patrick.net

Don't despair, here's your new medical team:

Can they legally reject it?

The article says they'll give patients a 20% discount off their prices, but they're not going to bill BlueCross/BlueShield for services, even though they used to apparently.

Pretty bizarre. They're saying BCBS doesn't pay enough to cover their costs, but that's not something the article actually ran down to verify, naturally.

Related (some very good points in there):

http://patrick.net/?p=1239856

FortWayne says

Can they legally reject it?

Of course. Doctors and insurers negotiate payment rates for network inclusion. If they don't agree, then the doctor is out of network and might not accept the insurance at all. Even if doctors accept one policy from a particular insurer, they can generally refuse to accept other policies from the same insurer. We've had several threads (for example this one) reporting medical practices that rejected Obamacare policies, even where they accepted other policies from the same insurance companies.

(from the linked article)

>>But adding patients may not be an attractive incentive for many doctors in the Valley who already are busy and would have to shorten patient visit times to accommodate more.

Aha. So that is the rub. The doctors simply have enough patients that pay more than ACA patients, so they refuse to accept new ACA patients.

Those who thought that it was only the health insurance companies that were bad will now find out that the doctor grpups, and a majoority of the doctors in them, are just as bad as the insurance companies.

justme says

(from the linked article)

>>But adding patients may not be an attractive incentive for many doctors in the Valley who already are busy and would have to shorten patient visit times to accommodate more.

Aha. So that is the rub. The doctors simply have enough patients that pay more than ACA patients, so they refuse to accept new ACA patients.

Those who thought that it was only the health insurance companies that were bad will now find out that the doctor grpups, and a majoority of the doctors in them, are just as bad as the insurance companies.

A doctors office is a business. They can do business with whatever insurance carrier they want to. If a carrier doesn't pay enough then there's no reason to do business with them. There's nothing good or bad involved. People are free to sign up for Kaiser or any of the employed docs carriers if they want to be assured of which doctors are available. More and more docs are ditching insurance all together and going cash only, the patient pays cash then files the insurance claims themselves.

If you don't like this then you should be lobbying for a single payer system with an employed doctors model.

bob2356 says

If you don't like this then you should be lobbying for a single payer system with an employed doctors model.

Those are hardly the only two options, Obamacare or "single payer system with an employed doctors model" (which sounds more like NHS than single payer anyway). The equivalent of NAFTA for doctors and hospitals, and repealing the Rx requirement, would achieve greater cost reductions more simply.

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_%28PPP%29_per_capita

Plenty of other countries spend 20% (or less) of what Americans spend (i.e., an 80% cost reduction), for similar benefits. (Sorry for using a Wikipedia link, but Health Affairs reported similar numbers years ago, if anyone wants to spend the time there is probably an updated version of their report.)

bob2356 says

If you don't like this then you should be lobbying for a single payer system with an employed doctors model.

For the record: I am! :-)

curious2 says

Those are hardly the only two options, Obamacare or "single payer system with an employed doctors model" (which sounds more like NHS than single payer anyway). The equivalent of NAFTA for doctors and hospitals, and repealing the Rx requirement, would achieve greater cost reductions more simply.

As usual you can't read. I never said those were the "only" two options. Your ideas are both stupid and totally impractical. Opening up the VA system (also expanding it) to the general public and selling coverage at operating cost would be the fastest and most practical way of bringing down health care costs especially for people buying their own insurance. Never going to happen, the hospital lobby would go insane. The same reason no other true cost saving is going to happen.

There are very few countries spending less than 3.4% (17%*.2) of gdp on health care, most are places no one would want to go all much less for health care. I don't give any credence to the PPP index. It is a totally flawed measurement.

bob2356 says

As usual you can't read. I never said those were the "only" two options. Your ideas are both stupid and totally impractical.

