Open thread August 8, 2014 Dan Crawford | August 8, 2014 5:58 am Comments (15) | Digg Facebook Twitter |
Illinois’ new Medicare-Medicaid narrow networks: the older you get, the less care you get?
In Illinois elderly patients on both Medicare and Medicaid are being forced into narrow networks under one insurance company (e.g., Aetna, Blue Cross, Cigna, Humana, Ilinicare, Meridian).
They may be lucky enough to keep their personal care provider — but he or she is stuck referring them to specialists on the network. PCPs usually refer patients to a physically contiguous medical group: in the same hospital or office building. What happens if PCPs are forced to refer the elderly (the sick elderly) to addresses all over town?
Old people see a lot of specialists. The older — and more infirm; the more unable to shuffle all over town by themselves — the more specialists they need to see. Some of the medical deflation we are going to see here may not be a healthy trend at all.
This is just speculation on my part — as I learn more I will add or subtract.
From my own experience and those of close family members I would assess the value of the referral via a PCP as bullshit. Medicare allows direct access to specialists. That save on the cost of seeing the PCP when the patient knows quite obviously that if the pain is from a sharp, sciatic like jab running down one’s leg it isn’t an internist who is going to resolve the problem. Why pay for the referral? Also, what makes the referring PCP such an expert in the process of referring? It seems likely that this referral for specialist consultation and evaluation is meant only as a road block put in front of the patient. How does it makes sense that one’s medical insurance doesn’t cover a medical procedure, including the examination, unless a third party, the PCP, is consulted first? Seems like restraint of trade to me, but that’s an economic concept that seems lost in recent years.
And what of the health insurer’s role in all of this? Why is the insurer insisting on paying the PCP to examine and then refer a patient who will then have to re-examined by the specialist? Does a financial company, that’s our health care insurers, really expect to save money by paying two professionals when only one is going to provide relevant care for a specific medical complaint? It seems obvious that the value of the PCP can only be to reject and deny a patient’s need for specialist care. And again, even if I’m referred because the malady is undeniable, why should I trust that the PCP is going to make a wise referral? Does the PCP know so much about all medical specialties and the practitioners of same?
The process is bogus and intended only to limit access to specialist care. If health care insurers don’t want to provide comprehensive health care coverage why let them in the game to begin with?
Hmmm, Jack. I had ongoing lower back pain. The last specialist I considered needing was an Urologist for the condition. My PCP knew I had prostatis. ‘Course she is very good and thus saved a bunch of money to our Ontario system if I had blundered around on my own.
Personal bias and economic thought
During the first 15 years of my career I received raises well above productivity measures. During the last 10 years I have not kept up with inflation.
The economic data available when I was in school was pre-Reagan. Median wages were keeping up with productivity. So, my personal data did not look like median data until 20 years after median data had started to change. I suspect this made it harder for me to notice that the median worker stopped keeping up with productivity 30 years ago.
Did Paul Krugman reach his peak earning power writing about Bush’s first term? Has stagnation of his salary made it easier to notice stagnation in general?
don’t know for sure, but I think your pattern is typical for engineering employees. unless they get into management.
Yes, my pattern is typical for engineers. It is also designed into our local teachers contracts.
My question is, did the fact that what indiviuals (like me) saw in their personal salaries from 1980 to 2000 was different from what the median employee saw from 1980 to 2000 slow our ability to see the stagnation of median salaries?
Certainly if the patient is experiencing an amorphous discomfort with no clear indication of the source of that discomfort other some internal organ dysfunction it makes sense to begin with the more generalist specialist, the internist. Through blood and other forms of evaluation the source of the condition is narrowed down until the most suitable specialty consultation becomes apparent. That’s not so much a case of gate keeper function on the part of the PCP, but a valuable first step in determining the source of the too general to tell discomfort. But if you fall and break your leg whose medical expertise are you going to seek? I’m assuming some personal awareness of self together with one’s knowledge of one’s own medical history. The point is, should the first step serve as a beginning of a solution to a mystery or as a means to manage medical costs rather than manage care?
in my case it did.
Starting with Reagan In the DoD side of the MICC all a techie had to do was tell the colonel; yes sir 3 bags full, you are going to get promoted and the stuff is better than the junk it replaces.
Slowed a little with Bush I but was a really good ride with Shrub!
Will return to a good ride with Rand Paul!
alas, I did not work for DOD. I had enough trouble getting paid for the work I did for (deleted). Which was not helped when I told them it was cheaper to do it right than to do it wrong. They didn’t care, because, you see, it wasn’t their money.
Never could salute.
I don’t know if anyone has mentioned this on any of the Social Security threads (I haven’t seen it and I try to read the articles and comments), but apparently this year’s Trustees Report omitted income replacement rates, which were included in previous reports.
I heard something about this. will try to verify and get back to you.
also i think it can be calculated from a table that IS included. i’ll try to do that too.
check back later. if this thread runs off the front page, remind me later.
Thanks, Dale, but I don’t really need the numbers – I assume they’re very similar to last year’s values. The point in the article I linked to is that this is useful information that should be included, so its deletion might be politically motivated. This year’s table (V.C.7) shows that benefits increase in real terms, reaching about twice their current level in 2075. Last year’s table also shows that, at NRA, the income replacement rate is nearly constant (after dropping a little in the next few years). Without this information, it is easier to make the argument that Social Security will be too generous in the future. (This year’s table does have AWI as the last column, so the fact that wages are rising in real terms is not totally left out.)
yes. i heard some more details about it’s being left out. waiting for confirmation from those who know more than i do.
you are right about the numbers.
Steve Goss talked about the replacement rate in
Testimony of Stephen C. Goss, Chief Actuary, Social SEcurity Administration
Before the Subcommittee on Social Security, Pensions, and Family Policy
of the Senate Committee on Finance
“Strengthening Social Security to Meed the Needs of Tomorrow’s Retirees”
Dirksen Senate Office Building, Room 215
May 21, 2014. 10 AM
I don’t know how to link to that or even send a copy, but i’ll try to write a post about it soon.
suspect this had somthing to do with the delay in issuing the 2014 Trustees Report
your cite to Hilzig is pretty much what I have heard.
as for replacement rates showing SS is too generous:
the lying bastards will say anything they think will help weaken Social Security. a few years ago they were saying SS was not generous enough…
If you calculate the “rate of return” that it takes to get those replacement rates you will find it is better than any lower income worker could hope to get on ANY market, and quite reasonable for even higher income workers for any “risk free” investment plus insurance.
i did this carefully back in 2009. those who did not do it carefully shouted insults at me from the back of the room.