i'm still reeling from the price increase- stunned

gerry gill

Our company uses medical mutual in Ohio for health insurance. Just got the notice of a 27-1/2% increase for next year. Stunned...

ratio

Yup, it was cheaper to keep our insurance with a twenty-something percent rate hike than switching to something else. Our boss is pretty good about shopping insurance too.

It's gonna be ugly when this bubble pops.

kcopp

Don't expect it to stop there.... Fewer companies will be able to do business and then the gov will step in w/ single payer.
No one wanted to listen to reason....
" You had to pass the bill before you could read the bill"

adambnyc

Health insurance due to the government has taken a hit. We welcomed our third child into the world last year. My first two boys (8 and 4 now) cost me 300.00 each. That's it. Covered the complete hospital stay and my wife.

This last boy cost me 4700.00 out of pocket. I was blown away. The bills just kept coming in. And my premium went up as an extra slap in the face.

BobC

Before health insurance was commonplace routine medical care was pretty reasonable, as soon as insurance started to cover the costs prices ballooned. When you go to a doctor now your not just covering him and his receptionist. You now pay for those two plus a heard of clerks trying to figure out the insurance forms and a larger heard at the insurance company trying to deny claims. I think the biggest cost is all those very well paid managers and CEO's over the doctors and at the insurance company.

A similar thing has happened with our schools, the admin costs dwarf the actual cost of paying the teacher to do his job. In the 50's and early 60's a semester cost about $300, now it can be $10,000. The bad thing is the kids coming out of school don't have anywhere near the knowledge they did 50 years ago.

Bob

ChrisJ

Medical insurance is too much of a buffer, it makes it so people don't notice the actual cost they pay. I believe it's this way intentionally. Maybe it didn't start out that way, but it's what it is now.

Doctor visit costs $250? Prescription costs $500? Who cares, my insurance covers it. Wrong, you cover it because you're paying for it all year long.

I'm not going to get into a political argument over how to fix it etc, but what we have doesn't work and what we had before didn't work and it never will.

That's my opinion anyway.

Imagine what would happen if all of a sudden, tomorrow everyone in the US started paying 100% out of pocket for all healthcare, drugs, hospital etc and saw the prices on the spot.

Steamhead

ChrisJ said:

Imagine what would happen if all of a sudden, tomorrow everyone in the US started paying 100% out of pocket for all healthcare, drugs, hospital etc and saw the prices on the spot.

That may come to pass by this time next year. Be very afraid.

ChrisJ

Steamhead said:

ChrisJ said:

Imagine what would happen if all of a sudden, tomorrow everyone in the US started paying 100% out of pocket for all healthcare, drugs, hospital etc and saw the prices on the spot.

That may come to pass by this time next year. Be very afraid.

Oh, I am.

SWEI

My dad has been doing management consulting for small medical practitioners since the early 1960s. I could go on for hours, but the system is borked, plain and simple.

The only way "no problem with preexisting conditions" works is if "everybody's in." Allowing the large employers to keep their negotiated plans, insignificant individual penalties for opting out, and the ability to sign up "just in time" if you do get sick paired with a complete lack of real cost control did exactly what anyone with a brain could have predicted. Bend over.

Robert O'Brien

ChrisJ said:

Steamhead said:

ChrisJ said:

Imagine what would happen if all of a sudden, tomorrow everyone in the US started paying 100% out of pocket for all healthcare, drugs, hospital etc and saw the prices on the spot.

That may come to pass by this time next year. Be very afraid.

Oh, I am.

I believe it was all out of pocket in the early 60's which is as far back as I can remember and no one died from lack of care and the Dr's all drove Cadillacs

SlamDunk

If we had to pay 100%, doctors won't make money-fewer people would see doctors. Mortality rate would climb. Doctors would have to charge competitively. Doctors will likely stop being doctors and there will be a shortage of doctors. Lose a doctor then you lose a couple nurses and several admins. Unemployment would go up.

