Healthcare Education and Q&A Thread

[Schneed10]

Originally Posted by firstdown

We hear all the time that people cannot switch their insurance because of existing condition. I thought if you had current insurance that if you wanted to switch to another company they could not underwrite, charge higher rates, or reject a person because of that condition. Is that true?

Yes they can, but there are limits to their ability to restrict. See JR's answer, it's right on.

[firstdown]

Originally Posted by JoeRedskin

Also, to clarify, HIPAA only applies when you have already been insured and are transferring ot a new group insurer - not when purchasing individual insurance plans.

Tips for getting insurance when you have a pre-existing condition - CNN.com

I guess I should have worded my question better because I was talking a family and not group plans.

[JoeRedskin]

In 2008, the average cost of insurance premiums for employer based policies was $3,400.00.

"Growth in health insurance premiums is far outstripping inflation and wages. Many employers have been forced to pass on premium increases to workers. Workers on average pay 27 percent of the premium. If workers continue to pay that percentage, by the end of 2009, employees, on average, will pay nearly $4,000 annually for their share of health insurance premiums.

The average employee contribution for family health insurance premiums increased 120 percent between 1999 and 2008 to $3400 annually. And average out-of-pocket expenses for deductibles, coinsurance and copayments have increased 115 percent over the same period. Salaries have only increased 34 percent during this period."

http://www.nchc.org/documents/Costs-Workers-2009.pdf

[JoeRedskin]

From the various sources I have gone through, it appears that the price of healthcare - and by that I mean doctor's visits, operations, and pharmaceuticals, not the cost of insurance - has risen drastically in the last 10 years.

In your opinion Schneed - what are the two or three factors driving this rapid increase. (I am assuming malpractice insurance is one but are there others?)

[firstdown]

We know that the goverment does provide health ins to people today. Do we know what the goverment pays on average for health coverage v/s private ins?

[Hog1]

I believe the last time I was writing those checks to BC/BS....good coverage, NOT great in a group was about $350ish p/family

[Schneed10]

Originally Posted by JoeRedskin

From the various sources I have gone through, it appears that the price of healthcare - and by that I mean doctor's visits, operations, and pharmaceuticals, not the cost of insurance - has risen drastically in the last 10 years.

In your opinion Schneed - what are the two or three factors driving this rapid increase. (I am assuming malpractice insurance is one but are there others?)

Main factors causing cost increases, in no particular order:

- Science & Technology
We're flat out coming out with amazing technology that can help people get better faster and with less inconvenience. Tiny cameras in the form of a pill that can be swallowed to diagnose gastrointestinal problems. A Gamma Knife machine which irradiates otherwise inoperable brain tumors with gamma particles, extending the life of cancer patients. Da Vinci robotic surgical machines allowing surgeons to operate with even more precision, eliminating the few tremors and quakes they experience by using their very steady fingers. Hospitals often fear that they will lose their existing patients to another hospital with superior technology, so they enter an arms race of sorts to keep up. This sometimes results in an abundance of advanced technology in the community that ends up underutilized.

- Pharmaceuticals
Similarly, advances in research are leading towards more advanced drugs. The cost of manufacturing the drugs, let alone researching them, can get exhorbitant. Many of these drugs can extend the lives of patients, but some don't do a better job than existing tried and true less expensive alternatives.

- Malpractice
Doctors, especially obstetricians, have difficulty breaking even in some states because of this problem. Their malpractice insurance costs are growing so wildly as claims and awards are taking off. It's just like your car insurance; if you live in an area with high accident rates then you will pay more to insure your car. Likewise, in areas where claims and awards are high, malpractice insurance grows to the point that it makes practicing medicine prohibitive. Caps on malpractice awards would curb malpractice premiums a great deal.

[Schneed10]

Originally Posted by firstdown

We know that the goverment does provide health ins to people today. Do we know what the goverment pays on average for health coverage v/s private ins?

