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View Diary: HCR:  Where Do We Go Now, Sweet Child 'O Mine? (45 comments)

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  •  The whole point is they don't want HMO (0+ / 0-)

    HMO insulates the patient from the true cost of medicine, whereas PPO makes the patient very aware of the costs.

    Instead of mandating one HMO plan in the exchange, why not mandate one HSA plan instead? I've always liked HSA plans, and it also has bipartisan support.

    •  Why? (1+ / 0-)
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      yella dawg

      Do you think that HSA's are a public policy for a family earning $50,000/yr. with a diabetic child?

      The problem with high cost-sharing policies is that as the famous RAND Study points out, people cut out the good and the bad?  Do you think a family is likely to take their teenage daughter who after school is lies in bed every day, cries, and tells her parents that they don't love her to shrink?

      HMOs, by limiting the bargaining power of providers, also control health care costs.  That's what the data shows.

      •  True. HSA is better for generaly healthy patients (0+ / 0-)

        Somebody with regular recurring health conditions will not be able to save up any substantial savings in the HSA account. But as I said- it should be a choice in the exchanges.

        How does HMO's limit the bargaining power of providers any better than PPO? PPO's also have in-network and out-of-network differentiation. The Kaiser example you are citing is a different animal. That HMO actually owns its own hospitals. Kaiser patients go to Kaiser hospitals exclusively. And actually this is not a bad idea at all. But I don't think the savings come from the HMO part of it. The savings come from the fact that the insurer owns the hospitals, and the insured are restricted to that hospital. In other words- a very restricted set of captive providers. San Francisco's exceptional 'Healthy San Francisco' program is somewhat similar. They restrict the patients to only local County hospitals and clinics (they might open up to the local Kaiser hospitals later- remains to be seen). By doing so, they are able to insure people for ridiculously cheap prices.

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