What’s your solution?

I managed employer health plans for nearly fifty years. During that time I was always under pressure to manage costs even as benefits were improved over the years.

We tried every tactic that came along, every consultants new idea. We shifted costs to workers, we gave them skin in the game as they say.

In the early years we tried things that seem silly today. We gave workers time off for pre-admission testing, we paid for second opinions, promoted HMOs and PPOs, offered choices to workers, promoted and provided incentives for generic drugs, etc. Back in the 1980s I even served on the Boards of four HMOs.

Nothing worked and still doesn’t, including high deductible health plans, FSAs, HSAs and HRAs.

What’s left? Is there any way to manage our costs and assure every American has coverage for necessary medical expenses.

I made a proposal a few months ago that included a public and private role, reasonable cost sharing, use of HSAs, private supplemental coverage, employer and citizen funding and universal coverage.

How can we settle for anything less? How do we guarantee every American can receive and afford decent health care according to their means?

You tell me‼️

7 comments

    1. Define “affordable” most want no cost. How do we measure high quality? Many people equate high cost with high quality or more care is better care, neither of which is true.

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  1. I’m interested in what you said about second opinions, which if I understand correctly, you listed among silly ideas.

    I’ m fairly sure that my health plan back in 1990, a well known national plan, required that I get a second opinion prior to approving a much needed back surgery.

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    1. Actually I said they seem silly today. Use of second opinion is a good idea, but not much of cost saving. We never required a second opinion, but encouraged it.

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  2. 1) bring back major medical coverage of the 1970s & 1980s to back up part 2.
    2) run healthcare coverage like most dental plans. I have “x” dollars in my my plan. I know this. My dentist knows this. We do the preventive care like cleanings and “emergency” care such as fillings. When crowns are involve we jointly discuss the cost of the crown, the type of the crown or should the tooth just be pulled to save money. Can I split the cost of the crown over two years? I currently have a chipped crown. We will wait until November 2020 to see how much money I have left and how much out of pocket I am willing to spend to replace the crown. But I also may never have to replace the crown as a result of total failure of the crown so maybe I’ll just roll the dice. SO give everybody “X” amount for healthcare and drugs. when the money runs out you’ll know that it coming out of your pocket. I am not sure which drugs I can’t live without but if I was paying 100% out of my pocket you could be sure that I would find out which ones really fast.

    This is where part 1 comes in. Just like the days of old or the HSA of today, when you have a major health crisis and spend over a certain amount this insurance would cover you to prevent you from going into bankruptcy. There should be a large gap between your allotted amount and the start of catastrophic coverage.

    3) doctors have to know their costs and they have to be the same for everybody. This is the only way that the dentist can help you decide on a course of treatment. Currently most doctors do not know their cost, or what is charged. By the EOB some bills are paid as little as 15 cents on the dollar so what will these labs and doctors really accept? They have large billing departments to get as much money as they can after figure out what your illness was. Even auto mechanics can give you estimates but doctors tell you I have to wait to see what I can find. I know there are reasons for this but if you have high blood pressure, you should not be nickel and dimed for 12 months while the doctor tries to figure out your dosage. That should be all one charge for treating hypertension for the year. You’ll have nurses taking blood pressure and remote consultations really fast to keep costs down. After covid-19 we know that this can be done. There are time for office visits and times I believe that they just try to run up the bill.

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    1. I doubt pushing the decision on the insured to select plans will change their decision to seek and obtain medical care except in the area of cosmetic surgery or elective surgical care. Pain and coughing are motivators to seek care. Putting prices on MRI or CT Scans in facilities will not determine where to have the procedure done. I know of no one who would leave an emergency room or doctors office to run across town to another facility to have a procedure done based on price especially if their systems are not tied together so the doctors have access to the data when needed. We see this with Lab work all the time.

      One concept is to have a basic Health Plan for coughs, sniffles and simple cuts, broken bones and short hospital stays with one premium and a co-pay at a reasonable cost. Then offer one of two “Major Medical type Plans” for surgical costs to remove gall bladders, tonsils or hernias. The second MMP would be used for extensive surgical procedures for cancer, reconstructive surgeries, or followup care. These plans would be administered by one carrier much like Lloyds of London to insure high value cargo. They split the liability cost between the various plans so no one plan gets hit with the full expense and the payee/insured gets the benefit of shared savings on premiums.

      We pretty much have this today for Medicare eligible individuals. You have Medicare as primary and then one of several alternative plans to pick up the deductibles and provide additional coverage with various premiums.

      Additionally, merge small groups into one larger plan base by business groups such as retail sales, retail delivery, food services, civil services and/or union plans. This will allow them to take advantage of premiums based upon the group’s experience.

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      1. How do you guarantee coverage for everyone? If medicare works for us, why not a version for everyone? Not the Sanders M4 A version, but one using supplemental insurance and HSAs

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