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Medical Costs Bankrupt Patients; It's the Computer's Fault
nbauman writes "Don't get cancer until 2015. The Obama health reform is supposed to limit out-of-pocket costs to $12,700. But the Obama Administration has delayed its implementation until 2015. The insurance companies told them that their computers weren't able to add up all their customers' out-of-pocket costs to see whether they had reached the limit. For some common diseases, such as cancer or heart failure, treatment can cost over $100,000, and patients will be responsible for the balance. Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs? 'A senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: "We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person's out-of-pocket costs. They asked for more time to comply."'"
The rollout is being delayed until after the 2014 congressional elections. The problem is political, not technical.
quiquid id est, timeo puellas et oscula dantes.
It's just another example of bought and paid for politicians sucking the dick of corporations. The famous words "of the people, by the people, for the people" are such a sick joke if you look at the USA government. Coming from a country that covers 100% of such common procedures, I just can't imagine how people can live like that. And Americans still think they have the most superior country in the world. America! Fuck Yeah! Please stop spreading your ideas of freedom to the world and try spreading those ideas at home instead.
Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs?
That depends entirely on whether the insurance company wants to remain in business or not. Next question.
#fuckbeta #iamslashdot #dicemustdie
Having worked firsthand in the medical data field, I'm actually more inclined to believe them. It's pretty easy for a billing system to say "You haven't met your deductible" or "You've paid about enough"... but as I understand it, the legislation requires that each patientis cost be tracked on a per-patient basis - not per-policy or even per-insurer. That means the records have to be combined from every participating hospital, correlated with information from every other insurance provider, and deduplicated accurately, before they can be added.
There are many people with multiple health insurance policies, who go to several healthcare systems, or have incorrect identification data in their records. What's being asked is not simply adding a few numbers in a bill, but rather merging trillions of records with few errors, across hundreds of formats from thousands of providers.
I wish them luck, and I'm glad I'm not in that field any more.
You do not have a moral or legal right to do absolutely anything you want.
By what legal authority did Obama delay this implementation?
Do you have ESP?
So what is the opposition party alternative? Repeal.
That will limit the out of pocket costs when? Never.
Plus it will eliminate the various positive effects that the ACA is already having.
Basically the people that are screwing up here are the beneficiaries of the higher out of pocket costs, our Medical Insurance Overlords.
5) This is an improvement over the decisions about life or death being about share prices and executive bonuses. I don't want it to even remotely cross the mind of anyone with a say in my health care that they might possibly make more money if they leave me sick.
6) Having someone in the family get a very nasty, expensive disease no longer ends in bankruptcy. Which means the rest of us continue to pay for it, but the afflicted family isn't ruined. As we live longer and eat more crap, this begins to affect almost everyone.
7) We quit talking about health care as though it should be less important than police or roads or a standing army - things we already care enough about to devote tax dollars to.
Well damn, better go tell Microsoft to stop making Excel... *facedesk*
Go ahead and try to put health data into Excel without violating HIPPAA and going to jail. The same medical procedure can be billed at hundreds of different rates, depending on numerous criteria, many of which are covered by privacy laws, or are calculated by third party labs or testing facilities. If you really think this is easy, then you don't have a clue. There is a reason that we spend 2 trillion a year on health care, and if you compare America's longevity, infant mortality, etc. to other countries, it is pretty obvious that all that money isn't being spent on actual effective medicine. My family doctor's office has one doctor, two nurses, and four people in the billing department.
Businesses exist to maximise profits, all profits, even those derived from delaying compliance activities. It becomes a simple cost benefit case. Is it cheaper to pay some politician's wage and go moan about how hard it is for your one programmer to re-write the software within a timeframe, or is it cheaper to simply hire the right number of people to do the job properly and quickly.
The answer is nearly universally the former. Major companies (not just healthcare) will rather moan about how hard done they are by the government than actually step up to comply with the new regulations. If a large fine is linked with non-compliance they'd have the software modified by the end of the month.
I've seen similar cases in industry too. Companies will replace truly horrendous parts of their plant like-for-like because installing what they want is tied with meeting the new standards of the day rather than the easier standards of when the equipment was originally designed, and thus we have a plant basically half replaced as new with no gear that meets any modern emission standards.
There's simply no motivation to go down the more expensive route.
Step 2 is an immediate response, step 4 is handled in batch processing nightly. So far so good. Except that the Affordable Care Act makes it *illegal* to make a patient pay more than the annual limit. The authorizer and/or the pharmacy can be charged for forcing the patient to pay above the annual limit. This means that the authorizer must be aware of limit of each patient and be able to respond in real-time so that neither they nor the pharmacy will be sued. The insurance company doesn't have that information available real-time, nor do they make it available to the authorizer.
