Well, this is encouraging: Terry Murray has started a serious conversation about controlling health care costs, and Charlie Baker seems to be singing the same tune:
I think given the rate of health care increases in Massachusetts I think that’s an idea whose time may have come … I’m a big believer in a more informed conversation about what’s driving up health care costs and if [the public hearing] process is the only way to put that question before the public and the body politic and everybody else, then it is worth considering, although it does come with significant downsides.
Murray’s ideas are straight-down-the-middle consensus for controlling the increase in health care costs; they’re all relatively uncontroversial, but mostly in a speculative way. For instance, we don’t know for sure whether electronic medical records will actually help control costs, and actually they would require a very signficant upfront investment in the new technology.
But I would love to think our political establishment is really coming around to the ugly reality of health care costs. This is the vast, underlying issue behind all the municipal woes and property tax battles; and the new health care law simply will not work without boldly and aggressively dealing with the issue. The legislature is looking at the budget numbers year after year; they’re hearing the complaints from municipalities and taxpayers; and they’re ready to do at least something.
Maybe we’re seeing the tough-mindedness that Murray is known for. Good on her.
1 Pharmacy——-Too many “nonessential meds” are being prescribed. Ie allergy meds, gastric reflux meds,various types of (PO) by mouth, diabetic meds, anti depressants. pain meds etc. The public DEMANDS a pill for every ailment.
Most of the time there is an OTC or wait three and the problem will resolve itself.
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2 Doctors visits—– Too many folks wanting to see a doctor for a perceived medical/physiological issue when they just need to wait three days and it will resolve itself. If it doesn’t they should see a psychiatrist first as many of these issues are of psychogenic etiology.
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3. Elderly/geriatric patients and ambulances—- There are many, many geriatric patients who are transported to doctors appointments by ambulance or chair car. A chair car is $250.00 minimum one way. An ambulance is $500.00 minimum one way. A seventy five year old patient on daily dialysis is eating up two grand a day in treatments. Start doing the math.
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4. Reimbursement —-medical and healthcare workers workload is increasing almost everyday and reimbursement is declining. Doctors are now padding the bill by wanting to see people (it seems) almost twice a week for one followup after another. This serves two purposes. First it generates more reimbursement, secong it is a CYA in the event of a lawsuit, frivilous or otherwise.
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Anyone given any thought that healthcare workers may just withhold services until they are properly compensated. Anyone have an issue with that? Baseball and football players make millions—-for what? Why does a union truckdriver make more money than I do. Why do some PA’s and RNP’s make more money per hour than and MD?
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You think healthcare is expensive now? Why do healthcare workers work for nothing each week? We give sometimes one to two hours a day and sometimes more. We are not missionaries. If we were properly compensated the cost of healthcare would double.
I asked him why — I try to avoid pain meds, and my injury wasn’t agonizing. She told me that it was exactly equal to “Aleve” but that with my insurance, it’s cheaper for me to pay the co-pay on the prescription than the OTC price.
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Exact. Same. Med.
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I wonder how often there are situations like this, and how much would be saved by remedying them.
that you would be paying more than the co-pay for that med. you (and probably your employer) have already paid something in the form of your premium.
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for me, the most important med/insurance problem is some (by no means all) doctors pushing certain brands due to incentives from the manufacturers. it is especially problematic if they are prescribing off-label. i have on occasion had doctors who i’ve suspected of doing this. on the other hand, i’ve had far more doctors who getting a rpescription from is almost like pulling teeth. it’s not easy to tell what the truth behind teh writing of any particular prescription, because it involves many factors: the doc’s personal medical philosophy & experience, the possible interference of drug promoters, and the demands of my health insurance.
The question was, would I pay $10 at the back counter of the CVS, or $16 at the front counter?
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Given that choice I’d choose $10. The insurance premiums are gonna get paid exactly the same whichever counter I choose.
i see them as a down payment on future services. whether that service is a bottle of aspirin or a retinal transplant, it’s money i’ve invested into health care for myself. so, i have no problem with you taking the $10 prescription.
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perhaps a larger savings could be reckoned if more medical practices employed more physicians assistants to handle such low-grade complaints as yours. it is a major waste of talent and money to have a doctor handing you that prescription. some practices don’t bother using expensive doctor minutes for such routine stuff.
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You couldn’t be more wrong. People need to go to the doctors early and often because it’s fair easier (and cheaper) to catch a minor condition than it is to send someone to the hospital at the cost of thousands of dollars, quite possibly when it’s too late.
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Case in point: years ago, I had some weird thing on my foot. I didn’t know what it was, but it didn’t look right and my foot sort of hurt when I walked on it. Now, keep in mind, I felt fine – other than minor, minor pain, but I went to the doctors immediately on the off chance that it was something they should take a look at.
