I'm not sure what you mean by insurance oversight, but there are requirements within the ACA that insurance companies spend a minimum percentage of premiums on health care. I believe that there are a lot of people around the country that are about to get a refund from their carrier based on that provision.

 

Also, the whole purpose of starting this thread was to generate a discussion of approach. There are advantages and drawbacks, regardless of the approach.

Ask yourself, what's in that for the insurance companies? When you find something that they think is preferable for them, let me know what you think that would be, seriously.

And therein lies a terrific problem. With every little bill not paid by the insurance carrier, the individual will spend his money in the HSA to cover those bills owed to the provider, never building up enough reserve to "afford" an insurance with a higher deductible and lower premiums. It's exactly what I have in coverage personally now. Pipe dream. Great in theory, not remotely great in practice.

 

Well, I think it would have worked well for me. For most of my long life I have had very low medical bills. In most years it would have been nothing but the annual physical that under the ACA is outside the dedutible. Now that I am older and the bills are a little higher, it will be more dificult to build a balance. There will also be people that because of their financial or health situation, never build a big balance. That's okay. It doesn't make it a pipe dream.

Ask yourself, what's in that for the insurance companies? When you find something that they think is preferable for them, let me know what you think that would be, seriously.

 

I'm not sure what you mean, but the insurance companies are in it to make a profit. Nothing wrong with that and nothing in the ACA stops them from making a profit.

I'm not sure what you mean, but the insurance companies are in it to make a profit. Nothing wrong with that and nothing in the ACA stops them from making a profit.

 

I think what you will find is this. Once the physicians stop being reimbursed at the rate they are accustomed, they'll individually stop taking PPOs and contracts of the sort, or at a minimum a much higher negotiated percentage. At that rate how is Humana or BC/BS going to make that same margin they've made all of these years? Well, they'll pass it on to you and me in the cost of the premiums and the ridiculous deductibles. Is there anything in the ACA that controls the premiums that those companies can charge me individually? I'll wait for your reply to make my next point on that issue.

Well, I think it would have worked well for me. For most of my long life I have had very low medical bills. In most years it would have been nothing but the annual physical that under the ACA is outside the dedutible. Now that I am older and the bills are a little higher, it will be more dificult to build a balance. There will also be people that because of their financial or health situation, never build a big balance. That's okay. It doesn't make it a pipe dream.

Look, I'm not trying to be combative here, but we live in a generation of walking wounded. It is what it is. With longer life span comes more difficult management of health care. I have a question for you TA, Why do you think that people (like me for instance) can get their prescriptions filled in Canada for 1/3 to 1/4 the cost as I can here? Why can't I get that same Rx here for that cost? Canada not interested in making a profit?

Not that I'm aware of (locally anyway). And this is strictly opinion on my part, if there is a shortage of GPs it's because of the over-specialization of the field of medicine. For instance, there are "general surgeons" these days that are even more specialized that in surgery groups there are sub specialties. Some surgeons don't do anything but gastric bypass, etc. Some of that has been in part due to insurance reimbursement but not entirely. However, with the topic at hand, I can't see how this gets better with what's looming in the package signed into law. Insurance and hospitals have become such a money hole that common sense medicine has flown the coop.

 

So would I be wrong to assume that if a good number of existing doctors quit taking Medicare patients that some other doctors would accept them? In other words, the "market" would work like it always does when there's a need?

So would I be wrong to assume that if a good number of existing doctors quit taking Medicare patients that some other doctors would accept them? In other words, the "market" would work like it always does when there's a need?

 

Well, I can say without much reservation, that the AMA and it's members are fairly tightly knit (not to mention wealthy). I'd guess that you'll see a blanket movement within the profession, whatever that may be. It's a very strong lobby.

I think what you will find is this. Once the physicians stop being reimbursed at the rate they are accustomed, they'll individually stop taking PPOs and contracts of the sort, or at a minimum a much higher negotiated percentage. At that rate how is Humana or BC/BS going to make that same margin they've made all of these years? Well, they'll pass it on to you and me in the cost of the premiums and the ridiculous deductibles. Is there anything in the ACA that controls the premiums that those companies can charge me individually? I'll wait for your reply to make my next point on that issue.

 

The only thing in the ACA that controls the premiums is that a minimum percentage of the premiums must be spent on health care. So the premiums can't go up faster than health spending on a company wide basis. If you mean only your individual policy, the group rates will be available under the exchanges. That is the main reason for the exchanges.

Look, I'm not trying to be combative here, but we live in a generation of walking wounded. It is what it is. With longer life span comes more difficult management of health care. I have a question for you TA, Why do you think that people (like me for instance) can get their prescriptions filled in Canada for 1/3 to 1/4 the cost as I can here? Why can't I get that same Rx here for that cost? Canada not interested in making a profit?

 

I think there are two reasons. First, the prescription drug act passed during the Bush administration prohibited the government from negotiating drug prices. Second, the Canadian government does negotiate prices. The incremental cost of manuafacturing most drugs is very small compared to the cost of R&D and profit. Therefore the drug companies can sell to the very small Canadian market by covering their incremental costs and sticking the much larger US market with the R&D costs.

