Author Topic: What comes after the ACA?  (Read 1143236 times)

pecunia

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Re: What comes after the ACA?
« Reply #5550 on: July 11, 2019, 01:34:41 PM »
Wow!  About one out of five are generally denied. (20 percent)  It sort of says that even with insurance the best you can expect is around 80 percent insurance.

partgypsy

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Re: What comes after the ACA?
« Reply #5551 on: July 11, 2019, 01:45:24 PM »
My brother had Medicaid through aca and if it wasn't for that, my parents would be swamped in medical bills after his 6 month bout of cancer treatment and care including hospice. Not to say there are things I wouldn't change about aca (I would make it universal and automatic) but things are better with it than without.

Some other concerns are "balance billing" that has been discussed in this thread, and then there's the matter of a large number of claimed being denied, even on appeal:

https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans/

Yes, I shouldn't speak too soon, as he died a week ago and paperwork is still being received. As he passed away there are some fees still to be paid such as cremation and appropriate urn for cemetary.

Exflyboy

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Re: What comes after the ACA?
« Reply #5552 on: July 11, 2019, 01:53:53 PM »
My brother had Medicaid through aca and if it wasn't for that, my parents would be swamped in medical bills after his 6 month bout of cancer treatment and care including hospice. Not to say there are things I wouldn't change about aca (I would make it universal and automatic) but things are better with it than without.

Some other concerns are "balance billing" that has been discussed in this thread, and then there's the matter of a large number of claimed being denied, even on appeal:

https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans/

Yes, I shouldn't speak too soon, as he died a week ago and paperwork is still being received. As he passed away there are some fees still to be paid such as cremation and appropriate urn for cemetary.

So sorry for your loss..:(

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5553 on: July 12, 2019, 04:24:48 PM »
Sorry to hear that PartGypsy

Paul der Krake

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Re: What comes after the ACA?
« Reply #5554 on: July 12, 2019, 08:03:48 PM »

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5555 on: July 13, 2019, 06:08:36 AM »
https://www.nytimes.com/2019/07/11/health/drug-prices-rebate-donald-trump.html

This thing may have legs.
You know, people keep saying the Republicans aren't doing anything to try to curb healthcare costs, but there sure seems to be a lot of things in that article that they're trying to do.

The prescription drug costs are an interesting one.  I've asked this before, but haven't seen an answer:  how much does the US effectively subsidize other countries' healthcare by paying so much more than other countries?

Roland of Gilead

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Re: What comes after the ACA?
« Reply #5556 on: July 13, 2019, 08:54:47 AM »
https://www.nytimes.com/2019/07/11/health/drug-prices-rebate-donald-trump.html

This thing may have legs.
You know, people keep saying the Republicans aren't doing anything to try to curb healthcare costs, but there sure seems to be a lot of things in that article that they're trying to do.

The prescription drug costs are an interesting one.  I've asked this before, but haven't seen an answer:  how much does the US effectively subsidize other countries' healthcare by paying so much more than other countries?

Drugs are the easy one to blame because they are produced mostly by large companies (mostly because it is hella expensive and time consuming to run the years of testing...and then to fail even then).  But drug costs are only a small part of the US healthcare cost.  We pay our doctors and care providers much more than other countries.   An anesthesiologist average salary is nearly $400,000 a year!   You never hear a lot about trying to implement price controls on these things though.

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #5557 on: July 13, 2019, 10:57:40 AM »
@Roland of Gilead You need to hear a little more of the other side of the argument mon frere - http://www.econtalk.org/robin-feldman-on-drugs-money-and-secret-handshakes/

Roland of Gilead

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Re: What comes after the ACA?
« Reply #5558 on: July 13, 2019, 11:22:55 AM »
@Roland of Gilead You need to hear a little more of the other side of the argument mon frere - http://www.econtalk.org/robin-feldman-on-drugs-money-and-secret-handshakes/

I know there are problems and issues with the drug industry, but strictly from an investor point of view it is not a great investment right now and thus the money to save from it cannot be that big.   Maybe you can trim the costs by 25% or so on average but this would make investors flee like crazy and I am not sure who then would pay the billions of dollars to advance new drugs through trials.   I guess the government would have to step in and pay for these trials or they would need to settle for lesser drugs.   Case in point is the HCV cure.  The government had a 50% success rate cure if you took a particular drug cocktail with huge side effects for many months.   Private industry has come up with a 99% cure in 6 weeks of a single pill a day.   Worth the cost?

