Explain to me why it is that the bigger the delivery
system gets, the more they can extract from the
payers? Yet the bigger the payer, the more they have
to pay (yes, this is true)? I’ll bet BCBSMA isn’t
paying much lower (if at all) rates to Partners
than HPHC or Tufts. That’s the equivalent of a
product supplier dictating to Wal-Mart what price they
should get. If a payer’s too small, the provider
won’t negotiate, and if they’re too big, well, then you
might put the hospital out of business (hey hospitals,
you could try and actually innovate and compete, just
like every other industry). Where oh where did the
basic principles of capitalism run off to when it
comes to healthcare? (don’t answer that – the payers
are a victim of their own system – I know that)

I believe that the “death spiral” health insurance policy practice should be outlawed and any who practice it should be drawn and quartered (without anesthesia). It is an inherently dishonest mechanism of business and guarantees those who develop health care needs are cast aside when they most need insurance, and the insurance company skates free with most of the previously paid premiums! From the insurance industry’s standpoint the “death spiral” method of writing health insurance is as close to legalized extortion as one can get without visiting the inside of Leavenworth. Great work if you can get it!

I will let my husband, cr, respond to your query about how we came to an HSA and how we like it. He was more involved in the details of this decision. We are both retired physicians below Medicare age, for background.

http://www.ihealthbeat.org/articles/2007/6/4/The-Opacity-of-Health-Care-Transparency-Efforts.aspx?ps=1&authorid=1571

And to (gently) continue pulling legs re: following celebrities for healthcare…br’s right in that EMass residents face a different (lessened) burden of choice around Boston for excellent healthcare. But the public, in infinite wisdom and impressionability, still hears the bits that are newsworthy (maybe Ben Affleck researched the dickens out of MAH first?). I can query charges/costs for all area hospitals, compare national benchmarks, check HEDIS scores, and research many dickens…or I read that Doug Mientkiewicz went to the MGH. The Quality and Cost Council shows the Baptist (state FY04) had higher than average costs for hip fracture but I also know that that’s where the Celtics go, or that BIDMC is the Sox’s hospital, or that whatever performer went to MEEI…transparency certainly has its work cut out for it.

Ian M mentions marketing and I can’t help but wonder the implications as I watch our fiscal allocations shift…can anyone say Pharm?

As far as HSAs are concerned, I believe they’re great on paper…reduce inefficiencies by not fully sparing consumers the marginal cost of their marginal actions, but maybe limited in application (borne out by utilization rates?). Consumers purchase insurance for the peace of mind, and HSAs don’t necessarily provide this (”use it or lose it”). I don’t know that I could sell my peace of mind for a (pittance of a) tax shelter.