Can anyone tell me
- Thread starter EERs 3:16
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I'll say the same thing I've said a million times. Neither the ACA nor the AHCA are actually addressing the issue of affordable health care. At best the ACA tried to address insurance, but the insurance is expensive because the healthcare itself is expensive. Part of the reason I feel healthcare is expensive is malpractice insurance and that there is no published pricing.
The whole model is completely different than anything else we do in this country. When you buy a car you can look up prices, safety ratings, mileage, historical reliability ratings and then you go make a decision and speak with multiple dealerships to find the best price. Healthcare? Nope. We can shop for insurance, but we go to a doctor, they recommend a surgeon, so we go to that surgeon who uses whatever hospital they use and we have really no idea how much it's going to cost.
Do you think when you go to a physicians office you should know before hand what you'll be charged? Do you know the difference between a level II, III, IV, and V visit and what goes into determining each one?
Yes. And why does someone with no insurance get charged less than someone with insurance.
We've created a model where the patient w/ insurance expects for things to be paid and the Doctor providing care to the patient w/ insurance is expecting be paid and therefore there is zero motivation to provide any savings to cost.
I'm not confident we'll ever get to a place where we can compare going to a doctor to going to buy a car.
Your run of the mill "I'm sick" visit is pretty basic...but when you come in for a pain in the (insert area) it's hard to tell what's going to be explored or how so I'm not sure anyone could ever give a cost/charge.
Agree how providers are paid/reimbursed needs to change if there is to be an impact on the cost of healthcare. Still don't think we'll ever get to a place where prices are transparent.
Yes, I think I should.
I don't know why that seems so unreasonable other than the fact that it's a different paradigm than we've been operating under.
I'd also like to know why I can get a blood screening from a mobile van at times for $30, but those same tests will cost $300 if I go to a doctor.
No I don't ... why would I? That's a billing level right? If I'm going for a routine followup and to get prescriptions refilled ... that should be on a billing sheet.
If I'm adding bloodwork to that, then that's on the billing sheet too.
If these rates are publicly available, then maybe I find out that my doctor charges twice as much as other doctors do and I go to a different PCP.
Was NOT sustainable from the beginning!! And Obama and those responsible for the law KNEW it (some even joked about it with video to prove it happened). Fraud at its greatest .
I think WhiteTailEER is onto something here. There is no correlation between customers and products in health care services in terms of how price is fixed relative to market demand.
If there is a Defense for this, it is the unique nature of specialized care, but standards and practices to treat illness still should be available for consumers to measure relative to other options. There are costs consumers need information on.
Part of what is missing here is true free market competition. Insurance markets are highly regulated, and often carved out by legislators for specific markets and clients.
Since there is limited competition, consumers do not drive the prices for products or services offered (often the Government does) so they are not sensitive to the prices for services they need because they are using Insurance to pay those costs.
Insurance then simply turns around and demands more in premiums to offset their expenses, and the Government regulators allow them to charge whatever they can lobby for because they have no price or service competition and the Government often mandates their product offerings.
Whitetail has nailed it here in terms of changing the way health care delivery systems are managed in this country. It must be driven by consumers, armed with prices and transparency behind the true costs of services and competition so they can compare value, quality and costs to make their health care decisions.
It's not the total answer...we must end community rating, "redlining" and other Insurance company abuses... but placing Consumers in charge of driving health care costs instead of third party cost shifters is the beginning to reigning in the price of 100.00 aspirins and 100,000 dollar gall bladder operations.
Excellent post.
By routine I assume you mean a well-visit...then you come in and say by the way doc I have this rash/pain. The you well-visit turns into another type of visit that requires a modifier so the doc can bill appropriately and get paid. Oh then since there is now a problem component to your visit your co-pay may now be different. All the while your standing there in your skivvies trying to figure out if you want to pay for that or not. Or you can decide to come back for that problem (and a different co-pay possibly), but you might not be able to get back in for some time and damn does that rash itch. And if the doc doesn't code it right, then it might hit your co-insurance (first of the year and you get a nice bill after the fact).
