Health Care Reform Debate-Megathread

[Shawn Hopkins]

Was that when you had made an appointment or when you hadn't?

Usually without, but I have waited about two hours with an appointment, and my grandma does it all the time. Doctors are just so booked up that showing up and expecting to go in right at your appointment time is usually unrealistic.

[7thangel]

another update

U.S. Set to Sponsor Health Insurance

The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.

These multistate plans were included in President Obama’s health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies.

The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.

Walton J. Francis, the author of a consumer guide to health plans for federal employees, said the personnel agency had been “extraordinarily successful” in managing that program, which has more than 200 health plans, including about 20 offered nationwide. The personnel agency has earned high marks for its ability to secure good terms for federal workers through negotiation rather than heavy-handed regulation of insurers.

John J. O’Brien, the director of health care and insurance at the agency, said the new plans would be offered to individuals and small employers through the insurance exchanges being set up in every state under the 2010 health care law.

No one knows how many people will sign up for the government-sponsored plans. In preparing cost estimates, the Obama administration told insurers to assume that each national plan would have 750,000 people enrolled in the first year.

Under the Affordable Care Act, at least one of the nationwide plans must be offered by a nonprofit entity. Insurance experts see an obvious candidate for that role: the Government Employees Health Association, a nonprofit group that covers more than 900,000 federal employees, retirees and dependents, making it the second-largest plan for federal workers, after the Blue Cross and Blue Shield program.

[...]

[7thangel]

some states are getting an extension

For hurried states, Obama administration extends health law deadlines

States are scrambling to make sure they’re ready to meet the health law’s deadlines. Today, they got a slight reprieve: The federal government will allow states additional time to plan health exchanges, the new marketplaces at the heart of the Affordable Care Act.

The Obama administration had initially set a deadline of Nov. 16 for states to decide whether they would run an exchange, or leave the task to the federal exchange. While that deadline still stands, states can now wait until Dec. 14 to turn in “blueprints” that detail how they would get the system up and running.

“We are committed to providing you with the flexibility, resources, and technical assistance necessary to help you achieve successful implementation of your state’s Exchange and look forward to continuing to work with you as we implement the health care law,” Health and Human Services secretary Kathleen Sebelius wrote in a Friday letter to the governors.

States that don’t want to go it alone on the exchange, but would rather partner with the federal government, now have until Feb. 15 to make that decision. For states that decide not to play any role in the process, no notice to the federal government is necessary.

Sebelius wrote the agency had “heard from many states that additional time would allow you to submit a more comprehensive, complete Blueprint application for your Exchange.”

Many states, however, have already made a decision not to play any role in setting up their exchanges: Florida, Kansas and Virginia all announced Thursday that they would leave the task to the federal government.

States have cited their opposition to the health care law as one reason they won’t move forward. Others also see logistical challenges: If they rush to set up the marketplace, it may not have a smooth launch.

Consulting firm Avalere Health expects that one third of the of the states will leave the task of running a health insurance exchange to the federal government.



“It would be very hard at this point to start from scratch,” Mendelson said of states that have waited until the last minute to start planning work. “I’m not going to say it’s impossible, but it would be unlikely.”

[Loren]

Wired: Peeling Away Health Care’s Sticker Shock:

In the early 1950s, it was nearly impossible to know the value of an automobile. They had prices, yes, but these would differ radically from dealer to dealer, the customer a pawn in the hands of the seller. This all changed in 1958, when US senator Mike Monroney of Oklahoma shepherded a bill through Congress requiring that official pricing information be glued to the window of every new automobile sold in the US. The “Monroney sticker,” as it came to be known, has been with us ever since. It became an effective means of disclosing the manufacturer’s suggested retail price, or MSRP, and a billboard for other data disclosures to the consumer: the car’s fuel economy, its environmental rating, and so on.

The sticker price was one of the triumphs of consumer-rights legislation and has made buying a car an easier—though never altogether easy—experience. What’s more, window stickers made automobile pricing rational and understandable. A customer who knows the base price going in will expect more value coming out. In economic terms, the sticker turned a failed market flummoxed by information asymmetry into something resembling a functioning, price-driven marketplace.

