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You mean minimum wage hikes come out of *our* pockets?

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Old 05-20-2016, 09:04 AM   #31
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Re: You mean minimum wage hikes come out of *our* pockets?

Obama care has been one lie after another
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Old 05-20-2016, 10:50 AM   #32
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Re: You mean minimum wage hikes come out of *our* pockets?

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Originally Posted by That Guy View Post
well for healthcare to go down, there need to be some changes that i don't see happening.

- price transparency, which is a big problem, but also doesn't save any money by itself unless we go from deductable plans to
- coinsurance, even if it's only 10%, means that people won't choose a $500,000 procedure when a $50,000 procedure will do.
- much more emphasis on preventative/proactive care. ie, get your yearly (or how ever often) cancer screening = you're covered for cancer related issues. at least in cases where being proactive is a big cost savings. giving away floss and toothpaste is much cheaper overall vs filling cavities and making crowns.
- independent medical cost boards like MD has that set reasonable rates and aren't influenced by lobbying (MD has some of the lowest medical costs in the US)
Has Maryland found a solution to the U.S. healthcare cost crisis?

of course, the problems are that there are cross interests. the population wants to keep costs down, but hospitals make more money off surgeries than screenings, and drug companies MUCH rather get you on a product that requires long term daily use vs a one shot cure. changing things dramatically also involves a lot of effort.

still, bluecross is giving people $100/year (after costs) to get physicals done. it's not much, but it's something.
Some of this is on point, but a couple things I just can't let go.

Hospitals generally do make money on procedures/surgeries, but they don't have the ability to perform them when not medically necessary. Insurers, including Medicare and Medicaid, have medical review processes in place to determine medical necessity. If a procedure (or admission or test) is deemed not medically necessary then the insurer will deny payment. Believe me, they're on top of that. Hospitals don't try to get away with anything there, it doesn't pay.

But, your point dovetails into the need for more focus on prevention so that the procedure isn't needed in the first place. We still reimburse based on a fee-for-service basis, when ideally we'd find a way to reimburse healthcare providers for keeping people out of the hospital, out of the emergency room, out of the operating room, and healthier.

Medicare has pilot programs for bundled reimbursement in place. Meaning, let's say you fall and break your arm. Right now, you'd go to the ER and get casted - your insurance pays$700 for that. Then you need to see the orthopedic physician a few times, that's $200 per visit. Then you need another x-ray to check up on it, that's $150 to the hospital for the x-ray and $100 to the radiologist for interpreting the result. Then you need the cast off, that's $100. Then maybe you need a little physical therapy, and that's a pay-per-visit deal. It adds up. Obviously, the more little visits you have, the more revenue the hospital and physician generates, so their incentive is to see you frequently. What Medicare is working on is trying out episodic payment bundles. Meaning as soon as you come to the ER with a broken arm, they'll just pay $2500 for the entire episode of care, and that's it. It's then up to the hospital and doctors to get together and determine how often you need to be seen by the doctor, how often you need to be x-ray'd, how much therapy you'll need, etc. The lingering threat of malpractice ensures that they'll still get you healthy, but they will be more judicious in managing hospital utilization.

That can help keep costs where they are for a good while, slowing cost growth quite a bit. You don't need a single payer system to accomplish that. But it's still not quite the ideal model, which would reimburse for preventing you from breaking your arm in the first place. Bad example, people will break arms. But how do you reimburse providers for preventing heart attacks in the first place? That's the holy grail, but thus far nobody's been able to figure that out.
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Old 05-20-2016, 10:52 AM   #33
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Re: You mean minimum wage hikes come out of *our* pockets?

PS we totally derailed this. This is supposed to be about min wage!

My fault.
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