"We raise rates only when absolutely necessary to pay the accelerating cost of medical care for our members"
January 6, 2011 3:46 PM Subscribe
Blue Shield of California seeks rate hikes of as much as 59% for individuals. 'Insurer says the increases result from fast-rising healthcare costs and other expenses resulting from new healthcare laws. The move comes less than a year after Anthem Blue Cross tried and failed to raise rates as much as 39%.''Nearly 1 in 4 of the affected customers will see cumulative increases of more than 50% over five months.''Michael Fraser, a Blue Shield policyholder from San Diego, learned recently that his monthly bill would climb 59%, to $431 from $271.''Anthem's attempt to raise rates by up to 39% led to national outrage and helped President Obama marshal support for his healthcare overhaul. The insurer was ultimately forced to back down, accepting maximum rate hikes of 20%.'
'Blue Shield said the cost of health coverage was being driven up by large hospital expenses, doctors' bills and prescription drug prices.' The non-profit insurer's spokesman Tom Epstein, said Blue Shield 'would again lose "tens of millions of dollars" on its individual business in 2011.'
'Anthem said Wednesday that it too expected to raise rates — an average of 9.8% for individual policyholders, effective April 1. That would come on top of increases in October averaging 14% that had been delayed for six months amid heightened scrutiny by state regulators.
Anthem is taking a cautious approach to its rate hikes given the controversy generated by last year's plan for 39% hikes.
Spokeswoman Kristin Binns said the company priced its 2011 rates competitively, saying: "We understand that these are difficult economic times, and we are committed to working to moderate the impact of rate increases on our members."'
'Blue Shield said the cost of health coverage was being driven up by large hospital expenses, doctors' bills and prescription drug prices.' The non-profit insurer's spokesman Tom Epstein, said Blue Shield 'would again lose "tens of millions of dollars" on its individual business in 2011.'
'Anthem said Wednesday that it too expected to raise rates — an average of 9.8% for individual policyholders, effective April 1. That would come on top of increases in October averaging 14% that had been delayed for six months amid heightened scrutiny by state regulators.
Anthem is taking a cautious approach to its rate hikes given the controversy generated by last year's plan for 39% hikes.
Spokeswoman Kristin Binns said the company priced its 2011 rates competitively, saying: "We understand that these are difficult economic times, and we are committed to working to moderate the impact of rate increases on our members."'
I would say I am as committed to hoping health insurance corporations die in a fire as they are to "working to moderate the impact of rate increases on our members" but I question their commitment and sincerity.
posted by ChrisHartley at 3:53 PM on January 6, 2011 [9 favorites]
posted by ChrisHartley at 3:53 PM on January 6, 2011 [9 favorites]
Absolutely obscene.
posted by entropicamericana at 3:54 PM on January 6, 2011 [1 favorite]
posted by entropicamericana at 3:54 PM on January 6, 2011 [1 favorite]
Well, this is plain proof that Obamacare needs repealin'!
posted by tjenks at 3:55 PM on January 6, 2011
posted by tjenks at 3:55 PM on January 6, 2011
... and this from a non-profit insurer.
posted by Ardiril at 3:57 PM on January 6, 2011 [2 favorites]
posted by Ardiril at 3:57 PM on January 6, 2011 [2 favorites]
Last chance before the 10%/annum cap.
posted by 2bucksplus at 4:00 PM on January 6, 2011 [5 favorites]
posted by 2bucksplus at 4:00 PM on January 6, 2011 [5 favorites]
If we had perhaps been set up with a public option, Obama could have compromised from that position, and the cabal of Republicans and insurance companies would have a more difficult time getting us back to square one.
posted by Blazecock Pileon at 4:02 PM on January 6, 2011 [10 favorites]
posted by Blazecock Pileon at 4:02 PM on January 6, 2011 [10 favorites]
Rep. Steve King (R-IA) argues that dead babies in garbage cans mean the health care law is unconstitutional.
posted by EarBucket at 4:03 PM on January 6, 2011 [1 favorite]
posted by EarBucket at 4:03 PM on January 6, 2011 [1 favorite]
So at 59%/year, in twenty years or so it will cost a about billion dollars to get an MRI?
SUSTAINABILITY CAT IS NOT IMPRESSED
posted by RobotVoodooPower at 4:05 PM on January 6, 2011 [23 favorites]
SUSTAINABILITY CAT IS NOT IMPRESSED
posted by RobotVoodooPower at 4:05 PM on January 6, 2011 [23 favorites]
The sweet smell of freedom
posted by Beardman at 4:06 PM on January 6, 2011 [2 favorites]
posted by Beardman at 4:06 PM on January 6, 2011 [2 favorites]
Wish I got a 59% raise annually...
posted by msbutah at 4:07 PM on January 6, 2011 [4 favorites]
posted by msbutah at 4:07 PM on January 6, 2011 [4 favorites]
One step closer to that blood in the streets...
posted by dbiedny at 4:10 PM on January 6, 2011 [3 favorites]
posted by dbiedny at 4:10 PM on January 6, 2011 [3 favorites]
In today's environment, $271 a month is a steal. I'm pretty sure the costs for an individual average much closer to the $400 number.
posted by gjc at 4:10 PM on January 6, 2011
posted by gjc at 4:10 PM on January 6, 2011
Idea: Draft and pass legislature that ties average health care insurance rate increases to gas taxes. If health insurance rates go up, gas prices go up with 'em.
Somebody figure out how to make this happen.
posted by Threeway Handshake at 4:14 PM on January 6, 2011 [4 favorites]
Somebody figure out how to make this happen.
posted by Threeway Handshake at 4:14 PM on January 6, 2011 [4 favorites]
So at 59%/year, in twenty years or so it will cost a about billion dollars to get an MRI?
SUSTAINABILITY CAT IS NOT IMPRESSED
"59% raise is all you got Healthcare System? I see your bet and raise you twice the pace of inflation for 20 years." - Higher Education
posted by Mister Fabulous at 4:20 PM on January 6, 2011 [20 favorites]
SUSTAINABILITY CAT IS NOT IMPRESSED
"59% raise is all you got Healthcare System? I see your bet and raise you twice the pace of inflation for 20 years." - Higher Education
posted by Mister Fabulous at 4:20 PM on January 6, 2011 [20 favorites]
Just applied for insurance (havn't had for 12 years). $385/month. Deductible $3500; copay $3500. 80% after that. Thats with no mental health, no maternity, no office copay, no presecription.
posted by tingting at 4:21 PM on January 6, 2011 [1 favorite]
posted by tingting at 4:21 PM on January 6, 2011 [1 favorite]
The move comes less than a year after Anthem Blue Cross tried and failed to raise rates as much as 39%
Which they tried to do in the months after their parent company, Wellpoint, announced it made $2.7 billion in the last quarter of 2009. So, you know, I was crying for them.
posted by rtha at 4:23 PM on January 6, 2011 [13 favorites]
Which they tried to do in the months after their parent company, Wellpoint, announced it made $2.7 billion in the last quarter of 2009. So, you know, I was crying for them.
posted by rtha at 4:23 PM on January 6, 2011 [13 favorites]
Well, thank god for my union-negotiated plan. How does anyone else afford this?
posted by TrialByMedia at 4:29 PM on January 6, 2011 [2 favorites]
posted by TrialByMedia at 4:29 PM on January 6, 2011 [2 favorites]
What individual insurance provider does Justinian have? Can we guess? I bet we can guess.
I'm 35 and my current insurance rate is about $600 a month. What is it going to be when I'm 50? 60? I won't be able to afford it so y'all will get to pick up the tab.
posted by Justinian at 4:30 PM on January 6, 2011
I'm 35 and my current insurance rate is about $600 a month. What is it going to be when I'm 50? 60? I won't be able to afford it so y'all will get to pick up the tab.
posted by Justinian at 4:30 PM on January 6, 2011
What the HELL, they just raised my rates in the fall and now they've raised it again? My letter helpfully points out that while my rate is going up by 47.1%, only 2% of every premium dollar goes to their net income.
I was under the impression these guys were gonna be first against the wall.
posted by danny the boy at 4:30 PM on January 6, 2011 [2 favorites]
I was under the impression these guys were gonna be first against the wall.
posted by danny the boy at 4:30 PM on January 6, 2011 [2 favorites]
So... rates are going up because hospital rates are going up?
What about Blue Cross profits? Where are they at?
posted by hippybear at 4:33 PM on January 6, 2011 [1 favorite]
What about Blue Cross profits? Where are they at?
posted by hippybear at 4:33 PM on January 6, 2011 [1 favorite]
As a man who assumes he will one day own an insurance company, I am fine with this.
posted by Pope Guilty at 4:37 PM on January 6, 2011 [26 favorites]
posted by Pope Guilty at 4:37 PM on January 6, 2011 [26 favorites]
Same for me too, danny the boy. This stinks out loud.
posted by Kloryne at 4:40 PM on January 6, 2011
posted by Kloryne at 4:40 PM on January 6, 2011
*softly whispers a prayer of thanks for Tommy Douglas*
posted by The Card Cheat at 4:41 PM on January 6, 2011 [16 favorites]
posted by The Card Cheat at 4:41 PM on January 6, 2011 [16 favorites]
As a non-American, I just can't comment on this without gloating and pitying. So I'll go check some other posts instead.
posted by Jimbob at 4:45 PM on January 6, 2011
posted by Jimbob at 4:45 PM on January 6, 2011
Apparently they have 9.7 billion in revenue and I believe that California may mandate that they now must spend only 80% on medical services. https://www.blueshieldca.com/bsc/aboutbsc/fast-facts/index.jhtml
posted by kilbanio at 4:57 PM on January 6, 2011
posted by kilbanio at 4:57 PM on January 6, 2011
How can deflation be considered a threat to the overall economy and these assholes are raising prices?
Probably because the investments that they are putting the premiums in are tanking. But rather than lose money like any other business, they can pass the increases on due to the nature of the health insurance market.
posted by Ironmouth at 4:58 PM on January 6, 2011 [4 favorites]
Probably because the investments that they are putting the premiums in are tanking. But rather than lose money like any other business, they can pass the increases on due to the nature of the health insurance market.
posted by Ironmouth at 4:58 PM on January 6, 2011 [4 favorites]
As a non-American, I just can't comment on this without gloating and pitying. So I'll go check some other posts instead.
The 45,000 people who die each year because they lack health insurance are glad they could provide you with amusement.
posted by winna at 5:00 PM on January 6, 2011 [20 favorites]
The 45,000 people who die each year because they lack health insurance are glad they could provide you with amusement.
posted by winna at 5:00 PM on January 6, 2011 [20 favorites]
What about Blue Cross profits? Where are they at?
It's not true of all Blue Shield franchises, but Blue Shield of California is non-profit. I guess that doesn't help much with cost control.
posted by It's Never Lurgi at 5:02 PM on January 6, 2011
It's not true of all Blue Shield franchises, but Blue Shield of California is non-profit. I guess that doesn't help much with cost control.
posted by It's Never Lurgi at 5:02 PM on January 6, 2011
I can confirm- my rates increased 54%. I never understood people who said they couldn't afford health insurance before (seriously, you're an idiot if you get cable TV but don't have health insurance), but after this hike it's finally entering territory where I am considering dropping coverage because despite the beating I take every month, my deductible is $2500 and nothing is covered. I received a letter a month prior to being informed of the increase blaming something like 9% of the increase on health care reform. That doesn't change my opinion that they're evil, and rather than thinking regulations harm competitiveness, all I think is that there should be even more regulations on health insurance, like perhaps one that limits executive pay, caps profits, and ties fee hikes to inflation. I've long been on the fence about how leftist exactly I am, but this kind of crap has really pushed me over the edge- I wish I lived in a country where the government worked to protect its citizens, not its corporations.
posted by BuddhaInABucket at 5:06 PM on January 6, 2011 [39 favorites]
posted by BuddhaInABucket at 5:06 PM on January 6, 2011 [39 favorites]
Like Jimbob, I'm a little astounded at the astronomical prices. I had a whinge to my boyfriend recently because I voluntarily upped my policy to cover more hospital procedures - to $80 per month. Pre-existing condition? Just wait 12 months and then we'll cover you.
Australian, where private health insurance is primarily still voluntary and one can still use the public, free option with minimal hassle. There is still genuine care for people who can't afford insurance.
posted by chronic sublime at 5:06 PM on January 6, 2011
Australian, where private health insurance is primarily still voluntary and one can still use the public, free option with minimal hassle. There is still genuine care for people who can't afford insurance.
posted by chronic sublime at 5:06 PM on January 6, 2011
Horrific. It makes me wonder just how badly our Anthem policy is going to jump when renewal comes in a couple of months. We're already barely paying a four-figure premium every month. I had back surgery back in March, and I'm sure Anthem isn't going to take that sort of outrage lying down.