Now consider that drug costs are only 10% to 13% of the total cost of US healthcare.   This means you can only cut a certain amount from the total cost of US healthcare by cutting drug prices.   Nobody talks about the other 90%.   A lot of it is the much higher pay we have in the USA (and maybe a little bit in the amount of medical lawsuits we allow here).

Why does nobody talk about the 90%?

FIREstache

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Re: What comes after the ACA?
« Reply #5559 on: July 13, 2019, 11:25:43 AM »

With the shortage of doctors expected to get even worse, I don't think the solution is to pay them less.

ysette9

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Re: What comes after the ACA?
« Reply #5560 on: July 13, 2019, 11:59:32 AM »
To pay then less you have to fix the med school debt problem. The only way it makes sense to take on $200-400k in student loans is of you are going to make massive amounts of $ on the other side.

So maybe open up med school slots so there isn’t an artificially low supply of doctors. Make med school free or low tuition so doctors can choose family medicine or pediatrics (lower paid professions) instead of automatically choosing anesthesiology because that is what will pay off the student loans first.

pecunia

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Re: What comes after the ACA?
« Reply #5561 on: July 13, 2019, 01:31:03 PM »
To pay then less you have to fix the med school debt problem. The only way it makes sense to take on $200-400k in student loans is of you are going to make massive amounts of $ on the other side.

So maybe open up med school slots so there isn’t an artificially low supply of doctors. Make med school free or low tuition so doctors can choose family medicine or pediatrics (lower paid professions) instead of automatically choosing anesthesiology because that is what will pay off the student loans first.

That sounds like a great idea.  Existing doctors would know there was a lot of new doctors coming down the pipeline so they could adjust if needed.  It provides people with a wonderful career.  It provides the public with the needed service.  I do think, however,  that these new doctors should be required to commit some time to public service

I'm not familiar with medical school, but wonder why it is so expensive.  The following article lays out the costs of public and private medical schools.  The public medical schools tend to be much less.

https://www.kaptest.com/study/mcat/whats-the-real-cost-of-medical-school/ 

Seems like if there were more public medical schools, it would not only provide the needed training, but do it for less money.  I am sure they receive some subsidies, but it sure does seem like a worthwhile investment.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #5562 on: July 13, 2019, 01:59:34 PM »
So I am curious why we need to do things to compensate doctors if we cut their pay yet we have no problem cutting the pay of drug researchers and the returns of investors who put their money into these drug companies?

Why are doctors in other countries paid so much less?   Why does their schooling cost a lower amount?  Why do other countries limit the awards on medical lawsuits which means the hospitals and doctors pay a lower rate of insurance?

I see so little of this discussed by either political party.   They go after the easy target, a big evil corporation that *gasp* is concerned about making a profit for their shareholders.   They don't mention that the returns on most of these big evil drug companies are lower than most tech stocks and the risk is much higher than most staple stocks and utility stocks.

But hey, it makes for a good sound bite.   We will save billions by going after these drug companies (we will ignore the other trillion or so we spend on all the other medical stuff)

John Galt incarnate!

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Re: What comes after the ACA?
« Reply #5563 on: July 13, 2019, 02:23:54 PM »
To pay then less you have to fix the med school debt problem. The only way it makes sense to take on $200-400k in student loans is of you are going to make massive amounts of $ on the other side.

So maybe open up med school slots so there isn’t an artificially low supply of doctors. Make med school free or low tuition so doctors can choose family medicine or pediatrics (lower paid professions) instead of automatically choosing anesthesiology because that is what will pay off the student loans first.

