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Khisanth Magus posted:The reason medical costs have balooned so much is that both the medical providers and insurance both benefit from the increases. Insurance companies are only allowed to keep a certain % of the premiums they get, the rest must be paid in claims, and premiums are more or less automatically calculated as what is necessary to cover expected claims. So to increase premiums so that their flat % cut also goes up they need medical costs to go up. Which of course directly benefits the medical providers. That is not why medical costs have ballooned so much. Insurance companies are constantly negotiating lower rates in order to capture much greater market share. You have a warped view of the insurance market.
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Oct 25, 2017 18:53
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esquilax posted:That is not why medical costs have ballooned so much. Insurance companies are constantly negotiating lower rates in order to capture much greater market share. You have a warped view of the insurance market. Only to a degree. It really doesn't hurt them much to have medical costs go up because its not like people can go to a different company if their premiums go up. First of all, the other company's premiums are also going up, and second, most people are tied to their insurance through their employer. It takes a hell of a reason for a company to switch over to a different insurance provider. And rising premiums means the amount they can keep also goes up.
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Oct 25, 2017 19:04
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JustJeff88 posted:I want to be clear that I am not being a dick here and am bringing this up just as an important talking point: Pretty much everyone else has some form of universal or semi-universal coverage and they do not have massive unemployment. The British NHS was established in 1948 during the Great Reconstruction after the devastation of the war and I know of no massive unemployment. That's because health insurance wasn't really a thing back then. Most people just paid out of pocket for the doctor. There was not the vast horde of billing/support/insurance claim/coding people that there are in the USA today. These might not be long term job losses, but very few people can see further than next year.
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Oct 25, 2017 19:05
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Khisanth Magus posted:Only to a degree. It really doesn't hurt them much to have medical costs go up because its not like people can go to a different company if their premiums go up. First of all, the other company's premiums are also going up, and second, most people are tied to their insurance through their employer. It takes a hell of a reason for a company to switch over to a different insurance provider. And rising premiums means the amount they can keep also goes up. A hell of a reason to switch such as - a lower premium from a different insurance company? Like do you seriously think that these companies are making contracts for millions of dollars and not going to market every once in a while?
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Oct 25, 2017 19:11
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esquilax posted:A hell of a reason to switch such as - a lower premium from a different insurance company? Unless it is substantially lower it is unlikely it is worth the costs associated with switching. And I rather doubt that the "negotiated" prices different insurance companies get with medical providers are really all that different.
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Oct 25, 2017 19:15
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Khisanth Magus posted:Only to a degree. It really doesn't hurt them much to have medical costs go up because its not like people can go to a different company if their premiums go up. First of all, the other company's premiums are also going up, and second, most people are tied to their insurance through their employer. It takes a hell of a reason for a company to switch over to a different insurance provider. And rising premiums means the amount they can keep also goes up. this is just so loving stupid i do not know where to begin. companies switch insurance providers all the time. the primary reason? COST. it's literally the thing the company cares about most and is the primary reason companies switch. i don't know how you got these stupid, stupid ideas but you should stop repeating them like you have any idea what you're talking about.
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Oct 25, 2017 19:16
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also the obamacare regulations that limit how much profit an insurance company can make off each dollar it collects, as you might imagine from the description, was passed AS PART OF OBAMACARE but the growth in medical costs far outpacing inflation predated obamacare and was reduced by obamacare so even that idiot mechanism is wrong
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Oct 25, 2017 19:18
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Khisanth Magus posted:Unless it is substantially lower it is unlikely it is worth the costs associated with switching. And I rather doubt that the "negotiated" prices different insurance companies get with medical providers are really all that different. As someone who has been part of this decision making process many dozens of times, switching medical vendors can have a year 1 ROI of like 100:1. You 100% have no clue what you are talking about and are on the wrong side of the Dunning-Kruger curve here
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Oct 25, 2017 19:19
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Whatever, continue to pretend that the insurance companies don't benefit from the rising healthcare costs.
