OT: Medicare

[NightMonkey]

I don't have much to say at this time on Medicare other than agewise I am on the s*** end of the stick.

... If the law, through either state or federal regulation of health insurance companies, required that ...

Any opinions out there on this idea?

You are not going to "fix" medical care/medical insurance by tacking little fixes onto a system that is already badly convoluted by years of federal and state regulation.

Just as one egregious example, my local community has been furious at the state for a year now over an expose that was done by a local popular newspaper.

I learned about a year ago that there is a state hospital board who must grant approval for any hospital that is built in the state. Two nearby providers wanted to build hospitals in my locality. But the state would only grant one approval and the other company may take an appeal all the way to the state supreme court.

The expose showed that the state hospital board has carved out areas all over the state where one or the other hospitals is given an exclusive territory with no competition.

The newspaper did some great work in showing how these hospitals operate when they are not restrained by the need to compete. Both hospitals that wanted to build locally are nonprofits. But they make huge profits and pay their top executives millions.

Many examples were given like you have seen before -$10 for one aspirin; several thousand dollars for a 12-hour hospital stay and patient was discharged having receive no treatment nor been given any prescription; etc.

The hospitals are able to get away with this because their area is protected by the state.

Now there is a move by some citizen action groups to tear apart the state bureaucracy which has started spending big bucks in advertising campaigns telling how they protect us from medical disaster.

It is going to be quite a long and nasty battle but I think the citizens action groups will not prevail.

As you might expect I have zero faith in governments to rescue us from the problems they created. Should they attempt they will only create bigger problems.

The one place where I will be tentatively optimistic is on the defeat of Obamacare and the return of control of all federal programs to the states. Surely then some few of the states would pass massive deregulation and allow effective and efficient market solutions to develop. That then might put great pressure on other states to follow suit.

[kempo]

Another thought - If the law, through either state or federal regulation of health insurance companies, required that all policies gave the policyholder, not the company, the option to purchase their own own FDA-approved medical equipment, online if they so chose from sources like cpap.com, and then be reimbursed by their insurance company in accordance with their policy terms, then the prices for cpap equipment for example would come down, and both the insurance companies and Medicare would save money. The insurance company or Medicare would still have the right to determine the medical necessity of the equipment in accordance with existing guidelines, tests, prescriptions, etc. but once they did so, they would have to give the policyholder the option of making the reimbursable purchase themselves if they so chose.

This would/should reduce the cost of private health insurance, and the cost to the taxpayers for Medicare.

And this would be in accordance with the best of the free enterprise, competitive market system, for which we could all Bless America as VVV encourages us to do!

Any opinions out there on this idea?

Regards, Nate

Nate I think that would help bring down the cost of cpap machines and supplies. In my humble opion if I we could go buy a cpap machine on the open market out of pocket the price of a cpap machine that now cost $1200 would drop to $400 to $500 dollars. I would be like buying a flat screen TV every 5 years. No big deal. no fighting with insurance companies or DMEs. Buy what you want and need.

How would you find out what machine is the best for you. Well from right here on cpaptalk.com or other forums. People are not stupid. They know how to find out what kind of cars, TVs, appliances, etc. to buy.

Yes Sir, If I could walk into a Wally World or any other retailer and buy a s9 for $400 every 5 years or buy cpap supplies at 1/3 the cost any time I wanted without dealing with insurance companies and DMEs, I would love it.

[chunkyfrog]

Remember, every dollar spent at the big national chain DME's add money to the slush fund that ensures we will have no choice!

[VVV]

Yesterday when I checked into the forum there was a call for all masks to be priced the same.

Today that has been revised for all masks to have price transparency.

Excellent progress IMO.

[VVV]

In my humble opion if I we could go buy a cpap machine on the open market out of pocket the price of a cpap machine that now cost $1200 would drop to $400 to $500 dollars. I would be like buying a flat screen TV every 5 years. No big deal. no fighting with insurance companies or DMEs. Buy what you want and need.

How would you find out what machine is the best for you. Well from right here on cpaptalk.com or other forums. People are not stupid. They know how to find out what kind of cars, TVs, appliances, etc. to buy.

Yes Sir, If I could walk into a Wally World or any other retailer and buy a s9 for $400 every 5 years or buy cpap supplies at 1/3 the cost any time I wanted without dealing with insurance companies and DMEs, I would love it.

I like this attitude. Isn't that really the way people operate when buying almost everything from aardvarks to zinc?

But then with medical care for some reason their brain goes into neutral. Why is this? Do they believe the doctors are gods and then fall to the knees before them?

[idamtnboy]

Do they believe the doctors are gods and then fall to the knees before them?

Aren't they? Apparently you haven't asked your doctor about his godship!!

My retired veterinarian brother said once that in the later years of his practice that the one thing that caused him the most consternation were the know-it-all clients who knew just exactly what was wrong with their pet and what the treatment should be because they learned it from the Internet. I think he said that something on the order of 80 to 90% of the time they were dead wrong.

The most knowledgeable patient is the one who knows how to ask questions, questions that are pertinent to the issue at hand. There is a big difference between asking questions of the doc, and questioning the doc. We must be willing and able to ask, but we also must be prudent when doing so. Remember, we are dealing with a community of professionals who can be labelled, oftentimes appropriately, as arrogant.

[VVV]

by idamtnboy on Thu Apr 26, 2012 3:01 pm

That is well and fine but my remarks were not about diagnosis, they were "on topic" about costs and upfront transparency of costs.

Ask the receptionist, ask the nurse, ask the doctor, "How much will this cost?"

You are not afraid to ask the mechanic before he starts checking fluids and pulling out parts, why be afraid to ask the doc?

This is one way to put pressure for cost containment and options for treatment. If a doctor sees patients all day long and no one asks about the costs he thinks they don't care and puts it to them and buys more expensive equipment when he has less expensive, good options.

[idamtnboy]

Ask the receptionist, ask the nurse, ask the doctor, "How much will this cost?"

Unfortunately, the number they can, and do, give you is more often than not meaningless. That's because the insurance contract amount will be something entirely different, probably always less and sometimes as much as 90% less.

The other day my dentist gave me a quote for some fillings. His quote showed that BCBS would pay $0, which I knew could not be right. It did show what the secondary payer would pay. So I call BCBS and the CSR tells me what fixed amount they will pay for the code on the quote. Then I asked her, "What's the maximum allowable charge, or MAC, for this code?" "Can't tell you. We don't know that number until the insurance claim is processed." The number on the dentist's quote may or may not be the MAC but I have no way of knowing. This is where there needs to be much more transparency for us medical consumers. Otherwise, how can we be effective in making decisions about how and where to get our treatment?

[diekatzepap]

Asking for the price is a good start but I agree it really doesn't matter what price the medical provider charges it all depends on the specific maximum allowable charge (MAC) the insurance plan has negotiated with each individual medical provider. That's the hidden/mystery charge we as consumers need to fight to reform and make more transparent. Not that I am in favor of The Afforadable Healthcare Act (Obamacare) but there are some provisions that I do like. In this case the mandatory listing of prices by 2014. I really think this will go a long way to help with competition between healthcare providers and maybe cut some costs. Its something to hope for anyway.