Just yesterday I heard something  about a bill in the California legislature that if passed and signed into law will pay the medical-school expenses of California medicos if they in return  accept Medi-Cal's  low reimbursement rates  for a certain period of years.
« Last Edit: July 13, 2019, 02:31:25 PM by John Galt incarnate! »

Roland of Gilead

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Re: What comes after the ACA?
« Reply #5564 on: July 13, 2019, 02:54:12 PM »
Just yesterday I heard something  about a bill in the California legislature that if passed and signed into law will pay the medical-school expenses of California medicos if they in return  accept Medi-Cal's  low reimbursement rates  for a certain period of years.

What would happen if they defaulted, went to another state to practice medicine for higher pay?   Would they have to pay back the expenses?

seattlecyclone

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Re: What comes after the ACA?
« Reply #5565 on: July 13, 2019, 02:54:51 PM »
To pay then less you have to fix the med school debt problem. The only way it makes sense to take on $200-400k in student loans is of you are going to make massive amounts of $ on the other side.

So maybe open up med school slots so there isn’t an artificially low supply of doctors. Make med school free or low tuition so doctors can choose family medicine or pediatrics (lower paid professions) instead of automatically choosing anesthesiology because that is what will pay off the student loans first.

Just yesterday I heard something  about a bill in the California legislature that if passed and signed into law will pay the medical-school expenses of California medicos if they in return  accept Medi-Cal's  low reimbursement rates  for a certain period of years.

Seems like a win-win. The state probably spends less overall this way if it keeps their reimbursement rates down, as the doctors don't need to mark up the cost of their services just to pay interest to the banks on the schooling they got.

John Galt incarnate!

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Re: What comes after the ACA?
« Reply #5566 on: July 13, 2019, 03:22:28 PM »
Just yesterday I heard something  about a bill in the California legislature that if passed and signed into law will pay the medical-school expenses of California medicos if they in return  accept Medi-Cal's  low reimbursement rates  for a certain period of years.

What would happen if they defaulted, went to another state to practice medicine for higher pay?   Would they have to pay back the expenses?

I don't know.

What I do know is that if I drafted the legislation I'd include a clawback  provision to deal with willful defaulters.
« Last Edit: July 13, 2019, 03:25:08 PM by John Galt incarnate! »

protostache

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Re: What comes after the ACA?
« Reply #5567 on: July 14, 2019, 06:36:28 AM »
Just yesterday I heard something  about a bill in the California legislature that if passed and signed into law will pay the medical-school expenses of California medicos if they in return  accept Medi-Cal's  low reimbursement rates  for a certain period of years.

What would happen if they defaulted, went to another state to practice medicine for higher pay?   Would they have to pay back the expenses?

Maybe something like, the license is provisional, only valid in California, and full licensure is contingent on accepting Medi-Cal for X number of years.

freya

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Re: What comes after the ACA?
« Reply #5568 on: July 14, 2019, 10:09:43 AM »
Now consider that drug costs are only 10% to 13% of the total cost of US healthcare.   This means you can only cut a certain amount from the total cost of US healthcare by cutting drug prices.   Nobody talks about the other 90%.   A lot of it is the much higher pay we have in the USA (and maybe a little bit in the amount of medical lawsuits we allow here).

Why does nobody talk about the 90%?

I'm very happy to talk about the 90%. Here's the breakdown according to a recent CMS report:

Hospital care:  33%
Physician and clinical services:  20%
Retail prescription drugs:  10%
Other health, residential, and personal care services:  5%
Nursing home:  5%
Dental:  4%
Home health care:  3%
Other professional (e.g. physical therapy, chiropractic etc): 3%
Non-prescription drug medical products/equipment: total 4%

link to the report here:  https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf

Of the 20% that goes to "physicians and clinical services", a large chunk, at least 30%, goes to administrative overhead.  This has been skyrocketing in recent years thanks to Obamacare's massive increase in regulation and the poorly implemented EHR mandate.  So yes, cutting physician pay will help a bit, but not as much as you all seem to think based on the erroneous sentiment in the above post that 90% of health care expenses goes to physician pay.   The big money in fact is going to administrators/executives of hospitals and insurance companies.  And the solution to cutting costs is going to have be systemic, not aimed at individuals.

