Healthcare reform

[lostfan]

It was my understanding he says they were equal -- no better/no worse -- yet I still know nothing about the people performing this care. To say everything, from doctors, to nurses, to technology is absolutely equal is impossible as far as I'm concerned, at least, unless you're writing a paper and want to send a message.

 

If everything is absolutely equal -- of even slightly worse in some cases -- yet they're charging 2x more, it should be pretty easy to bring them up on charges on allegedly attempting to defraud the medicare/medicaid system, right? So why aren't they?

Again from this article (I'm reading the rest of it), it doesn't seem to disagree with what you're trying to ask here:

 

Physicians in places like McAllen behave differently from others. The $2.4-trillion question is why. Unless we figure it out, health reform will fail.

[lostfan]

Obama knows Doctors will have to take a pay cut for universal health care to work. At least he's being realistic.

 

http://www.businessweek.com/technology/con...+temp_top+story

 

 

 

And honestly I think he is right. I know this is going to piss off some people, but I think some doctors are extremely overpaid. I honestly don't think most work doctors do should command a $400,000 a year salary.

It's not so much about the dollar amount of the salaries, but about the current system that pays doctors for each service they do. I agree, that needs to change.

[NorthSideSox72]

It's not so much about the dollar amount of the salaries, but about the current system that pays doctors for each service they do. I agree, that needs to change.

This gets partially to what I was saying earlier, about removing Doctors from more things going on.

 

Sort of a corner case, but, there is a neat example of this that I learned about back when I was an EMT. There was a large rural area in New Mexico that was underserved for medical care (also a mostly poor area, with a few pockets of very wealthy folks). There wasn't enough business in any one town for a decent clinic, and travel times were long for reasonable medical care. If people were unable to drive, that made the problem much worse.

 

What they did was, they took some of the more senior paramedics from local volunteer fire/EMS departments, and put them through a pilot training course on long term care - immunizations, basic meds, checkups and the like. They actually went out to those communities as a team, and handled some 80 or 90% of what was needed, by themselves. The other smaller percentage, they referred them to specific medical clinics or arranged for doctors to come to them.

 

Point is, this was a significantly cheaper option than building underutilized medical clinics in the middle of nowhere, but also saved people money in transportation, and dramatically raised the level of medical care in those areas - all without doctors.

 

[kapkomet]

Let's review.

 

El Paso and McAllen are roughly equal when it comes to demographics, including non-English speakers, and illegal immigrants.

They offer roughly the same services, and have tort reform legislation in place.

 

So straw man #1: Blood sucking Lawyers - not an issue.

Straw Man #2: Illegal "They took our jooobbbssss" immigrants - not an issue.

 

McAllen ranks below El Paso in quality of service across the board. Yet charges twice as much to Medicare.

 

Is it a lack of regulation keeping costs reasonable in McAllen? Is it that El Paso just hasn't caught up in charging as much? Or should health care just be this expensive?

It's probably because McAllen docs found dx codes they could charge more for using the same services. Hence, my arguement made in the first post of this thread: diagnosis codes need to be consistent, not cherry picked for higher reimbursement - although I made my living off of it for a while, it's not right.

 

[lostfan]

It's probably because McAllen docs found dx codes they could charge more for using the same services. Hence, my arguement made in the first post of this thread: diagnosis codes need to be consistent, not cherry picked for higher reimbursement - although I made my living off of it for a while, it's not right.

The conclusion that was drawn from the article was that it's a cultural thing among doctors in certain areas. Where the doctors are more collaborative, costs tend to be lower, and care is better overall. Where they are less collaborative, they tend to driven by profit margins, and as a rule, costs tend to be higher. McAllen is cited as an extreme example of the latter.

[jasonxctf]

i have very limited doctor interaction, thank goodness, but here is a recent experience my wife and I went through.

 

we went to a "family planning" doctor. The visit lasted about 45 minutes where we sat down with the doctor to discuss issues and potential remedies. My wife had a quick 5 minute "women visit" and we left on our marry way.

 

The doctor charged her insurance company $1,200 for the visit.

[kapkomet]

i have very limited doctor interaction, thank goodness, but here is a recent experience my wife and I went through.

 

we went to a "family planning" doctor. The visit lasted about 45 minutes where we sat down with the doctor to discuss issues and potential remedies. My wife had a quick 5 minute "women visit" and we left on our marry way.

 

The doctor charged her insurance company $1,200 for the visit.

Just remember: the current system was created by the government in the first place. So, "universal health care" is going to solve it all and "reduce costs".

 

Riiiiiiiight.

 

Let's see if some of you libs know your health care history.

[Balta1701]

Just remember: the current system was created by the government in the first place. So, "universal health care" is going to solve it all and "reduce costs".

 

Riiiiiiiight.

 

Let's see if some of you libs know your health care history.

