Unforeseen Consequences: One result of Obamacare

[BoyNextDoor]

However your employer may choose to switch insurers just like they've been doing for decades to save them and you money, and that may change which doctors are in your network.

Just to be clear employers having a "choice" is not reality. We asked for 6 national insurers to bid on our business and 5 of them flat out declined. In other words, one company basically dictated to us the 2013 rates, and they went up. The only choice for the company was what would the employer vs employee share of the plan be and that is a function of budget. And this was not the first time. This has happened several times in my career and from talking to colleagues this is not uncommon.

 

[GiggLeGasm]

Luckily, I live in a state without for profit hospital systems and I wouldn't have a health plan that uses a for profit hospital.

And, I'm sure your Medicare supplement would have cost you twice as much even without ObamaCare.

Without disregarding your personal experience, I work for a very large not-for-profit hospital. I assure you that we make a lot of money, we're paid very well, we accept both United Healthcare and Blue Cross/Blue Shield.

One thing I've noticed here is that there is a large push to shift practice because of the changes in reimbursement. Not only are we holding the business side of healthcare more accountable (or attempting to), we are asking the general public to change as well. I don't necessarily see this as a bad thing. We're requiring people to be more responsible for obtaining healthcare outside of the hospital setting. Let's face it, though, this is a cultural shift as much as a business one. There are a lot of people who, in addition to lacking resources to provide their own healthcare coverage, don't even have enough extra gas money to get themselves to a weekly appointment at a clinic.

I have appreciated reading a great deal of what has been written. I've been amused at the few people who have suggested that the problem is being either created or prolonged by any one side. There are so many sides to this issue that it can't possibly be summarised in one editorial.. add the facts that the editors don't reference research, the research holds recognisable bias, the selection of participants is questionable, etc .. lol.. yanno

 

[BoyNextDoor]

Without disregarding your personal experience, I work for a very large not-for-profit hospital. I assure you that we make a lot of money, we're paid very well, we accept both United Healthcare and Blue Cross/Blue Shield.

One thing I've noticed here is that there is a large push to shift practice because of the changes in reimbursement. Not only are we holding the business side of healthcare more accountable (or attempting to), we are asking the general public to change as well. I don't necessarily see this as a bad thing. We're requiring people to be more responsible for obtaining healthcare outside of the hospital setting. Let's face it, though, this is a cultural shift as much as a business one. There are a lot of people who, in addition to lacking resources to provide their own healthcare coverage, don't even have enough extra gas money to get themselves to a weekly appointment at a clinic.

I have appreciated reading a great deal of what has been written. I've been amused at the few people who have suggested that the problem is being either created or prolonged by any one side. There are so many sides to this issue that it can't possibly be summarised in one editorial.. add the facts that the editors don't reference research, the research holds recognisable bias, the selection of participants is questionable, etc .. lol.. yanno

Hey Giggles -

Is your shop getting ready to go in the ACO direction? Are you purchasing physician practices? You hit the nail on the head when you said that a lot of this is predicated on changing consumer behavior.

 

[SeaDaddy1]

Without disregarding your personal experience, I work for a very large not-for-profit hospital. I assure you that we make a lot of money, we're paid very well, we accept both United Healthcare and Blue Cross/Blue Shield.

One thing I've noticed here is that there is a large push to shift practice because of the changes in reimbursement. Not only are we holding the business side of healthcare more accountable (or attempting to), we are asking the general public to change as well. I don't necessarily see this as a bad thing. We're requiring people to be more responsible for obtaining healthcare outside of the hospital setting. Let's face it, though, this is a cultural shift as much as a business one. There are a lot of people who, in addition to lacking resources to provide their own healthcare coverage, don't even have enough extra gas money to get themselves to a weekly appointment at a clinic.

I have appreciated reading a great deal of what has been written. I've been amused at the few people who have suggested that the problem is being either created or prolonged by any one side. There are so many sides to this issue that it can't possibly be summarised in one editorial.. add the facts that the editors don't reference research, the research holds recognisable bias, the selection of participants is questionable, etc .. lol.. yanno

Aha! A voice of reasoning that can relate to reality. I so wanna hug you right now.

 

[Sean]

Just nationalise all the hospitals, doctors, clinics and insurance companies. You'd have a health system that could compete with civilised countries in no time.