Drug development will disappear if no one can afford the drugs. In fact, drug companies may disappear. More unemployment.

It wouldn't do politicians , or us, well to ignore this or be stupid with it.

SlamDunk

This illustrates the stupidity of the situation:

http://www.newsobserver.com/news/business/article116988418.html

Sailah

My dad is an ER doc, still practicing. He thinks one of the big problems, in addition to the fine points made above, is end of life decisions. A vast sum of money is spent on the the final twilight hours of a person's life.

People come in with a terminal diagnosis and even if they have a DNR order the kids will say "Do everything you can to save Granny" and will rack up massive bills to prolong suffering for another month.

How do you balance those things? We've come so far with medicine that cures and procedures that were unthinkable 25 years ago are now routine. But they also cost a fortune. And it's a huge cost driver.

It's hard because the money side of things is a business decision but how can you be business-like about a family member or an old person?

The other thing he complains about is basically being forced to order all sorts of tests out of fear of being sued. He had a patient come into ER with a toe laceration a few years ago. Guy drops dead of a stroke 3 weeks later. Family sues saying he should have ordered the tests and that he presented at risk symptoms. Like what? Being clumsy?

All those dumb tests just rack up the costs of care and a lot of it is just silly.

I don't know what the answer is but I think the best solution is going to be when everyone in the country is unhappy about the deal. Including Washington, doctors, insurance companies, lawyers, patients and taxpayers.

SlamDunk

All excellent points!

Koan

"The other thing he complains about is basically being forced to order all sorts of tests out of fear of being sued. He had a patient come into ER with a toe laceration a few years ago. Guy drops dead of a stroke 3 weeks later. Family sues saying he should have ordered the tests and that he presented at risk symptoms. Like what? Being clumsy?"

Doesn't very toe laceration results in stroke in 3 weeks.

I hope the suit was dismissed. I guess it is human nature to want to attach cause and effect to everything. It is a shame some lawyers pursue getting money rather that pursuing truth. It is a shame some doctors do make mistakes and then cannot admit it fueling the need for attorneys to pursue. the problem I see is the thinking that punishing doctors financially will force them to make less mistakes. I am pretty sure one does not become a doctor to err intentionally.

Maybe different medically collaborative checks as to a patient's treatment would be a good idea, or some systems to minimize errors?

ChrisJ

SlamDunk said:

If we had to pay 100%, doctors won't make money-fewer people would see doctors. Mortality rate would climb. Doctors would have to charge competitively. Doctors will likely stop being doctors and there will be a shortage of doctors. Lose a doctor then you lose a couple nurses and several admins. Unemployment would go up.

Drug development will disappear if no one can afford the drugs. In fact, drug companies may disappear. More unemployment.

It wouldn't do politicians , or us, well to ignore this or be stupid with it.

So what you're saying is the prices are completely justified?
What about prescription drugs in the US costing far more than they do in other countries? For the same exact drug?


"If we had to pay 100%, doctors won't make money"

Who's paying for it then if not us? We are paying 100% for it, just indirectly. Employers pay part of an employee's health insurance rather than give them the money in their check. There's no magic here, we are paying for it, all of it.

My point was if everyone saw just how much they were paying, and what it was for, things would change real quick.

I don't know if doctors are making huge profits, I suspect a lot of this is also from overhead.



Kind of thinking this thread should be in "The Politics of Heating"

Sailah

Koan said:

Doesn't very toe laceration results in stroke in 3 weeks.

I hope the suit was dismissed. I guess it is human nature to want to attach cause and effect to everything. It is a shame some lawyers pursue getting money rather that pursuing truth. It is a shame some doctors do make mistakes and then cannot admit it fueling the need for attorneys to pursue. the problem I see is the thinking that punishing doctors financially will force them to make less mistakes. I am pretty sure one does not become a doctor to err intentionally.

Maybe different medically collaborative checks as to a patient's treatment would be a good idea, or some systems to minimize errors?

