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The anatomy of a ripoff

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Re: The anatomy of a ripoff

#141

Post by dbcfd »

adolph wrote: post #109
dbcfd wrote: post #22

Earlier quoted context omitted.

Nope, that's capitalism. Someone (the insurance) is willing to pay that price. It'd only be fraud if the government was paying for it. [Edit]Some hate against my comment. For those that fail to understand... It isn't fraud if you go to a gas station that is charging $0.10 more a gallon, and fill up there. It's fraud if you pay for that gas, and its water. The insurance is still buying the same drug, they have just ch…

Taking advantage of the predicament of others is not capitalism; it is price gouging. It would be one thing if the consumer were able to compare prices and other aspects of the product and make a choice based on the consumer's values (of which price may not be the most important thing). This is a bit more like a gas station charging 10x more during a hurricane evacuation.

Price gouging is an aspect of capitalism. Demand goes up, price goes up. Without market interference, this should force demand down.

Health care can't be forced down by price (at least, life saving health care), so you either have to stop providing care to those that need it but can't pay, or pass along the costs to others.

Re: The anatomy of a ripoff

#142

Post by tdfx »

I'm in the US. I just recently switched to a high-deductible plan last year with an HSA account. My deductible is $5000 and my monthly premium is $98 (for an individual plan -- self employed here). I have and plan to always contribute the maximum amount to my HSA each year. My plan covers 2 checkup visits a year, and everything else I pay out of pocket up until I hit my deductible.

I really think this is the way insurance should be. I have a strong incentive not to needlessly get every possible test done or seek medical care that I don't need. I check my bills very carefully. I already located urgent care clinics that I can go to when I don't really need to visit the ER. I won't go to the doctor for a runny nose. It makes consumers care about costs.

I'm far from an expert on US healthcare and I'd love to get other peoples' more informed views on this. Could we put everyone on high deductible plans? If people can't afford their premiums or deductibles then perhaps there could be government assistance to pay those things based on their income. What would the pitfalls be in such a system?

Re: The anatomy of a ripoff

#143

Post by afterburner »

ipince wrote: post #134
afterburner wrote: post #126

Earlier quoted context omitted.

Sounds like it's still your money being spent. Do poor Americans typically have HSAs? Could people afford multiple hits? Where does the money come from after the HSA has run out?

Of course its still your money being spent (though you get some tax benefits). People should be able to afford one deductible per year. Not sure what you mean by multiple hits. I agree with yummyfajitas, but bottom line is, you should only get a high deductible plan if you can afford it. Thinking about a 5k bill as you head to the ER shouldn't be a problem then. If you can't afford it, d;not get it. Of course, therei…

Multiple hits meaning more surgeries per period that the savings can be refilled. Like, say, if you get into a major accident requiring multiple surgeries, or get a condition that requires multiple surgeries or extensive treatment. People can get seriously ill, not just "average" sick.

Re: The anatomy of a ripoff

#144

Post by tomjen3 »

afterburner wrote: post #143
ipince wrote: post #134

Earlier quoted context omitted.

Of course its still your money being spent (though you get some tax benefits). People should be able to afford one deductible per year. Not sure what you mean by multiple hits. I agree with yummyfajitas, but bottom line is, you should only get a high deductible plan if you can afford it. Thinking about a 5k bill as you head to the ER shouldn't be a problem then. If you can't afford it, d;not get it. Of course, therei…

Multiple hits meaning more surgeries per period that the savings can be refilled. Like, say, if you get into a major accident requiring multiple surgeries, or get a condition that requires multiple surgeries or extensive treatment. People can get seriously ill, not just "average" sick.

The details may change between the policies, but I do think the limit is per period, not per incident (how would you classify that, anyhow? Does several rounds of chemo count as one, or more incidents?).

Re: The anatomy of a ripoff

#145

Post by drumdance »

CWuestefeld wrote: post #3

My wife is the manager of budget and reimbursement at a hospital, and from many conversations with her, I can imagine that this article is accurate. However, if I were writing this, I would have given greater emphasis to the effect that Medicare has on these problems. The article does mention that Medicare typically pays fees that are below actual cost for the procedures, and that hospitals must therefore increase ch…

Here is a good article about how wildly Medicare costs can vary from place to place: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_...

The second highest reimbursement district in the country is in Texas, which passed a draconinan tort reform law back in the 90s (if memory serves), so you can't blame courts or defensive medicine directly.