I have a good idea where that thought came from.  Demonizing physicians has unfortunately become a national pastime, and it is doing the damage you might expect.  About half of physicians want out of the profession.  Even if they don't go through with it, that means that half the time you go to the doctor, the person treating you would rather be doing something else.   It's not hard to imagine how this can increase medical costs.  A disengaged physician will be more likely to order a lot of tests and refer to subspecialists.  A distrustful patient will doctor-shop resulting in multiple visits and repeated tests.  I hope the press (and especially the NY Times) is happy with the results of their diligent efforts.

Here's a blog post with a contrary view that most of you are guaranteed to hate, that's worth a look:

https://www.kevinmd.com/blog/2019/05/stop-the-anti-doctor-media-bias.html

 

FIREstache

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Re: What comes after the ACA?
« Reply #5569 on: July 14, 2019, 10:20:08 AM »
The big money in fact is going to administrators/executives of hospitals and insurance companies.  And the solution to cutting costs is going to have be systemic, not aimed at individuals.

I worked at a hospital for years, and the administrative staff were just one small part of the overall budget.  Cutting their pay wouldn't make a dent on healthcare costs.  There's a LOT of overhead, and the dollar mount didn't change all that much with the ACA - I could keep listing things for days going back 20 years.  It's far more complicated than some admin staff paychecks, and even the administrators often don't stick around long.

I also did not support cutting physician pay, as I mentioned a few posts back.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #5570 on: July 14, 2019, 02:53:29 PM »

I'm very happy to talk about the 90%. Here's the breakdown according to a recent CMS report:

Hospital care:  33%
Physician and clinical services:  20%
Retail prescription drugs:  10%
Other health, residential, and personal care services:  5%
Nursing home:  5%
Dental:  4%
Home health care:  3%
Other professional (e.g. physical therapy, chiropractic etc): 3%
Non-prescription drug medical products/equipment: total 4%

link to the report here:  https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf



Why does it all add up to only 87%?  Both in your quoted figures and in the actual report?

That is a pretty big error in an official looking report.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #5571 on: July 14, 2019, 02:59:04 PM »
The big money in fact is going to administrators/executives of hospitals and insurance companies.  And the solution to cutting costs is going to have be systemic, not aimed at individuals.

I worked at a hospital for years, and the administrative staff were just one small part of the overall budget.  Cutting their pay wouldn't make a dent on healthcare costs.  There's a LOT of overhead, and the dollar mount didn't change all that much with the ACA - I could keep listing things for days going back 20 years.  It's far more complicated than some admin staff paychecks, and even the administrators often don't stick around long.

I also did not support cutting physician pay, as I mentioned a few posts back.

This is the problem, nobody wants to take a pay cut.   The researchers and investors running the drug companies don't want to take a pay cut, the doctors don't want a pay cut, the medical schools and their professors don't want a pay cut, the hospitals certainly don't want a pay cut.

It just irks me that of all these the easiest one to target is the "big evil pharma" because a corporation doesn't have the same heart string pulling as the poor anesthesiologist barely able to afford two Tesla's on his $400,000 salary.  But if we go after pharma, full tilt and force them to sell their drugs at a buck each, even though this would eventually bankrupt every single one of them, the USA is still going to have the most expensive healthcare in the world because we don't want to touch the 90%.

bacchi

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Re: What comes after the ACA?
« Reply #5572 on: July 14, 2019, 03:12:20 PM »
The big money in fact is going to administrators/executives of hospitals and insurance companies.  And the solution to cutting costs is going to have be systemic, not aimed at individuals.

I worked at a hospital for years, and the administrative staff were just one small part of the overall budget.  Cutting their pay wouldn't make a dent on healthcare costs.  There's a LOT of overhead, and the dollar mount didn't change all that much with the ACA - I could keep listing things for days going back 20 years.  It's far more complicated than some admin staff paychecks, and even the administrators often don't stick around long.

I also did not support cutting physician pay, as I mentioned a few posts back.

This is the problem, nobody wants to take a pay cut.   The researchers and investors running the drug companies don't want to take a pay cut, the doctors don't want a pay cut, the medical schools and their professors don't want a pay cut, the hospitals certainly don't want a pay cut.

