View Full Version : Healthcare Question
This one has been perplexing me and since you guys are a knowledgable lot, I thought I'd pose the question here.
We all agree that Obamacare was an atrocity and it needs to be repealed, right? Here is my question: Why are we repealing one government healthcare POS and replacing it with another different government POS health care plan? Can't we just repeal it and let things go back the way they were before the government was so involved in healthcare? The way it was before Obamacare? I didn't like Obamacare because its none of the government's business. I'm not going to like the Republican plan for the same reason. The whole point of getting rid of Obamacare is to not have a government mandated healthcare plan. Isn't it?
I want the government out of my health care, and then we can begin working on the rampant waste, overpaid unnecessary administrators and bureaucracy, ridiculously high liability insurance premiums for hospitals and all of their suppliers, etc… I used to buy my own health insurance out of pocket, and it was reasonable. It was also true "full" coverage with no co-pays or deductibles. If we are going to pass health care laws, it should be laws that make health care affordable again, not laws that keep Uncle Sam's hand on my doctor's shoulder or rob the common man of half his income to pay outrageous administrator salaries and fight frivolous lawsuits.
Please enlighten me. Am I just ignorant? Overly idealistic? Naive? We once had a healthcare system that worked in this country. It was never perfect, but a person could get good coverage for their family for a reasonable price. What happened? Where did we go wrong? How do we get back?
Follow the $$$.
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The way it was before Obamacare didn't work either. Healthcare had become prohibitively expensive.
Of course Obamacare just made things worse. Not better.
Just like with most issues nobody is willing to look at the entire issue and make hard choices.
I don't know what the answer is.
What Bulletdog said: begin working on the rampant waste, overpaid unnecessary administrators and bureaucracy, ridiculously high liability insurance premiums for hospitals and all of their suppliers, etc… needs to happen.
The rub is that it I don't think it will happen without some degree of evenhanded government regulation. How is that possible with today's campaign finance rules, where going against big business results in millions of dollars flushed into your opponents campaign coffers?
Oversimplified, the problem is, those that can fix the problem are part of the problem. They either make their living within the system, or are supported by lobbyists from the system. They don't want to REALLY fix the system because to do so would cost them, and THEY aren't suffering.
How many of the folks involved in crafting this reform are struggling to pay health insurance premiums, or hospital/doctor bills?
And really, when you get right down to it, how many of us are really struggling with medical bills and insurance?
Because somebody has to pony up for the $45 BILLION dollars they want to spend on opiod recovery for addicts. And most critics complain it isn't enough enough money.
https://www.americanprogress.org/issues/healthcare/news/2017/06/20/434708/senates-opioid-fund-cannot-substitute-health-coverage/
Until people have a direct cost associated with their care, demand for care, demand for diagnostics, doctors don't have to practice defensive medicine, and providers aren't forced to treat those that cannot and will not pay, problems will persist.
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The biggest problem with healthcare, and the major reason for unnecessary cost increases over the last 30 years has been increased government intrusion with its attendant overregulation. Obamacare amplified that overregulation immensely. THAT is the reason why hospitals and health care systems have to have such an administrative burden -- to deal with the regulatory environment, which is a truly amazing cluster****. The insurance companies had made it bad enough. The liberal agenda made it worse. Obamacare made it a disaster. I do not believe for a second that any healthcare plan coming out of Washington will succeed in rolling that back. The government has an immense appetite for getting its fingers into the works of any expensive private sector endeavor.
In the end, the people of the US believe that they have a right to health care. And as Americans, they believe that they have a right to the very BEST health care. Any government-run health care system (like the VA Hospital System) is the exact opposite of a cheap and high quality health care system. A single-payer system, when it finally arrives, will be the death of the financial pre-eminence of the USA, and health care will get worse.
skywalkrNCSU
07-01-17, 07:40
Obama care is trash but it's not like things were perfect before Obama care either. The whole system is convoluted and needs to be burned to the ground and we just need to start over.
Obama care is trash but it's not like things were perfect before Obama care either. The whole system is convoluted and needs to be burned to the ground and we just need to start over.
How would you do that? Who is going to do that? I strongly doubt that the single-payer system you propose would improve anything about the way health care is delivered, it's quality, or how much it costs.
skywalkrNCSU
07-01-17, 07:48
How would you do that? Who is going to do that? I strongly doubt that the single-payer system you propose would improve anything about the way health care is delivered, it's quality, or how much it costs.
Who said I would propose single payer?
And no one is going to completely redo the system because that would be nearly impossible with our government
Who said I would propose single payer?
And no one is going to completely redo the system because that would be nearly impossible with our government
OK. You're correct. I assumed you were proposing single-payer because the government, with its legislative and regulatory power, is the only entity that has the capability to ignore all the moving parts of the existing system and then "burn it to the ground".
You're right...it will be impossible. The government can't burn it to the ground. They have to slowly boil that frog. The republican agenda, at least their stated agenda, was a major step toward taking that frog off the burner and that's one of the big reasons why the left is so very pissed about the Democrat loss last November. So much entitlement progress forestalled.....at least for the time being. I'm confident that they see it only as a setback. In no way do they believe that they might have misread the will of the American people.
I'm reminded of the left's agenda a lot this weekend...my brother-in-law and family are up here for July 4th holiday. He's from Los Angeles and is a big player in the entertainment industry (Steven Colbert was a groomsman in his wedding). He is otherwise a great guy and we're good friends, but.....we sustain that by not talking politics.
Averageman
07-01-17, 10:09
Perhaps someone needs to sit the American Public down and explain to them that "Life Isn't Fair." then we can explain that although it isn't fair you can do a number of things to have better health and if you do those things your chances are going to be much better to stay healthy and not need as much medical care outside of a annual physical.
Health Care needs to remain a business, it needs to turn a profit and be less regulated. Insurance purchases need to be deregulated so that insurance can be sold across State lines. Big Pharma needs to be reigned in and held accountable, if the FDA does much of the R&D for them, then they need to sell the same drugs world wide at the same price. Other than that the .Fed.Gov, needs to step away from the table. Step up and prosecute Medicaid and Medicare fraud and put some serious time behind being found guilty.
Return the burden to the States, if they want Socialized Medicine, let them have at it and figure it out on their own.
A free market devoid of an over-site that is burdensome, usually drives prices down, however the temptation to step up and stick your fingers in to one sixth of the economy is more than some in DC can bare to see go to waste.
Coming soon to a government near you........death panels. The U.K. and it's NHS have been making these decisions for quite some time.
So which of the following is the real driver in healthcare costs:
General practitioner compensation?
Specialist/Surgeon compensation?
Pharmaceutical costs?
Hospitalization costs?
Insurance costs/stipulations?
I know this is an overly simple listing but, to me, it serves to illuminate the problem. To me the bottom three are the issues. They won't be corrected without some degree of regulation.
If most Americans thought about it, they would agree that a free market approach probably isn't the best way to deal with medical emergencies, and that is what the major complaints seem to be stemming from - costs of hospitalization and medication costs.
I think the .gov needs to ensure that hospitals and healthcare providers can only charge one rate for non-elective treatment regardless of whether the patient is insured or is footing the bill on their own.
As an example: recently I had a root canal and a crown placed on a tooth. Delta Dental only covered the root canal, not the crown. Silly me, I had not initially renewed delta when I transitioned to tri-care. As a result when I signed on with delta again I had not yet been insured long enough for them to cover the crown. Fair enough, I could see that. Initially the dental office had thought that delta would cover it all, when they got the denial on the crown they sent me another bill. Not understanding the issue I went down to chat with them and go over the bill. As they explained the bill I mentioned that I thought it was wrong that they charged less for those who had insurance. They quickly assured me they had given me the write-off. When I said, yeah, but if I had walked though the door without insurance I would be paying you 2400.00 instead of 1200.00, you charge more if the person doesn't have insurance. 'No we charge everyone the same, the insurance makes us write off what they wont pay.' I talked with them for a couple of moments about this, during the conversation eliciting the fact from them that the vast majority of their patients were insured. When I remarked that judging from the waterfall in the waiting room they were doing okay at the insurance rate, so why charge more, the discussion went circular, so I smiled, paid my bill and walked out.
That my friends, is the root (pun intended) of the problem.
The government also needs to repeal the ban on Medicare’s negotiating on prescription drug pricing. See this short article: http://healthaffairs.org/blog/2016/09/19/the-politics-of-medicare-and-drug-price-negotiation/
Additionally, the government needs to ensure that non-profit hospitals are truly run with a non-profit motive.
I think these things would make a start. But as I have said in other posts, ain't going to happen because the SCOTUS decision in Citizens United v. Federal Election Commission, ensured that our government is for sale to the highest paying special interest group.
Wow, what a commie.
Spend a night in an ER and you'd learn how clueless you are, especially about emergencies.
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Averageman
07-01-17, 12:07
Wow, what a commie.
Spend a night in an ER and you'd learn how clueless you are, especially about emergencies.
The only problem I have with Emergency Room care is that, the Hobo's, Gimmie Dat's, Drug Abusers and Psycho's seem to take up way too much room and slow down legitimate emergencies from being cared for.
When you're sitting next to a scabie ridden meth head picking her scabs and mumbling to herself it is one thing, when she vomits on your shoe it is quite another.
The ER has become primary care for a large segment of our population because they "can't afford" insurance and/or primary care AND tobacco, alcohol, cell phones, satellite TV, eating out two meals a day, car payments, fancy clothes, big screen TVs, street drugs, etc.
Choices don't have consequences because of the goddamn bleeding heart liberals like 26.
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The ER has become primary care for a large segment of our population because they "can't afford" insurance and/or primary care AND tobacco, alcohol, cell phones, satellite TV, eating out two meals a day, car payments, fancy clothes, big screen TVs, street drugs, etc.
Choices don't have consequences because of the goddamn bleeding heart liberals like 26.
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Where is the "Like" button?
Choices don't have consequences because of the goddamn bleeding heart liberals like 26.
I really don't appreciate the expletive. I can accept the bleeding heart liberal, but don't appreciate the other.
In my view I'm more of a moderate than a liberal.
If you want we can compare ER stories.
I think that our primary difference is that you pretty much spout the party line with the venom thrown in, and I'm a little more circumspect and try to look at both sides of issues, there are no simple answers.
My goal in life isn't necessarily to please you, or anyone else.
ramairthree
07-01-17, 13:27
It is an unfixable problem.
There is far more expense associated with modern medicine.
Think MRIs, Dilaysis, Open Heart Sugery that has become common.
There are no coherent end of life standards. People can be kept alive using medical care over and over for decades. Should we pay for several admissions to the ICU each year for the non verbal, non moving nursing home patient?
There are no coherent standards for when a patient is done for. You have brain mets from your lung cancer or mets everywhere from your breast cancer? A lot of money is going o be spent vs. just letting you go home with some comfort medicines and stop coming to the hospital.
There are no repercussions for irresponsibility. You can't say, this is the tenth time in three months you skipped dialysis or your skill smoking crack since your last heart attack, funk you, no more care.
Ther is a shortage of physicians. This is not some AMA driven monopoly. The number of people that can successfully pass MD school and the boards is finite.
Lawyers make fortunes from medicine. We should do something about that.
Insurance executives, etc. Make fortunes from medicine. We should do something about that.
Medical administration has grown about 2500% in hospitals since the 1970s. What are we getting from those personnel for that money? How much would we save and how much more efficient would it be without a lot of them?
Drug companies need the incentive of huge profits to come up with medicines. They have massive investment costs. Somebody has to eat this. Right now it is the US and other countires make out like a bandit. We could trim some costs by giving them some legal protections and cutting them from direct advertising to patients, etc. We could have government take over but people punching the clock getting paid the same like the VA gives you VA like results.
Physician salaries...
After we take a look at insurance executives, administrators, lawyer expenses, and cities bankrupt from OT and pensions for LE and FD personnel that make more per hour than many physicians in the city, review the shortage of physicians, and the academic and training requirements and hours worked, I think we will find it's not the issue. When your daughter gets thrown from a horse and taken to the ER or your wife in a bad car accident, I think you will want the EM specialist and Neurosurgeon and the Trauma Surgeon to be shit hot, high quality, highly paid professionals. I suspect you give two shits that the insurance executive makes four times as much as any of them making policies to approve or pay for as little of their care as possible. OR the other insurance personnel getting rich off their malpractice premiums. Or the lawyer getting rich off them suing the hospital for the meth head junkie shorting at cops they did not save.
Now, some people just have bad genes, bad luck, etc. But when all is said and done a ton of the people eating billions of medical care for their renal failure, diabetes, heart attacks, strokes, sepsis, and trauma straight up did it to themselves. They have special programs helping them and even with all that help still won't take care of themselves. And productive citizens eat the cost in a myriad of ways. You get up, and every aspect of your life is affected by supporting and eating the time and financial costs of supporting a good portion of society. The only solution that would be effective would be to say fuk these asholes and let them die in the streets. Most are not willing to do so. So the problem won't be solved.