Seriously, Bob, get tested for toxoplasmosis. I don't say that to insult you. I just worry about everyone else on the road (including your family) when you're barreling along at 90mph in a rented Toyota that you've never even driven before. At least since Mrs. Bob can't get malpractice insurance anymore your exile keeps you out of your Mustang, which might be part of what makes you so angry but also might be what's kept you alive. T.Gondii may cause half of all car wrecks, including many fatalities.

As for what you said, you said that if "justme" doesn't like Obamacare then lobby "for a single payer system with an employed doctors model." You seem to be conflating two different models, but you presented them together as the alternative to Obamacare.

My ideas are based on the experience of many countries, including one just across the border, Mexico. Many Americans visit Mexico, and healthcare is a main reason why they want to go there. If you don't believe in PPP, then use the market exchange rate; Mexico has plenty of cash exchange places, and you can even use American credit cards and debit cards. I have personally observed prices 90% lower in Mexico than here, using market exchange rates.

It would be like this:
You have a service you charge $100 for. If you're feeling nice or there's a reason, you're willing to knock that down to $75. Joe comes in and uses your service. Then he leaves and his insurance pays you $35. You never agreed to that large a cut, so you stop doing business with Joe's insurance company. Since you're not legally allowed to charge Joe for the remainder of your bill, you must eat the difference, so you stop allowing Joe to use your service while using his insurance.
But wait, you say. $35 is not so bad! Why so greedy? Well, if you can see 4 patients an hour, that's $140/ hour, wow! That seems like a lot! But you must pay a receptionist and a insurance filer, plus rent office space, pay for medical equipment, and a hefty student loan. Each office worker (with employee costs) costs you $20/hour, the equipment costs $5/hour, and you must pay $140/day rent, or (140/8= $15/hour), so that's $140-$40=$100/hour. Now you count malpractice insurance ($5/hour), student loans($5/hour), miscellaneous business expenses and accounting ($10/hour) and you're at $80/hour! That's not so much, especially when you have bills of your own to pay. A 2000 hour/year job becomes a $160,000 job. That's not great for being a doctor.

Quigley says

Since you're not legally allowed to charge Joe for the remainder of your bill....

Really? Obamacare providers say the opposite, i.e. if the insurance doesn't pay the full bill, providers can pursue patients for the balance. That is called "balance billing." Usually the patient registration form contains a paragraph in which the signer consents to it. Try crossing it out. The purpose of the legislation is to maximize spending, which the recipients perceive as revenue. The mandatory premium gets you in the front door, but in general they can try to get you to pay more later too. BTW, balance billing isn't new; what's changed is that the insurance system is mandatory now.

Doctors are as bad as any worker in any field.
Who would work twice as hard for the same money?

justme says

Those who thought that it was only the health insurance companies that were bad will now find out that the doctor grpups, and a majoority of the doctors in them, are just as bad as the insurance companies.

Love Japan! Are you moving to Tokyo area? Do you speak Japanese? Can you really get decent insurance there as a foreigner?

Bellingham Bill says

Guess it's off to Japan for me. At least I can get affordable health care there.

Obamacare was intended to fail and default to a single-payer system. Then, if the single-payer system has any sense, they'll cut out the insurance companies and hospital groups for reimbursement.
Plus, make the drug companies bid their products for acceptance.
This will drop the cost of healthcare for everyone by 80% and make it a non-issue once again.

Indiana Jones says

Are you moving to Tokyo area? Do you speak Japanese?

I lived in Tokyo 1992-2000 and it's a much better place for foreigners to live now apparently (Costco stores have arrived at least).

Can you really get decent insurance there as a foreigner?

Depends on the job you have. Self-employed on a work or spouse visa pay into the gov't insurance system while if you're with a Japanese corporation it's a different insurance system.

Prices are rock-bottom there (well, compared to the US at least, globally they're middle of the road) but you'll generally need insurance coverage or cash up-front to be treated.

The insurance system works a lot like Medicare I guess, you get billed for 20-30% of the cost, and that's subject to monthly limits to reduce the overall hit to your savings.