You mean what they pay on behalf of the employees who work for them?

My father works for the federal government, I know he has the federal insurance program through Blue Cross. I can ask him what his premium is and get back to you.

Or did you mean what Medicare pays the hospital on behalf of people enrolled in Medicare?

I know for our hospitals, it works out to 42% less than what commercial insurance companies pay us on behalf of their patients.

[JoeRedskin]

I wonder how and if it would be possible to control malpractice costs by creating a workers comp type system for health care. Essentially, immunizing the doctor from malpractice claims but ensuring awards to individuals harmed by "treatment gone bad". Not quite no-fault but similar.

[dmek25]

Originally Posted by JoeRedskin

I wonder how and if it would be possible to control malpractice costs by creating a workers comp type system for health care. Essentially, immunizing the doctor from malpractice claims but ensuring awards to individuals harmed by "treatment gone bad". Not quite no-fault but similar.

sorry Joe, but they have to be accountable. if not, Dr.s all of a sudden turn into weathermen. really doesn't matter if they are right or wrong. and contrary to popular belief, there is a such thing as a bad doctor

[GhettoDogAllStars]

Originally Posted by dmek25

sorry Joe, but they have to be accountable. if not, Dr.s all of a sudden turn into weathermen. really doesn't matter if they are right or wrong. and contrary to popular belief, there is a such thing as a bad doctor

I think they could still be accountable (i.e.: lose their license), but still control malpractice costs in the manner that JR suggested.

[JoeRedskin]

Originally Posted by GhettoDogAllStars

I think they could still be accountable (i.e.: lose their license), but still control malpractice costs in the manner that JR suggested.

yeah. I was thinking something along those lines. For example, after claims abounting to X or after X number of claims paid regardless of amounts, a doctor loses their license.

[saden1]

Originally Posted by JoeRedskin

yeah. I was thinking something along those lines. For example, after claims abounting to X or after X number of claims paid regardless of amounts, a doctor loses their license.

How is this really any better than what currently happens? I mean, currently if a doctor's conduct is egregious enough they would most certainly lose their license. Add to this the fact that if a doctor is successfully sued their malpractice insurance cost goes up and the more it happens the more it goes up, and soon enough they won't be able to practice because they can't afford the malpractice insurance.

Also, you're just as likely to punish good doctors with a 3-strikes type of a law.

[JoeRedskin]

Fair points to an extent. The key of course is "sued successfully" , malpractice is a very difficult case to prove. Bad doctors do not necessarily lose lawsuits. In the WC situation, the question is not "did the doctor screw up", it is "was the patient harmed" - big difference. I understand your point about the similarities to 3 Strikes. At the same time, a doctor who causes harm and does so on a consistent basis - even if he causes harm w/o committing malpractice - is not one who should be practicing. A balance would have to be struck. What the balance is, I am not quite sure.

[Schneed10]

Originally Posted by dmek25

sorry Joe, but they have to be accountable. if not, Dr.s all of a sudden turn into weathermen. really doesn't matter if they are right or wrong. and contrary to popular belief, there is a such thing as a bad doctor

To that point though, by paying for malpractice insurance, they've essentially removed any financial incentive to avoid mistakes.

It's not like they have to be accountable under the current system; if they screw up their insurance carrier foots the bill. So under a capped system, the insurance premiums paid by doctors would be lower, and there would be no change in penalties felt by the doctor in cases of malpractice.

A loss of license would be effective, but I'm not even sure you need that. Doctors already try their damndest to avoid mistakes for fear of scaring all of their patients away. I wouldn't want to put any more pressure on them, they already practice costly defensive medicine as it is.

When you're trying to avoid malpractice suits, you tend to order more tests and procedures than is truly necessary. The rash of malpractice suits is partly responsible for healthcare expenses being as high as they are; we simply don't always need the tests doctors order. I'd rather not put anything in place that would make them any more defensive.