Also, right now EDs and hospitals MUST care for you when you show up. Whether you are a citizen or not. Whether it's 100% your own damn fault or not. So they get paid NOTHING for a lot of stuff that has real costs. They are eating those costs. Even when those losers get their SSDI, Medicaid, etc. It still loses money.
Let's say they had 1000 Medicaid / Medicare patients last month, and billed half a million dollars worth of stuff. They got approved for 250k, but asked for more documentation, justification, etc. For example, the guy got repeat X rays of a fracture for various reason but they only paid for one X ray, etc. And ended with 150K. They may have spent 300K, billed 500k, got approved for 250k, and ended up with 150K. Better than none, but did not cover their costs.
And, those surgeons, etc. Must by law care for those patients, can be sued by those patients, and, believe it or not, cannot even write all that stuff they did off as a loss.
So they rape the shit out of paying, well insured patients to cover it.
and I get that the dude who works as a janitor at the school and his wife is a bus driver could never afford the costs of modern medicine when his kid gets leukemia. I want a system of subsidized benefits for people that work.
But should we be paying for the non citizen undocumented worker that gets leukemia?
Should we be paying for the non working junkie that get leukemia?
A band aid would be a basic government health care system, like a civilian VA for citizens. With basic exams, urgent care, a base level of medicine.
Successful, productive citizens can have better insurance and a better care system.
It's not fair, but plenty of other countries do it. Hell, under the awesome Canadian system plenty come here to pay for a quicker or better care.
Right now we have productive citizens enslaved to pay for non productive ones,
Medical personnel enslaved to care for people,
And a ton of people that are not the patient and are not the medical personnel siphoning off a lot of money.
It is like being on a sinking ship. There is no way to do anything but expedient repairs that won't work while underway. Some bad weather is coming in. There is no way to get everyone to shore.
I really don't appreciate the expletive. I can accept the bleeding heart liberal, but don't appreciate the other.
In my view I'm more of a moderate than a liberal.
If you want we can compare ER stories.
I think that our primary difference is that you pretty much spout the party line with the venom thrown in, and I'm a little more circumspect and try to look at both sides of issues, there are no simple answers.
My goal in life isn't necessarily to please you, or anyone else.
My family owns a healthcare company and I also work in a hospital. This isn't anything about party lines. It's about experience. I've done literally millions upon millions of dollars worth of medical billing as well as provided direct patient care.
I don't care what you view yourself as. Your post sounds like a bleeding heart liberal.
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It is an unfixable problem.
There is far more expense associated with modern medicine.
Think MRIs, Dilaysis, Open Heart Sugery that has become common.
There are no coherent end of life standards. People can be kept alive using medical care over and over for decades. Should we pay for several admissions to the ICU each year for the non verbal, non moving nursing home patient?
There are no coherent standards for when a patient is done for. You have brain mets from your lung cancer or mets everywhere from your breast cancer? A lot of money is going o be spent vs. just letting you go home with some comfort medicines and stop coming to the hospital.
There are no repercussions for irresponsibility. You can't say, this is the tenth time in three months you skipped dialysis or your skill smoking crack since your last heart attack, funk you, no more care.
Ther is a shortage of physicians. This is not some AMA driven monopoly. The number of people that can successfully pass MD school and the boards is finite.
Lawyers make fortunes from medicine. We should do something about that.
Insurance executives, etc. Make fortunes from medicine. We should do something about that.
Medical administration has grown about 2500% in hospitals since the 1970s. What are we getting from those personnel for that money? How much would we save and how much more efficient would it be without a lot of them?
Drug companies need the incentive of huge profits to come up with medicines. They have massive investment costs. Somebody has to eat this. Right now it is the US and other countires make out like a bandit. We could trim some costs by giving them some legal protections and cutting them from direct advertising to patients, etc. We could have government take over but people punching the clock getting paid the same like the VA gives you VA like results.
Physician salaries...
After we take a look at insurance executives, administrators, lawyer expenses, and cities bankrupt from OT and pensions for LE and FD personnel that make more per hour than many physicians in the city, review the shortage of physicians, and the academic and training requirements and hours worked, I think we will find it's not the issue. When your daughter gets thrown from a horse and taken to the ER or your wife in a bad car accident, I think you will want the EM specialist and Neurosurgeon and the Trauma Surgeon to be shit hot, high quality, highly paid professionals. I suspect you give two shits that the insurance executive makes four times as much as any of them making policies to approve or pay for as little of their care as possible. OR the other insurance personnel getting rich off their malpractice premiums. Or the lawyer getting rich off them suing the hospital for the meth head junkie shorting at cops they did not save.
Now, some people just have bad genes, bad luck, etc. But when all is said and done a ton of the people eating billions of medical care for their renal failure, diabetes, heart attacks, strokes, sepsis, and trauma straight up did it to themselves. They have special programs helping them and even with all that help still won't take care of themselves. And productive citizens eat the cost in a myriad of ways. You get up, and every aspect of your life is affected by supporting and eating the time and financial costs of supporting a good portion of society. The only solution that would be effective would be to say fuk these asholes and let them die in the streets. Most are not willing to do so. So the problem won't be solved.
Also, right now EDs and hospitals MUST care for you when you show up. Whether you are a citizen or not. Whether it's 100% your own damn fault or not. So they get paid NOTHING for a lot of stuff that has real costs. They are eating those costs. Even when those losers get their SSDI, Medicaid, etc. It still loses money.
Let's say they had 1000 Medicaid / Medicare patients last month, and billed half a million dollars worth of stuff. They got approved for 250k, but asked for more documentation, justification, etc. For example, the guy got repeat X rays of a fracture for various reason but they only paid for one X ray, etc. And ended with 150K. They may have spent 300K, billed 500k, got approved for 250k, and ended up with 150K. Better than none, but did not cover their costs.
And, those surgeons, etc. Must by law care for those patients, can be sued by those patients, and, believe it or not, cannot even write all that stuff they did off as a loss.
So they rape the shit out of paying, well insured patients to cover it.
and I get that the dude who works as a janitor at the school and his wife is a bus driver could never afford the costs of modern medicine when his kid gets leukemia. I want a system of subsidized benefits for people that work.
But should we be paying for the non citizen undocumented worker that gets leukemia?
Should we be paying for the non working junkie that get leukemia?
A band aid would be a basic government health care system, like a civilian VA for citizens. With basic exams, urgent care, a base level of medicine.
Successful, productive citizens can have better insurance and a better care system.
It's not fair, but plenty of other countries do it. Hell, under the awesome Canadian system plenty come here to pay for a quicker or better care.
Right now we have productive citizens enslaved to pay for non productive ones,
Medical personnel enslaved to care for people,
And a ton of people that are not the patient and are not the medical personnel siphoning off a lot of money.
It is like being on a sinking ship. There is no way to do anything but expedient repairs that won't work while underway. Some bad weather is coming in. There is no way to get everyone to shore.
You get it dude. One thing though, the reason why administration has grown so much is compliance. As far as CEOs, like other companies, it takes a talented CEO with vision to make things work. My former hospital had a terrible CEO that nearly ran the place out of business. Now they've hired a high-priced experienced guy that has a plan to turn it around.
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SeriousStudent
07-01-17, 14:42
Stop with the personal attacks. Period.
Averageman
07-01-17, 15:03
At some point being forgiving and generous goes bad when your forgiving generosity allows you to stick your hand in my pocket.
Worst case it's someone who committed slow suicide with drugs, alcohol and tobacco.
Less worse case someone else was born with bad genetics and has a slow death sentence.
In either case, I don't own the bill for either of these examples.
Pay your insurance or dont, just don't expect free treatment or to have the costs spread around to people who do.
It is an unfixable problem.
I disagree.
1. Keep government out of it.
2. Allow health insurance to be purchased across state lines and create competition.
This means people will buy the level of coverage they need, rather than a one size fits everyone policy that many can't afford. It coverage isn't mandated, somebody will come up with a policy you can afford.
My family owns a healthcare company and I also work in a hospital. This isn't anything about party lines. It's about experience. I've done literally millions upon millions of dollars worth of medical billing as well as provided direct patient care.
I don't care what you view yourself as. Your post sounds like a bleeding heart liberal.
Thanks, I do care about people, even the ones I don't agree with, so I guess, to you, that makes me a liberal
If I may carefully tread the no personal attack line on the side of correctness, it sounds to me like you, like so many others, have a vested interest in the status quo.
In my view, giving your connections to the 'industry,' it would be unwise for me to expect you to be unbiased and able to see all sides of a semi-complex issue.
So I won't, and I will cordially continue to question and disagree.
ETA: BTW I have absolutely no problem with the ER triaging and telling folks - this isn't life-threatening, here's the address of the County Health Department, they open at 9:00.
Averageman
07-01-17, 17:53
I disagree.
1. Keep government out of it.
2. Allow health insurance to be purchased across state lines and create competition.
This means people will buy the level of coverage they need, rather than a one size fits everyone policy that many can't afford. It coverage isn't mandated, somebody will come up with a policy you can afford.
Innovative solutions are usually very profitable and in the case as suggested above rather simple to implement.
Remove the safety net for Insurance Companies, those who choose to be uninsured and hold the line. As I said earlier in this thread a basic understanding of how these costs are passed on would show you how some are playing the system, well, "play" the system and find yourself without medical care.
It is morally superior to let one of these people bleed out on the floor rather than to pass the cost of the medical care forward to those who purchase insurance and do the right thing.
I'm wondering how Illinois got in such financial straits and then I think about how much it cost to keep gangbangers alive who seem to be shooting each other at a rather prolific rate. Now if you think these cost aren't effecting everyone outside of the "Land of Lincoln" you're wrong, you are paying the tab for these Mopes also.
When you reward those who "game" the system long enough, they feel entitled to continue.
Innovative solutions are usually very profitable and in the case as suggested above rather simple to implement.
Remove the safety net for Insurance Companies, those who choose to be uninsured and hold the line. As I said earlier in this thread a basic understanding of how these costs are passed on would show you how some are playing the system, well, "play" the system and find yourself without medical care.
It is morally superior to let one of these people bleed out on the floor rather than to pass the cost of the medical care forward to those who purchase insurance and do the right thing.
When you reward those who "game" the system long enough, they feel entitled to continue.
See right here is where the discussion goes sideways. It seems you are primarily concerned with somebody getting care and not paying for it. That also bugs me, but my major concern is the inequality of billing and getting raped for drug costs.
Why does it make sense that every medical bill I get contains a write-off on the billed price for insurance?
According to Kaiser, in the last three decades, 18.5% was the highest percentage of uninsured non-elderly Americans. So that means at least 71.5+ percent of the non-elderly population has medical insurance at any one time. So the norm, outside the emergency room, is seeing patients who are covered by some type of insurance.
So, why then, the charade of the secret sauce pricing?
Bottom line, for ALL of us, insured or uninsured, medical care is more expensive than it needs to be. Why? Just explain in terms I can understand why my wife's knee replacement had about a third of the billed price written off and some poor schmuck with no insurance got charged the full rate. Explain that and how that is just in any way shape or form.
I'm way less concerned about someone getting free care through medicaide or medicare than I am about skyrocketing insurance rates.
...Bottom line, for ALL of us, insured or uninsured, medical care is more expensive than it needs to be. Why? Just explain in terms I can understand why my wife's knee replacement had about a third of the billed price written off and some poor schmuck with no insurance got charged the full rate. Explain that and how that is just in any way shape or form.
I have a EOB from my insurance company on the desk beside me. They were billed $275. They paid $26, and my co-pay was $6. I guess without insurance I would have been billed $275.
My biggest complaint is that health care is the one service where you are required to remain unaware of what you'll be paying until after the service is provided. And emergency room rates are ludicrous. About 18 months ago I had a lapse of good sense and attempted to cut off my left index finger with a very sharp knife in a shopping center parking lot. I drove to the nearest ER where a nurse practitioner gave me one lidocaine shot and five stiches. Two weeks later I got a bill for $2k (which my insurance covered). I can only imagine what the charge would have been if I hadn't refused the X-ray they tried to take.
Averageman
07-01-17, 19:24
See right here is where the discussion goes sideways. It seems you are primarily concerned with somebody getting care and not paying for it. That also bugs me, but my major concern is the inequality of billing and getting raped for drug costs.
Why does it make sense that every medical bill I get contains a write-off on the billed price for insurance?
Here is why you aren't tracking.
You don't see the cost of paying for those who refuse to pay or engage in risky behavior is a cost that we supplement with our insurance payments.
http://heyjackass.com/
The 1446 shot and wounded plus the 336 shot and killed, all cost money to attempt to save. Do you want to bet that the Insurance Company in't spreading the cost for that risk around a little bit?
