Shopping for Health Care is Easier than You Realize

yuConventional wisdom holds that it is nearly impossible to compare prices for medical care like consumers do in other markets. It’s easier than you realize — my wife and I do it just about every time we see our doctors or fill a prescription. Health plan deductibles have nearly tripled over the past decade. Shopping for medical care is more important than ever.

According to the Kaiser Family Foundation, an average employee deductible for self-coverage rose from $584 in 2006 to $1,478 in 2016. In the individual market, the average family deductible was $7,983 in 2016 according to eHealth.com. This suggests millions of Americans are essentially paying their medical bills out-of-pocket.

The first step in shopping for health care begins in your doctor’s office. I’ve found my doctors are very willing to discuss lower-cost treatment options when I tell them I have a high-deductible plan. Recently my dermatologist gave me free samples of a spray steroid, a prescription for a generic ointment and recommended starting less invasive therapy after discovering my health plan deductible was $5,000. I found the steroid ointment on Amazon for two-thirds less than my local chain pharmacy.

The easiest therapy to shop for is prescription drugs. The free drug samples doctors often hand out are for brand drugs, which often come with high prices once you need a refill. Start by asking your doctor if he or she can prescribe a generic drug rather than opting for a newer brand name without having tried the lower-cost option first. You may even want to ask your doctor about prescribing double-strength generic tablets that can be split in two. The savings is often 50 percent. I often use a service called GoodRx.com to compare drug prices at area pharmacies. The website also provides drug plan discount codes that are often much cheaper than paying cash without a code.

Patients can compare prices for diagnostic services and lab work as well. Do not make the mistake my wife almost made when she called a local hospital outpatient clinic to schedule a CT scan. She was taken aback when told her share of the cost would be $2,700. I’m a former hospital accountant; hospitals charge higher prices than anywhere else. Avoid them if you can. I used Google to check for CT scans using the billing code my wife’s doctor had ordered. In less than 10 minutes I found a cash price for $403 that included the radiologist fee. Always ask about cash prices, they are often cheaper than your insurers’ negotiated price — but remember paying cash may not count towards your deductible. My wife and I also look for deals on our periodic lab work. When our doctors order blood tests, we often take our lab orders and compare tests and prices online. MyMedLab and Walk-In Lab are two we have used.

A recent study by the Health Care Cost Institute found 43 percent of medical services for people with commercial health insurance are shoppable. Yet, a study from the National Bureau of Economic Research found patients are more likely to merely reject a recommended service based on the cost, rather than look for a better price for that service. Granted, few people are going to use their iPhones to compare prices in the back of an ambulance heading to the emergency room (ER). However, the care most people receive does not originate in an ER. Actually, knowing to use an urgent care center instead of an ER for non-emergencies is a great way to save 80 percent without even checking the price.

Acting like a prudent health care consumer is really not that hard. Another benefit is that consumerism spurs providers to act more like competitors.

A much improved version of this ran in the Wall Street Journal as a point/counterpoint debate on April 12, Can Consumers Be Smart Health-Care Shoppers?

 

 

Comments (110)

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  1. Z Woof says:

    Everybody already knew this stuff Devon.

    Hey Devon, Blue Cross is scamming the taxpayers in IOWA really really bad. Taxpayers are paying $1,000 a month for a single State employee. But, if the employee adds a child then ABRAABRACADABRA the taxpayers are paying $2,300 a month!!!

    That is $1,300 a month for a child!!! It’s like the Medical Mafia is in control of the Governor of IOWA HQ. Trump has picked Gov Branstad to be the Ambassador to CHINA.

    IOWA needs to DRAIN THE SWAMP.

    A little magic for ya

    https://www.youtube.com/watch?v=vWPQQbldFjw

    • bourne2y says:

      Ron you must be the only one who thinks he’s fooling anybody with that ridiculous alias.

      • Z Woof says:

        bourne2y, I had a boss once who was a great salesperson, manager and dictator when I ran the 6 Richard Simmons Anatomy Asylums in metro Denver. She was captain of the Romanian Olympic rowing team. She told me, “Ron, when you are the boss you have to be like Z Woof.”

        A Champion Is Always A Champion

        Mariana started her winning career with becoming Junior National Champion in rowing in her native country-Romania at 14 years old. (Her interest has always been helping people), so she also studied and became a physical therapist. Her success in rowing exploded with numerous international medals including a European Champion and the beautiful title of World Champion as well!

        She was the only one who didn’t get stock options if you know what I mean.

    • Devon Herrick says:

      Everybody already knew this stuff Devon.

      Ron it’s funny how you dismiss this as commonsense, yet I’m getting numerous replies from WSJ readers telling me it’s impossible.

  2. Bob Hertz says:

    Urgent care centers are a welcome development, but sometimes they cannot substitute for an overpriced ER:

    a. small towns may not have an urgent care center

    b. the emergency may happen when the urgent care center is closed

    c. urgent care centers generally have very little diagnostic hardware, so they often send you down to the ER anyways.
    Probably due in part to their own fear of malpractice suits.

  3. Doc Steve says:

    If you have insurance, the provider can only charge the allowed fee for that provider. The cash paying patient without insurance gets the greatly inflated “list” price. Sometimes you may get a little discount on that if you pay in full at time of service.

    The only way to get prices to a reasonable level is to offer plans for hospitalization/emergency care and let the market decide what a “fair” price should be with competition among providers, clearly available fee schedules and full transparency.

    Same with prescriptions. No real competition when most everything is paid by the “third” party.

    Would have to change the law that states Medicare must have the lowest charge, especially when Medicare requires the added support staff, paperwork and multiple billings.

    • Barry Carol says:

      I agree for the most part.

      Smart phone apps like GoodRx can provide cash prices for any given drug at pharmacies in the patient’s area and those prices can vary materially from one pharmacy to another, especially for generic drugs.

      I’ve also said many times that there needs to be special rules that govern how much hospitals and doctors can charge uninsured patients for care that must be delivered under emergency conditions when, by definition, there is no opportunity for price shopping. I personally think 125% of Medicare or the hospital’s lowest Blue Cross or other private insurance rate would be fair. NJ limits hospital charges to the uninsured to 115% of Medicare if the patient’s income is less than 500% of the FPL or about $120K for a family of four.

      Imaging prices can vary dramatically depending on whether the imaging center is owned by a hospital or not. A friend in Ohio needed a brain scan once a year. Her academic medical center has a list price of $4,200. Her local independent imaging center charged $600 (until it was later acquired by a hospital system).

      All that said, if the patient just makes his doctor aware that he has a high deductible health insurance plan and / or cost is a significant issue, it can result in prescribing a cheaper drug or receiving free samples, waiting to see if the complaint resolves itself or trying more conservative treatment like physical therapy first before resorting to imaging or even surgery.

      • Allan says:

        Barry, why should the uninsured person get a better price than persons that have private insurance? The latter was doing what is considered to be socially responsible, carrying insurance. Do you wish to penalize those that are socially responsible?

        • Bob Hertz says:

          Alan, I understand your frustration here.

          Insurance companies are constantly agreeing to high prices from providers. They do not pressure providers to get the lowest price, at least not for many outpatient procedures.

