The passage of ObamaCare eliminated what Obama called “trash insurance” AKA catastrophic insurance. The availability of inexpensive catastrophic health insurance coupled with pre-tax health savings accounts, would drive transparency, patient control and reduce over utilization.
Alex, Your point is correct but incomplete. It would not matter if the pricing were transparent as long as the consumer does not have to pay it -- and that is the current state of how things work. It is the decoupling of the consumer from the fiscal decisions that is the problem -- not whether the price is posted.
Let us say I twist my ankle. I go to urgent care and they say "This is a strain, not even a sprain. Elevate it and ice it and you will be fine in a couple days. BUT, there is a 0.01% chance that this could be something worse. We could rule that out with an MRI -- would you like one?" If the cost to the consumer is nil, it does not matter whether the posted price is $103 or $10,300...they will be inclined to say "sure". And THAT is the primary failing of the system today -- not transparency but responsibility for first dollar expenditure.
The proper fix will be a return to catastrophic insurance (yes, some amazing medicine is really quite expensive and that is OK), a broadly constituted Health Savings Account available to anyone and everyone where funds can be set aside for health related expenses, and a return to a practice model best exemplified today by Direct Primary Care -- where the overhead and complexity you note just does not exist.
That would put the patient at the center of making decisions about where and when to spend health care dollars, would ensure continuity of care at the base level, and would still protect for the catastrophes that might occur. Transparency is surely part of the solution. But making the patient have to make choices based on that transparency, as they do with virtually ALL other decisions, is what fixes it.
I agree that people are not going to pay much attention to specific prices when what they are responsible for are co-pays, deductibles, and premiums. The question that is interesting to me is whether insurance companies themselves are interested in transparent pricing. You would think they have the power to achieve whatever level of transparency they want. My guess would be either that (a) prices are more transparent to them than they are to us or (b) transparency isn't as important as Alex thinks it is.
The insurance companies DO NOT CARE what pricing is exposed or not -- they pay on their own schedules that are negotiated between payor and provider. They really have little control over the costing issues.
I will give you a case in point: A colonoscopy can be done as an outpatient for, perhaps, $500. It can be done as a "hospital outpatient" (which is the same effective procedure but charged at hospital prices) for $5000. I know insurance companies that have struggled/coerced/threatened/whatever about this but it does not matter -- the patient gets steered to the hospital and all of us end up participating in this effective fraud, since the procedure really only costs the $500. This would self correct if the patient had to pay these amounts (the transparency in pricing would just give them the data with which to make the decision) but without it, the multi-billions spent every year just for this outpatient vs "hospital outpatient" discrepancy will just continue. Excellent point.
This works, if you have an intelligent patient who speaks the language of the physician. In California, about 1/3 of the people are foreign born. They frequently have no trust of the government from which they came. With some 23 languages spoken in Sacramento, much of medicine is done via translation with a iPad on a stand and a translator at a distance. This means that the physician gets perhaps 1/4 of the information using 2 to 3 times the time. Physicians are expected to see four patients an hour and get the note into the electronic medical record.
Secondly, many patients are single, and on what is called Medicaid in most states. There is no actual personal cost, and some wish to have a second or third or fourth opinion. It is almost impossible to design a system that works with the mix of cultures that we now have in California. Universal access to healthcare will only make this even worse, with our aging population and chronic diseases and a political class that is always offering services or money in order to buy votes and remain in power.
Obamacare transferred any remaining control of medicine from physicians to administrators who are business school graduates. They have no shame in charging outrageous fees. I had a stress echocardiogram at UC Davis in April of this year. I received the explanation of benefits (EOB) from Blue Shield. Two charges were listed under two different code numbers both identified as “miscellaneous” and totaling over $14,000. Blue Shield paid their pre-negotiated fee which left me with a nominal charge. In 2015 when my private cardiology group of 22 providers joined a local hospital group of about 480 due to the regulations overwhelming our system, we charged under $400 for a stress echocardiogram. The hospital group immediately changed that to $1200 for the same test in the same room with the same technician and a cardiologist monitoring.
