Posted on 03/27/2014 10:13:38 AM PDT by Star Traveler
The problems with the implementation of the Affordable Care Act may be masking another major change in the way health care is delivered to U.S. consumers, experts believe.
At a conference in Washington on Thursday, health care and business professionals said that there’s an increasing trend in the industry toward cutting insurance companies out of the process entirely, as large, regional hospital systems move into the insurance business.
Dr. Kenneth L. Davis, CEO and president of Mount Sinai Health System, the largest health care provider in the state of New York, said that starting next year, Mt. Sinai will begin offering its own Medicare Advantage plan. It will look for other opportunities to bring premium payments directly into the hospital system, rather than filtering them through insurance companies.
Davis said he expects organizations similar to his to move in the same direction. “Inevitably the large systems are going to move to take part of the premium dollar,” he said.
(Excerpt) Read more at thefiscaltimes.com ...
I read a story some time back about a doctor who tried to do the same thing: have his clients pay him a monthly fee & he took care of them. The gov’t went after him for running an illegal insurance plan (I’ve forgotten what they actually called it). Anyway, he was prohibited from continuing because he wasn’t a licensed insurance company. These hospitals should proceed with care. (No pun intended.)
Since Medicare Advantage is going away as part of the ACA this administrator is so far behind the curve it isn’t even funny
As an insurance agent, the answers are already out there. HSA combined with a cat plan. People elect a % of their pretax income into a account with their name on it. If govt really can’t stay out they can mandate it. “Don’t say the obvious please” Their employers, church group, non profit, can negotiate a range of options from various providers. So if NAG’s (National Organization of Gals) wants a free pass to be whores they can pay their out of pocket costs for birth control and abortions with their HSA and their cat policy can be tailored to offer the in network discounts and coverage options. Gay men can work out their HIV/AIDS risks in this manner. Costs can be controlled via behavior. For example, everyone is at risk for cancer as it does not discriminate. You can make an argument for certain types of cancer such as breast for women and prostate for men and lung for smokers but if put cancer as one group it probably balances. AIDS on the other hand is contracted almost entirely based on behavior and is %99.9 preventable. Therefore, insuring AIDS and other STD’s should cost more as they are preventable.
As for heart diseases we can blame mainstream medicine and food companies and govt for lying and giving bad dieting advice for the last 50-70 years advocating low saturated fat high carb diets.
I’m now getting into politicized “science” so Ill stop now.
Bottom line HSA and Catastrophic plans.
Think Kaiser Permanente and all other forms of prepaid care or health maintenance organization that you have encountered in the past (PPO and HMO instead of insurance)
YES...I forgot “tort reform” on my “wish list”...
There was a TV news segment in these parts a few months back about turning annual medical checkups into small-group sessions for people with the same general health situations. It seemed like a possibly good innovation.
I'm all for clinic-style health care. If the hospitals took over insurance and offered a walk-in first come first served clinic option to their enrollees, that would be a step in a good direction.
For one year in the late 1960s, I was just making ends meet and depended on clinic-style medicine at hospital-run facility. It's the best medical care I ever had.
Some insurance companies are leaning into this already. I read somewhere recently that Humana is transitioning heavily and aggressively into the services side of the market.
It will be great when it works. Deadly when it doesnt.
Why deal with random insurance company _________ who may or may not pay you what you are owed. When you can cut them completely out of the picture and take those profits to pad your own with 1/100th the hassle.
I envision private hospitals that only serve members and accept no walk ins, that charge a monthly fee similar to what health insurance does, but it's insurance but a club fee, with free healthcare being simply one of the benefits of the club.
I’ve known people who worked in management at insurance companies. They tell stories of being told to reject a certain percentage of claims just to see if the patient will pay them instead.
I list out all my medications and run them through through an online "drug website" which does checking for interactions. Usually you will see there are interactions, but I guess that unless it's severe, some interactions are manageable.
Also, I have an app on the iPad which will do that. I suppose that the doctor has those computer programs on his terminal that does that, too. He writes out my prescriptions right in the examination room with me and "clicks" to send it directly to the pharmacy. The pharmacy also will have programs to check interactions, so I guess, from what I've seen in my case, it's covered all the way around.
you could have agreements between hospitals that each would take the others members similar to how colleges have agreements to allow the children of employees to attend tuition free often have agreements with other colleges to take their employees kids in exchange.
Until recently I didnt have prescription coverage. I was paying $120 a month for one of my wifes prescriptions at the cash price.
Now the insurance company says the charge is $671 of which I pay a $80 copay.
locally... the poor use the ambulances for a free ride to that side of town.
IOW you will be enslaved to a medical plantation.
Slave because trains only go to government appointed stations.
slave because only quasi government bureacrats can offer life saving medical care.
You are nothing more than a tax serf.
If it does work well, count on the government to make it untenable.
There are lots of attempts by doctors to open low-cost non-insurance clinics year after year...and it is seldom the finances of the medical care that causes them to fold.
Insurance was never meant to provide free medical care and medicine! Insurance was suppose to be for if something catastrophic” happened.
I have no idea how that notion was somehow lost.
You are probably screwed.
For the longest time, and way before Obamacare, it seems one issue with healthcare has been whether the doctors or the insurance companies are deciding what the best medical procedure or answer is.
What a wonderful idea. I am sure hospitals cannot WAIT to be run by the federal government.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.