Igor Volsky at Think Progress brought this recent report (PDF) from the Massachusetts Division of Health Care Finance and Policy to my attention. It adds even more proof to the mountain of evidence that private health insurance companies in America are a total failure at cost control. The study found that private insurance health care cost grow in the state grew much faster than public health insurance cost.
Spending by private payers grew faster than spending by public payers. The rate of growth for spending on privately insured people from 2007 to 2008 also outpaced the growth in spending for Massachusetts residents in Medicare (4.8 percent) or MassHealth (2.8 percent) during the same time period (Figure A). The rates of growth for both private and public payers in Massachusetts continued to outpace increases in per capita state gross domestic product and wages.
Even more important than the fact that private insurance cost grew faster that public insurance is the reason private insurance cost went up. It was not a result of the people covered by private insurance using more health care services but mainly a result of providers charge significantly higher prices for the services they did use.
Faster growth in spending by private payers was largely the result of increasing prices
Rising prices played a significant role in increasing private spending for inpatient and outpatient hospital services, as well as physician and other professional services. Higher prices explained virtually all of the increase in private inpatient spending from 2007 to 2009. Similarly, increases in prices accounted for about half of the growth in outpatient spending from 2007 to 2008, and virtually all of the growth from 2008 to 2009 (when spending per member year grew 13 percent). For professional services, higher prices explained 77 percent of the growth in spending from 2007 to 2008, and 88 percent of the increase from 2008 to 2009.
[...]
In each of the three categories, higher total private spending was predominately driven by price increases. For inpatient and outpatient hospital care, “pure” price growth accounted for most of the change in total spending. Neither changes in the distribution of care across providers nor service mix contributed nearly as much to spending growth as increased prices. For professional services, the impact of pure price was slightly less clear, due to the challenge of identifying shifts in the distribution of service use among providers. However, the same pattern was apparent: price changes drove most of the change in total spending each year.
In contrast, growth in Medicare and MassHealth spending per member year predominantly reflected increased service use per member year.
This is one of the largest of America’s many health care cost problems. The many private insurance companies lack the market power, will and/or ability to negotiate with providers for low prices. Forcing low income individual or senior citizens to shop for private insurance on an exchange will do nothing to address the problem.
The only way to fix this issue is to give everyone access to the government’s huge market power and ability to negotiate for lower prices. The best and simplest way is with single payer, Medicare for all.
You can also indirectly replicate most of the benefits of using the government’s market power with all-payer, where the government works with all the companies to agreed on one fixed set of prices everyone one will pay. In addition to getting lower prices you also eliminate a huge amount of the administrative waste which comes from each payer having a different price negotiated with every provider.




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Um hum.
Thanks John. What is it going to take to make Washington understand that its Single Payer …Single Payer….Single Payer
It is a known fact that Physicians charge the privately insured more for visits and procedures. WHY?? To make up for the losses incurred when seeing public insured individuals. Payments coming from public plans are more than inadequate. The doctors and hospitals must make up the shortfall somewhere.
The Mass study was comprehensive – indeed so much data it became blue smoke and mirrors to hide the basic facts -
it is not about doctors charging/making more and more, but doctors are working more and putting more services out to the Medicare population – whether they need it or not.
it is about for profit health care facilities charging more and more – indeed images from old equipment are somehow more valuable.
And the 2009 study on alternative payment methods – the study repeated in 2010 that went nowhere – the idea that is the heart of the latest Obama “I can cut cost without Maryland Medicare Waiver for price setting board and rule that all providers paid same rate, and without going to single payer” – is reported on with the comment that “Capitation eroded further as a method of payment in the private Massachusetts health care market..(despite)..the increasing political and industry support for alternate payment methods, including support of global payments in recommendations issued by the Special Commission on the Health Care Payment System in 2009 (with) relatively few private
health care services .. financed through capitated payments.
Indeed the use of low cost community care is dying relative to teaching hospital or tertiary care or specialty hospitals – all because the health insurance companies buy health care providers via ever higher payments for their who accepts our payments list – the main competitive tool to sell the policies.
The Maryland Medicare waiver should not be a waiver – it should be compulsory – along with the rule for each state setting up payment setting boards and all providers in the state getting the same price per service from all third party payers.
“It is a known”???
If it is “known” then you won’t mind backing that up with links and references.
Because it so well “known”?
The Mass plan is a failure.
Because it let the parasites feed on the host some more. What could possibly go wrong.
They’ve had decades to fix the “problem”. Price control is not something they want t fix. You don’t stop gouging consumers. You keep doing it. That’s business.
They provide nothing. They are parasites.
And they call it “good business”.
Not really – indeed that is the lie sold by the health insurance companies and since it leads to a little more income, bought by many doctors, as the ins co’s buy names for their “who accepts our payments” lists – the main competitive tool in policy sales – by bidding Medicare rate plus some percentage for those names.
It is amazing how much is wasted by the insurance company approach – Mass General in Boston estimates 1/3rd of its cost is ins forms billing. Most Doctors offices have a multiple person staff for billing.
Indeed the study showed that costs charged per service by doctors in Mass barely changed as total health care costs rose 4.8%. The ins co’s do not feel they need to bid higher for doctors during the recession, but do need to bid higher for acceptance to the latest for-profit hospitals.
The British medical system seems to be well in hand, I don’t know why we can’t follow their lead.
The doctors there are so thorough that they even decided to prescribe water for their patients. Great system.
