Depends. They typically end up consolidated in an Mdl then a number of bellwether trials take place and their outcome often determines the ultimate outcome. Settlements brokered. Cases abandoned etc
The Chosen One’s demand to drop interest rates
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Depends on all of those same factors. There are a lot of expenses and people and outfits with their hands in the jar. And don’t forget benefit managers. Literally some of the biggest companies in the country.
I’ll bite. And if I’m wrong link me the other thread or a starting point. Or a topic to search. Stop leading me on. I’m tired.
Hospital Price Transparency Enforcement Updates | CMS
CMS is committed to ensuring that consumers have the information they need to make fully informed decisions regarding their health care. CMS expects hospitals to comply with hospital price transparency requirements and is enforcing these rules to ensure that people are easily able to learn what...
Reading this link and knowing jack shit beyond my time interacting with the industry as a cog in the wheel (insurance adjuster…..shudder) I’d imagine bullet three regarding the requirement a hospital publish their negotiated prices with third party payers means exactly what it says.
So it’s hospital corporations and the payers (insurance and government programs) setting the prices through negotiation?
Thank you.
And that is definitely another part of the problem. Third parties and the way our system is designed complicates things. No doubt about it.
But our system has ran relatively well for 60 years. There is a design flaw inherited into our system. With few exceptions (none that I'm aware of) do things ever get cheaper. Why is that? And that question is something that everyone should be asking themselves, and another clue that healthcare has never been a market.
In your case, Murt, you have been so close and so in depth, that the answer is more broad than you were expecting. There is a basis to the prices in healthcare.
I never said governments can’t provide healthcare. It’s just not going to be as efficient and cost more than if it was left to the free market.
I assume the last 60 years was somewhat of a throw away comment, but it does line up with when we went off the gold standard (54 years ago). Which is 100% the main driver for costs far outpacing CPI (which is a shit manufactured number that is nowhere near the actual inflation rate).
Also, without looking I assume the 2nd largest has been demographics. It’s a lot easier to provide healthcare when people don’t use it. The average age in the U.S. in 1975 was 28 and life expectancy was 71. The average age now is 38 and life expectancy is around 78.
The cost of healthcare is only going to continue to get worse as the demographics trend in the wrong direction for the next 20 years and the government adds more regulations/programs, like Obamacare, which hasn’t helped with the cost.
Edit: The U.S. increasing obesity epidemic has also driven costs, which is why I think semaglutides will help cut costs. I read 1/8 adults have used them. I am short all alcohol and junk foods.
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Above is my original claim.
Edit: This was a quick, off the cuff comment, that is true. If you dig deep enough you'll come to same conclusion. There's more discussion and appropriate links inside of this thread.
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Thank you for your interest. I'm purposely leading people on so that they might get to the heart of the matter themselves. Because of hang ups over other political beliefs, or other posts, some people tune specific people out. I found this stuff out by searching on my own and continuously asking, why?I’ll bite. And if I’m wrong link me the other thread or a starting point. Or a topic to search. Stop leading me on. I’m tired.
Hospital Price Transparency Enforcement Updates | CMS
CMS is committed to ensuring that consumers have the information they need to make fully informed decisions regarding their health care. CMS expects hospitals to comply with hospital price transparency requirements and is enforcing these rules to ensure that people are easily able to learn what...www.cms.gov
Reading this link and knowing jack shit beyond my time interacting with the industry as a cog in the wheel (insurance adjuster…..shudder) I’d imagine bullet three regarding the requirement a hospital publish their negotiated prices with third party payers means exactly what it says.
So it’s hospital corporations and the payers (insurance and government programs) setting the prices through negotiation?
Thank you.
I've never heard anyone in the media, or in politics address what's really going on in healthcare. Some time ago someone on this board made the claim that healthcare costs couldn't be reduced because people in the industry would go broke. Knowing that healthcare costs had risen in terms of percent of gdp, I asked, why? And that got the ball rolling.
Here is a starter link. It sums up the basics of how services in the healthcare industry are priced.
The Medicare Physician Fee Schedule: Overview, Influence on Healthcare Spending, and Policy Options to Fix the Current Payment System
The Medicare Physician Fee Schedule (MPFS) determines how much healthcare providers are reimbursed for the services they provide to Medicare beneficiaries, and it has considerable influence on healthcare spending in the United States.
