One of the big canards about the current healthcare system in the US is that there is the potential for real competition.
Insurance companies might compete with each other to get businesses to sign on, and they may be competing with each other for bargaining with providers.
But at the user level, there’s not a lot of competition, not a lot of shopping going on.
At my workplace, employees have one plan available.
I’m a VP, so I’m involved in choosing the one plan. We don’t get much in the way of choice. We’re a small company of 25-30 people, and we don’t have many affordable options.
As a wife of a disabled person, I was heavily involved in choosing doctors, but those choices were limited by which doctors were accepting new patients, which doctors were within reasonable driving distance, and which listened. We didn’t have enough options that we could base things on price.
When it came to procedures and tests, we went where we were scheduled. Even if we chose a surgeon, we couldn’t choose the anesthesiologist or the radiologist or even the facility. We went were there were available slots. And “choosing a surgeon” was a crapshoot. The PCO’s office would call a surgery center and voila, you have a surgeon. The hospital calls a urologist and voila, you have a urologist. Cardiologist out of town? The ER calls in the on call cardiologist and voila.
My husband was told he needed bypass surgery. He went to the hospital where his cardiologist had admitting privileges and had the surgeon the cardiologist worked with.
After we married, he was told he needed a second bypass surgery. We were sent to the Cleveland Clinic because he was considered high risk and they were the best hospital for that. Local surgeons didn’t want to touch him with a 10 foot pole. (He did not end up having the second surgery.)
I don’t claim all of my experiences with the health care system are completely true of every American, but where in the above events was the shopping and competition supposed to be happening? At what point were we supposed to know where to turn, which doctors to choose, which hospitals to go to? Decision A led straight to Doctors B, C, and D and facilities E, F, and G.
Even getting a second opinion is extremely time-consuming and expensive. Third and fourth opinions? Who can afford that?
Who wants to find a heart surgeon based on price? “Ooh, you’ll bypass two arteries for the price of one?” Is it even possible to do this considering the surgeon charges, then the hospital charges, then the anesthesiologist charges, etc. And the price is dependent on what the insurance company feels like that day, and whether the person filling out the forms marked 14184 or 14185 as the billing code.
In short, patients do not have the time, the money, the information, or the expertise to shop. They are forced into making decisions based on gut feelings, trusting their doctors, and hoping for the best.
For debate: Am I wrong? Is there a really good mechanism for competition at the user level that I’ve simply missed out on all these years?
Competition on the supply side can sometimes lower prices. Competition on the demand side really doesn’t. (In fact it might raise them.) Since health insurers are really buyers of other services, I don’t think more health insurers will bring costs or prices down. On the other hand, a monopsony might.
Where we need greater supply, or competition, is in health care providers: hospitals, nurses, physicians, schools that train the latter two, labs, etc.
Doctors are very effective in covering up doctors with problems. They do not want people to know which docs are incompetent or on drugs . They like it that we fly blind.
There is currently only 1 method I’m aware of, and it’s only semi-viable.
IF you don’t have insurance, THEN you perforce care about the costs and you WILL be more inclined to ask the doc questions, make sure you’re seeing the right kind of specialist(s), and so on. If you get bad service at one place, you’ll go to another the next time. This only goes so far, though, because many times the docs don’t even know the costs, and just plain aren’t geared for these kinds of questions because they’re so uncommon.
The problem, IMO, is that insurance is artificially keeping competition away. I’m not saying no one should be allowed to get insurance, but I AM saying that insurance as it exists in this market is essentially a monopoly with all of the evils involved.
At my workplace, we have a choice of a half-dozen plans, some less expensive and less comprehensive, and some more expensive and full-featured. We’re allowed to change once a year. It’s not great competition, but it is competition.
Curiously, Federal employees get perhaps the most choice in health coverage. When I went to work for a Defense Department agency twenty years ago, we were given a book with about a hundred different plans available. All but a half dozen or so required you to join a union, but that was easily done. One of the people hired at the same time as I was had worked for the Post Office for a year, and so was able to choose their (very comprehensive) plan.
Oh, just to make it clear, the hundred or so union-connected plans weren’t all from the same union - to take advantage of most of the plans, you had to join some union or other, depending on the plan.
In Massachusetts one can go to the Commonwealth Connector website, browse through descriptions of a multitude of plans, and select whichever offers the combination of options and costs best suits you.