 

[CHNOPS]

Just nationalise all the hospitals, doctors, clinics and insurance companies. You'd have a health system that could compete with civilised countries in no time.

We have one of the world's lowest personal tax rates, and at the same time one of the world's highest "complaining that taxes are too high" rates. People would rather pay more money into private medical coverage than they would into a slightly higher tax rate, because it lets them pretend it's voluntary. As if the oncologist who saves your child's life would continue to work if you stopped paying him or her. But no matter.

 

[Sean]

We have one of the world's lowest personal tax rates, and at the same time one of the world's highest "complaining that taxes are too high" rates. People would rather pay more money into private medical coverage than they would into a slightly higher tax rate, because it lets them pretend it's voluntary. As if the oncologist who saves your child's life would continue to work if you stopped paying him or her. But no matter.

The one thing I truly hated about living in the US was your insane health care system. Specially with a wife and young kid. You spend more than double per person what we do and get worse results. But mention improving matters and the scumbag vultures that make millions off the suffering of Americans scream, "Socialism!" and the sheep follow on blindly. If it wasn't so fucking awful it would make me laugh.

 

[Squibbs]

Without disregarding your personal experience, I work for a very large not-for-profit hospital. I assure you that we make a lot of money, we're paid very well, we accept both United Healthcare and Blue Cross/Blue Shield.

One thing I've noticed here is that there is a large push to shift practice because of the changes in reimbursement. Not only are we holding the business side of healthcare more accountable (or attempting to), we are asking the general public to change as well. I don't necessarily see this as a bad thing. We're requiring people to be more responsible for obtaining healthcare outside of the hospital setting. Let's face it, though, this is a cultural shift as much as a business one. There are a lot of people who, in addition to lacking resources to provide their own healthcare coverage, don't even have enough extra gas money to get themselves to a weekly appointment at a clinic.

I have appreciated reading a great deal of what has been written. I've been amused at the few people who have suggested that the problem is being either created or prolonged by any one side. There are so many sides to this issue that it can't possibly be summarised in one editorial.. add the facts that the editors don't reference research, the research holds recognisable bias, the selection of participants is questionable, etc .. lol.. yanno

Tell that to Bill Orielly, twat!

 

[GiggLeGasm]

Hey Giggles -

Is your shop getting ready to go in the ACO direction? Are you purchasing physician practices? You hit the nail on the head when you said that a lot of this is predicated on changing consumer behavior.

I'm afraid you misunderstood. I never intended to say that the changes are in response to consumer behavior. We need to change the way many consumers view the healthcare system. A large percentage of our population uses the hospital as an avenue for primary care. That needs to change. It's expensive and unrealistic.

Regarding "the ACO direction" that you've mentioned, all hospitals that receive reimbursements medicare, to some extent, need to shift practice to play that game. It's not really something new and we've been preparing for it. Nobody in healthcare should be saying "holy cow! who knew THAT was coming!" The difference is, some companies have been able to spend big money to ensure the highest levels of reimbursements.. but whatever. the game is changing.

The hospital for whom I work has maintained a faculty practice for ages. Have we initiated clinics that specifically address the guidelines for an accountable care org?.. of course. we want to get the money if we're going to perform the service. lol.. it does actually cost money to take care of people in the hospital. It's not like the healthcare gods just bestow research and technology upon us.

Aha! A voice of reasoning that can relate to reality. I so wanna hug you right now.

ok.. but it has to be one of those fake internet hugs.. your abs have to be super tight and I promise to be wearing standard internet issue lingerie for those 3 minutes only.

 

[hogjack]

Just nationalise all the hospitals, doctors, clinics and insurance companies. You'd have a health system that could compete with civilised countries in no time.

Veterans' Hospitals are nationalized. Some of them are shit-holes.

Car/auto insurance isn't nationalized. Companies compete for customers and prices remain low. Same with life insurance companies. Competition reduces the prices and increases the services. Insurance companies also compete in many other services and the costs benefit.

One of the reasons (not the only one) health care costs have escalated is because doctors (hospitals, specialists, doctor groups) way over-charge for services they know that insurance or the government will pay. Some insurance companies are not allowed to compete in some states.

It's a rigged game.