So although I might donate to the Kid with cancer in Iowa, I get my pocket picked by the by the Thugs in Illinois.
Here is why you aren't tracking.
You don't see the cost of paying for those who refuse to pay or engage in risky behavior is a cost that we supplement with our insurance payments.
http://heyjackass.com/
The 1446 shot and wounded plus the 336 shot and killed, all cost money to attempt to save. Do you want to bet that the Insurance Company in't spreading the cost for that risk around a little bit?
So although I might donate to the Kid with cancer in Iowa, I get my pocket picked by the by the Thugs in Illinois.
Can we choose who to share risk with?
Because I quit riding motorcycles several years ago following a nearly fatal crash that wasn't my fault. Since the NHTSA states a motorcycle rider is 5 times more likely than a passenger car occupant per mile travelled (and 27 times more likely to be killed), I don't see why I should supplement their recreational activities.
Ditto for base jumpers, cave divers, and fat people.
Averageman
07-01-17, 19:44
Can we choose who to share risk with?
Because I quit riding motorcycles several years ago following a nearly fatal crash that wasn't my fault. Since the NHTSA states a motorcycle rider is 5 times more likely than a passenger car occupant per mile travelled (and 27 times more likely to be killed), I don't see why I should supplement their recreational activities.
Ditto for base jumpers, cave divers, and fat people.
Yes, actually you can.
You can join a group of people and purchase your insurance together and lower the cost, it is the same way groups like Unions have been doing for years. You could set whatever requirements necessary to reduce costs in such a case.
If Insurance were sold across State lines it would allow you to further reduce such insurance payments by selling to a larger group of people. Enforcing the rules you set would allow you to maintain the integrity of the program and keep costs low.
The difference being that it would take some effort on the part of the company insuring you to keep the rules enforced.
What is costing us money is the uninsured and those who use the Emergency Room as healthcare.
The other side of that would be some simple rules by the .gov.fed and tunring over much of these decisions to the States.
Pay your insurance or dont, just don't expect free treatment or to have the costs spread around to people who do.
Heh. That will never happen...:)
It is an unfixable problem.
It's a completely fixable problem, but one that will never be fixed. Too many people in all walks of life would have to give too much entitlement in order for everyone to have health care. They all want it top quality, cheap (or free), and they want it now. Ain't gonna happen.
ramairthree
07-01-17, 20:34
I disagree.
1. Keep government out of it.
2. Allow health insurance to be purchased across state lines and create competition.
This means people will buy the level of coverage they need, rather than a one size fits everyone policy that many can't afford. It coverage isn't mandated, somebody will come up with a policy you can afford.
Which addresses about two percent of the issues.
Let's say Everyone in America and visiting America felt entitled to, and companies were forced to,
Provide each and everyone of them with DJ equipment, power, etc. Regardless of how stupid they were, that they did not know how to use it, kept breaking records, were sucky no talent ass clowns, etc.
There are not enough records to go around. There is a shortage of records. High quality vinyl is very expensive. And the records are just part of a whole system.
Sony starting to press records again is not going to fix it.
Here is why you aren't tracking.
You don't see the cost of paying for those who refuse to pay or engage in risky behavior is a cost that we supplement with our insurance payments.
http://heyjackass.com/
The 1446 shot and wounded plus the 336 shot and killed, all cost money to attempt to save. Do you want to bet that the Insurance Company in't spreading the cost for that risk around a little bit?
So although I might donate to the Kid with cancer in Iowa, I get my pocket picked by the by the Thugs in Illinois.
Nope. That is too simplified and leaves out several considerations:
1) Assuming any insurance companies were on the hook for the Chicago Jackasses, insurance companies by definition spread the risk around. That is how they make their money. They figure if they 1) invest the premiums wisely; and 2) get enough healthy people to sign up those folks that they (the insurance company) will come out on the profit side.
Aside from that, as mentioned, I ass-u-me that many of those shot folks were on medicaide, so we (the taxpayers) picked up those bills not the insurance companies.
2) 1467 shot, plus the 336 killed, comes to 1779, comes to .056 of one percent of the population of Chicago. Statistically insignificant, especially when you consider some of the killed were DRT and many of the wounded required no hospitalization.
3) We all engage in risky behavior. I'd be willing to bet you either smoke or drink, maybe both. That is risky behavior. I ride a motorcycle. That is risky behavior.
Still does not answer why the write off for insurance companies, why the hospital/healthcare system doesn't bill everyone at the same rate.
How would you feel if the next time you filled your car up they charged you a dollar a gallon more than the guy next pump over, with no valid explanation?
Yes, actually you can.
You can join a group of people and purchase your insurance together and lower the cost, it is the same way groups like Unions have been doing for years. You could set whatever requirements necessary to reduce costs in such a case.
If Insurance were sold across State lines it would allow you to further reduce such insurance payments by selling to a larger group of people. Enforcing the rules you set would allow you to maintain the integrity of the program and keep costs low.
The difference being that it would take some effort on the part of the company insuring you to keep the rules enforced.
What is costing us money is the uninsured and those who use the Emergency Room as healthcare.
The other side of that would be some simple rules by the .gov.fed and tunring over much of these decisions to the States.
How would those work? The rule enforcement part? Like would there be some medical equivalent HOA that shows up at my house and watches me to see if I ride my bicycle without a helmet or I buy sugary pop?
This topic depresses me so I'm trying to have fun with it.
Sent from my XT1585 using Tapatalk
How would those work? The rule enforcement part? Like would there be some medical equivalent HOA that shows up at my house and watches me to see if I ride my bicycle without a helmet or I buy sugary pop?
This topic depresses me so I'm trying to have fun with it.
I was trying to have fun, too, but apparently it didn't take.
Despite all the wailing and gnashing of teeth, the handwriting is on the wall. There is only one *practical* solution (albeit a partial one): Medicare for all.
I don't like the idea of the government doing healthcare either, but they're already picking up the tab for the most expensive Americans (those 65 and over).
There are times when ideology must give way to pragmatism.
I have Government healthcare, it's called the VA, and it's pretty good here.
Other places not so much.
Which addresses about two percent of the issues.
Let's say Everyone in America and visiting America felt entitled to, and companies were forced to,
Provide each and everyone of them with DJ equipment, power, etc. Regardless of how stupid they were, that they did not know how to use it, kept breaking records, were sucky no talent ass clowns, etc.
There are not enough records to go around. There is a shortage of records. High quality vinyl is very expensive. And the records are just part of a whole system.
Sony starting to press records again is not going to fix it.
Found the problem.
From my own experience, when I was young and broke but on my own, I cut myself open pretty good and it necessitated a trip to the ER. Stitches and staples and I ended up owing something like $2,500 for the 10 minutes of treatment I received.
I paid it. Had to do a monthly payment plan and it took awhile and took money away from "wants and needs" but I paid it. If nothing else I learned to be more careful with sharp things.
Now lets say something more expensive happened, lets say I had a mechanical failure with a firearm and I caught a bounceback at very close range. I'm pretty sure that would be really, really expensive. But you know what, I'd pay it. Nobody works for free, might take awhile but I'd pay it. I might plead "poor pockets" and ask what if any assistance might be available, but I'd pay it.
And if I can't pay it for some reason, put me to work and let me work it off. If I can't find a way to make more money than working in the hospital cafeteria, then I'll be serving food in the hospital cafeteria until I'm square and paid off.
Found the problem.
From my own experience, when I was young and broke but on my own, I cut myself open pretty good and it necessitated a trip to the ER. Stitches and staples and I ended up owing something like $2,500 for the 10 minutes of treatment I received.
I paid it. Had to do a monthly payment plan and it took awhile and took money away from "wants and needs" but I paid it. If nothing else I learned to be more careful with sharp things.
Now lets say something more expensive happened, lets say I had a mechanical failure with a firearm and I caught a bounceback at very close range. I'm pretty sure that would be really, really expensive. But you know what, I'd pay it. Nobody works for free, might take awhile but I'd pay it. I might plead "poor pockets" and ask what if any assistance might be available, but I'd pay it.
And if I can't pay it for some reason, put me to work and let me work it off. If I can't find a way to make more money than working in the hospital cafeteria, then I'll be serving food in the hospital cafeteria until I'm square and paid off.
You expect the majority of Americans to take personal responsibility for their actions? Now whose dreaming?
Sometimes I think I have a mental disease because I see things exactly as you spelled them out, and few people around me seem to see it that way. If I make a mistake, I pay for my mistake. Simple, the right thing to do, the good thing to do, but people who think this way have become the minority. America became the great nation it is because people taking personal responsibility used to be the norm.
Now… How do we get back there?
Found the problem.
From my own experience, when I was young and broke but on my own, I cut myself open pretty good and it necessitated a trip to the ER. Stitches and staples and I ended up owing something like $2,500 for the 10 minutes of treatment I received.
I paid it. Had to do a monthly payment plan and it took awhile and took money away from "wants and needs" but I paid it. If nothing else I learned to be more careful with sharp things.
Now lets say something more expensive happened, lets say I had a mechanical failure with a firearm and I caught a bounceback at very close range. I'm pretty sure that would be really, really expensive. But you know what, I'd pay it. Nobody works for free, might take awhile but I'd pay it. I might plead "poor pockets" and ask what if any assistance might be available, but I'd pay it.
And if I can't pay it for some reason, put me to work and let me work it off. If I can't find a way to make more money than working in the hospital cafeteria, then I'll be serving food in the hospital cafeteria until I'm square and paid off.
I'm with you. I'd pay it off. The problem is that half of the people out there don't hold themselves to the same standards and integrity that we do...
Nope. That is too simplified and leaves out several considerations:
1) Assuming any insurance companies were on the hook for the Chicago Jackasses, insurance companies by definition spread the risk around. That is how they make their money. They figure if they 1) invest the premiums wisely; and 2) get enough healthy people to sign up those folks that they (the insurance company) will come out on the profit side.
Aside from that, as mentioned, I ass-u-me that many of those shot folks were on medicaide, so we (the taxpayers) picked up those bills not the insurance companies.
2) 1467 shot, plus the 336 killed, comes to 1779, comes to .056 of one percent of the population of Chicago. Statistically insignificant, especially when you consider some of the killed were DRT and many of the wounded required no hospitalization.
3) We all engage in risky behavior. I'd be willing to bet you either smoke or drink, maybe both. That is risky behavior. I ride a motorcycle. That is risky behavior.
Still does not answer why the write off for insurance companies, why the hospital/healthcare system doesn't bill everyone at the same rate.
How would you feel if the next time you filled your car up they charged you a dollar a gallon more than the guy next pump over, with no valid explanation?
There's a lot of real world truth there. I have a son who's been disabled since he was a year or so old (he's 21 now). I've had to take care of his medical bills before, and after insurance. I've seen first hand how the billing is a racket. It is not pro-consumer (even if you can pay your bill in full basically immediately), and very pro-insurance.
Don't even get me started on trying to get him insurance while both parents are working, and contributing. Thankfully my wife is a teacher, and was able to get hired full time when he was still young (around five or six).
It is an unfixable problem.
There is far more expense associated with modern medicine.
Think MRIs, Dilaysis, Open Heart Sugery that has become common.
There are no coherent end of life standards. People can be kept alive using medical care over and over for decades. Should we pay for several admissions to the ICU each year for the non verbal, non moving nursing home patient?
There are no coherent standards for when a patient is done for. You have brain mets from your lung cancer or mets everywhere from your breast cancer? A lot of money is going o be spent vs. just letting you go home with some comfort medicines and stop coming to the hospital.
There are no repercussions for irresponsibility. You can't say, this is the tenth time in three months you skipped dialysis or your skill smoking crack since your last heart attack, funk you, no more care.
Ther is a shortage of physicians. This is not some AMA driven monopoly. The number of people that can successfully pass MD school and the boards is finite.
Lawyers make fortunes from medicine. We should do something about that.
Insurance executives, etc. Make fortunes from medicine. We should do something about that.
Medical administration has grown about 2500% in hospitals since the 1970s. What are we getting from those personnel for that money? How much would we save and how much more efficient would it be without a lot of them?
Drug companies need the incentive of huge profits to come up with medicines. They have massive investment costs. Somebody has to eat this. Right now it is the US and other countires make out like a bandit. We could trim some costs by giving them some legal protections and cutting them from direct advertising to patients, etc. We could have government take over but people punching the clock getting paid the same like the VA gives you VA like results.
Physician salaries...
After we take a look at insurance executives, administrators, lawyer expenses, and cities bankrupt from OT and pensions for LE and FD personnel that make more per hour than many physicians in the city, review the shortage of physicians, and the academic and training requirements and hours worked, I think we will find it's not the issue. When your daughter gets thrown from a horse and taken to the ER or your wife in a bad car accident, I think you will want the EM specialist and Neurosurgeon and the Trauma Surgeon to be shit hot, high quality, highly paid professionals. I suspect you give two shits that the insurance executive makes four times as much as any of them making policies to approve or pay for as little of their care as possible. OR the other insurance personnel getting rich off their malpractice premiums. Or the lawyer getting rich off them suing the hospital for the meth head junkie shorting at cops they did not save.