          So the insured person goes in for care, and the provider must quote them the agreed upon price. I remember being billed for $240 for easy lab work, as I had a deductible, and when I complained to the insurer they told me that they had agreed to this fee with the hospital-owned clinic which I went to.

          Exactly why insurers tolerate high prices from providers is not clear to me.

          • Allan says:

            I bet you can figure out why insurers permit high prices after you answer the question why insurers don’t like HSA’s.

            Remember, there has been a lot of consolidation so none of the big insurers wish to rock the boat with innovation that can cause prices to fall.

            Understand, Bob, that healthcare has become political. That is a bad thing. The most likely scenario to eventually unfold is single payer. Even Trump showed sympathies towards single payer historically and his daughter is quite Liberal.

            Who are the winners under single payer? The very large companies, all the bureaucracies both private and governmental that provide little to no health advantage, the politicians and a few winners. The losers will be most of the population though they won’t recognize their losses since politicians tend to hide the harm they do to their constituents.

            With single payer look for global costs rising per unit of actual healthcare delivered to a real patient.

        • Barry Carol says:

          So Allan, your solution is what exactly? Suppose the uninsured person is uninsured because he couldn’t afford the premium and not because he was young, healthy, thought he was invincible and didn’t need insurance. Insurance contracts are the result of negotiations. A patient needing care under emergency conditions is not a willing buyer and should not be gouged. I think legislated price limits under these circumstances are appropriate.

          • Allan says:

            “So Allan, your solution is what exactly?”

            The solution is not to impose so much pain on so many innocent people which happens to be your solution. You are big on mandates, government, and force while being foggy about the terrible trade offs your solutions impose. You loved the ACA and promoted the ACA fighting tooth and nail every time someone tried to enlighten you. It’s going under because your solutions don’t work.

            “A patient needing care under emergency conditions is not a willing buyer and should not be gouged.”

            As I have said over and over again there are remedies for that and they can even be used in various ways without price fixing, but you prefer force and guns forgetting all about human nature which ends up biting you. Along with many other alternatives there is such a thing as a contract of adhesion. The courts could hold gouging to be unenforceable due to its unconscionability. Couldn’t gouging a sick and needy person “shock the conscience” (Rochin v. California)? Let that person pay his bill and if he goes bankrupt that will incentivize others to carry insurance. Treat the one without insurance better than those with insurance and that will incentivize people going bare making the problem you wish to solve worse.

            In any event the question was not whether I would accept some form of remedy to artificial pricing which obviously I do since I support the theory behind Rochin v. California. The question is “why should the uninsured person get a better price than persons that have private insurance?” That is what needs to be answered.

            • Barry Carol says:

              Most people can’t afford to pay a lawyer hundreds of dollars an hour to take a hospital to court and try to prove that the patient was gouged and the hospital’s bill / contract is unenforceable. I know you can afford to hire a lawyer to bring such a case if you had to but most people can’t. That’s why they need some legislated protection against price gouging.

              • Allan says:

                You have gone from saving a human life to finding a lawyer that may not even be necessary. It is amazing how little you value our freedoms and the taxpayer’s money.

                You have multiple solutions to the problem where the goal of saving a life is met, but you still are demanding more and more of government.

        • John Fembup says:

          Allan you ask “why should the uninsured person get a better price than persons that have private insurance?”

          There are probably a lot of reasons – but keep in mind that it’s a common and quite legal general business practice for vendors to discount prices for cash purchases vs credit card purchases. In such cases, the buyers get a better price; have you a similar objection to that?

          • Allan says:

            John, I was talking more in a specific having to do with Barry’s claims and desires. I have no problem with cash being king. In fact I generally favor that idea.

            My point was that one promotes insurance because one might believe it to be better for the common good. Barry seems to favor that idea and there is nothing wrong with him holding that belief. However, his suggestion at the time was that favoritism as to price be provided for the one that is uninsured. That seems to invalidate at least in part his position that insurance is better for the common good. Why would one favor the individual that was not acting in concert with the common good?

            • John Fembup says:

              “Why would one favor the individual that was not acting in concert with the common good?”

              Because the individual transaction takes place between the vendor and customer – or between physician and patient.

              I want my physician making decisions based on MY good.

              Doesn’t everyone?

              • AllanLook says:

                You are not getting the point. Try and look at the entire conversation above. Barry is trying to ***mandate*** a price that is likely lower than some or most of the insurers pay despite the fact that the uninsured chose to be uninsured.

                If, as Barry seems to think, insurance is a social good then my emphasis on the question was why Barry would want the insured charged more than the uninsured?

                • John Fembup says:

                  What a coincidence

                  I think you are not getting my point.

                  • AllanLook says:

                    I think your point was “I want my physician making decisions based on MY good.”

                    If it isn’t let me know what your point was.

                    My point was more specific to my discussion with Barry so I would not be surprised if anyone missed the point.

                    Just so I don’t miss your point again, was this a contrived coincidence?

      • Z Woof says:

        Barry, when I was stupid about health insurance and doctors I was scammed BIGLY. 1st, I never missed paying for employer-based health insurance out of my check but I was told that I didn’t have insurance to have a baby in 1984. I was told that because the employer was self insured out of CHICAGO and because I switched from Richard Simmons to Holiday Health Clubs, both owned by multi-millionaire DORTHY WILDMAN, that the baby was PRE-EXISTING.

        Then I made the big mistake and told the doctor we didn’t have insurance so she thinks we have to run every test in the world because jerks like me tend to sue. Also, my wife was teaching 2 exercise classes a day in Boulder, when she decided to have that last baby, so she didn’t blow up like a fat pig and was off norm. In November 1983, 2 months before the baby was born, this doctor wants to do a Rule Out Labor (ROL) on my wife. So I asked my wife, “Are you in labor?” She said, “NO.” I told the doctor we don’t need to do that test because this is her 3rd baby and she knows when she is in labor.

        This doctor insisted we do this (ROL) and I said, “If you put that belt on her you will want to bill us $200.” The doctor said, “No, No, No, it is only $50 and you can never be too careful.” So, like the fool that I was I gave in and 30 minutes later we Ruled Out that she was in Labor. Then when I got the bill it wasn’t $50, like the verbal contract I had with the doctor, it was $750!

        Hey Barry, did you see in the above post that a single parent 30-year-old MOTHER, that is a State of IOWA employee, when she gets OVARIAN CANCER and too sick to work, her COBRA EXPLODES to $2,300 a month!

        Take a wild guess which insurance company is charging $2,300 a month for single parents with 1 child in IOWA Barry. Could it possibly be a giant BLUE MONOPOLY terrorizing all of the Little Bitty people, you know, the taxpayers?

        Here in the real world

        https://www.youtube.com/watch?v=3mKkTm38w3E

  4. Don Levit says:

    Paying cash should provide a discount off the network price
    Why would the lower cash payment not be applied to the deductible?
    How else are patients to pay expenses under the deductible other than through cash?
    If you pay from an HSA, this payment does not apply to the deductible?

