50 golden guineas to anyone who can tell me how costs will be brought down in HCR

[Phoebe Loosinhouse]

The most obvious one is the drug negotiation for Medicare being handed to the Secretary of HHS, so skip that and come up with another.

The role of the public option originally was to drive down prices through lower overhead and admin and drug negotiation which was supposed to drive a corresponding competitive downward spiral in price for private insurance. But since now we have the reverse, a public option tied to prices in the private market(!), what mechanism exists to lower costs/prices in the future?

I am excluding subsidies because they are not addressing the core issue of cost before subsidy. I think I will arbitrarily also exclude all the feel good talk about wellness promotion. That possibly could have some small good effect, but I really don't believe that this reform will cause an obese, couch potato, cheese doodle eating citizenry to suddenly become sleek, muscled marathon runners.

So please tell me how the actual costs go down? Is that even a goal? I hear a lot of talk about slowing the rate of increase, but that's just not enough. Costs are too high right this second without even mentioning future increases.

This is not a snarky question, this is a sincere question. Cost, price, affordability will emerge as the MAJOR make or break in public perception and reality as concerns this round of reform.

[RUMMYisFROSTED]

1. Reduce/eliminate middleman profits.

For starters.

[midnight]

2. Remove the insurance co. Their overhead costs are a killer.

If those who are really interested in the no. Dr. Dean might have those.

[Phoebe Loosinhouse]

3. To be clear - I'm talking about the bills before us right now. nt

[T Wolf]

7. Oh, in that case - it won't. Nothing will change except greater insurance corps profits

and Democratic electoral losses.

Mission accomplished.

[xchrom]

4. ...

:popcorn:

[AllentownJake]

5. The theory is that when more people are forced to buy insurance

there will be less people stiffing providers in bankruptcy and providers won't have to charge more to the insured.

I think it is bullshit. The same bullshit we got when bankruptcy reform took place for interest rates.

[JackRiddler]

19. As classical econ says: Forced, inflexible demand always causes prices to fall.

[nightrain]

6. It's a major problem with Pelosi's bill, huh? And while we're asking good questions, let's

address how it will add more bureaucratic layers from the practitioners' point of view too!

[BeFree]

8. Show me the money, first

Otherwise i don't believe you, so why waste my time? You obviously are against any HCR, or you wouldn't ask stupid questions, eh?

[Phoebe Loosinhouse]

9. I don't think this is a stupid question and I think we all need to know the answers

so please do take it seriously.

[BeFree]

13. 50 golden guineas is some serious coin

Or were you kidding?

HCR, seriesly (sic) will reduce our costs if it is done properly. Duh... that's why we need reform, to reduce costs.

You can mail me the guineas. Insured, of course.

[lumberjack_jeff]

10. Section 102

http://energycommerce.house.gov/Press_111/health_care/hr3962_Section_by_Section.pdf

The bill enforces an 85% "medical loss ratio", meaning that insurers must pay 85% of their premiums out in payments to providers on behalf of subscribers. Any excess will be rebated to subscribers.

PM me for the address to send those guineas. I hope they lay golden guinea eggs.

[Phoebe Loosinhouse]

11. That is an excellent answer to my question!

And though I am trying to pay attention, I missed that one. That is really, really a good thing. It may even cause a drop in the wretchedly excessive executive compensation. Thank you for taking the question seriously.

Did I mention that they were chocolate guineas? Coins, not hens.

[lumberjack_jeff]

12. I like chocolate. n/t

[JackRiddler]

20. The problem with doing it like this is that they WILL cook the books.

Together with the health providers they will find ways to declare 85% in medical expenses while not lowering premiums. Besides, nothing says the 85% will be more efficient. In fact, waste may be used to cover the 85% while still not providing service to many. It's a half-assed, abusable way to do it.

How about a fee schedule for drugs and standard procedures? Enforce that, then set up a public plan to compete, premiums will drop.

[eridani]

34. No penalties specified if they don't, however.

And they still have the power to turn down any claims that they like. That there will be less of this statistically is not a huge thrill.

[lumberjack_jeff]

35. No penalty except for reimbursing their subscribers the difference. n/t

[Blue State Blues]

14. One theory is that if individuals pay more "cost sharing"

which is to say, more in deductibles and co-payments, individuals will choose to have fewer "unnecessary" procedures and tests. Those who promote this notion, think that since employers pay up to 2/3 rds or more of premiums, and insurance picks up most of the tab, that patients over-use procedures, tests and medications because they have no idea of the real cost. Once they do know, they can choose to not over-use, choose generic and less costly treatments, and thus produce consumer-based cost savings. This theory assumes that health care functions like any other market. But that is not reality.

