[jdonn]

I had heard things about this before but here is an example of where tons of the waste in the health care system is.

I guess my real question is, why don't insurance companies examine all these bills more closely? Surely the man hours spent doing that would save far far more than they would cost, thus they could charge less and make more etc. What is their incentive not to do so?

I also gleaned another thought from reading that. Freakonomics speaks about how many things have become much cheaper over time due to availability of information. In other words it's easy to compare the costs of trading stocks, auto insurance, and such things and so the cost of those things is much lower than it would otherwise be since people can shop around. So why not require all hospitals to make public (and easily accessible) the costs of all their services so people could shop around between hospitals? Or even turn things down (no thanks I don't need a tylenol the cost of a flight to Hawaii!) Competition drives down prices, no?

[PassedOut]

Because the US spends twice as much per capita for medical care as do countries with more advanced systems -- while obtaining poorer results -- it is obvious that around 50% of the money spent is wasted. Even folks who are not in business can grasp that, but to business people that fact stands out like a sore thumb.

Quote

Consider this: For every dollar the nation spends on health care, 50 cents is wasted.

According to a 2008 report by Pricewaterhouse Cooper's Health Research Institute, wasteful spending accounts for $1.2 trillion of the $2.2 trillion spent on health care in the United States. The medical waste includes costs associated with inefficient insurance claims processing, defensive medicine, preventable hospital readmissions, medical errors, and unnecessary emergency room visits.

"Our best estimate is that for the country as a whole, probably half of what we're spending on health care delivery today is technically waste from a patient's perspective. There are better ways of doing it," said Dr. Brent James, chief quality officer for Intermountain Healthcare, a nonprofit health system in Salt Lake City, Utah.

The way a doctor chooses to treat a patient may also contribute to waste. Variations in treatments waste the health system $10 billion annually, according to the report. When a hospital like Intermountain swaps out expensive procedures for cheaper, equally effective treatments it actually loses money. It can no longer charge for those pricier procedures.

Because there is so much waste, any reasonable measures taken now cannot help but cut medical costs. There is just too much low-hanging fruit ready to be picked. With the amount spent on medical care in the US today, every US citizen should be receiving the best medical care in the world -- with the money left over being applied to the national debt.

I've mentioned before that I wish Obama and the democrats had gone more aggressively after the waste in the system, but I understand that they had to consider the firestorm of opposition from those who feed on that waste. However, it is absolutely clear that the reforms Obama advocates will cut costs now and in the future.

Because anyone with a head for business can see that too, I suspect that one of the reasons the republicans have been trying so hard to block reform is solely to prevent Obama from having the long-term success he is certain to gain if the bill ever becomes law.

[Lobowolf]

PassedOut, on Mar 3 2010, 11:07 PM, said:

Because anyone with a head for business can see that too, I suspect that one of the reasons the republicans have been trying so hard to block reform is solely to prevent Obama from having the long-term success he is certain to gain if the bill ever becomes law.

I think this is unlikely enough that you could count the number of republicans trying to block reform for this reason on one hand, and pay down the national debt with 5 leftover fingers.

[kenberg]

We have a mess. Here is an excerpt from Josh.s reference:

Quote

Expensive charges aren't always a mistake.

Rich Umbdenstock, president and CEO of the American Hospital Association, says hospitals mark up prices on medical bills to make up for lower payments the government pays through Medicare and Medicaid.

"They're making up for underpayments elsewhere," Umbdenstock said. "Certainly if you're the patient to whom the cost is being shifted you feel you are paying more than you should. The public programs need to pay their fare share. At the same time hospitals are trying to lower their cost of providing care, so that they don't have as great a gap."

We "save on waste" by lowering payments on Medicare. Charges are raised elsewhere to "make up" for the loss. A very skeptoical attitude should be taken to claims of savings. Often they amount to shifting charges to another category.

