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Deacon923 said:
Sorry, I used a double negative. I agree with your last sentence in that post, I do not disagree with it. Totally agree that obesity and end of life care are huge issues.

I also agree that health care does not follow normal supply and demand rules. I don't really think it is possible for health care consumers to be meaningful participants in a fair market. the knowledge and power imbalance between the consumer and the provider is insurmountable. There has to be some kind of mediating force. In the US, that is supposed to be the insurance company, but it's a badly broken system and Obamacare is not going to improve it (at least as far as cost control). In many other countries, the government has taken over the role of mediating force. Some successfully, some less so.

Responding to CH and 2&2: because I think the market forces here are so unmanageable on an individual level, I have doubts that pushing HSAs and HDCPs will meaningfully affect health care costs. I think these kinds of things will induce people to skimp on preventive care, and do nothing to address overspending on end of life care, for example.
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But HSAs cover preventive at 100%. And nothing will fix end of life other than death panels. But there's a ton of commercial U65 spend it will impact. And thats where we need to focus on.
 
HSAs will never work for 80-95% of the public. In a country where the four Walton heirs own more than the bottom 40% (over 130 MILLION people), it is ludicrous to think a high number of Americans could ever afford HSAs.

The first thing that needs to be addressed is the outrageous fees the hospital charges and the insurers allow for everything from $15 bars of soap to $10 aspirin to the ridiculous costs for staying in facilities. No other nation on Earth allows such gouging. Until this is taken care of, we can't stem the costs.
 
CHDeac said:
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But HSAs cover preventive at 100%. And nothing will fix end of life other than death panels. But there's a ton of commercial U65 spend it will impact. And thats where we need to focus on.
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so what you are saying is that the "savings" part of HSAs don't actually pay for preventive, instead it goes into the insured part of the plan? The "savings" part pays for what then? Help me understand.
 
Deacon923 said:
so what you are saying is that the "savings" part of HSAs don't actually pay for preventive, instead it goes into the insured part of the plan? The "savings" part pays for what then? Help me understand.
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HSAs are actually 2 parts....a high ded health plan and the tax preferred account. Preventive care is covered at 100% on these plans, as required by the law. So no need pay for these out of the HDHP. The HDHP covers everything else like sick visits, Rx, accidents, etc. HDHPs should have equally high preventive take rates.
 
RJKarl said:
HSAs will never work for 80-95% of the public. In a country where the four Walton heirs own more than the bottom 40% (over 130 MILLION people), it is ludicrous to think a high number of Americans could ever afford HSAs.

The first thing that needs to be addressed is the outrageous fees the hospital charges and the insurers allow for everything from $15 bars of soap to $10 aspirin to the ridiculous costs for staying in facilities. No other nation on Earth allows such gouging. Until this is taken care of, we can't stem the costs.
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Except you know, for the fact that they are working for a lot of people not named Walton. Lots of data out there to support this.

Lets remember, employers can contribute to an HSA. So can other organizations like the state or the feds or even an insurer. Or just use it as a way to get tax free care outside of itemizing your deductions.

This model completely changes the purchase decision. And it also changes the "how much did you just charge me" dynamic. Insurers fight this all day (look at allowed amounts not whats billed) and we need to get consumers engaged on this too. So, this framework allows consumers to see the real costs and have a stake in the game in making better decisions.

Arguing "its all about the per unit price on the bill" is just too simplistic. We have to control demand (and lowering cost actually increases demand) This is one market driven way to do it that can be expanded in a way thats appealing to a lot of working class Americans. We have to get folks engaged in the financing of their care.
 
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CHDeac said:
Except you know, for the fact that they are working for a lot of people not named Walton. Lots of data out there to support this.

Lets remember, employers can contribute to an HSA. So can other organizations like the state or the feds or even an insurer. Or just use it as a way to get tax free care outside of itemizing your deductions.

This model completely changes the purchase decision. And it also changes the "how much did you just charge me" dynamic. Insurers fight this all day (look at allowed amounts not whats billed) and we need to get consumers engaged on this too. So, this framework allows consumers to see the real costs and have a stake in the game in making better decisions.