That said...
This does, however, put some focus on the aspect of healthcare costs that seems to get a pass with just about everyone...media, legislators, and public..namely the provider/manufacturer side of the equation. I have absolutely no love for the insurers and firmly believe they need reigning-in. But, until actual healthcare costs...that is, the prices charged by providers, hospitals, pharma, equipment manufacturers, etc....get a serious going-over, this fucking mess is never, ever, ever going to get better.
posted by Thorzdad at 5:09 PM on January 6, 2011 [4 favorites]
That said...
This does, however, put some focus on the aspect of healthcare costs that seems to get a pass with just about everyone...media, legislators, and public..namely the provider/manufacturer side of the equation. I have absolutely no love for the insurers and firmly believe they need reigning-in. But, until actual healthcare costs...that is, the prices charged by providers, hospitals, pharma, equipment manufacturers, etc....get a serious going-over, this fucking mess is never, ever, ever going to get better.
posted by Thorzdad at 5:09 PM on January 6, 2011 [4 favorites]
It's easy to grar about insurance companies but medical care is really fucking expensive even at whatever discounts they negotiate. Doctors and hospitals are making a lot of money and giggling on the sidelines while everyone rages at Blue Cross.
posted by ghharr at 5:17 PM on January 6, 2011 [3 favorites]
posted by ghharr at 5:17 PM on January 6, 2011 [3 favorites]
ghharr: "Doctors and hospitals are making a lot of money and giggling on the sidelines while everyone rages at Blue Cross."
My father's a physician and I can guarantee that this isn't true. Instead, they are raging at how hard it is to get insurance companies to cough up any money at all, and how every year the contracted fees for services goes down- meaning while customers are paying more for their insurance premiums, doctors are getting paid less for their work.
posted by BuddhaInABucket at 5:21 PM on January 6, 2011 [18 favorites]
My father's a physician and I can guarantee that this isn't true. Instead, they are raging at how hard it is to get insurance companies to cough up any money at all, and how every year the contracted fees for services goes down- meaning while customers are paying more for their insurance premiums, doctors are getting paid less for their work.
posted by BuddhaInABucket at 5:21 PM on January 6, 2011 [18 favorites]
(seriously, you're an idiot if you get cable TV but don't have health insurance)
Let's say I have about $120 dollars in discretionary spending in my monthly budget. I can get basic cable for $50, and health insurance would run my family $1000. I could save that $120 forever and still never be able to get health insurance, or I could save $70 and get my family some relatively cheap entertainment, since we aren't going to be able to go out to movie theaters, much less concerts or amusement parks. I could see someone disagreeing with my decision, but am I seriously an idiot for getting cable?
The price differences are so extreme that it's kind of like saying "you're a moron for buying chewing gum if you haven't bought a car with side-impact airbags."
posted by Pater Aletheias at 5:36 PM on January 6, 2011 [58 favorites]
Let's say I have about $120 dollars in discretionary spending in my monthly budget. I can get basic cable for $50, and health insurance would run my family $1000. I could save that $120 forever and still never be able to get health insurance, or I could save $70 and get my family some relatively cheap entertainment, since we aren't going to be able to go out to movie theaters, much less concerts or amusement parks. I could see someone disagreeing with my decision, but am I seriously an idiot for getting cable?
The price differences are so extreme that it's kind of like saying "you're a moron for buying chewing gum if you haven't bought a car with side-impact airbags."
posted by Pater Aletheias at 5:36 PM on January 6, 2011 [58 favorites]
For what it's worth, it is NOT a non-Profit, it is a not-for-profit. The difference is enormous.
posted by absalom at 5:39 PM on January 6, 2011 [1 favorite]
posted by absalom at 5:39 PM on January 6, 2011 [1 favorite]
Pater Aletheias - As a 20-something single man with no family, cable TV and health insurance have prices in the same neighborhood. My comment was meant for people in similar circumstances. I know lots of people in the same financial situation as me who are uninsured but could theoretically afford it if it was a priority. Anyway, the point of my post was that I used to feel that way but now I'm starting to see the shades of grey.
posted by BuddhaInABucket at 5:43 PM on January 6, 2011 [1 favorite]
posted by BuddhaInABucket at 5:43 PM on January 6, 2011 [1 favorite]
Instead, they are raging at how hard it is to get insurance companies to cough up any money at all, and how every year the contracted fees for services goes down- meaning while customers are paying more for their insurance premiums, doctors are getting paid less for their work.
And possibly, at the same time, insurance companies are paying more, because the number of patients hitting expensive old age is very high. Even if they companies are paying less per procedure, they may be paying for more procedures, especially the expensive ones.
posted by zippy at 5:46 PM on January 6, 2011
And possibly, at the same time, insurance companies are paying more, because the number of patients hitting expensive old age is very high. Even if they companies are paying less per procedure, they may be paying for more procedures, especially the expensive ones.
posted by zippy at 5:46 PM on January 6, 2011
For what it's worth, it is NOT a non-Profit, it is a not-for-profit.
Could you support that distinction? The International Center for Non-profit Law says that "The term 'not-for-profit organization' (NFPO) is used as a broad-based term that encompasses all organizations that are known variously as charities, non-profits," etc. The terms are often used interchangeably but even used "correctly," one is a subset of the other.
If you want to criticize the ability of an organization to pay out huge salaries, charge enormous rates, and still avoid paying income tax, that's one thing. But this terminology distinction is not what you're looking for.
posted by rkent at 5:50 PM on January 6, 2011 [1 favorite]
Could you support that distinction? The International Center for Non-profit Law says that "The term 'not-for-profit organization' (NFPO) is used as a broad-based term that encompasses all organizations that are known variously as charities, non-profits," etc. The terms are often used interchangeably but even used "correctly," one is a subset of the other.
If you want to criticize the ability of an organization to pay out huge salaries, charge enormous rates, and still avoid paying income tax, that's one thing. But this terminology distinction is not what you're looking for.
posted by rkent at 5:50 PM on January 6, 2011 [1 favorite]
There is a rule that going forward, insurance rate hikes need to be approved. And I think most of these rate hikes took place before 2011-01-01.
But what's interesting is that by requiring 80% of costs to be medical costs, it may mean that in order to continue to pay people at the insurance companies the same amount of money, you just jack up your rates immensely and start providing a lot more care, that way instead of taking 40% of $1000 for yourself, you take 20% of $2000. You make the same amount of money (but, care would improve, of course)
But yeah, Obama fucked up with this healthcare plan, IMO. The insurance companies have been behaving horrible over the past few years, and leaving them in charge means they are going to continue to do so. And in fact, by jacking up their rates, they actually score a political victory because people will blame Obama.
Talk about perverse incentives.
posted by delmoi at 5:51 PM on January 6, 2011 [3 favorites]
But what's interesting is that by requiring 80% of costs to be medical costs, it may mean that in order to continue to pay people at the insurance companies the same amount of money, you just jack up your rates immensely and start providing a lot more care, that way instead of taking 40% of $1000 for yourself, you take 20% of $2000. You make the same amount of money (but, care would improve, of course)
But yeah, Obama fucked up with this healthcare plan, IMO. The insurance companies have been behaving horrible over the past few years, and leaving them in charge means they are going to continue to do so. And in fact, by jacking up their rates, they actually score a political victory because people will blame Obama.
Talk about perverse incentives.
posted by delmoi at 5:51 PM on January 6, 2011 [3 favorites]
Let's say I have about $120 dollars in discretionary spending in my monthly budget. I can get basic cable for $50, and health insurance would run my family $1000. I could save that $120 forever and still never be able to get health insurance, or I could save $70 and get my family some relatively cheap entertainment, since we aren't going to be able to go out to movie theaters, much less concerts or amusement parks. I could see someone disagreeing with my decision, but am I seriously an idiot for getting cable?
The price differences are so extreme that it's kind of like saying "you're a moron for buying chewing gum if you haven't bought a car with side-impact airbags."
It's not quite so simple. I have never paid for cable in my life. I have not even had a TV for the past 10 years or so. What does my "$120 dollars in discretionary spending" go to, if it's $1000 for health insurance? It's still a choice. My $120 goes to better quality food - more fruits and vegetables, which unfortunately raise my food bill as sadly, fresh fruit is expensive around here (even though I'm very thrifty in finding the best deals). So, indirectly, that $120 goes to prevention, or you could say, a kind of proxy of health care insurance. It's therefore not strictly speaking true that you can do nothing because it's hopelessly expensive, and you may as well veg out in front of the TV for the extra $70 or whatever.
Now, to re-purpose Mat 4: 4, no doubt, 'man does not live by bread alone', so to stay mentally healthy, it may make sense to get that cable, but that's an individual decision about needs. For some the extra $70 is cable, just to maintain sanity, for somebody else it may be a gym membership, all with an eye to lowering health costs.
posted by VikingSword at 5:54 PM on January 6, 2011
The price differences are so extreme that it's kind of like saying "you're a moron for buying chewing gum if you haven't bought a car with side-impact airbags."
It's not quite so simple. I have never paid for cable in my life. I have not even had a TV for the past 10 years or so. What does my "$120 dollars in discretionary spending" go to, if it's $1000 for health insurance? It's still a choice. My $120 goes to better quality food - more fruits and vegetables, which unfortunately raise my food bill as sadly, fresh fruit is expensive around here (even though I'm very thrifty in finding the best deals). So, indirectly, that $120 goes to prevention, or you could say, a kind of proxy of health care insurance. It's therefore not strictly speaking true that you can do nothing because it's hopelessly expensive, and you may as well veg out in front of the TV for the extra $70 or whatever.
Now, to re-purpose Mat 4: 4, no doubt, 'man does not live by bread alone', so to stay mentally healthy, it may make sense to get that cable, but that's an individual decision about needs. For some the extra $70 is cable, just to maintain sanity, for somebody else it may be a gym membership, all with an eye to lowering health costs.
posted by VikingSword at 5:54 PM on January 6, 2011
Doctors and hospitals are making a lot of money and giggling on the sidelines while everyone rages at Blue Cross.
Your grar is misdirected. Try these groups instead: pharmaceuticals, hospital equipment manufacturers, hospital suppliers.
One joke we had when I worked in surgery was the "grade" of equipment. Our favorite was a screw. Let's pretend it is a rather ordinary 1 inch screw that holds together whatever you want. In a hardware store, a screw costs approximately $0.02, give or take large fractions of a penny. This is consumer grade. An industrial grade screw is double that, so maybe a nickel.
Once you move into hospital grade equipment, prices really begin to fluorish. A screw to hold a piece of equipment together? $40. If you don't use the screw ordered from the company who makes the IV Pole, they won't warrant it. If the IV pole falls down, IV pole manufacturer blames you.
Now let's move to surgical: We had to have a bolt replaced on an operating table. I know, not a screw, but a bolt. Four inches long. $800. Uh-huh. How about a screw in a leg? The kind that is put in by a surgeon: $400. For the screw. Not installed, not sterilized, just the metal.
Other great prices for your consideration: One pack of thread with a needle, pre-sterilized, commonly known as suture: $30 per pack. One bag IV fluid: $20. An ambu-bag (the hand operated respirator for people needing CPR or can't breathe on their own) $130. All prices may fluctuate by several hundred percent at the whim of any adjuster along the line.
posted by Mister Fabulous at 5:58 PM on January 6, 2011 [39 favorites]
Your grar is misdirected. Try these groups instead: pharmaceuticals, hospital equipment manufacturers, hospital suppliers.
One joke we had when I worked in surgery was the "grade" of equipment. Our favorite was a screw. Let's pretend it is a rather ordinary 1 inch screw that holds together whatever you want. In a hardware store, a screw costs approximately $0.02, give or take large fractions of a penny. This is consumer grade. An industrial grade screw is double that, so maybe a nickel.
Once you move into hospital grade equipment, prices really begin to fluorish. A screw to hold a piece of equipment together? $40. If you don't use the screw ordered from the company who makes the IV Pole, they won't warrant it. If the IV pole falls down, IV pole manufacturer blames you.
Now let's move to surgical: We had to have a bolt replaced on an operating table. I know, not a screw, but a bolt. Four inches long. $800. Uh-huh. How about a screw in a leg? The kind that is put in by a surgeon: $400. For the screw. Not installed, not sterilized, just the metal.
