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Mar 7, 2017 17:20
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Ze Pollack posted:Genuinely interested in your thoughts on this one, because I keep trying to figure out who the hell this is supposed to appeal to and not succeeding. I'm with you in that I don't really "get" it - there doesn't seem to be any kind of cohesive thesis behind what it's supposed to do, unlike the ACA itself and prior republican replacement plans. It looks as if it was designed by elected officials who read a few white papers instead of a wide coalition of experts and lobbyists like literally every other piece of major legislation. The lottery passage in particular stands out as something that looks like a no-name congressman demanded be included. It doesn't really move towards the republican "vision" for health care and doesn't really fix anything. One potential positive that I can see is the offering of subsidies to poor people in states that didn't expand medicaid (if I'm reading it correctly). Doubtful the numbers given will be enough to make insurance a viable choice for them though.
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Mar 7, 2017 19:17
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Lord Harbor posted:Anyone have a clear answer for these? 1. Yes, nothing preventing you from buying up to a richer health plan when you get sick except for the one-per-year open enrollment period. Same as under the ACA. 2. The tax credit is specifically for insurance coverage and not point-of-care cost sharing. Any point-of-care cost-sharing credits from the ACA are repealed and not replaced. For a rational health care consumer, 30% isn't that much. However, for many people the size is roughly comparable to the ACA individual penalty ($695 / 2.5% of income) for a few years . It's a motivator, similar to the individual mandate and inspired by the 1%/month/lifetime Medicare Part D "no coverage" penalty. Even though it's comparable in size to the ACA penalty, it definitely seems less useful from a behavioral economics standpoint (you are mandated to buy this or pay $1500 now vs. if you don't buy this you will eventually pay $1500 when you do buy it) and I'm skeptical.
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Mar 8, 2017 18:55
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Dr. Angela Ziegler posted:Maryland totally does this, though. An appendectomy costs the exact same no matter where you get it done. So it's not impossible. An all-payer system like that isn't exactly the same as no networks, and networks still exist in Maryland. Health plans can and do create networks (broad and narrow) to limit benefits to providers who are high quality, or to take into account a relationship with the providers (e.g. Kaiser).
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Mar 9, 2017 00:57
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Amused to Death posted:This seems like the exeception. No one i know truly knows what their current work health insurance costs. I asked when i found out mine, and i only did that by accident. It's on the W-2 now (box 12 code DD) so you can find out if you want. Jealous Cow posted:I lost track of it, but does the AHCA still reduce the tax exemption for employee contributions like an earlier leaked version? No it doesn't. Other republican plans in the past few years did that, but those weren't really "leaked versions of this bill"
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Mar 18, 2017 14:29
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HappyHippo posted:UHC countries tend to spend less on drugs, because larger purchasers can negotiate better prices. It's not the size that results in lower drug prices. ESI negotiates with the purchasing power of like 100 million members
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Mar 21, 2017 04:28
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Boon posted:It's a valid concern. CO taxpayers effectively subsidize everyone living within X miles of the border where X = someone's willingness to travel for cheap/free healthcare. How so? The plan was supposed to be a system of insurance for CO residents only. Hospitals would still charge out-of-staters
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Mar 21, 2017 18:10
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call to action posted:They're not dirty or even particularly poor, you loving idiot racist, but allowing people who've been abandoned by the US and other states to move to CO to have everything treated solely at CO expense doesn't make sense. There's a concept called insurance you may want to look up, particularly why the individual mandate was a part of Obamacare. Only national level UHC makes sense - if you don't agree, point to another country where some regions are UHC and others aren't. People who are dying in the gutters can already scrape together a few bucks to move to any state that offers them medicaid. If they aren't poor, then they can purchase private insurance coverage. This isn't a problem that is caused by Coloradocare, which is literally just another health insurance plan esquilax fucked around with this message at 21:27 on Mar 21, 2017 |
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Mar 21, 2017 21:24
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call to action posted:So are you aware who pays for the majority of Medicaid, versus who would pay for the majority of ColoradoCare? Because someone moving to take advantage of federal programs is different from someone moving to take advantage of state programs. Not from the perspective of the individual who would be moving, all they see is dollars from state A and no dollars from state B. Do we see a large number of people moving between states to take advantage of the medicaid discrepancy? Doesn't seem like your projections line up with reality
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Mar 21, 2017 21:54
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SHOP marketplace is not the same, it does the same thing but is on an individual employer basis. Multiple employer plans (which when several employers band together to provide a single plan) for health and retirement have been around like forever.
