Farewell. The Flying Pig Has Left The Building.

Steve Hynd, August 16, 2012

After four years on the Typepad site, eight years total blogging, Newshoggers is closing it's doors today. We've been coasting the last year or so, with many of us moving on to bigger projects (Hey, Eric!) or simply running out of blogging enthusiasm, and it's time to give the old flying pig a rest.

We've done okay over those eight years, although never being quite PC enough to gain wider acceptance from the partisan "party right or wrong" crowds. We like to think we moved political conversations a little, on the ever-present wish to rush to war with Iran, on the need for a real Left that isn't licking corporatist Dem boots every cycle, on America's foreign misadventures in Afghanistan and Iraq. We like to think we made a small difference while writing under that flying pig banner. We did pretty good for a bunch with no ties to big-party apparatuses or think tanks.

Those eight years of blogging will still exist. Because we're ending this typepad account, we've been archiving the typepad blog here. And the original blogger archive is still here. There will still be new content from the old 'hoggers crew too. Ron writes for The Moderate Voice, I post at The Agonist and Eric Martin's lucid foreign policy thoughts can be read at Democracy Arsenal.

I'd like to thank all our regular commenters, readers and the other bloggers who regularly linked to our posts over the years to agree or disagree. You all made writing for 'hoggers an amazingly fun and stimulating experience.

Thank you very much.

Note: This is an archive copy of Newshoggers. Most of the pictures are gone but the words are all here. There may be some occasional new content, John may do some posts and Ron will cross post some of his contributions to The Moderate Voice so check back.


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Tuesday, April 24, 2012

HCR -- Crazy Health Care Costs

By John Ballard


I'm encouraged to report that a national conversation about health care costs are finally going mainstream. ABC News, which has also done excellent journalism about health care in the past, put this piece up last night. 




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Those following the discussion may also be interested in the following links.


?By now readers here already know about ALEC (American Legislative Exchange Council), a well-funded outfit now finally under scrutiny from authorities, and its super-Conservative agendas. In  ALEC, �Shadowy Group� Behind State Efforts To Sabotage Health Reform Faces Heat From IRS  Naomi Freundlich tracks the latest ways that group continues to attack health care reforms, one of many items on an evil punch-list. 



In terms of health care, Wendell Potter, a former health care executive and CMD�s Senior Fellow on Health Care, writes in The Nation, �As its archive reveals, ALEC has been at work for more than a decade on what amounts to a comprehensive wish list for insurers: from turning over the Medicare and Medicaid programs to them�assuring them a vast new stream of revenue�to letting insurers continue marketing substandard yet highly profitable policies while giving them protection from litigation.� This includes model bills that allow insurers to sell products across state lines�including �junk insurance� and very high-deductible plans�even though they may not meet the standards of state insurance commissions.



?Consumer-Driven Medicine�s Fatal Flaw
Merrill Goozner, well-known writer and journalist specializing in health care matters, lays out the pricing issue (rather the lack of pricing information) in this post at The Health Care Blog. 


In a week it has collected a scrappy bunch of comments, mostly from insurance and other industry insiders (not many actual consumers go here for information), arguing among themselves. For a reader with patience, willing to overlook a lot of sarcasm and back-biting, one can catch a glimpse of the behind the scenes obfuscation involving providers, group insurers, TPAs (third party administrators) and insurance plans, mainly high deductible variety, being marketed for consumers with Health Savings Accounts (or Medical Savings Accounts -- I'm not sure which... they are not the same but since I'm on Medicare it isn't an issue that intrests me enough to do that homework.)



Where Are The Prices?


Employers are already moving in the direction of giving consumers �more skin in the game,� according to a recent survey by the Employee Benefits Research Institute. One in five Americans are already in high-deductible insurance plans, an all-time high, even though this approach is leading many to skimp on preventive services that could avoid higher health care costs down the road.


Unfortunately for the architects of such proposals, there�s a crucial element missing from their proposals, something that is necessary to make any market work: accurate and easily accessible price information for consumers. Have you ever walked into a doctor�s office and seen a price posted for all the tests, products or procedures that might be offered during your visit? At the hospital? Ever seen a price list at the local pharmacy?


The problem of price opacity in health care is not easily solved. Health care providers are more like airlines than the local Best Buy or Macy�s. They charge different patients different prices depending on who insures them. The uninsured pay the highest prices, the equivalent of a hotel rack rate.