    • Devon Herrick says:

      The cash price refers to a price for uninsured people (who pay in advance) that is different than the health plan’s negotiated discount. Say you are getting an MRI and they tell you the BlueCross price is $850. Then you discover an uninsured patient paying $500. If you say you want the “cash” price, they may charge you $500 but BlueCross will not count it against your deductible since you did not pay for it through your health plan.

      Medicare patients cannot pay cash unless the doctors are not participating in Medicare.

  5. Don Levit says:

    Why did you not pay for it through your health plan?
    The provider submits a claim form for $500 paid for a legitimate covered service

  6. Bob Hertz says:

    From what I have read, some small insurers like Molina do push providers to get the lowest prices on care.

    In my limited experience, the big Blues and big national carriers and big employer plans are the most lackadaisical as far as demanding the best price from suppliers.

    Is that because the big insurers want a huge network, and are willing to go easy on unit pricing? Just a guess.

    • Allan says:

      You might be right Bob, but take note how people disregard what you are saying. Many like Barry support the bean counter’s contention that consolidation is good (for the bottom line) forgetting that competition coming from the little guy can lead to positive innovation (for the people). Based upon what you say Molina is that little guy is doing what we all think is good for us, but if they are bought up in the consolidations that are occurring, that good thing will be past history.

    • Barry Carol says:

      Bob — Historically, large self-funded employers want to attract good employees. Part of that equation includes providing comprehensive health insurance coverage with a broad provider network. Molina, by contrast, specializes in Medicaid managed care. It’s a completely different market and business model. It won’t translate to the large employer market. If it would, employers would have shifted to Molina a long time ago.

      Employers also don’t back up insurers in fighting for lower prices with large hospital systems because they know their employees don’t want to lose those hospital systems, especially highly regarded academic medical centers, from their provider network.

      It’s highly unlikely that a small insurer new to the market with little or no market power can do anything innovative to lower health insurance premiums when 80%-90% of the premium dollar is spent on medical claims. To think otherwise is dreaming.

      • Allan says:

        That is what the collectivists always say. Innovation, stimulated by smaller entities is inhibited by collectivist ideas and that is why collectivists don’t innovate as much as the capitalist nations. Collectivists like large companies and monopolies that they can control.

        Let a bit of freedom and innovation enter the healthcare market and suddenly the impossible will appear. Barry is afraid of that because then government loses control and can’t pass legislation like the ACA.

        • Barry Carol says:

          There is absolutely nothing to stop innovators from entering the health insurance market. Indeed, numerous hospitals are doing just that albeit with networks limited to their own system. There is also loads of venture capital available for good ideas so if there are some geniuses out there who think they can disrupt the current health insurance market, have at it and pitch your idea(s) to investors.

          The problem isn’t consolidation. It’s that health insurance costs derive from healthcare costs as 80%-90% of the premium dollar is consumed by medical claims and doctors are already complaining loudly about insurers and government interfering with how they practice medicine and interact with their patients.

          What we need is innovation in healthcare, not health insurance and we need innovation that reduces costs instead of increasing them. We need to drive as much care as possible out of expensive hospital settings and we need drug pricing that doesn’t break the bank.

          • John Fembup says:

            Barry, I agree.

            And I think we also need the medical professions to take significantly greater roles is health policy. Ideally that would include providing info to the public, explaining in the simplest, most persuasive terms why medical care is so expensive.

            After all, who has greater interest in defending medical professions? Business types? Academic types? Government types? The general public? Medical professionals? You tell me.

            • Allan says:

              John, after reading my explanation to Barry, do you still wish, without qualification, to agree with Barry?

              • John Fembup says:

                “do you still wish, without qualification, to agree with Barry? –

                An absolutist? Moi?

                But I have begun to wonder about you.

                • Allan says:

                  John, why wonder based upon what I have said? Look at the evidence and if you believe your idea is better why not explain how that idea has worked in this country or why it didn’t already work in this country. I think you are for a type of single payer (I’m sorry if I am wrong). Single payer has more of a logic behind it than the ACA, but first correct the problems we see with the single payer, Medicare.

                  • John Fembup says:

                    “John, why wonder based upon what I have said?

                    Why do I wonder? You got me – I don’t really wonder, I was just being polite. (I’m sorry if I am wrong). 😎

                    • Allan says:

                      Wrong you are John, but being polite is a step towards redemption. :-)

                    • Z Woof says:

                      John never answers questions. He is above that. Hey John, the American Cancer Association says you have to work 20 hours a week to get their employer-based health insurance. I wonder what happens to those employees who get cancer and too sick to work. You are the expert on insurance TERMINATION, what do you think is happening to their sick employees?

                      Of course John will never answer but he knows. Their Phone Number: 1-800-227-2345

                      We don’t even have to call do we John?

            • Z Woof says:

              John, you can’t trust the doctors usually, unlike Allan who is really smart, because doc are the 1st to go socialistic. My good friend Dr. Lee Hieb, past president of the American Association of Physicians and Surgeons (AAPS) answered your question yesterday with, “GOVERNMENT MEDICINE IS EVIL.”

              “At the Nuremberg doctor trials, a witness testified that there was no problem getting doctors for the euthanasia program – they volunteered. I always wondered how doctors could have done that. I do not wonder now. In the Netherlands today, the No. 1 cause of death of children under 10 years old is euthanasia by a physician. And these doctors are the grandchildren and children of Dutch doctors who went to the camps themselves rather than participate in the Nazi horror. What happened between World War II and now was moral incrementalism. It began when physicians – in contravention of the Hippocratic Oath – served not their patients, but the state. Discussions about cost effectiveness, efficiency and coverage miss the essence of the problem.

              Government medicine is evil. It makes citizens into dependent children, and it turns once-honorable doctors into tools of the state. Just ask yourself this: When you are in your sick bed, whom do you trust at your bedside – a private physician you have hired or a doctor sent from the government?”

              http://www.wnd.com/2017/04/government-medicine-is-evil/

              The AAPS VS CLINTON lawsuit stopped Hillarycare in the 1990s. Dr. Heib and I are friends from Pottawatomie County, Iowa. That is where Abe Lincoln, the 1st Republican went to announce he was running for President. Back then Pottawatomie County was the west coast and beyond was territories, not states.

              Dr. Hieb is US NAVY and it is down deep in her bones. She always want to TORPEDO the enemy, the government.

              • Z Woof says:

                US NAVY Vet Dr. Lee Hieb commands, “lets drop some lead on those mother …FIRE !!!”

                https://www.youtube.com/watch?v=qd5MqjvhW9c

              • John Fembup says:

                The banned Ron Greiner opines “you can’t trust the doctors usually, unlike Allan who is really smart, because doc are the 1st to go socialistic.”

                More specifically, Ron, no ones ideas merit consideration if you consider them to be “socialist”. That even includes physicians, because they might be incompetent (“socialistic”) or turn incompetent (“go socialistic”) or because they might not even be smart (“socialistic). Except of course for doctors -and a few others – who agree with you.

                If only the rest of us benighted souls would listen to one insurance agent who believes keeping “socialists” away from the table is the beginning of wonderfulness.

                Meanwhile the chief obstacle to obtaining medical care remains its cost. I think it’s unfortunate that a political shibboleth (“socialism”) prevents some people from engaging unemotionally with that issue.

