Discussion: Cost-Control Plan For Health Care Could Cost You

Discussion for article #222821

Maybe they should consider strict PROFIT CONTROLS on all treatment rather than picking particular procedures to cap?

I know, we live in a society of struggling neoroyal billionaires who fear for their souls whenever the words “profit” and “control” appear within a mile of each other, but they will always survive.

They may have to give up a fraction of their abundance, which they seem willing to lose it all to prevent, and that alone might scuttle the future for all of us.

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Does this include any measures that will enable patients to find out what a procedure is going to cost?

So by calling an out of pocket expense something else, they don’t have to count it as out of pocket. BRILLIANT!

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Say the limit is $30,000. The plan offers you a choice of hospitals within its provider network. If you pick one that charges $40,000, you would owe $10,000 to the hospital plus your regular cost-sharing for the $30,000 that your plan covers.

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In truth since you have a choice to spend the extra or not it really doesn’t have to be out pocket if you do not want it to be.

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Isn’t this really a form of profit control? Hip and knee replacements are absurdly expensive, especially when you consider you can go abroad and have either procedure done , just as well, for half the cost.

It sure sounds like we no sooner make great strides in getting everyone insured and the money men at the insurance companies came up with a plan to hollow out that coverage. And the government bought it. So now you may have insurance, but you still have to fear that a major medical problem will bankrupt you.

A bigger impact may be the fear this policy creates, making patients afraid to use their coverage.

Up until now, we were trying to keep the patient from being left holding the bag.

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And what if the only hospital that charges the approved amount is in the other end of your state? Will you be forced to have a major medical procedure far away from family and friends?

we will have to wait and see, but maybe. However folks who previously had no insurance would regularly travel overseas for these types of procedures really away from family and friends, if they could afford it, and for those that couldn’t they went without tell me would you rather go without or have to travel a bit? People with cancer regularly travel to get the best care. We need to start getting a control on our healthcare costs and this is one way to do it by making people pay attention to what procedures costs and giving them a choice as to what they want to spend.

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I guess, then, my thought is, why not control the profit so these operations ARE available here for a fair price. But, then again, so many of these operations only go to those with the best insurance, which proves that these aren’t based on medical need but profitability, and that means there’s also a lot of misuse and abuse that can be mitigated, not just exorbitant profits.

This was the issue that generated all the “death panel” tripe, why replace a hip in a sedentary 80 yr old when some simple pain medication or minor surgical procedure would accomplish as much without the risks inherent with the more difficult surgery.

This is also playing out in other ways that were not expected. Some of the “marginal” oncology testing labs and clinics and hospital wings that popped up as previously “marginal” conditions became mainstream “pre-cancer” diagnosis and subsequently what were once considered extreme procedures became commonplace. Now that there is so much scrutiny on some of these diagnostic and treatment overreaches, they are simply fading from the picture.

These dubious procedures were the direct result of a totally unrestricted market. Now that there is a public oversight, some of those extreme and extremely costly procedures are no longer marketable.

Unreasonable profits aren’t just compounding the drug and treatment issue, the diagnostic process is wholly owned and capitalized, and that is one place where public funds could be better spent.

CAT scans and even newer technologies that enhance diagnosis cost so much more than they should, because there is so much crossover investment on the part of healthcare professionals in these devices, and if we were really a compassionate society, those diagnostic tools would not be managed in any way by profiteers of any sort, good or bad, because that simply defies the urgent public necessity that reliable and quick diagnosis addresses.

By taking some of that emerging technology out of the private investment loop, take the runaround out of the diagnostic process, then the cost of medical care as a whole drops dramatically, which would only be good for small business and We, the people.

Matters not to the Corporations, and they are the ones who profit from the patents, so it is a cycle of futility, I know, to even propose such a crazy thought.

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must have been the same crew that invented derivatives, and mortgage-backed securities?

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As far as I can tell, no one has stated it in so many words, but shopping for price isn’t an option for most consumers. First they have to find a doctor who takes their insurance, then make sure s/he has admitting privileges for that hospital. Then hospitals go to enormous lengths to conceal what they charge. Time magazine’s cover article on the broken medical system really is an eye-opener on that score.

Again is listing the cost of a procedure and giving me the choice to choose the lower cost route where the hospital is not profiting as much a step towards limiting profit.

And most times if a hip or knee issue can be solved with pain and steroid treatments they are. The only time knees and hips get replaced as a rule is if they have deteriorated so much as no function as they should or the pain cannot be controlled with meds.

My father-in-law had his knee replaced at around 80. He is now 92 and still going strong should they have not done it and relegated him to a wheel chair 12 years ago?

This si start to be the beginning of fixing this issue.

Grab your ankles boys and girls. More Hope & Change coming your way. It will only hurt a little.

Under this plan you may be forced to change doctors if your doctor isn’t authorized to do surgery at the cheaper hospital.
It also occurs to me that the hospital could state a certain cost for the actual surgery than make up for any shortage by adding on other cost that they will claim is related to the surgery.

THIS is where the government must take steps to make sure people dont get railroaded. Options have to be given to people, or make sure insurance companies cant squirrel out from their obligations, IN THIS PARTICULAR SITUATION. Otherwise, jsfox is right. People pick and choose the hospital they want to go with for these procedures, so costs after the insurance company pays their portion SHOULD be the responsibility of the patient.

Your health insurance plan slaps a dollar limit on what it will pay for certain procedures, for example, hospital charges associated with knee and hip replacement operations. That’s called the reference price.

Say the limit is $30,000. The plan offers you a choice of hospitals within its provider network. If you pick one that charges $40,000, you would owe $10,000 to the hospital plus your regular cost-sharing for the $30,000 that your plan covers.

It’s not clear to me how this is different from the current system. When I see a bill for some health services, it shows what the hospital bills, then what the insurance company determines are “allowable charges”. The difference doesn’t get billed to me, because that’s part of the agreement between the insurer and the provider in order to be in the network.