I'm a fairly sharp guy, but I've never fully understood this whole concept of networks. Is it tied to how much government is involved in someone's insurance plan?Florida attorney and former hospital president, Steven I. Weissman, sent President-elect Donald Trump a petition to end predatory pricing in the healthcare industry. The petition, signed by more than 104,000 Americans, was delivered Wednesday evening to Trump Tower in New York City. It is the first petition of its kind, and the first one the president-elect has received regarding healthcare.Weissman became the president of a Miami hospital when a friend, who founded the hospital, passed away. During his tenure as president, Weissman was able to get an inside look at how healthcare operates in the U.S., and, in his own words, it was “sickening.”“The biggest problem in healthcare is that there is no pricing at all,” Weissman tells The Daily Caller News Foundation. “It is not a coincidence that the only product or service permitted to be sold in the U.S. without legitimate pricing, is the one which has imposed tremendous financial hardship.”What Weissman claims is an accurate depiction of what is going on under the noses of consumers, and it can actually be corroborated. Take the cost of sending a simple blood test to a laboratory for analysis. The cost of that one blood test can range from $10 to $400 at the same lab. The differing rates for the same blood tests causes the system to waste an enormous amount of money. For instance, Medicare paid $910 million more than it would have had it paid the rates of state Medicare plans and private insurers in 2011, according to a 2013 report by the Department of Health and Human Services’ Office of Inspector General.There are even more dramatic examples. Say a patient is presented to an emergency department with chest pain, a condition that could prove serious as it is an early sign of an impending heart attack. The bill incurred by the patient for hospitalization for chest pain can range from $3,000 to $25,000, or more.Even if a patient actively sought prices for a given healthcare service, they would have no means of obtaining accurate, valid information.If a patient were to ask what the price of any healthcare service costs, they would be met ubiquitously with one question: What insurance do you have? Gouging occurs because the cost to the patient is not set, it’s determined by “how much can be extracted from each patient on a case by case basis,” Weissman explains to TheDCNF. Effectively, what Weissman is spelling out is that there is no base price for any service in the healthcare industry. Because billing rates are not set, the industry is essentially able to prey on patients at their most vulnerable.Weissman thinks Obamacare needs to be repealed and replaced in order to help fix the problem of rising costs, but in conjunction with legitimate pricing measures.“Until there is a requirement for legitimate pricing, we will really never know what prices are supposed to be,” Weissman tells TheDCNF. “Whether we have single-payer, Obamacare, or free market healthcare, we need to know what a legitimate price is or we can never solve the problem.” In our current system, “there is no going rate,” Weissman explains.Pricing occurs through insurance providers. Patients purchase a health insurance plan, either on the Obamacare exchanges or through a private company, and then enter into a network of hospitals and physicians that are covered in their package. Patients can find out what physicians might charge within their network, but is the extent to which there is any price transparency in the healthcare market.“If my neighbor’s paying half as much, I’m not entitled to know that,” Weissman explains. “Eliminating networks would be such an unbelievable improvement.”The problem networks pose for pricing in the healthcare market are easily seen in the working relationship between hospitals and insurance companies. Typically, a patient is presented to a hospital in need of medical care and comes in to talk about the finances and an insurance plan. The person asks, “how much money do I need for this?”The hospital system has to spend hours getting on the phone to get all the necessary information from insurance companies. Essentially, the physician can’t get the patient an accurate figure until they consult their insurance provider.“This causes billions of dollars, and thousands of wasted hours,” Weissman tells TheDCNF. “Insurance companies employ entire teams of people to work with physicians and hospitals on pricing, and this could be eliminated by having a posted legitimate price.”If there were legitimate prices posted, instead of being limited to just a few hospitals and limited number of physicians in a given network, “patients could go to any doctor in the United States,” Weissman exclaims. If networks were eliminated and prices were set by the free market, “no one can charge a patient these fantasy prices that are currently the norm, because they would be violating the law,” Weissman says. “It should be illegal to not have a real price.”“When Americans can shop competitive pricing for good value, our system will become the world’s role model for efficient healthcare. Total U.S. healthcare costs as a percentage GDP will be slashed and health cost misery will end,” Weissman concludes.
(I'm currently experiencing the mysteries of this "network" business, foregoing a fairly advanced device for one situation, and a scan for another, because the doctors who ordered them are not in the network of my new insurance provider. You see, my old provider got out of the "marketplace" business.)