                “Woof” indeed.

                • Allan says:

                  John, since my name is included in the comment let me say that though I believe the free marketplace is needed in healthcare, that doesn’t mean that I agree with everything said from anyone adopting that policy or disagree with everything said on an opposing side.

                  The fact is that almost all of us want the same thing, reasonable patient care for everyone at a reasonable price. The difference is not in what we are searching for rather the vehicle to get us there. There is more agreement than disagreement.

                  You are correct that at the present time cost is the issue for as cost falls access to healthcare becomes easier for the average American.

                  You are correct again when you indicate that people need to engage “unemotionally with that issue.” To do so one requires proof, a logical stream of ideas, basic principles to prevent a lot of jumping around and intellectual honesty. I don’t think most of the proponents of more and more government intervention have met those requirements.

                • Z Woof says:

                  John, Dr Hieb wrote, “For an in depth review there is no better source than “National Health Care: Medicine in Germany 1918-1945” by Marc Micozzi, M.D., written for the November 1993 Freeman magazine. Socialized medicine was inaugurated by Otto Von Bismarck to keep the German populace from voting for an even more socialist government. After World War I, the German government’s health-care system purposely discouraged private practice, for the express purpose of instituting universal coverage and standardization. Prevention of disease was emphasized over the treatment of disease, and doctors made a significant philosophic shift – from working solely for and in the interest of their patients, to working for the government and the collective good.”

                  John, you are the one who worked for employer-based health insurance that terminated their sick employees which is deadly. Now you want to say that we can’t discuss Socialized Medicine?

                  John you say, “If only the rest of us benighted souls would listen to one insurance agent who believes keeping “socialists” away from the table is the beginning of wonderfulness.” I don’t care what you do John.

                  If you love Socialism John then you fit right in with the young people in America today who have been indoctrinated by the educational system in America.

                  John, you want to point out I was banned huh? You and I know that you supported a system that killed a lot of people but I quit calling you Killer John.

                  John, explain to us again how sick people who were terminated off of your insurance were so pleased.

                  John, U R A hoot.

                  • John Fembup says:

                    “I don’t care what you do John.”

                    So? At least you have explained why you spout hundreds of words to illustrate just how little you care about what I do ( while of course all along the way slinging your usual petty, bitter, personal attacks and silly labeling.)

                    If your purpose is to persuade others to your point of view, I’d say you have selected the wrong tactics.

                    Other than that, Ron, I’m sure you are a kind person and the best insurance salesman ever.

                    • Z Woof says:

                      Thank you John. I always read your comments and many of them make sense. I am a sales trainer John. My best trainer ARLO told me, “You should read my Grandfather’s book – The Power of Prayer.” His Grandfather was R. A. Torrey.

                      When the prospect says, “I don’t know.” Arlo trained me to say in total surprise, “OH! If you would have ANY DOUBTS I would INSIST you pass this by. I only want the ones who jump up and scream – where is my checkbook – and you are not jumping high enough. Any questions before I go?”

                      It takes a while to get new salespeople to understand why that works. Of course we are not leaving till we get the sale.

                      Arlo says that is the way Jesus would have done it. And I NEVER argued with Arlo.

          • Allan says:

            “There is absolutely nothing to stop innovators from entering the health insurance market.”

            Bull! This is the logic of the collectivist.

            Rules and regulations make innovation in many areas impossible. Therefore, there is no need for new innovators as the status quo is presently desired by our insurers and our government.

            One simple example to prove ” absolutely nothing” to be absolutely wrong. The MLR

            “The problem isn’t consolidation. It’s that health insurance costs derive from healthcare costs as 80%-90% of the premium dollar”

            Absolutley wrong and totally foolish.

            The problem isn’t necessarily consolidation rather it is the rules and regulation that lead to consolidation. You have been proven wrong many placesbefore , but I will provide one place, Medicare. They originaly paid on a cost plus basis. The per capita cost similar to the premium plus administration and profit, rose The permitted % of profit to the insurers remained constant and prices rose.

            The problem is the collectivist idea that you join. You think control can be accomplished from the top with penalties, punishment and penal colonies.

            “What we need is innovation in healthcare”

            You talk a good story, but then forget about detalis like the MLR pointed out above despite the absoluteness in your comments such as “absolutely nothing…”. Consistency doesn’t seem to be one of your strong points.

            The end question we must ask ourselves is not your final suggestions that are near meaningless, rather how does society make that type of decision? That decision ends up being a fight between a government that decides what type of healthcare one needs and wants and the indivual who should be able to determine his own needs and wants. Money has little to do with this question as government could provide money without making personal decisions for the individual.

            • Barry Carol says:

              Government is not in the habit of providing money without strings attached. He who has the gold makes the rules.

              • Allan says:

                That is why government should step back, but if government is giving money based upon need, no matter which level of government, then government has that right.

                However, you want government to rule everyone, even those that do not need its help. To make that happen you are willing to use force. That is the mindset of a future dictator.

            • Barry Carol says:

              MLR rules didn’t exist prior to the ACA. Where were all the free market innovators then when, by the way, both the hospital sector and the health insurance sector were far less concentrated than they are now and healthcare costs were growing even faster than they are now?

              • Allan says:

                “MLR rules didn’t exist prior to the ACA.”

                Now you are hedging from “absolutely nothing” to all sorts of excuses that never end. Before the ACA there were other rules and regulations preventing innovative new comers from enterring the marketplace. One doesn’t get innovation where government sets so many rules and regulations.

                “Where were all the free market innovators then”

                They were fighting you and the collectivists. They pushed for and obtained the HSA. That is the only legislation I can think of that actually saved money without making another party pay for the savings. Even the HSA was dulled by the collectivist. Free marketers also advocated high deductibles which we now have from the collectivist, but the savings from that high deductible ends up in someone other than the patient’s pocket. Some more free market ideas are ending mandates or at least limiting their number, permit insurance vendors to sell accross state lines, end third party payer, etc.

            • Barry Carol says:

              Funny thing about consolidation. Even though Home Depot and Lowe’s dominate the building supply and home improvement business, around 20,000 small hardware stores and thousands of independent lumber yards still survive and thrive. Even though CVS and Walgreens dominate the retail pharmacy business, close to 20,000 independent pharmacies still survive and thrive.

              How the heck is some new small health insurance company will little market share and no market power supposed to negotiate competitive discounts with hospitals, doctors groups and other providers so it can offer a competitive health insurance premium? The bottom line is that it can’t with or without MLR rules.

              Even Kaiser wasn’t able to replicate its success in CA in most of the other markets it tried to enter. Technology and scale matter in the health insurance business and large size is needed to ensure a fair fight in negotiating with providers, especially powerful hospital systems and drug companies.

              The fact that millions of people who don’t get health insurance through an employer and don’t qualify for Medicare or Medicaid can’t afford health insurance even if they’re healthy and can pass underwriting is a whole separate discussion. Sometimes markets fail.

              • Allan says:

                “Funny thing about consolidation.”

                How foolish to compare consolidation that occurrs because of a free market and consolidation that occurs because of too much government regulation.

