Medical markets in something

by on February 29, 2012 at 1:51 pm in Medicine | Permalink

From John Goodman:

Can you buy health care the way you buy goods and services on eBay? Almost. A small, emerging online service called MediBid is letting providers bid to provide the care that patients need.

Patients must be able to pay cash. They fill out medical questionnaires; they can upload their medical records; and they can request the procedure they need. The patient’s identity is kept confidential until a transaction is consummated. MediBid-affiliated physicians and other medical providers respond by submitting competitive bids for the requested care.

Business at the site is growing.

Joshua February 29, 2012 at 1:56 pm

Now they just need an insurance approved version with compatible standards and rewards for choosing cheaper options (e.g. drive half an hour for a $700 cheaper MRI and they’ll give you $70 back/deducted from your premiums).

Tom Anderson February 29, 2012 at 3:25 pm

Hey, Joshua, problem is, all the overhead expenses related to insurance are what increase the costs that docs and patients are trying to get away from.

msgkings February 29, 2012 at 3:37 pm

I think it’s really more a problem of overuse of procedures, for doctor’s income and liability reasons.

KLO February 29, 2012 at 4:03 pm

Our third party payment system has been the greatest thing to ever happen to doctors. First off, it is highly redistributive, which means that people who need medical care but who would otherwise go without can afford to have the procedures performed. In a cash only system, doctors could only make money off of those who could–a much smaller group of people than under our current system. Secondly, because the person receiving the service does not pay for it directly, there is a tendency towards overconsumption of medical resources. Again, this means more paid procedures than before.

Tom Anderson February 29, 2012 at 5:26 pm

KLO, that makes absolutely no sense, and is exactly the opposite of what happens. When you’re spending your own money, you’re much more careful about who , what, where, when and how you spend it, and when patients have some skin in the game, take control of their health, instead of relying on pills. If you like the idea of being squeezed by the taxman, why not live in a country that subscribes to that type of government? If you do, in fact, live in the US, you’re lucky because you have the freedom to live like a socialist and practice socialism in your own life, while enjoying the benefits of a capitalist society. Try living under socialist/communist government and everyone’s house looks the same, clothes are the same, there is no ambition, and only those who had money before socialism/communism and politicians have the money to escape when their health is on the line. Everyone else is taxed to death.

RT3 February 29, 2012 at 6:14 pm

@Tom, you are right, good comemnt

Darren February 29, 2012 at 10:48 pm

Reading comprehension fail. Read KLO’s comment again. Your response is, well, non-responsive. She said it’s good for the “doctors”, not good generally. The reasons in your post actually support her argument that it’s good for the doctors (e.g., if people paid out of pocket, they would be more careful how it was spent).

RT3 February 29, 2012 at 6:13 pm

@KLO, the 3rd party payer systems, both public and private waste a TON of resources. People who pay cash have much better bargaining power than those who participate in managed care

KLO February 29, 2012 at 6:36 pm

One man’s waste is another man’s income. There is no doubt that doctors’ income went up enormously after the introduction of Medicare. Why do you think that is? The third party payment system does waste a lot of resources, largely by overpaying doctors and other vendors.

msgkings February 29, 2012 at 10:07 pm

This comment by KLO is very correct.

Tom Anderson March 1, 2012 at 9:24 am

The third party payer system turns doctors into slaves to the payer. It is not the best thing that’s happend to doctors because the decision making process is always skewed toward what and whom will pay for it. Completely obscuring the healing process. Docs will churn patients for as much as they can squeeze out of the payer. That’s why you come across docs who are seeing up to 60 patients a day. In an 8 hour day, that’s about 15 minutes per patient, which is exactly what you get in the Canadian system. Enough time to ask, “what do you need?”, and “Here’s your script.”

JoelP March 1, 2012 at 3:16 pm

There are more paid procedures, but less income for doctors. Insurance is redistributive, but it also exerts strong downward pressure on fees as well as intentionally-burdensome paperwork designed to avoid having to pay for the procedures doctors do.

Virtually all doctors hate dealing with insurers, and for very good reason.

RT3 March 2, 2012 at 11:58 pm

@KLO, true

robbl February 29, 2012 at 5:29 pm

Tom, if that were true, you would get a discount when you pay cash. The opposite is true.