Now, some people just have bad genes, bad luck, etc. But when all is said and done a ton of the people eating billions of medical care for their renal failure, diabetes, heart attacks, strokes, sepsis, and trauma straight up did it to themselves. They have special programs helping them and even with all that help still won't take care of themselves. And productive citizens eat the cost in a myriad of ways. You get up, and every aspect of your life is affected by supporting and eating the time and financial costs of supporting a good portion of society. The only solution that would be effective would be to say fuk these asholes and let them die in the streets. Most are not willing to do so. So the problem won't be solved.
Also, right now EDs and hospitals MUST care for you when you show up. Whether you are a citizen or not. Whether it's 100% your own damn fault or not. So they get paid NOTHING for a lot of stuff that has real costs. They are eating those costs. Even when those losers get their SSDI, Medicaid, etc. It still loses money.
Let's say they had 1000 Medicaid / Medicare patients last month, and billed half a million dollars worth of stuff. They got approved for 250k, but asked for more documentation, justification, etc. For example, the guy got repeat X rays of a fracture for various reason but they only paid for one X ray, etc. And ended with 150K. They may have spent 300K, billed 500k, got approved for 250k, and ended up with 150K. Better than none, but did not cover their costs.
And, those surgeons, etc. Must by law care for those patients, can be sued by those patients, and, believe it or not, cannot even write all that stuff they did off as a loss.
So they rape the shit out of paying, well insured patients to cover it.
and I get that the dude who works as a janitor at the school and his wife is a bus driver could never afford the costs of modern medicine when his kid gets leukemia. I want a system of subsidized benefits for people that work.
But should we be paying for the non citizen undocumented worker that gets leukemia?
Should we be paying for the non working junkie that get leukemia?
A band aid would be a basic government health care system, like a civilian VA for citizens. With basic exams, urgent care, a base level of medicine.
Successful, productive citizens can have better insurance and a better care system.
It's not fair, but plenty of other countries do it. Hell, under the awesome Canadian system plenty come here to pay for a quicker or better care.
Right now we have productive citizens enslaved to pay for non productive ones,
Medical personnel enslaved to care for people,
And a ton of people that are not the patient and are not the medical personnel siphoning off a lot of money.
It is like being on a sinking ship. There is no way to do anything but expedient repairs that won't work while underway. Some bad weather is coming in. There is no way to get everyone to shore.
This is a solid post, and shows how fragmented, and deep the problems are.
I was trying to have fun, too, but apparently it didn't take.
Despite all the wailing and gnashing of teeth, the handwriting is on the wall. There is only one *practical* solution (albeit a partial one): Medicare for all.
I don't like the idea of the government doing healthcare either, but they're already picking up the tab for the most expensive Americans (those 65 and over).
There are times when ideology must give way to pragmatism.
Finally this. As much as I hate to say it, this is beginning to look like the only viable option.
Trust me, I would love to see Obamacare fail, and it's exactly what the Republicans should do. Let the ACA die a horrible ugly death, so that all can see how truly doomed it was.
If the Republicans were smart, they would do their best to fix the ACA, and make it better. Mark my words, the Republican will never hold power again if they screw up the healthcare "reform". Regardless of what is happening to the ACA, taking away today what someone had yesterday is political suicide. Sure, the insurance companies pull out and take away every day, but that's not what the sheeple remember. They'll remember how the Republicans took their insurance away (regardless of how little they actually had), and the wailing and knashing of teeth will reach a crescendo.
I don't have the answers, and I don't have the solution. I sure wish I did though. The politicians need to get their heads out of their respective butts, and work together and figure out what is better for all of America. Oh, that's right, we don't work together anymore because we're divided between the entitled, and the one's who actually pay for it.
Which brings me to this. I don't give two cents about the "opiod epidemic". Once a pill head, always a pill head. The best deterrent now is the video's of these idiot's OD'ing and dying in the streets for all the world to see. If you do something illegal, and it kills you, don't expect me to have any sympathy, much less be jumping up and down to pay for you to get a "kickstart my heart". My sympathy is in the dictionary. I wish they would burn the drug dealers, and the bad doctor drug dealers to the ground. Then again, money is the root of all evil, which of course is where all of the problems with health care start in the first place. As someone said earlier in the thread, "follow the money".
All I want is Congress to not screw this up (again), and I (and I'm sure a bunch of others) have absolutely no faith that they won't.
Now… How do we get back there?
Well we were never there 100%, but you knew that.
Part of the problem is there was a time that hospitals didn't bill insurance companies $25 for a single ibuprofen to offset the cost of those who use the ER as "free health care." There was also a time when a regular working guy could afford to take care of the expected medical costs associated with having a family. But there was probably a cost. Nobody wants to see Joe Hobo left to die from a simple infection because he only has $3 to his name. But when the "Joe Hobos" outnumber the "regular working guys" when it comes to ER use then something has to give somewhere.
A LOT of shit gets passed on to us. Nobody is going to deny an 8 year old little girl a heart transplant because her father works at Starbucks and her mother is currently not working and has a substance abuse problem. And god help any doctor, politician or member of the medical community who suggests otherwise. And even if the father is a responsible type, he will never pay off what is currently billed for something like that if he worked at Starbucks for three lifetimes.
But little girls who need heart transplants really aren't the problem and thankfully that sort of thing is not very common. The real problem is everyone who games the system and everyone who allows them to game the system and simply passes the buck on to the rest of us for payment.
And since Obama made health care mandatory for a few years, now people have it in their head that they are entitled to it, simply because it was given to them at no cost for a time. Done long enough like social security (which is what the government wants) and you have yet another lucrative ponzi scheme where the majority pay in more than they get out, and that is how government generates revenue.
You expect the majority of Americans to take personal responsibility for their actions? Now whose dreaming?
Sometimes I think I have a mental disease because I see things exactly as you spelled them out, and few people around me seem to see it that way. If I make a mistake, I pay for my mistake. Simple, the right thing to do, the good thing to do, but people who think this way have become the minority. America became the great nation it is because people taking personal responsibility used to be the norm.
I see this all the time on the Apple/Mac/iPhone discussion forums. People drop their iPhone and crack the screen, or drop it in the toilet...then are outraged when they find that carelessness and stupidity isn't covered under warranty. Sign of the times.
skywalkrNCSU
07-02-17, 08:04
One problem with the people who think just letting the market decide is the right option is that the market is incredible inefficient when the consumer can't make informed decisions. I have a friend between jobs and lost insurance but needs to see a specialist. Willing to pay cash upfront but no doctors office will say how much a visit will cost.
You can't shop around at all when you don't know the cost until after your visit and that is completely asinine. Why can't you just see a chart of procedures and the cost? Other than the obvious of certain people/insurance companies pay totally different rates of course.
It makes no sense to let everyone benefit from a free market except the consumer. That is the opposite of free market and would not be efficient.
There is just so much going on that simple solutions like letting people buy insurance across state lines and let the market take care of it are missing way too much. We are trying to fix a boat with holes all over it by focusing on one or two holes when really we just need to get a totally new boat.
Averageman
07-02-17, 08:10
Nope. That is too simplified and leaves out several considerations:
1) Assuming any insurance companies were on the hook for the Chicago Jackasses, insurance companies by definition spread the risk around. That is how they make their money. They figure if they 1) invest the premiums wisely; and 2) get enough healthy people to sign up those folks that they (the insurance company) will come out on the profit side.
Aside from that, as mentioned, I ass-u-me that many of those shot folks were on medicaide, so we (the taxpayers) picked up those bills not the insurance companies.
2) 1467 shot, plus the 336 killed, comes to 1779, comes to .056 of one percent of the population of Chicago. Statistically insignificant, especially when you consider some of the killed were DRT and many of the wounded required no hospitalization.
3) We all engage in risky behavior. I'd be willing to bet you either smoke or drink, maybe both. That is risky behavior. I ride a motorcycle. That is risky behavior.
Still does not answer why the write off for insurance companies, why the hospital/healthcare system doesn't bill everyone at the same rate.
How would you feel if the next time you filled your car up they charged you a dollar a gallon more than the guy next pump over, with no valid explanation?
You aren't tracking with me.
The insurance company isn't paying because more than likely their isn't one in one hundred of those people insured. The cost to the Hospital however still exists, that cost will be spread around to all other consumers, which in turn will raise the cost of insurance. It is the only way for the Hospital to recover monies from people who can't or wont pay.
There is a very valid reason why auto insurance costs more for some drivers, they have a rack record of risky driving behaviors. Although they do not pay more at the pump, they pay more for auto insurance.
Saying that we all engage in risky behaviors doesn't mitigate the fact that some people are engaging in much riskier behaviors and habits than others and that cost is spread around to others via their insurance payments. Should your Grandmother who runs a 10K every weekend and trains daily pay the same rate as a vodka swilling weekend BASE Jumper?
Averageman
07-02-17, 08:17
How would those work? The rule enforcement part? Like would there be some medical equivalent HOA that shows up at my house and watches me to see if I ride my bicycle without a helmet or I buy sugary pop?
This topic depresses me so I'm trying to have fun with it.
Sent from my XT1585 using Tapatalk
Show up at the Hospital with a Broken neck incurred while parachuting and you own that one.
Cancer from smoking, you own that one too.
Show up weighing 100lbs more than you did at your last physical and with diabetes.
See how this works? You have a insurance policy with a basic set of rules, you need to use the insurance but you didn't play by the rules? Well, then you own the Bill.
Hospitals should be required to stabilize an ER Patient and then send them on their way, the cost of free ER visits is simply too much for some of these places to stay afloat. Much of that cost is due to using the ER as the totality of your Medical Care, people who do that screw everyone else because those costs get spread around to all others.
Show up at the Hospital with a Broken neck incurred while parachuting and you own that one.
Cancer from smoking, you own that one too.
Show up weighing 100lbs more than you did at your last physical and with diabetes.
See how this works? You have a insurance policy with a basic set of rules, you need to use the insurance but you didn't play by the rules? Well, then you own the Bill.
Hospitals should be required to stabilize an ER Patient and then send them on their way, the cost of free ER visits is simply too much for some of these places to stay afloat. Much of that cost is due to using the ER as the totality of your Medical Care, people who do that screw everyone else because those costs get spread around to all others.
Moving American society back toward personal responsibility would be great, but you know that it's not going to happen. The trend in US culture is inexorably moving toward "take care of me" and "my injury is your fault because you didn't put up a sign that said 'don't stick your hand in the whirling blades'.
Averageman
07-02-17, 14:17
Moving American society back toward personal responsibility would be great, but you know that it's not going to happen. The trend in US culture is inexorably moving toward "take care of me" and "my injury is your fault because you didn't put up a sign that said 'don't stick your hand in the whirling blades'.
I spent last weekend visiting with relatives, one was a particularly heavy smoker in his mid seventies. The guy is a complete and barely walking advertisement of why cigarettes will kill you.
He spent a lot of our time together sitting on the porch smoking Pall Mall's. Now mind you, that is after surviving "The Widow Maker" heart attack and being forced to use a walker to get around because his circulation in his legs was destroyed and his Wife complaining that he can't get an erection anymore even with chemical "help".
The irony to all of this is that he spent his life working in Hospital Pharmacies and knew this condition was an eventuality if he continued to smoke.
Now he is a relative, but honestly no one should be paying for his health care but him.
On another note;
I have a Nephew (Other side of the Family) that left the Army to pursue a new line of work and a college degree. Good for him, except he has a young Son that requires constant medical care due to a birth defect.
After leaving the Army this young Child has been left at the mercy (and I really mean mercy) of the kindness of strangers. Yeah, Dad could have stayed in and earned his healthcare for his Son, but as it is he didn't.
His Wife was bitching about "Preexisting Conditions" and wanting her Obama-Care for her disabled Son.
You know what? You cannot "fix" stupid. These guys, either one of them could have done something instead they passed the cost on to you and I.
Honestly, I wish them both the best, but my sympathy level is 0.
One problem with the people who think just letting the market decide is the right option is that the market is incredible inefficient when the consumer can't make informed decisions. I have a friend between jobs and lost insurance but needs to see a specialist. Willing to pay cash upfront but no doctors office will say how much a visit will cost.
You can't shop around at all when you don't know the cost until after your visit and that is completely asinine. Why can't you just see a chart of procedures and the cost? Other than the obvious of certain people/insurance companies pay totally different rates of course.
It makes no sense to let everyone benefit from a free market except the consumer. That is the opposite of free market and would not be efficient.
There is just so much going on that simple solutions like letting people buy insurance across state lines and let the market take care of it are missing way too much. We are trying to fix a boat with holes all over it by focusing on one or two holes when really we just need to get a totally new boat.
