How Technology & Health Care Systems Impact the Cost of Healthcare

stethoscope-on-moneyThe United States spends about $3 trillion on health care annually, nearly $10,000 per capita — accounting for about 18 percent of gross domestic product. Medical technology is costly, but it is not the only reason medicine is expensive. A variety of factors are to blame for what makes health care expensive in this country and abroad.

Role of Technology in health care spending. Technology is a significant driver of high health care expenditures, accounting for more than half of spending. Not only is providing medical care expensive, new treatments are developed every year. Many treatments common today were not available 40 years ago.

Moreover, every breakthrough therapy extends life — but at a cost well beyond the cost of the episode of care. Someone who does not die of a heart attack in their 50s because they have heart surgery may require periodic checkups and costly medications for the rest of their lives. Indeed, the patient who survives a heart attack in his or her 50s may need cardiac medications throughout their lives, a hip replacement in their 70s and later be diagnosed with cancer in the 80s. The societal (and individual) benefit of living longer is obvious, albeit costly.

Some new technology do replace more costly older technologies. For instance, drugs often substitute for more costly hospital care. Joint replacements may allow individuals to live independently longer, requiring less nursing home care. Once a drug’s patent expires, a low-cost generic is usually available within a couple years. By contrast, information technology has boosted productivity in many industries making them more efficient, it doesn’t have quite the same spillover effects in health care. Although health care systems use information technology, it has hardly changed the way patients are treated. Patients often encounter the health care system the same way their grandparents did 50 years ago. Telemedicine — speaking to a doctor by phone or remotely using information technology — is often a last resort rather than the first resort.

The Cost of Many Therapies Never Fall. Therapies that have been in use for decades are often still quite expensive. Of course generic drugs are cheaper than brand. But hip replacement implant designs that have been around for decades are not comparatively cheaper than when first introduced.

In typical consumer markets, the quality of technology gets progressively better while the (real) inflation-adjusted prices often fall as older technology is supplanted by newer technology. This is especially true of consumer electronics but also of true of automobiles, appliances and other types of consumer goods.

The reason consumer goods prices have held steady in the face of increasing quality is because consumers are price-sensitive. In consumer markets, consumers reward the firms who successfully compete for their business. Health care is different, however. It does not exhibit the hallmarks of typical consumer markets.

The role of Third-Party Payment. Health economists believe third party payment plays a role in keeping health care expensive. It also plays a role in keeping it inconvenient. Third party payment is common in the United States, where 88% of health expenditures are paid by someone other than the patient.

  • As recently as 1960, patients themselves paid about 96 percent of their drugs and dental care.
  • In 1960 they paid 60 percent of their physician care but only 21 percent of their hospital care.
  • Today Americans pay about 40 percent of dental care; 17 percent of prescription drugs; 9 percent of physician services and 3 percent of inpatient care.

Characteristics of Third-Party Payment. Third-party payers establish which treatments they will pay for and negotiate how much they will pay. When patients are not their primary customers, it is not in health care providers’ self-interest to compete on the basis of price. As a result, instead of price competition, competition among providers takes the form of providers seeking to maximize revenue against third parties’ reimbursement formulas. Over-use of third party payment also results in administrative overhead that is burdensome and rather expensive.

Another characteristic of third party payment is that hospitals negotiate reimbursement terms with insurers and employer health plans. This generally takes the form of negotiated discounts off list prices. It is seemingly in both payers’ and providers’ self-interest to ensure the spread between “list prices” and the percentage discounts are as high as possible. Hospitals then disaggregate services into as many billing codes as possible to boost billed charges. Health plans then reimburse the discounted amounts and hospitals write off the difference (what’s known as a contractual allowance).

Unfortunately, this is not in consumers’ best interest to have artificially high list prices with large discounts given only to health plans — especially uninsured consumers who get stuck paying list prices that are artificially high. Artificial list prices few payers actually owe also makes it hard for patients who want to compare prices — since providers are not competing on price. When providers are not competing on price, they have little reason to disclose price.

In addition, under a third-party payment scenario, hospitals and doctors are not competing to lower patients’ costs; providers are only trying to lower their own. This is why hospitals do not bundle and repackage service in patient-pleasing ways as is common in consumer industries.

The Role of Competition in Innovation. This lack of price competition has a profound effect on the cost of technology. Doctors, hospitals, drug makers and medical device makers are not competing in beneficial ways that rewards cost-saving technology. As a result, older technology does not sell at a discount. Consumers might buy a used car, but they mostly cannot make similar cost-saving in health care. What often occurs is patients decline services they cannot afford rather than seek out a lower price.

