I've heard they will be staffing nurse practitioners or something similar in the stores so people will be encouraged to do one stop shopping when they are ill and covered by Etna.

They've already had their Minute Clinics for a few years.

I was not aware of that. They don't offer that at my local CVS.

They already provide cheaper medication if it's something you have to take daily with their 90 day prescription plan.

Rara - as stated, they already have minute clinics in place in many, many locations. It's been reasonably smart, but nothing game changing. As a note though, that has nothing to do with Aetna as any insurance carrier can contract. And I don't foresee that changing moving forward (though you could argue they will give preferential pricing to Aetna which will hurt the other carriers)

As for the cheaper medication, a few things:

- Most likely your employer made that decision unless you aren't covered by an employer.
- The reason is that overall drug prices are cheaper for a larger batch. CVS did not make this true
- All PBMs do this and have done this. So how would this be bringing costs down?

Again, I'm just curious what you think they are doing to help bring costs down. Because I don't particularly see it. Instead I see an opaque system with incredibly limited oversight and minimal insights into "fixing" healthcare costs.

Rationing

http://www.cnn.com/2017/12/11/health...irl0954AMStory

Rationing

Nah, just incompetence. They're willing to pay for the more invasive/greater side effect procedure It's a lot of things, but it ain't rationing.

This sort of thing happens all the time - it took several years for insurers to agree to pay for ultrasound for guiding central line placements, long after it was clear that using the ultrasound was markedly safer and in the long run cheaper, as it cut way down on infection/dropped lung/other bad ****. You didn't hear about it because there wasn't a sympathetic 15 year old high school junior to put a face on it.

Aetna DOES have a vague point here - they don't want to pay for holistic kelpsicle therapy for end stage pancreatic cancer. I'd guess it's more of a case of a ginormous bureaucracy moving slowly than an evil mustache twirling VP of claims denial sitting in an ivory tower in Manhatten - I've done a lot of health care admin work over the years, and a rule of thumb is to just assume that **** goes sideways due to simple incompetence.


MM MD

The problem with "Minute Clinics" is that it actually increases overall healthcare spending. The easier access to healthcare you create, the more likely it is to be utilized. We sort of want to make healthcare inaccessible. You create Starbucks, the more coffee drinkers you will have.

I hereby declare you qualified to be Secretary of Energy

As long as the health care lobbyists are filling politician's pockets, health care will never be fixed.

The rest of the developed world looks at America in absolute bewilderment as it actively avoids the obvious solution with the consent of people WHO DON'T ****ING HAVE INSURANCE!! Honestly the whole thing is insane to me. I guess people just want to die young and don't mind taking others with them..

That 15 year old should stop being such a leech. Find some bootstraps and get to work (at a job where frequent seizures aren't a deal breaker).

I seriously hate this stupid country so much.

Yep. We are getting rid of multiple billion-dollar companies because it is the right thing to do. The public can't vote on it.

Powerful people beholden to powerful companies. Sucks. Sad.

What's the general consensus on whether Obamacare has been a net negative or positive for the country thus far?

I think you're a bit too into the subject matter to see the simplistic messaging. When single payer or the public option was brought up there were a ton of stories like this, bureaucrats preventing from people getting obvious medical procedures they needed with the government bureaucrats citing how much it costs, etc. with the implication that the current system is better because there isn't this kind of bureaucratic fiat.

Of course the truth is that those bureaucrats already exist and do deny coverage with reasons ranging from costs to simple incompetence. They just exist in the insurer's buildings instead of HHS or CMS, though they're there too.

Nah, I was just objecting to the term "rationing", which this isn't a case of.

The whole discussion of who's going to decide what gets what care goes way beyond this.

MM MD

fair enough

Does anybody think this is a f&cked as I do? How the f&ck should doctors even get involved with this?

***Dear Clinician,

As a reminder, we are modifying our policy regarding releasing payment amounts to patients.

Effective 12/13/17, we will release the "Bill Insurance" and "No Insurance" amounts to patients who call and request it unless you specifically direct us not to by emailing us at info.xxx. When patients do call our office for amounts, we will look up your account preferences before releasing any payment information. Additionally, our online Pay Assist Tool will NOT provide payment amounts to patients whose clinicians limit quoting of EasyPay amounts.

If you have further questions or concerns, please contact us at info@xxx.net.

Thank you,
Diagnostics

LOL at Hobbes. "Incompetence" that produces those results is, as a practical matter, indistinguishable from malice. Once again your defense of the status quo is a transparent attempt to paint your profession (and the entire "health care" industry) in a more favorable light.

Rara typifies the mind set of these people though. If poors hadn’t increased the costs of healthcare people like guys sister would be just fine. And apparently amazon is helping.

My posting history ITT would pretty clearly show that I don't feel the health care industry deserves to be painted in any sort of favorable light, and I've noted that docs deserve a piece of the blame for how screwed up it is.

And believe me, docs view the insurance companies as adversaries, with good reason. They ain't our friends in any way.

I was commenting on one particular event, in which an insurer for reasons that make no sense, refuse to pay for a procedure for a particular issue but are willing to pay significantly more for another procedure for the same problem, even when multiple specialists in the area say it's a bad idea. I think incompetence is the most likely reason. If you want to bring a bunch of other crap into the event that reflect your feelings about health care, have at it.

MM MD

ultrabasic questions,

as i understand it, the individual mandate requires ppl to buy a minimum level of health insurance else face a penalty

one of the problems with the repeal is that some young healthy people will naturally stop buying, people buying healthcare insurance will on average be less healthy and more expensive to insure, prices go up, burden is shifted to the less healthy (ie olds, ie GOP voters). have i got that about right?

what is the piece of legislation which means health insurers cant charge $9999999/month for those who have expensive healthcare needs. does that have anything to do with the individual mandate. is it under threat via this tax bill

The term you are looking for, I think, is "community rating," where the only factors insurers are allowed to use to set the price of insurance for a given customer is, IIRC, county of residence, age, and whether or not they smoke. It doesn't appear to be under attack. Yet.

this was already what was happening, seems like the repeal will just speed up the process

alright so what are my options if i decided to not to buy into a healthcare marketplace plan next year? is catastrophic insurance coming back or is that still not a thing?

there's gotta be a huge market that is opening up to insure healthy ppl, but is it legal for companies to offer insurance to these people?

We're certainly in an unsustainable place. You simply can't have the community ratings aspect, guaranteed issue, but not require everyone get coverage. The problem is that Congress can only eliminate the individual mandate aspect - I don't think they have any ability to remove the community rating or guaranteed issue. (They've tried and failed.)

Don't really know how this ends, though.

It ends by a bunch of people bitching about how they can't get health insurance because they voted in people that explicitly told them they were going to take away their health insurance.

Frankly, I think a whole lot of deplorables are going to have watch their family members die before they're able to connect the dots and figure out that the right doesn't have their best interests in mind.

We're probably 20 years (hopefully!) away from some form of universal healthcare or riots about it. I'm imagining hundreds of terminally ill people setting themselves on fire on the capitol steps to start the movement.