It's not fraud if there's a genuine difference in risk between doing it in a hospital vs. a doctor's office. And there is. In a hospital you have an anesthesiologist monitoring you; in a doctor's office, you don't. People should be able to balance that risk difference for themselves--but of course that requires price transparency so people know how much more the lower risk procedure costs.
Peter, that would be true where correct. But the prices I am comparing here are actually between surgicenter/outpatient procedure center and hospital. They both have anesthesiologists. It is just the pricing differential between "hospital outpatient" and "outpatient" In the pricing scenario I gave here, exactly the same staff and outcomes -- just the pricing difference. If the patient had to choose in that case and pay, the choice would be clear
We actually made that choice years ago for our daughter who needed strabismus surgery. Our ophthalmologist told us we could do it at our local pediatric small hospital, or in out patient surgery center. The cost difference was substantial, and as we had not met our deductible for the year, we chose the outpatient surgery center. Although now with many places staffed only with mid levels, I’d want to be sure a physician was on site. I agree with what you have outlined, and my husband has harped on this for years, both of us are physicians. Medicine as a profession was drastically altered for the worse by Obamacare, which did nothing to benefit patients or physicians (other than maybe eliminating the whole pre-existing condition stupidity that made things like seasonal allergies not covered whenever you switched insurance for like 6 months). I definitely think catastrophic insurance with HSAs would be the way to go. But it’s hard to know what anything costs because prices are so jacked up to cover “expenses” much of which now goes to the plethora of administrative personnel who are needed to keep in compliance with all the rules and regs. And small, independent practices get reimbursed way less for exact same services, as they have no negotiating power, and therefore can’t compete with the large groups. It’s beyond frustrating to see what has happened over the last 20 years, and health outcomes have only worsened.
> the prices I am comparing here are actually between surgicenter/outpatient procedure center and hospital. They both have anesthesiologists.
Hm, ok, that is a different comparison than the one I was making. When my wife had her colonoscopy, the options she was offered were the doctor's office (no anesthesiologist) vs. the hospital (with anesthesiologist). She took the latter because she has chronic conditions that make any kind of sedation risky and she wanted to be sure she was properly monitored. No in between option of an outpatient procedure center with an anesthesiologist was offered.
Years ago we were preparing for a planned home-birth and paying all things out of pocket, (cheaper at the time than our HSA deductible), so I had to shop around a bit. Routine blood work at the hospital: $700. Through my midwife, $45. Same with an ultrasound. At the birth center it was $200 if you paid cash, at the hospital, another $750. It was shocking there was such a disparity!
There’s something inherently wrong with our pharmaceutical companies and the FDA (otherwise known as the Federal Death Association ) when I can go to Mexico or any other country and get BRAND NAME birth control for $120 for the year without a prescription and insurance changes $70 PER MONTH for very same brand name! A close friend of mine had the most aggressive form of multiple myeloma. Her drug was $5000 PER MONTH WITH INSURANCE yet was able to get the very same drug directly from India for $1200 for the year!!!! Now that’s criminal! Being a retired airline employee I will go to out of the country regularly to get other drugs over the counter that need a prescription here. To say Big Pharma hadn’t bought and paid for the FDA is an understatement! Hopefully this new crew with RFK Jr can break the rotten system!
I had to have a pediatric surgeon remove my daughters infected earring - localized anesthesia. I have a medical share - so paid cash. (But don’t show the medical share card - it will be more!). Anyways $500.
Everyone should be demanding the cash price. Everyone.
I agree with stating pricing. I remember several years ago a hospital in Kansas City realized that patients were doing medical trips to India to obtain procedures they thought were cheaper. The hospital started posting prices and patients started going to the hospital rather than make the trip.
Alex, I want to tell you what is going on in my area. My wife and two neighbors started taking their selves off of their blood pressure medicine. They did it slowly and they feel better, think clearer and are more energetic. Prescribed blood pressure medicine is killing this nation.
"Another reader put the problem — and the solution — in a larger context:
The core problem in American healthcare is not simply cost. It is complexity, and more importantly, the velocity of complexity."
