BCBS to Offer ACA Plans in TX in 2017

[Zulu]

Dallas News

[Kirk W]

Thanks for posting the link to this informative article. One thing that I have noticed over the years is that part of the cost issue for health insurance over the years has been the ever expanding list of things that the insurance is expected to cover.

 

If you examine the history of all forms of insurance, when it was created the purpose of it was only to cover the major losses and none of them paid for things which were of a routine, or maintenance nature. Over the years that has all changed in the health insurance field. Back in in the 50's my parents were farmers and they bought a health plan for the family which I still have the policy for. It didn't cover anything like vaccinations, physicals, minor illnesses, or anything that might crop up in the routine living of the family. It did however pay for such things as my sister's appendectomy, another sister's tonsil removal, and my mother's hospital stay. Today we expect our health plan to pay all or at least part of everything that we may visit a doctor's office for. It would be like buying auto insurance that would pay for changing the oil and replacing worn tires. Changes such as that are a major factor in the price increases of medical insurance. Then add in the fact that as health plans began to pay for more and more, we have begun to visit our doctors more and more frequently for more minor issues. The lack of a need to pay the full cost of medical attention causes us to visit our doctors far more frequently than our parents or grandparents did.

 

Just food for thought!

[Velos]

Good point Kirk, people use to take care of themselves now many want to delegate that responsibility to someone else.

 

On the bright side in the news recently Zuckerburg and wife are donating billions to help find a cure for the the top 5 diseases: heart disease, cancer, stroke, neurodegenerative and infectious diseases. About the same time Microsoft announced it is going to solve cancer within the next 10 years by treating it like a computer virus. .

 

I'm a simple person and the cost of health care can be overwhelming but it all comes down to math: I was trying to figure out how health care could be paid for by our income taxes but according to the average income tax by adjusted income compared to the average annual premium there is no way our current income taxes could cover the cost of health care premiums? So I don't know where the money would come from for everyone to get medical care if each individual doesn't earn it themselves?

 

As Kirk said many people go to the dr a lot more than is probably necessary.

 

https://kaiserfamilyfoundation.files.wordpress.com/2015/08/8775-exhibit-1-18.png

 

http://kff.org/report-section/ehbs-2015-section-one-cost-of-health-insurance/

[Zulu]

Back in in the 50's my parents were farmers and they bought a health plan for the family which I still have the policy for. It didn't cover anything like vaccinations, physicals, minor illnesses, or anything that might crop up in the routine living of the family. It did however pay for such things as my sister's appendectomy, another sister's tonsil removal, and my mother's hospital stay.

 

Yes, yes . . . those glorious 50's. When all we had to fear was Eddie Haskell, and health care was so much . . . uh . . . different (house calls, polio, iron lung, TB, etc) . . . Then and Now

 

Today we expect our health plan to pay all or at least part of everything that we may visit a doctor's office for. It would be like buying auto insurance that would pay for changing the oil and replacing worn tires.

 

Well, if we go with your car analogy, 1950 autos are a tad different from today's cars -- fuel injected, auto transmission, all the computer-controlled stuff, safety equipment, etc, etc. So your 1950's car/health budget would have to be adjusted for all of today's new stuff.

 

 

Changes such as that are a major factor in the price increases of medical insurance. Then add in the fact that as health plans began to pay for more and more, we have begun to visit our doctors more and more frequently for more minor issues. The lack of a need to pay the full cost of medical attention causes us to visit our doctors far more frequently than our parents or grandparents did.

One of main reasons insurance companies are opting out of the ACA is because the people signing up are much sicker than expected. So if people were truly visiting doctors more, this would not have happened.

[Kirk W]

 

Today we expect our health plan to pay all or at least part of everything that we may visit a doctor's office for. It would be like buying auto insurance that would pay for changing the oil and replacing worn tires.

Well, if we go with your car analogy, 1950 autos are a tad different from today's cars -- fuel injected, auto transmission, all the computer-controlled stuff, safety equipment, etc, etc. So your 1950's car/health budget would have to be adjusted for all of today's new stuff.

