Health Care Reform

[Voronwë the Faithful]

I don't have an inside view, but I think the answer is pretty clear. Rampant bureaucracy.

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[yovargas]

I mean, fine, but why is there so much more "Rampant bureaucracy" in this industry than most others?

[Voronwë the Faithful]

I don't know, really. Maybe "inside view" Ax can help shed some light on that.

[axordil]

ax, as someone with a bit of an inside view, do you have an insight as to why insurance has such high, consistent cost inflation? More than anything that seems to be the biggest problem and I don't think I've ever seen a good explanation for it.

Here's the part that messes with people's heads: health insurance companies historically don't make huge profits. Almost all of the cost inflation before the ACA, and possibly the bulk of it still, can be traced directly to providers, that is, to doctors, hospitals, drug companies etc. charging more and such getting passed along. Part of that comes from the actual treatments getting more expensive with time, but historically part is because of the costs hospitals in particular knew they would eat from treating patients who couldn't pay.

On the other hand, measures designed to keep costs down by detecting fraudulent claims or unnecessary treatments increase the cost of administrative software and personnel to run it, as well as making it take longer to process claims. Ultimately they may end up costing as much as they save. For all our attempts to automate the process, I would say 25% of our claims-related code is devoted to what happens when the automation doesn't work the way clients want it to and manual intervention (i.e. a claims examiner or claims auditor) becomes involved, while another 25% goes to attempts to replicate that manual intervention through arcane business rule flowcharts.

Health insurance is complicit to the extent it doesn't complain about the business model (or not nearly as much as it might). You would think insurers would *want* to point at a procedure costing eight times as much at one hospital in a state than another and ask for something to change, but t'aint always so. Reasonable and Customary tables, which govern what the maximum acceptable charge is, can be based on zip code ranges (reflecting higher costs in, say, urban areas for standard procedures) OR they can be bypassed in favor of negotiated pricing structures--which in theory can save money but generally don't, in part because of the time and money needed to hammer out the contracts and then enforce them, and in part because hospitals aren't stupid. They're going to game the system so any lowball procedures are balanced by undiscounted ones.

But that doesn't change the fact that insurance companies are an interlocutor of dubious worth in the first place, especially since hospitals and doctors and such pretty much have to charge extra to cover the costs of the people who work for them that (wait for it) are only there to deal with insurance. That's the double whammy in terms of bureaucracy.

Honestly I think doctors should be salaried and R&C tables applied without exception. It removes the moral hazard of getting paid more to do more, even when not necessary, and it pretty much gets rid of the need for 90% of the claims infrastructure in one fell swoop. And yes, some bureaucracy would still be needed, but for things like measuring outcomes. Example: right now a lot of hospitals are assembly lines for particularly lucrative procedures such as coronary artery bypasses that work very well in the short term... but whether their cost is worth the average extra few years they provide their patients is another question. For someone who's 50? Almost certainly worth it, as they may recover fully and live for many years. For someone who's 80? At that point it's not merely a half-a-million-dollar gamble that they will recover and get that extra five years surgeons talk about (but of course can't promise), but that something else won't kill them in the interim.

[yovargas]

Honestly I think doctors should be salaried...

How can doctors running independent practices earn salaries? Or are you referring only to docs at hospitals?

[axordil]

The number of doctors in individual practice has been dropping for some time--the mountain of med school debt (another topic for discussion) means new doctors gravitate toward become junior "partners" with existing practices or joining larger "medical firms" to avoid taking on even more overhead. But I think even most individual practices are now LLCs, for tax purposes.

[Voronwë the Faithful]

Will "Obamacare" continue to be like the character in the horror films that keeps coming back no matter how many times you think it has been killed? It seems unlikely with the GOP firmly in control of both houses of the Congress and a president that made killing it a primary campaign pledge, but things never are as easy as they seem. This article by Jonathan Chait of the New Yorker is a good description of the pitfalls that the GOP is already facing in trying to find a clear path forward.

Obamacare Repeal Might Have Just Died Tonight

[Primula Baggins]

Wow, I just read an article about politics and didn't feel consumed by horror and dread.

Huh.

Thanks, Voronwë!

[yovargas]

Fellow Republican Lamar Alexander says the same thing as Paul: “We have to take each part of it and consider what it would take to create a new and better alternative and then begin to create that alternative and once it’s available to the American people, then we can finally repeal Obamacare.”

Oh thank god. I was never much a fan of Obamacare but it obviously did solve some serious problems and just destroying the whole thing just because is so damn reckless if they don't at least try other real solutions to those problems.

[JewelSong]

They've had six years to be working on this. They have nothing. Nothing, nada, zilch, bubkes.

So...*now* they're going to create "new and better alternatives?" Srsly?

[Voronwë the Faithful]

Despite the somewhat encouraging statements made by some GOP senators, I can't say I am optimistic. When it comes down to it, I can't really see them bucking their leaders. We'll see, though.

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[Frelga]

Yeah, I am not at all optimistic.

Still. Again. Call your representatives. Especially if they are Republican, and especially if you are registered Republican.

[Frelga]

Yeah, I am not at all optimistic.

Still. Again. Call your representatives. Especially if they are Republican, and especially if you are registered Republican.

[Frelga]

Senate Takes Major Step Toward Repealing Health Care Law

“This is our opportunity to keep our campaign promise,” said Senator Roger Wicker, Republican of Mississippi. “This is our opportunity to help the president-elect and the vice president-elect keep their campaign promises and show to the American people that elections have consequences.”

Yeah, they do.

Call. Your. Representatives.

[JewelSong]

“This is our opportunity to help the president-elect and the vice president-elect keep their campaign promises and show to the American people that elections have consequences.”

I have heard more than one interview with people who voted for Trump yet depend upon the ACA for their healthcare. They stated that they really hoped the healthcare wouldn't be taken away. That they didn't think Trump would do that.

So, you know what? Maybe people do need to be reminded that, yes - elections have consequences. Repealing the healthcare law was at the forefront of the platform. Wonder how that will work out for everyone...?

[Primula Baggins]

I saw a screen cap of a Facebook post with a Trump supporter saying, heck yeah he supported the idea of repealing Obamacare, that worthless pile of garbage. And it wouldn't affect him and his family, because they had great insurance through the Affordable Care Act, so there!

[JewelSong]

I saw that too, Prim, but I am not convinced it is real.

[Primula Baggins]

Well, there's never a way to know, is there? Except on Twitter, where that kind of thing happens in front of your eyes. . . .

[yovargas]

It would be very unsurprising if it was real.
It would be very unsurprising if it was fake.

And thus the world we live in.

[Voronwë the Faithful]

Yup.

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