If the AMA hadn't accused Truman of being a communist we might have single-payer already and not have to worry about this.

[Balta1701]

Again...this is another reason why universality is so necessary...because any time that a company is able to try to dump people who are more expensive in to the uninsured or on to another company, there is great profit for them in doing so. A system where you can't be turned down is a requirement.

Blue Cross of California encouraged employees through performance evaluations to cancel the health insurance policies of individuals with expensive illnesses, Rep. Bart Stupak (D-Mich.) charged at the start of a congressional hearing today on the controversial practice known as rescission.

 

The state's largest for-profit health insurer told The Times 18 months ago that it did not tie employee performance evaluations to rescission activity. And executives with Blue Cross parent company WellPoint Inc. reiterated that position today.

 

But documents obtained by the House Committee on Energy and Commerce and released today show that the company's employee performance evaluation program did include a review of rescission activity.

 

The documents show, for instance, that one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

 

WellPoint's Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said.

 

"When times are good, the insurance company is happy to sign you up and take your money in the form of premiums," Stupak said. "But when times are bad, and you are afflicted with cancer or some other life-threatening disease, it is supposed to honor its commitments and stand by you in your time of need.

 

"Instead, some insurance companies use a technicality to justify breaking its promise, at a time when most patients are too weak to fight back," he said.

[NorthSideSox72]

Again...this is another reason why universality is so necessary...because any time that a company is able to try to dump people who are more expensive in to the uninsured or on to another company, there is great profit for them in doing so. A system where you can't be turned down is a requirement.

This is not a problem of not having universality - its a problem of having the insurers between, as I've said here lots of times before, and the universal government program thing is ONE POSSIBLE solution to that.

 

[Balta1701]

This is not a problem of not having universality - its a problem of having the insurers between, as I've said here lots of times before, and the universal government program thing is ONE POSSIBLE solution to that.

Can you say that in a way that is a little more clear?

[mr_genius]

It's not so much about the dollar amount of the salaries, but about the current system that pays doctors for each service they do. I agree, that needs to change.

 

agreed. but there is major price gouging going on, that needs to end if there is going to be affordable health care.

Edited June 16, 2009 by mr_genius

[Balta1701]

agreed. but there is major price gouging going on, that needs to end if there is going to be affordable health care.

The problem is...any attempt to actually put those cost-controls in to the plan is being opposed by the people who oppose the plan as well. The cost-controls are probably the portion of the plan with the weakes support since both doctors and insurance companies will oppose them and the constituency for a public plan is stronger than the constituency for cost-controls...so the people who want to bring the plan down are attacking the cost-controls...things like focused preventative care, more efficient record keeping, and analysis of the actual effectiveness of treatments are running in to heavy resistance in Congress, esp. from people who tend to oppose "Big government spending".

[NorthSideSox72]

Can you say that in a way that is a little more clear?

Look, when you buy a service normally, what do you do? You shop, possibly compare or research, and then you buy. You can choose a product, choose a seller, work the price and quality... these key aspects to any market product are GONE with the insurance companies between you (the patient/consumer) and the providers. That pretty much ruins the whole thing.

 

But of course, we can't just get rid of insurance of some kind, because most people can't afford the huge, unexpected and uneven expenses.

 

One POSSIBLE solution is government provided healthcare via taxes, as you support.

 

But that is NOT the only possible solution.

 

[jasonxctf]

another quick medical story.. friend of my wife is pregnant. doctor orders her to get a flu shot at about 6 months pregnant. Her body freaks out due to the shot and within hours she's giving a pre-mature birth. Baby sits in a NIC unit for 4 weeks. Total bill to the insurance company was over $100,000.

 

 

[kapkomet]

Look, when you buy a service normally, what do you do? You shop, possibly compare or research, and then you buy. You can choose a product, choose a seller, work the price and quality... these key aspects to any market product are GONE with the insurance companies between you (the patient/consumer) and the providers. That pretty much ruins the whole thing.

 

But of course, we can't just get rid of insurance of some kind, because most people can't afford the huge, unexpected and uneven expenses.

 

One POSSIBLE solution is government provided healthcare via taxes, as you support.

 

But that is NOT the only possible solution.

Thank you.

 

Again, (again and again and again) - the government is also the major problem in the CURRENT system. I'll wait for a bit longer to see if anyone sniffs it out. Probably not, because it would admit that the current hurry up and run for this, get it passed, and we'll pay for it somehow f***ed up government of ours is wrong. Very wrong.

 

[Balta1701]

Look, when you buy a service normally, what do you do? You shop, possibly compare or research, and then you buy. You can choose a product, choose a seller, work the price and quality... these key aspects to any market product are GONE with the insurance companies between you (the patient/consumer) and the providers. That pretty much ruins the whole thing.