You clearly don't get it............. Let me ask you a question. How do you think that the cost of routine medical care is paid for today? Are you imagining that it isn't part of the price of your health insurance premiums? You can pay it either way, at the time of service direct to the doctor, or via monthly premiums to the insurance company that they pays the doctor. But pay you certainly will. If government pays then it just means that either someone else must pay for yours, or you can postpone payment by running up the national debt until either taxes rise of the government collapses.

[Zulu]

How do you think that the cost of routine medical care is paid for today?

 

For the ACA it's part of your premium + a host of taxes.

[whj469]

In the fifties we didn't health insurance. We paid $5 for an office visit and that was in the northeast. I

have had people who are my age tell me that a office visit was $3 in rural Texas during that time.

We have to make the decision if we are going to have health insurance for all of us or will we just let people

die if they can't afford to pay. That happens today in the US and we seem to be ok with that.

[Daveh]

WHJ, that is the honest way to frame the discussion and you very very seldom see it framed in that manner. Are we as a society okay with letting a portion of our population suffer and die. I think very few of us would say yes when dealing person on person, neighbor to neighbor, but somehow when we shift the discussion to millions of people we don't actually know then letting them die seems an acceptable option.

 

Kirk, I didn't see your post earlier. One of the problems historically with the US medical system is that the focus is always treatment of the sick or in crisis rather than preventative and maintenance. However, research conclusively shows that money is best spent on health education and preventative care. These type of expenditures reduce overall health expenditures but up until the ACA were never covered by insurance.

 

The ACA attempted to address this by including a requirement that tests and annual physicals be covered and not subject to deductions. With regard to deductions there long has been a very reasonable school of thought, reflected in your comment, that in order to decrease health costs people need to have some skin in the game and hence high deductible and even catastrophic plans are a good thing. However, what we are now seeing is that even with the ACA covering preventative care, people will often not proceed with treatment or further diagnostic efforts due to the high deductibles. Research is showing this defers treatment of many disease conditions, best example is pre- diabetes, which then fully develop and result in expensive and debilitating long term chronic conditions. So from a purely economic perspective everyone may be better off if we cover more rather than less.

[airstream harry]

One of the issues today is we live longer. Many of the treatments today did not happen 20 years ago,people died. Look at how many men are treated for prostrate poblems today compared to 20 years ago. Prevention works,but does it cost more on the back end?

I just do not see any answer but universal health care.

c u on the road

[Kirk W]

One of the issues today is we live longer. Many of the treatments today did not happen 20 years ago,people died.

I do believe that former governor of Colorado attempted to address this in a speech back in 1984 that caused quite a stir. Having traveled that road with my mother a few years back, and being close to a neighbor just this year who made the decision to stop all medical assistance and so pass in 4 days time, there really is a lot of validity to such considerations. I found this quote in an article that I read a couple of years ago.

 

According to one study (Banarto, McClellan, Kagy and Garber, 2004), 30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with 1/3 of that cost occurring in the last month of life.

Why 5% of Patients Create 50% of Health Care Costs

[Daveh]

Those numbers sound about right to me Kirk and it is a really tough issue to handle. The ACA added paid coverage for death counseling with your doctor so that an open discussion could be had of issues related to end of life care before the family is in crisis. That got turned into talk of death panels and you know the rest.

 

Speaking as a nurse we generally would know at least two weeks in advance that a patient is actively dying. To the medical professionals it is very obvious but it really takes time for the family to process. This was especially true when the patient was brought in by a sudden event like a stroke or accident. Doctors and nurses keep their foot on the accelerator unless they are told otherwise. This costs big money. We did our best to be open and bring the family along, but very understandably family want to feel they have both done everything they can and they don't want to let go. I often would struggle with the feeling that I was causing suffering to the patient because the family could not let go. I don't know what to do about the situation. I do know that with nursing being my second career my attitude toward death and dying has changed considerably. Interestingly those dying patients that still had their faculties were much more prepared for the process than the loved ones. Partially, I suppose because they have the advantage of feeling the signals from their own body. Anyway, that is a long way of saying that end of life care is a really really tough issue.