Under Massachusetts law, everyone is required to get health insurance, and there’s a tax penalty if you don’t or if the plan you have doesn’t cover a specified minimum of benefits. A while after passage of the health insurance law, the plan I’d had for many years (a) switched my prescription coverage to a separate plan requiring a separate (and higher) payment, and (b) notified me that my coverage would no longer meet the Massachusetts requirements. A phone inquiry into plans that would qualify left me reeling: Instead of paying a bit under $400/month as I had been (self-employed, individual), I’d have to come up with close to a grand a month.
:eek:
So I checked out the Connector, found a plan within Commonwealth Choice that worked for me, at a price I could afford ($440.20/month), and signed up online. Easy-peasy! It has higher deductibles and somewhat less overall coverage than what I had, but so far whatever claims I’ve had have been handled with no fuss, and I even got a refund check from a hospital for a service I’d paid for; they were reimbursing me for the amount my plan had later paid them.
Oh, and my coverage is from a private insurer – Harvard Pilgrim Health Care. And I got coverage despite having a couple of pre-existing conditions because under Massachusetts law no insurer can deny coverage based on that.
The Massachusetts system isn’t perfect, and it has its own problem – the economic downturn combined with its own roaring success at getting people signed up have made it more expensive to the state than originally envisioned – but it’s been a tremendous boon to multitudes of people.
We have undergone a lot of consolidation in the health care industry. Like the oil market, it allows the companies to share a market ,rather than compete. The buyer is given a myriad of options in coverages ,but not providers.
Fine, then. Increase the supply, & let costs drop that way. Seriously, the fact that politicians are willing to keep spending money out of habit on roads we don’t need, but not to build enough med schools to meet demand, shows how piss-poor they are at governing.
The GOP could save the US way of private medicine & their party’s prospects by supply-side investment. This is pork & construction, nothing radical.
But they don’t.
Let me say again. The GOP could save the US way of private medicine. No UHC, private hospitals, lower costs of private insurance.
But they don’t.
I think they really don’t have the will or imagination to do it.
I have a plan that combines a high-deductible (and low premium) insurance policy with a health savings account. This limits out of pocket expenses pretty well and does make us shop around a bit, especially for prescription drugs. We would buy some from mail-order pharmacies, switch some prescriptions to generics or less costly alternatives with the approval of our doctors, and schedule purchases of others to take advantage of times when we were beyond our deductible and fully covered for the cost.
This took some getting used to, but it works fine. I have no real complaints.
Under UHC there would be private hospitals, private pharmacies, private doctors, private suppliers for all medical supplies, etc. It would just change the way they got paid and the way funds for health are collected. The system would have no socialized components. Merely the government organization of the funding. When more than 30 percent of the health care is being eaten up by the providers, something is very wrong.
As BrotherCadfael noted, the federal government allows its employees to choose from a variety of plans. In practice, unless you’re interested in seeking out particular differences, it kind of boils down to “cheap plan with high deductible” (for when you’re a single man) vs. “expensive plan with lots of coverage” (once you have a family).
This sort of covers it for the Feds. We do have a lot of plans to choose from. It shows the enormous number of plans a doctor may have to deal with to collect his money. When I choose a plan, I have to decide on the costs to me, what services I think my family and I will need in the future and, very important, whether a particular doctor or type of doctor will accept the plan. Most Docs will take Blue Cross but maybe “Bob’s health insurance company” has better rates. What to choose?
I can “shop for medical care” in that sense. I can also refuse to go back to a doctor that truly sucks (too many, in my experience) because I have Big Blue.
Another way to shop is to actually ask a doctor how much something costs. I recommend this to all people with a strong sense of the absurd - the numbers a doctor comes up with, along with the mumbling and excuses, are almost worth the price of admission. I once asked a dioctor how much a knee operation would cost - I wanted to know if it was worth the cost and trouble - his quote $3000. Total cost for me and my insurance company, everything included: $145,000. Maybe he misunderstood?
Yes, Get competing quotes for medical services, manage the contract, and Pay cash!!!
A member of your group plan has an existing condition that must be paid for. You probably can’t afford that treatment by yourself so the group pays. Then insurance company merely acts on you behalf to find the lowest cost medical services and charges 10% for those medical services procurement administration ( use the data and calculate administrative based on US GDP is $13.48 trillion and Health care is 17% GDP) which includes overseeing the expenditures by the medical services to make sure there is no over charging and that the least expensive medical service is obtained… The insurance company then charges the group for premiums to pay for the treatment plus that 10%. Now of course it is unreasonable for an insurance company to charge a group for the entire cost of your special case so some of that cost is born by all the insured of that company. Sounds very reasonable on the part of the insurance company.