The Role of Regulations in Health Care. Regulations also play a role in keeping medical care and medical technology expensive. Medical technology firms and drug makers cannot innovate as easily as their counterparts in consumer markets. New drugs and medical technology must be approved by the U.S. Food and Drug Administration or other regulatory bodies.

Many estimates put the cost of bringing a new drug to market at more than $1 billion or more. The cost to bring a new medical device to market is also high.

Furthermore, doctors and other health care works are licensed, which also creates barriers to entry. Health insurers (both governmental and private) add their own layer of bureaucracy that stands in the way of competition.

The Role Consumer Sovereignty in Health Care. There is little in the way of consumer sovereignty in health care. Whereas consumers are always on the lookout for a good deal and novel goods and services they may be willing to pay for, insurers and third-party payers are not on the lookout for new ways to spend their money. Patients may like being able to merely call their doctor and consult over the phone, yet insurers are not going to reimburse new services until those services have been assessed to not increase spending.

Health Care in Other Countries. Patients are insulated from the cost of care in many countries. If price rationing is not to be used, another type of rationing has to take its place.

Faced with these constraints, different countries use a variety of methods to hold down the cost of medical care. These include:

  • Patients Cost-Sharing;
  • Third-party payers negotiating prices;
  • Monopsonistic (single-payer) price controls;
  • Rationing of equipment and services.

Cost-Sharing. The Rand Health Experiments conducted in the 1970s through the early 1980s discovered that patients exposed to cost-sharing consumed about 30 percent less medical care without impacting their health status. Insurers and employers use some variation of cost-sharing to align patients’ incentives more closely to insurers’ own. This included deductibles before benefits are paid and copayments. Third party payers also negotiate prices.

Monopsonistic Price Controls. Single payer is the ultimate government control of the health care system. By definition, a single-payer is a monopsony — the only purchaser of a good or service. When there is only purchaser in the country, it has significant market power to dictate the prices it is willing to pay — and limit with services it is willing to pay for.

Economic theory suggests a monopsony should set fees low enough so a sufficient number of providers exit the market, creating a slight shortage of services. This results in what is known as rationing by waiting.

To significantly reduce medical expenditures under a single-payer system, hospital fees would have to be lower than what American Medicare pays today — which is between 70 percent of what private payers reimburse. Doctors, medical device makers and drug companies would face a similar squeeze on fees and prices under a single-payer system.

Price controls are typically used to limit the cost of drugs and supplies in single payer programs like in Canada, Britain, New Zealand, etc. A single-payer could also use government data to arrive at a fixed global budget for each hospital.

Absent any of these preconditions a single payer would cost more than the current system.

The United States has a version of single-payer for seniors. Medicare pays slightly lower fees to hospitals and doctors, although it has shown very little political will to use what little monopsony power it has. Politicians who get campaign contributions are reluctant to enact price controls. Neither has Medicare shown a willingness to deprive seniors of costly treatments of little value.

Singapore Health Care System. The system that does the best to reduce perverse incentives can be found in Singapore. Singapore requires individuals save for their own future medical needs throughout their working lives. Singapore cannot be characterized as a truly free market for health care. However, it is an alternative to the socialized health care systems commonly found in Europe and in North America. Whereas other countries rely on government and / or employers to fund health care, Singapore relies on private saving and private insurance. The system in Singapore does its best to reduce cross subsidies across society and generations. Singapore believes:

  1. Each individual should mostly pay his own way;
  2. Each family should pay its own way;
  3. Each generation should be self-sufficient and pay its own way.

How Singapore Works. The government has a safety net for those who fall through the crack in these three levels. In Singapore, people are required to save for health care needs. For individuals up to age 50, the required saving rate is 7 percentage points is for health care and is deposited in a separate Medisave account. Individuals are also automatically enrolled in catastrophic health insurance with a deductible of about US $1,200, although they can opt out.

When a Medisave account balance reaches about US $35,000 excess funds are rolled over into another account and may be used for non-health care purposes.

Medisave accounts are a form of self-insurance that relies on personal saving. This results in beneficial incentives that benefit the entire marketplace. These incentives effect not only the demand side of the market, but also on the supply side. Individual patients have heightened incentives to be prudent consumers of health care, while providers have the incentive to compete for patients’ business. When consumers control more of their dollars, suppliers are more likely to compete for those dollars in patient pleasing ways.

After several decades of experience, Singapore has proven that individual self-insurance works and it works well. The Singapore model has shifted an enormous amount of money and power from the public to the private sector. Since 1984, the Singaporean government’s share of the nation’s total health care expenditure dropped from about 50 percent to 20 percent. The U.S. government share of health expenditures is approaching 60 percent when subsidies.