Other great prices for your consideration: One pack of thread with a needle, pre-sterilized, commonly known as suture: $30 per pack. One bag IV fluid: $20. An ambu-bag (the hand operated respirator for people needing CPR or can't breathe on their own) $130. All prices may fluctuate by several hundred percent at the whim of any adjuster along the line.
posted by Mister Fabulous at 5:58 PM on January 6, 2011 [39 favorites]
Can't we just nationalize this shit already?
That won't fix anything. This isn't being driven by 'insurance company greed'. After all, this one is losing money hand over fist. In general, most insurance companies actually pay out a little more in expenses than they make in earned premium; they make money by investing the 'float', the time during which they're holding your premium before they have to pay it out again. You're looking for a villain, but it ain't these guys.
Even if we nationalize everything, the best estimates I've seen is that we'd save 20% in efficiency costs, once. And at these rates of increase, that would be eaten up inside of two years, and then we'd be right back where we started. Further, since nationalized health care would add a lot of presently uninsured people to the coverage pool, the additional demand should drive prices up, not down, at least over the short term.
This isn't a problem of nationalized health care. My belief is that it's a combination of a profiteering medical industry and all the inflation we've been accumulating over the last ten years or so. Medicine is one of the few industries where it's hard to outsource. Doctors and drug companies have a captive market, and there's a lot more dollars floating around than there used to be. Since most medical functions can't be easily outsourced to other countries, that inflation can't be readily exported abroad and hidden; instead, we all have to bid with our ever-weakening dollars against a limited supply of healthcare.
The demand for healthcare is infinite; people will pay ANY amount of money to stay alive, particularly when other people have to pay the bills. Combine infinite demand, deep monetary disorder, and a strangely structured market where the consumers desperately want goods that they don't have to directly pay for, and skyrocketing prices are the inevitable outcome.
Further, since interest rates are being held artificially and unhealthily low, this is absolutely killing the ability of insurance companies to make a profit with their float, in turn meaning that you actually have to pay for what you receive.
This is what printing money means, endless price increases for things that must be produced locally, and the rotting out of local industries that can be shipped overseas to save money. It's not just vague and handwavy doom-and-gloom, it's showing up right here in your pocketbook. You're being outcompeted for medical services by Wall Street's endless fountains of cash, and the drug companies are making obscene profits because they can put any price tag they like on a drug and expect to get it.
The typical response of governments to inflation is almost never bringing their fiscal house in order. In severe cases, the reflex is always to impose price controls. And that's when the real damage starts happening... you get shortages, and eventually you simply can't get goods and services at all, because nobody can afford to sell them to you for the imposed price. The black market flourishes, and government revenue declines, further exacerbating the problem.
We've been trying to live beyond our means for far, far too long, and this is one of the areas where it's showing up first. These guys aren't the villains. The disease is much deeper. Nationalizing health care or legislating allowed costs won't solve this problem... that's like using morphine to treat cancer. Feels great for awhile, but the underlying problem just gets worse.
posted by Malor at 6:01 PM on January 6, 2011 [24 favorites]
That won't fix anything. This isn't being driven by 'insurance company greed'. After all, this one is losing money hand over fist. In general, most insurance companies actually pay out a little more in expenses than they make in earned premium; they make money by investing the 'float', the time during which they're holding your premium before they have to pay it out again. You're looking for a villain, but it ain't these guys.
Even if we nationalize everything, the best estimates I've seen is that we'd save 20% in efficiency costs, once. And at these rates of increase, that would be eaten up inside of two years, and then we'd be right back where we started. Further, since nationalized health care would add a lot of presently uninsured people to the coverage pool, the additional demand should drive prices up, not down, at least over the short term.
This isn't a problem of nationalized health care. My belief is that it's a combination of a profiteering medical industry and all the inflation we've been accumulating over the last ten years or so. Medicine is one of the few industries where it's hard to outsource. Doctors and drug companies have a captive market, and there's a lot more dollars floating around than there used to be. Since most medical functions can't be easily outsourced to other countries, that inflation can't be readily exported abroad and hidden; instead, we all have to bid with our ever-weakening dollars against a limited supply of healthcare.
The demand for healthcare is infinite; people will pay ANY amount of money to stay alive, particularly when other people have to pay the bills. Combine infinite demand, deep monetary disorder, and a strangely structured market where the consumers desperately want goods that they don't have to directly pay for, and skyrocketing prices are the inevitable outcome.
Further, since interest rates are being held artificially and unhealthily low, this is absolutely killing the ability of insurance companies to make a profit with their float, in turn meaning that you actually have to pay for what you receive.
This is what printing money means, endless price increases for things that must be produced locally, and the rotting out of local industries that can be shipped overseas to save money. It's not just vague and handwavy doom-and-gloom, it's showing up right here in your pocketbook. You're being outcompeted for medical services by Wall Street's endless fountains of cash, and the drug companies are making obscene profits because they can put any price tag they like on a drug and expect to get it.
The typical response of governments to inflation is almost never bringing their fiscal house in order. In severe cases, the reflex is always to impose price controls. And that's when the real damage starts happening... you get shortages, and eventually you simply can't get goods and services at all, because nobody can afford to sell them to you for the imposed price. The black market flourishes, and government revenue declines, further exacerbating the problem.
We've been trying to live beyond our means for far, far too long, and this is one of the areas where it's showing up first. These guys aren't the villains. The disease is much deeper. Nationalizing health care or legislating allowed costs won't solve this problem... that's like using morphine to treat cancer. Feels great for awhile, but the underlying problem just gets worse.
posted by Malor at 6:01 PM on January 6, 2011 [24 favorites]
More on "you are an idiot to pay for cable if you can't afford health insurance" - Orwell addressed this point most eloquently here:
"The basis of their diet, therefore, is white bread and margarine, corned beef, sugared tea, and potatoes — an appalling diet. Would it not be better if they spent more money on wholesome things like oranges and wholemeal bread or if they even, like the writer of the letter to the New Statesman, saved on fuel and ate their carrots raw? Yes, it would, but the point is that no ordinary human being is ever going to do such a thing. The ordinary human being would sooner starve than live on brown bread and raw carrots. And the peculiar evil is this, that the less money you have, the less inclined you feel to spend it on wholesome food. A millionaire may enjoy breakfasting off orange juice and Ryvita biscuits; an unemployed man doesn’t. Here the tendency of which I spoke at the end of the last chapter comes into play. When you are unemployed, which is to say when you are underfed, harassed, bored, and miserable, you don’t want to eat dull wholesome food. You want something a little bit ‘tasty’. There is always some cheaply pleasant thing to tempt you. Let’s have three pennorth of chips! Run out and buy us a twopenny ice-cream! Put the kettle on and we’ll all have a nice cup of tea! That is how your mind works when you are at the P.A.C. level. White bread-and-marg and sugared tea don’t nourish you to any extent, but they are nicer (at least most people think so) than brown bread-and-dripping and cold water. Unemployment is an endless misery that has got to be constantly palliated, and especially with tea, the English-man’s opium. A cup of tea or even an aspirin is much better as a temporary stimulant than a crust of brown bread."
posted by VikingSword at 6:01 PM on January 6, 2011 [42 favorites]
"The basis of their diet, therefore, is white bread and margarine, corned beef, sugared tea, and potatoes — an appalling diet. Would it not be better if they spent more money on wholesome things like oranges and wholemeal bread or if they even, like the writer of the letter to the New Statesman, saved on fuel and ate their carrots raw? Yes, it would, but the point is that no ordinary human being is ever going to do such a thing. The ordinary human being would sooner starve than live on brown bread and raw carrots. And the peculiar evil is this, that the less money you have, the less inclined you feel to spend it on wholesome food. A millionaire may enjoy breakfasting off orange juice and Ryvita biscuits; an unemployed man doesn’t. Here the tendency of which I spoke at the end of the last chapter comes into play. When you are unemployed, which is to say when you are underfed, harassed, bored, and miserable, you don’t want to eat dull wholesome food. You want something a little bit ‘tasty’. There is always some cheaply pleasant thing to tempt you. Let’s have three pennorth of chips! Run out and buy us a twopenny ice-cream! Put the kettle on and we’ll all have a nice cup of tea! That is how your mind works when you are at the P.A.C. level. White bread-and-marg and sugared tea don’t nourish you to any extent, but they are nicer (at least most people think so) than brown bread-and-dripping and cold water. Unemployment is an endless misery that has got to be constantly palliated, and especially with tea, the English-man’s opium. A cup of tea or even an aspirin is much better as a temporary stimulant than a crust of brown bread."
posted by VikingSword at 6:01 PM on January 6, 2011 [42 favorites]
**mind boggles**
How can deflation be considered a threat to the overall economy and these assholes are raising prices?
Probably because the investments that they are putting the premiums in are tanking. But rather than lose money like any other business, they can pass the increases on due to the nature of the health insurance market.
Because they are mostly a monopoly? While there are lots of insurance providers, in many states only a single provider is dominant. And, beyond that healthcare is only part of the economy. Healthcare costs have been rising much faster then other prices for years.
And further there is a political incentive to raising prices now, because the insurance providers are opposed to obama and support the republicans, and people will hold Obama responsible for their rate increases, as they should frankly. After all, these are the rules that he worked out with them. Had he created something like a public option tied to Medicare rates, people could have moved over to that.
(seriously, you're an idiot if you get cable TV but don't have health insurance)Well, for me personally, cable comes free with my apartment. The cost is $0. But beyond that, you can find cable packages for $40 or so. Meanwhile insurance can cost 5 to 10 times that much, if you don't have a pre-existing condition. Getting rid of cable won't make it possible to afford healthcare. If you don't have health insurance through work, and you don't have any medical conditions, why get it?
Pater Aletheias - As a 20-something single man with no family, cable TV and health insurance have prices in the same neighborhood.Well, what about all the people who aren't 20-something single men? If you're in that range why even bother with health insurance? I wouldn't pay for it if I had the choice.
And it is true that Doctors, as well as the whole medical supply chain, are way over paid in this country. There is a huge amount of inefficency caused by all kinds of bureaucratic bullshit at the insurance companies, and because overall healthcare costs only mean more money for everyone involved in the decision making process, the rates go up and up.
posted by delmoi at 6:04 PM on January 6, 2011
Nationalizing health care or legislating allowed costs won't solve this problem... that's like using morphine to treat cancer. Feels great for awhile, but the underlying problem just gets worse.
So -- what? Austerity is the answer then?
posted by blucevalo at 6:09 PM on January 6, 2011 [1 favorite]
So -- what? Austerity is the answer then?
posted by blucevalo at 6:09 PM on January 6, 2011 [1 favorite]
I'm not sure what to make of this. It's my understanding that Blue Shield of California is actually a non-profit (separate and unlike Anthem/Blue Cross in California).
If that's true, what would their incentive be to raise rates? Apparently not protection of profits. Unless I'm misunderstanding their status or there's subtleties to incentives in the non-profit world that I'm missing, it really has to be about their costs, and that's either a matter of organizational efficiency, genuine overhead related to the reform, or costs of claims.
I'm not quick to jump to the conclusion that Blue Shield is particularly less efficient than other insurers.
Reform-related overhead? Possible, I guess, but how many cost-inducing provisions of the 2010 legislation have really kicked in? I'm skeptical that new expenses resulting from new healthcare laws are really the lions share, unless it's one-time adaptation costs.
Cost of claims? I believe it. I don't think we really tamed the cost beast this last go round, and even with the benefits from the reform (which I still believe in), we've still got an opaque tangle of incentives is unlikely to operate efficiently.
posted by weston at 6:10 PM on January 6, 2011
If that's true, what would their incentive be to raise rates? Apparently not protection of profits. Unless I'm misunderstanding their status or there's subtleties to incentives in the non-profit world that I'm missing, it really has to be about their costs, and that's either a matter of organizational efficiency, genuine overhead related to the reform, or costs of claims.
I'm not quick to jump to the conclusion that Blue Shield is particularly less efficient than other insurers.
Reform-related overhead? Possible, I guess, but how many cost-inducing provisions of the 2010 legislation have really kicked in? I'm skeptical that new expenses resulting from new healthcare laws are really the lions share, unless it's one-time adaptation costs.
