Current Events > big political fights over health care costs on the horizon

(+) Yeah! (+)

https://www.axios.com/frustration-healthcare-costs-growing-employee-employers-db9a759d-2e29-4da4-ae47-a6935903f663.html

The next big battle in health care will almost certainly be about costs, and right now its largely confined to industry infighting and finger-pointing. But mounting frustration from employers and employees could put cost controls on the table faster than you might think.

The big picture: Frustration over health care costs is one thing. But the greater threat to the health care industry is one thats just starting to percolate concern that weve already maxed out the existing tools to control those costs.

Driving the news: Lawmakers in California recently proposed moving the state to an all-payer system giving the state more control over the rates that doctors and hospitals can charge private insurance plans.

Only one other state Maryland has an all-payer system.

And yet, I 100% agree with this take from Reason magazine's Peter Suderman:"The all payer rate setting debate is basically the Red Wedding of health policy. All the deep nerds have know it's coming for years and are very excited to finally talk about it with everyone else."

The big question: Are we really going to have a debate about all-payer? Is this one of those times when California is the wacky outlier state, or one of those times when its a trendsetter?

What theyre saying: Once employers reach the end of their rope on health care costs, the cost-control debate is going to ratchet into a higher gear. That may or may not mean a debate over all-payer in every state, but government intervention will probably be on the table, at least in some states.

The cost-containment debate is coming, because policymakers wont want to put too much new revenue on the table, Democratic health care strategist Chris Jennings tells me. And that means there will be a focal point on the two areas paying the most the private sector and Medicare.
Costs have risen modestly over the past few years, and private insurance has responded, in large part, by shifting more of those costs onto consumers through higher copays, deductibles and coinsurance.

But it appears were at the precipice of what the market will bear on cost-sharing, Jennings says.
The bottom line: This is a scary position for providers. If employees are at their breaking point on cost-sharing, and employers reach their breaking point on cost growth, expect political systems to get serious about cutting those costs themselves.
---

The first salvo in this fight is actually probably the enhanced scrutiny pharmacy benefit managers (PBMs) are facing. My state became the first to directly regulate PBMs just this year (I think) in a special legislative session.
---

Soon healthcare will be a luxury only the wealthy are allowed to have, that's an amazing win for capitalism.
---

I'd much rather the government be looking at healthcare than immigration. Now let's just hope they don't screw it up.
---

i would assume the republican solution will be "let's kick all the high-risk people out and let them die"
---

Healthcare sucks in America because the democrats want to build a sports car and the republicans want to build a pickup truck. And they spent decades one-upping and sabotaging each other. So now the healthcare system is like a car with the engine and breaks of a sports car and the body and wheels of a pickup truck. It's not working.
---

Darkman124 posted...

i would assume the republican solution will be "let's kick all the high-risk people out and let them die"

imo they're going to roll on big pharma (assuming they are still in power when these trends come to a head)

too many other big money providers that are more public facing have their costs partially driven by pharmaceuticals for them not to
---

Employers are spending an insane amount on healthcare. If we raise taxes and switch to single payer--and if this can actually decrease net cost to employers--I think we'll see much more support for socialized health care. I support capitalism but it's okay to have some elements of socialism in our country!
---

Darkman124 posted...

i would assume the republican solution will be "let's kick all the high-risk people out and let them die"

But remember universial healthcare means death panels. The Republicans told me so.
---

btw how does this all payer system in MD work, @Darkman124 ? I'm not at all familiar
---

Balrog0 posted...

btw how does this all payer system in MD work, @Darkman124 ? I'm not at all familiar

i have no idea. i havent been tracking what my state has done and this is news to me.
---

Didn't CA recently shoot down a Medicare-for-all plan because it would cost too much

If California won't do it because it costs too much, you know something's wrong
---

Sephiroth1288 posted...

Didn't CA recently shoot down a Medicare-for-all plan because it would cost too much

If California won't do it because it costs too much, you know something's wrong

The numbers indicated this was a lie, and a number of the senators tossing that line out had their medical industry ties tossed into the public domain. It's not that it cost too much, it's that senators even at the state level can be bought and paid for.
---

tremain07 posted...

Soon healthcare will be a luxury only the wealthy are allowed to have, that's an amazing win for capitalism.

