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Liz

Montana's Solution

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Liz

Montana's Solution

 

By Full Measure Staff

Sharyl Attkisson

Sunday, February 3rd 2019

 

Excerpt:

 

We begin with the cost of health care. High—and still rising. The cost of medical and drug benefits is expected to rise 5% in 2019. The 6th year in a row with a 5% increase. Premiums and out-of-pocket costs for employees and dependents will average $14,800. Congress has struggled for years to fight the escalating costs— with little success. But what if the answer lies in a place they haven’t bothered to look? What if it’s right there out in the open in Big Sky country? Today’s cover story takes us to Montana where their solution came from a senior citizen with a knack for numbers. Those who took her on quickly learned they’d grabbed a tiger by the tail.

 

Our story begins a few years back about two thousand miles from Washington DC in Helena, Montana - Where Marilyn Bartlett was assigned to tackle the seemingly impossible.

 

Sharyl: People have told you it couldn't be done?

 

Bartlett: Absolutely. People told me it could not be done.

 

It was 2015, and Bartlett had just been hired as Montana's new healthcare and benefits, or insurance administrator. Montana's 30,000 state employees and their families were in deep trouble: their health insurance plan was going broke. Fixing it would be like moving a mountain. But Montana passed a law saying it had to be done. So Bartlett had about a year to do what nobody else had ever done and what Congress hasn't been able to do on a national scale: drastically slash healthcare costs.

 

Bartlett: We had no choice, but I'll tell you, there were sleepless nights for me. I did not know how we're going to pull this off.

 

It was a tall order. But Bartlett came equipped with a very particular set of skills acquired over a very long career.

 

She'd managed finances at a Blue Cross Blue Shield plan, and been chief financial officer for a benefits firm. She believed the key to success had nothing to do with "insurance for everyone" after all, every state employee was already insured.

 

Sharyl: When we talk about what's the issue with healthcare today, a lot of people say the issue is getting everybody insured. This was not really the approach that you took.

 

Bartlett: You're right. I don't agree with that. I think the solution is getting the cost affordable and I did not take the approach of "insurance for everyone." I found a lot of waste just with the insurance part.

 

She began by comparing charges from two different hospitals for similar knee replacements.

 

Bartlett: And one came in around $30,000 in the other at $105,000. Huge difference. I just kept asking why, why? Well, the implant was much more expensive. Well, can I see the invoice? Can I see what you paid? No, that's private. You can't see that. So I couldn't get to the information. It was frustrating and I couldn't get to the answers. And one hospital said, well, we don't really know our costs.

 

Bartlett wanted to take the mystery out of hospital billing. Find out what things really cost, add on reasonable profit, and standardize prices. Her plan required an insurance company that would roll with the punches and fess up what it paid hospitals and why. Bartlett says Montana's insurer at the time, Cigna, would not play ball. So she fired them and took bids from other companies, settling on Allegiance Benefit Plan Management.

 

That's when she got her first taste of resistance from the insurance industry, including so-called third-party administrators or TPAs.

 

Bartlett: The other unsuccessful TPAs or insurance companies made fun of us and laughed, went to the Governor's office and said, 'what she's proposing is stupid. It's never going to go.'

 

With a new insurance company on board, the big questions were: how to set reasonable prices for medical care. And how to get Montana's hospitals to agree to them.

 

Montana's insurance plan had been paying some hospitals a whopping 600% of what federal insurance for the elderly, Medicare, pays for the same treatment.

 

After crunching the numbers, Bartlett suggested hospitals would get paid somewhere around 220 to 250 percent above Medicare. Way less - but still a healthy profit.

 

*snip*

 

Full Story

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Dean Adam Smithee

The REAL solution is so blindingly obvious that everyone but politicians can understand what it is.

 

Scrap the whole idea of all-inclusive healthcare "plans". Get back to a purely "insurance" model like I grew up under in the '60s/'70s: Pay for everything "small" (Doctor's visits, vaccinations, etc.) out of pocket, or maybe these days from HSA/FSA accounts for that purpose. Free Market controls the costs and prices become affordable to all but the poorest-of the-poor; If a doctor wants your businessthen he has to ;earn' it in the free market by selling you a product or service at a price that you're willing to pay for.

