“We’re seeing more and more consumer awareness every year,” [an insurance executive] told the Globe. “It’s a revolution that’s occurring, but it occurs over time.”
When I read about this ‘revolution’ it brought to mind an expression/poem/song from long ago: The Revolution Will Not Be Televised! The timeframe for the healthcare cost ‘revolution’ is on the order of decades, and I don’t think anyone will be able to sit still for a TV show of that length!
Not surprisingly, the Pioneer Institute’s survey demonstrated that while people with commercial insurance are interested in obtaining price information before receiving a healthcare service, they don’t often get it. Only 2 to 7 percent of people check costs on insurers’ websites, according to the Attorney General.
Although that number seems crazily low, it’s actually easy to understand once you consider the multitude of the barriers:
Patients don’t know what services they’re going to need
Choice of provider often trumps cost as a factor
Their health plans may not reward or punish them for saving or spending more money
Next year’s insurance premiums are unaffected by what they do this year
Those with a high deductible plan are likely to blow through the deductible anyway if they have serious medical expenses
Insurers’ cost estimators aren’t easy to use
The estimates may not be accurate anyway
People haven’t heard about the available tools
I’m an educated consumer with a high deductible plan but I don’t try to check the costs ahead of time.
So there’s no need to be glued to your TV (or other device) watching this ‘revolution.’
Looking through my news alerts today I saw a couple items that support the old adage, “there’s nothing new under the sun.”
Exhibit 1: Biosimilars
Two academics have been arguing for a few months that biosimilars aren’t like generics after all and that the US should regulate the prices of biotech drugs once they go off patent. They’ve been banging their heads against the wall and are getting tired of it. “Time to throw in the towel on biosimilars,” they write in the Wall Street Journal.
Maybe I shouldn’t be so cynical –I think I’ll write to the authors and see if I can lend them a hand!
Exhibit 2: Medical Tourism
In 2007 I got pretty excited about medical tourism (aka medical travel) as a way to reduce costs without cutting quality –at a time when we were throwing our hands up about costs and coverage in the US. I went so far as to travel to Singapore and South Korea to research the topic and set up a TripAdvisor-style website to facilitate the phenomenon. Here’s the transcript of my interview with the author of the first serious book on the topic.
It’s a great topic to write about, and there are some excellent anecdotes, but it didn’t catch on in a big way a decade ago and I’m skeptical it will do so now. Before the Affordable Care Act many middle class people were uninsured, so going abroad for orthopedic or heart surgery could mean the difference between losing one’s house/retirement savings or not. It was still a novel idea. But with the ACA there were many fewer people for whom it made great sense.
Most of what I saw was people going abroad for cosmetic treatments or dentistry. The other category was immigrants going back to their home country for treatment. (My sister-in-law went back to Canada for LASIK, for example.) Then as now, the US is the biggest destination country for medical “tourists.”
I really haven’t followed the field lately, but I’m seeing the same kinds of stories now (A prescription for a passport? Health plans covering medical tourism) that I saw then. This one says the industry is $439 billion growing at 15-25% per year. I haven’t reviewed the research but I promise you the market definition must be pretty broad!
“Beware the Ides of March” –Soothsayer to Julius Caesar
“Fear not the Ideas of March” –Health Business Blog to the wonkosphere
Your friendly neighborhood drug dealer
Count on Drug Channels to make sense of even the most convoluted pharmacy business models –and convoluted they are. This time the topic is the emerging trend of point-of-sale (POS) rebates. Did you know that many pharmacy benefit plans act like reverse insurance, with the sickest members subsidizing the healthiest? POS rebates start to right this wrong and bring forth uncomfortable questions such as: Where have the rebates been going until now?
Managed Care Matters shares its perspective that the Administration’s efforts to undermine the ACA have yielded bitter fruit on the marketplaces. Some premiums are up by 30% and meanwhile Congress is doing little or nothing.
Two years ago you couldn’t read the news without hearing about the disastrous premium increases due to “Obamacare,” but the media is silent now.
So what’s going on? Our blogger has a theory: The media is being manipulated and chasing bright, shiny objects.
Skimpy is as skimpy does
InsureBlog likes CMS’s proposal to restore the maximum policy length of short-term medical plans to 12 months from three. That’s even though some news outlets call the plans “skimpy” and some healthcare policy analysts consider such plans to be leeches on Obamacare, because they may siphon the healthiest people out of the marketplace risk pool and drive up premiums.
Location location location
When my son was a toddler, we trained him to say “location location location” when asked, ‘what are the three most important things about real estate?’ I still remember him driving a realtor crazy when one tried to pitch us on a house we didn’t like.
Now, Workers Comp Insider has decided that location is destiny in healthcare, too, declaring ‘It’s the Zip Code Stupid.’ Insider cites a recent JAMA Internal Medicine study that shows geography is “the biggest X-Factor in today’s American Hellzapoppin version of healthcare.”
Location: Wonk zone
The Hospital Leader (not to be confused with the Dear Leader) helpfully explains that “We need creative solutions” really means “the problem we are trying to solve has no answer.” Case study: Hospitals, hospice and SNFs – The big deceit.
A pending bill seeks to establish a state-based individual mandate in New Jersey. But a provision targeting employees of small businesses could inhibit Association Health Plans from selling insurance that does not comply with small group rules. Xpostfactoid explains.
Who knew? Health Care Renewal informs us that the ostensibly libertarian Washington Legal Foundation has become a front for healthcare corporate leaders –and leaders from other fields— to operate with impunity. The foundation’s campaign to abolish the Responsible Corporate Officer Doctrine failed, but the damage was done. (Hat tip to Health Care Renewal for anticipating today’s theme by including “methinks” in its cover note.)
The Wall Street Journal is a serious newspaper, so I had to laugh when I read GOP Senators weigh taxing employer health-plans. Apparently Senators are thinking about including a new tax in their Obamacare repeal bill in order to raise revenue, improve equity, and reduce the distorted incentives that divert taxable wages into non-taxable healthcare expenses.
We learn from the article that although it’s a solid policy idea and is being considered by many Republicans, “it could be politically risky, since it could expand the impact of GOP health proposals from Medicaid recipients and those who buy insurance on their own to the roughly 177 million people who get coverage through their employers.”
Republicans accused Obamacare opponents of not having read the Affordable Care Act before approving it in 2010. Seven years later it appears Republicans themselves haven’t read the law that they are now trying to overturn. If they did they would discover that Obamacare already includes this provision, an excise tax on high cost employer plans, nicknamed the Cadillac tax.
It’s far from perfect, but it’s not so bad either. It places a steep tax on corporate health spending above a certain high level, thus limiting the impact to the most serious cases, discouraging healthcare inflation, and phasing the tax in gradually.
So rather than wasting time discussing a new approach where consensus will be hard to forge, all the GOP has to do is leave the Cadillac tax in place. While they’re at it they might consider leaving the rest of the Obamacare in place, too, and working to improve the few areas that need a tune-up.
But I read the whole article in the print edition without finding any mention of the Cadillac tax. Someone must have pointed that out to the editor, because the online version tacked on two sentences at the end about it.
As I argued back in February (Can Congress agree on the Cadillac tax?) limiting the tax deductibility of employer sponsored health insurance is a good idea, but is opposed by a huge array of forces on the left and the right. I advocated then and am suggesting now, to leave the Cadillac tax in place.