Cliff February 29, 2012 at 5:42 pm

You have to negotiate the discount

ralph February 29, 2012 at 10:48 pm

KLO, you are partially correct. Many doctors, and medical facilities end up doing more tests than may be ordered if we were paying cash, but much of the wast is on pricing and repricing, and all of the middle me who get between you ad your doctor. Most medical offices have more administrative staff than mediucal staff

MC March 1, 2012 at 5:19 pm

My doctor’s office charges 15% less when people pay cash.

Tom Anderson March 1, 2012 at 9:27 am

You do get a discount, as long as you ask for it. In a hospital, that discount can be as much as 99%. 30% is an easy discount to get, but they’re willing to accept a whole lot less.

Rahul February 29, 2012 at 2:03 pm

Do they have outside-US doctors too? That is where the biggest cost-saving lies (yes, even adjusting for quality-of-care).

RT3 February 29, 2012 at 3:03 pm

@Rahul, yes, in germany, japan, korea, thailand, singapore, india, costa rica, and mexico as well as US and Canada

Rahul February 29, 2012 at 7:17 pm

Sounds like a great idea. What’s your protocol to validate quality though?

The other hurdle I foresee is followups; what happens if post-op care or followup is needed,say, a month after surgery? Travel might get mighty expensive?

msgkings February 29, 2012 at 10:08 pm

Skype?

RT3 February 29, 2012 at 10:51 pm

Rahul,
1) Rating systems by patients
2) not a problem domestically, some patients buy complications insurance when traveling overseas

Rahul March 1, 2012 at 12:34 am

I’m curious to see how well #1 works out. First, there is the seeding problem; what’s the average number of patient reviews per doctor right now? Second, there might be a long delay in being able to correctly assess medical procedure quality; a sub-par doctor’s work may not be evident until several years down the line.

It’s an interesting exercise.

Jan March 1, 2012 at 7:22 am

1) PPACA puts in place a Physician Compare provision that publishes performance info on physicians so patients can see the quality of care doctors deliver. This will be standardized and based on real metrics, so certain doctors can’t game the system and ambiguous patient narratives don’t confuse grandma.

2) Whaaa? Who has time when they are ill to bid, find a doctor in India, fly there, remember to get the “complications insurance” ahead of time, come home to find out it hasn’t worked, submit a claim to the “complications insurer,” fly back to Chennai, then let the physician try again.

Rahul March 1, 2012 at 7:45 am

@Jan Re #2

What fraction of Americans are retired? Plenty of people with money and free time.

Tom Anderson March 1, 2012 at 9:39 am

What’s the current protocol? NONE. If you’re using insurance: “Gee, is this guy in my network?” That’s the protocol. You don’t even get to see where the guy went to school. Most don’t check out the license number. Alternatively, you ask your friends to make recommendations. If a state has an over zealous Medicaid program, like MediCal, or TennCare, the quality of care SUCKS. The docs become as addicted to the system as the patients are to the drugs they get from that system, and the whole thing becomes one big addiction, costing taxpayers and costing those who buy insurance by gouging.

dead serious March 1, 2012 at 10:01 am

Yeah, NONE, I tell ya!!!!!

It’s utterly impossible, what with the internet and all, to see where a doctor went to school.

Asking your (local) friends for (local) recommendations is quite a bit different than asking an anonymous global audience for global recommendations.

The Original D March 1, 2012 at 2:44 pm

No doctor in Thailand is in my network.

RT3 March 3, 2012 at 12:00 am

@Original D, why do you need a “network”? Who isnt getting good value for your healthcare dollar more important?

NormD February 29, 2012 at 2:21 pm

Listened to an interview with this doc on Peter Schiff. They offer fixed prices for many surgical procedures

http://www.surgerycenterok.com/

RT3 February 29, 2012 at 3:19 pm

They are an outstanding facility, and they work with MediBid as well

KLO February 29, 2012 at 2:55 pm

Not sure I would want to go with the lowest bidder. Also, I have to wonder what kind of doctors would participate in this when any good doctor could make so much more money on insured patients. Don’t tell me that the administrative burden is so great that each additional Medicare-covered knee replacement patients eats up $10,000 in incremental administrative cost.

RT3 February 29, 2012 at 2:59 pm

@KLO, when you go to hotels.com do you always go to the lowest bidder? Or do you look for a nice facility whihc has a price that fits your budget for that trip?