                “How the heck is some new small health insurance company will little market share and no market power supposed to negotiate competitive discounts with hospitals, doctors groups and other providers so it can offer a competitive health insurance premium?”

                Get rid of regulations and a company will do just that. Most companies start small and grow even though they face competition from better funded companies. All they have to do is create a better product with a good price. Those with tunnel vision can only see straight ahead so I don’t envision that type of person to be able to see how this type of thing is accomplished.

                I so happen to have been a part owner in a tiny malpractice insurace compay. In fact we all (the insured) were. We used a unique method of leveraging our funds and maintaing our risk. It did so well we grew and were bought out by the big guy (we were not supposed to be able to compete with) and were paid a lot of money. I can see you looking over that agreement saying ‘it can’t work’ until it did when you would make a whole bunch of excuses why similar ideas couldn’t work. That wasn’t the only small guy company I was involved with that wasn’t supposed to work. The only thing that stopped the other health involved companies that had to compete with the big guys was government regulation despite the fact that our prices were lower and the patient’s were happier.

                “Even Kaiser wasn’t able to replicate its success in CA”

                Kaiser had and has a lot of political influence. Where it didn’t it mostly failed.

                Everyone, check out Apple a company starting in a garage that was too small to succeed against such giants as IBM.

                • Barry Carol says:

                  According to you, we haven’t had a free market in healthcare since World War II except at the margins like Lasik surgery and cosmetic plastic surgery that health insurance generally doesn’t cover.

                  There is little or no evidence that free market principles broadly applied have worked successfully anywhere in the developed world in ways that Americans would accept.

                  Even Singapore uses a single payer system for its catastrophic coverage plan and the Medi-Save accounts are coercive.

                  Moreover, Health Savings Accounts and Flexible Spending Accounts have done precious little to slow the growth of healthcare spending though they have provided tax benefits for middle class and upper middle class people who can afford to fund them.

                  • Z Woof says:

                    Barry, I sold the tax-free HSA correctly to businesses and they funded the HSA for employees so your BS is just that, BS.

                    You have to follow the law and it says that the employer must drop their cost for health insurance to ZERO. Then with all of that savings, $20,000 a year?, they make an HSA deposit, maximum $6,550 per year, to the employee’s HSA.

                    In the blink of an eye these employees had $10,000 in their tax-free HSA and in all of their other accounts they had ZERO!

                    Stop your uninformed lying Barry, you FRUITCAKE, about the tax-free HSA. After all, you are at the NCPA blog and we don’t allow lies about America’s best tax dodge.

                    https://www.youtube.com/watch?v=wneCa_yIuzg

                  • Allan says:

                    Barry, how can one have a free marketplace if most of the population is covered by third party payment?

                    You have a problem finding logical answers to the questions raised so you shift your focus to “There is little or no evidence that free market principles broadly applied have worked successfully anywhere in the developed world in ways that Americans would accept.”

                    Hogwash!

                    What is your proof the sun will rise tomorrow?

                    HSA’s alone cannot cure our problems. The collectivists are hard at work in the opposite direction. However, HSA’s demonstrated good success and something “that Americans would accept.”

                    • Z Woof says:

                      That’s right Allan, even Nancy Polosi is confused on how to attack the tax-free HSA. They thought years ago the best way to fight the HSA is NEVER mention them. Ha ha, that didn’t work too well.

                      Now we have a bunch of Democrats that are not trained on how to attack the HSA. Unlike Barry, but he is the best they have and he is terrible.

                      Hillary said, “no, No, NO, HSAs put too much money in the Private Sector.”

                      Barry, tell Hillary that WE THE PEOPLE are the Private Sector.

  7. Family Time Centers says:

    “A patient needing care under emergency conditions is not a willing buyer and should not be gouged”.It’s good to know about them. Health care need more attention and thanks for the information.

  8. Bob Hertz says:

    Note to Allan and Barry:

    Here is an article by an attorney, and in the 2nd half of the piece he gives more detail than I have seen before on actual court cases on price gouging:

    https://www.floridabar.org/DIVCOM/JN/JNJournal01.nsf/8c9f13012b96736985256aa900624829/4e6a247df232eb5b85257f45004c6b05!OpenDocument

    • Allan says:

      Barry is not interested in using the law and the Constitution to promote a better healthcare environment. He wants the bureaucrats and politicians to have control over almost 20% of our economy and our personal healthcare. He worries that using courts to solve disputes is too difficult and should be decided instead by the politicians in government.

  9. Bob Hertz says:

    Allan, this comment of yours is of interest….

    “Let that person pay his bill and if he goes bankrupt that will incentivize others to carry insurance.”

    This comment illustrates one of big, big challenges in American health reform…..

    namely, that each citizen must be incentivized to buy health insurance.

    I have no problem with incentives, but in the area of health insurance I am to be honest coming to appreciate the social insurance approach.

    The social-insurance approach assumes that people will want health care when they are sick, and since ultimately everyone who needs care will get it, then everyone should pay for it.

    Whereas the American approach is that every citizen must be prodded or penalized or financially terrified to get them to buy coverage. People are in some sense encouraged to ‘play the odds’, and not buy coverage until it might be too late.

    I am not making a plea for single payer, and its 20% payroll or sales taxes. I am willing to consider a much smaller tax for catastrophic care. If you bought a policy or had one from your employer, then the tax would be waived for you.

    As I have said before, we collect taxes for fire department protection in 99% of American cities. We do not use fire insurance to pay the firemen. I think there is merit is paying for safety net hospitals the same way.

    • Allan says:

      “ultimately everyone who needs care will get it”

      Focus on the word “ultimately”. Ultimately a person at the end of the line, if he survives, ends up at the front of the line. Then what will he get. I think I like the survival rate in the US which is a lot higher on average than is seen in those other countries. That way above average care costs a lot so maybe we could lower premiums and more easily insure more people if our outcome criteria weren’t as strict.

      Remember, fire insurance is run by localities not by the federal government.

      Additionally look at Canada and the Inuits. The native people don’t seem to receive the same healthcare and their lifespans are horribly low. This occurs in a country with good care run by the government.

      • Z Woof says:

        Allan, the way to fix the health insurance markets is restrict the Open Enrollments to Nov. 1st to Dec. 15th so insurance agents must work over Thanksgiving. But then they can take the rest of the year off.

        https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-07712.pdf?utm_campaign=hcgov_ab&utm_content=english&utm_medium=email&utm_source=govdelivery

        Do you have the Blues? OR Do the Blues have you?

        Iowa taxpayers paying $2,300 a month to Blue Cross for a single State employee with a child is robbery. How could the Unions bargain for this? If she gets cancer her COBRA is $2,300 a month!

        Iowa is having budget problems right now. Can you believe it? Iowa needs new politicians bad.

        • Bart I says:

          Assuming that’s accurate, either the coverage is extremely plush or state employees are a very unhealthy group. Or both.

          • Z Woof says:

            Bart, it is corruption plain and simple. Blue Cross is raping the good citizens of Iowa by buying the politicians of both political parties.