There is absolutely nothing Capitalist about our healthcare system.
---

gunplagirl posted...

Sephiroth1288 posted...

Didn't CA recently shoot down a Medicare-for-all plan because it would cost too much

If California won't do it because it costs too much, you know something's wrong

The numbers indicated this was a lie, and a number of the senators tossing that line out had their medical industry ties tossed into the public domain. It's not that it cost too much, it's that senators even at the state level can be bought and paid for.

link?
---

frozenshock posted...

Healthcare sucks in America because the democrats want to build a sports car and the republicans want to build a pickup truck. And they spent decades one-upping and sabotaging each other. So now the healthcare system is like a car with the engine and breaks of a sports car and the body and wheels of a pickup truck. It's not working.

If this is the analogy you use, you've never heard of Ultra4.
---

Sephiroth1288 posted...

Didn't CA recently shoot down a Medicare-for-all plan because it would cost too much

If California won't do it because it costs too much, you know something's wrong

yes, that's why they are attempting to do something that doesn't directly cost a lot of money.

I am not as familiar with all payer healthcare as I am single payer, but essentially the way it works from my understanding is that rates are set by a commission so costs get controlled through regulation rather than direct spending
---

Balrog0 posted...

Sephiroth1288 posted...

Didn't CA recently shoot down a Medicare-for-all plan because it would cost too much

If California won't do it because it costs too much, you know something's wrong

yes, that's why they are attempting to do something that doesn't directly cost a lot of money.

I am not as familiar with all payer healthcare as I am single payer, but essentially the way it works from my understanding is that rates are set by a commission so costs get controlled through regulation rather than direct spending

The funny thing is, this isn't even necessary to get health care costs down.

Make Medicare and Medicaid actually pay 100% of the reimbursement charge, instead of only 20% like it does now. This means that hospitals don't lose 80% of the cost of every procedure covered by the largest insurance provider in the country, forcing them to raise prices on everyone else to make up the difference.

Mandate that drug and medical device manufacturers can't advertise to the public. These companies often cite the advertising costs for their products as a reason for their expense. Along these lines, mandate that these companies are no longer allowed to add in 'future research' fees to their pricing.

There are plenty of other things that people on both sides of the aisle miss for a multitude of reasons, that would lower costs without fundamentally changing the entire system.
---

darkjedilink posted...

The funny thing is, this isn't even necessary to get health care costs down.

Make Medicare and Medicaid actually pay 100% of the reimbursement charge, instead of only 20% like it does now. This means that hospitals don't lose 80% of the cost of every procedure covered by the largest insurance provider in the country, forcing them to raise prices on everyone else to make up the difference.

Medicare on average pays 80% of what private insurance does, Medicaid pays about 56%. Paying more would not make costs go down, that is a crazy way of thinking.

It is true that they raise a lot of money through charging the uninsured, but it doesn't have much of anything to do with Medicaid or Medicare costs. It has to do with us mandating hospitals serve people without an ability to pay for their services.

darkjedilink posted...

Mandate that drug and medical device manufacturers can't advertise to the public. These companies often cite the advertising costs for their products as a reason for their expense. Along these lines, mandate that these companies are no longer allowed to add in 'future research' fees to their pricing.

There are plenty of other things that people on both sides of the aisle miss for a multitude of reasons, that would lower costs without fundamentally changing the entire system.

barring advertisements on drugs and medical devices isn't a bad idea, but it is a pretty lefty idea, and I don't think it would do much to control costs (it would help, just not sure how significantly)
---

Balrog0 posted...

that is a crazy way of thinking.

not crazy: utterly moronic

which is typical for the user you quoted, because he has no idea what he's talking about nor any experience with the logistics of the industry. but i'm glad you are sharing the real information, because i am learning from your post.
---

This is the time you've been waiting for Balrog. The people who work on health care policy can now crawl out from the shadows and take their rightful throne on cable news!
---

^ well then let me clarify something I said hastily

they actually don't raise a lot of money from the uninsured, who largely can't pay, but the uninsured are one group of people who they are capable of upcharging for services -- obviously because medicaid, medicare, and private insurers have the leverage and incentive to keep their charges lower than the uninsured -- and they do so aggressively.

of course, uninsured here also means not covered by your network, and that's why we see the kind of bullshit we see in ERs, where there are no providers in the ER that are in your network, even though the hospital itself is
---

Ban third-party payers, as a concept, and healthcare costs will collapse immediately.
Go look at lasik and dental implants as an example. Insurance doesn't cover them, so they have to actually compete for business, instead of bloating costs in the expectation of getting a fraction of the requested amount, while the patient complains about a $20 copay.