It just irks me that of all these the easiest one to target is the "big evil pharma" because a corporation doesn't have the same heart string pulling as the poor anesthesiologist barely able to afford two Tesla's on his $400,000 salary.  But if we go after pharma, full tilt and force them to sell their drugs at a buck each, even though this would eventually bankrupt every single one of them, the USA is still going to have the most expensive healthcare in the world because we don't want to touch the 90%.

It is odd in these conversations that no proposed cuts will do any good.

It's almost as if everyone has an interest (except the consumers) in keeping prices high.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5573 on: July 14, 2019, 03:41:09 PM »
Why are doctors in other countries paid so much less?   Why does their schooling cost a lower amount?  Why do other countries limit the awards on medical lawsuits which means the hospitals and doctors pay a lower rate of insurance?

I see so little of this discussed by either political party.   They go after the easy target, a big evil corporation that *gasp* is concerned about making a profit for their shareholders.   They don't mention that the returns on most of these big evil drug companies are lower than most tech stocks and the risk is much higher than most staple stocks and utility stocks.
I'm with you there--there seems to be a distinct *lack* of discussion of the root causes of high healthcare costs.  There has been a LOT of "healthcare is too expensive, so let's make other taxpayers have the government pay for it!" or "just let the (heavily-regulated) free market work!"

From a political perspective, it makes sense, because it's an effective political message.  "Let's dig down and figure out exactly how our real healthcare costs compare with other countries, and figure out all the root causes for every percentage!" doesn't get as many votes.  Medication may only represent 10% of medical spending, but if we're paying twice as much as other countries for the same drugs, there's a potential for probably 3-4% savings there.  And if Physician and Clinical services are 30%, but 50% of that is overhead, then by all means let's see what we can do about reducing that overhead.  It's the lack of attention to detail in favor of a sound byte, plus political opportunism and polarization (you can't be seen to agree with the other party, regardless of the merits of the proposal), that makes it very difficult to accomplish anything legislatively.

I see a similar phenomenon in our school district, which is looking at a 2%-ish (and worsening) deficit for the next 10 years.  The first few years, the administration and Board picked the low-hanging fruit (admin salary freeze, reduction of district-level staff, etc), but it's now getting harder.  Rather than putting forth the effort to find the myriad small-dollar cuts that would add up to significant cuts, the administration has jumped to cutting sports and increasing class sizes, and the BoE proposed a tax hike.  There appears to be an assumption that every task, every position, and every activity performed in the district is a sacred cow that cannot possibly be cut, without an evaluation of whether that task/position/activity is actually necessary.

Paul der Krake

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Re: What comes after the ACA?
« Reply #5574 on: July 14, 2019, 04:07:44 PM »
https://www.nytimes.com/2019/07/11/health/drug-prices-rebate-donald-trump.html

This thing may have legs.
You know, people keep saying the Republicans aren't doing anything to try to curb healthcare costs, but there sure seems to be a lot of things in that article that they're trying to do.

The prescription drug costs are an interesting one.  I've asked this before, but haven't seen an answer:  how much does the US effectively subsidize other countries' healthcare by paying so much more than other countries?
I too would love to get a credible answer on this. Here is what I know though: the price being sold in other first world countries (i.e. ignoring the developing world) is plenty to support a robust market. I know this because there are drug companies based outside the US, who don't sell their drugs in the US at all.

Can the world do without US drug companies altogether? I don't know.

I think Trump deserves credit for trying something here. Let's hope he succeeds.


MDM

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Re: What comes after the ACA?
« Reply #5575 on: July 14, 2019, 06:02:19 PM »

I'm very happy to talk about the 90%. Here's the breakdown according to a recent CMS report:

Hospital care:  33%
Physician and clinical services:  20%
Retail prescription drugs:  10%
Other health, residential, and personal care services:  5%
Nursing home:  5%
Dental:  4%
Home health care:  3%
Other professional (e.g. physical therapy, chiropractic etc): 3%
Non-prescription drug medical products/equipment: total 4%

link to the report here:  https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf



Why does it all add up to only 87%?  Both in your quoted figures and in the actual report?

That is a pretty big error in an official looking report.
Add 0.333% to each of the whole numbers and the total is 90%.