 

But of course, we can't just get rid of insurance of some kind, because most people can't afford the huge, unexpected and uneven expenses.

 

One POSSIBLE solution is government provided healthcare via taxes, as you support.

 

But that is NOT the only possible solution.

So then here's my question to you...what other alternative is there other than some version of mandatory insurance that gets rid of the economic benefit that occurs for an insurance company when they are able to dump the most expensive people on to someone else or dump them on to the ranks of the uninsured? It doesn't have to be public sector here although I'm obviously a fan of that...but IMO, it must be universal...you simply can't allow a health insurance company to pick and choose who pays in to its insurance pool, because they'll pick and choose only the profitable ones.

[ptatc]

So then here's my question to you...what other alternative is there other than some version of mandatory insurance that gets rid of the economic benefit that occurs for an insurance company when they are able to dump the most expensive people on to someone else or dump them on to the ranks of the uninsured? It doesn't have to be public sector here although I'm obviously a fan of that...but IMO, it must be universal...you simply can't allow a health insurance company to pick and choose who pays in to its insurance pool, because they'll pick and choose only the profitable ones.

 

The problem with your scenario is that if the universal health care comes to fruition, this person will not get treatment. The answer will be, we don't pay for that so treatment will be denied. The person will have to live (or die) wioth the condition.

The excuse will be "no improvement in the quality life is guaranteed" so no treatment will be recommended. Healthcare costs will drop because the sickest and the weakest will not get treatment thus the costliest treaments will not be prescribed.

 

[Balta1701]

The problem with your scenario is that if the universal health care comes to fruition, this person will not get treatment. The answer will be, we don't pay for that so treatment will be denied. The person will have to live (or die) wioth the condition.

The excuse will be "no improvement in the quality life is guaranteed" so no treatment will be recommended. Healthcare costs will drop because the sickest and the weakest will not get treatment thus the costliest treaments will not be prescribed.

My question in reply is...how is that any different from the path we're currently on? We're getting to a point where no one can afford health care except for the people with the best jobs or highest incomes, and that is going to get dramatically worse over the next 5 years. The sickest and weakest aren't treated already because they're uninsured and dumped on to Medicaid which can't keep up with the demand. We already have insurance companies that refuse to pay for lots of varieties of treatment, especially if you don't have good insurance.

[ptatc]

My question in reply is...how is that any different from the path we're currently on? We're getting to a point where no one can afford health care except for the people with the best jobs or highest incomes, and that is going to get dramatically worse over the next 5 years. The sickest and weakest aren't treated already because they're uninsured and dumped on to Medicaid which can't keep up with the demand. We already have insurance companies that refuse to pay for lots of varieties of treatment, especially if you don't have good insurance.

 

The current difference is the person gets treatment and it eventually gets paid for. The insurance companies will fight it out but someone will pay. Usually there is a settlement and they both will incur some of the cost.

 

It's not the sickest and the weakest that aren't unisured it's the poor. So the group btyou are talking about is smaller than just sick and weak. They are currenly being treated because if they go to an emergency room by law they get treatment for emergancy procedures. The government alonmg with you and I already foot the bill for that.

 

Insurance companies do deny treament but it will get much much worse under a universal health care sytem where one person will decide on treatment for everyone not just the group in the insurance plan.

 

I'm not for any plan that universally does anything. There is too much power and too much decision making in too few hands. This is usually a recipe for disaster.

 

I don't have the final answer but I think it should somehow revolve around health care savings accounts. Instead of insurance (except catastrophic), the money that goes to insurance should go into a tax free account. Much of the high cost of insurance goes to operation and lag time costs. This would be greatly reduced with cash payments. Current users of this system usually get a 60%-70% discount on thier medical bills for the reasons I've stated. Being in the medical field and seeing it daily, it makes the most practical sense. For people below the poverty line maybe the government could use some of the welfare or such money and deposit it an account for the person and earmark it ofr healthcare.

 

Just some ideas for change, the system, just like the law sytem does suck but it still the best and markedly better than auniversal healthcare sytem.

[kapkomet]

The current difference is the person gets treatment and it eventually gets paid for. The insurance companies will fight it out but someone will pay. Usually there is a settlement and they both will incur some of the cost.

 

It's not the sickest and the weakest that aren't unisured it's the poor. So the group btyou are talking about is smaller than just sick and weak. They are currenly being treated because if they go to an emergency room by law they get treatment for emergancy procedures. The government alonmg with you and I already foot the bill for that.

 

Insurance companies do deny treament but it will get much much worse under a universal health care sytem where one person will decide on treatment for everyone not just the group in the insurance plan.

 

I'm not for any plan that universally does anything. There is too much power and too much decision making in too few hands. This is usually a recipe for disaster.