If there is ever an industry in need of a Senator Monroney today, it is health care, in which 1950s-era thinking still rules the day, and irrational and inexplicable pricing is routine. The health care industry plays a gigantic game of Blind Man’s Bluff, keeping patients in the dark while asking them to make life-and-death decisions. The odds that they will make the best choice are negligible and largely depend on chance. Patients need to have data, including costs and their own medical histories, liberated and made freely available for thorough analysis. What health care needs is a window sticker—a transparent, good-faith effort at making prices clear and setting market forces to work.

How bad is it? Uwe Reinhardt, a leading health care economist, described the pricing of hospital services as “chaos behind a veil of secrecy.” Chaos due to lack of predictability; veil of secrecy because many organizations take a proprietary attitude toward data.

Consider a recent study of the costs of routine appendectomies performed throughout California. Though the procedures were largely identical, the charges varied more than 100-fold—from $1,529 at the cheapest to $182,955 at the most expensive...

The health care business is about patients. But the patient population has been largely powerless and remains so even as the members of the medical community—hospital chains, nationwide insurers, large employers—have become much more powerful. Over time, the patient—the raison d’être of the health care business—has been reduced to merely another raw material.

This should not last. What technology can do is change the game—change the basis of competition, change what it takes to win in the health care marketplace. In time, some players will compete better than others by making good use of technology. In this competitive environment, patient use of the available pertinent information, with all its benefits, is going to be critical, giving them more economic power. They will likely demand to know more about their various conditions and what their dollars are being spent on. That’s how American consumers have always operated, and I predict they will here as well.

But what they’ll need is transparency in treatment, cost, and institutions—in other words, a digital sticker. Getting that transparency has to be Job One.

I've experienced this firsthand. A few years back, when my doctor suspected I had a kidney stone, he ordered a CT scan at the hospital. On the day I was scheduled to go in, I called in to ask what that was going to cost, since I have a high deductible plan.

The answer? About $5000. For a single diagnostic scan.

I cancelled that immediately. In the end, I had an identical scan done at an independent diagnostic scan facility located next to another Atlanta hospital. The sticker price there? Less than $500.

I also take a prescription drug that's been available in generic form for, I believe, over 20 years. I take the generic. But the sticker price of the brand-name drug is STILL several times the cost of the generic. It's like going to the grocery store and finding that Marshmallow Mateys cost $3 a bag, whereas the same-sized box of Lucky Charms costs $25.

[Iangould]

I can't remember the last time I saw a doctor that wasn't ridiculously over-booked. 30-45 minute waits seem to be standard.

I've waited more than about 10 minutes to see my GP exactly once in the past 10 years (when I had an appointment).

She was so apologetic that she bulk-billed me for that appointment (i.e. she waived the co-pay on top of the reimbursement from the government.)

[Winslow]

I've experienced this firsthand. A few years back, when my doctor suspected I had a kidney stone, he ordered a CT scan at the hospital. On the day I was scheduled to go in, I called in to ask what that was going to cost, since I have a high deductible plan.

The answer? About $5000. For a single diagnostic scan.

I cancelled that immediately. In the end, I had an identical scan done at an independent diagnostic scan facility located next to another Atlanta hospital. The sticker price there? Less than $500.

I also take a prescription drug that's been available in generic form for, I believe, over 20 years. I take the generic. But the sticker price of the brand-name drug is STILL several times the cost of the generic. It's like going to the grocery store and finding that Marshmallow Mateys cost $3 a bag, whereas the same-sized box of Lucky Charms costs $25.

It would be nice to introduce some way of allowing people to shop the free market while still providing coverage for expensive procedures. The high deductible with options might work to bring costs down as long as people could be educated on how to shop for generic drugs, or services such as you described above, etc, etc

I am going in for a heart stress test in a week or so, and the thought of shopping around for a procedure as important as that is a bit nerve wracking. How do I get protected from quacks on such an important procedure?

[Loren]

One microcosm example of the screwiness of the health care industry:

In my line of work, we need medical records and bills for clients. And in hospitals, the medical records and billing departments are often separate, which mean we often have to send two requests, and make two payments.