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Oct 25, 2017 19:19
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Khisanth Magus posted:Whatever, continue to pretend that the insurance companies don't benefit from the rising healthcare costs. "wah wah wah stop knocking down my idiot ideas its mean" when every aspect of your argument is wrong the correct approach is to realize you were wrong and stop saying stupid things, not to say more stupid things
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Oct 25, 2017 19:21
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evilweasel posted:"wah wah wah stop knocking down my idiot ideas its mean" and yet, you continue to post for reference the math on this one changes dramatically from market to market and also from business size to business size, as you'd expect; Khisanth Magus is not wrong when it comes to legitimately small businesses, for whom redoing the paperwork just to get on the next provider over's shittiest, cheapest possible plan is a pretty sizeable speed bump. as you get bigger and actually become capable of negotiating with a health insurance company in any meaningful way, not to mention become interested in plans other than Literally the Cheapest Piece Of poo poo I Can Get Away With Offering, the math starts shifting in your favor. health insurers don't enjoy prices rising, to be sure, but they're in a particularly excellent market position to just pass the elevated costs onto consumers.
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Oct 25, 2017 19:54
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Khisanth Magus posted:Whatever, continue to pretend that the insurance companies don't benefit from the rising healthcare costs. I work for a large health insurance company and something like 40% of my annual bonus is directly tied to keeping healthcare costs down.
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Oct 25, 2017 19:55
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Reik posted:I work for a large health insurance company and something like 40% of my annual bonus is directly tied to keeping healthcare costs down. ~once the rockets go up who comes where they come down~ ~that's not my department says Wehrner Von Braun~
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Oct 25, 2017 19:58
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Ze Pollack posted:and yet, you continue to post At no point is any of this a disincentive for insurance companies to slow their (very strong) efforts to cut costs
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Oct 25, 2017 20:00
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esquilax posted:At no point is any of this a disincentive for insurance companies to slow their (very strong) efforts to cut costs absolutely. that their most efficient way to cut costs is and remains finding ways not to pay for expensive people's health treatment ends up being one of the drivers of increasing costs is one of the bits of tragic hilarity in this whole story. Reik's model says so-and-so's policy just ticked over into being a risky proposition, their next claim gets prioritized for inspection to see if there's any excuse Reik's employers can use not to pay for it, Reik gets his bonus, everyone's happy. except, well, the provider that was -charging- Reik's company is not happy about the money Reik saved his company, and they're going to get theirs back somehow. and so, some spreadsheet jockey increases the amount they charge by X% across the board in order to compensate for insurance denials. so Reik's gotta find more efficiencies. so his counterpart's gotta bump up the prices more. so Reik's gotta find more efficiencies. repeat process for a couple of decades and the good news is that we've got hundreds of thousands of people productively employed keeping this self-reinforcing cycle going, shame about all the bankrupted people
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Oct 25, 2017 20:06
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Cactus Jack posted:The millions out of work myth is pretty well debunked by Matt Bruenig here: http://peoplespolicyproject.org/2017/09/19/single-payer-myths-redundant-health-administration-workers/ This was a cool link that materially changed my opinion on the topic, thank you for sharing!
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Oct 25, 2017 20:10
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Ze Pollack posted:absolutely. that their most efficient way to cut costs is and remains finding ways not to pay for expensive people's health treatment ends up being one of the drivers of increasing costs is one of the bits of tragic hilarity in this whole story. The interplay of denials/upcoding/discounts/value-based-payments in the mix between providers and insurance companies is at worst, competitive jockeying independent of overall health care costs, and at best is has a downward impact on it. Do you honestly think provider prices would go down if they just dictated their own prices instead of having to negotiate them?
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Oct 25, 2017 20:17
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esquilax posted:The interplay of denials/upcoding/discounts/value-based-payments in the mix between providers and insurance companies is at worst, competitive jockeying independent of overall health care costs, and at best is has a downward impact on it. Do you honestly think provider prices would go down if they just dictated their own prices instead of having to negotiate them? do you honestly think health insurer claim denial rates would go down if costs stopped rising sorry, my man, the financial incentives here are pretty brutally in favor of killing people for the crime of wanting insurance companies to provide the service they paid for.
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Oct 25, 2017 20:58
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Ze Pollack posted:do you honestly think health insurer claim denial rates would go down if costs stopped rising It's almost like they should implement some kind of requirement where an insurance company can't pay out less than a certain percent of the premiums they collect as medical claims?