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Mar 24, 2017 16:02
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hobbesmaster posted:I guess that goes with the public's fundamental misunderstanding of insurance. The SHOP marketplace would be a larger group than any collection of small businesses so should be cheaper. Not necessarily, since each individual purchaser is still relatively small. I don't see any major reason why premiums would be lower than in the individual market, and a few reasons that they might be higher due to better benefits.
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Mar 24, 2017 16:15
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hobbesmaster posted:I thought it operated the same way as the normal individual marketplace and prices were the same for everyone? Employers in the SHOP market can (must?) curate the plans and offer only a few of them, which means that they are a target of anger and employee noise if they only offer ones with extremely narrow networks or scant benefits. Which likely means the plans chosen will have higher premiums, even if the apples-to-apples price for a comparable plan in the individual market is the same. Not sure if this is actually was has happened though. A benefit of the SHOP marketplace is that it allows the employer to circumvent age discrimination rules and allow younger people to have lower premiums, which I suppose could actually result in more people enrolled and lower premiums than a normal group plan, but would not be different than the individual market.
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Mar 24, 2017 16:28
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I'm pretty sure the authors just looked up the additional yearly cost of treatment for people with diagnoses under that, per year. This is a fairly decent proxy for the additional premium for continuing chronic conditions, but don't try to put too much meaning behind the numbers (especially for the acute conditions, as those are generally not predictable in advance). Ignore the actual numbers, the "so what" of the chart is that allowing insurance companies to charge a cost-neutral premium would lead to ridiculous outcomes for people who are sick. esquilax fucked around with this message at 19:30 on Apr 20, 2017 |
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Apr 20, 2017 19:28
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Medicare FFS denies just as many claims as other insurers, and I've never seen any evidence that shows insurers deny more claims when they have a profit motive (insured plans) versus when they don't have a profit motive (employer self-funded plans). For some reason my google skills are failing to find an AMA Health Insurer Report Card that's more recent than 2012, but those tend to have good stats on claim denials
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Apr 28, 2017 16:49
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Hieronymous Alloy posted:Medicare and.medicaid have better and easier processes to contest care denials, though. Or at least they did in the past, they're kinda getting cut apart. I thought I read somewhere that the ACA's external review process was working pretty well. If the new process has been shown to be insufficient or biased I'd definitely be interested in reading more. Maybe that only applies to patients though, not sure about the initial process on the provider side.
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Apr 28, 2017 17:13
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hobbesmaster posted:I saw in the freeper thread that some of the anti abortion folk are saying this "defunded planned parenthood"? Is there any other source for that? And what mechanism did they use, because I'm pretty sure its not planned parenthood billing medicaid but whatever random independent contractor OB/GYN billing them, right? It's section 103 of the bill. It prevents federal payments to states to cover medicaid payments to PP and it affects any "affiliates, subsidiaries, successors, or clinics of the entity".
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May 5, 2017 00:55
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hobbesmaster posted:So its an illegal bill of attainder. Got it. Of course not, it applies to any abortion-providing entity that gets over $350M in medicaid funds. It's just a coincidence that there only happens to be one of those
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May 5, 2017 01:28
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Leon Trotsky 2012 posted:Brookings did a study a couple of years ago and came to the conclusion that the higher rate Americans pay for healthcare boils down to three big things. Do you have a link to the study? Sounds neat
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May 9, 2017 19:04
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Peven Stan posted:The ACA was supposed to shift employer paid insurance gradually over time to the exchanges. Rahm Emanuels brother Ezekiel predicted by 2020 employer paid plans would be rare. The employer mandate, the small group exchanges, and the significant penalties against health reimbursement arrangements directly opposed a shift away from employer insurance to individual market. The overarching goal of the ACA was to fix the individual market, but the IRS and other executive departments spent a significant amount of time and regulatory effort making sure that it didn't cause everyone to be "dumped on the exchanges". A movement from employer healthcare to individual healthcare was what McCain was touting on the 2008 campaign trail and what republican replacement plans in 2013-2016 were focused on, in opposition to Obama.
