Paying More for Less

This comes from CNBC: Many Obamacare customers will be paying more for less this year, study show.

That is exactly what the free market should fix.

With the ACA, plan premiums, deductibles and other out-of-pocket insurance costs have grown sharply even as the size of networks of health providers covered by those plans are getting smaller.  More from the study:

  • Last year, just 4 percent of all regions of the United States had only one participating insurer on Obamacare exchange, according to Avalere’s analysis. This year, 36 percent of all regions in the U.S. will have only one participating health insurer on an Obamacare exchanges.
  • In 2017, just 31 percent of all exchange-sold plans are “preferred provider organizations” or “point of service” plans, which are wider network of doctors, are down from 52 percent of all plans in 2014, the first year of Obamacare coverage.
  • Silver plan premiums, the most commonly picked, for 2017 increased by an average of 12 percent, from $496 per month last year to $554 per month this year.
  • The average deductible for health services and drugs covered by an Obamacare plan “jumped by 20 percent for silver plans in 2017 to $3,703.”
  • The number of silver plans that impose “coinsurance” for specialty drugs, rose in 2017, from 74 percent of all such plans last year to 84 percent this year.

If people are lucky or unlucky enough to require subsidies then that will offset some of the above.  That being said, why does this keep going up?  In no other business does this happen.  As we dismantle the ACA we need to remember to dismantle the insurers!  We HAVE to figure a way to bring the free market in so that these greedy bastards have a reason to lower their prices.  And before anyone defends them please refer to their record breaking profits each and every year.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “Paying More for Less

  1. LJSlossMD
    January 24, 2017 at 12:15 pm

    Medicare available for all, but with a difference: real insurance model, not obligate first dollar, quality blind, price fixing payment system; free patient choice of physicians and other providers of service; primary patient responsibility for payment, open to negotiation and with means-scaled subsidy sufficient to eliminate financial barriers to access but leave the patient with real financial responsibility sufficient to demand and empower prudence and choice. Merge with Medicaid a further option; let the for-profit and pseudo-nonprofit “insurance” entities compete or wither away.

    • Pat
      January 24, 2017 at 1:29 pm

      How do you deal with these problems in the current Medicare system:
      1. Unrestrained demand, leading to price inflation, cost overruns, budget nightmares, and ultimately, rationing.
      2. Regulatory overhead that reduces physician profit margin, leading to rushed visits and over-scheduling. How to reduce the onerous time, cost, and emotional burdens of mandated EMR’s?
      3. Enforcing rules that purport to require patient “skin in the game”
      4. Eliminating idiotic, unproven “quality” goals, whose only real purposes are to constrain physicians and further empower politicians.
      5. Somehow convince physicians that being a government agent treating complaining, angry, entitled patients is worthy, profitable, and pleasurable.

      • RSW
        January 25, 2017 at 1:51 pm

        “How to reduce the onerous time, cost, and emotional burdens of mandated EMR’s?”

        Any doc who doesn’t realize that EMRs aren’t mandated and that it’s financially, emotionally and spiritually better to stick with paper . . . well, they deserve what they get.

        • Pat
          January 25, 2017 at 4:30 pm

          Oh please, don’t dissemble…when Medicare/Medicaid doc’s suffer financial penalties for not using EMR’s, then they are functionally mandated.

          • RSW
            January 25, 2017 at 5:52 pm

            Not dissembling at all.

            If docs would just do a little simple arithmetic, most would find they’re better off financially, get to leave work on time, and are happier if they ignore the regs and take the penalties.

            Medicare pays one fee for OV plus EMR, another fee for OV without EMR. Not a mandate – it’s a decision that the doc as a business owner makes based on what is best for her and her practice.

            There’s no substitute for common sense.

          • Pat
            January 25, 2017 at 7:42 pm

            We disagree on definition, but I do see your point.

      • Mary
        January 25, 2017 at 2:06 pm

        I have a tongue-in- cheek suggestion. We nationalize Medicare. We hire insurance companies to represent the various providers all over the nation. We do a step up taxation process. The more the insurance profits are made above what is rational for business maintenance and actual human beings to work there, those additional profits are taxed high! That tax money collected from high profits is placed back into the medicare program resulting in significant raises to recipients of social security whose earnings fall extremely below the poverty level. The incentive to remain in business may be diminished but that is what they have already done to physicians everywhere so it is time for insurance company profits re-distribution. A balance can be achieved by letting artificial intelligence deal with whiny complaining entitled patients since robotic surgeries and computer guided diagnoses is giving the doctors the hands off approach already.

  2. Steve O'
    January 24, 2017 at 8:15 am

    The Iron Triangle will increase in power, now that Obamacare is being rescinded.

    The Iron Triangle is: the Federal Government, “Healthcare Corporations,” e.g. health insurance, pharmaceuticals and such, and the Leading Universities.

    None of these faces the consumer. The Feds want to get rid of any responsibility for healthcare, such as the VA, IHS and such. Consumer-facing enterprises at the point of service are getting killed financially.

    REGULATE THE HUMAN NOT THE CORPORATION. If there is a fundamental law of the Iron Triangle, it is this. Government represents corporate entities, and Harvard is as much of an entity as Pfizer and HHS. They are the players. You are the audience. America just voted to help ease the regulatory burden on the Iron Triangle. Point-and-click medicine will continue; the eight-minute visit will become the standard. But nobody will dare “risk healthcare” by imposing on greed. It hasn’t happened for twenty years now, and it won’t start up.

    Deregulation means dumping risk on the doctor and patient. Note that the fury over narcotic addiction is balanced on the shoulders of bad doctor & bad patient, as though these were the only two identifiable causes. Blame the human, not the corporation. Give patients choice; and then have them give the corporations legal indemnity against suits for poor care. Have McPharmacy clinics – sure! Will they miss stuff? Of course! But that’s your fault, patient, for not going to seeing the specialist first!

    When jobs went over to Indonesia, they had much less health expenditures and no health coverage; no SSI, none of the onerous government regulation like “minimum wage” and OSHA. To bring them back profitably, do you expect that Carrier will add on $8,000 for healthcare to bring them back from Out-there-istan? Hell NO! That was “regulatory stuff” that went with Obamacare. If the companies need to save face, the Government will give a “subsidy” to the companies for relocation – that can either go to executive bonuses or employee health insurance. You guess.

    The final depressing bottom line is that AMERICA IS NOT PRODUCTIVE ENOUGH FOR THE HEALTHCARE IT DESIRES. A dozen Federal employees to regulate your clinical practice, is two dozen mouths to feed, and individuals to provide health insurance for. Who’s doing the “hard work” in this practice? Well everyone is, they all have a job. Who is making the PROFIT upon which the business runs? You, suckah.

    I generally use our likely national outcome for healthcare provision is Turkey. They’re pretty big, they have Western medicine, their uber-rich go to Zurich and such private hospitals for top-of-the-line service. What does the average Turk get in healthcare, life expectancy, etc? Look it up.

    Wal-Mart plans to have the most clinic beds in the US by 2020. With the new administration, this went from a hope to a guarantee. Have fun finding parking when you go into clinic, colleagues!

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