Impeding changes to our Health Care system

[TheMercenary]

Massachusetts is a complete failure.

[glatt]

Well, now, a statement like that is easy to prove false.
My niece and nephew were both born in Mass within the last 5 years, and their births both went well. They got the care that they needed.

So if the health care system in Mass works at least well enough for successful childbirths. It can't be a complete failure.

[TheMercenary]

I certainly can't dispute the success of your family members experience. That would be like me saying I have never had a problem receiving health care in the US since the day I was born so there must not be any problems with our system. I mean I have never had a problem so why is everyone complaining?

Here is one of numerous facts surrounding there current situation up in Mass.

When Massachusetts passed its pioneering health care reforms in 2006, critics warned that they would result in a slow but steady spiral downward toward a government-run health care system. Three years later, those predictions appear to be coming true:

Although the state has reduced the number of residents without health insurance, 200,000 people remain uninsured. Moreover, the increase in the number of insured is primarily due to the state's generous subsidies, not the celebrated individual mandate.

Health care costs continue to rise much faster than the national average. Since 2006, total state health care spending has increased by 28 percent. Insurance premiums have increased by 8–10 percent per year, nearly double the national average.

New regulations and bureaucracy are limiting consumer choice and adding to health care costs.

Program costs have skyrocketed. Despite tax increases, the program faces huge deficits. The state is considering caps on insurance premiums, cuts in reimbursements to providers, and even the possibility of a "global budget" on health care spending—with its attendant rationing.
A shortage of providers, combined with increased demand, is increasing waiting times to see a physician.

With the "Massachusetts model" frequently cited as a blueprint for health care reform, it is important to recognize that giving the government greater control over our health care system will have grave consequences for taxpayers, providers, and health care consumers. That is the lesson of the Massachusetts model.

http://www.cato.org/pub_display.php?pub_id=10268

Other sources:
http://www.healthcarefinancenews.com...system-failure

http://online.wsj.com/article/SB1000...871093652.html

[classicman]

Ahhh - Someone finally caught a provider doing what I've been bitching about.
Blatant disregard for all things moral....

Aetna Inc. is suing six New Jersey doctors over medical bills it calls “unconscionable,” including $56,980 for a bedside consultation and $59,490 for an ultrasound that typically costs $74.

The lawsuits could help determine what pricing limits insurers can impose on ”out-of-network” physicians who don’t have contracts with health plans that spell out how much a service or procedure can cost.

One defendant billed $30,000 for a Caesarean birth, and another raised his fee for seeing a critically ill patient in a hospital to $9,000 in 2008 from $500 the year before, the insurer alleges in the suits. The Caesarean price was more than 10 times the in-network amount Aetna quotes on its website.

“If these charges are accurate, consumers and purchasers should be outraged,” said David Lansky, president of the San Francisco-based Pacific Business Group on Health, a coalition of health-insurance buyers that includes Chevron Corp., Walt Disney Co. and General Electric Co.

Lawyers for the doctors declined to comment on specific charges in the suits, and said their clients did nothing wrong.

These are extreme cases of what I have personally experienced. It is so easy to blame the insurance companies, no I am not defending them, BUT there is a lot more blame to go around when they are being asked to pay for treatments, services or supplies that are marked up 1000% or much much more.
Addressing the cost component is an integral component where I believe the new law has fallen far short.

The insurance industry is grappling with how to respond to out-of-network hospital physicians who realize they have pricing muscle, according to Arthur Leibowitz, chief medical officer of Health Advocate Inc., a Plymouth Meeting, Pennsylvania, insurance adviser.

“These doctors can charge whatever they want,” Leibowitz said. “The challenge for the carriers is to come up with an agreeable, acceptable, unbiased judgment as to what a reasonable and customary reimbursement rate is.”

link

Does anyone know how this is impacted by the new HCRA? I have read as much as time permits and still cannot understand definitively the answer.
Going forward, what happens if more Docs drop out of networks and start billing whatever they feel is reasonable? That coupled with the infux of millions of new patients could be disastrous for the ever elusive cost-saving part of this law. I don't even want to think of adding those young healthy people who will opt out of coverage, which is certain to happen. In what numbers, no one knows.

[TheMercenary]

If you are out of network you will always pay more. If you are poor you pay nothing and they write it off. But if you have an income they will come after you. The biggest problem we have at one place I work is that the patients keep the huge insurance checks they are suppose to give to the provider. The practice takes everyone of them to court and has never lost a case.

