Health care reformers are passionate on all sides. Each side commissions studies that support their point, and another side fires back with their own study conflicting the first. The message is lost, and average Americans are struggling to make sense of it all. There’s finger-pointing, placing the blame on someone else, when instead we shouldn’t be worried about who is right, but rather what is right.
Blaming opposing political parties, government, or single industries isn’t going to address what’s really bringing down health care costs. So yesterday both parties came together to address Obama’s health care plan at a White House health care summit.
After watching the coverage last night, my mom called and went off about the health care debate. She said she just felt confused and didn’t understand who was right and who she should believe. She was hearing from Republicans, Democrats, even her health insurance company - all with differing messages on what reform should look like. And she wondered who to believe.
I told her – what does it matter? What matters is, were in this mess together. So let’s fix it together. Stop the blame game, and let’s come up with a real solution to address rising health care costs. I think we’re all for the same thing: a sustainable system that Americans can afford.
If you want to talk to your Congressperson about curbing health care costs you can send them a message through Regence’s Issues and Action center. Or if you just want to learn more, here are some resources you can visit:
http://americanhealthsolution.org/fact-check-what-causes-premiums-to-increase/
Top 10 Health Care Cost Drivers
More on health insurer competition
http://www.aarpmagazine.org/health/health_care_costs.html
Friday, February 26, 2010
Thursday, February 4, 2010
The Reimbursement Riddle
Do you pay the same for your McDonald’s meal as the guy behind you in line at the drive thru? Or better yet, should you? That’s the type of question the Massachusetts Attorney General (AG) is asking after a statewide investigation of health care costs.
The results of the investigation indicate that various insurers and consumers were paying different rates for the same care in the same hospitals. It turns out that the hospitals negotiated different paying agreements with each party. And this drove up health care prices – for one major insurer in Mass., provider price increases accounted for 80 percent of total medical growth – according to a recent article in the Boston Globe.
Don’t get me wrong, I like it that my insurer (and employer) Regence, negotiates good discounts for me. That’s part of the advantage of belonging to a group. But negotiating is a two-way proposition. Like in Massachusetts where the AG found that some providers negotiated higher prices for themselves, even though their outcomes (the outcome of the treatment or procedure) weren’t any better.
This all reminds me of the time my daughter was in the hospital. Every single day the case manager visited us and asked when we were leaving. Turns out my insurance coverage paid one flat fee for service, regardless of the time we spent there. In turn, the hospital wanted us out of there to open the bed to someone else.
Meanwhile, there was a child in the same room as my baby, with the same condition – and no one hassled those parents about discharge – they had different insurance coverage. So was that provider treating my daughter differently because of the way the reimbursement model was structured?
Which opens us up to ask – should negotiating these prices be allowed? Or should providers just post their prices, and insurers just set the prices they will pay – and let consumers sort out the difference with the providers? Are any of us ready for a system that operates this way? I’m not faulting the hospitals – they have staff to pay, technologies to keep up, and more. And I’m not faulting Regence or Tricare for their position, but I am faulting the system for allowing this type of reimbursement model to exist.
Maybe we should focus on other ways to curb costs – like incentives that make us stop and think about the resources we’re using, and that others are sharing the cost of. Incentives like discounts on coverage for extreme weight loss, or smoking cessation. I’m sure there are numerous ideas out there t hat would work, and I would like to hear yours.
The results of the investigation indicate that various insurers and consumers were paying different rates for the same care in the same hospitals. It turns out that the hospitals negotiated different paying agreements with each party. And this drove up health care prices – for one major insurer in Mass., provider price increases accounted for 80 percent of total medical growth – according to a recent article in the Boston Globe.
Don’t get me wrong, I like it that my insurer (and employer) Regence, negotiates good discounts for me. That’s part of the advantage of belonging to a group. But negotiating is a two-way proposition. Like in Massachusetts where the AG found that some providers negotiated higher prices for themselves, even though their outcomes (the outcome of the treatment or procedure) weren’t any better.
This all reminds me of the time my daughter was in the hospital. Every single day the case manager visited us and asked when we were leaving. Turns out my insurance coverage paid one flat fee for service, regardless of the time we spent there. In turn, the hospital wanted us out of there to open the bed to someone else.
Meanwhile, there was a child in the same room as my baby, with the same condition – and no one hassled those parents about discharge – they had different insurance coverage. So was that provider treating my daughter differently because of the way the reimbursement model was structured?