This is a function of the status quo in the health insurance market. Doctors offices must bill 2-3x what insurance companies typically pay in order to ensure the insurance companies pay fairly. Bill exactly what the insurance company pays and they are likely to decrease your payments. It's a stupid game and most physicians, myself included, hate playing it. The fee for service model whereby physicians charge reasonable and completely transparent fees, but do not accept insurance is IMO the best solution. This model does not mean you cannot use your insurance, only that the physician does not submit to the insurance company for payment. The patient pays the physician then submits their receipt to the insurance company for reimbursement.
This model works great for office visits and elective surgeries performed in a surgery center (i.e. not in a hospital). Where it falls apart is emergency services.
I propose we should figure out a way to mandate catastrophic coverage for all. This would ensure coverage for the expensive unavoidable things. Those who wish to do so can purchase a supplemental policy to cover meds, elective surgeries, etc...
skywalkrNCSU
07-02-17, 16:59
This is a function of the status quo in the health insurance market. Doctors offices must bill 2-3x what insurance companies typically pay in order to ensure the insurance companies pay fairly. Bill exactly what the insurance company pays and they are likely to decrease your payments. It's a stupid game and most physicians, myself included, hate playing it. The fee for service model whereby physicians charge reasonable and completely transparent fees, but do not accept insurance is IMO the best solution. This model does not mean you cannot use your insurance, only that the physician does not submit to the insurance company for payment. The patient pays the physician then submits their receipt to the insurance company for reimbursement.
This model works great for office visits and elective surgeries performed in a surgery center (i.e. not in a hospital). Where it falls apart is emergency services.
I propose we should figure out a way to mandate catastrophic coverage for all. This would ensure coverage for the expensive unavoidable things. Those who wish to do so can purchase a supplemental policy to cover meds, elective surgeries, etc...
My parents doctor quit taking insurance for that reason and he still has all the patients he can handle because he is that good. They submit things to insurance and get some reimbursement but they definitely pay more.
I agree with the catastrophic coverage too. It couldn't be that expensive if everyone had to have it and would help a lot of the major issues.
You aren't tracking with me.
No, I understand what you are saying, but you haven't answered my fundamental question, why the write off for insurance companies, why the hospital/healthcare system doesn't bill everyone at the same rate.
The insurance company isn't paying because more than likely their isn't one in one hundred of those people insured. The cost to the Hospital however still exists, that cost will be spread around to all other consumers, which in turn will raise the cost of insurance. It is the only way for the Hospital to recover monies from people who can't or wont pay.
I get that, but does it warrant balloon prices for some? Remember, over 80% of the non-elderly population has health insurance. Bottom line is, I just don't believe 3/4 of what any hospital administrator says about profit or loss, here's why:
One night last summer at her home near Stamford, Conn., a 64-year-old former sales clerk whom I'll call Janice S. felt chest pains. She was taken four miles by ambulance to the emergency room at Stamford Hospital, officially a nonprofit institution. After about three hours of tests and some brief encounters with a doctor, she was told she had indigestion and sent home. That was the good news.
The bad news was the bill: $995 for the ambulance ride, $3,000 for the doctors and $17,000 for the hospital — in sum, $21,000 for a false alarm.
Out of work for a year, Janice S. had no insurance. Among the hospital's charges were three "TROPONIN I" tests for $199.50 each. According to a National Institutes of Health website, a troponin test "measures the levels of certain proteins in the blood" whose release from the heart is a strong indicator of a heart attack. Some labs like to have the test done at intervals, so the fact that Janice S. got three of them is not necessarily an issue. The price is the problem.
Because she was 64, not 65, Janice S. was not on Medicare. But seeing what Medicare would have paid Stamford Hospital for the troponin test if she had been a year older shines a bright light on the role the chargemaster plays in our national medical crisis — and helps us understand the illegitimacy of that $199.50 charge. That's because Medicare collects troves of data on what every type of treatment, test and other service costs hospitals to deliver. Medicare takes seriously the notion that nonprofit hospitals should be paid for all their costs but actually be nonprofit after their calculation. Thus, under the law, Medicare is supposed to reimburse hospitals for any given service, factoring in not only direct costs but also allocated expenses such as overhead, capital expenses, executive salaries, insurance, differences in regional costs of living and even the education of medical students.
It turns out that Medicare would have paid Stamford $13.94 for each troponin test rather than the $199.50 Janice S. was charged.
Hospital finance people argue vehemently that Medicare doesn't pay enough and that they lose as much as 10% on an average Medicare patient......Yes, every hospital administrator grouses about Medicare's payment rates — rates that are supervised by a Congress that is heavily lobbied by the American Hospital Association, which spent $1,859,041 on lobbyists in 2012. But an annual expense report that Stamford Hospital is required to file with the federal Department of Health and Human Services offers evidence that Medicare's rates for the services Janice S. received are on the mark. According to the hospital's latest filing (covering 2010), its total expenses for laboratory work (like Janice S.'s blood tests) in the 12 months covered by the report were $27.5 million. Its total charges were $293.2 million. That means it charged about 11 times its costs. (from Bitter Pill)
Saying that we all engage in risky behaviors doesn't mitigate the fact that some people are engaging in much riskier behaviors and habits than others and that cost is spread around to others via their insurance payments. Should your Grandmother who runs a 10K every weekend and trains daily pay the same rate as a vodka swilling weekend BASE Jumper?
I got a deduction on my BCBS insurance for never being a smoker and for doing several health related activities throughout the year, I ass-u-me that most insurance companies do the same. The insurance companies are in business, they need to have a large pool of subscribers to make insurance affordable. In that pool of subscribers will be people with different risk factors. Their actuaries figure out what the "population" averages are and go from there.
Bottom line is our insurance rates would not be rising as much as they are if the pharmaceutical and hospital lobbies were not so vigorously violating the American public in pursuit of higher profits and wages.
My parents doctor quit taking insurance for that reason and he still has all the patients he can handle because he is that good. They submit things to insurance and get some reimbursement but they definitely pay more.
I agree with the catastrophic coverage too. It couldn't be that expensive if everyone had to have it and would help a lot of the major issues.
A number of primary care and orthopedic surgeons have gone to this model. It's success is very much dependent upon the region, as individuals are using out of network benefits. In NYC literally ever physician other than the large hospital systems is out of network, i.e. not contracted with any insurance carriers. So patients in that area are used to seeing out of network physicians. In my area it is rare to have an out of network physician and as such it's difficult to get patients to see you if you're out of network. This is due to the separate deductibles for in-network vs out of network. The insurance companies have purposefully made this very very cumbersome. The rise of the middlemen organizations that get a cut of everything to manage benefits for the insurance companies has also driven up costs.
Catastrophic coverage should literally cost a couple hundred dollars a year. I propose that catastrophic coverage premiums and all healthcare expenses should be 100% tax deductible. We need to find a way to incentivize people to buy it without making it government run or mandated. Though if the cost was low enough I personally would not have a problem with this being mandated and completely tax deductible.
ramairthree
07-02-17, 18:36
Let's dissect that lady from Stamford's visit.
She was having chest pain and called an ambulance. It could have been the big one, some minor ischemia, a blood clot in her lungs, a spontaneous pneumothorax, an asthma attack, an ulcer, gerd, her gall bladder, an aortic dissection, etc. All have been confused for one or the other or missed, not looked for, found, etc.
An ambulances showed up with a couple of guys ranging from shit pay to insane overtime, benefits, and pensions depending on where they are from. The ambulance is expensive. It has insurance, maintenance, can send in EKGs, has breathing treatments, equipment, etc. The guys have enough training to give basic meds, do CPR, start IVs, etc. This is not a 20$ Uber ride. It is not a 150$ limo ride. It has a real cost.
How much is needed to charge per run for it to meet operating costs?
She got to the ER, full of monitors, defibrillators, techs, nurses, janitors, bathrooms, etc. They have power, computers, oxygen, sinks, plumbing. All with real costs. This is not going to be kept open all night for the same overhead as your local Waffle House.
Some ER doctor with at least eleven years of higher education and training saw her. He did a physical exam and history. He got an EKG and read it. He ordered an X-ray and that equipment has costs and personnel. He read it. The next day a radiologist did their official read. That is not free. He ordered labs to look at her blood count, liver function, kidney function, heart enzymes, electrolytes, and whether they were on cocaine. All have a direct bearing on the patient.
How much should that have cost? I bet the ass wipe third string lawyer who closed on your last house made more per hour than the ER doctor. I bet the shady lawyer who handled your ass wipe cousins third DUI made more per hour than the radiologist. I bet the 2.0 and go D3 school lame major graduate real estate agent who drive you around one day to buy your last house made more that day than the either the ER doctor or the Radiologist. We are not counting all the other personnel and equipment, just comparing two of the people's involved day's work.
Now, they have figured out it's not an MI that needs to go straight for some stents, a dissection headed to the Operating room, a gall bladder that needs a stone plucked out, etc. But unlike on TV, medical stuff is not typically positive or negative for sure. They decide to get a scan to look for blood clots in the lungs because she smokes, sits on her ass a lot, is fat, and had a blood clot in her leg once. How much is a CT scanner, maintenance, the tech to run, the dye, the radiologist to do an immediate read, etc.
She gets admitted to the hospital. That doctor is not the ER doctor. It is an admitting doctor. They get a couple more sets of heart labs and EKGs, medicines, a bed with a monitor, nursing care. Heart labs can take several hours to change to positive. So that has real costs associated with it. It is not a hotel stay. There are computer systems, monitor techs, stuff to clean.
In the morning the heart doctor goes over everything, and may do a treadmill stress test, or a nuclear medicine stress test and then interpret those results. Maybe that was negative but there was blood in the stool and she was feeling pain in the chest from an ulcer, and a GI doctor came in and did a scope on her stomach.
Again, these are all real people, equipment, tests, and costs.
Like many here, I have no idea how much the overhead and pay, etc. Is for real on all of these things. I doubt the heart doctor or any of them do. Who you buy your lab tests from can change, there was a shortage on the ulcer medicines and the costs went up, they were out of nuclear medicine stuff and they had to stay an extra day, etc.
I am positive of one thing though,
Not cheap at all.
I am positive of another thing.
13.94 sounds like it would nowhere cover the cost of doing an IV, drawing blood, putting it in a tube, someone taking it to the lab, someone running it on the lab, the machine to run it, and the system to order it and put the results in.
It would not surprise me if the real world expenses on that were 10 grand.
And there are thousands of people going to the hospital everyday that will never pay that ten grand. Or their rent. Or their grocery bill. Or for their kids.
Let's dissect that lady from Stamford's visit.
She was having chest pain and called an ambulance. It could have been the big one, some minor ischemia, a blood clot in her lungs, a spontaneous pneumothorax, an asthma attack, an ulcer, gerd, her gall bladder, an aortic dissection, etc. All have been confused for one or the other or missed, not looked for, found, etc.
An ambulances showed up with a couple of guys ranging from shit pay to insane overtime, benefits, and pensions depending on where they are from. The ambulance is expensive. It has insurance, maintenance, can send in EKGs, has breathing treatments, equipment, etc. The guys have enough training to give basic meds, do CPR, start IVs, etc. This is not a 20$ Uber ride. It is not a 150$ limo ride. It has a real cost.
How much is needed to charge per run for it to meet operating costs?
She got to the ER, full of monitors, defibrillators, techs, nurses, janitors, bathrooms, etc. They have power, computers, oxygen, sinks, plumbing. All with real costs. This is not going to be kept open all night for the same overhead as your local Waffle House.
Some ER doctor with at least eleven years of higher education and training saw her. He did a physical exam and history. He got an EKG and read it. He ordered an X-ray and that equipment has costs and personnel. He read it. The next day a radiologist did their official read. That is not free. He ordered labs to look at her blood count, liver function, kidney function, heart enzymes, electrolytes, and whether they were on cocaine. All have a direct bearing on the patient.
How much should that have cost? I bet the ass wipe third string lawyer who closed on your last house made more per hour than the ER doctor. I bet the shady lawyer who handled your ass wipe cousins third DUI made more per hour than the radiologist. I bet the 2.0 and go D3 school lame major graduate real estate agent who drive you around one day to buy your last house made more that day than the either the ER doctor or the Radiologist. We are not counting all the other personnel and equipment, just comparing two of the people's involved day's work.
Now, they have figured out it's not an MI that needs to go straight for some stents, a dissection headed to the Operating room, a gall bladder that needs a stone plucked out, etc. But unlike on TV, medical stuff is not typically positive or negative for sure. They decide to get a scan to look for blood clots in the lungs because she smokes, sits on her ass a lot, is fat, and had a blood clot in her leg once. How much is a CT scanner, maintenance, the tech to run, the dye, the radiologist to do an immediate read, etc.