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Oct 25, 2017 21:03
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man, being legally required to spend a percentage of the money you collect to provide a service to provide that service what an arduous burden, surely unknown to literally every other transactional business on the face of the planet
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Oct 25, 2017 21:05
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Ze Pollack posted:do you honestly think health insurer claim denial rates would go down if costs stopped rising No, and there's no reason for you to get that impression from anything I've said. You and I both know that You jumped into a discussion about a guy who said that insurance companies are colluding with providers to increase costs, appeared to post in agreement with him, then decided to keep throwing words at the thread that are either irrelevant to the point or directly against it. I'd say you were moving goalposts but I am unable to recognize any point from your posts that is more sophisticated than "insurance company bad"
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Oct 25, 2017 21:09
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Ze Pollack posted:man, being legally required to spend a percentage of the money you collect to provide a service to provide that service Please list any other industry where they are required by law to spend no less than 80% of their revenue on material costs.
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Oct 25, 2017 21:13
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Here's CMS's version of how they are handling open enrollment. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-25.html Also, window shopping for 2018 plans is live on healthcare.com. Public use files are out too.
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Oct 25, 2017 21:46
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esquilax posted:No, and there's no reason for you to get that impression from anything I've said. You and I both know that sorry if it didn't come through. the reason I asked that question of you in response to yours was to demonstrate expecting any of the involved entities to stop trying to maximize their immediate payouts was a fool's errand. insurance companies are not -colluding- with providers to raise costs. they are merely trying to maximize their own profit by denying expensive claims. which results in for-profit providers trying to maximize their own profit by finding ways to upcharge insurance. Khisanth is not wrong about if insurance companies are acting to raise medical costs- he's just wrong about how and why.
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Oct 25, 2017 22:12
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Ze Pollack posted:
How would UHC change that? I am for UHC but I you need to be honest with yourself on this one.
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Oct 26, 2017 01:10
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Mooseontheloose posted:How would UHC change that? I am for UHC but I you need to be honest with yourself on this one. shift in incentive structure in a government-operated vs. private-operated environment. when you have goals other than maximum short-term profit, suddenly cost reduction methods like negotiation with pharmaceutical companies and providing preventative care become significantly more attractive than tasking Reik with identifying the people who should be getting a "lol eat poo poo we're not paying for you anymore" letter. see, as you get older, and your health costs multiply, and your lingering health issues become more and more pressing? private insurance dumps you on medicare and says you're the government's problem now. CIGNA does not give a poo poo that a hundo on preventative care now might save you a hundred thousand in medical bills down the road, if Uncle Sam's the one who has to end up paying them. which suits providers just fine, because giving you statins ahead of your first heart attack is picking your own pocket in a fee-for-service system. when you have to take the long view it becomes possible to take long-term corrective actions, as opposed to the currently most profitable business model for insurers and providers both, which is providers cultivating a nice rich crop of expensive health problems to bill insurers for, and insurers telling the expensively sick "lol eat poo poo" when providers send them the bill.
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Oct 26, 2017 22:14
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Got a letter in today letting me know my Silver plan will be going up by 75% in 2018 if I stick with it. Truly making America great those Republicans.
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Oct 27, 2017 02:23
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Cactus Jack posted:Got a letter in today letting me know my Silver plan will be going up by 75% in 2018 if I stick with it. Truly making America great those Republicans.  that blows dude, I'm sorry.Write an angry letter to your congressperson and tell them you're telling all your friends not to vote for them?
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Oct 27, 2017 03:03
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If I made $50 less per month I would qualify for an exchange plan My plan is going up $60/month through my employer, a 30% increase
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Oct 27, 2017 04:33
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Cactus Jack posted:Got a letter in today letting me know my Silver plan will be going up by 75% in 2018 if I stick with it. Truly making America great those Republicans. Switch plans. Some insurers (like Molina) are doing a soft exit from the market. e: we're up 40% but we're tracking BCBS mostly, so hopefully those second lowest silver plan subsidies work out for us! The Phlegmatist fucked around with this message at 07:50 on Oct 27, 2017 |
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Oct 27, 2017 07:41
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The Phlegmatist posted:Switch plans. Some insurers (like Molina) are doing a soft exit from the market. I'm definitely looking into other options, but just wanted to post that due to 75% being loving insane. I knew the average was going to be around a 30% increase and 75% just floored me.