 

Insurance would be what used to be called "Major Medical"; a backstop that covers the severe things that would otherwise be financially catastrophic.

 

THAT, in a nutshell, was essentially the US healthcare system up until the late 1960s or maybe 1970s. It seemed to work.

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zurg

The REAL solution is so blindingly obvious that everyone but politicians can understand what it is.

 

Scrap the whole idea of all-inclusive healthcare "plans". Get back to a purely "insurance" model like I grew up under in the '60s/'70s: Pay for everything "small" (Doctor's visits, vaccinations, etc.) out of pocket, or maybe these days from HSA/FSA accounts for that purpose. Free Market controls the costs and prices become affordable to all but the poorest-of the-poor; If a doctor wants your businessthen he has to ;earn' it in the free market by selling you a product or service at a price that you're willing to pay for.

 

Insurance would be what used to be called "Major Medical"; a backstop that covers the severe things that would otherwise be financially catastrophic.

 

THAT, in a nutshell, was essentially the US healthcare system up until the late 1960s or maybe 1970s. It seemed to work.

I completely agree.

 

I just have one point of correction. You’re calling out “doctors” (and therefore doctors’ offices/practices which are very often like mom and pop shops). They’re not the ones to call out. Most doctors’ offices would be happy to get LOWER payments in cash from the patient. It costs quite a bit to do the billing and exposes them to major problems should their staff get some coding (billing) wrong to insurance.

 

You should be calling out the fact that INSURANCE companies will be fighting your idea tooth and nail. Obviously. But where you’re 100% correct is that the insurance companies themselves are at the root of the escalating costs problems. When a third party (insurance) pays for a good chunk of everything, the result is escalating costs/premiums/co-pays. If all the basic stuff were self-pay, the market would take care of it and 90%+ of small providers (not the big hospitals and chains though) would be a-ok with it.

Edited by zurg

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Howsithangin

It's clear that far too many haven't noticed the correlation between increased government intervention in health care and increased costs.

 

sigh

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Howsithangin

The REAL solution is so blindingly obvious that everyone but politicians can understand what it is.

 

Scrap the whole idea of all-inclusive healthcare "plans". Get back to a purely "insurance" model like I grew up under in the '60s/'70s: Pay for everything "small" (Doctor's visits, vaccinations, etc.) out of pocket, or maybe these days from HSA/FSA accounts for that purpose. Free Market controls the costs and prices become affordable to all but the poorest-of the-poor; If a doctor wants your businessthen he has to ;earn' it in the free market by selling you a product or service at a price that you're willing to pay for.

 

Insurance would be what used to be called "Major Medical"; a backstop that covers the severe things that would otherwise be financially catastrophic.

 

THAT, in a nutshell, was essentially the US healthcare system up until the late 1960s or maybe 1970s. It seemed to work.

 

The reason it won't work now is 3 decades of indoctrination that health care is a 'right', and therefore, somebody else should pay for it, everything from cancer treatment to bandaids

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zurg

It's clear that far too many haven't noticed the correlation between increased government intervention in health care and increased costs.

 

sigh

Yup. Sigh x 2.

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kestrel

Yup. Sigh x 2.

 

..X3

 

Kestrel...

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Big Dave

It's clear that far too many haven't noticed the correlation between increased government intervention in health care and increased costs.

 

sigh

Too many sighs, so I will just say ditto....

And it is the gummint that sets all the standards--through medicare reimbursement--even if is private insurance. They have to bill high so they will collect as much as possible even if it much less than what they bill. And then there's the EMR and the push to check on a growing list of metrics that must be questioned --"do you smoke, do you have falls, what about your weight"-- so that a separate visit may be requested to address the issues brought up. My wife is completing at DNP program and I am learning that the government mandates more and more of what they do and how they must interact with each patient. It's why so many docs are retiring. :coffeenpc:

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