When Consumers Manage Their Health Care Dollars? Cosmetic surgery is one of the few types of medical care for which consumers pay almost exclusively out of pocket. In health markets without third-party payers, doctors and clinics use price competition, package prices, convenience, and other amenities in order to attract patients willing to purchase their services.

When patients pay their own medical bills, they become prudent consumers. Thus, the real (inflation-adjusted) price of cosmetic surgery fell over the past two decades — despite a huge increase in demand and considerable innovation.

  • The price of medical care has increased an average of 129 percent.
  • The price of physician services rose by 101 percent.
  • All goods, as measured by the inflation rate, increased by 69 percent.
  • Cosmetic surgery prices only rose only about 25 percent.

Cosmetic services have become competitive for a variety of reasons: As more people demanded the procedures, more physicians began to provide them. Licensed medical doctors are free to perform any cosmetic procedure they have been trained to perform, so there are fewer barriers to competing doctors. Physicians hire and train aestheticians and nurses to perform some minimally-invasive cosmetic treatments — boosting capacity.

Many providers increase efficiency by locating operating rooms in their clinics to reduce the cost of outpatient hospital surgery. Surgeons generally adjust their fees to stay competitive and quote package prices. New products and procedures have also become available.

  • The cost of having a physician administer botulism toxin averaged $371 in 2014, little more than the average price of $366 in 2000.
  • Yet deals on Groupon and Living Social occasionally offer Botox for as little as $99, with $149 quite common.
  • The cost of laser skin resurfacing was $1,062 in 2014. Yet, couponing websites routinely offer numerous laser resurfacing deals for only $299.

Furthermore, wherever there is price competition, quality competition tends to follow. Consider corrective eye surgery. From 1999 through 2011, the price of conventional Lasik fell about one-fourth due to intense competition ($2,100 per eye to $1,600). Eye surgeons who wanted to charge more had to provide more advanced Lasik technology, such as Custom Wavefront and IntraLase (a laser-created flap).

By 2014, the average price per eye for doctors performing Wavefront Lasik averaged just over $2,100 per eye — about what conventional Lasik had been more than a decade ago. However, the quality of custom Wavefront is far better. In inflation-adjusted terms, this represents a huge price decline.

Moreover, it’s often the same doctors who work in curative medicine who also dabble in cosmetic medicine. In one area of their practice they are encumbered by bureaucracy. In the other they compete for patients by on price, quality and other amenities

The following was based on my presentation at the May 4th conference, Healthcare in Hungary: Are There Any Lessons From Abroad? sponsored by the Danube Institute, Budapest Hungary.


Comments (58)

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  1. Hunter Business School says:

    The value of healthcare is worth much more than the cost. The cost of human life is priceless.

    • Allan says:

      Hunter, if the value of one life is priceless then that means a cost that would far exceed one trillion dollars so even though $1 Trillion is less than priceless we can use that number.

      There are 320 million people in the US. Do the multiplication. Do you think we have that type of funding available? Of course not, so you must realize now how ridiculoous your statement was.

    • Devon Herrick says:

      I have a problem with arguments that assert human life is “priceless.” For instance, does the precious nature of human life mean that all of society is obligated to protect another person’s life with everything we collectively own? If the goal is to maximize life regardless of the cost (which is implied if life is priceless), we will live long dreary lives since we will have nothing left for housing, vacations, food away from home or clothing. We might as well all be living and working at the hospital.

      My point is that we necessarily have to put a societal value on quality adjusted life years (QALY)saved in order to set priorities.

  2. Jimbino says:

    Hunter Business School is ignorant. Gold costs more per ounce than water, but while gold is valuable, water is more so, being essential to human life. Hence, value bears no relationship whatsoever to cost or price.

    • Stella Baskomb says:

      Jimbino, which is more plentiful and easier to obtain? Gold? Or water?

      Which do you find stacked on pallets in most US supermarkets? Gold or water?

      Who understands supply and demand?

      Herrick? Or Jimbino?

      To ask the questions is to answer them.

      • Ron Greiner says:

        Stella, I think Jimbino is right on with his comment. Maybe it is because I went to Iowa State University on a wrestling scholarship and I would go for a week without drinking water to make weight at the end of the season.

        I would have taken water over gold.

        OK Jimbino, U & I agree.

        • Stella Baskomb says:

          That’s your argument? That’s it?

          Regardless of your own behavior, water was still easier for you to get than gold.

          So who demonstrates understanding of supply and demand?

          Herrick? Or Greiner and his new best friend Jimbino?

          [Beam me up, Scotty – no intelligent life down here]

          • Ron Greiner says:

            Stella, have you ever heard of water rights?

          • Ron Greiner says:

            Stella, after Scotty beams you up into space, is water valuable up there in outer space?

            Stella, are you saying that Jimbino’s comment, “gold is valuable, water is more so, being essential to human life,” is wrong?