Which opens us up to ask – should negotiating these prices be allowed? Or should providers just post their prices, and insurers just set the prices they will pay – and let consumers sort out the difference with the providers? Are any of us ready for a system that operates this way? I’m not faulting the hospitals – they have staff to pay, technologies to keep up, and more. And I’m not faulting Regence or Tricare for their position, but I am faulting the system for allowing this type of reimbursement model to exist.
Maybe we should focus on other ways to curb costs – like incentives that make us stop and think about the resources we’re using, and that others are sharing the cost of. Incentives like discounts on coverage for extreme weight loss, or smoking cessation. I’m sure there are numerous ideas out there t hat would work, and I would like to hear yours.
Wednesday, January 27, 2010
They don't know the cost, but ask anyway
Last week I took my daughter in for a pediatrician’s office visit. One of those many last minute, scary appointments you make when you have an infant screaming with a fever and you don’t know why.
After her examination the diagnosis was apparent: ear infection, and something else -- abnormal test results on her kidneys. It sounds much worse than it is (I think something like 70% of kids come back with these findings), but I was told that I did need to follow up with another test sample (you don’t want the details).
I learned from the staff that no matter what the results are, there is nothing they can do for her anyway until she’s older.
So I asked how much the tests were going to cost, and the lab techs looked at me, stunned. They didn’t know. And neither did the lady that worked the front desk. This baffled me – wouldn’t you know the prices if you worked at the lab?
After going home and thinking about it, I called the doctor’s office and asked when I would find out the results, and if they came back abnormal, would they do anything? I was told no, but they would send my baby to a specialist.
I was ok with that, but if her last results already came back abnormal, why am I repeating them – so that I can be sent to a specialist, have the test out of date again and then have to do it all over again?
The nurse acted as though I was speaking Russian in Spain, but somewhat agreed with me. But the deed was done. Just for kicks, I asked how much this test was going to cost. No one in the doctor’s office seemed to know – I was told they don’t bill for it, so they weren’t sure.
I’m not criticizing the doctor for taking care of my daughter – if she needs a test, then run it. But why do it over and over again, with no new action in between? And why isn’t anyone clear on the costs of these procedures?
The whole thing reminded me of something this doctor wrote in the Seattle Times. http://seattletimes.nwsource.com/html/opinion/2010867306_guest24stitham.html
Maybe something like this has happened to you?
After her examination the diagnosis was apparent: ear infection, and something else -- abnormal test results on her kidneys. It sounds much worse than it is (I think something like 70% of kids come back with these findings), but I was told that I did need to follow up with another test sample (you don’t want the details).
I learned from the staff that no matter what the results are, there is nothing they can do for her anyway until she’s older.
So I asked how much the tests were going to cost, and the lab techs looked at me, stunned. They didn’t know. And neither did the lady that worked the front desk. This baffled me – wouldn’t you know the prices if you worked at the lab?
After going home and thinking about it, I called the doctor’s office and asked when I would find out the results, and if they came back abnormal, would they do anything? I was told no, but they would send my baby to a specialist.
I was ok with that, but if her last results already came back abnormal, why am I repeating them – so that I can be sent to a specialist, have the test out of date again and then have to do it all over again?
The nurse acted as though I was speaking Russian in Spain, but somewhat agreed with me. But the deed was done. Just for kicks, I asked how much this test was going to cost. No one in the doctor’s office seemed to know – I was told they don’t bill for it, so they weren’t sure.
I’m not criticizing the doctor for taking care of my daughter – if she needs a test, then run it. But why do it over and over again, with no new action in between? And why isn’t anyone clear on the costs of these procedures?
The whole thing reminded me of something this doctor wrote in the Seattle Times. http://seattletimes.nwsource.com/html/opinion/2010867306_guest24stitham.html
Maybe something like this has happened to you?
Thursday, January 14, 2010
Isabella's story
October 14, 2009 I woke up at 5:30a.m.frantically shaking my husband and shrieking, “I think it’s time!” He was as surprised as I was – I wasn’t due for our first child for another month, and I was scheduled for a c-section in November. We had no idea that my water would just BREAK in the middle of the night. So with no bag packed or baby “essentials” put together in our home, we left for the hospital.
In the midst of the hustle and bustle of delivery preparations that followed over the next few hours, I asked several medical personnel for assurances that although the baby was early, she would be healthy. They all told me not to worry, she would be fine.
And four hours later our beautiful Isabella joined our family! I can’t remember the details following delivery (the pain meds make it a bit of a blur), but Isabella had some breathing issues from the start. Within two hours she was taken to the Neonatal Intensive Care Unit (NICU) for pneumonia. Several breathing tubes and IVs later, she was in treatment.