            Hey Bart, Blue Cross used to be “non-profit” before they switched to a “mutual” insurance company. Anthem paid the State $3 Billion when they switched their tax status. Iowa Blue Cross never paid the State when they changed their tax status so they owe a bunch of money right now. Same with Blue Cross of Florida. These guys owe big money.

            Stinging the Blues

            When Blue Cross Blue Shield plans convert to for-profit status, states are entitled to big money. But they have to ask for it.

            The idea that the state has authority over the value of a private charitable enterprise is based on the legal doctrine of “cy pres,” a Norman French phrase meaning “as close as possible.” Common law holds that if a charitable organization changes its function or tax status, its assets must be used for a purpose as close as possible to the original one.

            READ ALL ABOUT IT:

            http://www.governing.com/topics/finance/Stinging-Blues.html?AMP

          • Barry Carol says:

            The coverage is probably pretty comprehensive. Also, in areas with a stable or declining population, the average age of the workforce is likely to be above average. Once a teacher finds that they are a good fit for the profession, they tend to spend their entire career in the same school system. It’s not surprising that average claims costs are high, deductibles are low, and the individual contribution toward the insurance is also low, at least for the employee himself or herself.

            • Z Woof says:

              Barry, how could these democrat union reps get a contract, with a Republican GOVERNOR, where a child is $1,300 a month? YOU say, “The coverage is probably pretty comprehensive.” That is too silly to respond to. When Obama took office a child could get HSA Qualifying insurance in IOWA for less than $40 a month.

              Both political parties are owned by Blue Cross of IOWA, it’s like the MAFIA.

              Then your uninformed NJ socialist mind spews the PROPAGANDA, “the average age of the workforce is likely to be above average.” So, is that what you tell the 27-year-old woman with OVARIAN CANCER that has to pay $2,300 a month for COBRA that her co-workers are too old? Is that a good argument why employer-based health insurance sucks?

              Then you continue with your COSMIK DEBRI spew with, “average claims costs are high, deductibles are low.” Above you were saying HSAs have done nothing to help but NOW you say that these teachers deductibles are too low. YOU are like a crack whore who will say anything to get what you want.

              Barry, who U jivin’ with your COSMIK Debri?

              https://www.youtube.com/watch?v=Dp6LT2MdaPI

              • Barry Carol says:

                I thought you were banned, Ron. The NCPA is not doing a very good job of enforcement it appears.

                • Allan says:

                  Barry, why should the NCPA ban Ron? The NCPA holds itself out to be a somewhat libertarian organization that promotes free market values. I don’t think it believes in strong central control so it permits the Constitutional 1st ammendment right of free speech whether that speech causes a measure of discomfort or not.

                  Everyone can judge everyone else based upon their ideas and what they say. I listen to what you say even though we have marked disagreements because you are intelligent and represent a segment of our population. If you didn’t have anything to add I might ignore your comments.

                  Do you really want this blog to censure opinions that are considered by some to be irritating?

                  • Barry Carol says:

                    All arguments and viewpoints are welcome, in my view. That’s what blogs like this are for — to debate, exchange ideas and learn.

                    What is not welcome are name calling and ad hominem attacks. I think they diminish the discussion and don’t reflect well on the blog operators if they allow them to persist.

                    I always try my best to be polite and respectful toward everyone who comments here no matter how much I may disagree with them. I think it’s reasonable to expect the same courtesy to be extended to me.

                    If Ron weren’t already banned, he would be commenting as Ron Greiner like he always has instead of coming back as Z Woof. If the blog operators want him to stay banned, they should just delete his comments as soon as they appear or shortly thereafter or block the IP address that the Z Woof comments are coming from.

                    • Allan says:

                      Barry, you are right in your approach about viewpoints and arguments. I even agree that ad hominen attacks for the most part diminish discussion, but to end them one requires another individual to determine what is acceptable or not and that opens the actual debate up to the individual bias of the moderator. I’ve seen that on many lists and it isn’t pleasant because eventually ideas are withheld based upon that bias.

                      I agree with you that sometimes people go too far, but I give a lot more credit to the people on the blog than perhaps you do. I have been on the receiving end where I was the lone libertarian type voice among a bunch of people espousing socialist theory. I was called all sorts of names and accused of all sorts of heinous crimes, but eventually it was those ad hominen attacks against principled discussion that won the day for those attacks were without merit.

                      Bloocking is a lot harder than you apparently understand. Moderation takes up resources. I was on the incidentaleconomist and continued disputing what was being said (at times). They delisted, moderated refusing to post, but eventually they realized that they could not maintain the image of free speech so they ended all comments.

                      My comments for the most part corrected mistakes being made by the owners of the blog. Much of that was done by merely quoting the named experts on individual subjects. Thin skin led to the blog being closed to comments. It also left the owners of the blog dumb to good ideas contrary to what they believed.

                    • Z Woof says:

                      Thanks Barry, YOU are so nice YOU want me banned again. I have been here a lot longer than you. If it makes you happy Obamacare has put me out of business many times and all of our customers have been cancelled. That is why my beautiful wife is working today, EASTER SUNDAY.

                      My beautiful wife spent $1 million advertising the tax-free MSA in IOWA alone, a very important political state. Without my wife we wouldn’t have the tax-free HSA in America today.

                      But, if it makes you happy she is all the way up to $11 a hour now.

                      YOU are heartless Barry.

                    • Barry Carol says:

                      Allan, banning anyone is a judgment call which is up to the moderator / operator. Inappropriate comments cannot be defined with precision but most people, I think, know them when they see them. I’ll leave it at that.

                    • Allan says:

                      Barry, you are somewhat correct, but banning a person is up to the owner of the list who has control. It is his product.

                      I assumed you would like tight controls on a blog for that is generally your policy, one person or a group of people decide right and wrong. That was Saddam’s policy as well. I say that just to push an understanding that your type of intolerance can (not will) lead to dictatorships.

                      Like you, I don’t approve of certain manners, but have learned to live and act while ignoring such behavior. Live and be well.

                    • Barry Carol says:

                      Allan, a blog is a free market product / service. The owner of the blog is entitled to set the rules of engagement. If he wants to adopt an anything goes policy, that’s his prerogative. If he wants to enforce some basic civility rules and ban people who don’t abide by them, that’s his choice as well.

                    • Allan says:

                      “Allan, a blog is a free market product / service.”

                      Barry, you are absolutely correct.

                      When one owns a private business they should be able to act somewhat like a dictator within their own boundaries and within the law. However, you also believe our “free” government has a right to force a private entity to do its business and even force private individuals to buy a product from private entities. You agree with enforcing these types of policies with penalties and jail.

                    • Z Woof says:

                      Barry, I think we should ban all Socialists like you. This is the NCPA blog and it should just ban you Barry because you don’t care about FREEDOM.

        • Allan says:

          “Allan, the way to fix the health insurance markets is restrict the Open Enrollments to Nov. 1st to Dec”

          Z Woof, that suggestion might help the present plan perform a trifle better, but is a drop in the bucket when considering sustainabilty.

          • Z Woof says:

            Allan, I was just teasing that insurance agents should only work 6 weeks a year over Thanksgiving.

            Do you honestly think these agents and navigators will answer ONE question about how a tax-free HSA works when they have a goal to get the consumer off the phone in 12 minutes?