[TheMercenary]

As we close in on the one-year anniversary of ObamaCare, it’s worth asking what has been the worst feature of this 2,000-plus page law. There are lots of unworthy contenders. But a good case can be made for Section 2711 waivers.
Those are the waivers granted to companies, unions, associations and other lucky duckies so that their current health insurance plans do not run afoul of ObamaCare regulations. Last September news broke that McDonald’s (MCD) would drop some of its health plans without a waiver. A few days later the Department of Health and Human Services announced it had granted 29 such waivers to different entities. At the time, one ObamaCare supporter dismissed the problem as a “big nothingburger.”
Well, it has since grown into a Hardee’s Monster Thick Burger, with the waivers now totaling 1,040.
Here are the various ways in which Section 2711 Waiver may be the worst feature of ObamaCare:
* Deceptive: It pretty much gives the lie to President Obama’s claim that “If you like your health care plan, you can keep your health care plan.” Adding “as long as HHS Secretary Kathleen Sebelius says it’s OK” would have made it more accurate.
* Politicizes Health Insurance: Want to keep your health care plan even though it runs afoul of ObamaCare regulations? Better hope that your company hasn’t upset the Obama Administration. The Administration denies that its waivers are political. Uh-huh. Perhaps that’s why close to 40% of the employees exempted via the waivers belong to labor union health plans.
* Rank Hypocrisy: How many unions applied for a waiver after lobbying hard for passage of ObamaCare? Quite a few, apparently. Actually following the laws that you advocate is for suckers anyway.
* Laughable: And we’re not talking about joyous laughter, but rather the absurd, almost “sick joke” kind. The headline announcing the waivers on the government website is Orwellian:“Helping Americans Keep the Coverage They Have and Promoting Transparency.”
What makes that headline ever more of a joke is that getting to that website, which is at the Center for Consumer Information & Insurance Oversight, takes about seven clicks from the HHS home page. (Start here and see how long it takes you; IBD wishes you luck). Transparency, indeed.
Whether Section 2711 waivers are the worst feature of ObamaCare is a matter of debate. They are undoubtedly a big sign that the law is unworkable.

http://blogs.investors.com/capitalhi...-worst-feature

[TheMercenary]

Kill it now...

Congress makes first major dent in health care law

http://www.washingtontimes.com/news/...alth-care-law/

[TheMercenary]

Obama administration delaying some rules for appealing health insurance denials

The Obama administration is delaying until next January its enforcement of some new rules designed to protect patients who appeal insurers' decisions to deny or reduce health care benefits.

In the meantime, the Labor Department said in a posting on its website that it will revise the requirements to deal with objections raised by insurers. These rules were mandated by the health care law, and federal officials had earlier said they would start enforcing them in July.

The delays were defended by the administration and the insurance industry but worry consumer advocates.

Among the rules now on hold are:

-- A reduction in the amount of time an insurance company is allowed to review a denial of coverage in urgent cases, from no more than 72 hours to 24 hours.

-- A requirement that insurers provide information about the denial and how to appeal in appropriate language for non-English speaking beneficiaries.

-- A requirement that insurers must provide consumers with specific details, which would include diagnostic codes used by doctors, hospitals and insurers, about what treatment isn't covered and why.

http://www.latimes.com/health/la-he-...,2873291.story

[TheMercenary]

The American people do not support Obamacare. This much we know. So I’m willing to bet they’re going to be furious when they learn that the Obama Department of Health and Human Services (HHS) wants to spend as much as $200 million on a propaganda campaign to convince them they’re wrong about the president’s socialist health care overhaul.

http://biggovernment.com/tfitton/201...n/#more-258244

[Urbane Guerrilla]

Two words, easily written: Tort Reform. Essentially a limit on how much recovery can actually can be made of punitive damages, rather than concentrating on coverage of actual medical expenses, say.

This lowers the stakes for insurers on the actual risk per policy. Their planning becomes simplified.

There's another necessity: not artificially circumscribing the size of the region in which insurers compete, but opening it nationwide and even wider will improve the scope and effect of competition among companies and plans. You know what that means for consumers. The hedging is by government fiat, a most changeable thing.

You could write a bill like this on one sheet of paper.

[TheMercenary]

Originally Posted by Urbane Guerrilla

Two words, easily written: Tort Reform. Essentially a limit on how much recovery can actually can be made of punitive damages, rather than concentrating on coverage of actual medical expenses, say.

This lowers the stakes for insurers on the actual risk per policy. Their planning becomes simplified.

Too many lawyers in Congress. They would never let it happen.

[infinite monkey]

To words, two many lawyers. Also.

[TheMercenary]

Ok spelling nazi.

[infinite monkey]

Couldn't help it. Please resume your regular posting.

[TheMercenary]

Thank you.