Comments on: Knowing the Price of Everything and the Value of Nothing http://healthblog.ncpa.org/knowing-the-price-of-everything-and-the-value-of-nothing/ Health Care Policy and Reform Insights | NCPA Thu, 24 May 2012 14:24:45 +0000 hourly 1 http://wordpress.org/?v=3.3.2 By: Ralph Weber http://healthblog.ncpa.org/knowing-the-price-of-everything-and-the-value-of-nothing/comment-page-1/#comment-61746 Ralph Weber Fri, 30 Apr 2010 03:29:12 +0000 http://www.john-goodman-blog.com/?p=10317#comment-61746 Well put Ralph, and Frank you're right too. BUCA wants clients to think that THEY are single handedly beating up the "greedy docs" on price, and getting knee replacements reduced in cost from $58,000 to $28,000. Meanwhile MediBid is sending people across satte lines for medical care every day where the meshing or quality and value occurs. Well put Ralph, and Frank you’re right too. BUCA wants clients to think that THEY are single handedly beating up the “greedy docs” on price, and getting knee replacements reduced in cost from $58,000 to $28,000. Meanwhile MediBid is sending people across satte lines for medical care every day where the meshing or quality and value occurs.

]]> By: Frank Timmins http://healthblog.ncpa.org/knowing-the-price-of-everything-and-the-value-of-nothing/comment-page-1/#comment-61697 Frank Timmins Thu, 29 Apr 2010 18:46:45 +0000 http://www.john-goodman-blog.com/?p=10317#comment-61697 As someone who works in this system on a daily basis, I can attest that the biggest monkey wrench in the process to achieve "transparency" is the current process of provider contracting. To be specific, the predatory contracting methodology of BUCA (The Blues, United Healthcare, Aetna) make any effort to move to a system of transparency and individual responsibility most problematical. Bart is correct in his assessment. I don't fully understand how BUCA (especially UHC) has avoided federal prosecution under anti-trust legislation. Clearly these carriers control both the buyer and seller in their methodology which eliminates the normal buyer seller (quality/price) market control. It is eerie how such a disfunctional and self serving process (for insurance companies) has woven itself firmly into the multi-billion dollar healthcare system while we paid no attention. As someone who works in this system on a daily basis, I can attest that the biggest monkey wrench in the process to achieve “transparency” is the current process of provider contracting. To be specific, the predatory contracting methodology of BUCA (The Blues, United Healthcare, Aetna) make any effort to move to a system of transparency and individual responsibility most problematical.

Bart is correct in his assessment. I don’t fully understand how BUCA (especially UHC) has avoided federal prosecution under anti-trust legislation. Clearly these carriers control both the buyer and seller in their methodology which eliminates the normal buyer seller (quality/price) market control. It is eerie how such a disfunctional and self serving process (for insurance companies) has woven itself firmly into the multi-billion dollar healthcare system while we paid no attention.

]]> By: Ralph Kristeller http://healthblog.ncpa.org/knowing-the-price-of-everything-and-the-value-of-nothing/comment-page-1/#comment-61679 Ralph Kristeller Thu, 29 Apr 2010 14:20:38 +0000 http://www.john-goodman-blog.com/?p=10317#comment-61679 My understanding of Quality, Value and Cost: Physicians are experts in the Quality of Medical Care. Patients are experts in the Value of the Medical Care they receive. When the patient directly pays the physician a fee for service, Quality and Value tend to come together very appropriately. The source of the funds that the patient uses to pay the physician are, and should be, strictly the responsibility of the patient. Cost (and transparency) falls into its proper place when the above are functioning optimally. However, I also believe that the true Professional takes into account the patient’s ability to pay when establishing a fee. My understanding of Quality, Value and Cost:

Physicians are experts in the Quality of Medical Care.

Patients are experts in the Value of the Medical Care they receive.

When the patient directly pays the physician a fee for service, Quality and Value tend to come together very appropriately.

The source of the funds that the patient uses to pay the physician are, and should be, strictly the responsibility of the patient.

Cost (and transparency) falls into its proper place when the above are functioning optimally.

However, I also believe that the true Professional takes into account the patient’s ability to pay when establishing a fee.