How many? A LOT of people will believe that.
Trump will blame inflation on interest rates/Powell, Fox commentators will echo that sentiment, people that watch Fox 10 hours a day will believe it. Guaranteed .
You think that’s far-fetched? Many of the same people were brainwashed that Antifa was responsible for 1/6, believed that Dominion voting machines cheated Trump (and many of them don’t realize Fox paid Dominion almost a billion to settle) and they will soon believe Trump should be able to run for a third term because Fox will trot out “scholar” after “scholar”, and commentators, that will tell them a third term is what the founding fathers wanted.
Ok, but that is only one payor (yes, by far the largest). That doesn’t change the fact that providers set their own prices. Stipulations for what is payable (or owed) by Medicare to providers does not equate to gross billings.
There are so many factors but among them are, Medicare is a notoriously slow and difficult payor compared to private payors. Not only that but certain jurisdictions have different payment speeds and requirements to obtain reimbursement for the same code.
There’s a reason a lot of providers don’t want to accept Medicare without supplemental coverage.
All that said, administrative costs among providers are a huge problem, much like with post-secondary education. Too much is spent on those who aren’t delivering care.
The Medicare Physician Fee Schedule: Overview, Influence on Healthcare Spending, and Policy Options to Fix the Current Payment System
The Medicare Physician Fee Schedule (MPFS) determines how much healthcare providers are reimbursed for the services they provide to Medicare beneficiaries, and it has considerable influence on healthcare spending in the United States.
They are tied together. A chart is linked in the other thread. Inside the Medicare bill of 1965, physicians were allowed a reasonable increase every year. Private insurance was allowed the same, but slightly higher. That's why both have a compounding interest curve. Read the link. Find other links on your own.
Medicare has been compounding at a rate of about cpi+1...private cpi +1.25. Medical equipment and supplies follow suit. The reason private is subsidizing medicare is because these two lines are diverging. And medical equipment is priced supposing a certain percentage of private vs public reimbursements.
Edit: Quick note: It's a complicated process as there are thousands of items priced and each item has it's own code and price inside the FFS. The AMA/RUC basically controls the recommendations and the CMS accepts them 90% of the time.
Inside of all this is that the specialties that control the RUC control the adjustments of the FFS. PCP's have never been represented. That is why their pay is lagging behind. I've posted articles in the past.
Good night, y'all.
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The Medicare Physician Fee Schedule: Overview, Influence on Healthcare Spending, and Policy Options to Fix the Current Payment System
The Medicare Physician Fee Schedule (MPFS) determines how much healthcare providers are reimbursed for the services they provide to Medicare beneficiaries, and it has considerable influence on healthcare spending in the United States.www.mercatus.org
They are tied together. A chart is linked in the other thread. Inside the Medicare bill of 1965, physicians were allowed a reasonable increase every year. Private insurance was allowed the same, but slightly higher. That's why both have a compounding interest curve. Read the link. Find other links on your own.
Medicare has been compounding at a rate of about cpi+1...private cpi +1.25. Medical equipment and supplies follow suit. The reason private is subsidizing medicare is because these two lines are diverging. And medical equipment is priced supposing a certain percentage of private vs public reimbursements.
Edit: Quick note: It's a complicated process as there are thousands of items priced and each item has it's own code and price inside the FFS. The AMA/RUC basically controls the recommendations and the CMS accepts them 90% of the time.
Inside of all this is that the specialties that control the RUC control the adjustments of the FFS. PCP's have never been represented. That is why their pay is lagging behind. I've posted articles in the past.
Good night, y'all.
But again, you are assuming a reimbursement schedule dictates pricing. I’m arguing there is a distinction between reimbursement (net payments by CMS) and pricing (gross billings by a provider).
Medicare and Medicaid are often the lowest payor. Third party insurance (commercial) tends to reimburse providers at higher rates, which is part of the reason they are preferred. Either way, providers are not simply going to submit pricing at reimbursement levels. It’s set materially higher so that it ensures procedures receive maximum reimbursement based on payor.
In other words, if a CPT code on CMS rate schedule is 5,000, but UHG reimburses 7,500, the provider needs to bill that to both at 10,000 and will know their expected net payment (reimbursement). Why? Because another payor could be over 7,500 and/or consumer co-pays could allow for a reimbursement above UHG’s rate.
