End of the year brings a crush of surgeries

[dflprincess]

This was a very long article in the Star Tribune and the snips I posted here don't tell the whole story. Mostly the article is about people putting off elective procedures (mainly orthopedic), it fails to mention that "elective" often just means "not urgent" and just because a procedure is considered elective, it doesn't mean it isn't necessary. The article also fails to mention that many people delay more urgent care when they're faced with big deductibles.

http://www.startribune.com/lifestyle/health/80094942.html?elr=KArks:DCiUHc3E7_V_nDaycUiD3aPc:_Yyc:aUU

People with insurance deductibles tend to put off medical care early in the year because they have to pay out of pocket. Some then burn through their deductibles anyway because of unexpected doctor visits or a trip to the emergency room. Anything else they get done this year is covered by insurance so they're trying to cram in procedures before Jan. 1.

It's a problem that's only going to get worse as more people get insurance with high deductibles.
About 13 percent of insured Minnesotans -- or 550,000 people -- now have high-deductible health plans paired with health savings accounts. These plans, which have been around since 2004, have deductibles of $1,150 and up for single coverage and $2,300 and up for family coverage

Even those with traditional plans are facing higher deductibles. Blue Cross and Blue Shield of Minnesota's Personal Blue policies, for example, have deductibles of $1,500 to $4,500.

Doctors report that deductibles do affect patient behavior. Many patients now ask about price. If in the past they demanded a costly MRI, now they'll question whether they need one. The plans' advocates say this sort of engagement is a first step to curbing the nation's runaway health costs.
But once the deductible is met, "they go right back to their old behavior," said Maureen Swan, a principal at health care consultancy MedTrend Inc. The incentive then is to use as many medical services as possible at little or no extra charge before the new year.

Of course, nothing is free in health care, and these extra procedures can translate into higher future premiums. But that doesn't stop people from viewing them as an early gift from Santa.

Hospital officials speculate that the weak economy also has played a part in the year-end crush. Some who had been putting things off because of the economy simply can't wait any longer. Others are afraid of losing their jobs and want to use their insurance while they still have it.

The line about Santa really irked me. Of all the western nations, only in the U.S. is access to medical care called a "gift from Santa".

Sadly, nothing in the bills passed by either the House and Senate allow for large annual out of pockets (with provisions letting them go up each year) so, for most of us, this year end situation will not change.

[elehhhhna]

1. ooh la la I'm gpoing to be wasteful anfd recklesss and have that mole checked

now that I've hit my max out=of=pocket amount for the year!

Yep! Edgy and on the fringes of the outlaw!!!1! That's how I roll !111 USA! USA!

[elleng]

2. Me too! Had mammogram yesterday!

[murielm99]

3. Too bad I can't get my cataract surgery done before Jan. 1st.

Think of all the money I would save.

Early in January 2009, I had e. coli. We had to pay all the deductibles then. I guess I should have arranged to have e. coli right after Christmas.

[elleng]

8. Of course!

Watch what you eat WHEN YOU EAT IT!

Last year I made the mistake of having my annual check up in Feb! 'Ate' the whole $500!

[Sarah Ibarruri]

4. Not just that, but have you seen the medical gift cards? Only in the U.S. is medical help

something you might get as a gift.

[johnaries]

5. Actually, both bills cap annual out-of-pockets, as well as

lifetime out-of-pockets and increasing premiums.

[dflprincess]

6. The maximum annual out of pockets in both bills

are as bad as what many people currently have. There is no relief in that regard and they are high enough that they will prevent people who are being forced to pay for premiums from having access to care. Also, insurance companies will be permitted to raise out of pocket expenses every year.

You'll have to provide a link for there being caps on lifetime out of pockets - that's the first I've heard anyone claim that. The bills do remove the cap on lifetime benefits paid out, but I really doubt that that is being done for of pockets. And, there is no real control of premium costs.

[johnaries]

7. Actually, it eliminates lifetime limits rather than an actual cap.

I misspoke.

Cap on Total Out-of-pocket Spending
 Out-of-Pocket Limit
o The Patient Protection and Affordable Care Act will put a cap on what insurance
companies can require individuals to pay in out-of-pocket expenses, such as co-pays and
deductibles.
o The Patient Protection and Affordable Care Act also will eliminate lifetime limits on how
much insurance companies cover if you get sick and restrict annual coverage limits.

http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm

AS far as the premium costs, there are "free market" controls, but there is also the MLR cap.

Lower Premiums
o The Patient Protection and Affordable Care Act will also require premium rate reviews to
track any arbitrary premium increases and crack down on excessive insurance overhead
by applying standards to how much insurance companies can spend on non-medical
costs, such as bureaucracy and advertising.

(same link as above)

Keeping Down the Cost of Coverage
 Stronger medical loss ratios. Health insurers will be required to spend more of their
premium revenues on clinical services and quality activities, with less going to administrative
costs and profits – or else pay rebates to policyholders. These stricter limits will continue
even after the Exchanges begin in 2014, and apply to all plans, including grandfathered plans.

http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm

edit to correct html errors.

[dflprincess]

9. The free market has just worked so well at controlling costs so far

and I believe Wendell Potter made it clear that they will find ways around the MLR which is hardly surprising.

I did find my copy of the House bill and that allows an annual deductible of $1,500 with maximum annual out of pockets (cutely called "cost-sharing") for a single person of up to $5,000 and $10,000 for families. The out of pockets do not include premiums and any uncovered expenses (like vision or dental) will not count toward the total.

I have a PDF version saved and this information is on page 23 in Section 101.