She gets admitted to the hospital. That doctor is not the ER doctor. It is an admitting doctor. They get a couple more sets of heart labs and EKGs, medicines, a bed with a monitor, nursing care. Heart labs can take several hours to change to positive. So that has real costs associated with it. It is not a hotel stay. There are computer systems, monitor techs, stuff to clean.
In the morning the heart doctor goes over everything, and may do a treadmill stress test, or a nuclear medicine stress test and then interpret those results. Maybe that was negative but there was blood in the stool and she was feeling pain in the chest from an ulcer, and a GI doctor came in and did a scope on her stomach.
Again, these are all real people, equipment, tests, and costs.
Like many here, I have no idea how much the overhead and pay, etc. Is for real on all of these things. I doubt the heart doctor or any of them do. Who you buy your lab tests from can change, there was a shortage on the ulcer medicines and the costs went up, they were out of nuclear medicine stuff and they had to stay an extra day, etc.
I am positive of one thing though,
Not cheap at all.
I am positive of another thing.
13.94 sounds like it would nowhere cover the cost of doing an IV, drawing blood, putting it in a tube, someone taking it to the lab, someone running it on the lab, the machine to run it, and the system to order it and put the results in.
It would not surprise me if the real world expenses on that were 10 grand.
And there are thousands of people going to the hospital everyday that will never pay that ten grand. Or their rent. Or their grocery bill. Or for their kids.
Uh, not trying to be a jerk, but did you read the story closely, because this is kind of key:
After about three hours of tests and some brief encounters with a doctor, she was told she had indigestion and sent home. That was the good news. The bad news was the bill: $995 for the ambulance ride, $3,000 for the doctors and $17,000 for the hospital — in sum, $21,000 for a false alarm.
So that means the histronics regarding the scan for blood clots, the admitting doctor, more heart labs, additional EKG's, bed, etc., are just that histronics. Here is the way it probably went: she presented to the paramedics on the ambulance as possibly cardiac, but likely not (I'm sure they ran a strip); she presented the same way to the ER doctor, who ran another strip and ordered the labs. Three hours later she is sprung.
I don't know what your involvement with ER's is, mine, while not extensive, comes from being a police officer and sitting with folks, some that I put in the ER, until they were released, a couple times assisting in the back of the ambulance (I WAS an EMT), a couple times accompanying students we'd broken, being hauled in myself several times, once unconscious (so I don't know about that one, woke up in ICU) and numerous trips with sons, daughters and grandkids, hey we are active, what can I say.
Based on that, I'd be willing to bet total actual contact time with medical personnel in the ER - doctors, nurses, lad techs, etc. was less than 45 minutes. It's not like the doctor, or even a nurse, was poised in a position of alertness standing over the patient for three hours. Doctors and nurses, ER types especially, multi-task and take care of multiple cases at once.
That being said, the issue isn't the $3,000.00 paid to the doctor, or the $900.00 ambulance ride. It was the $17,000 for three hours of hospital time.
As far as this:
I bet the ass wipe third string lawyer who closed on your last house made more per hour than the ER doctor. I bet the shady lawyer who handled your ass wipe cousins third DUI made more per hour than the radiologist. I bet the 2.0 and go D3 school lame major graduate real estate agent who drive you around one day to buy your last house made more that day than the either the ER doctor or the Radiologist.
In most cases, being a doctor is a calling. Good ones are in it for more than just the money. This is probably especially true for ER doctor. Last I knew they weren't drafted. Hey, you don't want to work shifts, be a GP. You want to make lots of money, be a plastic surgeon.
I've said it before, and I'll say it again, the doctors themselves are not our enemies in this mess.
And then this: And there are thousands of people going to the hospital everyday that will never pay that ten grand. Or their rent. Or their grocery bill. Or for their kids.
I have two sons, who both paid out of pocket for their first kid. I don't know what world you live in, but the first thing the hospital did was take them to court and get judgements against them. They wouldn't let them work out payments with them UNTIL they had that judgment. Likewise I had a brother-in-law who, unfortunately, had a heart attack during a 3 month period in which he was uninsured because he was transitioning to his wife's insurance and their enrollment periods didn't match. His fault. Well over 200,000 in medical bills. So the first the hospital did, get a judgement against him, then work out payments. End result, he had to mortgage the house he had paid for and built with his own hands. Several years later, when he died of cancer, my sister used most of his life insurance to pay off the remainder of the hospital.
Yeah, I'm sure a bunch of folks skate in urban areas, but in my experience that ain't the way it seems to roll out in Hutchinson, Wichita or Topeka.
ramairthree, you have some great points my friend.
I don't have the answer to the health care problems in our country. And I'm not going to get into a p!ssing contest about this either. Here is my opinions.
I feel that we're one of the most advanced countries in the world and we should be able to take care of our people better then we do. If we have some of the best medical care available in the world, then our citizens should have access to it with jumping through hoops. One reason is that we spend billions of our tax dollars on aid to other countries many that hate us. We should take care of our own first before taking care of people that sh!t on us.
I also think health insurance should be like auto insurance to this extent- If you have a bad driving record, speeding tickets, DWI's ect. as we all know, you pay more for insurance then someone that has a good driving record. I shouldn't pay the same for medical insurance as someone that smokes cigarettes, drinks heavily, is 50/100 lbs. over weight, addicted to pain pills and doesn't want to do anything to help themselves get healthier. Just doesn't seem right to me.
I also think someone other then politicians and insurance companies should have a major role in coming up with a better system. Medical professionals from every aspect of the medical industry, accountants and I'm sure there are others that are extremely qualified to do what's best for all involved. I have no confidence politicians (from all parties) or insurance companies, they all have their own interests.
Told you I don't have the answer to the health care problems in our country!
HAPPY 4TH WEEKEND TO ALL, NYH1. ;)
Let's dissect that lady from Stamford's visit.
She was having chest pain and called an ambulance. It could have been the big one, some minor ischemia, a blood clot in her lungs, a spontaneous pneumothorax, an asthma attack, an ulcer, gerd, her gall bladder, an aortic dissection, etc. All have been confused for one or the other or missed, not looked for, found, etc.
An ambulances showed up with a couple of guys ranging from shit pay to insane overtime, benefits, and pensions depending on where they are from. The ambulance is expensive. It has insurance, maintenance, can send in EKGs, has breathing treatments, equipment, etc. The guys have enough training to give basic meds, do CPR, start IVs, etc. This is not a 20$ Uber ride. It is not a 150$ limo ride. It has a real cost.
How much is needed to charge per run for it to meet operating costs?
She got to the ER, full of monitors, defibrillators, techs, nurses, janitors, bathrooms, etc. They have power, computers, oxygen, sinks, plumbing. All with real costs. This is not going to be kept open all night for the same overhead as your local Waffle House.
Some ER doctor with at least eleven years of higher education and training saw her. He did a physical exam and history. He got an EKG and read it. He ordered an X-ray and that equipment has costs and personnel. He read it. The next day a radiologist did their official read. That is not free. He ordered labs to look at her blood count, liver function, kidney function, heart enzymes, electrolytes, and whether they were on cocaine. All have a direct bearing on the patient.
How much should that have cost? I bet the ass wipe third string lawyer who closed on your last house made more per hour than the ER doctor. I bet the shady lawyer who handled your ass wipe cousins third DUI made more per hour than the radiologist. I bet the 2.0 and go D3 school lame major graduate real estate agent who drive you around one day to buy your last house made more that day than the either the ER doctor or the Radiologist. We are not counting all the other personnel and equipment, just comparing two of the people's involved day's work.
Now, they have figured out it's not an MI that needs to go straight for some stents, a dissection headed to the Operating room, a gall bladder that needs a stone plucked out, etc. But unlike on TV, medical stuff is not typically positive or negative for sure. They decide to get a scan to look for blood clots in the lungs because she smokes, sits on her ass a lot, is fat, and had a blood clot in her leg once. How much is a CT scanner, maintenance, the tech to run, the dye, the radiologist to do an immediate read, etc.
She gets admitted to the hospital. That doctor is not the ER doctor. It is an admitting doctor. They get a couple more sets of heart labs and EKGs, medicines, a bed with a monitor, nursing care. Heart labs can take several hours to change to positive. So that has real costs associated with it. It is not a hotel stay. There are computer systems, monitor techs, stuff to clean.
In the morning the heart doctor goes over everything, and may do a treadmill stress test, or a nuclear medicine stress test and then interpret those results. Maybe that was negative but there was blood in the stool and she was feeling pain in the chest from an ulcer, and a GI doctor came in and did a scope on her stomach.
Again, these are all real people, equipment, tests, and costs.
Like many here, I have no idea how much the overhead and pay, etc. Is for real on all of these things. I doubt the heart doctor or any of them do. Who you buy your lab tests from can change, there was a shortage on the ulcer medicines and the costs went up, they were out of nuclear medicine stuff and they had to stay an extra day, etc.
I am positive of one thing though,
Not cheap at all.
I am positive of another thing.
13.94 sounds like it would nowhere cover the cost of doing an IV, drawing blood, putting it in a tube, someone taking it to the lab, someone running it on the lab, the machine to run it, and the system to order it and put the results in.
It would not surprise me if the real world expenses on that were 10 grand.
And there are thousands of people going to the hospital everyday that will never pay that ten grand. Or their rent. Or their grocery bill. Or for their kids.
Medicare payment is not a good lithmus test for any reimbursement. Medicare reimbursement sucks.
This thread certainly illustrates the general lack of understanding about about medical system finances, and as far as I can tell, very few, if any, of the posters in this thread actually work in hospitals or actually provide health care. There are many moving parts in US health care, and furthermore the challenges of providing it vary WIDELY from state to state, city to city, county to county, even from hospital to hospital. It's hard, or impossible, to render intelligent opinion on the subject given the complexity. It's OK, that's what the internet is for -- rendering opinion -- I don't expect it to be accurate. I'd just counsel you all to be circumspect in taking to much of it as gospel.
RetroRevolver77
07-03-17, 08:06
The government has no business managing anything of importance as they have zero accountability nor have proven themselves to be proper stewards of public funds. The worse thing we can do in this nation is allow the government to run our health care- it will be a disaster just like everything else they manage.
Averageman
07-03-17, 08:11
I think there are some basic facts/rules we can agree on;
1) In order for a business to continue to provide a service in a free market, the costs of conducting business must be passed on to the consumer.
2) There are three or more possible ways to pay a bill, these are the basics.
The consumer of the goods, or in this case service pays.
In the case of certain services insurance pays, they will always default back to rule one.
The consumer of the goods or service can choose to not pay for the service. In this case, the Hospital or Physician isn't going to get paid and again, rule one goes in to effect.
3) The Insurance Company may negotiate prices with the Service Provider in order to negotiate a better and faster payment. The Service Provider will then pass this cost on to the Consumer.
4) In most cases where Insurance or Medical treatment is involved the consumer has very little power to negotiate prices for services.
So if you take these as basic facts, the only people getting really hurt by this system are the Consumers and the Hospitals, but only until the Hospital is able to pass their costs on to another Consumer. The only group seeming to come out on top in such cases seem to be the Consumers who refuse to pay for Insurance or for received Goods and Services and the Insurance Companies who unlike the Hospitals or the Consumers have the necessary time and ability to set prices and payments. Everyone else in many of these cases is either bleeding or trying to stop the blood.
These things may or may not be exactly correct, they are far too simply stated, but I believe them to be a basic guideline to go by. In this case time and time again those not paying hurt everyone in the system and the Insurance Companies are in the Cat Bird Seat when it comes to turning a profit.
Yes, there are some basic facts we can agree on, and that's not an unreasonable summary. But many people want to go beyond that and start tossing in anecdotes about their experience in medical billing departments, their parent's "health care company", their job as an EMT, nurse's aid, or police officer visiting the ER. I don't discount those experiences, but they each represent a microcosm of the system and one that is in no way globally illustrative. I've been "working in healthcare" for 40 years, doing my daily work under the rules and regulations of state, federal, county, city third party payers as well as a variety of insurance companies...trying to meet their various rule and regulations that change sometimes, literally, month by month so that I can get paid by them. 30 years ago, that wasn't exceptionally hard. Today, I have to have more than a half-dozen people to do that job for me. Yeah...I pass the cost for those people on to my patients, but since 50% of my patients are Medicare/Medicaid and most of the rest are negotiated fee-for-service (with the various insurance companies) the concept of "passing the costs on" is really kind of a pointless excercise. As long as I've been working under the health care system and its multiple facets and components, I don't understand the system very well. It's certainly possible that many of the folks on this gun forum understand it better than I do, but I sort of see these discussions as a "blind men and the elephant" story. Some of the opinions and observations that I read here are true or insightful, some of them are just silly.
Take a big grain of salt when reading these various gun forum posts on the health care system, mine included.
Averageman
07-03-17, 10:02
Thanks, I appreciate that insight and I'm sure you find your work rewarding, but this aspect increasingly frustrating.