]]> By: Ralph Weber http://healthblog.ncpa.org/knowing-the-price-of-everything-and-the-value-of-nothing/comment-page-1/#comment-61678 Ralph Weber Thu, 29 Apr 2010 14:17:24 +0000 http://www.john-goodman-blog.com/?p=10317#comment-61678 Exactly right Charles and Carroll! And it's working really well. The doctors are setting their own rates, and the patients get to chose. But they are not only looking at the price, they are looking at location, and the doctor's profile as well, something not possible under the old model Exactly right Charles and Carroll! And it’s working really well. The doctors are setting their own rates, and the patients get to chose. But they are not only looking at the price, they are looking at location, and the doctor’s profile as well, something not possible under the old model

]]> By: Robert H Bruce http://healthblog.ncpa.org/knowing-the-price-of-everything-and-the-value-of-nothing/comment-page-1/#comment-61677 Robert H Bruce Thu, 29 Apr 2010 14:15:55 +0000 http://www.john-goodman-blog.com/?p=10317#comment-61677 John Thank you for posting this. I know we’ve kicked it around before, and truly any real reform is going to include “menu pricing”, or full public disclosure of what everyone, including insurance companies, is paying for a service. Now THAT’s FREE MARKET! John

Thank you for posting this. I know we’ve kicked it around before, and truly any real reform is going to include “menu pricing”, or full public disclosure of what everyone, including insurance companies, is paying for a service. Now THAT’s FREE MARKET!

]]> By: Charles Johnsen http://healthblog.ncpa.org/knowing-the-price-of-everything-and-the-value-of-nothing/comment-page-1/#comment-61673 Charles Johnsen Thu, 29 Apr 2010 12:16:52 +0000 http://www.john-goodman-blog.com/?p=10317#comment-61673 A market of values and prices generated by millions of transactions between individual willing buyers and willing sellers is a natural system born with us as human beings. It works for everything from arrowheads to jet planes, from whores to church collections. It takes no regulation and no law beyond punishment for fraud. In contrast all imposed systems, be they democratic or monarchical, distort prices and value for political reasons. Good intentions are not enough, majority vote is not enough, pity for the poor is not enough. ANY interference with that individual transaction is foolish, mean spirited, and outdated. The market for medical care is way too complex for any person, computer network, or government agency to grasp or control. Yet a single completely local deal between two human beings mechanizes a natural ecology of trade and cooperation. Give it up. The time of history for authoritarian markets is past. The picture of the political system trying to freeze our world in the 1950's, or even the 1860's, is risible and dangerous. A market of values and prices generated by millions of transactions between individual willing buyers and willing sellers is a natural system born with us as human beings. It works for everything from arrowheads to jet planes, from whores to church collections. It takes no regulation and no law beyond punishment for fraud. In contrast all imposed systems, be they democratic or monarchical, distort prices and value for political reasons. Good intentions are not enough, majority vote is not enough, pity for the poor is not enough. ANY interference with that individual transaction is foolish, mean spirited, and outdated. The market for medical care is way too complex for any person, computer network, or government agency to grasp or control. Yet a single completely local deal between two human beings mechanizes a natural ecology of trade and cooperation. Give it up. The time of history for authoritarian markets is past. The picture of the political system trying to freeze our world in the 1950′s, or even the 1860′s, is risible and dangerous.

