BBO Discussion Forums: Affordable and Quality Health Care - BBO Discussion Forums

ldrews, on 2017-June-27, 19:10, said:

The underlying problem is at least twofold. People can't afford the hospital bill because they are poor. Also, patients can't afford hospital bills padded with an obscene amount of overhead. We in the industry call this ridiculous bidding. Hospitals have not been required to clean up their cost accounting structure--this is the true root cause; therefore, they have no earthly idea how much services should cost in an allegedly competitive marketplace.

This is why the average patient must vehemently negotiate against the hospital's FIRST BILLING OFFER. Treat it like a buying a car from a car dealer...everything is negotiable. The hospital bill is just a starting point.

For example, if I stay at a hospital and am not attached to any expensive equipment, I should not be billed $550/night for a room. I have stayed at the Ritz Carlton with 24/7 room service cheaper! Toothbrushes do not cost $10.00. In general, hospitals have not been required to have TRUTH IN BILLING PRACTICES; thus, they don't know how much their services really cost the patient so they apply all of their costs to overhead and are not compelled to track down inefficiency, waste, fraud, abuse, and poor inventory control.

Any hospital worth its weight should be on activity based cost accounting structures. Anything less is simply uncivilized and undisciplined.

See http://www.beckersho...es-in-2010.html for crazy inpatient rates!

I heard that Trump is saying that when they finish the negotiations, the new health care bill will be special. Isn't "special" the euphemism often used for children who used to be called "retarded"?

barmar, on 2017-June-28, 13:33, said:

I thought it was the church lady: Well, isn't that special.

Winstonm, on 2017-June-28, 14:10, said:

Or drugs - mummy's special cookies...

Winstonm, on 2017-June-28, 14:10, said:

You are too much....you took us way back

RedSpawn, on 2017-June-28, 06:02, said:

It's been years since I heard this but as I recall.....hospital bills are inflated for a business reason and are not a reflection of real costs. Most hospitals are businesses and to make the balance sheet look reasonable bills are inflated. They then fall into the category of Accounts Receivable until they are paid. Accounts Receivable is an asset, so the larger it is the more it offsets items on the Liability side of the balance sheet. I'm sort of foggy on what those Liabilites are, but for good reason they're pretty high for all hospitals. So to keep the hospitals viable and open, the fiction of overinflated bills is allowed and maintained.

If you are without insurance and huge medical bills come to you, a lawyer would tell you to not pay anything. Ultimately, a negotiation goes on with the hospital, doctors, and services that brings the total down closer to what insurance companies pay.

If you've ever seen a hospital bill with your medical insurance applied, you'd see that many items are reduced by significant amounts to get what the insurance and you have to pay. That write off is really reducing the bill to a more honest reflection of the cost of services rendered.

RedSpawn, on 2017-June-25, 10:54, said:

The average subsidy is something like $300/month. So in rough numbers, we're probably talking something like a total $5000/yr for each individual policy.

rmnka447, on 2017-June-28, 23:23, said:

Agreed.

Accounts Receivable and Patient Revenue is first set. Then Direct Cost, Indirect Cost, Direct Materials, Overhead Applied and Cost of Services Rendered is 2nd Set. Problem is 2nd set where overhead applications and indirect cost applications are huge cost pools relative to individual services rendered and creates unjustifiable bills.

Hospitals have been so top-line focused that they have not paid attention to cost control in the indirect cost and overhead applications. The billing gets more outrageous with outpatient services because the hospital can't hide all of that uncontrolled overhead cost inside a service where the patient doesn't stay overnight. Plus, as more hospital services are rendered on an outpatient basis, there are fewer inpatient services to apply that huge uncontrolled overhead to 😏. Very vicious cycle.

It's time hospitals pull back the curtain on their overhead cost pools and focus on controlling their bottom line as well. Hospitals can't artificially grow themselves out of this overhead problem through acquisition of other hospitals. Economies of scale isn't the solution..... managing the overhead cost is an ugly, inescapable responsibility.

http://www.beckersho...accounting.html

Then you got power play bosses like in this article====>An Art of the Deal move.
http://www.beckersho...et-hearing.html

I heard again from some Republican Congressman or Senator (can't remember who) the argument that health service is always available for someone who goes to a hospital emergency room, which is true. The Republicans have never had a problem with this model, never vowed to dismantle this model, or even said much about it other than to defend their own policies, yet, if anyone can obtain healthcare services then universal healthcare is already our norm without question, debate, or argument. The only thing left to do is determine how best to provide that universal healthcare that we have already agreed upon.

Winstonm, on 2017-June-29, 10:44, said:

Yes, that is the critical question. The problem is that Obamacare provided access to "insurance coverage", but not necessarily access to "health care".

One of the big reasons why that is the case is the deductible. If an individual has an insurance policy that has a high deductible than they have "insurance coverage", but they don't have access to healthcare because the deductible acts as a barrier to getting care. Now if you're wealthy enough the deductible really doesn't pose much of a problem. But if you're a middle class person who's struggling to get by, than a large deductible is an insurmountable barrier to getting "health care". And, if those individuals go to the emergency room, they're going to get stuck for the whole bill unlike indigent people who essentially get those services free. If the bill were a few hundred dollars, it might be a tolerable problem, but a $5000+ bill can be catastrophic to a middle class person living paycheck to paycheck. I believe it's been reported that the deductibles have risen to an average of something like $9000/yr on Obamacare policies.

rmnka447, on 2017-June-29, 11:23, said:

Reported where?