It is a computer issue, but as simple as everyone thinks. Putting individual insurance files on-line so that the out of pocket expenses can be tracked real-time isn't trivial. Now, maybe the Insurance companies were hoping the law wouldn't be implemented so they didn't do the hard work necessary to get set up, or maybe the rules were only written as to how to handle the annual limit must be handled.
Just remember, the last time companies put together a real-time on-line credit/debit system, the government decided that they charged too much to support the infrastructure, and started regulating it. That was the Durbin amendment to Dodd-Frank, which put a fixed limit on per swipe fees - regardless of what the infrastructure and support costs actually are.
jerry
"Software is the difference between hardware and reality"
The USA health care system has some of the worst possible perverse economic disincentives. At literally no point is there a clear economic incentive for you to be healthy and taken care of.
1) Consumers have no interest in keeping costs down. They pay the same deductible no matter what happens. Unfortunately, this is only up to a point (see #4 below) but that's not going to enter casual consideration.
2) Hospitals have no interest in keeping costs down. They blatantly inflate their costs knowing that the insurance companies will only pay a fraction anyway. They also have no incentive to keep supplies costs down since they are paid "cost +" by insurance companies. They'll tend to buy whatever sponge or soap dispenser is in "the catalog".
3) Providers of supplies to hospitals have no interest in keeping their costs down. Hospitals get paid on a "cost +" basis by the insurance companies so charging $35 for that "medical grade" sponge that cost them $0.35 wholesale has 99% profit margins as its incentive.
4) Insurance companies have some incentive to keep costs down, which they generally do by axing their most expensive customers with any of the myriad of technicalities written into their eye-gouging 10 page contracts full of inverted double negatives and exceptions. A good example is somebody with a job who gets cancer. Sure, he/she may have excellent health insurance, but what about when he/she loses his/her job because they didn't show for four months while undergoing chemo therapy? Even so, the myriad of regulations in place (and a legal department that ensures that one plan can't be compared to another) provides an opaque enough service offering that customers are unable to distinguish which plan is actually "cheaper".
5) Doctors had to just about kill their mother to get through medical school, and are saddled with enough debt to make anybody contract stress-related symptoms. Since they get paid for the work they actually perform, they have every incentive to declare a medical emergency and take you under the knife, regardless of whether or not it's necessary or even beneficial. I'm not saying every doctor will give you heart surgery when you come in with a rash, but I'm not alleging something that doesn't happen. Citation 2.
The majority of bankruptcies in the United States are for medical reasons, and the majority of *those* are by people who had health insurance at the time they got sick. Anybody who says this ridiculous would-be-laughable-if-it-wasn't-true system is lying or misinformed.
I have no problem with your religion until you decide it's reason to deprive others of the truth.
just do away with insurance companies and switch to single payer. We all need health care to live and stuff. What we don't need is a middle man that adds no value between us and our doctors.
Face it, health 'insurance' made since when the only thing a doctor could do was a) amputate and b) give out aspirin. It didn't matter that they only did a few big things that were mostly comfort before you died. Now we want to _use_ insurance. Insurance can't be profitable if we're all going to use it. The entire _point_ of insurance is that most of us aren't going to use it.
It's like hurricane insurance in Florida. Good luck buying it.
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It's not such a great idea to remove personal accountability.
You get cancer, it's your responsibility. Can't pay the bills? Then don't get cancer.
You get crippled by a drunk driver who speeds off and is never caught? It's your responsibility. Can't pay the bills? Then don't get hit by a drunk driver.
Leg blown off in a terrorist attack? It's your responsibility. Can't pay the bills? Then don't go to spots that terrorists want to blow up.
Oh, that happened to you? So sorry, here's a bailout because you had personal accountability. Enjoy your long life!
I love the "personal accountability" line. It's simply a nice way of saying "not my problem - fuck you".
they don't get to decide. Doctors do. It's single PAYER, not single INSURER. It doesn't work the way you're thinking in Europe, Canada, Germany or any of the other single payer systems where people are entitled (whoops used a bad word) to health care. The only purpose of the gov't is to pay doctors. And they can be well paid and still provide great service.
:).
But far be it from me to let a little thing like facts and the failures of the US healthcare system get in thy way of irrational fear mongering perpetuated by a multi-billion dollar insurance industry. Viva la death panels (well, the private ones anyway)
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Obamacare is really an attempt to create the sort of socialism that Americans can stomach. I got a good buddy with some serious health problems who relies on gov't health care (got several actually, because if you have a health problem it isn't long until you die or need help from the gov't unless you're an Heir/heiress).
