher premium.

    Which is how it works in the only real functioning consumer-facing insurance market we have, the marketplaces.

    Narrow-network plans' low premiums are a draw for many price-sensitive ACA exchange customers. A September 2017 Health Affairs article by researchers at Harvard and Northwestern University found that exchange plans with narrow physician and hospital networks were 16% cheaper than those with broad networks in 2014.
    The problem is that more people aren't shopping in the marketplaces.

    There are choices to be made, it just sounds like you're not the one making them, even if it's ultimately your money financing them. Which is why insurers outside the marketplaces have difficulty restraining (e.g., via aggressive negotiation) the prices of powerful providers, and sometimes effectively throw in the towel on even trying. Which is why it ends up feeling like collusion of sorts sometimes. If you have price sensitive consumers shopping for their own plans in a structured market, it's a whole different ballgame.

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    Re: Irrational rise in Healthcare Costs

    Quote Originally Posted by jonny5 View Post
    Go look at a pharmacies shelves, shop for insurance, find a dentist. It is not FAR from a free market at all.
    It's impossible for healthcare to be a free market because the issue of demand is fundamentally broken.
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    Re: Irrational rise in Healthcare Costs

    Quote Originally Posted by Deuce View Post
    It's impossible for healthcare to be a free market because the issue of demand is fundamentally broken.

    Nonsense. People can and do shop for healthcare pretty much the same way they shop for anything else. Even in emergency situations (which is only 2% of healthcare spending) people shop for a ride to the hospital by calling uber or lyft instead of taking the local price-gouging ambulance monopoly (Thanks government regulation!).

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