I have in front of me an invoice for the following:

Search and Retrieval Fee: $25.88 (this is a statutory maximum fee)
Postage: $1.10
Sales Tax: $2.24
Page Fee @ 97 cents per page: $0.97

Total: $30.19

In other words, it costs us, as a patient's attorney, over $30 to get a copy of the client's one-page BILL.

[Shellhead]

I can't remember the last time I saw a doctor that wasn't ridiculously over-booked. 30-45 minute waits seem to be standard.

That's deliberate. They overbook on appointments so if there are some no-shows or late people, they still have a full day of income.

[Paradox]

Because, heaven help us if they lose ten minutes of pay. That's what health is all about!

[Vibranium]

Because, heaven help us if they lose ten minutes of pay. That's what health is all about!

a Drs office is a business....nurses cost money, office equipment and medical supplies cost money, getting the office cleaned costs money

you can't do that when you only have half your appointments showing up

[thehod]

a Drs office is a business....nurses cost money, office equipment and medical supplies cost money, getting the office cleaned costs money

you can't do that when you only have half your appointments showing up

Healthcare is, first and foremost, a service.

Yes this stuff costs money and that needs to be catered for, but when you put the need to make money over the need to serve your patients requirements, then you've got your priorities arse about face.

[thehod]

I've waited more than about 10 minutes to see my GP exactly once in the past 10 years (when I had an appointment).

She was so apologetic that she bulk-billed me for that appointment (i.e. she waived the co-pay on top of the reimbursement from the government.)

I generally get to see the doctor within my appointment time. Rarely more than 10 minutes after it.

I have been known to wait over an hour, but then I have (or at least my wife has) had consultations that didn't end until the doctor was satisfied he'd covered everything, which inevitably led to some knock on wait with other patients, so I accept that as a consequence of the care shown to all.

[dupont2005]

a Drs office is a business....nurses cost money, office equipment and medical supplies cost money, getting the office cleaned costs money

you can't do that when you only have half your appointments showing up

Have you ever had an itemized hospital bill? The doctor and staff pay is only a tiny fraction of the cost of a hospital visit, and honestly those charges were actually reasonable. Hundred dollar asprins and three thousand dollars to rent an IV stand for a few days and all the other ridiculous charges for hospital use is the real problem. Maybe we can keep doctor and nurse pay exactly where it is, and turn hospitals from for-profit privately owned institutions to government facilities. Then those poor doctors can still collect Ferraris for that tough job of signing off everything the nurse does.

[Vibranium]

Have you ever had an itemized hospital bill? The doctor and staff pay is only a tiny fraction of the cost of a hospital visit, and honestly those charges were actually reasonable. Hundred dollar asprins and three thousand dollars to rent an IV stand for a few days and all the other ridiculous charges for hospital use is the real problem. Maybe we can keep doctor and nurse pay exactly where it is, and turn hospitals from for-profit privately owned institutions to government facilities. Then those poor doctors can still collect Ferraris for that tough job of signing off everything the nurse does.

I was talking about individual doctors offices, not hospitals but I get your point

and that would make them run better how? I ask because probably one of the better run private hospitals on the east coast is a 15 minute drive from my house, actually my mom spent the weekend there because she had an abcess on her kidney and needed surgery

making a hospital government run isn't going to stop medical supply companies from profiting, and thus making the hospital or drs office pass the cost to the consumer

i think that is a big part of why the cost is where it is

[dupont2005]

I was talking about individual doctors offices, not hospitals but I get your point

and that would make them run better how? I ask because probably one of the better run private hospitals on the east coast is a 15 minute drive from my house, actually my mom spent the weekend there because she had an abcess on her kidney and needed surgery

making a hospital government run isn't going to stop medical supply companies from profiting, and thus making the hospital or drs office pass the cost to the consumer

i think that is a big part of why the cost is where it is

Once the medical supplies have been purchased and paid for, the medical supply company isn't making money. Pretty sure I could buy an IV stand brand new for a tenth of the cost of renting one for a week. If the medical supply company is charging the hospital an arm and a leg for Asprin, I think I can supply them at a better rate. Hundred dollar box of kleenex, have these hospitals never heard of Costco?