Anyway, I started asking him what he was gonna do. How would he use private insurance. Wouldn't they insurer just keep raising his rates. He said that would be wrong, and so somebody should do something 'bout that. I asked who, and how and he said there should be a law that the insurance companies could only charge so much.
Basically he, like most Americans, deep down want single payer health care. But we're been taught from cradle to grave that socialism is bad. We're indoctrinated. It's called cognitive dissonance. He knows he needs socialism to live. He knows he needs help, and he knows it's his right (as a human) to live. Not just to have some blind dumb chance at good luck, but to actually have a life. But he's been taught, over and over, lied to and lied to. So he breaks down.
Obama recognized that there's lots of people like that. So he's giving them what they need (socialized health care) but doing it in the only way he can. He's letting the devil have it's due, and he's going to give billions and billions to parasitic insurance companies who's only purpose is to make us feel better about getting something that's a basic human right.
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As a Canadian I have yet to see the very interference of the government into my health. I have never had any government official stop me getting an x-ray, stomp on my doctor when he ordered an ECG, or any of the other numerous tests and prescriptions he has ordered for me.
It's true that there are flaws, but when my wife was diagnoses with a life threatening cancer, no time wastes in diagnostics and in the two surgeries that followed. Better still, I was unemployed by the second surgery and we didn't have to bankrupt ourselves to save her life.
The world's burning. Moped Jesus spotted on I50. Details at 11.
Yeah, ever so much better to let a vastly overpaid CEO make that decision.
It's not such a great idea to remove personal accountability. When nobody cares about being healthy because "someone else" will pay the bill, then nobody will be healthy, and the amount of money required to pay the bill every year will exceed all of our production (although we already do not produce enough to pay our bills).
This has been disproven by 40 years of research, starting with the Rand Health Insurance Experiment http://en.wikipedia.org/wiki/RAND_Health_Insurance_Experiment and confirmed with studies by insurance companies and big corporations that self-insure their employees. The reason people believe it, when the data contradicts it, is that they're following an irrational free-market ideology. The rich conservatives figure that they can easily afford copayments themselves, and they can save money by not having to pay for the poor. It's a way of making the poor pay more for worse health care. Copayments result in worse health outcomes, and higher health costs. Companies have tried copayments and gone back when it wound up costing more. In health care, the free market fails, and we know the reasons why. If a doctor tells you to go to the hospital immediately because you could die, you can't start researching it on the Internet and comparing prices. If you want to discourage people from spending money on needless health care, you should put pressure on the doctors, who actually make the big purchasing decisions. That's what they do in countries like Canada and England, that spend half as much as we do. This is part of the Republican war on science. They try a free-market solution, it doesn't work, and instead of accepting failure, they ignore the facts and make excuses.
The Rand study was a controlled study that randomly divided people into different groups, with different levels of copay among them. That's the strongest evidence you can get.
The goal of the Rand study was to find out whether people who must pay copayments would be more likely to use appropriate treatments, and less likely to use inappropriate treatments.
-- The people with copayments were less likely to use inappropriate treatments, but they were also less likely to use appropriate treatments -- like drugs to control blood pressure, asthma, diabetes, etc. As a result, they wound up in the hospital more.
-- With copayments, people with asthma would save $100 by not taking their asthma controller medication, have an asthma crisis, go to the emergency room, and run up a $1,000 hospital bill that they couldn't afford to pay anyway.
The Rand study didn't have the statistical power to tell whether people with higher copayments were more likely to die, but they did find that the secondary outcomes like high blood pressure and high blood sugar were worse.
Studies of copayments have been done ever since, by insurance companies and big employers that were looking for ways to save money. They consistently found that copayments cost them more money in the long run.
-- Copayments raised costs. http://www.nejm.org/doi/full/10.1056/NEJMsa0904533 Increased Ambulatory Care Copayments and Hospitalizations among the Elderly. People made worse health care decisions.
-- When Medicare managed care companies imposed a small copayment for mammograms -- in over-65yo women, one group in which mammograms are cost-effective -- the rate of mammograms went down significantly. http://www.nejm.org/doi/full/10.1056/NEJMsa070929 Effect of Cost Sharing on Screening Mammography in Medicare Health Plans
-- IBM tried a copayment scheme with their employees. It wound up costing them more money, so they dropped it.
The reason it doesn't work is that the free market doesn't work in health care. The Nobel prize-winning economist Kenneth Arrow explained why in an article seve