About a week later, the breathing tubes came out and a week after that, the IVs – Isabella was on the mend! But as any parent will tell you, just when you think you’re cruising along, your kids throw another curve ball at you. That was when Isabella decided to start “forgetting” to breathe sometimes. Medications were administered and time passed, and nothing was working. She just seemed to get worse every day, not better.
After consults and many treatments, and time for her to “grow out of it,” she was sent home a month later on a breathing monitor. We couldn’t be happier to get our little girl home.
All this time, medical bills didn’t even cross our minds. We would willingly be in debt for the rest of our lives if it meant that she had what she needed to get better. But should we have been more responsible in at least asking, “How much is this going to cost?” If for no reason than assuming that someone else was picking up the tab? Maybe, but we didn’t.
After we were home for one week, medical statements started showing up in our mailbox. The bills for Isabella alone were $80k! That didn’t include the extra $10k for my c-section, hospital stay, and meds. Or the $1k per week home breathing monitor rental (which she is still using).
Thankfully, I work for Regence and my husband is in the military – so as for insurance, we’re covered. I wonder if others who share my insurance carrier have seen premium increases even though they didn’t visit the doctor more than once or twice last year. The same pot of money they paid into was tapped to care for my family and others with medical difficulties. Thank you—I will be here for you, too.
But coverage has its limits, especially in the world of high-dollar, high-tech health care, and many people still end up owing thousands out of pocket. (Read more - http://www.boston.com/business/personalfinance/articles/2009/02/18/pleading_your_case_on_medical_bills_is_a_sound_policy).
And none of this begins to address the hardship faced by those without coverage at all.
As we watch how health care changes shape up in our country, I wonder if some of the fundamental issues are being addressed in our reformed system? For example, when will the actual costs of medical services be addressed, and more importantly, when as consumers will we collectively become more informed, and ask “how much does it cost?”
And I’m not the only one wondering (Read more - http://www.nytimes.com/2010/01/11/health/policy/11health.html).
In the midst of the hustle and bustle of delivery preparations that followed over the next few hours, I asked several medical personnel for assurances that although the baby was early, she would be healthy. They all told me not to worry, she would be fine.
And four hours later our beautiful Isabella joined our family! I can’t remember the details following delivery (the pain meds make it a bit of a blur), but Isabella had some breathing issues from the start. Within two hours she was taken to the Neonatal Intensive Care Unit (NICU) for pneumonia. Several breathing tubes and IVs later, she was in treatment.
About a week later, the breathing tubes came out and a week after that, the IVs – Isabella was on the mend! But as any parent will tell you, just when you think you’re cruising along, your kids throw another curve ball at you. That was when Isabella decided to start “forgetting” to breathe sometimes. Medications were administered and time passed, and nothing was working. She just seemed to get worse every day, not better.
After consults and many treatments, and time for her to “grow out of it,” she was sent home a month later on a breathing monitor. We couldn’t be happier to get our little girl home.
All this time, medical bills didn’t even cross our minds. We would willingly be in debt for the rest of our lives if it meant that she had what she needed to get better. But should we have been more responsible in at least asking, “How much is this going to cost?” If for no reason than assuming that someone else was picking up the tab? Maybe, but we didn’t.
After we were home for one week, medical statements started showing up in our mailbox. The bills for Isabella alone were $80k! That didn’t include the extra $10k for my c-section, hospital stay, and meds. Or the $1k per week home breathing monitor rental (which she is still using).
Thankfully, I work for Regence and my husband is in the military – so as for insurance, we’re covered. I wonder if others who share my insurance carrier have seen premium increases even though they didn’t visit the doctor more than once or twice last year. The same pot of money they paid into was tapped to care for my family and others with medical difficulties. Thank you—I will be here for you, too.
But coverage has its limits, especially in the world of high-dollar, high-tech health care, and many people still end up owing thousands out of pocket. (Read more - http://www.boston.com/business/personalfinance/articles/2009/02/18/pleading_your_case_on_medical_bills_is_a_sound_policy).
And none of this begins to address the hardship faced by those without coverage at all.
As we watch how health care changes shape up in our country, I wonder if some of the fundamental issues are being addressed in our reformed system? For example, when will the actual costs of medical services be addressed, and more importantly, when as consumers will we collectively become more informed, and ask “how much does it cost?”
And I’m not the only one wondering (Read more - http://www.nytimes.com/2010/01/11/health/policy/11health.html).
Wednesday, December 23, 2009
For health care reform, the only way to keep costs low
Have you noticed in the health care debate how some people start talking about car insurance? Specifically the argument goes that all drivers are required to purchase car insurance, so why not mandate health insurance the same way and make everyone buy it?