Cost of claims? I believe it. I don't think we really tamed the cost beast this last go round, and even with the benefits from the reform (which I still believe in), we've still got an opaque tangle of incentives is unlikely to operate efficiently.
posted by weston at 6:10 PM on January 6, 2011
they should at least be honest about how much of the increasing healthcare cost has to do with increased office/hospital staffing and demands on practitioners' time (and resulting decrease in max patient load) resulting from all the goddamn hoops they have to jump through in order to get approval and reimbursement for care from insurance companies. among my favorites: a patient needs an
mri, and the insurance company requires the requesting physician to be available to speak directly to their peer-review physician, who is three timezones away, within a two-hour window when the peer-review doctor is supposed to call, and at least half the time the request is denied because the call is never made yet is documented as 'md did not answer'. when society collapses, insurance co. administrators are the first ones i'm hunting for.
posted by fallacy of the beard at 6:21 PM on January 6, 2011 [1 favorite]
mri, and the insurance company requires the requesting physician to be available to speak directly to their peer-review physician, who is three timezones away, within a two-hour window when the peer-review doctor is supposed to call, and at least half the time the request is denied because the call is never made yet is documented as 'md did not answer'. when society collapses, insurance co. administrators are the first ones i'm hunting for.
posted by fallacy of the beard at 6:21 PM on January 6, 2011 [1 favorite]
"If you don't have health insurance through work, and you don't have any medical conditions, why get it?"
In case you get sick or injured, and don't want to risk poverty for the rest of your life, or death.
posted by PareidoliaticBoy at 6:25 PM on January 6, 2011 [6 favorites]
In case you get sick or injured, and don't want to risk poverty for the rest of your life, or death.
posted by PareidoliaticBoy at 6:25 PM on January 6, 2011 [6 favorites]
Nationalizing health care or legislating allowed costs won't solve this problem... that's like using morphine to treat cancer. Feels great for awhile, but the underlying problem just gets worse.That's not really true. Health care isn't like a commodity like onions where if you set a price cap, people will just buy until you run out and it needs to be rationed, whereas if you let the price float, people will cut their onion consumption if the price gets to high.
There is a fixed amount of health care available, but there's also a fixed amount of health care need. People will just pay the prices they need to to get care, and if they go bankrupt in the process then they can get medicaid and get care that way. Although some people do fall through the cracks and just die or suffer terribly for lack of care.
On the other hand, if prices are forced to go down, then doctors are not just going to sit idle, they'll still need to work. They'll just make less money, and potentially some might go into other fields (but what?)
Finally, it's also possible for the government to build medical capacity, but training more doctors, building hospitals, and so on. I actually think that's something the government should do.
Right now, the number of doctors we have in this country is actually controlled by the AMA. If the government got into the business of paying for medical school for interested students, we could have more doctors which would decrease costs. Obviously that would take a while, but it would help bring down costs in the long term.
posted by delmoi at 6:35 PM on January 6, 2011 [5 favorites]
"If you don't have health insurance through work, and you don't have any medical conditions, why get it?"
Because the total billed cost of my unplanned back surgery was right around $40,000.
posted by Thorzdad at 6:38 PM on January 6, 2011 [3 favorites]
Because the total billed cost of my unplanned back surgery was right around $40,000.
posted by Thorzdad at 6:38 PM on January 6, 2011 [3 favorites]
Does this affect people who have BSofCA through CalPERS?
posted by elsietheeel at 6:39 PM on January 6, 2011
posted by elsietheeel at 6:39 PM on January 6, 2011
If the government got into the business of paying for medical school for interested students, we could have more doctors which would decrease costs.
The US could also open its doors to larger numbers of foreign-trained doctors. Economist Dean Baker talks about this: "By most measures, doctors in the US are paid far more than doctors in other countries. The disparities tend to be largest in highly paid areas of specialisation, but the gap is substantial in most areas. This gap is preserved through licensing policies that are deliberately designed to restrict both domestic and international competition." Globalising healthcare: A prescription with benefits, by Dean Baker, Co-Director, Center for Economic and Policy Research (CEPR) Oct 2010)
(It's an interesting article; Baker discuses several ways that medical costs could be reduced by modifying trade policies)
posted by Auden at 6:48 PM on January 6, 2011 [4 favorites]
The US could also open its doors to larger numbers of foreign-trained doctors. Economist Dean Baker talks about this: "By most measures, doctors in the US are paid far more than doctors in other countries. The disparities tend to be largest in highly paid areas of specialisation, but the gap is substantial in most areas. This gap is preserved through licensing policies that are deliberately designed to restrict both domestic and international competition." Globalising healthcare: A prescription with benefits, by Dean Baker, Co-Director, Center for Economic and Policy Research (CEPR) Oct 2010)
(It's an interesting article; Baker discuses several ways that medical costs could be reduced by modifying trade policies)
posted by Auden at 6:48 PM on January 6, 2011 [4 favorites]
People are dying without basic care.
Collection jars for donations for medical care show up in convenience stores everywhere.
Medical bankruptcies occur for people who have health insurance in the U.S.
We are the wealthiest country in the world.
These things don't add up.
posted by yesster at 7:14 PM on January 6, 2011 [12 favorites]
Collection jars for donations for medical care show up in convenience stores everywhere.
Medical bankruptcies occur for people who have health insurance in the U.S.
We are the wealthiest country in the world.
These things don't add up.
posted by yesster at 7:14 PM on January 6, 2011 [12 favorites]
My 10-year old's health insurance costs $108 per month (double what it was 8 years ago.) As long as it's cheaper than adding her to either of our work policies (which do not subsidize dependents), we'll keep it (because I'm afraid that child insurance policies won't be available.).
posted by vespabelle at 7:19 PM on January 6, 2011
posted by vespabelle at 7:19 PM on January 6, 2011
Why does the insurance industry keep pointing out health care costs are going up but never point out that there's no real connection between health care costs and what the insurance companies pay out. The insurance companies pay what the fucking insurance companies want to pay.
Our health care is great. Our health care system is evil to the core.
posted by Benny Andajetz at 7:47 PM on January 6, 2011 [1 favorite]
Our health care is great. Our health care system is evil to the core.
posted by Benny Andajetz at 7:47 PM on January 6, 2011 [1 favorite]
Nationalizing health care or legislating allowed costs won't solve this problem... that's like using morphine to treat cancer. Feels great for awhile, but the underlying problem just gets worse.
Yeah, what delmoi said. Once everybody is in this together, we can have a conversation with the entities that are profiting from the current ridiculous system about the definition of the words "health" and "care", and what it means to be a part of civilization which, I suppose, is not merely the law of the jungle plus fancy gadgets and shiny vehicles.
To get there, my guess is that all of us ought to start wondering whether we want to keep up this culture war that has accompanied the decadence of American society, and whether we're happy with the way our elected representatives go about their business. Don't get me wrong: it's been a lot of fun, over the years, complaining about how all of the problems are their fault, and shrugging when politicians do very little but make most things worse because "that's just how the system works" or something, but I just turned thirty and the prospect of being unemployed, uninsured, and saddled with debt for the rest of my life is enough to make me consider a new approach.
posted by millions at 8:01 PM on January 6, 2011 [3 favorites]
Yeah, what delmoi said. Once everybody is in this together, we can have a conversation with the entities that are profiting from the current ridiculous system about the definition of the words "health" and "care", and what it means to be a part of civilization which, I suppose, is not merely the law of the jungle plus fancy gadgets and shiny vehicles.
To get there, my guess is that all of us ought to start wondering whether we want to keep up this culture war that has accompanied the decadence of American society, and whether we're happy with the way our elected representatives go about their business. Don't get me wrong: it's been a lot of fun, over the years, complaining about how all of the problems are their fault, and shrugging when politicians do very little but make most things worse because "that's just how the system works" or something, but I just turned thirty and the prospect of being unemployed, uninsured, and saddled with debt for the rest of my life is enough to make me consider a new approach.
posted by millions at 8:01 PM on January 6, 2011 [3 favorites]
I wouldn't mind the feeling great for a while bit. How long we talking? It there a 6 month economic hangover and 10 years of now after that before we start feeling great again?
posted by humanfont at 8:26 PM on January 6, 2011
posted by humanfont at 8:26 PM on January 6, 2011
The solution to fixing health care is simple: make people buy and pay for it themselves instead of having their employers do it for them. If everyone had to deal with the insurance companies directly we would nationalize this shit over night.
posted by bradbane at 8:30 PM on January 6, 2011 [2 favorites]
posted by bradbane at 8:30 PM on January 6, 2011 [2 favorites]
No, we need to aim a little ire at the doctors, too... and especially at the AMA which keeps the ranks of MD's unsustainably small. When I was a kid, if I needed to see a doctor, I'd see my pediatrician. Now I have to take my girl to a Nurse Practitioner, because the doctors are all way too overbooked.
That Nurse Practitioner? She should be a doctor.
Also, they have been known to play shenanigans with a patient's health to rake in some extra dough. Here in RI, the largest network of OBGYN practitioners got caught selling counterfeit IUDs - not the pencil pushers, the Doctors themselves knew the devices were phony, and still charged the full price to give their patients medicine that wasn't tested or approved by the FDA, just to make a quick buck.
posted by Slap*Happy at 8:50 PM on January 6, 2011
That Nurse Practitioner? She should be a doctor.
Also, they have been known to play shenanigans with a patient's health to rake in some extra dough. Here in RI, the largest network of OBGYN practitioners got caught selling counterfeit IUDs - not the pencil pushers, the Doctors themselves knew the devices were phony, and still charged the full price to give their patients medicine that wasn't tested or approved by the FDA, just to make a quick buck.
posted by Slap*Happy at 8:50 PM on January 6, 2011
$385/month. Deductible $3500; copay $3500.
So, for $4620, you promise to pay $3500, and help pay $3500, of your health care expenses?
Unless you have a preexisting chronic condition, or have been exposed to multi-Sievert radiation, the odds are clear.
You will do better buying $3500 in lottery tickets. Bonus -- if you dedicated the winnings to health care, you'll get better preventative care.
posted by eriko at 8:58 PM on January 6, 2011 [2 favorites]
So, for $4620, you promise to pay $3500, and help pay $3500, of your health care expenses?
Unless you have a preexisting chronic condition, or have been exposed to multi-Sievert radiation, the odds are clear.
You will do better buying $3500 in lottery tickets. Bonus -- if you dedicated the winnings to health care, you'll get better preventative care.
posted by eriko at 8:58 PM on January 6, 2011 [2 favorites]
As a non-American, I truly don't understand why all of you here on Metafilter aren't rioting in the streets about the way healthcare operates. This is Social Security, civil rights, women's suffrage level shit. Your government is perpetuating a system where any unforeseen illness potentially means bankruptcy, even if you have insurance. Your government has completely abandoned you.
Rioting. In. The. Streets.
posted by dry white toast at 9:08 PM on January 6, 2011 [19 favorites]
Rioting. In. The. Streets.
posted by dry white toast at 9:08 PM on January 6, 2011 [19 favorites]
This isn't a problem of nationalized health care. My belief is that it's a combination of a profiteering medical industry and all the inflation we've been accumulating over the last ten years or so
Jesus fucking christ, Malor, the whole fucking point of nationalized health care is you kill the fucking profiteering in the medical industry by destroying the profit motive!
Dude, you are so much smarter than this.
I don't know how many payers there are in the US. I know that there are at least 337 of them, because that's how many the transmission system I built sends claims to today.
Each one of them has a CEO, and a BOD, and a whole bank of staff dedicated to reducing the Medical Loss Ratio, because that makes them profitable.
Do you know what the Medical Loss Ratio is? It's the percentage of money "lost" by payers, because they had to pay for medical care.
The 2010 ACA mandates that the MLR cannot be lower than 80%. Wait, I'm speaking PayerSpeak. The MLR is the amount of money they pay *to treat patients* -- and the ACA demands that they spend 80% of the money they take in *to treat patients.*
What the US Health Care system pays for is CEO, accountants, lawyers, IT professionals, claims adjusters, and CS reps. By the new law, one dollar out of five goes to this.
And in reality? It's much worse than that.
Inflation? Please. You really think inflation is growing at 27% per annum for a decade? If that was true, we wouldn't bother printing $20 bills, because we'd need the press time to print the small bills, like the $10,000 bills.
Other countries have the exact same access to pharmaceuticals as we do -- and yet, they pay vastly less per dose. Why? Because the entire country, as a whole, negotiated the price. We slice the country into little bits, let them each negotiate the price, and then stick an enormous premium onto the uninsured -- while our pharmaceuticals work on analogs of drugs they've already made so that they can patent those and get insurance companies to pay for them -- rather than the about-to-be generic version they first found. See desloratadine (Clarinex), which came out four months before loratdine (Claritan) became generic, for one example -- there are *many* others.
The fundamental truth is that we spend vastly more per capita than any other industrialized country in the world for health care, and for this huge expense, we get vastly worse outcomes.
We are paying for Austin-Martins, and we are being given used Renaults.
We are being screwed, hard.