Neither statistically likely nor statistically extremely unlikely....

DaMa

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Re: What comes after the ACA?
« Reply #5576 on: July 14, 2019, 06:41:51 PM »
I would say the other 13% goes to non-medical "health care" expenses -- like the insurance companies. 

John Galt incarnate!

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Re: What comes after the ACA?
« Reply #5577 on: July 15, 2019, 08:15:49 AM »



Maybe something like, the license is provisional, only valid in California, and full licensure is contingent on accepting Medi-Cal for X number of years.

Yes.

Your provision would be  more effective (remedial before the fact)  than mine   at discouraging  willful defaulters.
« Last Edit: July 15, 2019, 08:19:58 AM by John Galt incarnate! »

freya

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Re: What comes after the ACA?
« Reply #5578 on: July 15, 2019, 12:47:27 PM »
Ha, that's hilarious - I didn't notice that the figures didn't sum up to 100%.  Way to go CMS...maybe a typo in there somewhere.

I'm actually in favor of cutting procedure reimbursements, because they are WAY out of proportion to office visit costs and are a principle reason why there are super highly paid specialties. For example, a dermatologist freezing off a small skin lesion (which takes about 7 minutes) gets paid the same as a neurologist spending two hours with a patient and family giving them an Alzheimer's diagnosis.  CMS embarked on exactly that project several years ago, and it's ongoing.  Radiology, cardiology, and neurology have all been hit hard.  The response so far has been to find ingenious ways to increase the number and complexity of procedures, so that to my knowledge no pay cuts have occurred.  Not really sure how this is going to play out long term.

When I said "systemic solutions" I meant improvements at a higher level than simple reimbursement cuts.  Here's an example:  EHR systems.  The EHR mandate was possibly the most disastrous regulation of the 21st century.  It has created a whole new set of medical errors, severely disrupted clinical practice and residency training by increasing note writing and order entry time from a few minutes to 6+ hours a day, and increased costs beyond belief - all while NOT achieving the stated goal of improving information sharing between health providers.  Due in no small part to the strengthening of HIPAA that occurred at the same time, that has actually gotten worse.

The simple solution would have been to take the VA's EHR system and mandate that as the national EHR.  Physicians would have loved it.  It's a very well designed, easy to use system and it can share data across sites.  It is built on a Linux platform and the VA offers it for free.   Everyone who trained at a VA hospital (which is just about everyone) already knows how to use it. There are private companies who will implement and support it, and some hospitals have gone that route very successfully.  Ours (I work for a major academic center) has not, because the lawyers didn't like the fact that there's no one to sue plus they could care less about clinical usability (I have a friend who was on the panel making the decision).  Instead, they spent $40 million for a horrible EHR system that was incompatible with other systems that turned out to be important, so they're scrapping that and are now paying $120 million for another one which is slightly less horrible.

Somebody was saying something about overhead?


DaMa

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Re: What comes after the ACA?
« Reply #5579 on: July 15, 2019, 01:09:21 PM »
Oh @freya, I can soooo relate.  I reviewed proposals and demos from 6 different vendors selling risk adjustment (CMS MA RAPS) software and worked on the implementation and ongoing use of two different packages.  What a joke.  I imagine at least 1% of healthcare cost is just thrown away on systems that never work as marketed.

MDM

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Re: What comes after the ACA?
« Reply #5580 on: July 15, 2019, 02:52:30 PM »
Ha, that's hilarious - I didn't notice that the figures didn't sum up to 100%.  Way to go CMS...maybe a typo in there somewhere.
They aren't supposed to add to 100%, and do plausibly add to 90% if one considers rounding.  Of course, there still could be a typo.

FIREstache

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Re: What comes after the ACA?
« Reply #5581 on: July 15, 2019, 04:11:56 PM »
The simple solution would have been to take the VA's EHR system and mandate that as the national EHR.  Physicians would have loved it.  It's a very well designed, easy to use system and it can share data across sites.  It is built on a Linux platform and the VA offers it for free. 