Arguing "its all about the per unit price on the bill" is just too simplistic. We have to control demand (and lowering cost actually increases demand) This is one market driven way to do it that can be expanded in a way thats appealing to a lot of working class Americans. We have to get folks engaged in the financing of their care.
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I know a lot less about this than you, I'll say that upfront. I am interested in learning more about the research showing that these things work to drive down costs without compromising outcomes. It would be great if you would provide some links.

I want to play devil's advocate here because intuitively I am struggling with how a typical patient is going to have any input into pricing simply because they are paying for some of it out of their HSA. Maybe for optional and elective procedures. Being a smart consumer of anything requires (a) substantial lead time before the purchase, (b) the ability to get educated about the product and (c) the existence of real competition in the consumer's market area. I'll discuss (a) in the next paragraph. (b) is a pretty big ask for most Americans given the complexity of health care. (c) does not exist in large portions of the country, especially away from the coasts. Even in Greensboro, one health system pretty much owns everything. I have the ability to research healthcare on the internet and transport myself to Winston or Charlotte or Raleigh to get a deal on a hip replacement, but a whole lot of people do not.

As for (a), lead time. How does an HSA have any impact on spending decisions for crisis care and serious illness - the really expensive stuff? If I have a heart attack tomorrow is my wife supposed to do some cost comparisons before calling the ambulance? Once I get to the ER, is she supposed to stand beside by gurney and demand the cheap stents? What happens if I get cancer? I'm going to blow through my HSA in about five minutes of chemo, the insurance piece is going to kick in, and I'm going to demand to be given every drug my doctor can think of to try and keep me kicking for a few more months, all on the insurance company dime. No cost control here.

I don't have the level of industry knowledge you do, as I said all this is playing devil's advocate for purposes of interwebz discussion. Thanks for your contributions to this thread so far.
 
Deacon923 said:
I know a lot less about this than you, I'll say that upfront. I am interested in learning more about the research showing that these things work to drive down costs without compromising outcomes. It would be great if you would provide some links.

I want to play devil's advocate here because intuitively I am struggling with how a typical patient is going to have any input into pricing simply because they are paying for some of it out of their HSA. Maybe for optional and elective procedures. Being a smart consumer of anything requires (a) substantial lead time before the purchase, (b) the ability to get educated about the product and (c) the existence of real competition in the consumer's market area. I'll discuss (a) in the next paragraph. (b) is a pretty big ask for most Americans given the complexity of health care. (c) does not exist in large portions of the country, especially away from the coasts. Even in Greensboro, one health system pretty much owns everything. I have the ability to research healthcare on the internet and transport myself to Winston or Charlotte or Raleigh to get a deal on a hip replacement, but a whole lot of people do not.

As for (a), lead time. How does an HSA have any impact on spending decisions for crisis care and serious illness - the really expensive stuff? If I have a heart attack tomorrow is my wife supposed to do some cost comparisons before calling the ambulance? Once I get to the ER, is she supposed to stand beside by gurney and demand the cheap stents? What happens if I get cancer? I'm going to blow through my HSA in about five minutes of chemo, the insurance piece is going to kick in, and I'm going to demand to be given every drug my doctor can think of to try and keep me kicking for a few more months, all on the insurance company dime. No cost control here.

I don't have the level of industry knowledge you do, as I said all this is playing devil's advocate for purposes of interwebz discussion. Thanks for your contributions to this thread so far.
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I'll see if I can dig up some links. A lot of what I see is research we buy from consultants et al so not for wide public consumption. I make no promises on what I can share.