But even THAT is confusing effect for cause.
Cost, complexity, and velocity of complexity are SYMPTOMS. Symptoms of the cause, which is employer-based tax-favored health insurance.
NO OTHER insurance is plagued by "cost, complexity, and velocity of complexity", and NO OTHER insurance is inextricably tied to employment.
Sever the g/d tie between employment and health insurance and put it on the same footing as ALL other insurances, and most of the problems will disappear in short order simply due to market forces.
NO ONE gets oil changes and scheduled maintenance and tires paid for by their auto insurance. NO ONE gets broken windows and roof repairs and driveway sealing paid for by their homeowners insurance.
And both auto and homeowners insurance are affordable and easy to shop around for.
But ALL of those things, in the health insurance context, ARE paid for by health insurance. There is a TOTAL disconnect between health care services costs and actual out of pocket payments, whereas there is NO disconnect between auto or homeowners insurance costs and out of pocket payments.
Our health insurance paradigm is an artifact of the g/d WWII era. It's nearly a century old. It needs to be burned to the ground and the earth salted where it stood.
Until that happens, NOTHING will make a dent in the shitshow that is American health insurance and health care.
100%. And very nice pick up. I was trying to simplify, but employer based insurance was always part of the complexity problem! It is just so entrenched in tax and benefits…so more difficult to unwind.
Perhaps this is the right time for small businesses, accounting for a large percentage of the US economy, who would be happy to give up this tax exemption for a more level playing field with large businesses if they were protected by new policy. This would be a great trade-off!
Please know I wasn't trying to jump ugly with you!
This just happens to be something I've been arguing for two decades, that we need to sever the tie between employment and health insurance by [cue the virtual if not literal impossibility] eliminating the tax-favored treatment (i.e. tax-free nature) of employer-provided health insurance.
If an employer gave you a $10/month gym membership it has to include that in your W2. But give you health insurance worth $35...THOUSAND, and there's no tax on it (AND, the employer gets a tax deduction).
It's friggin' insane, and no matter what other remedies are tried, the current Tax Code treatment of employer-provided health insurance will forever prevent the consumer from driving the health insurance market.
Big Pharma lobbyists and craven, feckless politicians will keep the health care industry the absolute and vastly overpriced shitshow it is and has been for a long, long time.
My concern is that if Kennedy is gone in july who will pick up the gauntlet! He's had nothing but opposition at every change he's tried to make. It just proves that an honest person will never make in the current corrupt administration
It's not the administration so much as the corrupt bureaucracies that most administrations can't rein in. The opposition to Kennedy comes from the agencies below him, more than his bosses above him. There is some of the latter because it's politics, and his bosses are being pressured by others including members of the legislative branch who are pressured by "interest groups." In the health care field those are Big Pharma, Big Hospital Corporations, and Big Insurance.
check out the Surgery Center of Oklahoma - transparent pricing on many different surgeries since 1997 and posts their infection rates etc. Very successful - I don't think they take insurance but am not clear about that. https://surgerycenterok.com/
Transparency in pricing sounds reasonable, and yes, a clinic, hospital, radiology center can print out a Chargemaster list for you with all the procedures/services and prices. Depending on the size of the facility, it can be 10 pages or 10,000 pages. It's really not as simple as you make it sound, especially for a hospital. A stand-alone radiology center, it's easy. Ideally, you call the scheduler to get on the calendar, ask for pricing, and voila, you get an estimate, which legally should be somewhat close. However, the Chargemaster system is integrated in the computer systems of each department, which are different by services...and this gets complicated to explain. I managed a Chargemaster and Item Master system for a large healthcare system for a decade, after the electronic medical records integrated with the rest of the computer systems, it got really complex to get pricing. You need a MD order and those are electronic now. Then register your account, information input, and a medical record is created. Depending on your payor status, meaning insurance, self pay, Medicare, Medicaid, Worker's Comp etc...each of those creates different compliance requirements. The person registering and scheduling you has your order pulled up, knows the CPT procedure code assigned to your service, but all the medications, supplies, surgical supplies, suture types, screws, etc are not listed with that CPT procedure code for say repair of a fracture of the foot. Every single item used in surgery is linked to your procedure/record...and registration has no way of knowing those charges. A surgery clerk reconciles your charges after the procedure; sometimes they are based on time, sometimes pre-set amounts then all supplies/medications etc. Sometimes there is a set price, say 10K and it includes all supplies/meds etc. But the inventory system requires scanning all supplies etc....and the bill goes way past 10K...so they take a contract adjustment and net the bill to the 10K. This is a simple example, but understand that every department is billing differently, pharmacy is by the pill, radiology is by the procedure, Physical Therapy is timed charges. Your record is a LEGAL record, and as lawsuits went up, so did the complexity of maintaining all charges, supplies, medications, diagnostic services, etc The real problem is the actual price of these services....insurance, Medicare, Medicaid never pay that amount. But higher prices mean not-for-profits can inflate those charges and clear their requirements.
