Comments on: Cost-Sharing: The Good, the Bad and the Ugly http://healthblog.ncpa.org/cost-sharing-the-good-the-bad-and-the-ugly/ Health Care Policy and Reform Insights | NCPA Tue, 22 May 2012 20:53:53 +0000 hourly 1 http://wordpress.org/?v=3.3.2 By: Health insurance cost by state http://healthblog.ncpa.org/cost-sharing-the-good-the-bad-and-the-ugly/comment-page-1/#comment-114872 Health insurance cost by state Tue, 22 May 2012 11:33:28 +0000 http://www.john-goodman-blog.com/?p=11302#comment-114872 New Article Alerts: Would you like to be notified when a new article is added to the Insurance: Health category?<a href="http://asiguraridesanatateprivate.com" rel="nofollow">George</a> New Article Alerts: Would you like to be notified when a new article is added to the Insurance: Health category?George

]]> By: John Goodman http://healthblog.ncpa.org/cost-sharing-the-good-the-bad-and-the-ugly/comment-page-1/#comment-67628 John Goodman Wed, 23 Jun 2010 21:47:25 +0000 http://www.john-goodman-blog.com/?p=11302#comment-67628 Good points, Gerry. Thanks for your comments. Good points, Gerry. Thanks for your comments.

]]> By: Gerald Musgrave http://healthblog.ncpa.org/cost-sharing-the-good-the-bad-and-the-ugly/comment-page-1/#comment-67626 Gerald Musgrave Wed, 23 Jun 2010 21:40:19 +0000 http://www.john-goodman-blog.com/?p=11302#comment-67626 Hospital charges are not different from others. While it is true that most high-ticket episodes are hospital based, many are not. Lots of cancer patients are never hospitalized and many who are have only minor hospital charges. It is out-patient radiation, chemo and lots and lots of visits and tests that generate the costs. The same is true for many chronic problems from Alzheimer’s to HIV and MS to kidney failure. The issue is the unpredictability and high cost of the problem and not where or how it is treated. Actually, it gets worse because the different charges based on in-patient vs. out-patient are just an artifact of the regulatory process, and not produced by genuine markets. Some might think that patients cannot or should not have a central place in the case of a broken leg, a ruptured appendix, cardiac arrest or the onset of a stroke. NOT TRUE. Here is a way to think about it. Real markets for health care would have us pay less only when that is appropriate. In other cases, we might pay a lot more. Would anyone in their right mind suggest that Tiger Woods have a badly broken leg, knee or ankle fixed by any-ole orthopedic specialist in a regional medical center? Silly. The same is true in a real market. We have folks in our gym who would want to be taken to a big-time expert. They would pay a $100k out of pocket, even though they were not super rich. In some cases, stabilizing the patient is, of course, the first step. Then getting to a world class place is next. This is so common in Mexico that there are several competing firms that offer the insurance and the jet ambulances, as well as the on-call service. There is really not an economic difference between breaking your leg in Cancun or Traverse City. Patients should have the economic incentive to plan ahead and determine the level of service they want in an emergency too. If we had real health care markets and health savings accounts, this would be so common everyone would think it was natural, rather than unusual. Genuine markets would allow for a much wider array of services than are available in regulatory administered systems. Hospital charges are not different from others. While it is true that most high-ticket episodes are hospital based, many are not. Lots of cancer patients are never hospitalized and many who are have only minor hospital charges. It is out-patient radiation, chemo and lots and lots of visits and tests that generate the costs. The same is true for many chronic problems from Alzheimer’s to HIV and MS to kidney failure. The issue is the unpredictability and high cost of the problem and not where or how it is treated. Actually, it gets worse because the different charges based on in-patient vs. out-patient are just an artifact of the regulatory process, and not produced by genuine markets.

Some might think that patients cannot or should not have a central place in the case of a broken leg, a ruptured appendix, cardiac arrest or the onset of a stroke. NOT TRUE.

Here is a way to think about it. Real markets for health care would have us pay less only when that is appropriate. In other cases, we might pay a lot more. Would anyone in their right mind suggest that Tiger Woods have a badly broken leg, knee or ankle fixed by any-ole orthopedic specialist in a regional medical center? Silly. The same is true in a real market. We have folks in our gym who would want to be taken to a big-time expert. They would pay a $100k out of pocket, even though they were not super rich. In some cases, stabilizing the patient is, of course, the first step. Then getting to a world class place is next.

This is so common in Mexico that there are several competing firms that offer the insurance and the jet ambulances, as well as the on-call service. There is really not an economic difference between breaking your leg in Cancun or Traverse City.

Patients should have the economic incentive to plan ahead and determine the level of service they want in an emergency too. If we had real health care markets and health savings accounts, this would be so common everyone would think it was natural, rather than unusual. Genuine markets would allow for a much wider array of services than are available in regulatory administered systems.

]]> By: Nancy http://healthblog.ncpa.org/cost-sharing-the-good-the-bad-and-the-ugly/comment-page-1/#comment-67620 Nancy Wed, 23 Jun 2010 20:14:12 +0000 http://www.john-goodman-blog.com/?p=11302#comment-67620 I agree with Vicki. Great video. I agree with Vicki. Great video.