            I’m not going too fast for you am I Stella?

            • Stella Baskomb says:

              “Stella, are you saying that Jimbino’s comment, “gold is valuable, water is more so, being essential to human life,” is wrong?

              That’s your argument? That’s it?

              • Ron Greiner says:

                Stella, you say, “To ask the questions is to answer them.”

                I asked you if Jimbino comment was wrong and your answer is, “That’s your argument? That’s it?”

                I had a boss once who was captain of the Romanian Olympic Rowing Team and she also held the beautiful title of World Champion. Her English wasn’t the best but if you would have answered her like you did me she would have asked you, ‘What, are you retarded?”

                • Stella Baskomb says:

                  That’s your argument?

                  That’s it?

                  Yeah. That’s it.

                  • Ron Greiner says:

                    Stella, is knowledge more valuable than money?

                    I know you will say that google will get you FREE knowledge it is so plentiful. I understand there is the Library of Congress too, the largest library in the world.

                    YOU ask,”Regardless of your own behavior, water was still easier for you to get than gold.

                    So who demonstrates understanding of supply and demand?

                    Herrick? Or Greiner and his new best friend Jimbino?”

                    Admit it Stella, your fruitcake questions provide no answers.

                    Devon, Stella thinks that google makes knowledge so plentiful that your knowledge is now worthless. It’s a supply and demand thing.

                    Stella is this Jimmy Buffett song about you?


                    • Allan says:

                      Ron, actually the comparison between intelligence and money was made. (knowledge means little without the intelligence to use knowledge). Charles Murray made the statement (based upon data) that a man with money that was unintelligent was more likely to lose it while a man with intelligence was more likely to gain it. I think that comes from his book The Bell Curve.

          • Ron Greiner says:

            Stella, you wrote here at the NCPA, “btw, any money you can set aside in your HSA reduces your taxes – which reduces your cost of setting it aside in the first place. The idea is that people will fund the HSA to fill in for the deductible.”

            Let me help you Stella, I enrolled the USA’s 1st HSA when they were called MSAs. People in the know don’t spend their HSA funds growing tax free. They have the FREEDOM to use other funds and keep the receipt and take the withdrawal at any time in the future.

            Really Stella, who would spend the funds that are growing tax free?

  3. Barry Carol says:

    Regarding the value of a life, it’s important to note that when federal agencies like the EPA, DOL, OSHA, FAA, etc. develop new rules and regulations that require affected industries to spend substantial amounts of money to comply with them, a cost vs. benefit analysis is done to ensure that the benefits exceed the cost of compliance. Determining the benefits implicitly requires putting a value on human life. From what I’ve read, various agencies deal with this in different ways but end up with valuing a human life in a range of $5-$12 million. Interestingly, using the higher figure of $12 million and assuming a normal life expectancy of 80 years results in a value of $150,000 per life year. In the end, we have to at least implicitly place a value on a human life not just in healthcare but in every other area that requires cost vs. benefits tradeoffs. Resources are finite and we have to make choices that are sometimes difficult.

    Looked at another way, the determinants of pay for most jobs are based on some combination of skill, education, responsibility and DANGER. This is why dangerous jobs like underground coal miner or lumberjack pay more than less dangerous jobs requiring similar skill and education. The marketplace determines how much incremental pay above the scale for safer jobs is required to attract enough people to fill the dangerous jobs.

    With respect to the debate over the value of water vs. gold, it depends on the circumstances. If one is in imminent danger of dying of thirst, then one or two bottles of water might be worth more than all the gold in the world to that person at that point in time. On the other hand, during normal times, a single ounce of gold can be sold for several hundred times as much as a 24 unit case of bottled water.

    • Bart I says:

      How much will a drowning man pay for a bottle of water? Or ounce of gold for that matter.

      I suppose the water has neutral buoyancy and is less likely to pull him under, so it has less negative value.

      • Allan says:

        How many people have been killed for a single bottle of water and how many people have been killed for an ounce of gold?

        • Bart I says:

          So the most valuable things in life are drugs and tennis shoes.

          • Ron Greiner says:

            Bart, it depends on who you are. If you are a NASA project manager what will you spend the most tax dollars on sending people to Mars and back? Will you spend more money on drugs, tennis shoes, gold or WATER?

            Baskomb will probably say gold with her Little-Bitty one tract mind stuck in her small world.

            • Bart I says:

              So your aim is to discourage anyone new from commenting on the blog?

              You really are the troll-under-the-bridge.

              • Ron Greiner says:

                Bart, Bascomb said to me 1st, “[Beam me up, Scotty – no intelligent life down here]

                Why didn’t you tell her she is a troll?

                Bart, you have to be fair.