And it's the payers who are screwing us. They set the rates. They ration the health care. And if you want *one* reason to be desperately afraid of the 2010 ACA, it's this.
The payers, by and large, wrote it.
posted by eriko at 9:21 PM on January 6, 2011 [38 favorites]
Jesus fucking christ, Malor, the whole fucking point of nationalized health care is you kill the fucking profiteering in the medical industry by destroying the profit motive!
Dude, you are so much smarter than this.
I don't know how many payers there are in the US. I know that there are at least 337 of them, because that's how many the transmission system I built sends claims to today.
Each one of them has a CEO, and a BOD, and a whole bank of staff dedicated to reducing the Medical Loss Ratio, because that makes them profitable.
Do you know what the Medical Loss Ratio is? It's the percentage of money "lost" by payers, because they had to pay for medical care.
The 2010 ACA mandates that the MLR cannot be lower than 80%. Wait, I'm speaking PayerSpeak. The MLR is the amount of money they pay *to treat patients* -- and the ACA demands that they spend 80% of the money they take in *to treat patients.*
What the US Health Care system pays for is CEO, accountants, lawyers, IT professionals, claims adjusters, and CS reps. By the new law, one dollar out of five goes to this.
And in reality? It's much worse than that.
Inflation? Please. You really think inflation is growing at 27% per annum for a decade? If that was true, we wouldn't bother printing $20 bills, because we'd need the press time to print the small bills, like the $10,000 bills.
Other countries have the exact same access to pharmaceuticals as we do -- and yet, they pay vastly less per dose. Why? Because the entire country, as a whole, negotiated the price. We slice the country into little bits, let them each negotiate the price, and then stick an enormous premium onto the uninsured -- while our pharmaceuticals work on analogs of drugs they've already made so that they can patent those and get insurance companies to pay for them -- rather than the about-to-be generic version they first found. See desloratadine (Clarinex), which came out four months before loratdine (Claritan) became generic, for one example -- there are *many* others.
The fundamental truth is that we spend vastly more per capita than any other industrialized country in the world for health care, and for this huge expense, we get vastly worse outcomes.
We are paying for Austin-Martins, and we are being given used Renaults.
We are being screwed, hard.
And it's the payers who are screwing us. They set the rates. They ration the health care. And if you want *one* reason to be desperately afraid of the 2010 ACA, it's this.
The payers, by and large, wrote it.
posted by eriko at 9:21 PM on January 6, 2011 [38 favorites]
How long are we going to sit here and just take this shit? Seriously? Anyone???
posted by wuwei at 9:23 PM on January 6, 2011 [3 favorites]
posted by wuwei at 9:23 PM on January 6, 2011 [3 favorites]
Single payer.
posted by bardic at 9:33 PM on January 6, 2011 [1 favorite]
posted by bardic at 9:33 PM on January 6, 2011 [1 favorite]
Well, if you havent heard the news, it is about to get a LOT WORSE... Medicare is on the ropes, and if you want to guarantee you are able to cover your medical expenses in retirement it is suggested that you put an EXTRA 600 thousand aside. (for a couple).... According to the Employee Benefit Research Institute, a couple retiring in 10 years might need north of $650,000 to cover their out-of pocket medical expenses in retirement. And that figure does not include any potential changes to Medicare
posted by jcworth at 10:12 PM on January 6, 2011
posted by jcworth at 10:12 PM on January 6, 2011
The fundamental truth is that we spend vastly more per capita than any other industrialized country in the world for health care, and for this huge expense, we get vastly worse outcomes.
This graph shows the issue pretty clearly.
posted by flug at 10:14 PM on January 6, 2011 [3 favorites]
This graph shows the issue pretty clearly.
posted by flug at 10:14 PM on January 6, 2011 [3 favorites]
While I agree that gouging in the medical field obviously exists, here's some thoughts about the $400 implantable screw...
Imagine, for a moment, that you are designing and making the screw. Keep in mind, if you mess it up, someone could quite literally die or be crippled for life. This may lead you to a certain, somewhat more expensive rigor in your design and test process.
Now, add to that a federal authority that must approve the implantable screw, and can unilaterally shut down your company if you don't comply. You will, of course, have to be aware of and meet all of the several thousands of pages of regulations from this authority. Maybe even a bit more rigor and risk analysis and testing and verification and traceability are called for, yes?
In fact, by the time you're done, you will have verified every function and every use for your implantable screw, assessed and mitigated every possible risk you can think of, put warnings on every available surface, visited and verified every supplier, checked thousands of competing patents, and tested, and tested, and tested, and tested, and communicated all of this in a mind boggling number of documents to the FDA on multiple occasions.... along with a few thousand other tasks.
And that's before you can even legally talk to a single customer about actually buying your implantable screw.
It takes many man-years of effort to make things as simple as screws. Many more complex products effectively cannot even be built. The cost of a medical iPod would be beyond belief.
The US has extremely stringent regulations, and, like it or not, that costs money. Would you be willing to relax the regulations in order to make things cheaper, but possibly more lethal? Would you be willing to limit liability to make products cheaper?
There's less fat to cut than you think.
posted by underflow at 11:35 PM on January 6, 2011 [1 favorite]
Imagine, for a moment, that you are designing and making the screw. Keep in mind, if you mess it up, someone could quite literally die or be crippled for life. This may lead you to a certain, somewhat more expensive rigor in your design and test process.
Now, add to that a federal authority that must approve the implantable screw, and can unilaterally shut down your company if you don't comply. You will, of course, have to be aware of and meet all of the several thousands of pages of regulations from this authority. Maybe even a bit more rigor and risk analysis and testing and verification and traceability are called for, yes?
In fact, by the time you're done, you will have verified every function and every use for your implantable screw, assessed and mitigated every possible risk you can think of, put warnings on every available surface, visited and verified every supplier, checked thousands of competing patents, and tested, and tested, and tested, and tested, and communicated all of this in a mind boggling number of documents to the FDA on multiple occasions.... along with a few thousand other tasks.
And that's before you can even legally talk to a single customer about actually buying your implantable screw.
It takes many man-years of effort to make things as simple as screws. Many more complex products effectively cannot even be built. The cost of a medical iPod would be beyond belief.
The US has extremely stringent regulations, and, like it or not, that costs money. Would you be willing to relax the regulations in order to make things cheaper, but possibly more lethal? Would you be willing to limit liability to make products cheaper?
There's less fat to cut than you think.
posted by underflow at 11:35 PM on January 6, 2011 [1 favorite]
Insurance companies exist because they buy influence with people who are basically so wealthy that the price increases don't touch them. It's about greed, and evil profit-mongering. Today, some people will die for no other reason than they didn't access medical care - even emergency, free medical care - because they operated under the mistaken notion that it would somehow bankrupt their family (and maybe it would). The point here is that this is sanctioned murder, period. Insurance executive and others who make it impossible to buy insurance (causing stress, which also contributes to disease) are *criminals* of the first order. They, like the recent spate of bankers who are only now recovering from their holiday excesses, are little more than worthless. We need to say it like it is. These people are, at bottom, evil, and greedy. They deserve no consideration other than letting them live out the rest of their miserable lives with the barest minimum of necessities, including basic health insurance, provided by our government. A pox on every one of them!
posted by Vibrissae at 11:54 PM on January 6, 2011 [6 favorites]
posted by Vibrissae at 11:54 PM on January 6, 2011 [6 favorites]
"The US has extremely stringent regulations, and, like it or not, that costs money. Would you be willing to relax the regulations in order to make things cheaper, but possibly more lethal? Would you be willing to limit liability to make products cheaper? "
Why do we have regulations that are so stringent? Is it to protect the patient, or the insurance company from a lawsuit? Think about that.
Why does an aspirin cost $10. Why does a plastic bedpan cost $38. Most will say that they cost that much because the hospital has to break even, or profit. One of the reasons for that is because the hospitals are forced to treat and hospitalize people who don't have insurance, for free. And through all this, we can't cause the insurance companies to suffer a loss, can we? The system is set to preserve private capital, and to expand private capital, period. Has anyone ever done an opportunity cost analysis of what the *lack* of medical care costs our society? The lost jobs; the long-term benefits that could have been prevented; the broken families; etc. Where is that opportunity cost analysis? I have never seen one. Again, the evil fo double bottom line accounting that doesn't account for social cost (later translating to fiscal cost that society has to bear). Sick, stupid, and insane.
posted by Vibrissae at 12:14 AM on January 7, 2011 [9 favorites]
Why do we have regulations that are so stringent? Is it to protect the patient, or the insurance company from a lawsuit? Think about that.
Why does an aspirin cost $10. Why does a plastic bedpan cost $38. Most will say that they cost that much because the hospital has to break even, or profit. One of the reasons for that is because the hospitals are forced to treat and hospitalize people who don't have insurance, for free. And through all this, we can't cause the insurance companies to suffer a loss, can we? The system is set to preserve private capital, and to expand private capital, period. Has anyone ever done an opportunity cost analysis of what the *lack* of medical care costs our society? The lost jobs; the long-term benefits that could have been prevented; the broken families; etc. Where is that opportunity cost analysis? I have never seen one. Again, the evil fo double bottom line accounting that doesn't account for social cost (later translating to fiscal cost that society has to bear). Sick, stupid, and insane.
posted by Vibrissae at 12:14 AM on January 7, 2011 [9 favorites]
There's less fat to cut than you think.
So, you're blaming stringent regulation? Where have I heard that before. Strange how R&D costs with every other product in the world tend to be absorbed early on causing products to drop in price over time. With health care we see the exact opposite and gov't regulation or no, how can any company (let alone companies that post billion dollar + profits annually) justify continued cost increases for its customers that routinely jump into the 25, 35, and 59% range on a yearly basis? What. The. Fuck.
Pox on all of them indeed.
posted by IvoShandor at 12:20 AM on January 7, 2011 [2 favorites]
So, you're blaming stringent regulation? Where have I heard that before. Strange how R&D costs with every other product in the world tend to be absorbed early on causing products to drop in price over time. With health care we see the exact opposite and gov't regulation or no, how can any company (let alone companies that post billion dollar + profits annually) justify continued cost increases for its customers that routinely jump into the 25, 35, and 59% range on a yearly basis? What. The. Fuck.
Pox on all of them indeed.
posted by IvoShandor at 12:20 AM on January 7, 2011 [2 favorites]
The 45,000 people who die each year because they lack health insurance are glad they could provide you with amusement.
Speaking as a European, this is unimaginably horrible and sad.
The people responsible for propping up this system seem to me to be committing a crime against humanity.
posted by lucien_reeve at 1:42 AM on January 7, 2011 [4 favorites]
Speaking as a European, this is unimaginably horrible and sad.
The people responsible for propping up this system seem to me to be committing a crime against humanity.
posted by lucien_reeve at 1:42 AM on January 7, 2011 [4 favorites]
lucien, we, as a nation love corporations more than we love people. I am not jesting.
posted by maxwelton at 2:16 AM on January 7, 2011 [3 favorites]
posted by maxwelton at 2:16 AM on January 7, 2011 [3 favorites]
wuwei: "How long are we going to sit here and just take this shit? Seriously? Anyone??"
Until we figure out that the armed populace outnumbers the combined military and police forces by about 50 to 1?
posted by pjern at 2:26 AM on January 7, 2011
Until we figure out that the armed populace outnumbers the combined military and police forces by about 50 to 1?
posted by pjern at 2:26 AM on January 7, 2011
Vibrissae: "Insurance executive and others who make it impossible to buy insurance (causing stress, which also contributes to disease) are *criminals* of the first order."
I like you already, Vibrissae. You think like I do.
posted by pjern at 2:28 AM on January 7, 2011 [2 favorites]
I like you already, Vibrissae. You think like I do.
posted by pjern at 2:28 AM on January 7, 2011 [2 favorites]
It seems that the thrust of this conversation is that medical care in its current state in the US is something that is imperative to having a decent life, or in some cases any life at all, and that the problem is lack of access to care because costs are prohibitive. If people could all afford insurance, or if we had nationalized health care, everything would be hunky-dory. I don't share that view. I think the actual care itself is by and large horrendous.
Someone linked to an article that stated that 45,000 people per year die in the US because of lack of health insurance. But how many people die because of medical treatment? Brief Googling shows me that in-hospital deaths from medical error alone are thought to be at 195,000 A YEAR.
I have had so many bad experiences with the medical industry, and seen so much rotten care given to those I love, that I recently made the decision that I will no longer participate. Although I realize that it is possible to get good care, it's much more common in my experience to get awful care, and frankly it's just not worth exposing myself to the bad (and yes, extremely expensive) care anymore in hopes of finding real help. I am done spending my time and money looking for help for what ails me with strangers who don't care about me, don't spend any time listening to me, don't stay up to date in their field, and who are so rigid and arrogant that they will not look at things except from a very set predefined narrow perspective.