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May 16, 2017 17:45
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The Phlegmatist posted:It's a possibility. CBO was rushed last time and didn't really get to calculate the additional cost of subsidies paid by the federal government as part of the expenses of AHCA. Between insurers being able to charge you more based on your health status (i.e., the preexisting condition changes) and the government's reticence to actually pay for the high risk corridors, you'd see average premiums jump up substantially along with subsidies. Two reasons. 1. In the AHCA, subsidies are decoupled from that "Second lowest cost silver plan" calculation 2. Under current regulations and professional actuarial guidelines at least, the calculation of the actuarial value depends on the benefits covered. If you don't cover hospitalization, e.g., the actuarial value would tank and it wouldn't be a silver plan any more.
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May 18, 2017 23:18
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There is no actual consistent definition of single payer other than "what I imagine the mostest leftist health care is". People consistently call US Medicare single payer even though it is a system with multiple payers
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Jun 27, 2017 16:28
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You forgot the best parts - traditional medicare has no out-of-pocket maximum, and has a lifetime limit after which they will cut you off This and the above is the reason why like 90% of traditional medicare enrollees have supplementary coverage.
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Jun 27, 2017 23:35
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The Phlegmatist posted:The PSA screen is just a blood test, so it's not harmful in and of itself. This is the reason why a lot of preventive services have a minimum age before they are covered. Start too early and the true positive rate is so low that the financial and human cost of false positives is out of proportion to the benefits There's like a whole political conversation about the age at which to begin mammogram screening
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Jun 28, 2017 16:41
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Solkanar512 posted:Is there an actual case study about this? Instead of joining an association pool, moderate to large companies would generally choose to self insure to save on administrative costs and get the benefits of ERISA. Unless, of course, they had very high claims costs. Then they might realize that they could get a better deal from joining an association, and mix in all of their bad risk with the rest of the association's good risk. This jacks up the rates. Similarly, if a company has a lot of good risk, then they don't actually see a benefit to being a part of the association. They would make their own deal with an insurance company, leaving only the bad risk.
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Jun 28, 2017 21:33
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FizFashizzle posted:are you guys familiar with what's going on with mission healthcare in western NC and BCBS? There's a recent trend in provider/insurer agreements to tie prices to the value that the hospital provides to patients. This is generally called value based care or pay-for-performance, and gives providers "skin in the game" in regards to providing higher quality care to patients and reducing hospital readmittance. BCBS NC wants to keep the reimbursement-per-service flat, with future increases being solely on pay-for-performance agreements. Mission wants inflationary increases, with pay-for-performance increases on top. If they can't come to an agreement, there's a big PR hit in there for someone. They are both trying to sell their side to the public to deflect the potential PR blow and improve their negotiating position. BCBS NC's position is more consistent with recent trends in insurer/provider arrangement, but attributing "fault" is not really helpful.
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Aug 2, 2017 15:57
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Dems learned from the losing end how an unworkable healthcare policy that only appeals to the base can be a powerful tool to win elections. Even if the wonks give it an honest try, the actual politicians might not see it as in-their-interest to put forward anything resembling good policy.
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Aug 29, 2017 18:56
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evilweasel posted:yes but republicans are learning that once you get into office you better deliver or there's going to be consequences I agree, I just expect there to be a big pushback against it based on the reason I gave and all the ones that Yglesias identified in his article. A lot of dems really are not going to like it when a pro-single payer organization comes out and says that they recommend a $15 trillion tax increase.
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Aug 29, 2017 19:06
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Medical fraud is like $100+ billion per year? Like literally everyone in the insurance industry cares about it a lot, and spends a significant amount of their own resources to stop it
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Aug 30, 2017 16:55
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Hieronymous Alloy posted:The insurance industry cares about "medical fraud" because that's their pretext for denying care they don't want to pay for. https://www.justice.gov/criminal-fraud/health-care-fraud-unit quote:The Criminal Division plays a critical role in HEAT. The Criminal Division’s Fraud Section has 40 prosecutors assigned on health care fraud matters across the country. Most of these 40 prosecutors are assigned to the Medicare Fraud Strike Force (MFSF). Partnering with nine U.S. Attorney’s Offices, the MFSF has filed almost 1000 cases, charging over 2100 defendants who collectively billed the Medicare program more than $6.5 billion. Almost 1500 of these defendants pleaded guilty and 200 others were convicted in jury trials; over 1200 defendants were sentenced to imprisonment for an average term of approximately 48 months. And that's just Medicare fraud that they could prove, for this one particular unit of the DOJ. You're in conspiracy theory territory
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Aug 30, 2017 17:07
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Hieronymous Alloy posted:No, that supports my point and is in line with what I expected. That's just the people that they caught and charged. The most conservative estimates I've seen put it at the dozens of billions per year, with most going $100+ It's extremely hard to catch, which is why preventative measures and proper incentives are more important than literal actual enforcement.