KLO February 29, 2012 at 3:05 pm

Well, I did once and the place was infested with cockroaches. The pictures on hotels.com looked nothing like the actual place. When I left the hotel the night I arrived, hotels.com refused to give me my money back. I had to threaten to cancel the charge card with which I paid for the room to get American Express to give me my money back.

I can only imagine what the surgical equivalent to this experience would be.

The Original D February 29, 2012 at 3:15 pm

Presumably reviews will be gathered over time.

RT3 February 29, 2012 at 3:21 pm

Imagination can be a scary thing which prevents progress.

msgkings February 29, 2012 at 3:39 pm

+1 to RT3

Jan March 1, 2012 at 7:27 am

It’s the difference between a night on dirty bed in a stuffy room or potentially obtaining a hospital-acquired infection, having to have your hip replacement surgery revised or being placed on a non-optimal drug regime.

PS if your bidding system doctor is in Jamaica and he writes your a prescription, how do you get it refilled in the US? I don’t think foreign docs have prescribing authority in the US.

Rahul March 1, 2012 at 7:55 am

@Jan

Unless it is a controlled substance is there anything preventing them from shipping the medications from the original foreign doctor too? If at all they’ll probably be cheaper anyways.

dead serious March 1, 2012 at 10:04 am

Yes, it’s illegal.

Tom Anderson February 29, 2012 at 3:30 pm

KLO, That’s why they don’t put pictures of the doctors on MediBid. Patients tend not to make their decisions based on price, either. They look at the docs creds, and license. The system is not designed to drive price one way or the other. Only person who sees the prices are the patients. Docs don’t compare pricing. But, some people prefer to subject themselves to the dictates of insurance companies and thank God we live in a free country where people can still CHOOSE to do that, and doctors can CHOOSE not to take third party payments.

Tom Anderson February 29, 2012 at 3:31 pm

KLO, That’s why they don’t put pictures of the doctors on MediBid. Patients tend not to make their decisions based on price, either. They look at the docs creds, and license. The system is not designed to drive price one way or the other. Only person who sees the prices are the patients. Docs don’t compare pricing. But, some people prefer to subject themselves to the dictates of insurance companies and thank God we live in a free country where people can still CHOOSE to do that, and doctors can CHOOSE not to take third party payments

dead serious March 1, 2012 at 10:06 am

You seem not to understand this whole internet thing. It sounds impossible, from what you’ve written, for a doctor to log in as a patient and check other doctor’s pricing. IMPOSSIBLE I TELL YA!!!!!!!!!!

Dan Weber February 29, 2012 at 4:55 pm

XKCD on hotel reviews

The mouseover sounds like KLO’s comment.

Rich Berger February 29, 2012 at 3:01 pm

Try offering your doctor (the one that is normally paid through insurance) cash for a non-covered expense. I have, and cash is very attractive to them – you can make a deal. And I don’t mean paying in small bills under the table.

Why $10,000? What if it were $1,000? Answer – strawman.

RT3 February 29, 2012 at 3:04 pm

Administrative bureaucracy gobles up about $200,000 per year in a doctor’s office billing multiple payers and waiting 3-6 months for payment

KLO February 29, 2012 at 3:08 pm

And bidding to provide services on a procedure-by-procedure basis is free?

RT3 February 29, 2012 at 3:22 pm

nothing is free

Tom Anderson February 29, 2012 at 3:32 pm

Nor shoud it be.

Gabriel E February 29, 2012 at 3:35 pm

+1

Rich Berger February 29, 2012 at 4:01 pm

Here’s some free advice – read Economics in One Lesson by Hazlitt and What is Seen and What is Not Seen by Bastiat.

Rahul February 29, 2012 at 7:34 pm

How does it hurt if it costs $100 to bid for a $20,000 surgery?

alexh February 29, 2012 at 10:54 pm

> Try offering your doctor (the one that is normally paid through insurance) cash for a non-covered expense

Me, me, ask me, I’ve done this! A procedure was $1300 [total, not my deductible] if paid by insurance, $9800 quote if paid by cash. So “I’d like
to negotiate” … it was just incredible just getting to the point of taking me seriously, basically the only response
was “no, no, you really need better insurance that will cover this”. When I made it really clear that I couldn’t,
they made it very clear in the nicest but most insistent possible way that they didn’t want my business. “Maybe
we could discount 20% “… but even then it was “look how vastly less it would be if you had insurance”. They GAVE
me – entirely unsolicited – quotes for what they charge major insurance companies for this vs what they would have to charge me.
To repeat: this was not a deductible vs full payment issue: this was – here’s the total cost we’ve negotiated from major partners, here’s the > 7x more that
is our rack rate, we can discount off the latter if you insist but it’s never going to ever be in the ballpark of how low it would be if you had insurance. (Hint, please go away until you have insurance.)

