[quote=ocrenter] . . . reality is every PPO patient that walks into a physician’s door is viewed as a cash cow. like it or not, this is the reality. this is especially true in regard to the low deductible plans, which one will immediately switch to if there’s ever a chronic disease diagnosed. as for the high deductible plans, yes it does prevent someone from going in to seek care, and this may also cause a real chest pain guy to wait until a heart attack, forcing a 911 call to the ER.
The young and healthy are going to pick the HDHP. That much is true. But their utilization under the HMO system is not high either.
The real juice comes with the population with chronic conditions. Those will not be picking the HDHP. So if 50% of PPO are HDHP, I guarantee you the other 50% picking are chronic disease folks picking low deductible plans.
-snip-
The cost spillover from the PPO guy will be adsorbed by everyone else on the PPO plan, and that is why everyone pays.[/quote]
ocrenter, I agree about the “cost spillover” from those with chronic conditions. That’s why individual and small-business plans are priced according to age. This is done so the healthy in a particular age-group can subsidize the ills of their unluckier (or more often, those who made bad choices in life) contemporaries. This “cost” spillover in premiums applies to both PPOs and HMOs alike.
Your “PPO guy” (above) is likely paying a far higher monthly premium than your “HMO guy” is, either themselves or in conjunction with an employer. Many, many persons that would experience the problems you recounted above are at an age where they have been downsized, involuntarily retired or laid off and thus have to pay their OWN health premiums.
You touched above on the “choices” people make between low and high deductible plans as though they were pastries displayed in a bakery case. More often, people who choose HDHPs can’t afford the premiums for lower-deductible plans. Even HMO premiums are higher than HDHPs. Many small businesses can only afford to offer HDHPs or the barest bones HMO to their workers/
For instance, for a new insured in my “age group,” monthly premiums are (approximately) as follows:
Kaiser HMO: $540 mo
Pacificare HMO: $530 mo
Indemnity Plan ($10,000 ded): $830 mo
Aetna PPO with $250 ded: $870 mo (Group only [not sure if still avail])
Aetna PPO with $500 ded: $790 mo (Group only)
Until 2014, these (individual, best-case scenario) HDHP premiums are currently subject to state of health):
Aetna PPO with $1750 ded: $523 mo
Aetna PPO with $2750 ded: $497 mo
Aetna PPO with $3500 ded: $421 mo
Aetna PPO with $5000 ded: $372 mo
Catastrophic coverage only:
Aetna PPO with $2500 ded: $281 mo
Aetna PPO with $5000 ded: $206 mo
Aetna PPO with $8000 ded: $173 mo
ocrenter, your two typical sample “guys” (with health issues) paid different premiums to have their coverage. Are you forgetting that your two sample “guys” paid substantial premiums to their carriers (perhaps $540 to $870 mo)?
Aetna reduces their payments to providers down to their “allowable charge” just like Tricare or Medicare. Not sure why you are stating that providers consider PPO patients “cash-cows.”
ocrenter, are you employed in the healthcare field? Just wondering.
