Inkwell: Authors and Artists
descend into a fractal hell of meta-truthiness (jmcarlin) Fri 10 Jan 14 16:46
The comparison to car buying sets a low bar at least for many I know. If more than a small minority read Consumer Reports reviews (for example) incuding expected repair rates, get Consumer Reports (or other) real cost information to bargain with and so forth, I'd be very surprised. And health care is seriously more complex.
Morgan Rowe-Morris (rowemorris) Fri 10 Jan 14 16:59
And, at least at the low end of the consumption spectrum, it is seriously hard to make smart decisions when you are scared and in pain.
Joe Flower (bbear) Fri 10 Jan 14 17:26
> it is seriously hard to make smart decisions when you are scared and in pain First: Everyone goes there, imagining that the moment you are making these decisions is when you're being scraped off the highway or have a fever of 106. No, for emergencies you're making these decisions ahead of time about what your insurance will cover will you take the chance of a huge expense if you go to an out-of-network ED? For the fever, you are making the decision what kind of system to sign up with, what kind of after-hours primary care support they have, does your insurance cover urgent care centers, and so on.
Joe Flower (bbear) Fri 10 Jan 14 17:31
> If more than a small minority read Consumer Reports reviews... If I mention to you a Ford F-150, a Mercedes 500, and a Kia Sport, would you have any difficulty identifying the pickup truck, or the luxury sedan? We are saturated with such knowledge. And people regularly look at TripAdviser to see what other people thought about a hotel or restaurant. That level of information is all we need, and we will be getting it from lots of sources, crowd-sourced and supplied through our insurance. And many types of insurance will make it seriously advantageous to find out: This high-quality place to get your MRI will cost you no co-pay, this equally high-quality place will cost you a $1200 co-pay. Given such incentives, people will quickly learn how to look it up.
descend into a fractal hell of meta-truthiness (jmcarlin) Fri 10 Jan 14 22:49
Well, I know the difference between the local community hospital which is understaffed, overworked and deals with the uninsured (at least until recently) versus the high quality nearby hospital. But my complaint was at one level deeper. If you asked me which hospital in the surrounding 50 miles is better when dealing with cardiac surgery, I would have no idea and have a hard time finding out. You need to be stronly motivated and most aren't. I'm not saying that knowing the price is not very helpful because it is. An example happened recently with a good friend of mine who was concerned about general anaesthesia caused cognitive disturbance/dementia because she's not 100% mentally sharp any longer. She was strongly motivated to look around and find a doctor and hospital that would do some surgery not under general. Cost was utterly not a concern in her case.
Mark McDonough (mcdee) Sat 11 Jan 14 07:25
The whole idea that our bacon will be saved by people becoming highly discriminating health care shoppers is a fantasy. But it will keep everyone looking in the wrong direction for a while so that the health insurers and the drug companies can continue making billions at our expense.
descend into a fractal hell of meta-truthiness (jmcarlin) Sun 12 Jan 14 16:39
There does seems to be a freight train on the tracks and rolling at high speed. Here's another example of switching away from fee-for-service: Maryland's Bold Hospital Spending Plan Gets Feds' Blessing Maryland officials have reached what analysts say is an unprecedented deal to limit medical spending and abandon decades of expensively paying hospitals for each extra procedure they perform. If the plan works, Maryland hospitals will be financially rewarded for keeping people out of the hospital -- a once unimaginable arrangement. "This is without any question the boldest proposal in the U.S. in the last half century to grab the problem of cost growth by the horns," said Uwe Reinhardt, a healthcare economist at Princeton University. After months of negotiations with state and the federal officials, the hospitals also agreed that their revenue from all sources -- private insurance, government, and employers -- will rise no faster than growth in the overall state economy. ... http://www.medpagetoday.com/Washington-Watch/Reform/43749
Joe Flower (bbear) Fri 24 Jan 14 11:33
Thanks for that article, Jerry. I have been following Maryland for some time. It is one of those states, like Vermont and Hawaii, that seem to be able and willing to try new methods of reform. Sorry for dropping out of the conversation for a while. In the last two weeks I have been speaking and advocating for serious change in the industry at conferences in Orlando (a software company's clients), Fresno CA (a local hospital group), Copper Mountain Colorado (an insurance company and its top brokers), and Miami (a national hospice and palliative care group). Next week I head to San Diego to speak before some more insurance folks. Then I finally have a few weeks for writing before the next foray.
Joe Flower (bbear) Fri 24 Jan 14 11:51
> The whole idea that our bacon will be saved by people becoming highly discriminating health care shoppers is a fantasy. This is obviously the big question. But there are several good reasons for optimism. 1) All the new customers brought in through the exchanges pay some of the cost themselves. Even if their premiums are 100% covered, the "Bronze" participants pay 40% of the cost, the "Silver" pay 30%. So any time that they have a choice (that is, they are not unconscious or otherwise unable to choose), that their are places to choose among, and they can find out about them, they will be in serious shopping mode. 2) Increasingly, employers are changing their health plans to similar "participation" plans. These are obviously unwelcome to the employees, but there is little doubt that they do change the behavior of the employees and make them vigorous shoppers. 3) Health plans, the government, and employers are all getting vigorous about supplying the information that people need to make "shopping" choices and the variations in price are so huge that no one can afford to ignore them. 4) Employers are doing a lot of "shopping" themselves, through direct contracts with major, high-quality providers at lower than the median price; through reference pricing, which effectively cuts the high-end price outliers out of the market; though "cost+" contracts; through local buyers groups; through bill auditing it's a full-court press. Most of these are things that a small minority of employers have tried in the past few years, but a big majority say they are going to try this year. It's going to have a huge effect on the market.
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