              • Bart I says:

                I suppose you have a point. Although I wonder how many times it’s necessary to retaliate.

                • Ron Greiner says:

                  Thanks Bart. Bascomb really hurt my feelings. She is kinda mean coming in here and saying stuff like that to a regular.

  4. Barry Carol says:

    The benefit of technology in healthcare is a tricky subject. The cheapest outcome from the standpoint of cost to the healthcare system is for a sick patient to die quickly. Then healthcare costs stop. As a patient who had quintuple bypass surgery 17 years ago, I was saved from an early death that probably would have occurred if that procedure and technology were not available. I’ve been on medical management since then and needed two other fairly expensive interventions along the way. In the meantime, I’ve had 17 years of pretty good quality life that I wouldn’t have otherwise had and I continued to work and pay lots of money in taxes for 12 of those years until my retirement at the end of 2011. Medical management, not smoking, maintaining a normal weight and a reasonably healthy diet keeps me out of the hospital and avoids further costs.

    I happened to attend a presentation last night by executives from Celgene, a biotech company, and Stryker, a medical device manufacturer. Celgene’s largest revenue producing product is a drug called Revlimid which treats the blood cancer, Multiple Myeloma. Not that long ago, these patients rarely lived more than three years or so beyond their initial diagnosis. Now 10 years is common. Since bone fractures are also common among these patients, Revlimid helps to avoid those too. So, argues the company, the drug saves money by keeping these patients healthier than they would be without it.

    However, to the extent that any medical innovation extends lives, it gives people time to develop other medical issues that will cost money to treat including such debilitating and expensive conditions as Alzheimer’s and dementia. In the end, I think it would be more informative to look at healthcare costs on an aggregate population level life year basis rather than an annual per capita basis or economy wide total cost basis. People can then make their own judgment about whether or not healthcare costs represent good value, at least at the population level. At the individual level, different people will obviously reach different conclusions and judgments.

  5. Barry Carol says:

    At the presentations I attended last night, an important point about single payer healthcare systems that I hadn’t heard before is that there are significant differences around the world in the willingness of various single payer systems to support and pay for medical innovation. One presenter made the point that Japan and, to at least some extent, Australia, are both willing to pay for medical innovation by agreeing to pay fairly high prices for new innovative drugs and devices, at least at first. This is much less true in Western Europe, especially in the UK.

    I’m highly skeptical of Singapore’s approach. The 7% tax that funds the Medi-save accounts might be a good deal for healthy people but what happens to those who develop an expensive disease or condition? I haven’t heard much of anything about what the catastrophic insurance plan costs, how it’s funded, what it covers, how much provider choice there is, etc. There are also, of course, huge differences between Asian and American cultures and values.

    It’s also important to note that 75%-80% of healthcare spending in the U.S. is related to the management of chronic diseases and conditions including virtually all of my own claims. While being sensitive to the cost of a diagnostic MRI and asking the doctor if it’s really necessary or not are good things, I don’t think they are going to move the needle on total healthcare costs across the system. If a doctor has a preferred protocol for managing heart disease, diabetes, asthma, hypertension, depression, etc., I don’t know how much flexibility he has to vary his treatment recommendations based on cost depending on whether the patient in front of him has a high deductible insurance plan, a low deductible plan, an HMO, a PPO or no insurance at all. I also don’t think the preferred treatment regimen would vary much depending on whether the patient has Medicare, Medicaid, employer coverage or insurance purchased in the individual insurance market. If we want to drive healthcare costs down, let’s stop over treating patients near death; let’s have sensible medical tort reform, price and quality transparency and less fraud in Medicare and Medicaid.

  6. Allan says:

    Value is based upon perception, rarity, transportability and a whole host of other things. In one desert area of the world starved of water due to draught a relocation of people has been seen along with killing of an unbelieveable magnitude. Much of this was caused by a lack of water, not gold. Yet the brain power of some in this same area faced by the same drought was able to produce a technological revolution in desalinization so that drinking water can be created for a cost of 58 cents for 1,000 liters of water. So much water is being produced that some of it is exported to other nations. The value of a single container of water in that area has drastically fallen while the cost of gold remains high. To date, though the Israelis can create purified water at exceptionally low prices, they cannot create gold.

    • Barry Carol says:

      Gold has only limited utility in industry mainly in electronics and for jewelry. Most gold has value only as a store of value because lots of people believe and perceive it is a store of value mainly because government can’t create more of it and the supply is comparatively limited. For the most part, gold is only worth what people perceive it to be worth as a store of value and that includes a lot of gold made into jewelry in places like India. That price can fluctuate quite widely in the short term depending on numerous factors, mainly related to political instability and excessive price inflation. Most of the time over the past 200 plus years, an ounce of gold would buy you a good man’s suit. Think Brooks Brothers. It has largely maintained its purchasing power over time but it’s a poor long term investment if your objective is to grow your wealth in purchasing power terms.