Report: Average Obamacare Deductible Will Jump 20% in 2017

Quote

I'd be interested in seeing a link to the report you mentioned.

The problem with eliminating the mandate, while allowing freeloaders to get expensive emergency care for nothing, is that the rest of us have to pay for it. The attorneys-general for a number of republican states asked the US Supreme Court to find that citizens have a constitutional right to such freeloading, but Justice Roberts joined with four others to reject that request.

rmnka447, on 2017-June-29, 11:23, said:

No, the question is why aren't Republicans pushing for Medicare or Medicaid for everyone, as they have shown they believe a basic level of healthcare for everyone is a right.

Instead, they are pushing for a tax cut for the wealthiest Americans, paid for by decreasing access to healthcare for the poorest Americans.

Winstonm, on 2017-June-29, 13:03, said:

Good question. I wonder why the Democrats, when they had control, didn't push the same thing?

ldrews, on 2017-June-29, 19:48, said:

What, a tax cut for the wealthy? I guess because they don't believe in fiction.

ldrews, on 2017-June-29, 19:48, said:

Democrats have pushed for a single-payer system for a long time, including Hillary Clinton's plan in the 1990s. When the ACA passed, there was an attempt to add a "public option" which was included in the bill that Nancy Pelosi passed in the house, but this was removed in the Senate version. And more recently Bernie Sanders and allies have proposed Medicare for all.

However, there are a few problems with single-payer which ended up being the reasons that not even a public option made it into the ACA:

1. Single payer (or even a public option) will put a lot of private insurance companies out of business, or at least cause them to downsize significantly. This means there's a pretty big lobby lined up against such a change! Further, making such a move will lead to a short-term bump in unemployment, perhaps a particularly bad idea when unemployment is already high (as it was in 2009-2010 when ACA was debated). In the longer term single payer will help reduce costs for many types of non-insurance businesses (employer-provided health care is a huge expense for many large companies) and may create job openings and spur entrepreneurship (easier to leave your job and start your own company if you know health insurance will be taken care of). But these are long-term effects and must be weighted against huge short-term upheaval.

2. Single payer is a big expansion of government. Despite conservative hostility to government, this is not necessarily a bad thing. The increased taxes for the new program will probably be less than the payments people are currently making to health insurance companies so most people/businesses end up ahead. And we already have health care rationing, but it's done by unelected commissions in private companies driven by the profit motive, rather than by government commissions. Nonetheless, there are plenty of congresspeople (including conservative Democrats) who oppose expansion of government for its own sake. And there are some constitutional issues that would have to be addressed to do this on the federal level.

3. The way the ACA was passed would have made single payer difficult. The initial idea was to get 60 senate votes (bypassing the filibuster). However, this required either Republican votes (and every single Republican held McConnell's line about opposing everything Obama wanted, despite the inclusion of many Republican amendments in the bill) or getting all 60 Democratic votes (difficult first because of the election situation in Minnesota, where it took a long time for recounts to resolve and let Al Franken be seated, and then because of the death of Ted Kennedy and his replacement by a Republican, and also because of very conservative Democrats from states like West Virginia and Nebraska). Eventually the strategy switched to using reconciliation to bypass the filibuster, but this tool is intended for budget bills that reduce the deficit, and it's not clear something like single payer could even be implemented in such a way.

Note that in Canada, single payer was organized on the provincial level (and is still managed that way). The ACA intentionally leaves open the possibility for states to implement a single-payer program of their own, and several states have in fact made efforts in that direction (most recently California). It's still possible this may happen, but it does require some cooperation from the federal government which the Trump administration is unlikely to provide.

Winstonm, on 2017-June-29, 20:52, said:

I know that you are not that obtuse. So you must be deliberately misleading. The question is: Why did the Democrats, when they were in power, not institute a single payer system or expand medicare to be universal? It seems to be the obvious solution and was even back then.

ldrews, on 2017-June-30, 07:44, said:

I must be obtuse, too. I thought "the same thing" referred to "a tax cut for the wealthiest Americans, paid for by decreasing access to healthcare for the poorest Americans." The fiction is trickle-down economics, which is the usual Republican explanation for why reducing taxes on billionaires is a good thing for the country.

ldrews, on 2017-June-30, 07:44, said:

Adam's answered is more nuanced - I can only add the reason I think the Democrats failed to get a single payer system passed was the Southern Democrats would not support cutting off the insurance companies.

However, the compromise reached helped but was far from perfect. Why are Trump and the Republicans trying to generate a massive tax cut for the wealthiest Americans by eliminating healthcare coverage to millions of poorer Americans?

Winstonm, on 2017-June-30, 08:44, said:

To me the tax cut per se is a red herring. The current program is imploding, millions of people have access to healthcare insurance with premiums and decuctibles that they can't afford. Hence they have no effective health care. The situation seems destined to get even worse. Premiums continue to soar, deductibles continue to go up, insurance companies continue to bail out. Is this the program that you want to continue? If not, what is your solution to the problem? The liberals came up with this mess, now you want the Republicans/Trump to fix it? And you criticize the proffered solution? OK, then give us your solution.

ldrews, on 2017-June-30, 10:31, said:

No, I'd rather hear facts than regurgitation of Trump talking points.