            They refuse to even tell the consumer now that they can get a tax-free HSA because if the consumer asks a question it opens up a can of worms. One question leads to another and before you know it you have spent an hour educating the consumer and missed out on 4 other sales.

            That’s why nobody knows anything today about the tax-free HSA. Agents are trained not to bring it up.

            • Allan says:

              I wasn’t concerning myself with the agents work schedule. My comment had to do with the ability of patients to game the system. Shortening of the enrollment period provides a bit of help.

              • Z Woof says:

                Allan, nobody cares about the agent in America but me. I am a sales trainer so I have to care. Most of the agents have been run out of business.

                The agents complain that because the tax-free HSA is FREE there are no commissions. Then I jump on their side and say, “It’s salesman abuse!” Then I have to brainwash the agents about how its better for the consumer blah blah blah.

                Then I tell them that we see these people 1 time and forget about them tomorrow. BUT, these consumers will remember the guy that set them tax free for the rest of their lives. Also, consumers are CONFUSED people and they have this illusion that if you are smart on 1 thing, the HSA, you are smart on other things so they buy everything you are selling.

                Then I train them on how to be really, really HIGH PRESSURE in a sneaky way. The agents always say it’s like MAGIC.

                • Allan says:

                  Ron, I so happen to believe that we need insurance agents. How many and in what capacity is something the free marketplace should be deciding. If it turns out that agents are not needed then that human capital should be released to other endeavors.

        • Bart I says:

          “the way to fix the health insurance markets is restrict the Open Enrollments to Nov. 1st to Dec. 15th”

          It only makes slightly less sense than restarting the deductible clock every January 1, when the policy effective date happened to be on July 1 (or December 1).

      • Bob Hertz says:

        I will make a confession, conclude what you will.

        Personally I do not care whether all Americans or all Canadians receive top-notch medical attention.

        What I care about is that they are not in debt.

        What I appreciate about American Medicaid (or Canada’s Medicare) is that it is free at the point of service.

        If some poor people get lousy medical care, I can live with that.

        By the way this is coming from someone who spent a small part of his adult life being poor. I suspect it is a widely held emotion.

        • Allan says:

          “What I appreciate about American Medicaid (or Canada’s Medicare) is that it is free at the point of service.”

          Bob, nothing is free. It is simply a mattter of how one pays for it. Apparently, many beleive they aren’t paying a price whent things are silently stolen from them in the middle of the night.

        • Z Woof says:

          Bob, you say, “If some poor people get lousy medical care, I can live with that.” So you think that when a young family finds out that their child’s survival odds go up 40% at an out of state medical provider that they should have an over-priced HMO that pays NOTHING if they try and save their child?

          That is really disgusting Bob. Why should you decide about their coverage instead of these young parents who love their child? You don’t love their child so you don’t care if they die. Let me tell you Bob it costs a pretty penny to bury a child. So they are in debt anyway.

          In IOWA it is the law that all self employed families with 2 children must put those kids on an HMO if they earn under $70,000 to get Obamacare tax credits. So a lot of Medicaid CEOs think just like you Bob.

          • Bob Hertz says:

            Granted that we are dealing in highly charged generalities here………

            but the British or Canadian view as I understand it says that if one thousand people get free health care in a closed system, and that system cannot save one child with cancer, that this result is acceptable.

            Of course it is not acceptable if the child is your child, and some of these families do come to America where there is very little rationing.

            All I am saying here is that I can understand the Canadian viewpoint.

            • Allan says:

              That is understandable, but, Bob, do you also recognize that some ethnic groups in Canada suffer from very poor care and their lifespan is remarkably shorter despite single payer and national health insurance? Why under that type of system isn’t more of that money saved going to them?

              • Bob Hertz says:

                I do not have expertise, but I believe that American Indians have poor health outcomes, and they have had a single payer plan with no deductibles for many years at least on the reservations.

                Their sad state of self-destructive behaviors creates bad health no matter what plan is supported.

                • Lee Benham says:

                  Are you advocating moving all democrats and socialists to a reservation? Now that’s a plan I could support, 😂

                • Allan says:

                  The care of American Indians could be a lot better despite their destructive behaviour.

                  I was referring the the Inuits and other Canadian native people. They are insured under the same health plan as everyone else, but even with single payer they don’t get the same services. They die years earlier than their neighbors.

                  • John Fembup says:

                    Keep in mind too that part of the problem is the distribution of Canadian physicians – too few of whom practice in rural areas where many native Americans live. The provincial governments have struggled with this problem for a long time

                    • AllanLook says:

                      But the provincial governments also don’t provide the same facilities. There are ways to get physicians and doctors together even in remote areas.

                    • Bob Hertz says:

                      According to Prof Joseph White, one of my favorite health care authors, even Josef Stalin had trouble getting doctors to go to rural areas.

                    • AllanLook says:

                      Stalin had problems transporting grain from one portion of Russia to another. He lost it from rats, stealing and broken trains. Stalin is a good example for economic failure.

  10. Z Woof says:

    So Trumpcare may be passed in the next few weeks says Rep. DeSantis (R-FL) a member of the House Freedom Caucus. This means their will be NO MANDATE to purchase insurance for employers. So, these auto dealerships here in Florida, and coast to coast, who charge $1,100 a month for the employee to add their family to the employer-based insurance now have a choice. They can cancel their GROUP insurance which gives the employees a Special Enrollment Period (SEP) to enroll into Obamacare with federal tax credits. For Example in TAMPA: a 55-year-old couple with 2 children earning $60,000 a year can get $1,054 a month in Obamacare tax credits to purchase insurance! I recommend BlueSelect Bronze (HSA) 1735 – EPO for $317 a month after tax credits. So the employee saves $800 a month but most importantly the employer’s cost drops to ZERO!

    I further recommend that the employer put $200 a month into the employees tax-free HSA for 1st dollar coverage of medical, vision and dental expenses. I say this because I want these employees happy when my agents talk to them because my agents will SELL them the new type of life insurance that pays them a mountain-of-money (MOM) when they get cancer, heart attack or stroke. TRUST ME, when you get cancer you want a check for $300,000!

    If the auto dealership has 100 employees my agent should earn $200,000 on the life alone. Some of the auto dealerships are a lot bigger than 100 employees.

    Who wants to earn $1,000,000 in the summer of 2017? It takes a week to get an insurance license so it is easier than becoming a dentist.

    It’s like money for NOTHING!

    https://www.youtube.com/watch?v=lAD6Obi7Cag

    • Z Woof says:

      Of course the big money is in management. I train the managers how to pump up their sales team. To the agents it looks like the managers do nothing but that is not true. Managers have to scream, “Stop that stinking thinking and start thinking proper.” PLUS, managers train the agents on how to high pressure close so agents don’t leave money on the table. That is my money it’s not their money.

      The really big money happens when the manager does personal production, they make more, PLUS they get OVER-RIDES on 100 agents.