And consider: "Certainly if you're the patient to whom the cost is being shifted you feel you are paying more than you should." This only applies if that patient actually does the paying. If his insurance company pays, he may well not even know of the charges, and if he does know he doesn't much care.

last November I had a kidney stone issue. This involved a trip to the emergency room, a next day appointment with a urologist and a trip to surgery the following week where they put a camera and a laser gun up me and blasted it to bits. The charges are still being worked on. A few weeks ago we got a bill and it appeared we might actually have to pay something. My wife called and apparently there were some glitches. They will let us know when/if they get it all figured out. Even the professionals in the offices can't figure all this stuff out, and my procedure was modest as these things go. Snafu. Someday I suppose we will get a correct bill and we will pay it.

These things are not all that new, although they seem to have gotten worse. When my father died in 1977 I was the one to handle the (many) bills. One office just couldn't get it right. Eventually I wrote to them and said that if they ever sent a correct bill they would get a check by return mail, otherwise they should quit bothering me. They never sent a correct bill, I never sent a check.


Some sort of simplification is essential. Every year at re-enrollment time I get a booklet explaining my insurance options. It's about 150 pages. More information available upon request. Who reads this *****?

Anyway, savings would be good. Clarity would be good. There is, I think, some linkage between savings and clarity. Good luck to us all.

[PassedOut]

Interesting idea to address republicans' stated concerns: A Health Insurance Mandate With a Choice

Quote

But the Democrats could modify one key provision of their legislation — the mandate that individuals buy insurance — in a way that goes to the heart of conservative and libertarian objections.

President Obama clearly stated the rationale for the mandate at the last week’s health care forum. If Congress merely banned exclusions for pre-existing conditions, healthy people would have no reason to buy coverage until they got sick, and the insurance system wouldn’t work. So in addition to offering subsidies to enable people to afford coverage, the Democratic reforms impose tax penalties on those who remain uninsured — $695 a year or 2.5 percent of income, whichever is greater, under the president’s proposal.

There is another way, however, to accomplish the same purpose: let individuals opt out of the new insurance system, without a penalty, by signing a form on their tax return acknowledging that they would then be ineligible for federal health insurance subsidies for a fixed period — say, five years.

During that time, if they had second thoughts and decided to buy health insurance, they would have no guarantee that they could find a policy or that it would cover pre-existing conditions. In other words, they would face a market much like the one that exists now. And while that’s hardly a desirable position to be in, they would have made the decision themselves, and the option to step outside the system would relieve Republican concerns about government mandates.

Didn't we discuss just such a solution in the Water Cooler a while back? I'd say ten years instead of five though.

[kenberg]

I cannot recall if we discussed it but the idea had occurred to me, as I suppose that it has to many. When I retired, I could opt out of medicare. But if I did, I could not just waltz back in later. I don't recall the details but I think they were pretty intimidating and I opted in.

There are issues for young people though, the most obvious being that they often have family responsibilities. Opting out for yourself is one thing, opting out for your kids is a different matter. I doubt many of us would be comfortable saying "Tough luck, kid, your old man opted out".

Possibly this could be overcome. If adults want to go back to school, maybe for a GED after they opted out of high school when they were young, , it is expected that they will at least partly bear the cost. Their kids go to school for free.

Somehow I doubt we will be pursuing this option. We are either going to pass the current bill, largely intact, or else we stick with the current unpleasant approach.

[jdonn]

PassedOut, on Mar 4 2010, 08:54 AM, said:

Quote

President Obama clearly stated the rationale for the mandate at the last week’s health care forum. If Congress merely banned exclusions for pre-existing conditions, healthy people would have no reason to buy coverage until they got sick, and the insurance system wouldn’t work.

But saying insurance companies can't deny coverage due to pre-exisiting conditions doesn't mean they can't charge more to people who have them, no? I think the system would still work, although of course I understand the great incentive to have as many healthy people in the system as possible, both for them and for the less healthy.