Re: The anatomy of a ripoff

#146

Post by a5seo »

snorkel wrote: post #139
a5seo wrote: post #8

Bottom line is that if you're middle class and don't have health insurance, a serious accident could bankrupt you. The system was designed with the idea that you don't exist, and would never actually pay the rack rates that hospitals charge. Planet Money had some good coverage of the joke that is medical billing a couple of years ago: http://www.npr.org/blogs/money/2010/07/06/128338526/ex-ambul... http://www.npr.org/…

I don't understand why an uninsured patient who pays out of pocket can not dispute the charges and prove that the price has been fraudulently inflated due to "cost shifting".

You can /try/ to negotiate, but you don't have much leverage after the fact. If your BATNA is going bankrupt, you get into a game of brinksmanship.

Should you really have to threaten to declare bankruptcy to settle a hospital bill?

Re: The anatomy of a ripoff

#147

Post by drumdance »

tdfx wrote: post #142

I'm in the US. I just recently switched to a high-deductible plan last year with an HSA account. My deductible is $5000 and my monthly premium is $98 (for an individual plan -- self employed here). I have and plan to always contribute the maximum amount to my HSA each year. My plan covers 2 checkup visits a year, and everything else I pay out of pocket up until I hit my deductible. I really think this is the way insu…

Just curious, what's the maximum you can contribute? If it's $5k, that works out to about $416/month, so you're total monthly cost is $514.

Re: The anatomy of a ripoff

#148

Post by drumdance »

tansey wrote: post #41

Can someone please explain to me why it would be a bad idea to make it illegal for hospitals to negotiate rates? It seems like the majority of the problem here is that we let the insurance companies bargain with hospitals, so everyone pays a different rate. Just make everyone pay the same rate and let insurance worry about how to drive the costs down across the board by encouraging people to get/stay healthier and re…

This American Life did a story on this a while back. I don't remember all the details, but it turns out that insurance companies have very little bargaining power with hospitals in general. What ends up happening is that one or two carriers dominate a given local market and get preferential pricing, and everyone else either leaves or doesn't try hard to compete.

Re: The anatomy of a ripoff

#149

Post by bzbarsky »

afterburner wrote: post #143
ipince wrote: post #134

Earlier quoted context omitted.

Of course its still your money being spent (though you get some tax benefits). People should be able to afford one deductible per year. Not sure what you mean by multiple hits. I agree with yummyfajitas, but bottom line is, you should only get a high deductible plan if you can afford it. Thinking about a 5k bill as you head to the ER shouldn't be a problem then. If you can't afford it, d;not get it. Of course, therei…

Multiple hits meaning more surgeries per period that the savings can be refilled. Like, say, if you get into a major accident requiring multiple surgeries, or get a condition that requires multiple surgeries or extensive treatment. People can get seriously ill, not just "average" sick.

The $5000 deductible is per year. Your typical decent high-deductible plan will have a $5000 deductible and 100% coverage thereafter until year end.

The worst-case scenario with such a plan is that you end up with a chronic condition that requires extensive treatment every year, at which point it will cost you $5000 per year. Oh, and that's typically a per-family deductible, not per-person.

Just to put that in perspective, health care spending in the US as of 4 years ago was about $7400 per person. It's likely higher now. So if we managed to get into a situation where everyone was spending $5000/year on the deductible and $100/month on premiums, that would actually be less spending... and that assumes that everyone is sick all the time.

Now in practice, we won't get there; even high-deductible plans cost have more than $100/month premiums when you take away employer subsidies. But the point is that having high deductibles and HSAs that automatically get money put into them every year for those who can't afford to do so themselves is not a completely unreasonable approach to the situation. Actually getting the politics and details worked out could take some work, of course.

Re: The anatomy of a ripoff

#150

Post by Splines »

yardie wrote: post #38
yummyfajitas wrote: post #28

Earlier quoted context omitted.

This is why high deductible insurance offers the best hope for cost control. Too bad it becomes illegal in 2014.

I think it only delays the inevitable and ends up making things worse. If people don't have the money for surgery (and really how many of us can pull ou $5000, right no). They'll delay it. Delay it too long and that $4000 surgery becomes a $50000 intensive care, emergency operation.

and really how many of us can pull out $5000, right now

If you don't have an emergency fund (~$1000) and a few months of living expenses saved up, please try and do so.

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