Well, first let's ask where did the $2,500 per year in savings go that was promised by the PPACA pundits that would be real since the participation was going up by 10 or 20 or even some said 30 million people? Coverage DID increase but largely because of expanded Medicaide ... not because all those that are newly insured decided to comply and buy health insurance for the first time.
So, where is the savings? You add millions to the roles and costs still go up? That is NOT insurance ... which is purely based on spreading risk to make it more predictable and cost effective to manage. Since I spend most of my time on the frontlines in this changing system, let's really examine what happened and how NONE of what is being discussed by Congress and Trump can possibly make any difference. The "not make any difference" part is easily demonstrated in most any series of reports you may choose to read on most any day. Here are a couple of examples.
Here is why by example.
You like ice cream so you just want it delivered to your door like pizza. In fact, a dream would be to get hot pizza AND fresh ice cream delivered every night for a good price. First you start out driving around in your car to find the favorites, then price becomes and issue, then you get sensitive to the time and effort that takes and you hire a service to do the shopping and delivery for you. You agree to pay the service each month, they agreed to deliver hot pizza and fresh ice cream at a fixed price. Their price is good at first. Then they say that your house is in a higher cost area so, they add a fee per delivery and really gouge you if you do not take the pizza combos and ice cream flavors that are on "special" each day. Then they start saying that you have deliveries from the places THEY choose and it costs more is may not even include your favorites. The price just keeps going and going and going ... UP.
Well it is really easy to blame the delivery provider. They are the one that you actually pay, yet you have left it to them to choose which pizza and ice cream parlors to include. What is that based on? Oh, you forgot to ask and now since you have "hired" this chosing activity out, what questions should be asked or even can be asked are lost. You just got lazy.
Well, that is the problem. We got lazy. Everyday I speak to people that still believe that having insurance makes things free or some version of free. Really? That is NOT insurance!
The real problem is the total lack of transparency that we blindly accept everyday. Here is one blatant and regularly occurring example. Remember the Epipen issue last summer. Well, in an interview with ABC prime time news, the company representative said that the costs for this life saving and patented drug is "due to the increased deductibles in many plans today". Wait a minute. What in the world does that mean? Well, here is part of it. When I buy my Epipen(s) my insurance is NOT used because paying cash saves me over $100. That is right. On my plan, at my pharmacy, I am charged MORE IF my deductible is not met. So, that means their are three prices for Epipen. In decreasing order, they are ... High Deductible Insured person (before deductible met) pays $650. Cash (non-insured person) pays $500. After Deductible met the price drops to $300. Really? Really!
So, who is really setting the price for pizza and ice cream in our example? Certainly the delivery company (insurance company) benefits by the higher prices ... 20% margin on $100 is less net dollars than 20% on $10. So, when the workload is the same (number of claims processed) and the dollar volume takes a huge leap, profits go up. Simple math. But, WHY does the dollar volume (prices) increase? Because they can! My gosh, what are we still missing? NOBODY talks about this part AT ALL.
Washington University did a study a few years ago about the price of a hip replacement surgery on a 50 year old female without insurance. Using the SAME service codes, the survey showed that in the 150 hospitals checked ... from big name brands to small regional providers ... the price for those specific codes and specific patient ranged from just over $25,000 to more than $150,000! Fully 1/3 of those in the survey COULD not even provide estimates because their billing structure was either too complicated, too private or crazy to provide an estimate. Well ... there is the real root of the problem!
In addition, malpractice costs for both professionals and facilities are totally out of control because Congress looks away from Tort Reform to cap millions in claims because the coffee may be too hot. Come on. This is NOT simple, but it is plain what needs to happen. Let's get started. That is my next post.
So, where is the savings? You add millions to the roles and costs still go up? That is NOT insurance ... which is purely based on spreading risk to make it more predictable and cost effective to manage. Since I spend most of my time on the frontlines in this changing system, let's really examine what happened and how NONE of what is being discussed by Congress and Trump can possibly make any difference. The "not make any difference" part is easily demonstrated in most any series of reports you may choose to read on most any day. Here are a couple of examples.
- If the Republicans limit Medicaide funding by capping it or restricting it in anyway, the Democrats say that will drive up costs for everyone else.
- If the individual mandate is dropped, healthy young people will buy insurance and that will drive up costs for everyone else.
Here is why by example.
You like ice cream so you just want it delivered to your door like pizza. In fact, a dream would be to get hot pizza AND fresh ice cream delivered every night for a good price. First you start out driving around in your car to find the favorites, then price becomes and issue, then you get sensitive to the time and effort that takes and you hire a service to do the shopping and delivery for you. You agree to pay the service each month, they agreed to deliver hot pizza and fresh ice cream at a fixed price. Their price is good at first. Then they say that your house is in a higher cost area so, they add a fee per delivery and really gouge you if you do not take the pizza combos and ice cream flavors that are on "special" each day. Then they start saying that you have deliveries from the places THEY choose and it costs more is may not even include your favorites. The price just keeps going and going and going ... UP.
Well it is really easy to blame the delivery provider. They are the one that you actually pay, yet you have left it to them to choose which pizza and ice cream parlors to include. What is that based on? Oh, you forgot to ask and now since you have "hired" this chosing activity out, what questions should be asked or even can be asked are lost. You just got lazy.
Well, that is the problem. We got lazy. Everyday I speak to people that still believe that having insurance makes things free or some version of free. Really? That is NOT insurance!
The real problem is the total lack of transparency that we blindly accept everyday. Here is one blatant and regularly occurring example. Remember the Epipen issue last summer. Well, in an interview with ABC prime time news, the company representative said that the costs for this life saving and patented drug is "due to the increased deductibles in many plans today". Wait a minute. What in the world does that mean? Well, here is part of it. When I buy my Epipen(s) my insurance is NOT used because paying cash saves me over $100. That is right. On my plan, at my pharmacy, I am charged MORE IF my deductible is not met. So, that means their are three prices for Epipen. In decreasing order, they are ... High Deductible Insured person (before deductible met) pays $650. Cash (non-insured person) pays $500. After Deductible met the price drops to $300. Really? Really!
So, who is really setting the price for pizza and ice cream in our example? Certainly the delivery company (insurance company) benefits by the higher prices ... 20% margin on $100 is less net dollars than 20% on $10. So, when the workload is the same (number of claims processed) and the dollar volume takes a huge leap, profits go up. Simple math. But, WHY does the dollar volume (prices) increase? Because they can! My gosh, what are we still missing? NOBODY talks about this part AT ALL.
Washington University did a study a few years ago about the price of a hip replacement surgery on a 50 year old female without insurance. Using the SAME service codes, the survey showed that in the 150 hospitals checked ... from big name brands to small regional providers ... the price for those specific codes and specific patient ranged from just over $25,000 to more than $150,000! Fully 1/3 of those in the survey COULD not even provide estimates because their billing structure was either too complicated, too private or crazy to provide an estimate. Well ... there is the real root of the problem!
In addition, malpractice costs for both professionals and facilities are totally out of control because Congress looks away from Tort Reform to cap millions in claims because the coffee may be too hot. Come on. This is NOT simple, but it is plain what needs to happen. Let's get started. That is my next post.
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