HSAs don't really impact crises care or things like cancer. You are spot on there. So if you have a heart attack, you aren't (or shoudn't) be too worried about what an ambulance costs, etc. And the reality is these folks are all hitting their OOP limits anyway and getting 100% coverage so its not terribly relevant. But it is for a diabetic. And for the kid you breaks his arm. Or the person on cholesterol meds. And for the patient on cardiac rehab. I'm all about tackling the discretionary spend here, the $ we can influence. I think we tackle some of the other issues through reimbursement and outcomes. And medical policy. These are tough questiosn that we ultimately have to make as a society,

However, HSAs can provide an great incentive tool on prevention. Hey, if you quit smoking, we give you $x in your HSA. Manage your BMI? Same thing. I'm a huge believer that cash makes a difference in behavior, much more so than a poster in the break room.

I'll see if I can get a swag at the bucket of spend that HSAs influence.

Im not arguing HSAs are a panacea, they aren't, but they sure can help.

I'll put a more coherent set if ideas out once we get through this latest challenge of extending plans for a year...
 
His "research" and posts have all been to protect his own fiefdom.

It's ludicrous to bring up "charged" versus "paid". This is the only consumer based business where this happens. Insurance companies pass these outrageous price on. It's unconscionable to charge $15 for a bar of soap or $65 for a box of Kleenex or $10 for $.20 aspirin. CH will defend charging these prices but they make loan look beneficent.

"Except you know, for the fact that they are working for a lot of people not named Walton. Lots of data out there to support this."

This has NOTHING to do with the fact that FOUR people have more money than over 130+Million do as a group.
 
And why are we talking about how much money a family that founded a company that employs over 2.25 million people has? This thread is about Obamacare.

In other news, it turns out the President was briefed on the McKinsey report that said Healthcare.gov was going to suck ass. So much for "I learned about it on the news."

http://www.reuters.com/article/2013/11/20/us-usa-healthcare-idUSBRE9AI18920131120
 
RJKarl said:
His "research" and posts have all been to protect his own fiefdom.

It's ludicrous to bring up "charged" versus "paid". This is the only consumer based business where this happens. Insurance companies pass these outrageous price on. It's unconscionable to charge $15 for a bar of soap or $65 for a box of Kleenex or $10 for $.20 aspirin. CH will defend charging these prices but they make loan look beneficent.

"Except you know, for the fact that they are working for a lot of people not named Walton. Lots of data out there to support this."

This has NOTHING to do with the fact that FOUR people have more money than over 130+Million do as a group.
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What a hospital "charges" and what is allowed are very very different. Insurance carriers negotiate and pay of an their allowed amount. And I can assure you they negotiate to get these lower prices. Most insurers pay a per day or per admission amount based on DRG etc. so its not even relevant. And as Kramer told Jerry, retail is for suckers. I wont defend what a hospital charges, just explain how insurers reimburse.

I'm pretty sure you brought up the Waltons to suggest that HSAs weren't for anyone but the super rich, which is absurd. Or at least that's how I read your post. But your posts can be hard to understand at times (e.g. "but they make loan look beneficent".)
 
CHDeac said:
HSAs don't really impact crises care or things like cancer. You are spot on there. So if you have a heart attack, you aren't (or shoudn't) be too worried about what an ambulance costs, etc. And the reality is these folks are all hitting their OOP limits anyway and getting 100% coverage so its not terribly relevant. But it is for a diabetic. And for the kid you breaks his arm. Or the person on cholesterol meds. And for the patient on cardiac rehab. I'm all about tackling the discretionary spend here, the $ we can influence. I think we tackle some of the other issues through reimbursement and outcomes. And medical policy. These are tough questiosn that we ultimately have to make as a society,

However, HSAs can provide an great incentive tool on prevention. Hey, if you quit smoking, we give you $x in your HSA. Manage your BMI? Same thing. I'm a huge believer that cash makes a difference in behavior, much more so than a poster in the break room.
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1st paragraph: I do not understand how spending by any of the patients you mention is discretionary. We should be discouraging someone from taking their cholesterol meds? So we can pay for his heart attack later? What? That makes no sense. You can already control trend on these meds by requiring generics. Broken arm? What's discretionary there? I'm going to do cost comparisons before I drive my busted up kid to the ER? I just don't understand this.