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Oct 27, 2017 08:08
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I've been browsing plans on healthcare.gov and punching in a bunch of different numbers and nothing makes sense this year.
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Oct 27, 2017 08:33
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esquilax posted:IANAL but I think the no drawbacks for overstating income is a regulatory thing which the IRS can change. A $600 fee from the IRS is a pittance in comparison to the savings of being on a CSR plan. The difference in deductibles, and especially OOP max, is *thousands*. The Phlegmatist posted:I've been browsing plans on healthcare.gov and punching in a bunch of different numbers and nothing makes sense this year. BCBS seems to be focusing on trying to get people to stop taking brand-name drugs. Most of the plans I'm seeing have mandatory 30% to 50% coinsurance for each prescription fill. If you're not on a CSR plan next year is gonna be a loving bitch.
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Oct 27, 2017 11:37
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Crashrat posted:A $600 fee from the IRS is a pittance in comparison to the savings of being on a CSR plan. The difference in deductibles, and especially OOP max, is *thousands*. I don't believe the feds claw back cost sharing reductions at all, even if you understate income - I could be wrong though. But yes the $600, if Trump decides to apply the law, is probably significantly less than the premium subsidy they get via lying.
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Oct 27, 2017 13:24
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Cactus Jack posted:Got a letter in today letting me know my Silver plan will be going up by 75% in 2018 if I stick with it. Truly making America great those Republicans. Are you receiving any premium subsidies? The Phlegmatist posted:Switch plans. Some insurers (like Molina) are doing a soft exit from the market. Which BCBS plan?
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Oct 27, 2017 15:13
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esquilax posted:I don't believe the feds claw back cost sharing reductions at all, even if you understate income - I could be wrong though. I'm not saying to lie but the CSR plans are very very good and there's no real way for the IRS to be like "well you should have been on a plan with a $6,500 deductible rather than a $0 deductible and a $200 out of pocket maximum so we're fining you" because there's just no mechanism in the ACA for penalizing people like that. Even if you got dinged for the full subsidy amount, you're looking at maybe a 25% increase in premium to jump from 60% AV to 94% AV. e: in our case, our bronze EPO costs like 10$ less than our CSR EPO. The former has a $6k deductible and the latter has a $0 deductible. Reik posted:Which BCBS plan? We offer two EPOs and an HMO on the marketplace here much like BCBS and our EPOs are slightly cheaper than theirs due to the provider network being...us. Payer/provider integration has some benefits.
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Oct 27, 2017 17:14
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The Phlegmatist posted:We offer two EPOs and an HMO on the marketplace here much like BCBS and our EPOs are slightly cheaper than theirs due to the provider network being...us. Payer/provider integration has some benefits. How does that payer/provider integration work? Do you have one department trying to maximize revenue from services and another department down the hall trying to keep claim costs down? I ask because historically IDS's have had a rough go at it
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Oct 27, 2017 17:37
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Reik posted:How does that payer/provider integration work? Do you have one department trying to maximize revenue from services and another department down the hall trying to keep claim costs down? I ask because historically IDS's have had a rough go at it Yeah, although instead of down the hall it's like a 30 minute drive away. There's really no other way to do it since we have competition in the region, although moreso on the payer level than the provider level (since we own ~75% of the hospitals in the county.) Provider side needs revenue and the payer side needs to keep costs down in order to compete with other insurers in the area. The most beneficial part of being an IDS is that we can choke out other providers in the area. We'll pay claims if you go to the other hospital chain but we get special joy in making them dig up durable medical equipment maintenance logs.
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Oct 27, 2017 19:24
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The Phlegmatist posted:The most beneficial part of being an IDS is that we can choke out other providers in the area. We'll pay claims if you go to the other hospital chain but we get special joy in making them dig up durable medical equipment maintenance logs. How are there actual people that look at this and go "the free market knows best"?
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Oct 27, 2017 19:30
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KillHour posted:How are there actual people that look at this and go "the free market knows best"? Healthcare is a market failure through and through.
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Oct 27, 2017 19:33
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