So you decide to have the doc look at the rash - how detailed do you want him/her to be...this is where the various levels come into play. Do you want to decide the history they take, the physical exam, and the level of medical decision making? Do you know which E&M guidelines they're using - 95 or 97? Still in your skivvies scratching rash trying to decide or just say **** it and take the itch away?
Damn!
I thought it was just that Hoochie Momma I picked up while I was drunk at a bar that night.
She didn't smell very nice, so I wondered when was the last time soap and water made it below her waist?
Does the doctor know how much those things cost? If so, then publish them.
I look down the list .... "skin condition evaluation" ... rash $50, acne $30,
Somebody at the doctor's office knows what to charge for everything that just went into that, so publish it and make it readily available. Then I can look down the list and see how much it's going to cost. Maybe the doctor has already treated a rash like that for me, so all they have to do is look and confirm its the same and prescribe what they did before. Somebody else, maybe they have to do the testing.
The point is that THEY know ... so publish it so that everybody knows.
Part of the reason insurance is so expensive is because they need so many damn people at the doctor's offices just to do the billing for the insurance, which makes the doctor have to charge more to cover that overhead, which makes the visit more expensive.
There is no "skin care evaluation" on the list.
If it were only that simple
It is simple ... and you completely missed the point. I can only assume that you missed the point because you don't want to acknowledge it.
So "skin care evaluation" isn't on the list ... but whatever the doctor did, IS on the list and the list could be published in a somewhat user friendly format.
There is no reason in the world why it can't ... other than to refuse to see it because it hasn't been done before.
I never said implementation would be easy, but the concept is. We've done a lot harder stuff than this.
The list can't be simplified because you don't understand how the doc decides what level of service you received until he or she actually does it...and even then some docs may do more or less than another doc and that impacts the charge.
We'll just have to agree to disagree.
Right now ... I go to the doctor ... she does whatever, and runs whatever tests and she hands something to somebody that does the billing. That person then looks at what was done and then they look at something that shows what to charge.
Or are you saying nobody knows how much anything costs and they just make something up?
If they aren't just making it up ... then there is something that shows what to charge for what service ... but you're saying it would be impossible to make that publicly accessible?
I'm saying when you come in the door for a sick/problem visit the doc doesn't know what he or she is going to do until they start examining you...do you want them to stop mid-way and give you options for everything? Would you understand what they're talking about. Right now they get paid (E&M levels) based on how much work they put into your issue (simplistic explanation) it's not just a #4 on the value meal that you can upsize the soda and/or fries.
Sure they could make a price list available but I doubt you'd know what most of it means...and it wouldn't guarantee that when you went in a said I just want the level III visit that they may need to do more work because of what is going on.
Fair point, but WhiteTailEER is saying how do they determine what to charge you once they decide what you need? (under your scenario)
I'm not against them ordering what's needed to treat you, but why can't we have some say in what it costs?
What's the big secret?
The docs aren't necessarily looking at what the charge will be, they're looking at what they think you need. Some places might use a fee sheet but most are using an EMR nowadays and they're either ticking things off in the EMR or a coder is abstracting off their notes to create the charge or a combination of both.
How that charge/dollar amount is determined is based on variables and each office is probably slightly different.
It will never be like McDonalds where you can stroll in and pick off a menu.
I understand that, but in the free market prices for goods and services are determined by something other than a Doctor's healthcare checklist!
Where do they get their information to charge what they bill to the Insurance companies?
Do they simply use a "sliding scale" or do they have a list of prices drawn from a market based analysis of the demand and actual costs of the services?
If that list exists, why can't we as consumers also have access to it? Who's ultimately paying for this stuff?
WhiteTailEER and I agree on very little, but he has a point if you agree with me that we have to do something about runaway costs of health care if we're ever going to begin to solve this problem of Health care coverage.
I favor a market based solution which would necessarily include consumer information about prices and the ability for them to pick and choose services that fit their ability to pay for them.
Neither ACA nor the proposed AHCA addresses this central issue in the health care cost crisis facing this country.
He is 100% correct about that much at least.
Reimbursement is negotiated with each payer...price is can be set at what the highest amount a payer will pay. If someone is going to pay you $100 for X, would you set your price at $100 or something lower? People don't care about prices because they aren't usually paying anything but the co-pay. Until they put some skin in the game, price transparency means very little.