      WHO WANTS TO BE A BILLIONAIRE?

      https://www.youtube.com/watch?v=8aRor905cCw

      • Z Woof says:

        When Clinton signed HIPPA and tax-free MSAs were born I called my nephew 1st. He is smart and we are bringing him onto the team. We already have the best AUDIO guy in the business who has done our radio spots on Rush Limbaugh for 15 years. My nephew can get 1 million views in 24 hours on social media. Here is his qualifications:

        Integrated and strategic marketing professional with over 20 years of leadership experience in corporate and agency environments directing traditional and digital marketing operations with proven skills, education and accomplishments. With a MS in Direct & Digital Marketing, everything I do is based on experience and knowledge.

        Multichannel traditional/digital data-driven marketer. Reach and engage customers and prospects in a continuous conversation that is timely, relevant and welcome through cross channel dialogue that builds upon past and current behavior. Connect technologies, staff and processes to achieve integrated marketing goals. Achieve revenue and profitability improvements and gain the trust and support of management, vendors, and customers to accomplish objectives and facilitate overall sales and marketing efforts.

        Specialties: Strategy, analysis and planning; database marketing / CRM management and integrated multichannel promotional campaign development and deployment. Improving the sophistication of targeting within each channel and increasing the degree of integration between those channels. Convergence marketing, crosschannel marketing, digital marketing strategy, direct response marketing, integrated marketing, interactive marketing, multichannel marketing strategy and programs, strategic marketing, traditional marketing. Email, content, direct mail, direct marketing programs, DRTV, lead generation programs, lead generation campaigns, new customer acquisition, display, earned media (PR), lead generation, mobile, paid search, pay-per-click, referral, social, SEO, telemarketing, video.

        Georgetown University, Washington DC

        YUP, the tax-free HSA has some friends

        https://www.youtube.com/watch?v=t4X3ZRU5Ghg

  11. Lee Benham says:

    It appears to me we are needing to fix an unfixable system . Now what are we going to do?.

    • Bart I says:

      I don’t see any two people agreeing on a solution, so most likely, nothing.

      • Z Woof says:

        Bart, not true. Lee and I agree 100% I know what Lee is going to do when there is no mandate for large employers to sell health insurance to their employees. Lee is going to stroll into Sid Dillon Auto Group and their 8 Omaha locations and 750 employees and say, “Why, oh why, are you spending $20,000 a year per family for health insurance when the government is giving it away for free if I create an SEP (Special Enrollment Period) for you?

        Then Lee is going to look into Sid Dillon’s beedy little car salesman eyes and say, “Sid, you are so lucky they don’t give mandatory IQ Tests to own a car dealership because I’m afraid you would have flunked Sid.” Then Lee will ask an Obligating Question (OQ) with, “I’m not going to fast for you am I Sid?”

        I wonder what Sid would say? The tightwad.

      • Allan says:

        Their will not be a solution because of ideology, not that people don’t agree on a solution. Essentially, we all want the same thing.

        • Z Woof says:

          Allan, I NEVER correct you but this TIME you are wrong. The current CRISIS demands a solution, period. Lucky we have the FREE Market coming to the rescue. Let me give you an example with those loony-Rooney Golden Rule (UHC) people that Devon LIES and says that they wrote the 1st tax-free MSA instead of TIME Insurance Company (TIC), America’s oldest health insurance company (1892), in 44 states with IM, more than ANY competitor.

          Royal Governor Branstad (R-IA) was bought off by Blue Cross of Iowa and negotiated a contract with the Union, also bought of by Blue Cross of Iowa (At TIME (TIC) we call them the local-yocal), and came up with a CONTRACT were the Little-Bitty people (TAXPAYERS) pay $27,000 a year for a 30-year-old State employee with ONE CHILD! BUT, UHC has coverage in IOWA for a 30-year-old MALE and child for $214.21 per quarter or $856.84 per year. HSA Qualifing I further assert.

          If Royal bought off Governor Branstad only paid 30 TIMES more, to evil Blue Cross, it would only be $25,705.52 per year. no, No, NO, Royal Branstad is charging the Little-Bitty people (TAXPAYERS) OVER 30 TIMES (TIC) more!! TRUST ME, Royal Branstad doesn’t care about us.

          Father TIME, “It is like playing chess with these pawns (TAXPAYERS).” LAZY politicians – geeez.

          https://www.youtube.com/watch?v=l-9VZZWtMfQ

          • AllanLook says:

            “The current CRISIS demands a solution, period.”

            What I said in my preceding response does not exclude the reality of the comment above. Of course the crisis demands a solution, but can we get there focusing on our personal ideologies rather than the common agreement we all have?

            • Z Woof says:

              AllanLook, I said we will find a solution, PERIOD.

              You have twisted that statement of fact with your “personal ideologies” as that makes a difference, which it doesn’t.

              I will go real slow for you. I say, “The current CRISIS demands a solution, period.”

              AllanLook, instead of coming to the NCPA blog and asking questions why don’t you explain what you said, “the common agreement we all have?”

              What is this common agreement AllanLook?

              • Allan says:

                Firstly, it is Allan. I don’t know how the “Look” got entered into my name.

                “the common agreement we all have”

                I believe all who have been active in the recent debate want healthcare’s costs to be reasonable with reasonable access and quality.

          • Bob Hertz says:

            The UHC United Health policy is short term coverage for 3 months, with no drug coverage, and is underwritten. Young people pay the premium for their age, with no subsidy of the old.

            You cannot compare this to a state employee plan with no underwriting, extensive drug coverage, no expiration date, and for a very old work force.

            • Z Woof says:

              Bob, I am licensed to compare health insurance in IOWA so don’t tell me what I can do. Besides, YOU are wrong, figures, like usual. Rx is a covered expense.

              BUT, I didn’t mention the UHC HSA Qualifying plan without Rx and it is cheaper yet. The cost on that plan is $644.36 a year. The $856.84 above has Rx coverage. That means that Governor Branstad is paying 40 TIMES more than this HSA Qualifying coverage, PITIFUL.

              Bob, you further spew, “no expiration date,” – UNLESS this employee gets too sick to work because then they drop him like a hot potato.

              Bob, U R A hoot. I am comparing a 30-year-old MALE but YOU restrict his age with your further spew, “very old work force.” YOU and your SOCIALISM.

              BOB, Wake Up! If this employee is a part TIMEr and works 25 hours a week as a janitor Governor Branstad charges him $1,258 a month out of his check and the Little-Bitty taxpayers pay a $1,000 too. Bob these Janitors get Little-Bitty paychecks at $9 an hour. His monthly earnings are only $900 but the health insurance cost is $1,258.

              If he leaves his pretty little 9-year-old girl flying naked with no insurance just his coverage is $477 a month and the Little-Bitty taxpayers are paying $458.

              Someone email Dr. John Graham at HHS and tell him the Little-Bitty people in America need the UNCONSTITUTIONAL ban on STM lifted pronto. John won’t care because he is so rich.

              LAZY politicians beware: It’s Lunch TIME!

              https://www.youtube.com/watch?v=NO2cHJmDkBg

  12. OAtext says:

    “A patient requiring care under crisis conditions is not a ready purchaser and ought not be gouged”.It’s great to think about them. Medicinal services require more consideration and a debt of gratitude is in order for the data.
    – See more at Clinical trails journal

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