They are not allowed to do so. That’s what I was trying to say. The hospital rates are a trade secret. I ran a trauma center for 7 years. One year, Blue Cross refused to agree to a fair rate for our hospital. They contracted with another hospital that cut a better deal for them and all subscribers had to switch hospitals. However, all trauma cases came to our hospital and we charged them “retail.” Two years later, they came back.

Doctors will be dropped from the plan as “Not suitable for managed care” which usually means you spent too much time with your patients. Medical groups now provide “bonuses” to GPs which are half their annual income for following “guidelines” that minimize hospital stays and complex care. The incentives are all against the patient these days. Now that I am a patient, I am lucky I still know some older docs I can go to.

It’s intentional. The unions can’t skim off the top and sides without that layer of complexity.

The contracted rate for your hospital bill is a fraction of the price you saw on the bill.
–Mike K, June 27th, 2016 at 3:57 pm

That’s true but that doesn’t bother me. What I’d like from the hospital, group practice, or individual practitioner is a price up front. An honest car mechanic does that, even without a law to impose such a requirement on him or other tradesmen. But ask for the price for non-emergency surgery, to correct an inguinal hernia for example, and no one knows the answer to the question in advance of actually doing it. Whaddya know, medical charges are more bizarre and unpredictable than Heisenberg quantum mechanics!

I knew the fix was in two years ago, when I saw Justin Amash, Tea Party darling, address a donors’ group in NYC and “promise to repeal and REPLACE Obamacare.” I wanted to jump up and shout “No REPLACE!”
–Beverly, June 26th, 2016 at 3:35 am

Bad news, Beverly. The fault is not in conspiracies but in ourselves, i.e. the voters generally. The great majority of voters have a covet thy neighbor’s goods problem which manifests itself particularly intensely in matters of access to health care. Until your neighbors shake their greed (the desire for the unearned) completely, a politician who loves the Republic and wishes to rescue it will have to shepherd greedy voters bit by bit back to a habit of honestly paying the health care providers whose services they consume. This is not easy, 40 years it took God to change the hearts of the Israelites so they’d stop pining for their old lives as slaves in Egypt. The alternative to slowly walking the majority of voters back from their desire for the unearned* is losing races completely to the politics of greed and corruption (a.k.a. Mainstream Democrat Politicians, the crooked Mrs. Clinton is an example of such).

As long as they’re futzing around with socialized medicine, it’s still the government’s stockyard and we’re still the cattle.

I feel your pain, Beverly. Unfortunately, the struggle to turn our neighbors away from the tempting promises of Democrats (and all their false show) is never ending. The story of Pinocchio is illustrative, Pinocchio and the boys who fell for the tempting false promises of The Land of All Play and No Work became donkeys ruled by, of course, animal-enslaving and whip-cracking Donkeycrats!

* recall Ambrose Bierce’s definition of an election in The Devil’s Dictionary

It took a long time to repeal Obamacare for reasons described here.

And in fact there were many replacement plans proposed over the years, as I described here (and linked to in the present post).

One reason for the change is that Paul Ryan was able to get the GOP members of the House to agree on one. His predecessor Boehner was unable or unwilling to do so.

With Obama as president, any bill passed (if it manages to clear the Senate) would automatically be vetoed by Obama. That’s what happened to the repeal bill. Ryan has decided it’s important to try to pass them anyway to show people what the GOP would be able to do with a Republican president in the White House signing bills instead of vetoing them. This was a different philosophy than Boehner’s.

This is why so many older docs are going to cash practice. The medical groups all have contracts that do not allow them to publish prices as they are “trade secrets.” The contracted rate for your hospital bill is a fraction of the price you saw on the bill. Many people have health “insurance” that includes a provision for the insurance to pay 80% and you pay 20%. Think about it for a moment. You pay 20% of that high bill and your payment may, and often is, more than the “80%” the health plan pays.

Maybe I should do another blog post on this. My previous posts are over at Chicagoboyz and my own blog.
http://abriefhistory.org/?cat=184

The answer is complicated. The short version is that the bill has to be structured according to the rules of Medicare and insurance. Doctors and hospitals have contracts with Medicare and insurance companies (When I retired 20 years ago, I had 276 contracts all at different rates and rules) and those contracts cannot be violated. With Medicare it is either a crime or your “profile” will be rest at a lower level and you will be paid 10% of that lower rate. With insurance, you will be terminated.

Since I retired much has changed, Most doctors are no longer in independent practice and work for salary from large “vertically integrated” plans that own hospitals. They have no, absolutely no, freedom to alter the status quo.