The comparison is a little shaky, but interesting. As a driver it's reassuring for me to know that other people on the road are insured in case one of them hits me. I won't have to shoulder the price of someone else's mistake. With health care, the "shared responsibility" works a little different, but it comes down to this: Insurance costs can't be controlled without everyone required to buy in.
Here’s another example to help put it into perspective that the Wall Street Journal recently used:
Think about it. If insurers cannot turn away anyone, and yet people are allowed decide not to buy insurance, what would happen? Unhealthy or sick individuals would purchase coverage, while younger, healthier individuals would conclude that they could save money by skipping it. As a result, the overall group of people insured would be less healthy, and thus the costs to each of them would increase.
What would happen next? Responsible people who are currently healthy would be hit with paying a lot more money. Without a doubt, some of them will decide that coverage is too expensive and will drop out. Which increases costs again, as the group loses even more of its healthier — and thus less expensive — participants.
By keeping healthy people in the insurance mix, the individual mandate will help keep average premium costs low. Pure and simple.
The Washington Post's Ezra Klein has a great blog post about the need for an individual mandate. It's worth the read.
Tell us what you think at our Facebook page.
— Susan with Regence
The comparison is a little shaky, but interesting. As a driver it's reassuring for me to know that other people on the road are insured in case one of them hits me. I won't have to shoulder the price of someone else's mistake. With health care, the "shared responsibility" works a little different, but it comes down to this: Insurance costs can't be controlled without everyone required to buy in.
Here’s another example to help put it into perspective that the Wall Street Journal recently used:
Imagine that parking tickets were only 25 cents. Would drivers have much reason to feed parking meters? The answer, of course, is no. Paying a fine would be cheaper than putting a dollar or more into a meter. A weak coverage mandate would have the same result.
Think about it. If insurers cannot turn away anyone, and yet people are allowed decide not to buy insurance, what would happen? Unhealthy or sick individuals would purchase coverage, while younger, healthier individuals would conclude that they could save money by skipping it. As a result, the overall group of people insured would be less healthy, and thus the costs to each of them would increase.
What would happen next? Responsible people who are currently healthy would be hit with paying a lot more money. Without a doubt, some of them will decide that coverage is too expensive and will drop out. Which increases costs again, as the group loses even more of its healthier — and thus less expensive — participants.
By keeping healthy people in the insurance mix, the individual mandate will help keep average premium costs low. Pure and simple.
The Washington Post's Ezra Klein has a great blog post about the need for an individual mandate. It's worth the read.
Tell us what you think at our Facebook page.
— Susan with Regence
Friday, December 11, 2009
The first word in health care reform is health
There’s a lot of passion in the health reform debate about who should do what. Health plans should take everybody. Premiums should be affordable. The system should be more efficient. I say, "Yes" to all of the above.
But there are some things doctors, hospitals, medicines and health plans just can’t do.
Case in point: My husband Mike was diagnosed as “pre-diabetic” – not to worry, there’s medication for that. I said, “Whoa. Type II diabetes is wakeup call. We gotta make some changes.” What’s the big deal, he says -- one more pill, just a $20 co-pay.
I dared him to ask the doctor, “What would it take to lower blood sugar and not be pre-diabetic?” Answer: lose weight, start exercising. And that would also reduce your high blood pressure. Ha -- two birds, one stone, no meds.
Mike also got the low-down from friends with advanced Type II diabetes. Linda has such bad pain in her legs, “I wish they would just cut them off, some days.” Renee warned: “You do not want this. Stop it now.”
So, we got a stationary bike, adjusted our eating and he dropped 40 pounds in three months. The doctor was impressed: lower blood pressure and blood sugar. No meds—for now. The challenge is to keep it up.
Of course, a pill would be easier -- at first. Those (many) times we just want to watch TV and break out the snack food, it is reeeealy haaaard to remember -- walk, or suffer pain like Linda. Shut the refrigerator, or struggle with yo-yo blood sugar craziness, like Renee.
I realize not every disease is within our control, but these conditions -- high blood pressure and diabetes – usually reflect a lifetime of choices around food and exercise. They are strongly correlated to heart disease, which kills more Americans than all cancers combined.
No doctor can make me do the right thing. Having health coverage does not liberate me from the responsibility to eat right and break a sweat a couple times a week.
An act of Congress can get more people covered but it doesn’t come free. And, I still have to do my own exercise. Darn it.
What are your challenges to staying healthy? Please share what’s helped you stay on track at the What’sTheRealCost Facebook page..
Susan at Regence
But there are some things doctors, hospitals, medicines and health plans just can’t do.
