High Deductible Plans with Health Savings Accounts

jaeger19 said:

Well you said it.. its cheaper for the insurance company.. or government if they deny services.

Lowering utilization is a method of cost control.

You seem to be contradicting yourself.

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Not really, you're not getting the point, I was clear.

Controlling costs by lowering utilization (volume) simply lowers access to healthcare - takes healthcare services away from patients. I was very clear on that.

True cost control reduces the costs of current services being offered.

The ACA's cost control tactic in many models cited show that services are reduced, therefore costs are lowered.

If you want to do a little research on your own and educate yourself, look up the healthcare services CPI. Notice where it is in relation to the overall CPI index.

jaeger19 said:

Technology is not going to lower insurance costs. Insurance prices are based on what the market will bear.

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wait, didn't you just suggest state provided public options to compete with for-profit insurers? Wouldn't that keep em honest?

And don't look to india..

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Why not!? From Harvard Business Review:

"At a time when health care costs in the United States threaten to bankrupt the federal government, U.S. hospitals would do well to take a leaf or two from the book of Indian doctors and hospitals that are treating problems of the eye, heart, and kidney all the way to maternity care, orthopedics, and cancer for less than 5% to 10% of U.S. costs by using practices commonly associated with mass production and lean production.

The nine Indian hospitals we studied are not cheap because their care is shoddy; in fact, most of them are accredited by the U.S.-based Joint Commission International or its Indian equivalent, the National Accreditation Board for Hospitals. Where available, data show that their medical outcomes are as good as or better than the average U.S. hospital.

The ultra-low-cost position of Indian hospitals may not seem surprising — after all, wages in India are significantly lower than in the U.S. However, the health care available in Indian hospitals is cheaper even when you adjust for wages: For example, even if Indian heart hospitals paid their doctors and staff U.S.-level salaries, their costs of open-heart surgery would still be one-fifth of those in the U.S.

Captain Obvious said:

Not really, you're not getting the point, I was clear.

Controlling costs by lowering utilization (volume) simply lowers access to healthcare - takes healthcare services away from patients. I was very clear on that.

True cost control reduces the costs of current services being offered.

The ACA's cost control tactic in many models cited show that services are reduced, therefore costs are lowered.

If you want to do a little research on your own and educate yourself, look up the healthcare services CPI. Notice where it is in relation to the overall CPI index.

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No you weren't clear.

Sorry but you said that lowering utilization doesn't decrease costs.

I pointed out that lowering utilization is definitely a way to decrease costs.

and I pointed out the way that the ACA does that by things like bundled payments.

Now you are agreeing with me.. and telling me to do the research that I provided to you already!. :doh

Cassandra said:

wait, didn't you just suggest state provided public options to compete with for-profit insurers? Wouldn't that keep em honest?

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Yes. in some situations it would.. if done right. There are issues with public options.. which is why I suggest it as something at the state level and not the federal level.

First is that it MIGHT increase competition..and thus lower premiums for everyone. In some markets that might occur.
In fact. the THREAT of a public option might do the same thing.

However Two.. a public option.. MIGHT become a dumping ground for the insurance companies. Anyone who is a bad risk gets dumped on the public option.. and the private insurance companies cherry pick the rest. That's a distinct possibility given the lobbying power the insurance companies have.

Three. In some markets.. where the risk pool is fairly small.. say a rural state. It is conceivable that if more competition is introduced into the state.. the divided risk pool will be too small for each competitor.. and thus premiums will actually have to go UP because of more competition not go down.

This is why I think it should be a state option.. and frankly the THREAT of a public option looming over the insurance companies might keep prices down.

At a time when health care costs in the United States threaten to bankrupt the federal government, U.S. hospitals would do well to take a leaf or two from the book of Indian doctors and hospitals that are treating problems of the eye, heart, and kidney all the way to maternity care, orthopedics, and cancer for less than 5% to 10% of U.S. costs by using practices commonly associated with mass production and lean production.

The nine Indian hospitals we studied are not cheap because their care is shoddy; in fact, most of them are accredited by the U.S.-based Joint Commission International or its Indian equivalent, the National Accreditation Board for Hospitals. Where available, data show that their medical outcomes are as good as or better than the average U.S. hospital.

The ultra-low-cost position of Indian hospitals may not seem surprising — after all, wages in India are significantly lower than in the U.S. However, the health care available in Indian hospitals is cheaper even when you adjust for wages: For example, even if Indian heart hospitals paid their doctors and staff U.S.-level salaries, their costs of open-heart surgery would still be one-fifth of those in the U.S.

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Yeah wages are lower.. and they calculated that. oops.. but they forgot cost of malpractice, costs of floor space and building costs, the cost of research and development which is added to the US. Other countries do things cheaper because we develop the techniques in the US.. which has a cost that's recouped in higher prices in the US. then when its cheaper.. and easier.. then its adopted in other countries.

Lastly the cost is different because of access. there are most likely fewer places in India.. fewer hospitals that can provide that surgery.. particularly in the rural areas. meanwhile in the US.. rural Idaho has surgeons that offer that service.

that increases the cost in the US. Because a rural surgeon who just has a few open heart surgeries a day.. has to get more per procedure than a surgeon in a big city that has a huge market.