Of course talk about whatever you want but I'm still wondering my original two questions. Why in the world don't insurance companies examine hospital bills more closely? And wouldn't it be a good idea to make hospitals post price lists for most/all of their services for the public to be able to compare against each other?

[hrothgar]

Lobowolf, on Mar 4 2010, 10:43 AM, said:

PassedOut, on Mar 3 2010, 11:07 PM, said:

Because anyone with a head for business can see that too, I suspect that one of the reasons the republicans have been trying so hard to block reform is solely to prevent Obama from having the long-term success he is certain to gain if the bill ever becomes law.

I think this is unlikely enough that you could count the number of republicans trying to block reform for this reason on one hand, and pay down the national debt with 5 leftover fingers.

I'm a betting man...

How much you want to put down? A thousand? Two thousand? More?

For the record, there are direct quotes from Republican strategists discussing the need to block health care reform to deprive the Democrats of any electoral success and prevent the emergence of a new constituency that supports government supported health care the same way they support Social Security, Medicare, COBRA, and the like.

There is also the HIGHLY amusing example of multiple Republican's voting against bills that they sponsored to deprive the Democratics of any legislative momentum...

[PassedOut]

jdonn, on Mar 4 2010, 03:43 PM, said:

I'm still wondering my original two questions. Why in the world don't insurance companies examine hospital bills more closely?

If the full congress votes to revoke the anti-trust exemption for insurance companies -- as the house as already done with a huge bipartisan majority -- the increased competition should help force that response.

[kenberg]

There used to be this song:

We sing the song of the sewer
Of the sewer we sing this song.
Together we stand
With shovel in hand
To keep things moving along.


For one thing, as my recent experience shows, the rules are so damned complicated that it is all they can do just to put the right numbers in the right lines. But consider the following hypothetical conversation.

Insurance Company: You clowns charged $25 for an aspirin. Was it laced with cocaine?
Hospital: It's what we charge.
IC: It's outrageous.
H: I can put you through to the manager
IC: Please do
HM: May I help you?
IC: What's with the $25 aspirin?
HM: We charge, you pay.
IC: We won't pay $25 for an aspirin
HM: The hospital no longer accepts your insurance.
IC: The check is in the mail

[PassedOut]

kenberg, on Mar 4 2010, 04:39 PM, said:

IC: What's with the $25 aspirin?
HM: We charge, you pay.
IC: We won't pay $25 for an aspirin
HM: The hospital no longer accepts your insurance.
IC: The check is in the mail

How does the conversation go when the bill is for 41 bags of IV fluid and the patient used only one?

[kenberg]

I expect there should be some serious auditing. Perhaps, even probably, there is, it would seem an obvious need. It would be interesting to know how much money goes to pay for services that are not actually done and how much goes to items that are posted up front but simply with ridiculous prices. My uninformed guess is that most of the time the patient actually gets the aspirin. Why put yourself at risk of criminal charges when it is so simple to just drastically overcharge?

Added; To look at the other issue raised, posting of prices by the hopstal, the patient simply doesn't care as long as he is just making a co-pay.

Further add-on: Some cost control exists. I regularly get bills that say: Your doctor charged x, medicare will pay y, you can be billed for z, where y+z<x. In fact this was the issue back in 1977 with the doc that I never paid. The office sent a bill for x-y, I called, they agreed the bill should be for z, next month they sent another bill for x-y. After maybe three months of this merry-go-round, I bailed. I'll still send them z if they ever send a correct bill.

[jdonn]

PassedOut, on Mar 4 2010, 04:45 PM, said:

kenberg, on Mar 4 2010, 04:39 PM, said:

IC: What's with the $25 aspirin?
HM: We charge, you pay.
IC: We won't pay $25 for an aspirin
HM: The hospital no longer accepts your insurance.
IC: The check is in the mail

How does the conversation go when the bill is for 41 bags of IV fluid and the patient used only one?