It wasn't dismissed, went to trial. They lost. But a bunch of money gets spent on lawyers to sue and defend those cases. All that gets passed along.

I think the problem with this specific area is that Drs are expected to bat 1000 every time. No one is that good. I make mistakes all the time, fortunately none are life threatening. But you're right when someone dies under someones care they want answers and correlate the death to your care. Even if the person smoked 5 packs a day and morbidly obese. Which is what I think was the case during that trial if I remember the details.

SlamDunk

never said prices are justified Chris. A big portion of a routine doctors visit goes to administrating insurance claims. Well, that has to be paid for, so maybe they are justified. Ironic. Pay insurance premiums and then pay higher costs for healthcare to pay for administering insurance claims that you already paid premiums for!

I Did use the word IF. Take away medical insurance and market forces take over. Doctors have, in fact , been reported to charge less if patients pay cash up front and not file a claim.

There is no politics on my part. Just expressing an opinion.

ChrisJ

SlamDunk said:

never said prices are justified Chris. A big portion of a routine doctors visit goes to administrating insurance claims.

I Did use the word IF. Take away medical insurance and market forces take over. Doctors have, in fact , been reported to charge less if patients pay cash up front and not file a claim.

There is no politics on my part. Just expressing an opinion.

Oh, I know that, same here.

But this really is a political thread as a whole in my opinion.
Hopefully, everyone will continue to play nice.

Abracadabra

Lawsuits against doctors have skyrocketed.
Everyone is looking for hitting the lottery when a medical issue pops up. Doctor's premiums go up, their fees go up. Doctors are moving out of my state to go to neighboring states to avoid the sue happy Illinoisians.

hot_rod

And who pays for these massive hospital expansions? Both of the large hospital in my area have been expanding for 15 years, massive, expensive expansion projects. They look like castles!

Seems it took 8 people to shuffle the paperwork for the last small procedure I had.

Doctors don't make the big bucks like in the past, unless they can pull a small independent specialty practice. Is it the HMOs reeling in the buck?

All the above, lawsuits, testing that is not needed, administrative cost, and trying to extending end of life decisions.


Drop the Govt Health Care and the ER's fill up with immediately with non insured getting top notch treatment.


How, and who cleans up a mess like this?

Harvey Ramer

We could each start by preserving our own health through proper diet, exercise and sleep habits. That would have a larger impact on health care costs than any other thing that could be done.

Paul48

My company gutted our medical insurance over the last 2 -3 years. On top of taking away paid breaks, which doesn't sound like a big deal, but on our schedule, it amounts to about 12%. We lost 3 holidays. For me, it's about 20 grand a year, all together, out of my pocket,above and beyond what was already coming out. We have no changes/increases for the coming year....yippeeee.....there's nothing left to take. Welcome to the club.

gerry gill

Paul48 said:

My company gutted our medical insurance over the last 2 -3 years. On top of taking away paid breaks, which doesn't sound like a big deal, but on our schedule, it amounts to about 12%. We lost 3 holidays. For me, it's about 20 grand a year, all together, out of my pocket,above and beyond what was already coming out. We have no changes/increases for the coming year....yippeeee.....there's nothing left to take. Welcome to the club.

Damn, thats brutal Paul48..i'm going to institute spending controls on 'stuff' and try to increase efficiency..but i really don't want to take from my guys..they are my only true asset! They are to important.

The Steam Whisperer

We've been hit with an 80% increase from Blue Cross. We are using high deductible policies with Medical savings accounts. It looks like the high deductible policies have taken the biggest hit. Also, there are now almost no Medical savings account approved policies available, so more of the medical expenses come from taxed dollars. The IRS also changed the % of income where you can begin taking medical expenses off your taxable income from 7% to 10% last year. However, we have found a potential alternative, Medi-share plans. It appears they can replace traditional Health insurance, and, from what I've read, are approved alternative in the "Obama-care" policies.... due to, believe it or not, the combined efforts of both some Democrats and Republicans. However, they do adhere to what some call "conservative" Christian policies, which causes them to exclude things like birth control, abortion. They also have a history of denying coverage for injuries caused by accidents due to driving drunk. Other "high risk" lifestyles that include smoking and obesity are either charged higher rates and/or are required to enter programs to address the issues. The costs for these programs are about 1/4 that of traditional insurance. Makes me ask where all that extra money is going.