 

I don't have the final answer but I think it should somehow revolve around health care savings accounts. Instead of insurance (except catastrophic), the money that goes to insurance should go into a tax free account. Much of the high cost of insurance goes to operation and lag time costs. This would be greatly reduced with cash payments. Current users of this system usually get a 60%-70% discount on thier medical bills for the reasons I've stated. Being in the medical field and seeing it daily, it makes the most practical sense. For people below the poverty line maybe the government could use some of the welfare or such money and deposit it an account for the person and earmark it ofr healthcare.

 

Just some ideas for change, the system, just like the law sytem does suck but it still the best and markedly better than auniversal healthcare sytem.

Good post. Clearly, what we have is not perfect but it is far better then anything else in the world, no matter what propaganda the left wants to spoon feed people with.

 

[mr_genius]

The problem is...any attempt to actually put those cost-controls in to the plan is being opposed by the people who oppose the plan as well. The cost-controls are probably the portion of the plan with the weakes support since both doctors and insurance companies will oppose them and the constituency for a public plan is stronger than the constituency for cost-controls...so the people who want to bring the plan down are attacking the cost-controls...things like focused preventative care, more efficient record keeping, and analysis of the actual effectiveness of treatments are running in to heavy resistance in Congress, esp. from people who tend to oppose "Big government spending".

 

Yes of course, opponents of a central health care policy will look for 'support' anywhere they can find it. I'm just saying from my point of view, I can support a plan but it NEEDS to have cost cutting measures in the forefront. A hybrid plan of super high prices with the tax payers fitting the bill is the worst scenerio. Imagine the gouging we will see, everyone can go to the doc for free, yet the doctor may charge anything they please. The costs will spiral out of control, even worse than they are now!

 

Just saying.

[kapkomet]

Yes of course, opponents of a central health care policy will look for 'support' anywhere they can find it. I'm just saying from my point of view, I can support a plan but it NEEDS to have cost cutting measures in the forefront. A hybrid plan of super high prices with the tax payers fitting the bill is the worst scenerio. Imagine the gouging we will see, everyone can go to the doc for free, yet the doctor may charge anything they please. The costs will spiral out of control, even worse than they are now!

 

Just saying.

The only way to cut costs by bringing in 16-20 million more people (this is the real number, not the bulls*** 46.6 or 50 million number) is to DRASTICALLY reduce services provided. There is NO other way.

 

I still say that there can be cost controls put in place without a government takeover.

[lostfan]

Yes of course, opponents of a central health care policy will look for 'support' anywhere they can find it. I'm just saying from my point of view, I can support a plan but it NEEDS to have cost cutting measures in the forefront. A hybrid plan of super high prices with the tax payers fitting the bill is the worst scenerio. Imagine the gouging we will see, everyone can go to the doc for free, yet the doctor may charge anything they please. The costs will spiral out of control, even worse than they are now!

 

Just saying.

That's what happened with Medicare originally, before they made rules about it.

[Y2HH]

From what I gather, a lot of people seem to think "Universal healthcare" is the same exact healthcare they get now, only they won't have to pay as much -- at least, in theory -- as higher taxes would obviously have to subsidize this. Whatever the case, the point is, they think they will get the same exact care they get now but for far less money, rich or poor, sickness or health.

 

The problem is, that's incorrect. The care will not be the same, nor will the system of getting that care be the same.

 

I keep hearing people repeat how 3rd world our healthcare system is compared to Canada, Mexico, [insert Country Name here], etc...but they leave out a lot of information on these "universal" plans. My advice is to stop watching Michael Moore movies where 90% of the information is left on the cutting room floor to help him make his biased point(s).

 

First and foremost, we have the *best* healthcare there is -- for those who can afford insurance or have jobs that supply insurance...bar none -- nobody with universal care comes close. This is why the highest paid most skilled doctors/surgeons work here, because they get well compensated for said expertise. Now, there isn't a universal plan in existence where you can go to a hospital and say, "You know what, my knee hurts so I'd like an MRI", and have them actually give you that MRI. In the system we have here, you CAN do that, if you have the insurance or other means. People seem to be convinced nothing will change, when in fact they will ask a series of questions -- and if it's determined that you don't have a pressing need to have your knee checked, it won't be -- they'll send you into a waiting list where you'll get to wait 3-4 months (or however long their backlog is) before they even begin to treat you.

 

I'm not sure about some of you, but I like having the choices and power I have to go into any doctors office or hospital I want and REQUEST care because I know somethings bothering me -- if for nothing else other than piece of mind. I don't want or need someone determining if I need a procedure based on my livelihood, or if I can "live with it for now".

 

And I know some of you will deny what I've said -- say how wrong I am and how it doesn't work this way...but it does work that way, regardless of what people in favor of this "free" healthcare say, and that includes Michael Moore.

Edited June 17, 2009 by Y2HH