I'm not sure how we require a car on the road to be insured, but we cannot require someone walking in to an Emergency Room to be insured before being served.
There should triage allowed and a swift kick in the backside applied to those who game the system and have created this mess, Insurance Companies included.
I'm not sure how we require a car on the road to be insured, but we cannot require someone walking in to an Emergency Room to be insured before being served.
An increasing number of Americans these days see health care as a right. Not just "health care", but top quality health care and right now....
Averageman
07-03-17, 10:16
An increasing number of Americans these days see health care as a right. Not just "health care", but top quality health care and right now....
There is no appreciation for skilled work, education, or the amount of effort put in to gain the combined two and put them in to action.
In the meantime, I would imagine that you could easily put a 250K to 500K Bill to many of those Chicago GSW's listed earlier.
There is no appreciation for skilled work, education, or the amount of effort put in to gain the combined two and put them in to action.
In the meantime, I would imagine that you could easily put a 250K to 500K Bill to many of those Chicago GSW's listed earlier.
If "the government" is going to make health care a basic right, then they need to play more of a role in providing the components to fulfill that obligation that they assume. The majority of doctors these days come out of medical school $300,000 or more in debt, and they don't start earning a living until age 30-35 at the earliest. Government's gotta start by fixing that. They gotta pay for educating those doctors.
Averageman
07-03-17, 10:55
It would seem to be an all or nothing deal to me. You want it, you need to buy in to the whole enchilada, not just the savory bits with the most cheese and sauce.
The problem with that as I see it, is that during my Military Service, I saw what could go wrong with such a system. It was a bureaucratic nightmare with sometimes outlandish wait times for the most basic of services.
Military healthcare has gotten better, but if we let the .gov take over the system I would imagine it might well end up like the VA. Some places you'll get great care, in other places it will be terrible.
I'm all for them stepping back in most every case and if the States want to revise a system, let them. It would be far more easily fixed by State and Local Authorities than allowing it to turn in to a Federal Nightmare of Bureaucratic nonsense.
It would seem to be an all or nothing deal to me. You want it, you need to buy in to the whole enchilada, not just the savory bits with the most cheese and sauce.
The problem with that as I see it, is that during my Military Service, I saw what could go wrong with such a system. It was a bureaucratic nightmare with sometimes outlandish wait times for the most basic of services.
Military healthcare has gotten better, but if we let the .gov take over the system I would imagine it might well end up like the VA. Some places you'll get great care, in other places it will be terrible.
I'm all for them stepping back in most every case and if the States want to revise a system, let them. It would be far more easily fixed by State and Local Authorities than allowing it to turn in to a Federal Nightmare of Bureaucratic nonsense.
The Veteran's Administration Hospital system is a great example of the US Government's ability to manage a health care system. The VAH has been standing joke in Medicine for 50 years. People make a big deal about the state of the VAH today. I can guarantee you that virtually all of the current system complaints existed 40 years ago, as well as several others. When I was an intern doing my first Surgery rotation at the 650 bed VAH in Omaha, it was my job to keep "the Hernia Book". That was the list of VA patients that we saw in clinic that needed their hernias fixed. At that time, the Hernia Book had a little more than 250 patients waiting to be scheduled. The guy on the end had a 2 1/2 year wait. That kind of wait-listing was common 40 years ago across all specialties. It is not a new phenomenon.
This thread certainly illustrates the general lack of understanding about about medical system finances, and as far as I can tell, very few, if any, of the posters in this thread actually work in hospitals or actually provide health care. There are many moving parts in US health care, and furthermore the challenges of providing it vary WIDELY from state to state, city to city, county to county, even from hospital to hospital. It's hard, or impossible, to render intelligent opinion on the subject given the complexity. It's OK, that's what the internet is for -- rendering opinion -- I don't expect it to be accurate. I'd just counsel you all to be circumspect in taking to much of it as gospel.
Truth. I am a surgeon. I have worked at major academic centers and am currently in private practice. I cringe at having medical policy discussions in an open forum about as much as I cringe at congress debating healthcare.
An increasing number of Americans these days see health care as a right. Not just "health care", but top quality health care and right now....
And this is one of the major problems with our healthcare system. I believe that gov run single payor healthcare works well in some countries. In those countries where it works, the government system provides the very basic healthcare needs - emergent services, primary care, ob-gyn. Under such a system elective tests and elective surgery require review and typically a wait. Those who can afford supplemental insurance to see private physicians buy it. This works well in Austria, Australia, New Zealand, Barbados to name a few. In theory it can work but I am not willing to cede control of healthcare to the giver nor do I want the associated tax increases. I do not trust the government to manage healthcare.
That a large number of Americans believe the highest quality of healthcare is a right means that single payor healthcare system will grow into a financially untenable leviathan as the people demand more and more services despite the having no financial skin in the game.
You are spot on in your assessment that healthcare should be left to the states. This republican plan is a DISASTER. And we will no longer have Obsma to blame once the republicans pass it.
Truth. I am a surgeon. I have worked at major academic centers and am currently in private practice. I cringe at having medical policy discussions in an open forum about as much as I cringe at congress debating healthcare.
You, HMAC and Sensei (may he rest in peace) have always been civil in these discussions, and that is appreciated.
But the last couple posts you and HMAC have made kind of point out a problem with this whole deal. You've both intimated that we should just step back, keep our noses out of business that doesn't concern us and let you pros from Dover handle the heavy thinking.
There isn't much transparency in the whole medical billing process, and it seems that the medical profession as a whole wants it to stay that way.
I hope that changes.
I hope enough Americans get mad enough about health insurance and hospital billing practices that the problem gets addressed.
Maybe then we can have an honest open discussion without the usual distracting statements.
You, HMAC and Sensei (may he rest in peace) have always been civil in these discussions, and that is appreciated.
But the last couple posts you and HMAC have made kind of point out a problem with this whole deal. You've both intimated that we should just step back, keep our noses out of business that doesn't concern us and let you pros from Dover handle the heavy thinking.
There isn't much transparency in the whole medical billing process, and it seems that the medical profession as a whole wants it to stay that way.
I hope that changes.
I hope enough Americans get mad enough about health insurance and hospital billing practices that the problem gets addressed.
Maybe then we can have an honest open discussion without the usual distracting statements.
I don't know who the "pros from dover" are, but I know that I'm not one of them. I'm as clueless about the solution as you are. I do know enough to realize that the whole problem is very complex and the simplistic approach to the problem widely espoused here in this thread is wide of the mark.
I don't know who the "pros from dover" are, but I know that I'm not one of them. I'm as clueless about the solution as you are. I do know enough to realize that the whole problem is very complex and the simplistic approach to the problem widely espoused here in this thread is wide of the mark.
The movie MASH:
"Look, mother, I want to go to work in one hour. We are the Pros from Dover and we figure to crack this kid's chest and get out to golf course before it gets dark. So you go find the gas-passer and you have him pre-medicate this patient. Then bring me the latest pictures on him. The ones we saw must be 48 hours old by now. Then call the kitchen and have them rustle us up some lunch. Ham and eggs will be all right. Steak would be even better. And then give me at least ONE nurse who knows how to work in close without getting her tits in my way."
One the items that is often bandied about that I tire of hearing is about how most Americans want top tier health care but don't want to pay for it.
This analysis draws upon data from the Organization for Economic Cooperation and Development and other cross-national analyses to compare health care spending, supply, utilization, prices, and health outcomes across 13 high-income countries: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.
These data predate the major insurance provisions of the Affordable Care Act. In 2013, the U.S. spent far more on health care than these other countries. Higher spending appeared to be largely driven by greater use of medical technology and higher health care prices, rather than more frequent doctor visits or hospital admissions.........Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions.........
In 2013, the average U.S. resident spent $1,074 out-of-pocket on health care, for things like co-payments for doctor’s office visits and prescription drugs and health insurance deductibles. Only the Swiss spent more at $1,630.....As for other private health spending, including on private insurance premiums, U.S. spending towered over that of the other countries at $3,442 per capita—more than five times what was spent in Canada ($654), the second-highest spending country............
Public spending on health care amounted to $4,197 per capita in the U.S. in 2013, more than in any other country except Norway ($4,981) and the Netherlands ($4,495), despite the fact that the U.S. was the only country studied that did not have a universal health care system........Public spending on health care would be even greater in the U.S. if the tax exclusion for employer-sponsored health insurance (amounting to about $250 billion each year) was counted as a public expenditure. http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective
When comparing procedures across the seven countries, the Federation ensured that the entire process was "like-for-like, across international boundaries," Sackville said. For example, when comparing the price for a standard MRI scan, the data came from procedures where identical types of machines were used with equal staffing resources per procedure.
Huge Price Differences
Not only did the Federation conclude that the average price in the U.S. is far higher than anywhere else, but it also found a wide disparity in the prices paid within the U.S. Sackville called the huge variation in cost "completely unwarranted for any clinical reason."
For example, the average cost in the U.S. for an MRI scan is $1,119, compared to $811 in New Zealand, $215 in Australia and $181 in Spain. However, data showed that the 95th percentile in the price of this procedure in the U.S. was $3,031, meaning some people are paying nearly $3,000 more for a standard MRI scan in the U.S. than the average person in Australia and Spain......
The researchers also observed the trend in prescription drugs. Avastin, prescribed as a treatment for certain types of cancer, has an average price of $3,930 in the U.S. Switzerland is the second most expensive at $1,752. However, the data found that the 95th percentile in the U.S. paid up to $8,831. Avastin costs $470 in the U.K. Similar trends were found in Truvada (a treatment for HIV/AIDS), Harvoni (hepatitis C), Humira (rheumatoid arthritis) and Xarelto (blood clot prevention). One outlier was OxyContin, a general pain killer that is the most expensive in the U.K. at $590 per prescription, and the U.S. was second in cost with averaging $265. (Note: the prices are based on a 4-week to one month supply)
Read more: U.S. Healthcare Costs Compared to Other Countries | Investopedia http://www.investopedia.com/articles/personal-finance/072116/us-healthcare-costs-compared-other-countries.asp#ixzz4lpirEihL
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So my thoughts are, we are paying top tier healthcare prices, but aren't getting it:
46320
The system is broken and I understand that as part of the system it is frustrating to have folks talking disparagingly about something you care deeply about. As I've said before, I don't believe doctors, nurses, techs, are the major problem.
But the fact remains, the system is broken. We need more transparency and honest dialog to fix it.
ETA: Of the 13 high income countries the US was compared to, I believe 10 have single-payer systems. Not sure how to process that, as I am not in favor of a single-payer system.
RetroRevolver77
07-04-17, 00:25
I can't even focus on that wall of text.
Bottom line, government run healthcare sucks.
7n6
The system is broken and I understand that as part of the system it is frustrating to have folks talking disparagingly about something you care deeply about. As I've said before, I don't believe doctors, nurses, techs, are the major problem.
But the fact remains, the system is broken. We need more transparency and honest dialog to fix it.
.
I don't "care deeply about the system", except the extent to which I dislike it. I work in that system every day. I've seen how it's changed over the last 40 years. And I'm also a patient. I get it from both ends of the spectrum. Its brokenness affects me far more than it does you.
Anyway, you can't just pick and choose component parts as illustrative points. They're all related and interdependent. I'm no expert in the way that they're interrelated, but I deal with the practical consequences every day. I don't have any solutions for fixing it, but I do know enough to know that no solution exists here on this gun forum. That's OK. Everybody gets to spout their opinion and presumably they come away feeling better for having vented. I get it. That's what General Discussion is for.
I can't even focus on that wall of text.
That's a good summary of modern society right there.
"I hate to read; fortunately, I already have a firmly-held opinion."
I can't even focus on that wall of text.
Bottom line, government run healthcare sucks.
7n6
Yeah, I know. :) My mom instilled a love of reading in me and I don't mind plowing through stuff as long as it has decent paragraphing, often forget others don't enjoy it as much.
Regarding government run healthcare, the government doesn't 'run/provide' healthcare for the majority of the population. I do believe that the Kaiser foundation has a pretty good reputation; they say that about 80% of the non-elderly Americans are covered by health insurance, not government programs such as medicare and medicaide.
We pay out the ass, and according to most sources, the healthcare outcomes are not consistent with what we pay for them.
Please read this: First let me say that I don't think I have enough info to be a fan of socialized medicine. But riddle me this - medicare and medicaide can't competitively bid for drugs. A cancer drug, Avastin, has an average price of $3,930 in the U.S. Switzerland is the second most expensive at $1,752. However, the data found that the 95th percentile in the U.S. paid up to $8,831. Avastin costs $470 in the U.K.
Why the differences in prices? Seems to me it is because the government isn't allowed to negotiate prices on drugs in medicare and medicaide programs, which I believe do cover more patients than any single insurance provider. In essence setting an artificial floor on pricing.
