Cost of Health Care Continues to Rise

[finnbow]

Originally Posted by whell

If we eliminate the anti-trust exemption and reduce or eliminate state regs, and allow insurance to be sold across state lines, it would open up the whole market to significant competition. I'd suggest at that point you might see prices impacted in favor of the consumer, and more freedom to innovate insurance product design.

Sounds good on its face, but states aren't going to give up their rights with regard to regulation of the insurance industry. Constitutionally, insurance is one of those things that has remained outside of the purview of the Constitution's commerce clause (thus far anyway). It seems to be somewhat contradictory that conservatives are championing taking these powers away from the States. This presumes, of course, that they're sincere in this argument to begin with.

I don't buy the argument that competition between private insurance companies more than offsets the administrative costs of 50 sets of regulations, not to mention the differing coverage levels and forms each insurance company offers (not to mention the need for each of these insurance companies to earn a profit). I have a number of friends who are doctors and dentists and the one thing they universally detest about maintaining a practice is the administrative/billing/paperwork burdens imposed by the various insurance companies they deal with.

[d-ray657]

Originally Posted by merrylander

So if we allow sale across statelines what will prevent, oh say Aetna, from establishing themselves in a state with little or no regulation and thus be free to screw people more than they currently do? I pick on Aetna because in my last employment they administered the health insurance. I retired at 73 so every time I submitted a claim after I reached 65 (Hell I was 69 when I started there.) some clerk would send it back saying that I should submit it to Medicare as they were my prime insurer. Then I would have to point them to the place in company litereature where it said they were prime for all employees regardless of age. They were not the sharpest knives in the drawer.

The voters in Illinois should have the fertility rites removed if that is how they feel.

Rob, what would prevent that is exclusive federal regulation of health insurance similar to the exclusive federal regulation of joint employer/union health and welfare funds. Under that scheme, the trust funds have delivered high quality coverage at lower prices than insurance. BTW, one feature of the joint funds is universal coverage. Employers make hourly contributions for all employees, regardless of age. Universal coverage is, of course, one of the major components of the new health care reform package.

To the extent that Whell agrees with the elimination of the anti-trust exemptions in the healthcare industry, and with a comprehensive exclusive federal federal regulatory program, I would agree with him on sale of insurance across state lines. The exclusive federal regulation would eliminate the incentive to go shopping for the best state regulations. It would also obliterate any argument that the exercise of federal regulation does not arise under the commerce clause.

Regard,

D-Ray

[whell]

Originally Posted by finnbow

Sounds good on its face, but states aren't going to give up their rights with regard to regulation of the insurance industry. Constitutionally, insurance is one of those things that has remained outside of the purview of the Constitution's commerce clause (thus far anyway). It seems to be somewhat contradictory that conservatives are championing taking these powers away from the States. This presumes, of course, that they're sincere in this argument to begin with.

I think the concept that is being championed is deregulation, or at least keeping the states from interfering in inter-state commerce. As far as the Commerce clause regulating insurance, the PPACA leverages the commerce clause to put forth the requirement that most individuals be required to purchase health insurance. So, it looks like we're already moving in that direction.

Originally Posted by finnbow

I don't buy the argument that competition between private insurance companies more than offsets the administrative costs of 50 sets of regulations, not to mention the differing coverage levels and forms each insurance company offers (not to mention the need for each of these insurance companies to earn a profit). I have a number of friends who are doctors and dentists and the one thing they universally detest about maintaining a practice is the administrative/billing/paperwork burdens imposed by the various insurance companies they deal with.

Well, we could always go back to the "good old days" (or, bad old days depending on your perspective): payment to the provider at the time of service, and managing the relationship with/receiving reimbursements from the insurance carrier is then the responsibility of the patient. Many physicians, particularly specialists, have already chosen to go down this path. I suspect, however, that most physicians would like this arrangement much less.

[d-ray657]

Originally Posted by finnbow

Sounds good on its face, but states aren't going to give up their rights with regard to regulation of the insurance industry. Constitutionally, insurance is one of those things that has remained outside of the purview of the Constitution's commerce clause (thus far anyway). It seems to be somewhat contradictory that conservatives are championing taking these powers away from the States. This presumes, of course, that they're sincere in this argument to begin with.

I don't buy the argument that competition between private insurance companies more than offsets the administrative costs of 50 sets of regulations, not to mention the differing coverage levels and forms each insurance company offers (not to mention the need for each of these insurance companies to earn a profit). I have a number of friends who are doctors and dentists and the one thing they universally detest about maintaining a practice is the administrative/billing/paperwork burdens imposed by the various insurance companies they deal with.

I would suggest that some of the complexity of the reporting requirements imposed by insurance companies arises from trying to meet (or beat) the regulations in each state in which they operate. The insurance companies have their own entrenched bureaucracies. I would hope that by being able to trim the bureaucracy, they would be better able to deliver coverage and still make their precious profits.

Regards,

D-Ray

[finnbow]

Originally Posted by d-ray657

I would suggest that some of the complexity of the reporting requirements imposed by insurance companies arises from trying to meet (or beat) the regulations in each state in which they operate. The insurance companies have their own entrenched bureaucracies. I would hope that by being able to trim the bureaucracy, they would be better able to deliver coverage and still make their precious profits.