Anteaterking posted...

This is the time you've been waiting for Balrog. The people who work on health care policy can now crawl out from the shadows and take their rightful throne on cable news!

I've actually been pretty lucky as far as that goes. During the ACA repeal we were in high demand, and then after that my state became the first to implement work requirements for Medicaid. Journalists haven't stopped talking to me since last June basically

I've never been on TV though
---

yeah not so much uninsured as 'denied'
---

America sucks its so sad
---

I work in the industry. We'll be seeing costs go down as the industry digitizes, automates, and competes. More public scrutiny on administration pay will help pass on a larger share of the savings to consumers.
---

FLUFFYGERM posted...

We'll be seeing costs go down as the industry digitizes, automates, and competes.

We'll have to get over the hump of all the administrative costs involved first.

How it should work:
"It'll cost $250 to do the thing."
"Okay. Here's $250."

How it actually works:
"I did the thing. It costs-."
"Pfft whatever, here's my insurance card."
"I'm with Shady Insurance, Inc. You didn't code that properly, so we can't process the payment."
"Okay now It's coded properly - I had to hire someone to do it."
"We're only paying you $110, take it or leave it."
"Why the hell do I have a $50 copay - I HAVE INSURANCE DAMMIT!"

HIPAA really stymies digitization and automation though
---

Balrog0 posted...

HIPAA really stymies digitization and automation though

Gee, it's almost like some government regulations impede progress.
---

okay? HIPAA is just one aspect of record keeping and sharing that makes progress slow. there are plenty of other issues sharing records between different health care systems.

I mention HIPAA because it is an obvious one I knew you would agree with. so tell me how digitization works to reduce costs here in reality.
---

Wtf? You don't understand how digitizing the indutstry, from claims to information delivery to instant communication between pcps and benefits admins and consumers would lower costs?
---

... I'm asking you how you imagine that happening given the regulations around patient data. Even if there weren't regs there would be issues with different networks of providers and types of providers sharing relevant data with each other (not to mention the non-medical providers that might need to access the data!)

but I'm asking you how you think that will all happen. Give me the steps. Obviously if we assume an outcome we can explain how it would be good. I'm asking you to tell me how we get there.
---

darkjedilink posted...

Mandate that drug and medical device manufacturers can't advertise to the public. These companies often cite the advertising costs for their products as a reason for their expense.

That wouldn't really do much to lower advertising costs. The vast majority of drug company advertising costs are spend advertising to medical providers and not the public.

that is a good point too
---

Balrog0 posted...

... I'm asking you how you imagine that happening given the regulations around patient data. Even if there weren't regs there would be issues with different networks of providers and types of providers sharing relevant data with each other (not to mention the non-medical providers that might need to access the data!)

but I'm asking you how you think that will all happen. Give me the steps. Obviously if we assume an outcome we can explain how it would be good. I'm asking you to tell me how we get there.

Digitization decreases costs and increases quality even between the insured and their health insurance company. Most health insurance plans offer access to free preventive programs (sometimes thinks like weight loss, smoking cessation, mental help, etc) that people don't use because they don't even know about that. Digital platforms that show people what their benefits are and help them interact with their benefits get more people through those programs which improves individual health and also the insurance company's bottom line at the same time.

And as insurance providers and healthcare providers digitize, they build platforms. These platforms can be used by anyone, even other insurance providers and healthcare providers, so long as the people who own the platform get a cut. So ultimately you can have someone's health record be shared across providers for no cost at all.

If we can get to the first steps of having people stay in touch with their primary care physician and taking advantage of the free preventive programs, we've already reduced a tremendous amount of waste in the system. I can't disclose specific numbers due to contractual obligations, but doing just these two things can improve individual health and reduce insurance costs by a substantial amount.

Simply having someone's phone number and having them switch over to paperless billing is a tough problem in healthcare because of how deprecated the model is. Doing those things represents quick and substantial cost savings. Do these types of things across the entire health insurance and provider systems and you'll have a lean and mean machine with time.
---