 

[BoyNextDoor]

I'm afraid you misunderstood. I never intended to say that the changes are in response to consumer behavior. We need to change the way many consumers view the healthcare system. A large percentage of our population uses the hospital as an avenue for primary care. That needs to change. It's expensive and unrealistic.

Regarding "the ACO direction" that you've mentioned, all hospitals that receive reimbursements medicare, to some extent, need to shift practice to play that game. It's not really something new and we've been preparing for it. Nobody in healthcare should be saying "holy cow! who knew THAT was coming!" The difference is, some companies have been able to spend big money to ensure the highest levels of reimbursements.. but whatever. the game is changing.

The hospital for whom I work has maintained a faculty practice for ages. Have we initiated clinics that specifically address the guidelines for an accountable care org?.. of course. we want to get the money if we're going to perform the service. lol.. it does actually cost money to take care of people in the hospital. It's not like the healthcare gods just bestow research and technology upon us.



ok.. but it has to be one of those fake internet hugs.. your abs have to be super tight and I promise to be wearing standard internet issue lingerie for those 3 minutes only.

No misunderstanding. ACA is not a reaction to changing consumer behavior, it is based on the belief that it can be changed. I am not so sure it can be, at least in the near term of 10+ years. The ER is not the place to dispense primary care.

ACOs are not a surprise. I was asking if your institution is acquiring physician practices as a part of the ACO strategy. It sounds like you are part of an academic medical center.

 

[hogjack]

Just nationalise all the hospitals, doctors, clinics and insurance companies. You'd have a health system that could compete with civilised countries in no time.

The US Federal Government is TRILLIONS (TRILLIONS) in debt. It literally is the worst business-model ever and borrows 40 cents on the dollar it spends. This is the entity to run everything? Ridiculous. And UNSUSTAINABLE.

It's inefficient and getting worse, not better. The military is nationalized and it has billions-of-dollars in redundancies (also known as WASTE).

 

[GiggLeGasm]

No misunderstanding. ACA is not a reaction to changing consumer behavior, it is based on the belief that it can be changed. I am not so sure it can be, at least in the near term of 10+ years. The ER is not the place to dispense primary care.

ACOs are not a surprise. I was asking if your institution is acquiring physician practices as a part of the ACO strategy. It sounds like you are part of an academic medical center.

Cleveland is unique in that it is, essentially, a city that has two primary healthcare networks. We have a couple of smaller players, but even they tend to use resources from both University Hospitals and the Cleveland Clinic. That is not to say that we don't have city/VA healthcare available. We do. All that "buying up" happened over the past several decades. When I say that we are a faculty based system, I don't mean that as it relates to academia, although but UH and CCF are associated there as well. Faculty practice in this sense means that the doctors are hospital staff. Patients rarely see their primary care provider if they go to the hospital.

 

[Sean]

Veterans' Hospitals are nationalized. Some of them are shit-holes.

Car/auto insurance isn't nationalized. Companies compete for customers and prices remain low. Same with life insurance companies. Competition reduces the prices and increases the services. Insurance companies also compete in many other services and the costs benefit.

One of the reasons (not the only one) health care costs have escalated is because doctors (hospitals, specialists, doctor groups) way over-charge for services they know that insurance or the government will pay. Some insurance companies are not allowed to compete in some states.

It's a rigged game.

Insurance companies are running a cartel. And US car insurance isn't cheap, it's about five times what the equivalent in the UK would be.

 

[BoyNextDoor]

The US Federal Government is TRILLIONS (TRILLIONS) in debt. It literally is the worst business-model ever and borrows 40 cents on the dollar it spends. This is the entity to run everything? Ridiculous. And UNSUSTAINABLE.

It's inefficient and getting worse, not better. The military is nationalized and it has billions-of-dollars in redundancies (also known as WASTE).

Not to split hairs but it is NOT a business. FFS, people have to drop that thinking.

The market has inefficiencies as well, the hard part is getting the right mix. And the market is wildly inefficient at allocation for healthcare. Just like it is near impossible to market National Defense.

 

[SeaDaddy1]

So here is some reality: In all probability my company will drop medical insurance because the fines will be less expensive than the employer share and other costs.