 

The medical goal is for a human life is to live the life span with few chronic conditions or disabilities and then the inevitable and rather quick (months to year) end of life care when body systems start to fail. Envision a long very gradual decline with a sudden drop off. The US is not meeting that goal. We have sedentary life styles, high obesity and diabetes rates, a large uninsured, or inadequately insured, population that does not get proper early medical care and we end up with very many avoidable chronic medical conditions that lead to repeated hospitalizations, significantly reduced quality of life, numerous prescriptions and consequent high medical costs.

 

The other big areas to look at are drug prices and usage of high cost technology. Inevitably you then start to get into very difficult resource allocation questions which force us to look at the cost-reward of providing certain treatments.

 

Just tremendously difficult issues with exceptional moral significance.

[Velos]

Interesting articles Kirk, thanks for posting.

 

Health care, dying and death don't have to be difficult decisions if discussed frequently through out life to establish a comfort level and understanding of the life cycle with family and friends. Faith, Spirituality or Science are all avenues of understanding that can pave the way to a smoother and more productive life process and possibly lessen the volatility of the subject? Over the years in my work a day world I attended several training seminars that suggested " living your life according to your desired epitaph" or "beginning with the end in mind". Both good food for thought.

 

On a recent Dr Oz show they discussed what happens when you die: http://www.doctoroz.com/episode/oz-investigates-final-7-minutes-death-what-does-it-really-feel-die

in hopes of taking the fear out of it by understanding what happens to your body when you die. An interesting comment from the discussion was that people that died and were revived said they either didn't feel pain or don't remember dying but upon waking up felt very differently about life in a positive way and their biggest regret was not what they had done in their life but the many things they had not and lived much differently afterwards.

[Kirk W]

Health care, dying and death don't have to be difficult decisions if discussed frequently through out life to establish a comfort level and understanding of the life cycle with family and friends. Faith, Spirituality or Science are all avenues of understanding that can pave the way to a smoother and more productive life process and possibly lessen the volatility of the subject?

For those who I have helped in the final stages of life, faith seems to be the most helpful for the patient and the family. Religion is a taboo subject on the forums, as is probably a good thing but most of them deal with the end of life better than science for the majority of us. It can be very difficult for family to give the order for medical care to cease for one we care about. That is one of the reasons that having a medical directive is so very important. End of life isn't always a gradual thing and can arrive suddenly, without warning. Most of us do not find it easy to give serious thought to the end of our own life, but we really need to do it.

 

I am at an age that doesn't feel all that old, yet of the 15 students in my HS graduating class, 6 have already passed away. It does cause one to think.

[Blues]

 

Then add in the fact that as health plans began to pay for more and more, we have begun to visit our doctors more and more frequently for more minor issues. The lack of a need to pay the full cost of medical attention causes us to visit our doctors far more frequently than our parents or grandparents did.

 

One of main reasons insurance companies are opting out of the ACA is because the people signing up are much sicker than expected. So if people were truly visiting doctors more, this would not have happened.

 

I read Kirk's statement as people who have insurance see doctors more frequently. It is my understanding that a lot of people who got insurance via ACA didn't have insurance before that, so they weren't among those who Kirk was talking about who see doctors more frequently.

[Kirk W]

I read Kirk's statement as people who have insurance see doctors more frequently. It is my understanding that a lot of people who got insurance via ACA didn't have insurance before that, so they weren't among those who Kirk was talking about who see doctors more frequently.

While that is probably true, it is not quite what I said. My point is that as the patient has to pay a smaller share or no cost at all, studies have shown that people go to the doctor for much more minor issues than do those who pay a small part of that cost and far more than those who pay a larger share.

[Zulu]

While that is probably true, it is not quite what I said. My point is that as the patient has to pay a smaller share or no cost at all, studies have shown that people go to the doctor for much more minor issues than do those who pay a small part of that cost and far more than those who pay a larger share.

What studies?