]]> By: Tom H. http://healthblog.ncpa.org/cost-sharing-the-good-the-bad-and-the-ugly/comment-page-1/#comment-67542 Tom H. Wed, 23 Jun 2010 00:19:01 +0000 http://www.john-goodman-blog.com/?p=11302#comment-67542 I agree with Vicki. Great visual. I agree with Vicki. Great visual.

]]> By: Virginia http://healthblog.ncpa.org/cost-sharing-the-good-the-bad-and-the-ugly/comment-page-1/#comment-67514 Virginia Tue, 22 Jun 2010 17:22:14 +0000 http://www.john-goodman-blog.com/?p=11302#comment-67514 I agree with this post 100%. You don't ask your home insurance provider to pay for maintenance or to fix light bulbs. Why ask the same of your health insurance? Devon, Is it because people don't want to pay out of pocket for OTC meds? Or is it a sort of reverse placebo effect whereby the meds don't work if they're easy to obtain? I agree with this post 100%. You don’t ask your home insurance provider to pay for maintenance or to fix light bulbs. Why ask the same of your health insurance?

Devon, Is it because people don’t want to pay out of pocket for OTC meds? Or is it a sort of reverse placebo effect whereby the meds don’t work if they’re easy to obtain?

]]> By: Tom H. http://healthblog.ncpa.org/cost-sharing-the-good-the-bad-and-the-ugly/comment-page-1/#comment-67513 Tom H. Tue, 22 Jun 2010 16:59:17 +0000 http://www.john-goodman-blog.com/?p=11302#comment-67513 Beverly, thanks for that very helpful information. Beverly, thanks for that very helpful information.

]]> By: Beverly Gossage http://healthblog.ncpa.org/cost-sharing-the-good-the-bad-and-the-ugly/comment-page-1/#comment-67512 Beverly Gossage Tue, 22 Jun 2010 16:56:31 +0000 http://www.john-goodman-blog.com/?p=11302#comment-67512 Federal legislation would cap the out-of-pocket in policies to the current HDHP cap. This is a greater change than most people realize. In any policy, other than an HSA, the out-of-pocket expenses are not capped because co-pays do not apply to deductible and are unlimited. If insurers are to cap these and maintain co-pays, they must raise rates. HDHP rates are lower because the out-of-pocket is all upfront to the insured who is taking the first risk. Another lesser known mandate is that the deductible may not be more than $2000. Most HDHP's are more than that. The most popular for my client's is between 2500-3500 for individuals and 5000-7500 for families with a 0% coinsurance. Carriers will work around this requirement by assessing a lesser deductible but adding a coinsurance of 10%-50% up to the out-of-pocket maximum. Since the insured is paying less of the "upfront dollars" the rates must be increased. If the out-of-pocket is tied to the income of the insured, they policies' structure become intricately more complicated. Federal legislation would cap the out-of-pocket in policies to the current HDHP cap. This is a greater change than most people realize. In any policy, other than an HSA, the out-of-pocket expenses are not capped because co-pays do not apply to deductible and are unlimited. If insurers are to cap these and maintain co-pays, they must raise rates. HDHP rates are lower because the out-of-pocket is all upfront to the insured who is taking the first risk.

Another lesser known mandate is that the deductible may not be more than $2000. Most HDHP’s are more than that. The most popular for my client’s is between 2500-3500 for individuals and 5000-7500 for families with a 0% coinsurance. Carriers will work around this requirement by assessing a lesser deductible but adding a coinsurance of 10%-50% up to the out-of-pocket maximum. Since the insured is paying less of the “upfront dollars” the rates must be increased.

If the out-of-pocket is tied to the income of the insured, they policies’ structure become intricately more complicated.

]]> By: Woody http://healthblog.ncpa.org/cost-sharing-the-good-the-bad-and-the-ugly/comment-page-1/#comment-67511 Woody Tue, 22 Jun 2010 16:53:45 +0000 http://www.john-goodman-blog.com/?p=11302#comment-67511 John, thanks for the post. Your Marx Brother reference reminds me of a favorite clip that is a great visualization of the complexity and frustration faced by healthcare professionals in trying to get paid for the work they do. Interested readers can find it at http://www.youtube.com/watch?v=9LBIsDBC848 Cheers! John, thanks for the post. Your Marx Brother reference reminds me of a favorite clip that is a great visualization of the complexity and frustration faced by healthcare professionals in trying to get paid for the work they do. Interested readers can find it at http://www.youtube.com/watch?v=9LBIsDBC848

Cheers!

]]> By: LAURENCE BRODY http://healthblog.ncpa.org/cost-sharing-the-good-the-bad-and-the-ugly/comment-page-1/#comment-67506 LAURENCE BRODY Tue, 22 Jun 2010 16:43:01 +0000 http://www.john-goodman-blog.com/?p=11302#comment-67506 As usual, John hits another bulls eye. The US public may never be able to wake up until they are ill, and then it is too late. The Obama taxation scheme will result in a lot of rationing. Thanks John Don't stop thinking ahead of the curve. As usual, John hits another bulls eye. The US public may never be able to wake up until they are ill, and then it is too late.

The Obama taxation scheme will result in a lot of rationing.

Thanks John

Don’t stop thinking ahead of the curve.

]]>