      • Allan says:

        Gold has been an accepted measure of wealth for centuries and many utilize gold to determine what has happened to the value of fiat money. It is portable so it is also useful when exchanging goods and services. It is not just perception that makes gold valuable, rather among other things, its history as well.

        • Ron Greiner says:

          Allen, just because people though a certain way in the pea-picking-past doesn’t make it true.

          All the good music has already been written by people with wigs and stuff. Frank Zappa

    • Stella Baskomb says:

      True, Allan.

      It’s simply false to insist – as the feisty Greiner stubbornly does – that “essential to life” is the only criterion for value. If that were so, even the air we breathe would command an immense price, far above gold. Which all reminds me of something the brilliant scientist Richard Feynman once said about real life. . . .

      “If your theory disagrees with experiment . . . it’s wrong”.

      • Allan says:

        Stella, that is a great video clip that should be seen by a lot of people involved in healthcare. Those students were lucky to have Feynman as a teacher. It may seem a little soft in a physics class attended by students, but when they get out and discuss real life situations his emphasis on proof can go a long way.

        If one has never a book of his one would find a few of them to be very pleasant and funny reading.

      • Ron Greiner says:

        Stella, you lie and said, “It’s simply false to insist – as the feisty Greiner stubbornly does – that “essential to life” is the only criterion for value.” I NEVER said that.

        When I catch you lying and blowing your credibility how do I know when you are telling the truth?

  7. IHaveBeenTalkingwithYourDoctor says:

    If we don’t start treating our doctors with more respect and paying them adequately, we won’t have any doctors.

  8. Stella Baskomb says:

    Jimbino said “while gold is valuable, water is more so, being essential to human life”

    Greiner then said “Stella, I think Jimbino is right on with his comment.”

    That’s not hard to understand.

    What is harder to understand is Greiners furious determination to assert he never “said” what Jimbino said. As if splitting that particular hair is one of the most important things in Greiners life.

    I think Bart has it right – Greiner is a troll under the NCPA bridge. But to be fair, Greiner is a sensitive troll – look how easily I hurt his wittel feewings.

  9. Ron Greiner says:

    Baskomb, correct, Bart is right that he admits you attacked me 1st.

    YOU LIED Baskomb when you said, “as the feisty Greiner stubbornly does – that “essential to life” is the [[only]] criterion for value.” I NEVER said that. NOW, you try and justify your LIE by saying, “splitting that particular hair.” NOT TRUE, you either LIED or you didn’t and the truth is – you LIED.

    Basckomb, it doesn’t hurt my feeling in the slightest bit that you are a liar. I still have my question, NOW that we have caught you lying here at the NCPA blog, blown your credibility out of the water, how can we tell when you are telling the truth?

  10. Bart I says:

    I’m sorry I involved myself in this moronic exchange. I only did so because of a direct response to one of my comments.

    • Stella Baskomb says:

      Bart – Man oh man do I ever agree with you about regretting being involved in a moronic conversation. As a newbie, my only excuse is that I got sucked in by a resident troll. Not a very good excuse, I know – it’s my own darn fault.

      Anyway, I’ll happily continue at some other site that isn’t dominated by one thin-skinned bandhog. Adios.

      • Ron Greiner says:

        Now I do feel bad Baskomb that you are such a victim when you said I lacked any intelligence. And I suckered you into calling me names, I’m so sorry.

        Please come back Baskomb and I will try and not say anything when you tell me how stupid I am. Even as you leave you call me a “skinned bandhog” like a sincere victim would. You poor thing, I regret all of the truth about you that I exposed.

        Baskomb, give me another chance and I promise I won’t correct you as you call me more names. You have to admit I’m bending over backwards for you. It’s the least I can do for someone that we caught red handed lying through her teeth.

  11. Ron Greiner says:

    It’s really bad: Early signs are ugly:

    Maryland’s top insurer, CareFirst Blue Cross, has requested an average 50% rate increase for 2018.

    In Virginia, Anthem Blue Cross is asking for 37.7% higher rates.

    Aetna said it will be pulling out of all Obamacare exchanges nationwide.

    Iowa is down to only one carrier, Medica, which only covers a few counties.

    We’ll see more such stories in the coming months. Barring some legislative miracle, the result will be an individual health insurance market with sky-high rates and deductibles—if your area has any insurers at all. Many won’t.

    Bottom line: In 2018, Obamacare will still exist, but only as taxpayer-provided indigent care. The program’s heart and soul—the grand vision of “Affordable Health Care” for every American—will be gone.