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It was a good thing too, because I had a serious staff infection that had entered my bloodstream and was maybe a day or two away from losing my leg and probably three or four days away from the doctors having to fight for my life (according to doctors, anyway). If I waited a few days before going to the doctors, even though I wasn’t in much pain and my foot didn’t initially look very bad, I would have been screwed.
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This is why people shouldn’t wait – and why waiting actually costs far more money in the long run. It’s better to catch cancer in its early stages than when it’s too late. It’s better to know you have the flu instead of meningitas.
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But keep pretending that you know anything about this when you clearly don’t. I don’t even care if you work in the medical industry; I’ve never seen or known a doctors and nurses (which includes about half my family) give such terrible advice concerning one’s health.
In strictly dollar terms, I have no idea where US insured [and US non-insured] people fall.
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It’s true, in your case you made the right decision, and likely saved tens of thousands in costs. However, how often is it a staph infection, and how often does it just need some Advil?
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So, I’ve read both claims — but never seen good evidence that either is correct.
just give up on docs ‘n medicine altogether, we’d save a wad a dough! if you have some evidence to back up any of your points, i’m interested to see it. otherwise, why not get straight to the point and just say “a bullet to the head is the cheapest remedy”. i mean, at pennies a pop…
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[that is satire, but the way]
I used to go to the doctors after having a “cold” for three or more days. I was prescribed antibiotics to treat an “infection”. This was done to get me out of the office. I’ve stopped going to the doctors for colds, they go away. I only go if I’m really unable to get out of bed.
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Many people go to the doctors way too often. I used to be one of them. MCRD is completely right when he talks about this.
my doctor won’t prescribe antibiotics for something that is likely a viral infection. how do you know you were prescribed antibiotics “to get you out of the office”? there are people who need “just in case” antibiotic protection.
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if you’re really unable to get out of bed, how do you go to the doctor? đŸ˜‰
You do know that overprescribing of antibiotics is a real problem right. Here are multiple articles showing that my experience wasn’t out of the ordinary. In fact it was, maybe not is anymore, but was the norm.
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http://www.news.harv…
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http://www.medicalne…
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Heck, here just look at the Google search
and it is exacerbated by the huge use of antibiotics in livestock feed.
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however, whether or not to prescribe antibiotics isn’t always a simple question. i, for example, am susceptible to staph infections (which include bacterial pneumonia) for reasons i will not go into. so, doctors commonly prefer to give me what might be an unnecessary round of antibiotics, even though my sinus infection or whatever may be viral, to insure that i don’t develop pneumonia. as a bean counter, you should be happy about that since me getting bacterial pneumonia could cost us all a lot of insurance pay-outs in the form of hospital and funeral bills.
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there are other people with other conditions that warrant similar treatment. just keep that in mind when you think someone is being irresponsible or a spend-thrift by getting what Dr EaBo thinks is unneeded antibiotics. it is great that you’re not going to the doctor for a silver bullet to fix your cold. that is commendable. but just be aware (and very happy) that we don’t all live in your body. we all have different needs.
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if you are really concerned about overuse of antibiotics leading to decreases in effectiveness (a problem you won’t be surprised that i am personally concerned over), i suggest you get buys lobbying the food industry to stop those practices. something very easy that almost every household can do is simply switch to buying milk that comes from cows not shot up with growth hormones and antibiotics. then write a letter to your former milk producer telling them what you’ve done and why. then call your egg producer and ask them if they used antibiotic-laced feeds, etc..
There seems to me little doubt that we spend enormous amounts of money on things that people would not spend if they had to pay for it. My own example comes from when my wife had breast cancer a few years ago. After chemo, they did a body scan. Reasonable. Then: “There is something on the liver. It is probably just a hematoma but we ought to do a CATscan…..Well, it looks like a hematoma but I want to do another round to make sure….Well, it is pretty surely a hematoma but I think we ought to do an MRI….Well, I am pretty sure it is nothing…..
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Now the main point is that if she had had mets to the liver, she was going to die from it. There are no substantial treatments for that. Did I object? Hell no! It was my wife and it was the insurance paying for it.
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I don’t know what to do, the Oregon experiment in which they limited what Medicaid would pay and then agreed to pay for only the procedures that could be afforded in that budget is one idea. The original Hillarycare plan would have saved tremendous amounts of administrative costs but it is only a temporary fix. In the meantime, NIH continues to put large amounts of money into developing new and more expensive technologies……
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Something, somewhere, has got to give..
You have to remember to consider that if they dont do the apparently unnecesesary testing then they open themselves up to be sued … There are so many cattle feeding at this trough that its hard to remember who all the players are without a scorecard.
…that is a huge profit center for American medical institutions.
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I’ll give you an example. Every 3-4 weeks, my spouse has an INR test taken. (INR is a measure of blood thick/thin-ness). When we’re in the US, it’s done at Lahey Clinic, cost on the order of US$50. When we’re in Germany, it’s done at our local physician, cost on the order of US$10.