**
But you aren’t happy paying cash or with your insurance service!!! So, what to do, what to do?**
You pay into Medicare government program with every paycheck so do not consider it a handout.
If your loved one is not eligible for Medicare then your personal case is unique. Find a loop hole and use it. Barring finding a loop hole then we the People have a choice? We either change the whole medical services industry at the risk of all the unintended consequences of government meddling or We the People foot the bill for your special case being compassionate as we are. Not burdening the private sector with the your predictable high costs but let the private sector deal with the unpredictable but statistically probable costs which is what insurance is there for in the first place will reduce costs for everyone. But of course in major calamities like an H1N1 pandemic insurance companies and medical facilities may be so strapped that national intervention may be required which is the only reason it is there in the first place.
The existing private medical service industry is working just fine. The private system has ample supply to meet the demand and has ample financial resources to cover losses and is amply competitive. And your special treatment needs are being met. If it ain’t broken then don’t fix it.
It is the existing public system that is not working. Fraud in the public system is out of control. Over prescription of drugs is out of control. Misappropriation is out of control. Many people that get public care don’t need it while many that need public care don’t get it. The existing national emergency care system may be working now after the experience with Katrina but who is to know for sure till we need it. And it is exactly these problems that Massachusetts faces.
So EddyTeddyFreddy pays the same amount for less coverage and Massachusetts is bankrupt and the Massachusetts hospitals our overtaxed treating hang nails… Such a deal!!! Who is going to bailout Massachusetts? The existing Massachusetts public system is not working!!!
But EddyTeddyFreddy is happy with that, TODAY!!! What about when it becomes time to pay the piper? Those Massachusetts expenses are EddyTeddyFreddy’s, he just doesn’t know it yet! ** So, what to do, what to do?**
jsgoddess your problems are one of perception. Your personal income is insufficient to cover the costs of todays available medical procedures but yet some one is paying and you are being treated. I perceive that to be a good thing.
We the people would like it that you could afford your own medical procedures and you would like it if you could stand on your own two feet to care for your loved one. Well you could if the government’s existing Medicare was fixed.
Tort reform of 2% of $2.291 trillion would be $45 billion dollars of savings
Medicare misappropriation 2006 26% of $325 billion would be $84 billion dollars of savings
Misappropriation - If you have an income between $170,000 and $300,000 per year and you require a wheel chair are you really disabled?
(link is good for 7 days)PRESS THE SHOW STATISTICS BUTTON
Before we act out of fear with ‘Hope’ and Before we go head long into ‘Change’
Do not listen to the likes of gonzomax and EddyTeddyFreddy, but rather:
** 1. Compile facts on true state of medical service industry, public and private
2. Set up Medical Services Information Agency
3. From this compendium propose changes to meet objectives
4. And reduce medical service costs making it more affordable
**
Medical services comprising 17% of GDP demands an Information Agency much like theEnergy Information Agency with easily accessible data tables indexed by state, service types, consumption, supply, and etc Work smarter not harder! I demand to see the data!!!
Your decision A, the best priced coverage for your company, was a contract for medical service procurement and oversight which the insurance company provided by finding the medical service provider you needed at a competitive price. If you want to be independent then you must take ownership and obtain the medical service of your choosing by negotiating a firm fixed price contract with the medical service provider and pay cash!!! Elect for the no malpractice option and select providers that don’t accept Medicare or insurance, and be proactive in disease prevention and the treatment process.
Parting words.
Your loved one is being cared for now! No where in 1000 pages of the bill (AKA UHC) is the care of your loved one guaranteed and legal redress of grievance against the government is specifically disallowed. DO YOU WANT YOUR LOVED ONE TO BECOME AN UNINTENDED CONSEQUENCE?
Junk it All! All 1000 pages! I want a law that requires medical services to have posted prices and a UPC!
What do you mean by “public system”? The new healthcare plans in Massachusetts don’t include a private option AFAIK, all the new “affordable” plans are run by insurance companies.
Massachusetts is not bankrupt. What is this bailout the state is requesting? Where are you getting this info about Massachusetts hospitals and hangnails?
There have been some bumps in the road with the new healthcare law. I am not ready to call it a success but it’s too early to say it has failed.
:eek: 