The last time I sought care, reluctantly and due to pressure from my boyfriend and mother, it was for a persistent cough. 4 or 5 appointments and many hundreds of dollars later (WITH insurance), I had no diagnosis, and I still had the cough. I had two doctors who had thrown lots of treatments at me for things as diverse as asthma and acid reflux. These doctors spent a few minutes with me each time, were ready to plug me into whatever equation they were most familiar or comfortable with. The lung doctor was insistent the cough was due to asthma. He decided this because I had asthma as a child, period. Nothing else I said mattered. It didn't even matter to him that the results of my breathing test were not sufficiently different after using the inhaler to support a diagnosis of asthma. This has been a common experience with doctors, that they decide something and then stick with it, not taking the time to consider multiple possibilities or input from the patient. It didn't matter that I said this doesn't feel like asthma, I can breathe fine, it isn't triggered by asthma, etc.
I saw an acupuncturist a few times. While I can't say he cured my cough, the whole process was so much more humane. He treated me like a person. He listened to me. He considered my entire health picture, not just a few numbers on a test. If there is to be any hope for medical care in the US, it will have to start with once again considering patients as actual human beings with dignity rather than numbers and dollar signs and test results.
During the process of consulting with doctors about my cough, I had a bunch of blood tests taken. At one point, I had to have liver tests re-taken because supposedly they were high the first time. It took me almost two months to get that doctor's office to actually bother telling me what the test results were. They kept simply leaving messages for me saying they were "high" and to call a gastroenterologist. I finally wrested the information from them. ONE of the numbers was just barely outside of the reference range (and different labs have different reference ranges), with absolutely no other symptoms or test results to support the idea that I have liver issues. If they thought I really had liver issues, it's indefensible to take so long to report that. And I was entitled to my specific test results, not to be paternalistically shuttled off to the next specialist.
When I was young I self-diagnosed with an endocrine disease. I had to, because none of the doctors I saw even took my symptoms seriously, let alone knew what caused them. The doctors I saw, even the endocrinologists, to a one knew less than I did about the disease just from doing some research at Johns Hopkins medical library, even though it's relatively common. This was nearly two decades ago. Since then this disorder has been associated with "real concerns" like heart disease and diabetes, so perhaps doctors are taking it more seriously. But to dismiss a disease as "just cosmetic" when those cosmetic effects were causing a patient serious grief and stress, even social impairment, is inhumane. Our system of medicine supports this type of thing. This is the narrow definition of "health" and "care" that most doctors in my society seem to subscribe to.
When I was 17, I had jaw surgery to correct an underbite. My parents signed the release forms since I was underage. After the surgery, we were surprised to find that the incisions had been made on the neck. We had been told that the incisions would be inside the mouth and would leave no visible scars. Without my permission, and without I or my parents' knowledge (they hadn't properly read the forms), an inexperienced surgeon had operated on one side of my jaw. We had never met this man and were under the impression that the entire operation would be done by the surgeon we had consulted with. Coincidentally enough, one side of my jaw hurt more badly than the other, and took much longer healing, and had a much worse scar. When we confronted the doctor at a follow-up checkup after the surgery, his response to our concerns in its entirety was this lovely phrase: "I'm the doctor". Meaning, I am not to be questioned. Anything I do is ok. This seems to be a common attitude of doctors, supported by our society's near-worship of them.
I think it could be likened to Stockholm Syndrome: Doctors and other medical professionals have so much power over us, they hold our very lives in their hands. We need to believe in their goodness and competence. It's too scary not to. It's too scary to accurately assess the situation, acknowledge the poor care we are often receiving. We cope by believing our captors are actually benevolent.
As a fat woman, I'm used to being villified by many members of my society, and doctors are not immune to that. Many doctors assume that whatever's wrong with me must be due to my weight. This leads them to fail to thoroughly explore other possibilities. The idea that overweight causes health problems is a self-fulfilling prophesy. I had a doctor spend most of an appointment once trying to convince me to exercise more, when the reason I had come to her was because I was so exhausted I feared I couldn't go to work anymore (um, yeah, I'll just rush right out and go for a hike; thank you so much for listening to me). I had to fight every step of the way, diagnose myself (with a friend's mother's help) with Lyme disease, and tell my doctor what antibiotic to prescribe. Frankly I have received the best medical care when I simply research and diagnose myself. I try not to use meds much, but when necessary, they can be obtained without consulting a physician.
I've watched several friends and loved ones go through similar travails with the medical community. I don't think I and my dear ones have just had a run of spectacularly bad luck. I think bad medical care is extremely common, more common than good medical care, and I see it as at least as much of a problem as the high price of insurance.
posted by parrot_person at 3:52 AM on January 7, 2011 [6 favorites]
Someone linked to an article that stated that 45,000 people per year die in the US because of lack of health insurance. But how many people die because of medical treatment? Brief Googling shows me that in-hospital deaths from medical error alone are thought to be at 195,000 A YEAR.
I have had so many bad experiences with the medical industry, and seen so much rotten care given to those I love, that I recently made the decision that I will no longer participate. Although I realize that it is possible to get good care, it's much more common in my experience to get awful care, and frankly it's just not worth exposing myself to the bad (and yes, extremely expensive) care anymore in hopes of finding real help. I am done spending my time and money looking for help for what ails me with strangers who don't care about me, don't spend any time listening to me, don't stay up to date in their field, and who are so rigid and arrogant that they will not look at things except from a very set predefined narrow perspective.
The last time I sought care, reluctantly and due to pressure from my boyfriend and mother, it was for a persistent cough. 4 or 5 appointments and many hundreds of dollars later (WITH insurance), I had no diagnosis, and I still had the cough. I had two doctors who had thrown lots of treatments at me for things as diverse as asthma and acid reflux. These doctors spent a few minutes with me each time, were ready to plug me into whatever equation they were most familiar or comfortable with. The lung doctor was insistent the cough was due to asthma. He decided this because I had asthma as a child, period. Nothing else I said mattered. It didn't even matter to him that the results of my breathing test were not sufficiently different after using the inhaler to support a diagnosis of asthma. This has been a common experience with doctors, that they decide something and then stick with it, not taking the time to consider multiple possibilities or input from the patient. It didn't matter that I said this doesn't feel like asthma, I can breathe fine, it isn't triggered by asthma, etc.
I saw an acupuncturist a few times. While I can't say he cured my cough, the whole process was so much more humane. He treated me like a person. He listened to me. He considered my entire health picture, not just a few numbers on a test. If there is to be any hope for medical care in the US, it will have to start with once again considering patients as actual human beings with dignity rather than numbers and dollar signs and test results.
During the process of consulting with doctors about my cough, I had a bunch of blood tests taken. At one point, I had to have liver tests re-taken because supposedly they were high the first time. It took me almost two months to get that doctor's office to actually bother telling me what the test results were. They kept simply leaving messages for me saying they were "high" and to call a gastroenterologist. I finally wrested the information from them. ONE of the numbers was just barely outside of the reference range (and different labs have different reference ranges), with absolutely no other symptoms or test results to support the idea that I have liver issues. If they thought I really had liver issues, it's indefensible to take so long to report that. And I was entitled to my specific test results, not to be paternalistically shuttled off to the next specialist.
When I was young I self-diagnosed with an endocrine disease. I had to, because none of the doctors I saw even took my symptoms seriously, let alone knew what caused them. The doctors I saw, even the endocrinologists, to a one knew less than I did about the disease just from doing some research at Johns Hopkins medical library, even though it's relatively common. This was nearly two decades ago. Since then this disorder has been associated with "real concerns" like heart disease and diabetes, so perhaps doctors are taking it more seriously. But to dismiss a disease as "just cosmetic" when those cosmetic effects were causing a patient serious grief and stress, even social impairment, is inhumane. Our system of medicine supports this type of thing. This is the narrow definition of "health" and "care" that most doctors in my society seem to subscribe to.
When I was 17, I had jaw surgery to correct an underbite. My parents signed the release forms since I was underage. After the surgery, we were surprised to find that the incisions had been made on the neck. We had been told that the incisions would be inside the mouth and would leave no visible scars. Without my permission, and without I or my parents' knowledge (they hadn't properly read the forms), an inexperienced surgeon had operated on one side of my jaw. We had never met this man and were under the impression that the entire operation would be done by the surgeon we had consulted with. Coincidentally enough, one side of my jaw hurt more badly than the other, and took much longer healing, and had a much worse scar. When we confronted the doctor at a follow-up checkup after the surgery, his response to our concerns in its entirety was this lovely phrase: "I'm the doctor". Meaning, I am not to be questioned. Anything I do is ok. This seems to be a common attitude of doctors, supported by our society's near-worship of them.
I think it could be likened to Stockholm Syndrome: Doctors and other medical professionals have so much power over us, they hold our very lives in their hands. We need to believe in their goodness and competence. It's too scary not to. It's too scary to accurately assess the situation, acknowledge the poor care we are often receiving. We cope by believing our captors are actually benevolent.
As a fat woman, I'm used to being villified by many members of my society, and doctors are not immune to that. Many doctors assume that whatever's wrong with me must be due to my weight. This leads them to fail to thoroughly explore other possibilities. The idea that overweight causes health problems is a self-fulfilling prophesy. I had a doctor spend most of an appointment once trying to convince me to exercise more, when the reason I had come to her was because I was so exhausted I feared I couldn't go to work anymore (um, yeah, I'll just rush right out and go for a hike; thank you so much for listening to me). I had to fight every step of the way, diagnose myself (with a friend's mother's help) with Lyme disease, and tell my doctor what antibiotic to prescribe. Frankly I have received the best medical care when I simply research and diagnose myself. I try not to use meds much, but when necessary, they can be obtained without consulting a physician.
I've watched several friends and loved ones go through similar travails with the medical community. I don't think I and my dear ones have just had a run of spectacularly bad luck. I think bad medical care is extremely common, more common than good medical care, and I see it as at least as much of a problem as the high price of insurance.
posted by parrot_person at 3:52 AM on January 7, 2011 [6 favorites]
The solution to fixing health care is simple: make people buy and pay for it themselves instead of having their employers do it for them. If everyone had to deal with the insurance companies directly we would nationalize this shit over night.
Agreed.
Similarly, if doctors and hospitals had to actually compete with each other, we would see prices drop, or at least stabilize. "What? $10 for an aspirin?? I'm going to Metro South, where they only charge $4!"
posted by gjc at 5:32 AM on January 7, 2011
Agreed.
Similarly, if doctors and hospitals had to actually compete with each other, we would see prices drop, or at least stabilize. "What? $10 for an aspirin?? I'm going to Metro South, where they only charge $4!"
posted by gjc at 5:32 AM on January 7, 2011
As a Canadian, I don't understand why you guys aren't rioting in the streets.
My total tax rate is about 22%/year (all taxes combined) and I pay nothing extra for full coverage. It's really NOT that hard a concept. Socialized medicine works, and it works for EVERYONE.
posted by blue_beetle at 5:45 AM on January 7, 2011 [1 favorite]
My total tax rate is about 22%/year (all taxes combined) and I pay nothing extra for full coverage. It's really NOT that hard a concept. Socialized medicine works, and it works for EVERYONE.
posted by blue_beetle at 5:45 AM on January 7, 2011 [1 favorite]
Why are you all not celebrating this triumph of free market capitalism?
U! S! A! U! S! A!
posted by Legomancer at 6:26 AM on January 7, 2011 [2 favorites]
U! S! A! U! S! A!
posted by Legomancer at 6:26 AM on January 7, 2011 [2 favorites]
Similarly, if doctors and hospitals had to actually compete with each other, we would see prices drop, or at least stabilize. "What? $10 for an aspirin?? I'm going to Metro South, where they only charge $4!"
At what point are we supposed to be price-checking? Should I check hospital costs before I get into a car accident/have a seizure/have a heart attack/begin miscarrying? Oh, hospital A has lower costs for trauma surgery, but much higher for cardiac care - hmm, hope I'm conscious enough in the ambulance to tell them that the cheapest post-seizure care is at hospital B!
And how am I, a non-medical professional, supposed to judge what I'm being overcharged for ($10 aspirin) vs what's reasonable (anesthesiologists are expensive), and how do I decide which thing is most important? Like, one hospital pays its floor nurses less than that other hospital....and hires less experienced nurses in order to do so. Does that put me at higher risk? Do I have to go to med school in order to figure this out?
