Anyone out there with the time to answer some questions on the Health Care Reform Bill?

[hedgehog]

I know I can google the info, but I'm short of time and by asking the questions here, more people will see the answers. So here goes:

1. When do provisions go into effect?

2. Is my 25 year old son covered by my company health insurance now?

3. Does the bill address costs of care or try to reduce the cost of care in any way?

4. Hospitals and doctors charge the uninsured up to twice as much as the insured for a given procedure or service. Does the bill address this inequity?

[zipplewrath]

1. A little

1. When do provisions go into effect?

Which ones? Some kick in this fall, like the coverage of children through 26. Others aren't in full force until 2014 such as pre-existing conditions and preventative care.

2. Is my 25 year old son covered by my company health insurance now?

Ask your employer. Ours always covered them through 25.

3. Does the bill address costs of care or try to reduce the cost of care in any way?

"in any way" is a very vague term. Community health care centers could claim to want to do that. The "100% coverage for preventative care" could claim that as well. Generally though, no, there isn't much DIRECT affect on the cost of medical CARE. There are some second and third order things like improving efficiency, lowering payments for medicaid, and the supposed effect of having so many more people covered so that they aren't showing up at emergency rooms uninsured. I think you'll find that most of that isn't going to save the "already insured" any money at all. At best it will slightly slow the unsustainable rate of increase.

4. Hospitals and doctors charge the uninsured up to twice as much as the insured for a given procedure or service. Does the bill address this inequity?

Not that I'm aware of. Of course, all the regulations that this bill authorizes the Feds to write haven't begun to be written so that will be an argument for the future. You may not like the http://thehill.com/blogs/healthwatch/health-reform-implementation/112165-its-official-top-baucus-staffer-now-overseeing-insurance-exchanges-at-hhs-">person who is being suggested to write the regulations though.

[hedgehog]

2. I am convinced that hospital costs amount to little more than a shell game.

I don't think the managers have any idea what it costs them to operate the hospital, and that the emergency room is used as a convenient place to dump costs. That is, it really doesn't cost $2000 for a doctor to check an infant's ears and prescribe an antibiotic, but the hospital has to get the money somewhere.

Until hospitals understand what they are actually doing, there is no way to get their costs down. Ironically, some methods of reducing costs also result in better care. Several studies have shown that when doctors are forced to use checklists for certain routine procedures, the rate of complications such as infections drops considerably.

One measure of how little change there has been in how hospitals are operated: the television series ER ran for 20 years as a dramatization of a typical busy big city ER. Fashions and actors aside, there is no real difference between the first and the last episodes. Nothing, from basic patient triage to the education of doctors changed in that time.

[zipplewrath]

4. True of any business

What you are describing is often called "what the customer will bear". For the vast majority of products you purchase, the price has little connection to the cost of manufacture. Everything from clothes to i-pods is based upon "price points" that have little to do with the cost involved in making and getting them to the market. To a degree that we don't want to admit, medical care is no different. They make the money where they can, they have effectively "loss leaders", and they funnel patients towards "products" that can increase revenues.

I've spoken to more than one dentist that considers the bi-annual cleaning a "loss leader". It is there predominately to create a customer base for more expensive dental work. The facility where my wife goes for the annual mammogram suddenly began "recommending" an additional MRI scan, after they purchased an MRI machine. In sales they call that the "up sale". The $2000 emergency room visit is effectively a "because they can" charge. It is "what the customer will bear".

Because of my new insurance set up, I get to see what the providers actually get paid by the insurance company (because often I pay the whole bill). It is a bit shocking in the sense that it is easily 40 - 60% of what they charge "retail". Furthermore, some charges are completely skipped altogether (lab tests and the like). Retail, they bill for all this stuff and that's how they get to things like $2000.

We'll get to single payer because we have to get the vast majority of the profit motive out of health CARE, not just insurance. When I'm in Europe, and have to see a doctor, I often don't pay anything. It isn't because it is free, it is because the provider and his compensation is completely disconnected with whether I pay or not. He get's paid, period. They often go through the motions of trying to collect payment, but they really have no method to collect "retail" so they take down all my information and tell me they'll send me a bill. They never do. They never do because they have no incentive to do so and also no incentive to deny me care. The government that ultimately is paying the cost would come to collect, except the cost is so trivial to them they don't even bother. There basically is no profit motive for anyone in the system, and the "payer" is incetivized (politically) merely to deliver the best care they can afford. We'll get there too, I'm just afraid it will be the GOP that brings it to us.

[BzaDem]

3. Here

1. Most provisions (such as the exchanges, subsidies for the exchanges, ban on considering pre-existing conditions) goes into effectd 2014. Other select provisions (high risk pools, covering children, Medical loss ratios) go into effect earlier.

2. If your insurance plan covered dependents, it should now cover them until age 26 (starting September 23, 2010).

3. Yes. Medical loss ratios limit profits to insurance companies, which requires more premiums be spent on care (which reduces out of pocket expenses/etc.) There are various pilot projects to try to reduce costs in the bill, and the results of these will dictate whether the HHS continues them or expands them. These include things like paying for outcomes instead of the current fee-for-service model in Medicare. Often, private insurance uses Medicare reimbursement rates/procedures as a baseline.

For more detailed information on cost controls, go here: http://voices.washingtonpost.com/ezra-klein/2010/03/the_five_most_promising_cost_c.html

4. While the bill doesn't place direct price controls on hospitals, increasing the number of insured will reduce uncompensated care (and therefore reduce the reason why this inequity exists).

[hedgehog]

5. I'm waiting for hospitals to figure out that they are taking in less

money because insured people pay less for the same services.