At minimum, we need to get back to true insurance. Since most are paying high premiums and outrageous deductibles, people want something for their money. Insurance should be there for those expenses that could bankrupt you and your family. There should be insurance available to cover those conditions that are really expensive….the regular doctor visits and tests should be paid for out of pocket and hence a market is created. If you have money in your own pocket you are able to seek out all kinds of treatment including chiropractic, holistic medical providers and soft tissue work (massage). Our current western medical system is set up to provide a pill and/or surgery….there are no other options. Our doctors today do not even touch you these days. That is a problem.
As many other commenters in this thread have noted, transparent pricing is meaningless unless the patient is the actual paying consumer. Going to a restaurant with a menu featuring a $3 hot dog and a $100 steak and lobster meal is meaningless if you know that you will only pay a $20 copay for the meal. You will still order five of the surf and turf specials. The real answer lies in the tax code, where many incentives are created. Employers now have tax incentives to contribute to employees' health insurance premiums and therefore offer group policies through the employer. The employee seeks the lowest deductible option, and contributing to health savings accounts becomes an afterthought. The employee views the insurance policy as the way they pay for health care costs and becomes stuck with their employer lest they loose health coverage. Steering employers to contribute to employee health savings accounts (owned by the employee and portable) and offering high deductible catastrophic insurance policies in a national individual market would properly realign incentives, making the patient the actual paying consumer for all but catastrophic care, and create worker mobility by making both the HSA and catastrophic care policy individually owned by the employee.
Need to get back to individual GP doctor's practices. For insurance, the only insurance should be for catastrophic issues, and then everyone has a health savings account that you then chose where to spend it and on which doctors.
I don't think the general populace is aware that you can get direct primary care for about 100$ per month (for adults, less for children), and couple it with a catastrophic insurance policy that protects against accidents and hospitalizations.
It's much cheaper than getting insurance with all the bells and whistles.
Many employers are moving to this model because the primary care is protective--it's health care not sick care.
The tax code should be changed to encourage direct primary care, HSA's and high deductible catastrophic coverage insurance. Employers should be able to deduct the cost of contributing to employees HSA's and the cost of providing direct primary care options, but not the premiums on health insurance policies. Health insurance companies should be allowed to offer no-frills high deductible policies nationally (across all 50 states) in the individual market with federal government support for high risk pools. Self employed should be able to deduct all contributions to HSA's, and all payments for direct primary care and premiums on individual policies. The employee will then be freed from their employer for health care coverage, increasing worker mobility. The patient would then be paying out of their own funds for health care, making them act like a consumer (shop for better prices, reject unnecessary tests, pay attention to service quality, etc.). Insurance would be returned to its intended role (cover low probability, high impact events). And HSA's will build value while people are young and healthy, self funding the inevitable higher costs of health care in older age.
The passage of ObamaCare eliminated what Obama called “trash insurance” AKA catastrophic insurance. The availability of inexpensive catastrophic health insurance coupled with pre-tax health savings accounts, would drive transparency, patient control and reduce over utilization.
The ability to buy this type of coverage would save me thousands a year.