The second paragraph makes a little more sense to me, seems like a lot of trouble to accomplish this though.

Respond when you can. Appreciate the discussion.
 
CHDeac said:
What a hospital "charges" and what is allowed are very very different. Insurance carriers negotiate and pay of an their allowed amount. And I can assure you they negotiate to get these lower prices. Most insurers pay a per day or per admission amount based on DRG etc. so its not even relevant. And as Kramer told Jerry, retail is for suckers. I wont defend what a hospital charges, just explain how insurers reimburse.

I'm pretty sure you brought up the Waltons to suggest that HSAs weren't for anyone but the super rich, which is absurd. Or at least that's how I read your post. But your posts can be hard to understand at times (e.g. "but they make loan look beneficent".)
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What is reimbursed is also skewed dramatically. We pay much higher prices for the same things than other G8 countries do.

As to my typing- over the past six weeks I've been dealing with three versions of "English" each day- British, American and Indian. It's starting to wear on me.
 
Deacon923 said:
1st paragraph: I do not understand how spending by any of the patients you mention is discretionary. We should be discouraging someone from taking their cholesterol meds? So we can pay for his heart attack later? What? That makes no sense. You can already control trend on these meds by requiring generics. Broken arm? What's discretionary there? I'm going to do cost comparisons before I drive my busted up kid to the ER? I just don't understand this.

The second paragraph makes a little more sense to me, seems like a lot of trouble to accomplish this though.

Respond when you can. Appreciate the discussion.
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I used discretionary to describe non emergency or non critical care. So the cholesterol med example was really aimed at things like generics or the extended release version that formularies don't always control.

When a generic is $25 and the brand is $200 (the allowed amount, not the copay), people should have skin in the game and chose based off true costs. Or when 2 drugs do the same thing and one is lot cheaper. We need to unmask the costs that copays hide. I'm all for people taking these meds if needed, I just want them to see the real costs to make a conscious choice and pay more if it costs more.

On the broken arm...Consumers have choices....ER vs. Urgent Care vs. Ortho Urgent Care....HUGE difference in costs. So arm hirts, do you rush to the ER or find a close ortho? Or wait until the next day?

My crazy idea is we score consumers on their effective use of the system and reward good behaviors and educate poor behaviors.
 
LOL. 50 - 100 million Americans work for small, young, entrepreneurial companies....

And Forbes has called this myth BS: http://www.forbes.com/sites/rickung...not-responsible-for-growth-in-part-time-jobs/

And the WSJ has called this myth BS: http://blogs.wsj.com/economics/2013...w-for-high-part-time-employment%2Ftab%2Fprint

And the Department of Labor has called this myth BS:
BN-AC009_HOURS2_E_20131022085315.jpg


And Reuters has called this myth BS: http://www.reuters.com/article/2013/10/22/us-usa-healthcare-hiring-analysis-idUSBRE99L1F220131022

But I'll take Gretchen Carlson's word for it....
 
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ONW said:
LOL. 50 - 100 million Americans work for small, young, entrepreneurial companies....

And Forbes has called this myth BS: http://www.forbes.com/sites/rickung...not-responsible-for-growth-in-part-time-jobs/

And the WSJ has called this myth BS: http://blogs.wsj.com/economics/2013...w-for-high-part-time-employment%2Ftab%2Fprint
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Thanks for the links. Unfortunately, none of them are relevant to the substance of the article. The article discusses existing small group policies being canceled because they do not meet the requirements of the ACA.

We've already seen big employers canceling the retiree health care coverage they previously offered. http://www.forbes.com/sites/brucejapsen/2013/08/06/citing-obamacare-employees-tell-retirees-to-seek-their-own-coverage/

If anywhere close to 50 million policies are canceled next Fall, the Dems will be lucky to hold on to the Senate.
 
Each and everyone of those articles are relevant to the "substance" of your article, they just illuminate the BS of the article you referenced.

You really think the Democrats are going to watch 1/5th of the potential voting public lose their health insurance in an election year?
 
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