I agree with this 100%, and this is the reason we need a market based solution that removes third party payers and demands transparency for costs of health care services.
Mandates by Government, and Insurance companies being allowed exclusive access to markets does nothing but drive costs way beyond consumer's ability to pay for them.
Health care providers bill whatever they think Insurance will pay as you correctly described here, and insurance companies under mandates and with limited competition simply pay those charges then bill their policy holders for the losses.
It's not based on any rational understanding of how most of us decide how much of our money to spend because as you've correctly pointed out, we have no skin in the game.
Price sheets, competition, transparency, and other market based solutions are the prescriptions needed to put patients in charge and making health care providers responsive to those consumer choices and demands.
We can figure this out and make it work, but we have to get the Government, Health care providers and Insurance companies to accept the fact that a free market works every time it's tried.
Healthcare providers don't bill what they think the payers will pay...they have negotiated the reimbursement ahead of time. And then what ever the highest reimbursement is for any given visit/procedure, then that is the charges across the board for all. Patients don't get balanced-billed for everything - depends on their insurance and how their plan is set-up.
We don't necessarily need to remove payers - but rather shift in paying for outcomes versus procedures. And even then that is not the only variable that will impact the cost curve. There is the cost of education, the cost of new/better equipment, the cost of regulation, the cost of lawsuits, etc.
Agreed. However all of those "costs" are knowable, measurable, negotiable, and should be made available!
Why is health care delivery such a "privately held" secret among providers and Insurance companies? Who pays the Insurance companies?
WE DO!
Don't you want to know why the aspirin they're giving you and your Insurance company is paying for costs 100.00 a pill when you can get a whole bottle @ 200 mgs of the same sh*t at Walgreens for 7.95?
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When you go to Walgreens for that 'cheaper' aspirin...who is getting it off the shelf...who is administering the aspirin...what are the regulations surround the transaction at Walgreens versus in the hospital...who is checking to see if the aspirin is safe for you or not? I could go on, but the argument is apples to oranges.
That's not even what I'm saying.
Everybody is missing the point entirely.
OK, when I go in, I won't know if it will be level I II III IV or V visit. That doesn't even matter.
What I'm saying is to make publicly available what everybody charges for those levels of a visit. Chances are that they are going to be higher across the board for one doctor or clinic than another one. Maybe not, but I'd say that if Level I care is higher then Level V care will be too.
I get charged $5 to fill an extra vial of blood when they are doing blood work. I have one vial that I have to send to the transplant folks every month on top of the other blood work. Maybe somebody else charges $10 for that, or another won't do it at all if they aren't doing the lab work. If things like that were publicly available, I'd know that.
Yes, it's a vastly different paradigm ... but as flawed as ACA is/was, it was an attempt to address a real issue. That issue still exists. Variations on the same theme aren't going to fix it, it's going to take a different approach.
Maybe, but the principle is the same. Consumers have those prices at Walgreens in front of them to compare, and if there was some Hellatious aspirin @ 200.00 a bottle I doubt many consumers would be buying it unless word got out that it gives you one Hell of buzz!
I get what you're saying, but unless we find a way to put patients in charge of determining some of these costs and if they're justified in a competitive market vs other services, we are headed for a single payer system.
I don't know about you, but I don't want my health care coming from a VA modeled facility.
No thanks.
I don't agree the ACA attempted to fix this aspect of runaway costs, through it's mandates and subsidies for folks who can't pay, costs for care services and Insurance skyrocketed.
But the issue is real. It still exists. 100% correct on that.
It is going to take a radically different approach similar to themes expressed in this thread. A Market based solution in my opinion is the ultimate answer, but that's tough to implement when so many people refuse to pay for the care they need or can't pay for it.
That scenario is a lot tougher nut to crack, but I think it begins with price and cost transparency, market based competition, and consumers in charge of how their health care dollars are spent instead of detached third party payers either from the Government or Insurance companies.
You will never escape what something costs, including Health care. If you're interested in reducing costs, you don't want the Government paying for everything.
It won't be something anyone can afford, and ultimately will end up being something very few actually get.