I also believe that drug costs are outrageous. A little bit of online reasearch will reveal that drugs here in US are about 7 to 10 times more costly than elsewhere. This is comparing identical manufacturer products...no substituting generics! In fact, I found the generics to be higher than the original manufacturer's products in some I looked at.

SlamDunk

The Steam Whisperer said:

I also believe that drug costs are outrageous. A little bit of online reasearch will reveal that drugs here in US are about 7 to 10 times more costly than elsewhere. This is comparing identical manufacturer products...no substituting generics! In fact, I found the generics to be higher than the original manufacturer's products in some I looked at.

The US will not allow Medicare to bargain on drug prices collectively. Other governments have a more socialized healthcare systems that insist on collective bargaining.

Working in pharma, I can tell you this- The R&D, clinical trials, law suits and patent suits from generic mfrs, are HUGELY expensive risks. Once you get past approval stages hen you have to have a qualified facility to manufacture, package, store, and distribute your product. And, these facilities must meet the qualifications of every country the drug is sold. There are regular validation and re-validation of equipment, regular calibrations etc. etc.

A drug company called Chimerex had an antibiotic designed to help transplant patients. The drug had so much potential that, while in a blinded trial, the fda, social media, and the family of a sick boy guilted the company into giving the unproven drug to the boy. It worked! It also held promise to fight small pox if there was a bio terror attack. It was also widely used to fight the ebola epidemic. All while in trials. Their stock went from $12 to 50.

Then the results of the trial showed the drug was ineffective for its intended purpose and the stock plunged to $2! Currently trades at 5. Millions upon million was spent and lost and they have not even made it to the manufacturing stage. Drugs are not cheap! For everyone that makes it to market dozens fail. Eli Lilly just had an Alzheimer drug fail...

Koan

@Sailah
"It wasn't dismissed, went to trial. They lost. But a bunch of money gets spent on lawyers to sue and defend those cases. All that gets passed along.

I think the problem with this specific area is that Drs are expected to bat 1000 every time. No one is that good. I make mistakes all the time, fortunately none are life threatening. But you're right when someone dies under someones care they want answers and correlate the death to your care. Even if the person smoked 5 packs a day and morbidly obese. Which is what I think was the case during that trial if I remember the details."

This is a great example of a case where money is simply and unethically wasted for the wrong reasons. This case probably should have been dismissed before it got close to a court. Don't misread, there are cases where there is true injustice, but bringing a suit like this is an injustice as well. We need a system where if a case like this without merit is brought to trial, the defendant automatically gets awarded his or her legal fees.

The Steam Whisperer

I am not on Medicare. I am looking at open market prices on drugs. I also have no doubt that the costs to develop new drugs are huge, especially since I was trained at a worldwide recognized research University in Chicago and was surrounded by many others where research was occurring and have been involved in development work myself. It seems pretty likely that drug companys are making money on selling drugs at negociated prices in other countries, otherwise they simply wouldn't sell the drug in that market.... why would they if they can't make a profit on the sales? This especially applies to drugs where there is only one manufacturer and not competing drugs. If this is the case, then why do they charge 7 to 12 times more in the U.S.? If it costs x to develop the drug and produce it and they mark up the drug lets say 70% for profit at the negociated prices outside the US. bringing the total to 1.7x then why is the price 17x in the US?