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Aug 30, 2017 17:19
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hobbesmaster posted:Who is defining what fraud is here though? Illegally charged or obtained services, probably as determined by whoever does the study. If you want an actual source, the Institute of Medicine (division of the National Academies of Sciences) estimated $75b in CY2009
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Aug 30, 2017 17:30
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Hieronymous Alloy posted:Negotiated pricing or price controls under Medicare / Medicaid could absolutely address that issue (by reducing the number of expensive treatments; I would argue that almost no medical treatment, procedure, or device is currently "fairly priced" in America). For example, (edit: most state Medicaid programs have) Medicaid currently has a preferred drug list, and it's no coincidence that the preferred drugs are cheaper than the non-preferred alternatives. Private insurance already does both those things - negotiated pricing and preferred drug lists. Medicaid programs also have significant utilization management and prior authorization programs, comparable to private insurance.
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Aug 30, 2017 18:08
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Peven Stan posted:Private employer insurance is a clusterfuck if different payers setting different prices. I've been seeing the same allergist for 4 years while changing jobs enough that he's been paid through 3 different employer plans, at $78, $112, and finally now $153 a visit. How is that a reasonable or a functional insurance system? The healthcare debate is too politicized to make payment reforms like that to improve the system. Leveling payments across payers is a wonkish solution that is hard to convey as "helps people" and doesn't energize anyone's base. Medicare and Medicaid pay different rates from each other and both cost shift significantly to private plans which adds to the problem.
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Sep 16, 2017 15:02
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Nevermind
esquilax fucked around with this message at 15:33 on Sep 29, 2017 |
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Sep 29, 2017 15:31
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Lote posted:Software already does automatic checks for medication interactions that are much more complex than this mistake. It would be trivial to implement a "Are you sure you want to give 38 times the normal dose?" Screen after a large medication order. You should read the full 4 part article, all of these points are directly addressed and either happened or explained in detail why that line of thinking is disastrous.
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Oct 4, 2017 15:33
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Lote posted:I understand the article. This is a case where the medication in question is a combo drug that comes written as double strength 1 pill instead of other medications. Pediatrics is also obsessed with weight based dosing even for medications that don't need to be dosed based off weight. This is primarily a systems design issue where there's a flaw in the system. The system should take into account mistakes possibly happening at every interaction, including during the additional steps to correct those mistakes. You apparently don't understand all four articles, because it explained very clearly that there was a warning, why they allowed the nurse to override the warning, why the nurse did override the warning, and why designing a system to account for mistakes happening at every interaction is often counterproductive (and is literally one of the main causes of this specific drug error).
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Oct 4, 2017 16:25
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Magic Underwear posted:The nurse ignored a warning? I thought it was the doctor. The nurse scanned each of the 39 pills and the computer said yep, feed all of these to the patient. She was only guilty of trusting the machine over common sense and not wanting to raise a fuss, something aviation CRM was invented to fix. The hospital industry should be stealing that methodology as well as the much better warning/caution/info methodology that planes use, to keep people informed of what's actually important and not bothering them with what isn't important. Oops yes I meant the doctor. It's a good case study in general, and shows a lot of actionable recommendations.
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Oct 4, 2017 16:58
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The aarp plans are some of the most popular med supp, med c and med d plans. Kind of a different animal than the pre65 market though
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Oct 11, 2017 23:25
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Flip Yr Wig posted:I know this was pretty much the entire point of the last round of ACA litigation, but I won't lie and say I entirely understood the issue. To what extent are the CSRs statutorily required, and to what extent does the president have the discretion to fund them? They are required by the text of the ACA but Congress did not appropriate funding for it. Congress sued Obama to stop payment of the CSRs because of this issue
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Oct 13, 2017 15:39
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The Phlegmatist posted:Nope, there's no mechanism for that in the law. So if you estimate your income at, say, 120% FPL and wind up making 70% FPL you are fine. There's no penalty for falling under the 100% FPL cutoff. IANAL but I think the no drawbacks for overstating income is a regulatory thing which the IRS can change. 36b.f.2.B.i has no lower limit which implies that they can claw back up to $600 in subsidy from someone below the FPL.
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Oct 23, 2017 15:40
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