I will admit I am not in HR or benefits so I don't know all the details but we are sort of like a Mc Donald's in that we have a large FTE population that is in the min wage to min wage +$6 range (~85% of total headcount) and then a tier of management/salaried and a gap in between. We currently offer a Mini-Med Health Plan but since FOX and http://abcnews.go.com/Health/mini-med-health-plans-useless-consumers/story?id=15522939 shit on them and the ACA discontinues them, that option is going away and putting that population on a HMO style plan is costly. The new law says you can't differentiate plans by capping benefits so companies are confronted with just doing the math.

I believe that most companies structured with populations like ours are waiting for what the Mc Donalds, Wallmarts, etc are going to do and then just follow suit.

So a big part of this will be how the White House is able to react if they start falling out like dominoes. I think it is a 2014 budget issue so decision will be made this fall as companies get their budgets together.

Just to be clear employers having a "choice" is not reality. We asked for 6 national insurers to bid on our business and 5 of them flat out declined. In other words, one company basically dictated to us the 2013 rates, and they went up. The only choice for the company was what would the employer vs employee share of the plan be and that is a function of budget. And this was not the first time. This has happened several times in my career and from talking to colleagues this is not uncommon.

The thing is, people like us in the same boat have experienced the reality of employers having a "choice".

I've been rehired recently by the same company I left almost 2 years ago, on good terms. They were a new company then; almost completely reliant on its own profits and not bank financing. They still operate in that capacity. I should have stuck w/them. The 2 reasons I left them is because #1) The larger company they were partnered with was trying to buy them out. And what 70% says, 30% does.And the larger company has a nasty habit of shit-canning people who disagree w/some of their corporate decisions. I would have been fired eventually, because the larger changed the goals and plans of the original partnership. #2)That would have also meant switching healthcare providers and the company I work for again was dead set against being bought out and fucking over its' employees while losing its' healthcare provider in the process too. Fortunately, that partnership was dissolved after the smaller company backed out and sold their assets and interest to the larger company in exchange for severing all ties except mutual supplier and merchandise agreements they both benefit from. Also, they're non-union, home based in TX.

I fucked up when I quit the first time. I'm so happy they've rehired me in a similar capacity as before, though on a smaller scale. But there's no longer a larger, clueless company dictating terms to us now.

 

[hogjack]

President Obama cut his political teeth in Illinois.

Illinois is one of the three WORST-OFF states financially literally BILLIONS in debt, can't pay vendors who have done work for the state, closing facilities serving the handicapped/less fortunate, unable to pay pensions... Illinois is extremely BROKE. It's financial debt is close to junk bond status.

The President has taken that political knowledge nationally.

Hooray!

 

[SeaDaddy1]

President Obama cut his political teeth in Illinois.

Illinois is one of the three WORST-OFF states financially literally BILLIONS in debt, can't pay vendors who have done work for the state, closing facilities serving the handicapped/less fortunate, unable to pay pensions... Illinois is extremely BROKE. It's financial debt is close to junk bond status.

The President has taken that political knowledge nationally.

Hooray!

That larger company I was talking about in the post above you was home based in Illinois 2 years ago. They moved their home office to DFW, TX. And their still trying to get rid of vacant properties they own in Illinois.

 

[mercury14]

So here is some reality: In all probability my company will drop medical insurance because the fines will be less expensive than the employer share and other costs.

I will admit I am not in HR or benefits so I don't know all the details but we are sort of like a Mc Donald's in that we have a large FTE population that is in the min wage to min wage +$6 range (~85% of total headcount) and then a tier of management/salaried and a gap in between. We currently offer a Mini-Med Health Plan but since FOX and http://abcnews.go.com/Health/mini-med-health-plans-useless-consumers/story?id=15522939 shit on them and the ACA discontinues them, that option is going away and putting that population on a HMO style plan is costly. The new law says you can't differentiate plans by capping benefits so companies are confronted with just doing the math.

I believe that most companies structured with populations like ours are waiting for what the Mc Donalds, Wallmarts, etc are going to do and then just follow suit.

So a big part of this will be how the White House is able to react if they start falling out like dominoes. I think it is a 2014 budget issue so decision will be made this fall as companies get their budgets together.