Alex, Your point is correct but incomplete. It would not matter if the pricing were transparent as long as the consumer does not have to pay it -- and that is the current state of how things work. It is the decoupling of the consumer from the fiscal decisions that is the problem -- not whether the price is posted.
Let us say I twist my ankle. I go to urgent care and they say "This is a strain, not even a sprain. Elevate it and ice it and you will be fine in a couple days. BUT, there is a 0.01% chance that this could be something worse. We could rule that out with an MRI -- would you like one?" If the cost to the consumer is nil, it does not matter whether the posted price is $103 or $10,300...they will be inclined to say "sure". And THAT is the primary failing of the system today -- not transparency but responsibility for first dollar expenditure.
The proper fix will be a return to catastrophic insurance (yes, some amazing medicine is really quite expensive and that is OK), a broadly constituted Health Savings Account available to anyone and everyone where funds can be set aside for health related expenses, and a return to a practice model best exemplified today by Direct Primary Care -- where the overhead and complexity you note just does not exist.
That would put the patient at the center of making decisions about where and when to spend health care dollars, would ensure continuity of care at the base level, and would still protect for the catastrophes that might occur. Transparency is surely part of the solution. But making the patient have to make choices based on that transparency, as they do with virtually ALL other decisions, is what fixes it.
I agree that people are not going to pay much attention to specific prices when what they are responsible for are co-pays, deductibles, and premiums. The question that is interesting to me is whether insurance companies themselves are interested in transparent pricing. You would think they have the power to achieve whatever level of transparency they want. My guess would be either that (a) prices are more transparent to them than they are to us or (b) transparency isn't as important as Alex thinks it is.
The insurance companies DO NOT CARE what pricing is exposed or not -- they pay on their own schedules that are negotiated between payor and provider. They really have little control over the costing issues.
I will give you a case in point: A colonoscopy can be done as an outpatient for, perhaps, $500. It can be done as a "hospital outpatient" (which is the same effective procedure but charged at hospital prices) for $5000. I know insurance companies that have struggled/coerced/threatened/whatever about this but it does not matter -- the patient gets steered to the hospital and all of us end up participating in this effective fraud, since the procedure really only costs the $500. This would self correct if the patient had to pay these amounts (the transparency in pricing would just give them the data with which to make the decision) but without it, the multi-billions spent every year just for this outpatient vs "hospital outpatient" discrepancy will just continue. Excellent point.
This works, if you have an intelligent patient who speaks the language of the physician. In California, about 1/3 of the people are foreign born. They frequently have no trust of the government from which they came. With some 23 languages spoken in Sacramento, much of medicine is done via translation with a iPad on a stand and a translator at a distance. This means that the physician gets perhaps 1/4 of the information using 2 to 3 times the time. Physicians are expected to see four patients an hour and get the note into the electronic medical record.
Secondly, many patients are single, and on what is called Medicaid in most states. There is no actual personal cost, and some wish to have a second or third or fourth opinion. It is almost impossible to design a system that works with the mix of cultures that we now have in California. Universal access to healthcare will only make this even worse, with our aging population and chronic diseases and a political class that is always offering services or money in order to buy votes and remain in power.
Obamacare transferred any remaining control of medicine from physicians to administrators who are business school graduates. They have no shame in charging outrageous fees. I had a stress echocardiogram at UC Davis in April of this year. I received the explanation of benefits (EOB) from Blue Shield. Two charges were listed under two different code numbers both identified as “miscellaneous” and totaling over $14,000. Blue Shield paid their pre-negotiated fee which left me with a nominal charge. In 2015 when my private cardiology group of 22 providers joined a local hospital group of about 480 due to the regulations overwhelming our system, we charged under $400 for a stress echocardiogram. The hospital group immediately changed that to $1200 for the same test in the same room with the same technician and a cardiologist monitoring.
Perhaps the more important question would be to ask if colonoscopies are really adding value? If not, don't pay the $500 OR the $5000.