I try to understand the broad economics of the health care industry, but to this day I don’t quite get this one. There was no credit issue,
I was going to pay cash if they could get it to the low thousands.

Doc Merlin March 1, 2012 at 12:42 am

Yes, I have had this experience too. If you have insurance they will do whatever, if you want to pay cash they will charge you many times as much and will tell you to go away if you want to pay the insured rate.

The reason for this is that medical insurance has contracts with them that require this, and medical insurance is exempt from the laws that hold anticompetitive contracts unenforceable.

dead serious March 1, 2012 at 10:09 am

Advice: free market zealots never let reality interrupt their utopian fantasies. It’s pointless to try.

Rich Berger March 1, 2012 at 2:45 pm

I have personal experience with three cash negotiations (all of which would not have been covered by insurance). Also, how would you explain the tremendous growth of high deductible plans combined with medical savings accounts?

Careless March 1, 2012 at 7:36 pm

Not at all my experience, Alexh. I mentioned I didn’t have insurance and they knocked 2/3 off the major surgery I needed. Told our pediatrician about a hole in our insurance and the cost for that dropped 75%.

So, anyone have an actual study on this?

RT3 March 3, 2012 at 12:05 am

@Alexah, find another doctor. Some want your business, others are addicted to OPM (Other People’s Money). Docs on MediBid usually offer good value and are willing to work in the free market

Andreas Moser February 29, 2012 at 4:02 pm

I am afraid I don’t have that much time when I have a toothache. Let alone when I have a bullet wound.

Rich Berger February 29, 2012 at 4:15 pm

Well you had better get in the express line – that’ll cost you more.

KLO February 29, 2012 at 4:16 pm

Yes, but marginal revolution commenters apparently do not understand that bidding processes much loved by economists are highly inefficient in the real world. If you dare suggest that humans strongly disfavor bidding as a means of price discovery, you are in need of remedial economics lessons.

Rich Berger February 29, 2012 at 4:35 pm

What makes you think that bidding processes are “much loved by economists”? Sometimes bidding makes sense and other times (maybe most of the time) having publicly advertised fixed prices makes sense. I really don’t want to do my grocery shopping with bidding. I will choose supermarkets based on convenience and price – maybe from a half dozen different options.

What process do you recommend?

Dan Weber February 29, 2012 at 4:57 pm

Some medical procedures are not readily subject to a bidding process.

This doesn’t mean none of them should be.

MC March 1, 2012 at 5:26 pm

+1

Don’t you know that all free market outcomes are not to be compared with the world we presently live in, but with the Kingdom of Heaven?

Rahul February 29, 2012 at 7:39 pm

That’s like trying to dig a ditch with a screwdriver and then complaining that screwdrivers are useless.

John Schilling February 29, 2012 at 5:02 pm

Nobody has asked the important question: Do we get William Shatner to personally neogotiate for low-cost health care services on our behalf?

msgkings February 29, 2012 at 10:09 pm

Boom!

Bill February 29, 2012 at 7:25 pm

I’m surprised no one spotted the obvious pricing and risk issues here.

Here is one example.

A chronic condition.

Sure, a doc may bid low on a procedure, but then have lockin for follow on, or complications, when the scope of the contract may change.

RT3 February 29, 2012 at 11:49 pm

Or they may bid a price for 12 sessions
at least the patient can request a bid for 12

Bill March 1, 2012 at 8:40 am

RT3, That assumes that future services can be specified so that they can be contracted for. Chronic conditions evolve, unpredicatably.

Rahul March 1, 2012 at 8:45 am

You can bid on the surgery, with an option on getting 12 follow ups at a mutually pre-agreed price if medically necessary. It isn’t uncharted territory, really.

RT3 March 3, 2012 at 12:07 am

@Bill, fact is a third party payer plan shrinks your money, in the free market you get 100 cents on the dollar, and you have more negotiating power than 3rd party payers

Ricardo March 1, 2012 at 1:58 am

Another problem is that for any procedure beyond the most innocuous and routine, there is the potential for unanticipated complications. I once had a very honest endodontist who gave me two prices depending on whether my root canal was easy or more difficult — I know she was honest because she charged me the lower price after the procedure was over. But the point is exactly that this is not at all like buying a spare battery for your laptop on eBay. The closest analogy is to auto-repair and here, too, price competition isn’t always practical. For anything more than the most routine services, people will almost always go with a doctor they have a prior relationship with over one who charges less.