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I think this video has been up before. But in any case it's a good time to run it again.




5 comments:

  1. " Have you ever walked into a doctor�s office and seen a price posted for all the tests, products or procedures that might be offered during your visit?"
    What good would it do if the prices were posted? Are you really going to have brain surgery performed by the lowest bidder? Are you going to go to different doctors for different ailments based on which one has the lowest price for each one?
    When discussing your care with your doctor you are perfectly free to discuss cost concerns if you have them, and I have alwoys done so. I have never had a doctor become offended by me raising cost concerns.

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  2. My experience has been the same as yours as well as several of my family members. When my son-in-law had to have a procedure done by a podiatrist he asked about the costs. Whatever it was got reduced by half or more on the spot when he informed the doc he would be paying himself, not submitted as an insurance claim. My sister and her husband have used a very high-deductible plan for years ($5000 each, I believe) and have always shopped prices. Wide variations for CT and other procedures are fairly easy to find.
    What seems to be happening now is the dirty underwear of the healthcare-industrial complex is finally getting closer scrutiny and the awareness is increasing. Journalists have been picking this low fruit for years, but discussions of healthcare reform are becoming mainstream. Here are a few recent related links.
    http://www.nytimes.com/2012/04/24/nyregion/health-insurers-switch-baseline-for-out-of-network-charges.html?_r=1&ref=todayspaper
    http://archinte.ama-assn.org/cgi/content/short/archinternmed.2012.1173
    http://www.joepaduda.com/archives/002320.html
    This last one from Paduda is a clue to what's happening. He's the go-to guy for all matters having to do with workers comp, which is at the intersection of corporate expenses and health care. As costs steadily went up corporate group policies simply went along, guided by whoever TPA was used. Because of the complexities of billing third party administrators have little of no motivation to question costs because most companies are "self-insured." In other words costs are simply passed on, added to premiums, divided between corporate and individual contributions, and swallowed with little more than a bit of grumbling.
    The new rules of PPACA now have the attention of insurers and corporate group providers and for the first time since World War Two medical charges from hospitals and high-end specialists are getting a closer look.
    And I'm loving it.

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  3. Interesting. The vidoe clip was not working yesterday, but today I ran it and realized that CBS News ran almost the exact same piece. It contained precisely the same numbers and, while the script was slightly different, the approach was precisely the same. It could have been done by the same people, and must have been because using even one different source would have resulted in different numbers.
    That says something about our "network news" doesn't it?

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  4. "Unfortunately for the architects of such proposals, there�s a crucial element missing from their proposals, something that is necessary to make any market work: accurate and easily accessible price information for consumers. Have you ever walked into a doctor�s office and seen a price posted for all the tests, products or procedures that might be offered during your visit? At the hospital? Ever seen a price list at the local pharmacy?"
    That is the crux of the problem. Imagine being able to shop, comparing prices and quality of services, for your healthcare. Some good old fashioned competition would definitely bring the cost of healthcare down

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  5. One would think that competition would bring prices in line, but I have noticed two flies in the ointment.
    First, of course, is the grip that insurance companies have had on the system for years. When the same type of market distortion appears in other goods or services anti-trust and other regulatory measures are put into place as a corrective. Just last week there was a big flap about Apple and the publishing industry engaging in price-fixing to stop Amazon from selling both paper and e-books at more competitive prices. Examples abound. Make a list of your own. But medical services (especially pharmaceutical and device makers) and their insurance handlers have been getting a pass for years on fleecing those who ultimately must pay.
    Second, there is widespread ignorance of basic accounting among medical professionals. This is not universally true, of course, but most doctors cannot discern the difference between professional compensation and business profits.
    Pricing, such as it is, is not based on supplies + depreciation + utilities + other overhead + rent/lease obligations + debt service + (this is the good one) professional compensation + profit.
    Instead they shoot from the hip, looking at "usual and customary charges", coding lists, percentages or reimbursements expected from various insurance and government sources, etc. Everyday retailers who operate in the same manner typically crash and burn in the marketplace.
    As I said, I'm loving it, watching an entire segment of the economy (healthcare accounts for about twenty percent of all money spent in America) finally experiencing what the stock market people euphemistically call a "correction." It's just getting under way. And even if PPACA is struck down, the process will continue. Reversing what "Obamacare" has begun is as futile as trying to push a baby backward in the birth canal. It ain't gonna happen.

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