PMJ

Health care in this country has been allowed to change from a public service to a business in the last 25-30 years. Doctors, hospitals, drug and insurance companies all advertise and sell just like any commercial business now. The problem is that normal business goals, especially financial ones, are not at all aligned with our health goals as patients. They are succeeding when we spend more not less. But if we were actually trending healthier on the whole we would spend less. Our fundamental interests are really not the same and to me this is dangerous.

The most fundamental indicator of a successful business is growing revenue. Watch what happens to the stock of any company with consistently falling revenue. So now that health care is a business run by businessmen, why are we surprised that their revenue (which is our total spend) goes up not down?

The most successful drug for a drug making business is the one they get people to agree to take forever like the statins, the most profitable drugs ever. A drug you take once and then don't need anymore (like the polio vaccine) because you are cured is definitely not good for business. Pretty obvious conflict of interest there. Notice that the list of drugs they prescribe for us to take forever(whether doing so is really good for us or not) just keeps growing. The long term use of prescription drugs is skyrocketing. This really should surprise no one. All the "businesses" in the chain, the maker, the doctor, the hospital, and the insurance companies wouldn't have it any other way. Revenues are up! Hmmm.

The major error was to allow health care to leave its previous status as a public service and become a business. Marketing drugs directly to the general public was actually illegal not so very long ago - and with good reason. This is one arena where otherwise normally healthy business competition will not bring about a good result. Too many fundamental conflicts of interest between the natural and normal goals of a business and our goals in leading healthy lives. It could easily be argued that the true financial interests of businesses in the health care industry are more aligned with our health declining than improving. Pause and think about that for a moment.

FranklinD

@PMJ - I totally agree with everything you said. My sister (a family practice/internal medicine doc) has said basically all the same things to me.

Her clinic is one of the few where you can choose a cash option and pay right then and there. I remember her setting a simple fracture in a farmers arm and putting on a cast for $300 total, X-rays and all. Not something that could be done in every part of the country, sadly...as stated before we are such a litigious society now.

I work for a small municipality and our healthcare costs went from a $300/month premium (family) and $1000 annual deductible (which I know was insanely low nowadays) to $380/month, an HSA, and a $6200 annual deductible, all overnight. ALL of the paperwork burden was shifted to us. I now have 2 three drawer filing cabinets FULL of medical documents...and my small family is relatively healthy. Pay more, get less.

I count us lucky that we still get a matching pension contribution and have one of the healthiest state retirement funds in the country. Unless Walker can screw that one up too...he certainly will try.

ChrisJ

@PMJ
I completely agree.

So,
How do we fix it?

Paul48

@PMJ
That is one of the most spot-on, concise descriptions of the root cause of the problem, that I've ever read. Now we have to make members of Congress have the same medical plans as us. That way, when these facts are pointed out to them, they will see the need to fix this broken system.

ChrisJ

Paul48 said:

@PMJ
That is one of the most spot-on, concise descriptions of the root cause of the problem, that I've ever read. Now we have to make members of Congress have the same medical plans as us. That way, when these facts are pointed out to them, they will see the need to fix this broken system.

Yeah,
How exactly do we get that done?

PMJ

ChrisJ said:

@PMJ
I completely agree.

So,
How do we fix it?

@ChrisJ

I truly do not have an answer for that question. I am afraid the the numbers just continue into la la land until it all blows up.

Health care is not an "industry" like steel or automobile manufacturing, just isn't. It is a cost item not a wealth generator. But otherwise intelligent people talk about it like an equivalent industry. With this much misunderstanding out there I don't see the smooth way out.

NY_Rob

Something has to give sooner or later.
In my profession- we handle many medical accounts, In the last several years I've seen quite a few doctors retire early- mostly due to the amount of stress and bureaucratic compliance nonsense they're forced to deal with nowadays on a daily basis.
Due to financial issues, many of them don't even own/control their practice any longer even though their name is still on the sign on the building.... they're just an employee now and must produce just like the rest of the 'staff'.
One of the accounts we deal with started with under 10 dr's... five years later they have now adsorbed another 40+ local physicians- all just 'employees' now who answer to the Practice Administrator or her assistant, or the assistant PA's assistant! One Dr we know personally (his father was our local Dr back in the 70's) told me his father would be "rolling in his grave" if he knew his son sold out his practice to this group.