Peter February 29, 2012 at 7:52 pm

I was going to see how much they’d charge for a tapeworm removal, but you have to pay to see the bids.

Rahul February 29, 2012 at 8:05 pm

They saw you coming.

RT3 February 29, 2012 at 11:51 pm

When you go to a home and garden show you have to pay in whether you buy or not

WaggingFinger February 29, 2012 at 9:32 pm

While the idea may seem appealing on the surface, only a certain type of person would be able to participate. This person would be uninsured, fairly wealthy, yet not rich enough to disregard cost altogether. There is not a large market for people like this. Were insurance carriers to participate, we’d have a different story to tell, but alas, they already do. Carriers’ networks negotiate discounts with doctors and hospitals. With PPACA, there is even a mechanism to reward performance. To top it off, they make it convenient and cheap in terms time. A single payer system would be even more efficient, but we can’t get all our goodies at once.

Taking John Goodman as an authority on healthcare is like watching a mime describe a song.

RT3 February 29, 2012 at 11:53 pm

what kind of “performance” does PPACA reward exactly? These is no single payer system that has ever proven more efficient

Jan March 1, 2012 at 7:16 am

They are piloting this, because they do not want to pick the performance measures arbitrarily. The measures will likely link back to patient health outcomes and adherence to guidelines that physicians organizations themselves develop.

Your second sentence is automatically dismissed if you’ve no evidence.

RT3 March 1, 2012 at 7:18 am

There is decades of evidence, even in the US, both Medicare and medicaid carry higher admin and overhead costs

Jan March 1, 2012 at 7:34 am

False. Large, public insurer programs have never been tested on a large scale against a bidding system. You’ve said yourself on this forum that some, not all, procedures are appropriate for your the Medibid system. Are you submitting that they have tested bidding for some procedures–only the appropriate ones–against getting those procedures via Medicare and Medicaid? Just link the study.

RT3 March 3, 2012 at 12:09 am

@Jan, if you’re having a heart attack, call 911, dont try to get abid

Tom T. March 1, 2012 at 8:18 am

“Taking John Goodman as an authority on healthcare is like watching a mime describe a song.”

I liked him in Barton Fink.

ad*m February 29, 2012 at 10:03 pm

Many practices would love to participate, but the problem is that carriers look everywhere for your lowest charge and use that as the upper bound on a procedure’s reimbursement. You cannot go up with your charges after participating.

Thus, by entering such a system, a practice effectively says goodbye to those patients that want their insurer to pay.

RT3 February 29, 2012 at 11:54 pm

Not neccessarily

Rahul March 1, 2012 at 1:16 am

The insurance product that needs to evolve is a policy that offers minor and emergency care in the US but major elective procedures at cheaper foreign locations. I think that’s a win-win. I wonder if there are any?

Health-insurance premiums are drastically lower in, say, India. Part of this is indeed lower cost of care; but the other part is a more competitive market, lesser administrative overhead and smaller profit margins.

RT3 March 1, 2012 at 7:19 am

Yes, there are insurance products just like that

WaggingFinger March 1, 2012 at 5:01 am

The creation of ACOs. Also, having payers on the side of performance metrics directs a lot of brain power to devise ways to track and reward it while keeping costs low.

To your point about single payer efficiency, see medicare.

The problem with the approach advocated in this post is the assumption that the high costs are created by opaque and inflated prices by providers. It’s like blaming all pistons for all engine trouble. Its called a system for a reason and no single magical bullet will fix it.

Healthcare inflation is a confluence of medical education costs, demographic shift, technological advances, divorcing patients from cost via initiatives under the “insurance” umbrella but really being reimbursements. Probably most importantly, it’s a more realistic way to capture true inflation as most services are provided in country by skilled domestic labor. This idea is an interesting way to look at a fix, but its too simplistic and not global enough.

Rahul March 1, 2012 at 8:06 am

Aren’t you arguing at cross purposes? MediBid isn’t some magic bullet. If you have private insurance, or Medicaire etc. and it is covering the procedures you want, you are not MediBid’s target customer anyways.