What exactly do so called private health Insurance companies do? It seems to me all they are is unnecessary bureaucaries that do nothing more then shuffle paper and rake off huge sums for a few CEOS and stockholders. Its a scam and one being supported and perpetrated by the Pols who they The Insurers) fund with they’re booty. Its more Too Big To Fail BS and its the fault of our corrupt non-political system. We need a REVOLUTION to stop this thievery.
If anyone has ANY question about Obama’s HCR, read Jon’s extensive, fair, thorough coverage.
If Dems don’t hold Obama accountable for blowing a once in thirty year opportunity to enact substantive HCR that would’ve substantially REDUCED COSTS AND substantially IMPROVED HC for MORE Americans, we will get EXACTLY what we deserve. The 2012 election is NOT about the lunatic, whacko Republican who runs against Obama; it’s a referendum on Obama, it is all about holding Obama accountable for his failure to even try to do what he campaigned on. Shame on Obama, shame on EVERYONE who votes for him in 2012!!!!!!!!!!!!!!!!!!!!!
Well, now we have a large bureaucracy to determine your eligibility in various different health plans,should you not be covered by an employer. So each time my ‘status’ changed, i had to enroll in a different health plan. I went from employed, to laid off with COBRA, to collecting unemployment, to not collecting unemployment (99er), to employed again, to unemployed with no income again. Each change of status meant new ID cards, new brochures, developing in me a thorough loathing of this whole industry.
If anyone in Congress cared, it would be obvious that private insurers do not consider their jobs to be keeping costs down. Their job is to maximize profits, which requires them to increase their insurance prices as much and as rapidly as possible, while paying out as little in claims – legitimate or otherwise – as possible. That’s their job. Their bloody good at it, in part because they are mysteriously able to convince legislators to make them subject to as few governmental rules and oversight as possible.
That obvious picture would tell Congress that relying on private insurers will never keep costs down. It will only keep them up and rising faster than any index used to track them in comparison with other costs.
Congress has convinced itself that it needn’t care that that’s the picture. That is, so long as its concerns about cost are limited to federal expenditures (excluding defense and spying and the cost of their own benefits), which allows them to claim that the issue is NOT whether their constituents and fellow citizens have access to health care.
Curiously, such arguments have left constituents and legislators in every other developed country laughing in the aisles as beyond foolish. Surprisingly, that hasn’t happened here – yet.
iff we have a govt with functioning regulatory institutions, will and bipartisan support.
big if and we don’t.
even less administrative waste with single payer.
single payer also greatly diminishes (hopefully destroys) the insurance industry lobby power to influence govt against the public good.
amen. and while we’re at it, let’s go further with the grass roots single payer plan: Expanded & Improved Medicare for all.
everybody in, nobody out
no deductibles, no copays, no coinsurance
doctors and hospitals compete for your business
if our MA state legislators (80% D) and gov deval gave a flying &%*! what the voters here think, we’d already have state based single payer.
Single Payer Ballot Questions Pass in All Fourteen Massachusetts Districts!
I guess that would make them adequate.
As you say this is just more proof that private insurance companies are no good at controlling costs. Pick your reason:not enough market clout, uncaring or ih bed with the AMA. And the really sad thing is millions don’t care, never did and will never pay enough attention to find out. So we spend near 17% of GDP for health care ($2.4T) where other western countries pay 10%. And who has the huge deficit problem and the competitive problem as corporate health care costs get passed along in their products? Oh yeah, we do!!!!
As ususal Selise, you’re right on. I see you like MR Black.
“The shortfall”
Right-it would be a shame if we had any more doctors eating out of dumpsters…
Why? OH OH wait I know that one. Got it, b/c they can.
With Obamacare it encourages insurances companies to pay as much as possible since they’ll get more money as part of their 20% administrative share – saving money would actually lose them money with the way it is designed.
But all Obamacare did was make that a formal rule. Insurers never really cared about cost. If their clients paid what they wanted for premiums, who really cares what they get to pay to providers. They can always get a little extra by cutting people off for whatever reason struck them, if they wanted a little extra. Single payer or strict regs like all payer is the only way to control this cost. And I woulnt’ hold my breath about all payer too long either.
As soon as we get them all out (congress) and replace with Americans who will represent “America”.
True -
we must share some coffee at the shop of your choice some time in the future – I know I would enjoy it! Wellesley/Newton is my world but I’m open!
I love your love of MMT – which we both agree is true only I add “as far as it goes” usually in these posts, as I worry about inflation.
What a surprise!/s
“If their clients paid what they wanted for premiums, who really cares what they get to pay to providers”
When it’s based on profit margin for service, you’d care a great deal because the difference between what the company receives in premiums and what they pay out is their profits. Now instead they don’t profit from reducing costs, but instead they profit from increasing costs.
That may be a tough slog, if you’re thinking along the lines of what VT is trying to do.
As I understand the VT single payer goal, HHS waivers for such may be doable. Yet Congress would also have to accommodate it in ACA. With the GOP House that would be a show stopper, no?
waving from your west!
my understanding (from my congress critter’s office) is that MA already has a waiver — which we got for romneycare. i was also told that waiver is why we can keep our exchange, etc. instead of having to use the federal plans.
have not done anything further to confirm that info though…
LOL. just lucky i guess.
maybe next time you’ll be telling me i’m full of it :)
Framingham? – Zaftigs (the old Joan and Ed’s)?
We will get together eventually!
I do not believe Congress need do anything if the waiver for the single payer is granted in 2017. But to get a waiver at an earlier date requires Congressional action as Obama put in a no major waiver until 2017 rule into the ACA.
The state can use its own exchange via a waiver on the exchange required to be set up by 2014 date.
In other news:
Water is wet and ice is cold.