Health care is not like any other market. Consumers do not choose their coverage, their employers do. Patients do not choose their tests or medications, their doctors do -- and doctors don't know the costs of different medications, they're just supposed to know which ones work better for different patients. And it is ridiculous to expect that someone who is at their most vulnerable because they are ill, is in a position to second guess their doctors.

Moreover, it is simply false that the problem is over-use. Japan has an aging population that sees the doctor more often (average 15 times a year, if I remember correctly) and uses even more testing than we do, but they spend far less on health care than we do.

Our cost problem is simply that we have Wall Street driven health insurance, Wall Street driven pharmaceutical companies, and increasingly profit-driven providers (hospital conglomerates, entrepreneurial testing facilities). Our system is expensive for the simple reason that each part of it must produce a large, ever-growing profit.

[nightrain]

15. +5

[Joe Fields]

16. we will be paying on a sliding scale, in order to remain "deficit neutral."

The govt. can then say, "hey, we aren't spending anymore taxpayer money for our programs."

The insurance companies will now become our new utility companies.

[cpamomfromtexas]

17. Hubby got 3 stitches and was billed for "outpatient surgery" by Baylor Healthcare

Oh and when our first child was born, baylor had apparently figured out we each had our own insurance policies, so I was billed twice for delivery and hospitalization. The only way I caught it was they billed me twice for the lunch they brought to the new father, and I knew I had already paid that, got to looking closer and wala, found fraud. And that was Baylor healthcare too.

[cpamomfromtexas]

18. I'm thinking we can reduce this crap by having gov't auditors checking on the charges.

[berni_mccoy]

21. Sec. 104 Sunshine on price gouging by health insurance issuers.

Secretary of HHS can call into question *any* rate increase on premiums and open a review. My rates went up more than 25% this year. Why? I bet it's not just cost of insurance.

http://energycommerce.house.gov/Press_111/health_care/hr3962_Section_by_Section.pdf

[eridani]

30. What horseshit. A list of the naughty, naughty boys and girls?

No penalties or enforcement powers listed.

[Kansas Wyatt]

22. Don't you understand it's a FOOT IN THE DOOR?

In time, depending on how old you are, you will be on Medicare, so your problem will be solved with this plan.

Can't you see what a GREAT plan this is? You will eventually get on Medicare!

[eridani]

31. Like I want the private insurer fucktards to have their feet in my door n/t

[berni_mccoy]

23. Sec. 262. Restoring application of anti-trust laws to health insurers.

http://energycommerce.house.gov/Press_111/health_care/hr3962_Section_by_Section.pdf

Removes the anti‐trust exemption for health insurers and medical malpractice insurers.

[berni_mccoy]

24. Sec. 1171. Limitation on cost-sharing for individual health services.

http://energycommerce.house.gov/Press_111/health_care/hr3962_Section_by_Section.pdf

Ensures that beneficiaries in Medicare Advantage plans are not subjected to higher cost‐sharing than they would face in fee‐for‐service Medicare. Ensures that beneficiaries dually eligible for Medicare and Medicaid are not subject to higher cost‐sharing than they would face under Medicaid were they not enrolled in Medicare.

[berni_mccoy]

25. Sec. 1185. No mid-year formulary changes permitted.

Prevents Part D plans from making any formulary change that increase cost‐sharing or otherwise reduce coverage once the plan marketing period begins.

[eridani]

32. Wonderful! They only get to fuck us over once a year now! n/t

[berni_mccoy]

26. Sec. 1202. Elimination of Part D cost-sharing for certain non-institutionalized ...

Sec. 1202. Elimination of Part D cost-sharing for certain non‐institutionalized full‐benefit dual eligible individuals. Eliminates cost sharing for people receiving care under a home and community based waiver who would otherwise require institutional care.

[lumberjack_jeff]

27. Have I told you lately how much you rock, Berni?

:thumbsup:

[berni_mccoy]

28. Heh, thanks Jeff. I *could* keep going with this, but I think the OP gets the message

and of course, you were first.

But the OP *did* say he'd pay 50 to *anyone*, not the first. So I guess we're both going to get some gold (chocolate) lol.

[eridani]

33. Yes. The message is that telling insurance companies that

--they have been very, very naughty will cause them to change their behavior.

[eridani]

29. There are no cost controls, other than the Medicare reform

In countries that have universal health care and mandated private insurance as well, the government sets the price ranges and dictates the minimum benefit packages. Many also directly control hospital, provider and drug prices as well.