I heard the VA was in process of migrating to Cerner.

freya

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Re: What comes after the ACA?
« Reply #5582 on: July 16, 2019, 10:46:46 AM »
The simple solution would have been to take the VA's EHR system and mandate that as the national EHR.  Physicians would have loved it.  It's a very well designed, easy to use system and it can share data across sites.  It is built on a Linux platform and the VA offers it for free. 

I heard the VA was in process of migrating to Cerner.

OMG that is tragic.  Just found articles, some of which are bemoaning the waste of $10 billion on this needless transition.  Oh if you only knew that's just the beginning of the costs...

Dang lawyers.  They run the world.  Maybe the best way to control healthcare costs is to start shutting down law schools.

pecunia

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Re: What comes after the ACA?
« Reply #5583 on: July 16, 2019, 01:19:18 PM »
The US pays twice as much for health care per person than the next country.

How much of that is due to litigation needless or otherwise?

The litigation used to be the stock excuse for the high cost of health care.

bacchi

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Re: What comes after the ACA?
« Reply #5584 on: July 16, 2019, 02:37:42 PM »
The US pays twice as much for health care per person than the next country.

How much of that is due to litigation needless or otherwise?

The litigation used to be the stock excuse for the high cost of health care.

A few states have severely limited tort actions brought against doctors. It has a minimal effect, on the order of a few %.

It's definitely not a panacea to lower costs.

seattlecyclone

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Re: What comes after the ACA?
« Reply #5585 on: July 16, 2019, 02:50:48 PM »
Right. There is no panacea. Lowering drug costs won't fix things, but it will help. Lowering legal bills won't fix things, but it will help. Do enough of these small things and it adds up to a bigger deal.

AdrianC

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Re: What comes after the ACA?
« Reply #5586 on: July 17, 2019, 07:58:49 AM »
Biden unveils health care plan: Affordable Care Act 2.0

https://www.politico.com/story/2019/07/15/joe-biden-health-care-plan-1415850

“We’re starting with the Affordable Care Act as the base and going to insist on the elements that we sought last time,” said a senior Biden campaign official. “And we’ll get them this time.”

Sound good?

Seems like a step in the right direction, and actually achievable. I like the fixing of the premium tax credit cap, and adding a public option.

pecunia

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Re: What comes after the ACA?
« Reply #5587 on: July 17, 2019, 08:09:12 AM »
From the article:

"Biden's public option plan drew fire from Republicans and health care industry lobbyists who said that the proposal went too far."

What have any of them done to help people who need health care?

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5588 on: July 17, 2019, 09:00:38 AM »
What have any of them done to help people who need health care?
You may have missed this link from not that far upthread: https://www.nytimes.com/2019/07/11/health/drug-prices-rebate-donald-trump.html

It's not for lack of trying.

pecunia

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Re: What comes after the ACA?
« Reply #5589 on: July 17, 2019, 05:25:22 PM »
What have any of them done to help people who need health care?
You may have missed this link from not that far upthread: https://www.nytimes.com/2019/07/11/health/drug-prices-rebate-donald-trump.html

It's not for lack of trying.

I can't read that link as I don't subscribe to the New York Times.  Lowering drug prices is a good idea.  Bernie Sanders has been ranting about that for a long time.  Give them one attempt.  I did find another article on a quick search.

https://www.axios.com/trump-drug-prices-plan-pharma-ec527a14-0287-492b-937d-a7144c47b734.html

He's got to throw us one or two bones if he wants to get re-elected.  Health care will give him a big bang for his buck.

Exflyboy

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Re: What comes after the ACA?
« Reply #5590 on: July 17, 2019, 05:57:38 PM »
My one political prediction is that the biggest bone to be thrown will be in the spring of next year, i.e a resolution to the trade war with China.

Grammar fixed..:)
« Last Edit: July 17, 2019, 07:06:18 PM by Exflyboy »

FIREstache

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Re: What comes after the ACA?
« Reply #5591 on: July 17, 2019, 06:52:47 PM »
Biden unveils health care plan: Affordable Care Act 2.0

https://www.politico.com/story/2019/07/15/joe-biden-health-care-plan-1415850

“We’re starting with the Affordable Care Act as the base and going to insist on the elements that we sought last time,” said a senior Biden campaign official. “And we’ll get them this time.”