    What’s left will be a mere shell, stumbling around and consuming resources.

    Or, as Laszewski called it, Zombiecare.

    • Barry Carol says:

      Ron, believe it or not, I agree with your assessment. In the meantime, high deductible health insurance plans paired with a Health Savings Account seem to be gaining considerable traction in the self-funded employer market. At my son’s current employer, 58% of employees have the high deductible ($3,250) plan plus the HSA vs. 42% with the low deductible ($900) plan with no HSA. The employer contributes $2,000 to the HSA and the required employee contribution toward the premium is $80 per month lower than for the low deductible plan. The out-of-pocket annual maximum is also only $600 higher for the HSA plan. The incentives to choose the HSA plan are pretty strong, I think and it appears that more and more large employers are moving in this direction or have already done so.

      • Allan says:

        Eventually even socialistic ideas have to yield to the ideas behind capitalism.

      • Lee Benham says:

        Hasent Ron always said get employers out of the business of buying insurance that employees rent and instead fund the employees individual hsa?

        • Barry Carol says:

          I don’t think employers can do that under current law. They can only fund an HSA if it’s paired with a high deductible health insurance plan.

        • Allan says:

          We should open the employer’s market up to choice, where choice can incentivize the employer to choose better healthinsurance trade-offs or face the employee purchasing his own insurance without discrimination due to tax laws. That is something the statists do not wish to permit. Statists want control and the ability to tell everyone else what to do.

          • Ron Greiner says:

            Allen, Government is like the Mafia Protection Racket. From Oklahoma: “If you just block $2 billion in Medicaid to the state and say ‘you can handle that how you want,’ the state may decide to let Blue Cross Blue Shield administer that money with up to 40 percent taken in administrative costs. Under Obamacare, the limit to administrative costs is 20 percent.”

            Florida Medicaid money is BIGGER. Florida Blue Cross CEO Pat Geraghty has promised if we give him $41 BILLION in Medicaid Money he will give us VALUE. Who in their right mind is against VALUE? Now you are saying Blue Cross will scam us and keep 40%, $16 BILLION, for administration. Bald headed CEO Pat Geraghty of Florida BLUES does look like a scam artist and con man. CEO pay is part of administration, right?

            PHD Devon is smart about Medicaid where is he?


            • Ron Greiner says:

              In IOWA, 2 Blue Cross companies split $4 Billion for Medicaid. Anthem Blue Cross and Independence Blue Cross of Philly.

              Anthem Blue Cross also has the DANGEROUS State Children Health Insurance Plan (SCHIP) (HAWK-I) that terminates all childrens’ health insurance on their 19th birthday regardless of medical history.

              Rep. Steve King (R-IA) said SCHIP was, “A cornerstone of Socialized Medicine.”

              Of course most uncomplicated politicians say, “I love helping children.” What they mean is Blue Cross gives me Mountains Of Money for government contracts.


              • Ron Greiner says:

                KidCare Ploy (Hillary Clinton)
                The 1997 Balanced Budget bill included $24 billion for “KidCare,” through which was enacted another significant portion of the rejected HillaryCare plan. Hailed by statist commentators in both the lay press and specialized medical journals as the largest federal health care initiative since the enactment of Medicare and Medicaid in 1965, KidCare purportedly extended insurance coverage to “millions of uninsured children.”

                As Paul Bedard of the Washington Times reported, KidCare “was to be the ‘precursor’ to universal health care sought by First Lady Hillary Rodham Clinton in a secret White House fallback plan prepared in April 1993” Internal Administration documents have revealed that Hillary’s Health Care Task Force “plotted to push a ‘kids first’ insurance program as the start of a universal health care program if Mrs. Clinton’s grander effort failed, as it did.” The KidCare program enacted with bipartisan support, reported the Times, is a “duplicate” of the original White House stopgap measure.

                According to a statement issued by the First Lady on April 20th, KidCare – which was re-christened the Children’s Health Insurance Plan (CHIP) after it was inserted into the Balanced Budget agreement (for implementation by the states) – enrolled about 1,000,000 children in 1998. Mrs. Clinton boasted that the program “enables states to insure children from working families with incomes too high to qualify for Medicaid through non-Medicaid state programs, Medicaid expansions, or a combination of both programs.” What Mrs. Clinton did not point out was that the program is intended to help “fill in the gaps” in federal control over our health care system.

            • Allan says:

              Ron, CEO pay is part of administrative costs, but without administrative costs companies could not function. As far as the level of benefits the CEO is paid, I don’t think that generally affects the premium significantly. Use horrible leadership and you will get horrible results so be careful for what you wish for.

              As far as giving money back to the states for the state to do as it wishes, that probably in more cases than not will be very valuable. I believe in local control because the closer to local control the more able the voter population becomes in picking out good responsible candidates.