Most have also commented that there's just no satisfaction in their job any longer. That's a problem....

Paul48

@ChrisJ
That's just it........We can't. It's big business steam-rolling over the masses. There may be an end-game, but we certainly aren't privy to it.

Brewbeer

The system isn't broken, it is working quite well for those who can afford to purchase and own stocks in publicly traded health care companies. If you are wealthy enough to own lots of these stocks, you are making money hand over fist - by doing nothing. This is why America is Great - people with money can make even more money by doing nothing other than owning and trading assets.

If you return for-profit health care to its previous "public service" function, making money by owning stocks in health care companies will no longer be as lucrative as it is, and wealthy people will not be able to make the kind of money they are used to making from owning shares of these companies.

Health care that is run like a "public service" is essentially what most other advanced economies of the world already have. In America, we've been taught that these systems are horrible, and that "government death panels" make all health care decisions about who gets treated and how much it costs. These facts alone will prevent "public service" heath care from being returned to our nation.

I suggest everybody purchase stock in health care companies.

PMJ

Brewbeer said:

The system isn't broken, it is working quite well for those who can afford to purchase and own stocks in publicly traded health care companies. If you are wealthy enough to own lots of these stocks, you are making money hand over fist - by doing nothing. This is why America is Great - people with money can make even more money by doing nothing other than owning and trading assets.

If you return for-profit health care to its previous "public service" function, making money by owning stocks in health care companies will no longer be as lucrative as it is, and wealthy people will not be able to make the kind of money they are used to making from owning shares of these companies.

Health care that is run like a "public service" is essentially what most other advanced economies of the world already have. In America, we've been taught that these systems are horrible, and that "government death panels" make all health care decisions about who gets treated and how much it costs. These facts along will prevent "public service" heath care from being returned to our nation.

I suggest everybody purchase stock in health care companies.

Somehow medicine was able to operate in that zone between government and private enterprise for over 200 years until very recently and at costs we never even talked about. Quite impressive actually. The businessmen were kept out of it somehow for a very long time. They somehow managed a very high level of integrity. I'm truly not sure exactly how it went astray. I can only observe that letting the businessmen into this was a big mistake.

Brewbeer

PMJ said:

Somehow medicine was able to operate in that zone between government and private enterprise for over 200 years until very recently and at costs we never even talked about. Quite impressive actually. The businessmen were kept out of it somehow for a very long time. They somehow managed a very high level of integrity. I'm truly not sure exactly how it went astray. I can only observe that letting the businessmen into this was a big mistake.

In a word to the bolded: GREED It makes us great, but at a cost. It the cost too high? That is a discussion for a different forum.

SlamDunk

@PMJ , sorry but I disagree.

And I may be biased may because pharma allows me to earn a good living. Any company that is publicly traded has an obligation to make shareholders-including those who hold shares through 401k's, wealthier. I cant believe pro's on here rely strictly on word of mouth and not advertise occasionally.

Pharma's have to be efficient, comply with every single regulatory agency on earth, and succeed more than they fail.

Drug companys' cant plateau on one drug and they can't pocket the money. They have to reinvest to keep the pipeline full by looking forward 20 years knowing some goals will fail.

We are growing organs at my company to market in 2020. We pay for it by selling drugs we created in 1998 and 2008. We have been working on growing organs since 2009. That requires us to have highly educated employees. We have Phd's who aren't old enough to buy a beer! They must be paid well. You know millenials, they go to the highest bidder!

Each success is a step to the next great thing. Pharma's make a lot. But they spend a lot too.

Paul48

Akin to singing the praises of Serial Killers cuz they thin the herd. Right?