I think there are two reasons. First, the prescription drug act passed during the Bush administration prohibited the government from negotiating drug prices. Second, the Canadian government does negotiate prices. The incremental cost of manuafacturing most drugs is very small compared to the cost of R&D and profit. Therefore the drug companies can sell to the very small Canadian market by covering their incremental costs and sticking the much larger US market with the R&D costs.

So, with that in mind, don't you think with an aging population that the astronomical amount of $ spent on prescription drugs should have been a major point addressed in the bill? Unless I missed it, nada.

So, with that in mind, don't you think with an aging population that the astronomical amount of $ spent on prescription drugs should have been a major point addressed in the bill? Unless I missed it, nada.

 

I don't believe that the bill removed the ban on the government negotiating drug prices. Someone can correct me if that is not correct. I think it should have, but big pharma is a big lobby. The insurance companies can and do negotiate prices, as do the big retail chains. That will create some pressure, but not enough.

 

Something to keep in mind though is that just like all of the other health care providers, there has to be enough in it for the drug companies to continue their R&D. It is a tough nut to crack. We want the drug companies to make a good return on their investment but we don't want them to take advantage. Where that point lies is tough to determine.

I don't believe that the bill removed the ban on the government negotiating drug prices. Someone can correct me if that is not correct. I think it should have, but big pharma is a big lobby. The insurance companies can and do negotiate prices, as do the big retail chains. That will create some pressure, but not enough.

 

Something to keep in mind though is that just like all of the other health care providers, there has to be enough in it for the drug companies to continue their R&D. It is a tough nut to crack. We want the drug companies to make a good return on their investment but we don't want them to take advantage. Where that point lies is tough to determine.

Which is where I'll make my argument full circle, regardless of the administration in office, the smart thing to be done is total insurance reform. That should be all encompassing from payment for delivery of care to prescription drug coverage. The insurance giants and drug companies are the area we should be addressing in my opinion if you want to control the cost of health care and make it something individuals (small business included) can afford.

When I wave a wound at my doctor I always get care.

 

We can agree to disagree as to which of us is "spinning" the Medicare numbers. It seems that we both understand what is happening.

 

In a different thread, I made the same point that putting the economic burden on the providers MIGHT result in a shortage of providers. Negotiated rates do not have to result in a loss of service. Insurance companies have been doing it for years and yet, most doctors and hospitals still take insurance. On a recent visit, my doctor charged $409.00. The negotiated rate he had agreed to with my insurance carrier was $196. I don't believe I received any less service because of the lowered rate and I don't think my doctor is planning to go out of business. On the other hand, transfering the economic burden to the users will result in some users not being able to afford the service. That is a form of rationing based on ability to pay.

 

My biggest problem with the Ryan approach to Medicare is that I believe it reflects a fundamental misunderstanding of the problem. His approach is based on the idea that the government is paying an unaffordable amount for Medicare so the extra costs are transferred to the users in the belief that market forces will drive down the costs. That is true, but only because market forces will force those that can't afford the services to do without. The real problem is that we as a society are paying an unaffordable amount for Medicare services. The ACA attempts to lower the total by first trying to increase the efficiency of the system and second, controling the rate of increase in provider payments. That seems to me to be a much more sound approach. The hard choices will come when as technology improves, we have an ability to keep people alive for longer and longer times at greater and greater cost.

You are the only person I have heard stating that Obamacare does not cut Medicare $700B. That goes for the talking heads on the left. We can debate which method, Obama's or Ryan's, of cutting Medicare is better but to state Obama is not cutting is dishonest.

 

That said, cutting what doctors will be reimbursed has a threshold. There will be a basement and when Medicare digs through the basement floor the doctors are going to tell them to take a hike. There is a reason your last bill was $196 instead of $96. The doctor said $409, the insurance said $50 and they ended up agreeing on $196. Had your insurance stood their ground on a lower rate you would have received a letter stating your doctor no longer excepted your insurance.

What it's going to do is close medical schools because why in the frig would I want to subject myself to that torture and ridiculous student loan burden for the "reward" at the end? As a young man of good conscience I want to help people, but that only goes so far, I want to get paid!!! At that rate, law schools will be so overcrowded with the cream of the crop students all battling to pass the bar so they can go into politics.

I think to truly reform health insurance you have to start with overall costs of health care. And I don't mean you tell doctors what their gonna make but the whole process has to be more transparent and realistic. At the same time people have to be smarter with health care. They have to make better choices. I think health care is much like taxes. People would care alot more if they had to write the checks directly. With health care people don't think about what is being spent because their insurance pays the bill and normally the premiums comes direct out of their check (just like taxes). How many unneeded trips to the ER or unneseccary procedures would be avoided if the you had to write the check? I have a friend who is a mailman. Everytime you turn around his wife is taking one of their kids to the ER. They get a fever and it's off to the ER.

 

Secondly you have to allow insurance to be sold across statelines.