tag:blogger.com,1999:blog-32053362.post3927094207174396890..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: What's going on at Harvard?Paul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-32053362.post-38600526155685033302015-01-06T17:59:12.903-05:002015-01-06T17:59:12.903-05:00Stop whining.Stop whining.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-85153010655692578692014-11-04T09:16:26.808-05:002014-11-04T09:16:26.808-05:00I don't understand the health care system at t...I don't understand the health care system at the level of some of the other commenters, but these hospitals employ Harvard Medical School faculty and teach HMS students. I think it's a good idea to drive down - or at least make transparent - these costs. But the effect will be on the wallets of HMS-affiliated doctors and may be on the student access to these top teaching/research institutions. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-80443963963426907492014-11-04T07:29:07.079-05:002014-11-04T07:29:07.079-05:00There are two issues that trouble me about this as...There are two issues that trouble me about this aside from the high prices commanded by certain Harvard affiliated hospitals and the plan’s failure to address that. Both apply to employees in many organizations, not just Harvard. The first is that, in my opinion, too many employees view health insurance as pre-paid healthcare instead of the transfer of actuarial risk from the employee to an insurer, including a self-funded insurer. That tends to lead to a preference for lower deductibles and coinsurance than is probably appropriate, especially for higher income employees. <br /><br />The second is either the employees don’t understand that money spent by an employer for health insurance is part of their total compensation and tends to crowd out the ability to raise wages if health insurance costs are rising faster than general inflation. Alternatively, employees may indeed prefer more of their total compensation in the form of health insurance benefits mainly because of the employer tax preference. That’s an issue that should be addressed as part of broad based tax reform.<br /><br />As for the suggestion that high deductible health plans are regressive, perhaps that impact could be mitigated by Health Savings Accounts into which the employer would deposit a sum of money inversely related to income. I don’t know whether or not the law would even allow such an approach, however.<br />Barry Carolnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-86838561759845313542014-11-04T06:46:36.477-05:002014-11-04T06:46:36.477-05:00Great post, Paul! You are clearly right.
Your po...Great post, Paul! You are clearly right.<br /><br />Your point is the most interesting one, but let me call your attention also to the HDHP point - high deductibles are inherently regressive, and they have other deficits TNTC (medical jargon, usually for microscopic urinalysis - Too Numerous To Count.) My policy paper for the AAP, published in Pediatrics earlier this year, looks to be the most complete critique on HDHPs at this point. These things are just poison! I think many people are now experiencing them for the first time directly themselves and coming to realize how awful they are.Budd Shenkinnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-4870557624523099712014-11-03T17:11:07.698-05:002014-11-03T17:11:07.698-05:00I don't pretend to understand the relationship...I don't pretend to understand the relationship between Harvard and all its hospitals, but on the face of it this appears to be the world's most obvious case of an employer's failure to use its clout to protect its employees from predatory health providers. Instead, they all take the route of forcing the employees, who have no clout individually, to pay more of the freight.<br />Other than a few like Walmart contracting for specific surgeries, etc., employers have largely been asleep at the switch on this issue. I don't understand it, since it would benefit their bottom line as well as gain them LOTS of appreciation from their employees.<br />In Harvard's case, there seems to be a conflict of interest involved, no?nonlocal MDnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-36440480496653580622014-11-02T19:46:23.086-05:002014-11-02T19:46:23.086-05:00Just to clarify, the new Harvard thresholds of $15...Just to clarify, the new Harvard thresholds of $1500/$4500, though technically "lower" than the old ones ($2000/$6000), are functionally higher because the old ones only applied to co-pays (fixed fees when you visit the doctor, usually $20 per visit), whereas the new thresholds include "co-insurance" which the insured now pays for diagnostic tests, procedures, hospital stays, surgery, etc. While it would take 300 co-pays to reach the old $6000 family threshold in a year, it is comparatively easy to reach the new $1500/$4500 threshold - a procedure or two (including childbirth) and you're there. Harvard Profnoreply@blogger.com