And, you know, they do compete with each other. I see ads on TV all the time for This Hospital or That Hospital and how quick their walk-in care is and like that. I can't recall offhand if any of them mention price, but in that respect, they're sort of like ads for cars - it's less about monetary cost and more about tapping your emotions about product X. I guess, actually, that's like ads for everything.
posted by rtha at 6:40 AM on January 7, 2011 [3 favorites]
At what point are we supposed to be price-checking? Should I check hospital costs before I get into a car accident/have a seizure/have a heart attack/begin miscarrying? Oh, hospital A has lower costs for trauma surgery, but much higher for cardiac care - hmm, hope I'm conscious enough in the ambulance to tell them that the cheapest post-seizure care is at hospital B!
And how am I, a non-medical professional, supposed to judge what I'm being overcharged for ($10 aspirin) vs what's reasonable (anesthesiologists are expensive), and how do I decide which thing is most important? Like, one hospital pays its floor nurses less than that other hospital....and hires less experienced nurses in order to do so. Does that put me at higher risk? Do I have to go to med school in order to figure this out?
And, you know, they do compete with each other. I see ads on TV all the time for This Hospital or That Hospital and how quick their walk-in care is and like that. I can't recall offhand if any of them mention price, but in that respect, they're sort of like ads for cars - it's less about monetary cost and more about tapping your emotions about product X. I guess, actually, that's like ads for everything.
posted by rtha at 6:40 AM on January 7, 2011 [3 favorites]
The requiring approval for more than 10% rate hikes just means your rate will be increased by 9.9% per year. Like clockwork. I'd bet my next year's salary that this rate of premium increases is slightly higher than the pace at which reimbursements go up for services.
posted by DigDoug at 7:04 AM on January 7, 2011
posted by DigDoug at 7:04 AM on January 7, 2011
With regard to high fees at doctors' offices and hospitals:
When I worked in medical billing for a pediatric neurologist, in order to receive something approaching fair compensation from insurance companies, the base charge for a 1 hour initial consultation was $250, not including any tests. From this $250 charge, our office received anywhere between $25 and $70 due to the insurance discount. Unfortunately, in order not to be charged with insurance fraud, this had to be the base rate that all patients are charged; in other words, the uninsured objectively paid more for their care than the insurance companies, because they did not negotiate these discounts.
Because of my, what, four, five years working in that field, I came to realize that most doctors are not playing golf four days a week - they lead comfortable lives, but are not the primary perpetrators of the brokenness and expense of the system. Hospitals are often barely breaking even, even as they take in a tremendous amount of revenue. Prices seem to be going up for a variety of reasons, but I would posit that the practices of the insurers themselves are partially responsible for the increase in prices, as providers find it necessary to charge 400% more than they would were it not for the insurance discounts.
These artificially inflated prices are only really noticed by people who have to pay for care out of pocket - via deductibles, copays, or simply being uninsured. Those with 'good' - or even better, dual - insurance coverage don't feel the pain on this, because they live well-ensconced in insurance discount land, never paying the falsely elevated prices that the law of the land seems to require in order to keep our medical institutions afloat and out of fraud court.
Sidenote: I remember trying to buy insurance for myself at age 20 - no pre-existing conditions of any sort - and found myself wondering why on earth I would pay ~$3000 for the privilege of paying a $5000 deductible if I ever should use my insurance. I doubt I've racked up $5000 in medical care in the past 8 years combined, and that's counting inflated medical bills. Nice scam those insurers have going...
posted by palindromic at 7:12 AM on January 7, 2011 [2 favorites]
When I worked in medical billing for a pediatric neurologist, in order to receive something approaching fair compensation from insurance companies, the base charge for a 1 hour initial consultation was $250, not including any tests. From this $250 charge, our office received anywhere between $25 and $70 due to the insurance discount. Unfortunately, in order not to be charged with insurance fraud, this had to be the base rate that all patients are charged; in other words, the uninsured objectively paid more for their care than the insurance companies, because they did not negotiate these discounts.
Because of my, what, four, five years working in that field, I came to realize that most doctors are not playing golf four days a week - they lead comfortable lives, but are not the primary perpetrators of the brokenness and expense of the system. Hospitals are often barely breaking even, even as they take in a tremendous amount of revenue. Prices seem to be going up for a variety of reasons, but I would posit that the practices of the insurers themselves are partially responsible for the increase in prices, as providers find it necessary to charge 400% more than they would were it not for the insurance discounts.
These artificially inflated prices are only really noticed by people who have to pay for care out of pocket - via deductibles, copays, or simply being uninsured. Those with 'good' - or even better, dual - insurance coverage don't feel the pain on this, because they live well-ensconced in insurance discount land, never paying the falsely elevated prices that the law of the land seems to require in order to keep our medical institutions afloat and out of fraud court.
Sidenote: I remember trying to buy insurance for myself at age 20 - no pre-existing conditions of any sort - and found myself wondering why on earth I would pay ~$3000 for the privilege of paying a $5000 deductible if I ever should use my insurance. I doubt I've racked up $5000 in medical care in the past 8 years combined, and that's counting inflated medical bills. Nice scam those insurers have going...
posted by palindromic at 7:12 AM on January 7, 2011 [2 favorites]
I see ads on TV all the time for This Hospital or That Hospital...
What? Just... what???
How much % of the money y'all pay is going to marketing? The EU has strict legislation on advertising for medicinal products, and, in addition, EU member countries have their own legislation that (usually) further limits medical advertising. I honestly don't recall the last time I saw advertising for anything medicinally related, outside of pharmacies and medical offices. The idea that hospitals could advertise... is like... the cognitive dissonance between humanist values and capitalism is making my brain explode. (Remember, I'm American, I've been living in Europe for the last 14 years.)
posted by fraula at 7:24 AM on January 7, 2011 [1 favorite]
What? Just... what???
How much % of the money y'all pay is going to marketing? The EU has strict legislation on advertising for medicinal products, and, in addition, EU member countries have their own legislation that (usually) further limits medical advertising. I honestly don't recall the last time I saw advertising for anything medicinally related, outside of pharmacies and medical offices. The idea that hospitals could advertise... is like... the cognitive dissonance between humanist values and capitalism is making my brain explode. (Remember, I'm American, I've been living in Europe for the last 14 years.)
posted by fraula at 7:24 AM on January 7, 2011 [1 favorite]
We are paying for Austin-Martins, and we are being given used Renaults.
This line made me re-read eriko's comment in Jeremy Clarkson's voice.
posted by hippybear at 7:27 AM on January 7, 2011 [2 favorites]
This line made me re-read eriko's comment in Jeremy Clarkson's voice.
posted by hippybear at 7:27 AM on January 7, 2011 [2 favorites]
The idea that hospitals could advertise
Crazy, right? There are ads on TV and on bus shelters and whathaveyou that are all "If you tripped over your dog's leash and sprained your ankle, come to St. Mary's, where you won't wait more than 30 minutes!" and "Come to BlahBlah Hospital, the official health care provider for the San Francisco Giants!" (I am not making these up.)
posted by rtha at 8:31 AM on January 7, 2011
Crazy, right? There are ads on TV and on bus shelters and whathaveyou that are all "If you tripped over your dog's leash and sprained your ankle, come to St. Mary's, where you won't wait more than 30 minutes!" and "Come to BlahBlah Hospital, the official health care provider for the San Francisco Giants!" (I am not making these up.)
posted by rtha at 8:31 AM on January 7, 2011
The US has extremely stringent regulations, and, like it or not, that costs money. Would you be willing to relax the regulations in order to make things cheaper, but possibly more lethal? Would you be willing to limit liability to make products cheaper?
When I was working in surgery, we were very aware of that fact. Case in point: DePuy Hip Replacements. I probably saw a few dozen of the things go into patients. They ran a 12% failure rate. If you watch daytime TV in the US, you will see the tort lawyers trying to find anyone who has one installed so they can add to the lawsuits. DePuy has to hedge their bets. We get it.
DePuy (Johnson & Johnson) Hip Replacements in a nutshell: They were a new set of hip replacements that were developed and released somewhere around 2005. Functionally they were expected to last 3-7 years longer than previous generations. When they dropped them in to patients, about 7 out of 8 had a good experience with the new hips, no problem. The other 1 of 8 were having the socket part of the hip fail, usually by not implanting into the pelvis. It was rumored that a large number of the sockets were not cleaned properly in the factory, leaving a chemical residue that would prevent bone growth into the socket. The second surgery to replace the replacement never went well.
posted by Mister Fabulous at 9:46 AM on January 7, 2011 [1 favorite]
When I was working in surgery, we were very aware of that fact. Case in point: DePuy Hip Replacements. I probably saw a few dozen of the things go into patients. They ran a 12% failure rate. If you watch daytime TV in the US, you will see the tort lawyers trying to find anyone who has one installed so they can add to the lawsuits. DePuy has to hedge their bets. We get it.
DePuy (Johnson & Johnson) Hip Replacements in a nutshell: They were a new set of hip replacements that were developed and released somewhere around 2005. Functionally they were expected to last 3-7 years longer than previous generations. When they dropped them in to patients, about 7 out of 8 had a good experience with the new hips, no problem. The other 1 of 8 were having the socket part of the hip fail, usually by not implanting into the pelvis. It was rumored that a large number of the sockets were not cleaned properly in the factory, leaving a chemical residue that would prevent bone growth into the socket. The second surgery to replace the replacement never went well.
posted by Mister Fabulous at 9:46 AM on January 7, 2011 [1 favorite]
pjern: "wuwei: "How long are we going to sit here and just take this shit? Seriously? Anyone??"
Until we figure out that the armed populace outnumbers the combined military and police forces by about 50 to 1?"
And what percent of this armed populace actually is on "our" side vs whater percent of the armed populace is of the the teabagger "NO OBAMASOCIALISMDEATHNAZIPANELS!!!" ilk???
posted by symbioid at 9:55 AM on January 7, 2011
Until we figure out that the armed populace outnumbers the combined military and police forces by about 50 to 1?"
And what percent of this armed populace actually is on "our" side vs whater percent of the armed populace is of the the teabagger "NO OBAMASOCIALISMDEATHNAZIPANELS!!!" ilk???
posted by symbioid at 9:55 AM on January 7, 2011
But will it cover having a cockroach in your colon?
Why the hell did I click that? The contents of that link are clearly advertised. FFUUUU
posted by Amanojaku at 9:56 AM on January 7, 2011 [1 favorite]
Why the hell did I click that? The contents of that link are clearly advertised. FFUUUU
posted by Amanojaku at 9:56 AM on January 7, 2011 [1 favorite]
Alright, my medical insurance story - my introduction to cost-shifting.
I made a lateral career move to a fly by night company, about 15 years ago. Part of the deal was that I would need health insurance, so we wound up with a discount BlueCross / BlueShield deal obtained through an agent.
My wife got pregnant, and I wound up leaving the company, paying $300 a month for coverage. The standard deductible was $1,000. There was also a maternity deductible, another $1000. Turns out in the fine print, that the standard deductible applied for every calendar year - so unless we had the baby by December, it was going to be another $1,000 - and we were due in June the next year.
On top of that, for various treatments, the coverage was between 70% covered to 90% covered, depending - for the sake of simplicity, we'll say 80%. The average ob/gyn and hospital for a pregnancy with no complications at the time was about $10,000, so 20% of that, we would be out another $2,000.
$3,000 in deductibles, plus $2,000, is $5,000. Plus the fact that I'd be paying $300 a month during the pregnancy, we'd be out another $2,700. We just flat out couldn't afford it. $7,700...wtf did I have insurance for?
The ob said the same thing. He said if we didn't have insurance, both he and the hospital would cut the fees by 50% or more. On top of that the hospital didn't charge interest on their fee if we had to make payments. So we dropped the insurance.
The ob came to $1,800, the hospital came out to $1,800. Total, $3,600. My second child was perfectly healthy, and the entire experience was awesome.
Granted, if there had been complications, we would have been massively screwed - but we simply could not afford to have the coverage, it was going to cost us more to be insured than to not be. Not to mention we probably would have been only slightly less massively screwed had we had the insurance anyway.
Now this is what truly baffles me - cost shifting. Everybody knows about this. It is not a secret. Why do people continue to think that a universal coverage, single payer system is going to increase health care costs? The insured are already paying for the uninsured. On top of that, it is well known, well studied, and pretty much completely proven and universally accepted as fact that preventative medicine reduces costs and benefits the population as a whole. All things considered, you're looking at a wash - a break even. And we aren't factoring in other benefits, such as increased productivity by a healthier population.
