Since PPOs make their revenues off access fees with absolutely no responsibility to screen claims for accuracy and since their market value is directly tied to the number of physicians and facilities they have inside their networks, employers and their administrative payers’ demands for transparency have gone unmet over the last decade. This has led to the significant movement to eliminate PPO arrangements altogether as they not only provide no real value to the healthcare equation but in many cases promote a negative value. This is the efficient market theory at work, all elements within a market that do not add value to the overall market will eventually be eliminated.
I’m all about repeal. But let’s not stop with Obamacare. Let’s move on to many disastrous legislative interventions brought to us from the other side of the aisle. How about Medicare Part D, brought to us by a GOP-led executive? Why didn’t the GOP change the tax code to end the discrimination against individual purchases of health insurance during the time they had all the power? Hint: see paragraph one of this blog. This tax reform isn’t likely as the shift away from employer-purchased plans will gut the scam of PPO repricing, a devastating blow to the big insurance companies.
Georgia Chapter Free Market Medical Association spokesperson, Dr. Bob Nelson, had the honor of addressing the 3rd annual Citizens in Action, Palmetto Panel held at Clemson University on February 25th about healthcare freedom and the importance of liberating markets with price honesty in healthcare.
<p><a href=”https://vimeo.com/205822572″>Palmetto Panel: Dr. Bob Nelson, Free Market Medical Association</a> from <a href=”https://vimeo.com/user1416051″>Thomas Hanson</a> on <a href=”https://vimeo.com”>Vimeo</a>.</p>
One of the best pieces I’ve read that exposes the real cost drivers in healthcare. Many of us have been shouting from the rooftops that the “villains” we implicate are just symptoms of a more fundamental poison in that is embedded in our third-party billing system and the cartel-like system it has created. Thanks to Dave Chase for putting the pieces together so clearly. Given the realities exposed here, we can no longer implicate something that has been virtually wholly absent from the healthcare economy which could have prevented this generational theft: A free market.
The Sovereign Patient
Mike Dendy: I hear the talking heads on business TV (like CNBC) talk about stagnation of incomes for the middle class. Wrong. The additional money is there every year, it’s just going into a pool to pay for healthcare instead of into the pockets of the employees in the form of salary increases.
Americans overpay for healthcare by at least 30% and likely 50% in aggregate. For all intents and purposes, every employer in America gives every covered member on their healthcare plan a blank check every year and says….consume all the healthcare you want, anywhere you want, anytime you want, and never be concerned with or ask the price because it’s all paid for. Deductibles and co-pays are irrelevant, especially to hospitals, because pricing is so high it becomes somewhat immaterial.
Trillions Have Been Redistributed from the American Workforce to the Healthcare Industry Creating An Economic Depression for the Middle Class The Washington Post and Vox have done excellent reporting that shows U.S. spends so much more than other countries for one simple reason — price. The good news is that some […]
Who is likely to negotiate the lowest fee with a doctor, hospital or some other health care provider? The federal government? A large employer? An insurance company? Or, a patient spending her own money? Strange as it may seem, the answer is often the patient. One of the most persistent myths on […]
Canadians coming to the United States (and paying a cash price upfront) were paying almost half as much as US employers were paying and even less than the typical payment by Medicare. Think about that. These patients not only lacked a big bureaucracy to bargain on their behalf; they were foreigners.
The other factor is third party payment. After the deductibles and copayments are exhausted (which is almost immediately in the case of a knee replacement) the only payer is the third party. The incentive of the hospital is not to lower charges, but to raise them. In fact hospitals typically try to maximize against third-party payment formulas and they have sophisticated computer programs to help them do it.
An individual patient, paying with his own money and willing to travel to another city for care, is a different kind of buyer. If the hospital wants his patronage, it has strong incentives to compete on price.
This very large insurance company, representing tens of thousands of people and their very large employer (the state of California), achieved a remarkable reduction in costs by doing nothing more than sending patients into the hospital marketplace with the knowledge that the money they had to spend totaled no more than $30,000.
Oh, I neglected to mention there is one class of customer that gets knee replacements for as little as one-fifth of what Medicare pays: the family dog. This is for a procedure that involves the same technology and requires the same basic surgical skills as knee replacements for humans.
Source: Free The Patient – Forbes
Our third-party payer system, by the nature of how coding & billing is contractually mandated, promotes increased health spending on aggregate – and the economic design of the system includes a perverse incentive to keep the spending going.
This occurs in large part due to price insensitivity on the consumer-patient side due to the low marginal cost of entry compared to the inflated CPT billed charges which serve as a pivot point for network discounts. i.e. ~ once a co-pay is paid, patients don’t have any incentive to know or care what is done or how much it costs.
These perverse motivations are what keeps premiums going up and up… Without utilization (claims), there is no other way to grow the pie because payers are not free to make a higher profit margin beyond the mandated cap, even if they do things to lower aggregate utilization which might lower premiums for everyone. In other words, payers are not rewarded for efficiency, they reap financial reward to the extent that utilization, thus costs, continue to rise.