Sound good?

Seems like a step in the right direction, and actually achievable. I like the fixing of the premium tax credit cap, and adding a public option.

Biden's plan is the only health care related plan I've heard that I like.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #5592 on: July 17, 2019, 07:44:45 PM »

Biden's plan is the only health care related plan I've heard that I like.

Its ok, but again there is the hand waving to attack high drug prices and then this tidbit about all the rest (the 90% of the cost of healthcare):

"Biden’s plan also takes aim at health care providers, suggesting that he’ll try to tackle problems like unexpected large medical bills and health care market concentration, although the details released by the campaign are sparse. "


I am still waiting for the candidate that says "Here is exactly how I plan to bring our costs in-line with healthcare costs in other countries".   

katsiki

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Re: What comes after the ACA?
« Reply #5593 on: July 17, 2019, 08:50:07 PM »
Dang lawyers.  They run the world.  Maybe the best way to control healthcare costs is to start shutting down law schools.

And how many other problems would that solve... :)

katsiki

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Re: What comes after the ACA?
« Reply #5594 on: July 17, 2019, 08:50:52 PM »
I am still waiting for the candidate that says "Here is exactly how I plan to bring our costs in-line with healthcare costs in other countries".

Don't hold your breath.  I don't think such a person exists.

pecunia

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Re: What comes after the ACA?
« Reply #5595 on: July 18, 2019, 07:52:17 AM »
I am still waiting for the candidate that says "Here is exactly how I plan to bring our costs in-line with healthcare costs in other countries".

Don't hold your breath.  I don't think such a person exists.

Old man Bernie says it all the time.  Then they try to tell him he is full of it and he pulls out all these facts and figures as to what they have in other countries. 

Roland of Gilead

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Re: What comes after the ACA?
« Reply #5596 on: July 18, 2019, 08:30:58 AM »
I am still waiting for the candidate that says "Here is exactly how I plan to bring our costs in-line with healthcare costs in other countries".

Don't hold your breath.  I don't think such a person exists.

Old man Bernie says it all the time.  Then they try to tell him he is full of it and he pulls out all these facts and figures as to what they have in other countries.

I don't mean bring our costs in line with other countries by shifting the cost from the individual to the government, I mean bring our costs in-line with other countries by actually reducing the cost to go to the hospital and get tests or treatments, as well as cheaper drugs.   Why is a hospital stay so much more expensive in the USA?

Davnasty

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Re: What comes after the ACA?
« Reply #5597 on: July 18, 2019, 10:15:06 AM »
I am still waiting for the candidate that says "Here is exactly how I plan to bring our costs in-line with healthcare costs in other countries".

Don't hold your breath.  I don't think such a person exists.

Old man Bernie says it all the time.  Then they try to tell him he is full of it and he pulls out all these facts and figures as to what they have in other countries.

I don't mean bring our costs in line with other countries by shifting the cost from the individual to the government, I mean bring our costs in-line with other countries by actually reducing the cost to go to the hospital and get tests or treatments, as well as cheaper drugs.   Why is a hospital stay so much more expensive in the USA?

When we say "cost per capita" that is total cost paid by the individual and the government. Shifting costs from one to the other doesn't change that number.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #5598 on: July 18, 2019, 11:08:22 AM »

When we say "cost per capita" that is total cost paid by the individual and the government. Shifting costs from one to the other doesn't change that number.

Right.  I have not heard that Bernie's plan will reduce "cost per capita", just that it will majorly shift the cost to the government.   He will pay for that with other taxes and stuff but it still is not getting the USA the cheaper healthcare that other countries enjoy...it is just moving money from one bucket to another.

Exflyboy

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Re: What comes after the ACA?
« Reply #5599 on: July 18, 2019, 11:21:04 AM »
Pretty much what the ACA did.. all while keeping the existing HC industry happy.

Unless you are going to use the huge purchasing power of the Government to drive down costs (like almost every other developed nation on Earth does) then there is little point.

As wealthy people we will simply game the system as best we can.. Just like I can gerrymander our income down to maximise ACA subsidies.