]]> By: H.Carroll http://healthblog.ncpa.org/knowing-the-price-of-everything-and-the-value-of-nothing/comment-page-1/#comment-61663 H.Carroll Thu, 29 Apr 2010 07:43:26 +0000 http://www.john-goodman-blog.com/?p=10317#comment-61663 It surely is the "third party payer negotiating/setting of prices" that is the evil. Consistent pricing must be added to "market based" and "transparent" pricing requirements for the market system to work. It should be illegal for a provider to do a "special" deal with any patient based on that patient's affiliation with a particular third-party relationship, whether that third party is a self funded TPA, a health carrier network, or any government program. Balance billing should be required, though the provider is free to modify the resulting patient "net" responsibility (after cost sharing of the insurance plan, if any, and any balance billing, if applicable) in any way they choose (bringing back control to the "charity" aspect of the provider/patient relationship). The key is that this situation forces a truer market determination of value for the service and quality of that service. Until the pricing mechanism is fixed, no other area of "reform" can be properly measured, no quality improvement properly valued, and no true total cost to the system can be determined. Fix the metric. It surely is the “third party payer negotiating/setting of prices” that is the evil. Consistent pricing must be added to “market based” and “transparent” pricing requirements for the market system to work. It should be illegal for a provider to do a “special” deal with any patient based on that patient’s affiliation with a particular third-party relationship, whether that third party is a self funded TPA, a health carrier network, or any government program. Balance billing should be required, though the provider is free to modify the resulting patient “net” responsibility (after cost sharing of the insurance plan, if any, and any balance billing, if applicable) in any way they choose (bringing back control to the “charity” aspect of the provider/patient relationship). The key is that this situation forces a truer market determination of value for the service and quality of that service. Until the pricing mechanism is fixed, no other area of “reform” can be properly measured, no quality improvement properly valued, and no true total cost to the system can be determined. Fix the metric.

]]> By: Ralph Weber http://healthblog.ncpa.org/knowing-the-price-of-everything-and-the-value-of-nothing/comment-page-1/#comment-61659 Ralph Weber Thu, 29 Apr 2010 06:05:43 +0000 http://www.john-goodman-blog.com/?p=10317#comment-61659 By CMS setting prices "price fixing", they force providers to pay the game of trying to add up enough procedures to break even. Doing un needed EKG's etc. If I asked you to get me a Grey Goose Martini, and told you I'd only pay $5 for it, you'd get me one, and ask me for my $5. THEN you'd ask for a $3 delivery fee, $1 per olive, and $2 glass rental. Medicine is no different. That's why doctors need to set their own rates, and the consumer will make market based decisions. By CMS setting prices “price fixing”, they force providers to pay the game of trying to add up enough procedures to break even. Doing un needed EKG’s etc. If I asked you to get me a Grey Goose Martini, and told you I’d only pay $5 for it, you’d get me one, and ask me for my $5. THEN you’d ask for a $3 delivery fee, $1 per olive, and $2 glass rental.
Medicine is no different.
That’s why doctors need to set their own rates, and the consumer will make market based decisions.

]]> By: Steven Bassett http://healthblog.ncpa.org/knowing-the-price-of-everything-and-the-value-of-nothing/comment-page-1/#comment-61652 Steven Bassett Thu, 29 Apr 2010 01:42:23 +0000 http://www.john-goodman-blog.com/?p=10317#comment-61652 TPAs and employers could grease the skids to a marketplace: A handful of employers now send their employees and companion to certain best cost / quality facilities for select procedures. I believe the product design ultimately should award a fraction of savings achieved to the consumer. If we do this and cut primary and other low cost care as an insurable expense then cost and quality will go in the right direction. TPAs and employers could grease the skids to a marketplace: A handful of employers now send their employees and companion to certain best cost / quality facilities for select procedures. I believe the product design ultimately should award a fraction of savings achieved to the consumer. If we do this and cut primary and other low cost care as an insurable expense then cost and quality will go in the right direction.

]]> By: Bob Geist http://healthblog.ncpa.org/knowing-the-price-of-everything-and-the-value-of-nothing/comment-page-1/#comment-61646 Bob Geist Wed, 28 Apr 2010 22:43:05 +0000 http://www.john-goodman-blog.com/?p=10317#comment-61646 #5 Money for primary care (using debit cards) is in a bill in the MN House for the Medicaid population. The party controlling the legislature is not interested. So what's new about that from politicians, who think they know better than patients and doctors of what is "necessary" and, who want to control "the system" for the "good of society". As one doctor said, legislators always talk about populations and doctors about patients--it's like two ships passing in the dark. Bob #5 Money for primary care (using debit cards) is in a bill in the MN House for the Medicaid population. The party controlling the legislature is not interested. So what’s new about that from politicians, who think they know better than patients and doctors of what is “necessary” and, who want to control “the system” for the “good of society”. As one doctor said, legislators always talk about populations and doctors about patients–it’s like two ships passing in the dark. Bob

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