> this effective fraud
It's not fraud if there's a genuine difference in risk between doing it in a hospital vs. a doctor's office. And there is. In a hospital you have an anesthesiologist monitoring you; in a doctor's office, you don't. People should be able to balance that risk difference for themselves--but of course that requires price transparency so people know how much more the lower risk procedure costs.
Peter, that would be true where correct. But the prices I am comparing here are actually between surgicenter/outpatient procedure center and hospital. They both have anesthesiologists. It is just the pricing differential between "hospital outpatient" and "outpatient" In the pricing scenario I gave here, exactly the same staff and outcomes -- just the pricing difference. If the patient had to choose in that case and pay, the choice would be clear
We actually made that choice years ago for our daughter who needed strabismus surgery. Our ophthalmologist told us we could do it at our local pediatric small hospital, or in out patient surgery center. The cost difference was substantial, and as we had not met our deductible for the year, we chose the outpatient surgery center. Although now with many places staffed only with mid levels, I’d want to be sure a physician was on site. I agree with what you have outlined, and my husband has harped on this for years, both of us are physicians. Medicine as a profession was drastically altered for the worse by Obamacare, which did nothing to benefit patients or physicians (other than maybe eliminating the whole pre-existing condition stupidity that made things like seasonal allergies not covered whenever you switched insurance for like 6 months). I definitely think catastrophic insurance with HSAs would be the way to go. But it’s hard to know what anything costs because prices are so jacked up to cover “expenses” much of which now goes to the plethora of administrative personnel who are needed to keep in compliance with all the rules and regs. And small, independent practices get reimbursed way less for exact same services, as they have no negotiating power, and therefore can’t compete with the large groups. It’s beyond frustrating to see what has happened over the last 20 years, and health outcomes have only worsened.
> the prices I am comparing here are actually between surgicenter/outpatient procedure center and hospital. They both have anesthesiologists.
Hm, ok, that is a different comparison than the one I was making. When my wife had her colonoscopy, the options she was offered were the doctor's office (no anesthesiologist) vs. the hospital (with anesthesiologist). She took the latter because she has chronic conditions that make any kind of sedation risky and she wanted to be sure she was properly monitored. No in between option of an outpatient procedure center with an anesthesiologist was offered.
Years ago we were preparing for a planned home-birth and paying all things out of pocket, (cheaper at the time than our HSA deductible), so I had to shop around a bit. Routine blood work at the hospital: $700. Through my midwife, $45. Same with an ultrasound. At the birth center it was $200 if you paid cash, at the hospital, another $750. It was shocking there was such a disparity!
There’s something inherently wrong with our pharmaceutical companies and the FDA (otherwise known as the Federal Death Association ) when I can go to Mexico or any other country and get BRAND NAME birth control for $120 for the year without a prescription and insurance changes $70 PER MONTH for very same brand name! A close friend of mine had the most aggressive form of multiple myeloma. Her drug was $5000 PER MONTH WITH INSURANCE yet was able to get the very same drug directly from India for $1200 for the year!!!! Now that’s criminal! Being a retired airline employee I will go to out of the country regularly to get other drugs over the counter that need a prescription here. To say Big Pharma hadn’t bought and paid for the FDA is an understatement! Hopefully this new crew with RFK Jr can break the rotten system!
I've heard these stories. It IS criminal.
I had to have a pediatric surgeon remove my daughters infected earring - localized anesthesia. I have a medical share - so paid cash. (But don’t show the medical share card - it will be more!). Anyways $500.
Everyone should be demanding the cash price. Everyone.
I agree with stating pricing. I remember several years ago a hospital in Kansas City realized that patients were doing medical trips to India to obtain procedures they thought were cheaper. The hospital started posting prices and patients started going to the hospital rather than make the trip.
Alex, I want to tell you what is going on in my area. My wife and two neighbors started taking their selves off of their blood pressure medicine. They did it slowly and they feel better, think clearer and are more energetic. Prescribed blood pressure medicine is killing this nation.
"Another reader put the problem — and the solution — in a larger context:
The core problem in American healthcare is not simply cost. It is complexity, and more importantly, the velocity of complexity."