Some government involvement is needed in healthcare. The problem is the balance between too much and too little. Left completely alone what do you think pricing would be? You can find instances of predatory billing practices without much effort. Healthcare costs have risen several percentage points above inflation for over two decades, before the ACHA, so inflation isn't the answer.
And, bingo, another wall of text. :(
Averageman
07-04-17, 12:18
I don't have a perfect understanding of the system, but from what I understand, the FDA approval is a costly process and sometimes takes years.
These costs are then passed on to the Consumer, but not quiet like you might think. In the United States these things cost what the market will bear, in other Countries the Governments will demand lower prices or simply not allow the drug on to their market.
The market pressures allow the companies to sell the drugs and pick up the slack in costs where they are allowed.
So if you are perplexed why something cost $50.00 in Germany, then 39.50 in Great Britain it is because they can pick up the slack in profits and sell them in the United States for $75.00.
Once the drug has been on the market for X number of years the R&D costs are met and then the Pharma Company has another X number of years before other companies come bring copies of that drug on to the market at a lower cost. The Pharma Companies spread the cost and profits around in order to get the maximum return before they are going to be undercut by a generic formula and then either drop their price or move on to the next drug.
I may not have a perfect understanding of the system, but my Ex was pretty prominent in big Pharma for a number of years.
I don't have a perfect understanding of the system, but from what I understand, the FDA approval is a costly process and sometimes takes years.
Often, not always, drugs are developed in conjunction with government funded research which lessens the cost of development.
In the United States these things cost what the market will bear, in other Countries the Governments will demand lower prices or simply not allow the drug on to their market.
Medical care is not like buying a car. What the market will bear is not an acceptable metric for lifesaving drugs. Just my opinion. Would you want to pay 'what the market will bear' for electricity? There are some essential industries/services which need to be minimally regulated for the good of the whole of society. How to do that effectively without over intrusion is the fly in the ointment.
So if you are perplexed why something cost $50.00 in Germany, then 39.50 in Great Britain it is because they can pick up the slack in profits and sell them in the United States for $75.00.
Not perplexed at all, I understood that. I just htink it is bullshit.
I may not have a perfect understanding of the system, but my Ex was pretty prominent in big Pharma for a number of years.
I assume the reason she is your ex is because you tired of living with a soulless ginger? (JK)
Averageman
07-04-17, 13:43
I assume the reason she is your ex is because you tired of living with a soulless ginger? (JK)
Something like that,....
I would agree, the way they work costs internationally is far from a perfect system and almost works against the American public in some cases. Its not at all like buying a car when someone you love cannot live without the drug or treatment, but you go ahead with the full knowledge that you are trading everything you spent a lifetime working for in order for them to live. In the meantime in another Country they will never know that kind of a decision, they are getting the same drug for sometimes dimes on the dollar.
I've seen hours spent running those statistics, an entire day making them fit the desired solution they were looking for.
Yeah, pretty soulless.
You, HMAC and Sensei (may he rest in peace) have always been civil in these discussions, and that is appreciated.
But the last couple posts you and HMAC have made kind of point out a problem with this whole deal. You've both intimated that we should just step back, keep our noses out of business that doesn't concern us and let you pros from Dover handle the heavy thinking.
There isn't much transparency in the whole medical billing process, and it seems that the medical profession as a whole wants it to stay that way.
I hope that changes.
I hope enough Americans get mad enough about health insurance and hospital billing practices that the problem gets addressed.
Maybe then we can have an honest open discussion without the usual distracting statements.
I most certainly do not have the answers. I think the point Hmac made is that there are complexities to healthcare that are out of the lane of the general public. Frankly most of these complexities are out of the lane of most physicians, nurses, extended providers.
Fixing healthcare in a way that doesn't bankrupt the system, doesn't negatively impact those who can afford health insurance, doesn't overburden those paying for health insurance, ensures basic coverage for all (not because it's a right, but because the uninsured cost all of us money), doesn't add pork or special measures for specific groups, and ensures that this does not become an entitlement program that spirals out of control....that is going to require a group of very smart people who approach this in a completely non-partisan apolitical fashion. It will require input from physicians of all specialties, actuarials, economists, among others. I don't think a real fix on a national level is attainable.
You can find instances of predatory billing practices without much effort.
That sentence is fit for the MSM or someone not actually familiar with medical billing. Aside from frank fraud, which does exist, if you are in network with an insurance carrier there really is no such animal as predatory billing. Physicians set their fees higher than the insurance allowable because if you bill exactly the allowable, the insurance company may decrease what they pay. If a physician is out of network (i.e. not contracted with your insurance carrier), they can set whatever fees they wish. In this scenario it is incumbent upon the patient to determine how much they will be out of pocket.
Physician salaries have been decreasing since around the early 90s. All the while the cost of practicing medicine and the cost of living have increased. Reimbursements from insurance companies are generally decreasing.
If you look at the itemization for a patient surgical bill at a hospital, you will see that the surgeon typically gets paid far less than the anesthesiologist and the hospital's facility fees.
The system is a total mess.
If you are in network with an insurance carrier there really is no such animal as predatory billing. Physicians set their fees higher than the insurance allowable because if you bill exactly the allowable, the insurance company may decrease what they pay. If a physician is out of network (i.e. not contracted with your insurance carrier), they can set whatever fees they wish. In this scenario it is incumbent upon the patient to determine how much they will be out of pocket.
That first bold-face sentence certainly doesn't bode well for the uninsured, does it?
May decrease - we call that a plausible excuse where I come from. That still doesn't explain the need to bone people without insurance. Likewise, if the insurance company doesn't have a lot of practices willing to be in their network, then they might have difficulty selling policies. So, my belief is that excuse is pretty much 'all hat, no cattle.'
As I understand from my readings, there are different codes (and therefore charges?) for stitching up someone with, say, 5 stitches, after a mole was removed and stitching up someone with the same 5 stitches after they cut themselves with a knife. I can see how that could get confusing and how a doctor is more interested in the procedure itself rather than the billing aspect.
Likewise, as I understand, most insurance companies somewhat key of medicare's reimbursement rates which are based on the RBRVS. From my perspective that RBRVS is kind of the flat rate manual for doctors. I believe it is made up of a panel of doctors from the AMA and has adjustments for geographic area, etc. Just like in auto repair, if you cant beat the flat rate, your not much of a doctor. I say that because I've also read that from what some doctors bill in a single day, they would have to be working way more hours than they do.
Regardless of how you spin it, the fact is there are two billing scales, the only difference is where in the process the insurance's 'cut' occurs.
That first bold-face sentence certainly doesn't bode well for the uninsured, does it?
May decrease - we call that a plausible excuse where I come from. That still doesn't explain the need to bone people without insurance. Likewise, if the insurance company doesn't have a lot of practices willing to be in their network, then they might have difficulty selling policies. So, my belief is that excuse is pretty much 'all hat, no cattle.'
As I understand from my readings, there are different codes (and therefore charges?) for stitching up someone with, say, 5 stitches, after a mole was removed and stitching up someone with the same 5 stitches after they cut themselves with a knife. I can see how that could get confusing and how a doctor is more interested in the procedure itself rather than the billing aspect.
Likewise, as I understand, most insurance companies somewhat key of medicare's reimbursement rates which are based on the RBRVS. From my perspective that RBRVS is kind of the flat rate manual for doctors. I believe it is made up of a panel of doctors from the AMA and has adjustments for geographic area, etc. Just like in auto repair, if you cant beat the flat rate, your not much of a doctor. I say that because I've also read that from what some doctors bill in a single day, they would have to be working way more hours than they do.
Regardless of how you spin it, the fact is there are two billing scales, the only difference is where in the process the insurance's 'cut' occurs.
I am framing this from the standpoint of being a private practice surgeon, because I am a surgeon in private practice. What you describe is not occurring at this level. Where it does occur is in hospital systems. And I completely agree with you on this point as it relates to hospitals. Some of the uninsured will skip out on their bills and the hospital pricing reflects their making up the cost by raising prices across the board for "self pay" patients in order to cover the losses of those who don't pay. It's wrong. What is the solution? I personally don't know the answer. Do we invite the government in to regulate, fix the prices that are allowed to be charged for each test, each procedure? I don't trust the government to do this and not adversely affect physician reimbursement for practices like mine. There are SO many moving parts to this. Drop reimbursement too much and I think many physicians will just stop practicing and find something else to do. Why subject ones self to the stress and risk inherent in this profession if the financial rewards aren't there? And then what will our healthcare system be left with? Physicians of lesser quality.
Your impression re: patients choosing plans based upon in-network physicians is overly simplistic. People frequently choose plans based upon cost and cost alone. They may complain about the benefits, lack of in-network physicians, etc. But price is often the single biggest driver. Also, employers may only offer plans from one insurer, leaving employees one option unless they wish to seek out their own coverage. And this will come at a significantly higher expense. Finally, deciding upon a plan is akin to reading tea leaves. Very few people have the faculty to wade through all the details of their plan in order to make a decision re: what makes the most sense for them/their family. There is a ton of fine print and inane details. I have experienced this as a surgeon and a health insurance consumer.
Please don't take offense to this - you are way out of your lane discussing RVUs and coding. No amount of reading by a lay person will result in sufficient understanding to discuss the topic in a meaningful way. Are there some physicians who over bill? Sure. There are outliers in everything. These people are the exception, not the rule. Fraud is usually caught rather easily. If a physician over codes a certain procedure due to a simple mistake, this is identified by the insurance company based upon the operative report. And most of the surgeons I know are very facile at billing and coding. We have to be.
But again, HOW do we fix these issues without creating myriad more issues? I don't know the answer.
That's it for me on this topic of discussion on a firearm forum. I'm popping smoke.....
I think I will also.
I realize that 1) I ain't going to change anyone's mind; 2) I am beginning to sound like one of the pizza gate crowd except about healthcare; 3) I need to continue to address this via letters and calls to my bought and paid for representatives.
BTW: no offense taken re the out of your lane remark, although I don't necessarily agree about the lay person comment. :)
This one has been perplexing me and since you guys are a knowledgable lot, I thought I'd pose the question here.
We all agree that Obamacare was an atrocity and it needs to be repealed, right? Here is my question: Why are we repealing one government healthcare POS and replacing it with another different government POS health care plan? Can't we just repeal it and let things go back the way they were before the government was so involved in healthcare? The way it was before Obamacare? I didn't like Obamacare because its none of the government's business. I'm not going to like the Republican plan for the same reason. The whole point of getting rid of Obamacare is to not have a government mandated healthcare plan. Isn't it?
I want the government out of my health care, and then we can begin working on the rampant waste, overpaid unnecessary administrators and bureaucracy, ridiculously high liability insurance premiums for hospitals and all of their suppliers, etc… I used to buy my own health insurance out of pocket, and it was reasonable. It was also true "full" coverage with no co-pays or deductibles. If we are going to pass health care laws, it should be laws that make health care affordable again, not laws that keep Uncle Sam's hand on my doctor's shoulder or rob the common man of half his income to pay outrageous administrator salaries and fight frivolous lawsuits.
Please enlighten me. Am I just ignorant? Overly idealistic? Naive? We once had a healthcare system that worked in this country. It was never perfect, but a person could get good coverage for their family for a reasonable price. What happened? Where did we go wrong? How do we get back?
1) The government will never be fully divested from healthcare. Never, ever, ever.
2) The second part of your premise doesn't follow the first: the second part--the waste, the bloating, the bureaucracy, will be there regardless of the government.
Unfortunately, everyone, all the "key stakeholders," need to nut up to do their part, and unless one makes a move, none of the others will.
Please don't take offense to this - you are way out of your lane discussing RVUs and coding. No amount of reading by a lay person will result in sufficient understanding to discuss the topic in a meaningful way. Are there some physicians who over bill? Sure. There are outliers in everything. These people are the exception, not the rule. Fraud is usually caught rather easily. If a physician over codes a certain procedure due to a simple mistake, this is identified by the insurance company based upon the operative report. And most of the surgeons I know are very facile at billing and coding. We have to be.
Sadly I work far too closely with billers and coders, and 99% of any fraudulent practice is simply because the system is set up to be onerous, unwieldy, and redundant. Overbilling happens, and when it's caught (at whatever level), it is fixed.
1) The government will never be fully divested from healthcare. Never, ever, ever.
2) The second part of your premise doesn't follow the first: the second part--the waste, the bloating, the bureaucracy, will be there regardless of the government.
Unfortunately, everyone, all the "key stakeholders," need to nut up to do their part, and unless one makes a move, none of the others will.
Agreed.
Those that claim that Obamacare was an abomination because it put government in charge of health care haven't a clue.
It is an abomination because:
- it is a tax on breathing, and
- it forces citizens to purchase a service, whether they want it or not
It is, without question, the law most antithetical to our basic founding principles ever passed by Congress.
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