While I may be fairly sharp, I am a huge fan of simplicity. That's one of the main appeals of free-market economics for me. You inquire with someone offering a good or service about the price. The response either suits you or it doesn't. Even other types of insurance work this way.
I hope this guy is consulted by both the legislative and executive branches as we disentangle ourselves from the "A"CA. He has a thorough understanding of what is so currently hosed up, and of what the remedy is: good old economic freedom.
Replace and Execute will press me.
ReplyDelete?
ReplyDeleteImpress me. Sorry, cell phone transmission
ReplyDeleteFYI, networks are variations on HMOs and long preceded Obamacare.
ReplyDeleteA health maintenance organization (HMO) is a type of managed care organization (MCO) that provides a form of health care coverage that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract. The Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options.[90] Unlike traditional indemnity insurance, an HMO covers only care rendered by those doctors and other professionals who have agreed to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers. Benefits are provided through a network of providers. Providers may be employees of the HMO ("staff model"), employees of a provider group that has contracted with the HMO ("group model"), or members of an independent practice association ("IPA model"). HMOs may also use a combination of these approaches ("network model").[23][91]
https://en.wikipedia.org/wiki/Health_insurance_in_the_United_States#The_rise_of_employer-sponsored_coverage
Sounds like government interference in the market to me.
ReplyDeleteInsurance has traditionally been the most regulated industry because of all the abuses that came before. Wherever there is a large pool of $$$, the potential for abuse abounds and it is often difficult for the state to continue to preserve domestic tranquility. You do want cops, dontcha? At any rate, networks are nothing new. But, be my guest, all ye neo movers/shakers, shake it all up and we'll just have to deal with what we get. Make it all perfect now. But I really don't think that's your goal at all. More like, pad your coffers and hide the trail, fiduciary obligations be damned, if they can get by with it.
ReplyDeleteFrom your wiki excerpt: "require employers."
ReplyDeleteBad and wrong.
Where the hell did the Congress of 1973 get off having government make private organizations offer anything whatsoever?
But you're right, employer paid plans only entered a tight job market in the 50s to attract employees and by 1973 gummit is mandating HMOs. It would be interesting to know more about the history of the development of health insurance in America, but it would be boring.
ReplyDeleteMr Barney it is really Mr Dings understands insurance throughout. Maybe we begin to price procedure and medicine more in accordance with other western nations? I do enjoy watching you joust.
ReplyDeleteNo, Michael, "in accordance with other Western nations" is an utterly meaningless formulation
ReplyDeleteNaah, those other nations largely have variations of universal coverage plans and that's out for the bloggie. He'll only tear them down.
ReplyDeleteHealth care is a privilege to the bloggie. You've got to work, better yet, suffer to succeed.
ReplyDeleteWhilst the demigods play roulette with the world economy.
ReplyDeleteNeither President-elect Donald Trump nor Vice President-elect Mike Pence, who met with House and Senate Republicans at the Capitol, offered lawmakers details about their repeal plan — a centerpiece of their winning campaign — short of vague promises that Trump would take executive action after he assumes office in just over two weeks. And GOP congressional leaders would not say how they will proceed or even how long they will take to develop a replacement for the current law, widely known as Obamacare.
ReplyDelete“This is going to take a little time,” Texas Sen. John Cornyn, the No. 2 Republican in the Senate, said after the meeting with Pence.
http://www.latimes.com/politics/la-na-pol-obamacare-repeal-congress-20170104-story.html
That "privilege" charge is dog shit and you know it. Jut because something is not a right doesn't make it a privilege.
ReplyDeleteSo here we are in 2017, back to where we started in 2008, the signature domestic financial issue for many high and haughty and low and naughty back on the table, and all the double-talk, brouhaha and, what's an acronym for canine emesis (projectile)?
ReplyDeleteJust get government out of the picture and let people buy and sell health insurance the way they do everything else.
ReplyDeleteKinda difficult to take government out of it since,unless of course you or Trump disputes this, we have always anchored ourselves with laws instead of men.
ReplyDeleteIn America the laws have served to keep government out of human activity
ReplyDeleteI was only talking about reigning in health care costs. Our system is very over priced. I am sure we can agree we need to reign in medical liability settlements "drastically". As to Universal or pay to play, there will always be catastrophic (or) left unpaid in the emergency rooms of our hospitals. Lot of graft there. "Meaningless" I love that word. Daniel Webster," People mean well but they mean nevertheless."
ReplyDelete