Interesting sidebar to this discussion. My son just had his cat neutered. They provided him with a bill that showed the charge would have been $814.50 except that he had bought some sort of care package (insurance?) that costs $20/month, and so the charge is zero. This is almost exactly parallel to the health insurance charges we have been discussing. Anyone know if $814.50 is reasonable for a cat neutering, or are these charges inflated, presumably to make my son's purchase of the cathealth plan more reasonable? Is it obscene that some people (presumably) pay $814.50 and others pay zero?

(09-24-2009 05:25 PM)OptimisticOwl Wrote:  Interesting sidebar to this discussion. My son just had his cat neutered. They provided him with a bill that showed the charge would have been $814.50 except that he had bought some sort of care package (insurance?) that costs $20/month, and so the charge is zero. This is almost exactly parallel to the health insurance charges we have been discussing. Anyone know if $814.50 is reasonable for a cat neutering, or are these charges inflated, presumably to make my son's purchase of the cathealth plan more reasonable? Is it obscene that some people (presumably) pay $814.50 and others pay zero?

That seems very high. I had my dog spayed about a year and a half ago and the standard fee was $80 and if I elected to let the vet use his new laser knife, it would be $120 but the healing would be quicker and no stitches would be used and the need for that head thingy would be uneccesary. I went for the laser but thought that would never fly in the human world. Suboptimal care for less money. You would think that the vet would not want to increase the potential for adverse outcomes with an antiquated method. Why not charge a nominal increase in the global fee and use the laser everytime instead of a greater mark up for select cases? It probably is a case of those who could afford it got the better care and paid a higher price. In the prepaid example above, that is the same principle as an HMO, with capitated payments, versus fee for service. A guaranteed income for routine care.

OO and COL,

Something lost in RU's explanation is that the "RACK" rate is merely a tool for maximizing the negotiated rate. Unless they're suing you or filing their taxes and claiming a loss... it doesn't sound like ANYONE pays the full fare.

As to the solution... and using Wikipedia for general figures... I'm not ready to do the research...

It seems to me that we are currently paying $6700 PER CAPITA (not per insured) for insurance with our taxes covering about 45% of that... so... we should be able to buy a $6700 policy for 45% of our population JUST with what we are spending now... that is federal dollars only... no private money and I don't think it applies to state and local funds... but even if it does, the math is still striking.

If you go online, $6700/year PER PERSON buys a pretty darn good policy. Most FAMILIES under most corporate policies pay about $12,000 for a full blown policy and more like 6 or 7k for an HMO type policy.... which, let's face it... is what Medicaid (or "the Public Option") is... and not a very good HMO at that.

So... take the $6700 * 0.45 (the public portion) and divide it by the entire population... thats just over $3,000 per person... and then exclude the top wage earners down to say 75% and we're at $4,000 per person... (again, not per family, but per person)

GENERALLY speaking, individual policies are priced similarly to corporate policies, but they have restrictions for PECs... while corporate policies don't because they (by definition) can spread the risk. I'm betting that INCLUDING covering PECs... we could offer a variety of VERY good HMO policies to 75% of the population for our $4,000. The top 25% of wage earners are generally already paying for their plan (remember, this $4,000 pp is ONLY the 45% of healthcare expense that the government already pays... There's another 55% being paid by individuals)

My suggestion... Insurance comanies are already processing payments, administering policies, negotiating with doctors... Dismantle the government's replication of what the private sector is already doing well (administering contracts) and direct those administrative expenses to oversight of the insurers. For all the complaints of insurers... I don't see "failure to process the paperwork or negotiate with hospitals/doctors" as being a big one.

The government would be charged with investigating consumer complaints, with the ultimate power to not only fine/prosecute the companies, but to kick them out of the pool of providers costing them the ability to spread their risks if they aren't being fair... this is, afterall, public money.

People could even be able to select a variety of plans from a basic HMO plan with no out of pocket expenses to a preferred PPO plan with deductibles and co-pays just like corporate America for their $4,000... or purchase supplimental policies if they chose to.... The ability to further spread the risk would be a huge carrot to the insurers, and the risk of losing access to the pool of customers would be an incentive to "fly straight".

My numbers are probably WAY off... but the idea of taking an inherently cost-prohibitive task such as contract administration away from one entity (the government) and giving it to an entity(s) already doing it (insurers) while greatly increasing the oversight compnent by a body SUPPOSEDLY designed for such a task (the government) seems to make too much sense.

I'd REALLY like for someone in the industry to run those numbers and tell me how far we could stretch the money we're already paying.

NOT a single payor system, but a single payor BASE system with the ability to pay more if you want more... for doctors to charge more if thety are worth it... and for consumers to have a choice...

Go to the Nurse Practitioner/PA for free.... Pay $50 copay to see a "generic" Doctor... or pay $150 to see Dr. RUOWLS.... with the government paying $250 in every case.

Sounds OK to me. Wish I could crunch the numbers for you, but that is beyond my area(s) of competency.

If you ever want to run for state or national office, you can count on a maximum contribution from me plus probably some volunteer work. I like the way you come up with ideas, and I don't care if the letter behind your name is R, D, I or L. Plus you have those great advisors, RUowls and RiceDoc.