National health expenditure total U.S 2032 forecast | Statista
This statistic shows a forecast of the U.S.
www.statista.com
The raw data: download- National Health Expenditures by type of service and source of funds, CY 1960-2023 (ZIP)
Health Care Costs: What’s the Problem?
What costs are too high, and can they be controlled through policy while improving access to care and the health of the population?
"no single sector’s health care cost — doctors, hospitals, equipment, or any other sector — has increased disproportionately enough over time to be the single cause of high costs."
Quick summation... Every year since 1965 the RUC(rook) has asked the CMS for adjustments to the FFS schedule(individuallyon thousands of codes which form the aggregate). By law they are allowed a reasonable increase in reimbursements. That has equated to a cpi(cola) +1% increase every year.
Then private insurers negotiate with providers to change the FFS on the same codes. The basis(start of the negotiation) is the Medicare FFS on each code. This ends up being cpi +1.25. All of this in the aggregate.
I've read hundreds of articles and have looked over thousands of charts. Please, everyone, go figure this out on your own. But if you don't have time, just ask yourself a few questions and back test this proposal.
I have provided charts and the raw data. It is clear that everything in healthcare is on a compounding interest curve. If I ask, "what is the Dow going to be in 10 years?" You don't have a clue. If I ask, "What is the price of copper going to be in ten years?" You don't have a clue. But go back and look at the predictions of healthcare expenditures from 2000, 2010, 2020. How do they always get it right? 2030 is in the link above. They don't have that one wrong either.
What market(read graph) outside of healthcare can you show me, that's always on a continuous compounding interest curve? You can’t. So, ask yourself, what is in the healthcare "doctors bag" that can justify this increase in prices. How much has the: plastic, rubber, titanium, cotton ball market increased over the last 60 years. There isn’t. The compounding increase in prices are baked in. And everyone has their hand in the cookie jar.
Total revenue UnitedHealth Group 2023 | Statista
This statistic shows the total revenue of UnitedHealth Group from 2007 to 2023.
www.statista.com
I address this above. Look at the charts. The reimbursement rates for private are based on public. And year over year the problem is getting worse. That's because private reimbursements are increasing at an increasing rate relative to public.
There is no argument against that. Look at the chart. Read the raw data.
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Always used units sold as a key metric when looking at our P&L.
Helps sort out the inflation/deflationary data.
Also net earnings per employee.
I've been retired 10 years in June.
You haven't found a nugget..
Find a chart for the cost of an MRI machine, or hip replacement, and post it.
Edit: or the cost to set a broken arm from 1960 to today. Or the cost of the cast from 1960 to today.
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To be clear, what you stated is accurate. What your statement doesn't explain is why the problem is getting progressively worse.
The cost of CMS rubber stamping increases in the FFS has added 2.614 trillion dollars to the deficit over the past 10 years. That’s Medicare alone. If I have time I'll try to add up the additional costs(ultimately a tax) to the private sector. And what the cost of inaction will be for both.
Everyone bitches about the debt. I'm offering a solution. I found an inefficiency.
Everyone: "Entitlements are too high." "We have to slow entitlement growth."
Me: Why don't we slow the growth rate that healthcare providers charge for every single service. There aren’t any expenses that justify it's rate of growth. It's been set on auto pilot and has guaranteed a rate of growth above cpi in perpetuity. If we don't bend the cost curve we know that it will lead to insolvency. It's already added trillions of dollars to our debt.
Everyone: Nah. That's not it. We'll just keep bitching until we're broke.
Yo add to jdb I’m skeptical of the data and the thesis. Having reviewed thousands of cases maybe 1/15 or 20 had Medicare. And the Medicare reimbursement rate was peanuts compared to every carrier. It was a step above treating at a military base
What has been the increase in Medicare reimbursement rates over the past 60 years. Forget about private rates for a moment.
What expense/product/commodity under the sun could possibly justify that increase in prices over the past 60 years? Compare it to anything, CPI, GDP, titanium prices, whatever you'd like?
Edit: If calculated like healthcare, the price of corn would be $9 today. It was $1.13 in 1960. But that’s not the biggest issue. The biggest issue is that-in 10 years- I know the price of corn is going to be $12.50. And I knew 10 years ago it would be $9 today.