MediBid caters a niche which has cash to pay and doesn’t have the luxury of some insurance or government program to go to. Rather than go to their community hospital this opens up more options. What’s wrong with that?

WaggingFinger March 1, 2012 at 8:52 am

I agree that there is a market for what they’re selling. It’s just very small and limited to probably elective procedures and/or a very narrow group of people. It’s great they are trying it out and I wish them well.

Rahul March 1, 2012 at 9:15 am

Now that’s a fair assessment. Even if their target market is 0.1% of the entire population, that is still 300,000 individuals we are talking about.

The interesting moment comes when insurers realize why are we paying $50,000 for a procedure in a “high cost community” when we can get it done at 20% of the cost, by flying the patient 500 miles (or 5000 miles) to a more-efficient, comparable-quality hospital.

RT3 March 1, 2012 at 7:24 am

WaggingFinger March 1, 2012 at 5:01 am

The creation of ACOs. Also, having payers on the side of performance metrics directs a lot of brain power to devise ways to track and reward it while keeping costs low.
ACO’S PAY DCTORS NOT TO SEE YOU, AND TO PERFORM PROCEDURES DIRECTED BY MEDICRATS

To your point about single payer efficiency, see medicare.
EXACTLY. MEDICARE INFLATION IS 3 TIMES AS HIGH AS PRIVATE INSURANCE, AND ADMIN COSTS ARE HIGHER

Healthcare inflation is a confluence of medical education costs, demographic shift, technological advances, divorcing patients from cost via initiatives under the “insurance” umbrella but really being reimbursements. Probably most importantly, it’s a more realistic way to capture true inflation as most services are provided in country by skilled domestic labor. This idea is an interesting way to look at a fix, but its too simplistic and not global enough.
HEALTHCARE INFLATION IS DRIVEN MY 3RD PARTY PAYERS, PUBLIC AND PRIVATE. WHAT’S NOT GLOBAL ENOUGH?

Jan March 1, 2012 at 7:39 am

Do you think Medicare inflation has something to do with how many old people there are entering the system these days?

Admin costs of Medicare are not higher than private insurance: http://www.cahi.org/cahi_contents/resources/pdf/CAHIMedicareTechnicalPaper.pdf

“The Federal government usually reports its Medicare administrative costs at about 2% of total payments under the program while private costs vary dramatically from market to market, but frequently are cited to be in the 15-20% range on average.”

RT3 March 3, 2012 at 12:17 am

@Jan, Medicare admin costs per enrollee are higher than insurance admin costs per enrollee. Those are hard facts. Medicare admin is 5% of per enrollee costs of $10,422, which is $522. Private insurance admin costs are 12% of $3,836, which is $438. To say admin costs are lower for medicare since 5% is lower than private insurance admin cots of 12% is a manipulation of statistics. Saying that medicare admin costs of $522 is higher than private insurance admin cotss of $438 is using hard facts

WaggingFinger March 1, 2012 at 9:07 am

ACOs aren’t even fully hashed out yet, but their main purpose is to align the interest of the payer and the provider with the patient as much as possible. Again, it’s no panacea, but a step in the right direction. As for “Medicrats,” I know you can do better than that.

RT3, few people even agree as to what admin costs consist of fully. For example, should sales commissions be included or not? With single payer, there aren’t sales commissions. Loss Ratio rules for carriers are set to 85% meaning that 15% of total cost can be allocated to admin. Guess what most of that 15% is. What’s that? Sales? Good answer. Yes, you’re right, sales.Secondly, Medicare treats a very expensive population. It’s not the admin that’s higher, it’s the actual cost, but that’s because of claims.

RT3, you’d probably be much better served to read Jan’s link below than repeating tired and wrong memes of the right.

Rahul March 1, 2012 at 9:26 am

The biggest advantage of a solution like MediBid is that worst case we end up with a failed company and life moves on.

Brian Donohue March 1, 2012 at 7:31 pm

+1

RT3 March 3, 2012 at 12:21 am

Wagging finger, you are ill-informed. Medicare admin costs are higher than insurance, and Medicaid admin costs are even higher. The inverse of the MLR, meaning the 15% or 20% for small groups or individuals includes premium tax, hich is as high as 6.1% in some states, which exceeds the sales commission

Bill March 1, 2012 at 6:04 pm

Is surgery a chronic condition?

RT3 March 3, 2012 at 1:12 am

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