There are two things you need to consider IMO:

1) Your employer's contribution to your health care plan is tax deductible for them. So if they get rid of your health benefits then they lose hundreds of thousands of dollars in tax deductions PLUS they have to pay the tax per employee for not providing insurance. That's an awful lot to have to pay just to take stuff away from your workers. Your HR department is factoring this even if you aren't

2) Your employer is not going to just stop providing health benefits and just pocket your would-be compensation. No honest person is suggesting that companies are just going to make themselves extremely rich and blame Obama for it. As per the Mercer and EBSI studies, some companies are looking at defined benefit plans where they pay employees extra and tell them to take that money and buy their own insurance through the private market, a bargaining group, or an exchange. The benefit is that the employer can plan better for their health care costs, total compensation becomes more transparent, and companies save money on administration costs.

It's pretty easy to qualify for an exchange subsidy especially if one has kids. Here's an online calculator for it. So the min wage +$6 person in your company makes $27,560 per year (let's say the person is 40 years old). If they're single they can go to an exchange where cost is negotiated at the large group rate and have 53% of the total given back to them in a tax credit.

If they have a family of four and the spouse doesn't have an income they'd be at 118% of the poverty level and get full Medicaid coverage. If the spouse worked and had the same 27.5k income they'd be eligible for a 66% tax rebate.

 

[Wrong Element]

What will the Chicago Way do for Health Care?

Let us examine what it managed to do for the urban youth of Obama's political crucible and home to a lot of his mentors from the NAMBLA member "Uncle Frank" to Saul David Alinsky to the Rev'rund Wright...

Obama was 10 when Alinsky died. They never met.

I don't think it's an unintended consequence. I think it was planned. What will actually save business is universal health care. And I do believe it will happen - maybe not in my lifetime, but it will happen.

I expect the same. The pretense that we have "the best system in the world" can't stand even the mildest scrutiny.

 

[Sean]

Obama was 10 when Alinsky died. They never met.

I've told him that on numerous occasions. Facts don't actually matter to AJ.

 

[mercury14]

Veterans' Hospitals are nationalized. Some of them are shit-holes.

Car/auto insurance isn't nationalized. Companies compete for customers and prices remain low. Same with life insurance companies. Competition reduces the prices and increases the services. Insurance companies also compete in many other services and the costs benefit.

It's a rigged game.

There's so much wrong with this post.

- Veterans rate VA care higher than the general population rates their private sector care.

- You called car insurance in the US "low" but that's a subjective term. Low compared to what? Not Canada or Europe.

- Health insurance companies have high costs because of competition, not low ones. Medicare is much more cost-effective because they don't jack up their rates to pay for stadium naming rights and TV commercials, plus profit. In fact, Medicare is so cost-effective that Republicans said that's why we couldn't have a public option: government insurance would be too cheap because they didn't have to make a profit, therefore private insurers couldn't compete and would go out of business.

I don't know about you, but I want as much of my health care dollar to go toward actual care as possible. And with private insurance each dollar I pay shitty Humana first goes towards administration (redundantly duplicated a few dozen times across the industry with so many companies), other overhead, profit, advertising costs, and then whatever is left over goes towards getting medical care. Hence public/government insurance is far cheaper and more cost-effective.

One of the reasons (not the only one) health care costs have escalated is because doctors (hospitals, specialists, doctor groups) way over-charge for services they know that insurance or the government will pay. Some insurance companies are not allowed to compete in some states.

Where are you getting your information from? I work in a hospital and the Medicare and Medicaid reimbursement rate for our services are far lower than those of any private company. We're constantly looking at capping Medicaid beds because sometimes we even lose money on them.

Some insurance companies are not allowed to compete in some states.

What? Which states are banning individual companies?

 

[GiggLeGasm]

Where are you getting your information from? I work in a hospital and the Medicare and Medicaid reimbursement rate for our services are far lower than those of any private company. We're constantly looking at capping Medicaid beds because sometimes we even lose money on them.

just for curiosity, are you running into an increased problem because LOS numbers aren't in alignment with drg numbers.. or just because the reimbursement rates are that low? we're hitting our heads on both.

 

[unregistered]

 

[GiggLeGasm]

"Unforeseen Consequences" are usually the result of cluelessness. Imagine how you can triple down on this by putting Obama, Reid, and Pelosi, into the equation.

I think we've established that this wasn't really unforeseen. This isn't the first time there has been an attempt to figure out the healthcare mess and it certainly won't be something that is solved during any one presidency. Removing the politics, it's an issue that needs transition/resolve.