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If you want to know why Americans are getting screwed on medical expenses, that is one reason.
remove shareholders from the equation. it never ceases to amaze me that people forget that health care is mediated in this country by FOR-PROFIT insurance corporations. their primary concern isn’t your health, it is maximizing profit.
The primary concern of insurance companies is profit. But, how does this compare to the biggest health care payer, Medicare. You believe its primary concern is health? It’s a hard case to make that Medicare’s ‘primary concern’ is health. It’s primary concern is bill-paying, not health. BTW, my insurer is Fallon, a NOT-FOR-PROFIT corporation, and its costs are just as high as others.
Think about it. The state stepped in and mandated its purchase and presto /// amidst record profits, auto insurance rates went going through the roof.
Then the state got smarter and started to hold the companies accountable … made them submit reasons for increases, created some oversite and what do we see now. Insurers suddenly have felt motivated to find ways to cut their own fat, they still have record profits but rates have flattened out or are even dropping.
Notice every year the insurers ask for a huge increase but get nothing and still manage to turn a profit.
Oversite = good IMO
I’d accept your argument, but for the fact that Massachusetts has more auto insurance that is more expensive than any state except DC, New York and New Jersey.
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http://www.iii.org/m…
Not so long ago the rates here were laughably high.
Today they are about the same as similarly populated areas (you would expect rates in say, Wyoming to be lower based on less dense traffic patterns).
So we are about par …
Imagine where it would be without oversite.
Every year the insurers submit for a 15-20 percent increase and every year they walk away satisfied with little or nothing.
Now with health insurance, every year they submit to themselves for 15-20% and every year they attach the increase to your bill , no checks, no balances … buy it or pay fines … a recipe for disaster IMO.
If you want an idea how regulation and oversite are effective look at gasoline. Its unrelated but not realy so …
Last year crude oil spiked to 60$ and we were paying about 3.25$ at the pumps. The Big Oils turned in record profits, people screamed and congress hauled the execs before committee.
Now look … Crude oil is now over 90$, and at the pumps we are paying …. 2.70$ ?
Hmmm … something good must have come from a little oversite, wouldnt you say?
…a “not for profit” corporation only means that it has no shareholders to whom the profits might go in the way of dividends. With more than a few NfPs, the surplus (which would otherwise be called “profits”) goes to the administrators of the NfP.
and perhaps a source of waste that would have to be addressed. however, i wonder how many n-f-p’s sponge as much extra cash from their ‘customers’ as do for-profit corps. my guess is that the magnitude of any such graft is small when compared to the for-profit world.
I don’t know anything about Fallon or the constraints within which they operate in the present system. My guess is that the for-profits have raised the cost of doing business, and this affects the non-profits too.
… are not-for-profits, IIRC: BCBS, Fallon, Tufts, Neighborhood.
The public is in need of rigorous investigative journalism on this issue. It should also include a critical examination of the role of Blue Cross Blue Shield and Partners Health Care in the formulation, passage and implementation of the state’s “landmark health reform law”.
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Taxpayers are getting soaked. The dominant players are cloaked. As usual.
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Analysts in other states are providing better coverage than our own media, as in this excellent piece and the pdf document within it Massachusetts Mandatory Health Insurance Purchase Law Is No Model for California
It contained more detail than anything I have seen to date. The piece of info I found most enlightening is the part about the “unaffordability” exemption which to me read like everyone I know is free to continue ignoring the law because it is unafordable đŸ™‚
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3. Many cannot afford coverage even under this high affordability standard: Massachusetts estimates that 18% of the uninsured will be unable to afford to pay even the premiums of any insurance plan. This includes:
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– Everyone, of any age, making just above 300% of the federal poverty level (the cutoff point for state subsidies);
– Singles over 55 making less than $50,000 a year;
– Couples over 50 making less than $80,000 a year;
– Families, with parents over 30, making less than $90,000 a year
the business model of “not-for-profit” insurers. What do you mean, that they’re “profit-driven”? Do they have shareholders who get a cut? If they’re making money beyond their expenses (i.e. profit), where’s that going?
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I’d love a link to some explanation of this.
…as best I can tell, the only differences between NfPs and fPs (for profits) are (i) they are (very) loosely regulated by the states’ attorneys general (the “very loosely” is probably because NfPs have persuaded people to believe their sh!t don’t stink), and (ii) the surpluses that would otherwise go to stockholders eventually makes its way into the administrators’ back pockets.
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The latter became clear to me a few years ago, when the head of the NfP national United Way was accused of–more or less–raking in millions of US$ in salary instead of sending the money to the charities for which it was intended. I don’t recall the actual charge, but fraud works pretty well for me.
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BTW, I could go on and on about the United Way/United Appeal. In the 1960s, my father, who was an engineering manager at GE/Evendale OH, told me that UW/UA had hornswaggled corporations into touting their employee’s contributions to UW/UA. The employees were marked down if they didn’t play along. It really was advertising for the “corporate citizenship” of the big corporations. It was, also disgusting.