              • Ron Greiner says:

                Allan, on the so-called Florida Obamacare Marketplace 70% of Florida counties have just ONE option, Florida Blue Cross, a giant government created MONOPOLY. Florida Blue CEO Patrick Geraghty appeared on Meet the Press Sunday morning and defended Obamacare. He LOVES Obamacare and was at the White House with Obama creating this MONSTER. You can tell he is a bald headed crook who uses government to ELIMINATE competition. Thanks Obama.

                He won’t even answer the questions.


                • Allan says:

                  Ron, whether that is true or not is open to question, but that doesn’t differentiate him from any other CEO. Did he create the BC/BS monopoly? No. Legislation did and I would assume he fulfilled his obligation to his company by pushing for legislation that increased the company’s value.

                  I don’t know why you can’t separate your dissatisfaction with the political process involving health care from criminal action of CEO’s that live under the rule of law.

                  • Ron Greiner says:

                    Allan, I’m a salesman. It’s worse than that, I’m a sales trainer. It is my job to demonize the competition. That’s what I do. I thought you knew that.

                    Sales is a transfer of perspective (TOP). Typically, we present the problem, grab a commitment or two with a few buying obligation questions, then provide the sweet solutions.

                    Then we trick the buyer by asking, “I’m not going too fast for you, am I?”

                    An analysis of the sales process concludes that prospects say yes so they don’t look foolish in front of the salesman that they will never meet again. It’s a sad state of affairs but it is what it is.

                    See you at the TOP!

                    • Allan says:

                      Ron, along with being a physician I am also an entrepreneur so I buy a lot of things and have had to deal with a lot of “salespeople”. When a salesperson’s chatter depends upon demonizing others I might be polite and listen a minute or two, but I don’t buy and he is shortly out the door.

                      The good salesperson in my opinion is an educator who doesn’t depend upon cheap tricks. As far as looking foolish, that doesn’t bother me. Remember, the salesman comes knocking on my door. I don’t go to his.

                    • Ron Greiner says:

                      Allan, well aren’t you an important doctor. I have sold a lot of doctors and to me they treat their employees like second class citizens. They do not care about having the best coverage on their employees but instead are trying to save a buck.

                      I have saved a lot of doctors from their foolishness. I saved one on an 18-member-physician group that he had to work full time to keep his insurance. He switched to me because I was much cheaper. Then at 35-years-old he gets bone cancer and in his 1st surgery he had a stroke. YOU can’t be an anesthesiologist if you have had a stroke can you? I know I saved his hide and he would have lost his old plan.

                      My little brother ran the loan department for PPS who made loans to docs. He says they had 40% TD because these docs didn’t know how to handle money.

                      PPS hired Dr. Annis and he worked for my brother-in-law. I know all about how smart docs are.

                      Just because you look down your nose at salespeople and “think” they are using cheap tricks, you are just confused. I have much more respect for a good salesperson that these docs who are defrauding Medicare.

                    • Allan says:

                      Ron, If you look above you will see that I reserve my brusk attitude for those whose chatter is demeaning or too self-serving. I don’t have time for that type of behavior.

                      I dealt with a lot of salespeople who could demonstrate why their product was better and met my needs whether I was purchasing as a physician or for another business. My relationships lasted decades because they were based upon honesty. I don’t think any of the people I dealt with would ever try to use embarrassment to sell the deal and would never ask “I’m not going too fast for you, am I?” If they did they would be shown the door.

                    • Ron Greiner says:

                      Allan, my beautiful daughter was the best sales person I have ever trained. She worked her way through college enrolling people into tax-free MSAs. I would set up her appointments for her and back then we had to see the prospects in person. She would have to drive 2 hours one way to see these prospects and she was a busy girl going through school.

                      I would ask her, “Did you get the sale?” She would say, “I went didn’t I?”

                      She changed that question that you are all bent out of shape on. She would say, “I hope you are picking up what I am laying down, you are aren’t you?”

                      I’m sure you would say to her, OH there is the door because I’m a DOCTOR!

                      My daughter would have told your employees, “YOU are responsible for your children and not some uninformed DOCTOR who only cares about the bottom line.”

                      She would have meant it too.

                    • Allan says:

                      Ron, your stories have become more and more of a distorted fiction residing in your head to satisfy an inexplicable personal need. It seems that in your mind you climb a ladder by pulling people down rather than you climbing up. That is your modus operandi.

                    • Ron Greiner says:

                      No Allan, I was expecting heat from the fire before I added the wood. I got ahead of myself like I sometimes do.

                      Everybody and their dog knows that there are natural born doctors. Not so with salespeople, they have to be trained.