But even THAT is confusing effect for cause.
Cost, complexity, and velocity of complexity are SYMPTOMS. Symptoms of the cause, which is employer-based tax-favored health insurance.
NO OTHER insurance is plagued by "cost, complexity, and velocity of complexity", and NO OTHER insurance is inextricably tied to employment.
Sever the g/d tie between employment and health insurance and put it on the same footing as ALL other insurances, and most of the problems will disappear in short order simply due to market forces.
NO ONE gets oil changes and scheduled maintenance and tires paid for by their auto insurance. NO ONE gets broken windows and roof repairs and driveway sealing paid for by their homeowners insurance.
And both auto and homeowners insurance are affordable and easy to shop around for.
But ALL of those things, in the health insurance context, ARE paid for by health insurance. There is a TOTAL disconnect between health care services costs and actual out of pocket payments, whereas there is NO disconnect between auto or homeowners insurance costs and out of pocket payments.
Our health insurance paradigm is an artifact of the g/d WWII era. It's nearly a century old. It needs to be burned to the ground and the earth salted where it stood.
Until that happens, NOTHING will make a dent in the shitshow that is American health insurance and health care.
100%. And very nice pick up. I was trying to simplify, but employer based insurance was always part of the complexity problem! It is just so entrenched in tax and benefits…so more difficult to unwind.
Perhaps this is the right time for small businesses, accounting for a large percentage of the US economy, who would be happy to give up this tax exemption for a more level playing field with large businesses if they were protected by new policy. This would be a great trade-off!
Please know I wasn't trying to jump ugly with you!
This just happens to be something I've been arguing for two decades, that we need to sever the tie between employment and health insurance by [cue the virtual if not literal impossibility] eliminating the tax-favored treatment (i.e. tax-free nature) of employer-provided health insurance.
If an employer gave you a $10/month gym membership it has to include that in your W2. But give you health insurance worth $35...THOUSAND, and there's no tax on it (AND, the employer gets a tax deduction).
It's friggin' insane, and no matter what other remedies are tried, the current Tax Code treatment of employer-provided health insurance will forever prevent the consumer from driving the health insurance market.
Big Pharma lobbyists and craven, feckless politicians will keep the health care industry the absolute and vastly overpriced shitshow it is and has been for a long, long time.
Just more of the same
My concern is that if Kennedy is gone in july who will pick up the gauntlet! He's had nothing but opposition at every change he's tried to make. It just proves that an honest person will never make in the current corrupt administration
It's not the administration so much as the corrupt bureaucracies that most administrations can't rein in. The opposition to Kennedy comes from the agencies below him, more than his bosses above him. There is some of the latter because it's politics, and his bosses are being pressured by others including members of the legislative branch who are pressured by "interest groups." In the health care field those are Big Pharma, Big Hospital Corporations, and Big Insurance.
I know all that. I just had such high hopes when he finally got in. Someone who is actually incorruptable
cf Surgery Center of Oklahoma. Set prices, cash only, no insurance, minimal to no "add ons".