Insurance premiums are relative to annual income, and are around $3,000 a year. A bit less if you make peanuts, and a bit more if you're doing well.

Apparently they've loosened up their new points system so it's not impossible to self-sponsor a residence/work visa now.

http://www.asianewsnet.net/Japan-to-ease-visa-criteria-for-highly-skilled-for-52469.html

That is a long stint in Japan! Your Japanese must be pretty good. 14 years later, besides healthcare, what do you see as the advantage of moving there? I hear they have some of the same economic issues as U.S. And it is a pretty homogenous culture, difficult for the gaijin to assimilate.

Bellingham Bill says

I lived in Tokyo 1992-2000 and it's a much better place for foreigners to live now apparently (Costco stores have arrived at least).

Indiana Jones says

14 years later, besides healthcare, what do you see as the advantage of moving there?

I think their declining population will be a good thing for them, not a bad thing, putting downward pressure on rents and land values -- they say in 10-20 years one out of four homes will be abandoned (!).

http://research.stlouisfed.org/fred2/series/LFWA64TTJPM647S

Free land! The US gave away all the good land 100+ years ago . . .

I hear they have some of the same economic issues as U.S.

Nah, their problems are exactly opposite our problems. Going by accumulated trade surplus, they're sitting on $2-3T worth of savings held in global equity and bonds, while the US is $4T+ in the hole in this department. They're the largest net creditor and we're the largest debtor.

http://www.bea.gov/newsreleases/international/intinv/intinvnewsrelease.htm

While their trade deficit has exploded recently, if & when they can get their nuke fleet restarted they'll be able to cut back on the fuel imports that are killing them.

They are an aging society, but not because they have a flood of old people coming. Actually, their postwar baby boom was very sharp and short, and they've mostly arrived into their mid-60s already, while the US baby boom was IMMENSE -- 80M, aged 50-68 currently, plus tons of immigrants in the 1980s and 90s, meaning our retirement-age population is going to keep expanding right through 2037 (the year as a Gen-Xer I near retirement, natch)

this graph scares the crap out of me! The blue is working-age, growing 50M, meaning we need 35M jobs or more by 2060, in addition to the 12M our economy is currently not providing people who would want to work. Red is seniors, showing the retirement wave that's going to hit us. Plus on top of it we have an ever-increasing burden of school-age kids this century. This is great from a healthcare and education employment perspective -- tons of jobs, but taxes are going to have to go up a lot to pay for all of this -- or we'll just print to pay for it all, which I think is the only solution our broken system is capable of doing now.

And it is a pretty homogenous culture, difficult for the gaijin to assimilate.

yeah, if you can't at least tolerate the japanese culture, you're going to have a bad time.

I had a good time there as a 20yo, not sure how being an old fart will compare. Tokyo getting the 2020 Olympics is actually a life-changing thing for me I think. Not that I will get an Olympics-job, but it's going to really push Japan's outlook outwards a lot more, putting them on their "best behavior" maybe.

I'm also interested in moving to Germany or the nordic states, they seem to be doing pretty good too, but the language thing is a lot tougher, even though getting by in English is pretty easy I gather.

Or maybe I'll just buy a boat and sell up and sail . . . I think Japan Inc is going to have a tough row to hoe vs. China, and life there isn't all that great compared to e.g. coastal California or some mountain shack 30 minutes out of Santa Cruz, Medford, Bellingham, or Boulder (all these places have Trader Joes, LOL).

carrieon says

Obamacare was intended to fail and default to a single-payer system

And anyone who thought differently ... basically wasn't thinking.

carrieon says

Then, if the single-payer system has any sense, they'll cut out the insurance
companies and hospital groups for reimbursement.
Plus, make the drug
companies bid their products for acceptance.
This will drop the cost of
healthcare for everyone by 80% and make it a non-issue once again.

You must live in Colorado and have been smoking that strange smelling stuff. Sorry, I'm not for higher taxes and waiting and waiting and waiting in line to see my doctor.