Case in point: My husband Mike was diagnosed as “pre-diabetic” – not to worry, there’s medication for that. I said, “Whoa. Type II diabetes is wakeup call. We gotta make some changes.” What’s the big deal, he says -- one more pill, just a $20 co-pay.
I dared him to ask the doctor, “What would it take to lower blood sugar and not be pre-diabetic?” Answer: lose weight, start exercising. And that would also reduce your high blood pressure. Ha -- two birds, one stone, no meds.
Mike also got the low-down from friends with advanced Type II diabetes. Linda has such bad pain in her legs, “I wish they would just cut them off, some days.” Renee warned: “You do not want this. Stop it now.”
So, we got a stationary bike, adjusted our eating and he dropped 40 pounds in three months. The doctor was impressed: lower blood pressure and blood sugar. No meds—for now. The challenge is to keep it up.
Of course, a pill would be easier -- at first. Those (many) times we just want to watch TV and break out the snack food, it is reeeealy haaaard to remember -- walk, or suffer pain like Linda. Shut the refrigerator, or struggle with yo-yo blood sugar craziness, like Renee.
I realize not every disease is within our control, but these conditions -- high blood pressure and diabetes – usually reflect a lifetime of choices around food and exercise. They are strongly correlated to heart disease, which kills more Americans than all cancers combined.
No doctor can make me do the right thing. Having health coverage does not liberate me from the responsibility to eat right and break a sweat a couple times a week.
An act of Congress can get more people covered but it doesn’t come free. And, I still have to do my own exercise. Darn it.
What are your challenges to staying healthy? Please share what’s helped you stay on track at the What’sTheRealCost Facebook page.
Susan at Regence
Wednesday, December 2, 2009
Concerns around cost of reform
Here’s what I want to know: how will health reform being considered by Congress affect what I pay for health insurance?
The Senate bill is estimated to cost around $900 billion; the House bill around $1.2 TRILLION (gulp). That money has to come from somewhere and I can’t shake the feeling that I’m going to feel it one way or another.
A much anticipated budget analysis from the Congressional Budget Office (CBO) released this week attempts to address those concerns. Unfortunately, it does little to clarify the matter, for a regular person like me anyway.
Here’s why: on the one hand, the analysis suggests that the large number of Americans who currently have employer-sponsored medical insurance – like me – would not see much change in their premium costs.
But get this: the New York Times Prescriptions blog says that “calculating the proposed legislation’s effect on premiums is so complicated that the budget office pegged its analysis to a single year, 2016.”
A single year?! How does an estimate for a single year inspire confidence that reform won’t cost me, or the country, a heckuva lot of money?
Here’s another head scratcher: those who buy health insurance on their own would see an increase, but about half would have that increase offset with government subsidies. Subsidies that would artificially lower premiums.
Many in Congress would like me to believe that health insurers are to blame for rising premiums. The hard truth is that premiums go up because medical care is expensive and we use a lot of it. And what happens to premiums is dependent on whether reform can lower health care spending.
Please understand, I support health care reform but I’m concerned that all we’re doing is expanding access to a dysfunctional system. There’s still time though. I’ve been hammering on my elected representatives to give me better answers.
I don’t want a fairy tale, I want accountability because we all deserve a health care system that works for everyone.
–Laura at Regence
The Senate bill is estimated to cost around $900 billion; the House bill around $1.2 TRILLION (gulp). That money has to come from somewhere and I can’t shake the feeling that I’m going to feel it one way or another.
A much anticipated budget analysis from the Congressional Budget Office (CBO) released this week attempts to address those concerns. Unfortunately, it does little to clarify the matter, for a regular person like me anyway.
Here’s why: on the one hand, the analysis suggests that the large number of Americans who currently have employer-sponsored medical insurance – like me – would not see much change in their premium costs.
But get this: the New York Times Prescriptions blog says that “calculating the proposed legislation’s effect on premiums is so complicated that the budget office pegged its analysis to a single year, 2016.”
A single year?! How does an estimate for a single year inspire confidence that reform won’t cost me, or the country, a heckuva lot of money?
Here’s another head scratcher: those who buy health insurance on their own would see an increase, but about half would have that increase offset with government subsidies. Subsidies that would artificially lower premiums.
Many in Congress would like me to believe that health insurers are to blame for rising premiums. The hard truth is that premiums go up because medical care is expensive and we use a lot of it. And what happens to premiums is dependent on whether reform can lower health care spending.
Please understand, I support health care reform but I’m concerned that all we’re doing is expanding access to a dysfunctional system. There’s still time though. I’ve been hammering on my elected representatives to give me better answers.
I don’t want a fairy tale, I want accountability because we all deserve a health care system that works for everyone.
–Laura at Regence
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