Regards,

D-Ray

That may be a part of it, but I think the larger aspect is that different companies require their own proprietary forms, offer different deductibles, have different levels of coverage (if any) for particular treatments, and have employees who are instructed to send back/deny any forms/claims that are not letter-perfect. Compounding this problem is the fee-for-service model that pays for each checkmark the doctor puts on a form (whether done for invoice padding or "defensive medicine") rather than for the office visit itself (or for the success of a prescribed treatment).

The current system, with its built-in inefficiencies and perverse incentives, is a gawd-awful, indefensible mess. However, there are a lot of vested interests in maintaining the status quo and they will resort to all sorts of skullduggery to do so.

I, for one, apprciate Whell's perspective even though I may disagree with parts of it.

The fundamental question remains:

Why is it that every other advanced society of earth has some variation of single payer, gets better overall results than we do, pays less in the process, and is more satisfied with their system while we limp along with an unsustainable hodge-podge of mostly employer-paid insurance through hundreds of private (and often unsavory) insurance providers and leave tens of millions uninsured in the process? Simply shameful, IMHO.

Today is my day for pointing out irony - Is it not ironic that the party who always wants to advocate simple (maybe even simplistic solutions) oppose the one obvious simple solution - single payer, in favor of the complex, indecipherable mess we currently have? Since nearly everyone else has single-payer, can't we evaluate the lower performing aspects of their plans (that are still better than our for the most part) and improve upon them?

BTW, this argument comes from a guy with excellent employer provided insurance.

[merrylander]

Originally Posted by whell

I've got some more "realistic and politically feasible" ideas, a couple of which I've already posted, but let me try this one on you first. There's no way in hell this idea would see the light of day in our current political climate, but here goes:

Let's eliminate health insurance completely, or at least scale it back significantly. Health insurance is an idea that has been distorted far beyond its original intent, pushed by regulations, market conditions, good intentions gone awry, and utilization that is off the scale.

So how many more families would expect to face bankruptcy then we currently have?

The rationale is pretty basic: insurance is insurance. At its core, there's no magic or mystery that makes health insurance unique from home, auto, or any other insurance product.

Most folks, for example, buy home owners insurance, they size the policy appropriately based on their needs, and they hope like hell that they never, ever have to file a claim. However, when it comes time for open enrollment at work, employees will look for what they consider the "best" policy: the plan with the lowest deductibles, co-pays and co-insurance. Many end up buying more insurance than they need, spending money on premium for a product that they didn't use much last year, won't use much this year, and might not use much next year. For the occasional medical need that they have, they could have "bought down" to a more affordable policy, pocketed and saved the money they paid out in premium for the richer plan, and used that savings to cover the stay doctors office visit or prescription if they ever needed it.

Interesting, at none of the companies that I have worked for since coming here in 84 was I offered a choice among plans, there was a single plan, take it or leave it.

When many of these folks buy health insurance, they fully expect to generate claims. This stands in stark contrast to how and why individuals buy just about any other kind of insurance product.

For what it is worth I take no prescription drugs, at each physical my internist finishes up and says "Get out of here, you are bad for business, I will be 80 come December 8th.

These folks might also be less inclined to engage in more healthy lifestyles if there was a financial incentive to do so. The latest health plan designs that reward healthy lifestyles with premium rebates, or offering richer plan designs without premium increases do show promise. If these programs caught on and folks truly worked to achieve healthier lifestyles, economies of scale could be achieved that prevented the delivery system devoting resources to minimize the health impacts from poor individual health maintenance, and allows resources in the system to be devoted to dealing more cost - effectively with those who have chronic health conditions or disabilities. I think PPACA acknowledges the need for some of this by creating a pool of funds to help businesses install wellness programs. It also requires non-grandfathered health plans to provide first - dollar coverage for many preventative care services.

Perhaps insted of closing down the insurance companieas we should close Mickey Ds

We certainly have those who are chronically ill, disabled, or otherwise in need of more focused care. Certainly the marketplace, or government reforms, would need to deliver well - conceived options for these individuals. Possibly expanding health savings accounts would be one element of a solution. Deregulation of insurance would potentially allow customization of insurance products that might better meet the needs of those with chronic health issues. Reducing the overall cost of coverage as outlined above would positively impact this group as well. Other solutions would need to be brought to bear on this segment of the population as well.

There you go again - deregulation, deregulation, was not this last crash sufficient for you? Every recent derugulation has been a disaster. They did it to the airlines - you can't pay me to climb on a commercial flight. They deregulated electricity providers, last year ours hiked their rates 72%. Actually power generation should not be in the hands of private industry, but that is another thread.

[merrylander]

Regarding paperwork our internist has one nurse in his office and two or three people doing the paperwork, arranging patient visits, etc.

[BlueStreak]

And will continue to rise regardless of what we do.

However, I would rather pay more knowing more (Or all.) are covered and covered completely than pay more knowing less are covered and covered less.

And, isn't that the way we've been going for the last few decades?

Cutting coverage as costs rise?

Where might that trend lead?

Dave

[merrylander]

Originally Posted by BlueStreak

And will continue to rise regardless of what we do.

However, I would rather pay more knowing more (Or all.) are covered and covered completely than pay more knowing less are covered and covered less.

And, isn't that the way we've been going for the last few decades?

Cutting coverage as costs rise?

Where might that trend lead?

Dave

$20,000 per year for Aspirin?

[BlueStreak]

Originally Posted by merrylander

$20,000 per year for Aspirin?

That's what I was thinking. Or maybe $12,000 for an office vist, just to have the doctor call you a "pussy" and tell you to "Stop your damn bellyaching."

Dave