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Illinois requires this for high school students. Financial literacy. Also now requires digital/media literacy. Believe both are one semester courses.
I'm not sure they cover macroeconomic concepts as discussed in this thread, though.
Digital media literacy 🤣🤣🤣. Ask what it pays for an adjunct and I’ll send my daughter
I understand to a degree but things have changed considerably in that time. Regulations alone. Think about a knee replacement system from zimmer or one of them. That product will have materials that are more expensive, r &d costs that go up, reg compliance, third party testing, sales costs, marketing costs, distribution costs, clinicals, patents, more competitors, on and on and on. We’ve become a very complicated world and with that comes added expense. And believe me I know there’s bullshit. Every time my ex wife who is a frequent flyer in the system from Wash u to Mayo she gets a pregnancy test that’s billed. She had a hysterectomy. Come on. And our medical bills after insurance are insane. Two weeks ago my daughter got an mri. $700 out of pocket right when we walked in the door. Swiped my card. On top of a $10k deductible we paid last year. We are easily paying close to $50k a year between insurance and out of pocket. So believe me I get it and agree it’s untenable
FYI I'm editing the post you replied to.
No, I get it. I agree with everything you've said. There are certainly other factors in play, and other ways to cut costs.
This seems like a slam dunk to me. Bitcoin to SC type shit.
Lawyers I left out too. In 1950 there were 220,000. Now there’s 1.3 mil holding everyone’s feet to the fire in some of that process.
This is how pricing occurs…it is set by the highest reimbursement rate
How you drill down on the pricing is left to smart people like you and JDB but he’s exactly right on how that price is set. No one is billing less that best reimbursement.
It’s why we should eliminate these third parties except for high ticket items….like hospital stays and surgeries and the like. The overall cost to the consumer will plummet
My minion’s training is about to start so I’ll come back to this but I do believe as I trust digressions does too that that is part of the problem. There’s a negotiated, or maybe fiction, or artificial element to this that isn’t really tied to care. I’m not articulating this well and my boy is in one of his moods. Someone could pay. I’ll come back to it
Anecdotally, my wife works on an ortho floor at a downtown hospital. Their docs are world renowned. They won't take insurance. Straight up pay as you go, cash. They have billionaires, former Presidents, royalty, etc. flying in from all over the world to have their procedures done by these guys. I'm guessing they set their own prices.
Well, buyers and sellers are constantly interacting with each other in pursuing the best way to satisfy their needs/wants - which the other can provide. The seller is interested in getting the highest price for their supply, as their need is profit. The buyer is interested in paying the lowest price to satisfy their needs/wants.
All buyers and sellers have options - alternative ways to allocate their finite resources to best serve their needs/wants. The options may exist within the same marketplace, or they may exist elsewhere.
The equilibrium price is where buyers and sellers are agreeing to make the trade, given these alternatives.
Numerous external forces constantly impact where this will be. Scarcity of supply, things like taxes and subsidies, product advancements and substitutes, inflation/deflation, consumer tastes, adjacent market conditions, weather, extraordinary events (like wildfires in CA causing rents to spike).
Price signals also affect activity among buyers and sellers. Higher prices encourage additional supply, but may temper demand (depending on elasticities). Lower prices encourage more demand, but may temper supply - as suppliers may find other allocations of their resources more gainful.
All of these factors are highly dynamic and are, to one degree or another, sympathetic with each other.
That’s prices, in a nutshell.
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FWIW, several Canadian provinces have sought to prohibit private contracted medical services. The efforts have run into problems in their courts.
But the fact that they’ve even sought to do this is very instructive.
https://nationalpost.com/news/canad...-no-other-universal-system-bans-it-like-we-do
And I agree with you and JDB. What I'm trying to point out is why/how private reimbursements are growing faster than public reimbursements. The difference wasn't as bad 10 years ago, and we know it will be worse 10 years from now. That's what the charts show.
Without Medicare and without private insurance….how much would the cost of an office visit increased compared to now?
How much would the price of insulin increased compared to now?
Insurance should cover only the high end items..not an office visit or a bottle of lisinopril. We’ve artificially increased the prices.
Correct. One thing we should focus on is reducing the number of healthcare transactions paid for by a third party.
But people are attracted to the “all you can eat for one low price!” model. And I’m reminded of it every time I pass by the packed parking lot at our local Golden Corral.