The only people who would not benefit from universal coverage, single payer system are the insurance providers.
posted by Xoebe at 10:29 AM on January 7, 2011 [3 favorites]
I made a lateral career move to a fly by night company, about 15 years ago. Part of the deal was that I would need health insurance, so we wound up with a discount BlueCross / BlueShield deal obtained through an agent.
My wife got pregnant, and I wound up leaving the company, paying $300 a month for coverage. The standard deductible was $1,000. There was also a maternity deductible, another $1000. Turns out in the fine print, that the standard deductible applied for every calendar year - so unless we had the baby by December, it was going to be another $1,000 - and we were due in June the next year.
On top of that, for various treatments, the coverage was between 70% covered to 90% covered, depending - for the sake of simplicity, we'll say 80%. The average ob/gyn and hospital for a pregnancy with no complications at the time was about $10,000, so 20% of that, we would be out another $2,000.
$3,000 in deductibles, plus $2,000, is $5,000. Plus the fact that I'd be paying $300 a month during the pregnancy, we'd be out another $2,700. We just flat out couldn't afford it. $7,700...wtf did I have insurance for?
The ob said the same thing. He said if we didn't have insurance, both he and the hospital would cut the fees by 50% or more. On top of that the hospital didn't charge interest on their fee if we had to make payments. So we dropped the insurance.
The ob came to $1,800, the hospital came out to $1,800. Total, $3,600. My second child was perfectly healthy, and the entire experience was awesome.
Granted, if there had been complications, we would have been massively screwed - but we simply could not afford to have the coverage, it was going to cost us more to be insured than to not be. Not to mention we probably would have been only slightly less massively screwed had we had the insurance anyway.
Now this is what truly baffles me - cost shifting. Everybody knows about this. It is not a secret. Why do people continue to think that a universal coverage, single payer system is going to increase health care costs? The insured are already paying for the uninsured. On top of that, it is well known, well studied, and pretty much completely proven and universally accepted as fact that preventative medicine reduces costs and benefits the population as a whole. All things considered, you're looking at a wash - a break even. And we aren't factoring in other benefits, such as increased productivity by a healthier population.
The only people who would not benefit from universal coverage, single payer system are the insurance providers.
posted by Xoebe at 10:29 AM on January 7, 2011 [3 favorites]
For what it's worth, it is NOT a non-Profit, it is a not-for-profit. The difference is enormous.
I don't think the difference you are talking about actually exists in the law. Either you are incorporated as a non-profit corporation or you are not.
posted by Ironmouth at 10:36 AM on January 7, 2011
I don't think the difference you are talking about actually exists in the law. Either you are incorporated as a non-profit corporation or you are not.
posted by Ironmouth at 10:36 AM on January 7, 2011
The only people who would not benefit from universal coverage, single payer system are the insurance providers.
The ultra-rich would also benefit, because they would not be able to claim a disproportionate share of health-care resources.
posted by Ironmouth at 10:37 AM on January 7, 2011
The ultra-rich would also benefit, because they would not be able to claim a disproportionate share of health-care resources.
posted by Ironmouth at 10:37 AM on January 7, 2011
I share the outrage of constantly climbing premiums. I live in the Soviet Socialist Canuckistan of British Columbia, and here we have no choice of insurer: the provincial government. We all have to pay our Medical Service Plan (MSP) premiums to the Orwellian named "Revenue Services of British Columbia". Of course, this is the same entity we pay our provincial income tax to, which raises the question of why premiums don't just come from general revenue. The answer, of course, is that conservative governments love the MSP because not only is it a tax that isn't called a tax, despite being paid to the tax collector, but it's also a ludicrously regressive poll tax, i.e. a flat tax per head. (At least it is if you make over 30k/yr. Make less than 22k you pay nothing, and between that there is a varying amount of "premium assistance".) To make matters worse, it doesn't even cover everything. I get extended medical through my work, which covers things like supplimentary long-term disability benefit, eyecare, dental, prescription drugs, physiotherapy, etc. This year, I am seeing premium increases for both my provincal MSP and extended medical go up. I'm now paying over $1400 per year in total for this, up from only $1300 last year. After all this, I still have to pay out-of-pocket. For instance, I fractured my tibial head and broke my front teeth in an accident last year, and I ended up paying almost $80 in co-pays for crutches, prescription drugs, dental work and physiotherapy.
As you can clearly see, things aren't any better in this supposed socialist utopia, which explains why the current government is so eager to push us into a privatized US-style system.
posted by [citation needed] at 11:21 AM on January 7, 2011 [1 favorite]
As you can clearly see, things aren't any better in this supposed socialist utopia, which explains why the current government is so eager to push us into a privatized US-style system.
posted by [citation needed] at 11:21 AM on January 7, 2011 [1 favorite]
Oh, and I forgot to mention, after the accident, I had to wait 90 minutes for an X-ray, and then when that showed a small fracture and possible build up of fatty fluid from bone marrow on the knee, I had to wait another FOUR HOURS for a CT scan. Outrageous. The freedom-killing Canada Health Act won't even let you pay to skip the wait in order to ensure "equal access to care" and other such nonsense.
posted by [citation needed] at 11:26 AM on January 7, 2011
posted by [citation needed] at 11:26 AM on January 7, 2011
Haha! $1400 a year! That's what I pay a month! MEANING THAT I AM TWELVE TIMES AS HEALTHY AS YOU MOTHAFUCKA!
posted by Mister_A at 11:53 AM on January 7, 2011 [3 favorites]
posted by Mister_A at 11:53 AM on January 7, 2011 [3 favorites]
As a non-American, I truly don't understand why all of you here on Metafilter aren't rioting in the streets about the way healthcare operates. This is Social Security, civil rights, women's suffrage level shit. Your government is perpetuating a system where any unforeseen illness potentially means bankruptcy, even if you have insurance. Your government has completely abandoned you.
Rioting. In. The. Streets.
One sec, dancing with the stars is on.
posted by thsmchnekllsfascists at 12:00 PM on January 7, 2011 [3 favorites]
Rioting. In. The. Streets.
One sec, dancing with the stars is on.
posted by thsmchnekllsfascists at 12:00 PM on January 7, 2011 [3 favorites]
Oh, and I forgot to mention, after the accident, I had to wait 90 minutes for an X-ray, and then when that showed a small fracture and possible build up of fatty fluid from bone marrow on the knee, I had to wait another FOUR HOURS for a CT scan. Outrageous. The freedom-killing Canada Health Act won't even let you pay to skip the wait in order to ensure "equal access to care" and other such nonsense.
Thank god you added this, because I almost thought you were serious in your first post. Phew-- you really had me going there for a minute! -- Fellow resident of BC
posted by jokeefe at 12:33 PM on January 7, 2011
Thank god you added this, because I almost thought you were serious in your first post. Phew-- you really had me going there for a minute! -- Fellow resident of BC
posted by jokeefe at 12:33 PM on January 7, 2011
It's a well known fact that if he had to rely on socialized medicine Stephen Hawking would have been killed by the death panels decades ago.
posted by humanfont at 1:20 PM on January 7, 2011
posted by humanfont at 1:20 PM on January 7, 2011
http://www.delawareliberal.net/2009/08/10/good-thing-stephen-hawking-doesnt-live-in-the-u-k-except-he-does/
Wait, Hawking lives in the UK? I can't tell by his accent....
posted by hippybear at 1:56 PM on January 7, 2011 [1 favorite]
Wait, Hawking lives in the UK? I can't tell by his accent....
posted by hippybear at 1:56 PM on January 7, 2011 [1 favorite]
At what point are we supposed to be price-checking? Should I check hospital costs before I get into a car accident/have a seizure/have a heart attack/begin miscarrying? Oh, hospital A has lower costs for trauma surgery, but much higher for cardiac care - hmm, hope I'm conscious enough in the ambulance to tell them that the cheapest post-seizure care is at hospital B!
I'm not sure what your point is. How is knowing the prices a bad thing?
posted by gjc at 5:54 PM on January 7, 2011
I'm not sure what your point is. How is knowing the prices a bad thing?
posted by gjc at 5:54 PM on January 7, 2011
There are ads on TV and on bus shelters and whathaveyou that are all "If you tripped over your dog's leash and sprained your ankle, come to St. Mary's, where you won't wait more than 30 minutes!"
what was funny about those ads was that some showed the types of accidents their emergency room cannot treat because they are not a trauma center.
posted by fallacy of the beard at 5:59 PM on January 7, 2011
what was funny about those ads was that some showed the types of accidents their emergency room cannot treat because they are not a trauma center.
posted by fallacy of the beard at 5:59 PM on January 7, 2011
For instance, I fractured my tibial head and broke my front teeth in an accident last year, and I ended up paying almost $80 in co-pays for crutches, prescription drugs, dental work and physiotherapy.
I'd laugh, but it's not funny. You do realize that Americans would kill for such coverage? I live in B.C as well, and I pay $65 a month for my coverage. Anything not covered is taken care of by my group medical, for which the $50 premium is paid by my company. If you don't have coverage they will fix you for free, and backdate last month's premium. Hell, they will patch up foreigners visiting here for no charge, if needed. Happens in Whistler all the time.
posted by PareidoliaticBoy at 6:54 PM on January 7, 2011
I'd laugh, but it's not funny. You do realize that Americans would kill for such coverage? I live in B.C as well, and I pay $65 a month for my coverage. Anything not covered is taken care of by my group medical, for which the $50 premium is paid by my company. If you don't have coverage they will fix you for free, and backdate last month's premium. Hell, they will patch up foreigners visiting here for no charge, if needed. Happens in Whistler all the time.
posted by PareidoliaticBoy at 6:54 PM on January 7, 2011
I'd laugh, but it's not funny.
Sarcasm is wasted on the internet.
posted by thsmchnekllsfascists at 9:55 PM on January 7, 2011
Sarcasm is wasted on the internet.
posted by thsmchnekllsfascists at 9:55 PM on January 7, 2011
I'm not sure what your point is.
So you've checked the prices for things at the hospitals and trauma centers in your areas, yes? You know how much it would cost to get a broken leg set, have an MRI, you are qualified to evaluate the price and quality issues for various kinds of cancer treatments?
I mean, if you want to get a budget nose job, well, fine - check prices till the cows come home. But your disengenous "How is knowing the prices a bad thing?" falls flat in the face of emergencies (are you really going to tell the EMTs who scooped you out of your crushed car to take you to Hospital A because they're cheaper than Hospital B?).
A lot of this is false economy, anyway. Ten-dollar aspirin is idiotic, of course, but it pales in comparison to stuff like a hospital that "saves" its patients money by have fewer nurses per patient.
posted by rtha at 10:35 PM on January 7, 2011
So you've checked the prices for things at the hospitals and trauma centers in your areas, yes? You know how much it would cost to get a broken leg set, have an MRI, you are qualified to evaluate the price and quality issues for various kinds of cancer treatments?
I mean, if you want to get a budget nose job, well, fine - check prices till the cows come home. But your disengenous "How is knowing the prices a bad thing?" falls flat in the face of emergencies (are you really going to tell the EMTs who scooped you out of your crushed car to take you to Hospital A because they're cheaper than Hospital B?).
A lot of this is false economy, anyway. Ten-dollar aspirin is idiotic, of course, but it pales in comparison to stuff like a hospital that "saves" its patients money by have fewer nurses per patient.
posted by rtha at 10:35 PM on January 7, 2011
So you've checked the prices for things at the hospitals and trauma centers in your areas, yes? You know how much it would cost to get a broken leg set, have an MRI, you are qualified to evaluate the price and quality issues for various kinds of cancer treatments?
Actually, I've tried to do pretty much this, and the system is set up exactly to keep the consumer from doing this. Not even the care providers themselves typically know what they are charging for a service. This is because they have negotiated different prices for these services with different insurance companies, and they can't let the information about what they charge one company out into the wild because then the others would know that the prices are different for them and there would be hell to pay.
Our system is broken, and the Affordable Health Care act only came at the problem from one side. Until we do something about COSTS, the price of insurance is only going to rise.
posted by hippybear at 8:33 AM on January 8, 2011 [1 favorite]
Actually, I've tried to do pretty much this, and the system is set up exactly to keep the consumer from doing this. Not even the care providers themselves typically know what they are charging for a service. This is because they have negotiated different prices for these services with different insurance companies, and they can't let the information about what they charge one company out into the wild because then the others would know that the prices are different for them and there would be hell to pay.
Our system is broken, and the Affordable Health Care act only came at the problem from one side. Until we do something about COSTS, the price of insurance is only going to rise.
posted by hippybear at 8:33 AM on January 8, 2011 [1 favorite]
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