Perhaps everything used should be required to be signed for at or soon after the time of use, by either the patient or someone representing them (ie spouse or parent), at least when feasible?

[luke warm]

kenberg, on Mar 4 2010, 04:39 PM, said:

But consider the following hypothetical conversation.~~

most everyone blames the evil insurance companies, but that's not always the full story... for example, in many places it's almost impossible to find some specialists who are 'in network' with any company... you might be admitted to a hospital in your insurance company's network, have to undergo surgery, and a few weeks later get a bill from a radiologist and an anesthesiologist you never heard of... your ic will pay them, but usually the out net benefits come with a large deductible and larger than normal copays - and then you're balance billed after that

insurance companies negotiate with providers over the fee that will be paid... if a provider (and it's usually either a hospital or a provider from a specialty that has no need to sign a contract, such as an ambulance company or anesthesiologist - after all, what are your options?) refuses to contract, what can be done?

[hotShot]

jdonn, on Mar 4 2010, 02:28 AM, said:

I guess my real question is, why don't insurance companies examine all these bills more closely?

How would they benefit?
They just need to keep the balance between what they have to pay and what they charge you.

[gwnn]

girls are more complicated than healthcare

[jdonn]

hotShot, on Mar 4 2010, 06:27 PM, said:

jdonn, on Mar 4 2010, 02:28 AM, said:

I guess my real question is, why don't insurance companies examine all these bills more closely?

How would they benefit?
They just need to keep the balance between what they have to pay and what they charge you.

If insurance companies had to pay (say) $100 less per customer per year, they could charge each customer $50 less per year (thus gaining more customers) while at the same time earning $50 more profit from each customer per year. Or heck they could charge the same as they do now and just make an even bigger profit. No?

[Lobowolf]

hrothgar, on Mar 4 2010, 03:45 PM, said:

For the record, there are direct quotes from Republican strategists discussing the need to block health care reform to deprive the Democrats of any electoral success and prevent the emergence of a new constituency that supports government supported health care the same way they support Social Security, Medicare, COBRA, and the like.

That's a far cry from opposing it because they believe it will be a huge success that would reflect favorably on Obama.

[Lobowolf]

hrothgar, on Mar 4 2010, 03:45 PM, said:

Lobowolf, on Mar 4 2010, 10:43 AM, said:

PassedOut, on Mar 3 2010, 11:07 PM, said:

Because anyone with a head for business can see that too, I suspect that one of the reasons the republicans have been trying so hard to block reform is solely to prevent Obama from having the long-term success he is certain to gain if the bill ever becomes law.

I think this is unlikely enough that you could count the number of republicans trying to block reform for this reason on one hand, and pay down the national debt with 5 leftover fingers.

I'm a betting man...

How much you want to put down? A thousand? Two thousand? More?

For the record, there are direct quotes from Republican strategists discussing the need to block health care reform to deprive the Democrats of any electoral success and prevent the emergence of a new constituency that supports government supported health care the same way they support Social Security, Medicare, COBRA, and the like.

There is also the HIGHLY amusing example of multiple Republican's voting against bills that they sponsored to deprive the Democratics of any legislative momentum...

All my gambling money is tied up in March madness and boxing, and I'm also looking for a site that will take bets on whether or not the proposed healthcare bill, if passed, will be deficit-neutral.

[jdonn]

Lobowolf, on Mar 4 2010, 07:53 PM, said:

hrothgar, on Mar 4 2010, 03:45 PM, said:

For the record, there are direct quotes from Republican strategists discussing the need to block health care reform to deprive the Democrats of any electoral success and prevent the emergence of a new constituency that supports government supported health care the same way they support Social Security, Medicare, COBRA, and the like.

That's a far cry from opposing it because they believe it will be a huge success that would reflect favorably on Obama.

And that's a far cry from opposing it because Obama would have success if it became law, which was the original comment.