check out the Surgery Center of Oklahoma - transparent pricing on many different surgeries since 1997 and posts their infection rates etc. Very successful - I don't think they take insurance but am not clear about that. https://surgerycenterok.com/
Transparency in pricing sounds reasonable, and yes, a clinic, hospital, radiology center can print out a Chargemaster list for you with all the procedures/services and prices. Depending on the size of the facility, it can be 10 pages or 10,000 pages. It's really not as simple as you make it sound, especially for a hospital. A stand-alone radiology center, it's easy. Ideally, you call the scheduler to get on the calendar, ask for pricing, and voila, you get an estimate, which legally should be somewhat close. However, the Chargemaster system is integrated in the computer systems of each department, which are different by services...and this gets complicated to explain. I managed a Chargemaster and Item Master system for a large healthcare system for a decade, after the electronic medical records integrated with the rest of the computer systems, it got really complex to get pricing. You need a MD order and those are electronic now. Then register your account, information input, and a medical record is created. Depending on your payor status, meaning insurance, self pay, Medicare, Medicaid, Worker's Comp etc...each of those creates different compliance requirements. The person registering and scheduling you has your order pulled up, knows the CPT procedure code assigned to your service, but all the medications, supplies, surgical supplies, suture types, screws, etc are not listed with that CPT procedure code for say repair of a fracture of the foot. Every single item used in surgery is linked to your procedure/record...and registration has no way of knowing those charges. A surgery clerk reconciles your charges after the procedure; sometimes they are based on time, sometimes pre-set amounts then all supplies/medications etc. Sometimes there is a set price, say 10K and it includes all supplies/meds etc. But the inventory system requires scanning all supplies etc....and the bill goes way past 10K...so they take a contract adjustment and net the bill to the 10K. This is a simple example, but understand that every department is billing differently, pharmacy is by the pill, radiology is by the procedure, Physical Therapy is timed charges. Your record is a LEGAL record, and as lawsuits went up, so did the complexity of maintaining all charges, supplies, medications, diagnostic services, etc The real problem is the actual price of these services....insurance, Medicare, Medicaid never pay that amount. But higher prices mean not-for-profits can inflate those charges and clear their requirements.
We also paid cash for a colonoscopy at a surgery center. $1800.
If we had ACA insurance, that would have been half a month’s payment.
At minimum, we need to get back to true insurance. Since most are paying high premiums and outrageous deductibles, people want something for their money. Insurance should be there for those expenses that could bankrupt you and your family. There should be insurance available to cover those conditions that are really expensive….the regular doctor visits and tests should be paid for out of pocket and hence a market is created. If you have money in your own pocket you are able to seek out all kinds of treatment including chiropractic, holistic medical providers and soft tissue work (massage). Our current western medical system is set up to provide a pill and/or surgery….there are no other options. Our doctors today do not even touch you these days. That is a problem.
As many other commenters in this thread have noted, transparent pricing is meaningless unless the patient is the actual paying consumer. Going to a restaurant with a menu featuring a $3 hot dog and a $100 steak and lobster meal is meaningless if you know that you will only pay a $20 copay for the meal. You will still order five of the surf and turf specials. The real answer lies in the tax code, where many incentives are created. Employers now have tax incentives to contribute to employees' health insurance premiums and therefore offer group policies through the employer. The employee seeks the lowest deductible option, and contributing to health savings accounts becomes an afterthought. The employee views the insurance policy as the way they pay for health care costs and becomes stuck with their employer lest they loose health coverage. Steering employers to contribute to employee health savings accounts (owned by the employee and portable) and offering high deductible catastrophic insurance policies in a national individual market would properly realign incentives, making the patient the actual paying consumer for all but catastrophic care, and create worker mobility by making both the HSA and catastrophic care policy individually owned by the employee.
Need to get back to individual GP doctor's practices. For insurance, the only insurance should be for catastrophic issues, and then everyone has a health savings account that you then chose where to spend it and on which doctors.
I don't think the general populace is aware that you can get direct primary care for about 100$ per month (for adults, less for children), and couple it with a catastrophic insurance policy that protects against accidents and hospitalizations.
It's much cheaper than getting insurance with all the bells and whistles.
Many employers are moving to this model because the primary care is protective--it's health care not sick care.
The tax code should be changed to encourage direct primary care, HSA's and high deductible catastrophic coverage insurance. Employers should be able to deduct the cost of contributing to employees HSA's and the cost of providing direct primary care options, but not the premiums on health insurance policies. Health insurance companies should be allowed to offer no-frills high deductible policies nationally (across all 50 states) in the individual market with federal government support for high risk pools. Self employed should be able to deduct all contributions to HSA's, and all payments for direct primary care and premiums on individual policies. The employee will then be freed from their employer for health care coverage, increasing worker mobility. The patient would then be paying out of their own funds for health care, making them act like a consumer (shop for better prices, reject unnecessary tests, pay attention to service quality, etc.). Insurance would be returned to its intended role (cover low probability, high impact events). And HSA's will build value while people are young and healthy, self funding the inevitable higher costs of health care in older age.