[Kirk W]

 

This study estimated the impact of a $5 copayment on office visit rates in a health maintenance organization. A quasi-experimental design was used to compare the observed changes in visit rates by state government enrollees between the year before copayments and their first year of copayments with changes between the same time periods for a control group of enrollees without copayments. Visit data for 30,415 state enrollees and 21,633 federal enrollees who were enrolled continuously for at least 12 months before and after the start of copayments were obtained from automated data systems. The introduction of a $5 copayment for office visits resulted in an estimated 10.9% decrease in primary care visits (95% confidence interval (CI): -13.4% to -8.4%) and a 3.3% drop in specialty care visits (95% CI: -15.6% to +9.0%). The effect of copayments on primary care visits by enrollees under 40 years of age was twice as large for females as for males. Copayments also had a significantly greater impact on enrollees who were high users (>ten primary care visits) during the year before copayments. The copayment effect was immediate and did not diminish over the 12-month study period.

© Lippincott-Raven Publishers.

 

New England Journal of Medicine

 

Hitting the Co-Pay Sweet Spot

 

Springer Link

 

The Kaiser Foundation

 

 

If you really are interested, do a Google search as there are dozens of them over quite a number of years.

[Blues]

For those who I have helped in the final stages of life, faith seems to be the most helpful for the patient and the family. Religion is a taboo subject on the forums, as is probably a good thing but most of them deal with the end of life better than science for the majority of us.

 

I'm curious...how did the atheists you helped in the final stages of life handle it differently?

 

 

The introduction of a $5 copayment for office visits resulted in an estimated 10.9% decrease in primary care visits (95% confidence interval (CI): -13.4% to -8.4%) and a 3.3% drop in specialty care visits (95% CI: -15.6% to +9.0%).

 

I find this amazing. And dispiriting. The thought that $5 can sway the actions of someone who is sick enough to need a specialist boggles my mind.

[Pat & Pete]

5 bucks may be nothing to you . But , if you have nothing or that 5 bucks means the next meal for your family ...

[Zulu]

While that is probably true, it is not quite what I said. My point is that as the patient has to pay a smaller share or no cost at all, studies have shown that people go to the doctor for much more minor issues than do those who pay a small part of that cost and far more than those who pay a larger share.

What studies?

 

 

This study estimated the impact of a $5 copayment on office visit rates in a health maintenance organization. A quasi-experimental design was used to compare the observed changes in visit rates by state government enrollees between the year before copayments and their first year of copayments with changes between the same time periods for a control group of enrollees without copayments. Visit data for 30,415 state enrollees and 21,633 federal enrollees who were enrolled continuously for at least 12 months before and after the start of copayments were obtained from automated data systems. The introduction of a $5 copayment for office visits resulted in an estimated 10.9% decrease in primary care visits (95% confidence interval (CI): -13.4% to -8.4%) and a 3.3% drop in specialty care visits (95% CI: -15.6% to +9.0%). The effect of copayments on primary care visits by enrollees under 40 years of age was twice as large for females as for males. Copayments also had a significantly greater impact on enrollees who were high users (>ten primary care visits) during the year before copayments. The copayment effect was immediate and did not diminish over the 12-month study period.

© Lippincott-Raven Publishers.

 

 

New England Journal of Medicine

 

Hitting the Co-Pay Sweet Spot

 

Springer Link

 

The Kaiser Foundation

 

 

If you really are interested, do a Google search as there are dozens of them over quite a number of years.

 

Kirk, I bolded and colored your original statement to make it clear for others.

 

I asked for examples of those studies you mentioned in that statement and you listed several in your response.

 

I read them all and none of them support what you claim.

 

Most of your examples do say something like: "Study after study has shown that the $5 copayment generally does have the expected impact of lowering utilization" (1). That is, even a small co-payment causes people to use less healthcare services (doctors, medicine, hospitals, etc).

 

However, these same studies say "the oft-encountered $5 copay should be applied judiciously—do you really want to reduce utilization of drugs that help those with chronic illnesses manage their conditions? One study, for example, found that copays as low as $12.50 were enough to (inadvertently) deter women from getting needed mammograms" (1).

 

So, yes, paying something (co-pay, deductible, etc) up front means people will use less medical services, but this isn't necessarily a good thing.

 

Finally, there was nothing in any of your examples that said or indicated paying little or nothing leads people to use the healthcare system for "minor issues".

 

 

 

(1) Hitting the Copay Sweet Spot