Let's talk about health care

[Roguish Lawyer]

I think we've got representatives from every interest group except perhaps the insurance companies.

Topic: What is wrong with our health care system and how do we fix it?

[pulque]

[NousDefionsDoc]

Malpractice

[Roguish Lawyer]

The players:

Patients
Health Care Providers
Insurance Companies
Lawyers
Pharmaceutical Companies
State and Federal Government

[DunbarFC]

Costs

[Roguish Lawyer]

Originally posted by NousDefionsDoc
Malpractice

Too much of it, or fear of lawsuits alleging it?

[Roguish Lawyer]

Originally posted by DunbarFC
Costs

Why are costs so high?

[DunbarFC]

Originally posted by Roguish Lawyer
Why are costs so high?


I'd say lack of true competition

And the medical "arms" race - every hospital has to have an MRI machine etc

[Roguish Lawyer]

Is there a doctor in the house? A medic?

[Surgicalcric]

Working on a response RL.

I will try to get it posted shortly.

[Eagle5US]

Originally posted by DunbarFC
I'd say lack of true competition

And the medical "arms" race - every hospital has to have an MRI machine etc
I have to disagree here...
With the SOARING cost of malpractice and the legal thinktanks and administrative liasions with insurance regulations and requirements that must be met, physicians and midlevel providers both have to divide their attention between patient care and the insurance representative who says that care is excessive or unnecessary.
As a PA my malpractice in the civilian sector was a little over $300 / month as a part time employee (less than 32 hours a week)...that is a MINISCULE amount when comparing with physician malpractice insurance costs.
Hospital administrators will often use malpractice stipends in their slary negotiations in order to attract physicians to their groups. With the possibility of lawsuits into the HUNDREDS OF MILLIONS OF DOLLARS because Little Susie has a "less than sightly scar" on her chin from where she split it on her tricycle at 3 y/o...and it has "prevented her from becoming a runway model and significantly damaged her lifetime earning potential"...THESE are the issues that soar healthcare costs.
Even the "not able to pay cases" are may times easier to handle administratively because we are able to do what is necessary without having to fight for every tylenol or use 4x4 instead of 2 opened up 2x2's because they are cheaper.
Healthcare has gone rom being a noble profession for the people, to target practice for the public, and frivolous use of the judicial system has yet to be adequately quashed against the guy who has chosen to attempt and save your life instead of leave you on the doorstep to bleed to death or rot from disease.

Eagle

[Roguish Lawyer]

And the Eagle has landed! Very nice effort. Who's next?

[Roguish Lawyer]

OK, me. A little at a time.

What does a doctor or other health care provider do when an insurance company pays only part of an invoice?

[NousDefionsDoc]

Malpractice

[Roguish Lawyer]

Originally posted by NousDefionsDoc
Malpractice

Are you going to answer the question I asked last time you said this word?

[Sacamuelas]

Litigation, overintrusive government regulations, irrational healthcare laws, inadequate judicial discretion concerning frivolous lawsuits, uneducated juries, unrealistic expectations of the patient and their family, complete exaggeration of the monetary value concerning punitive damages .....

Should I go on? I don't seem much problem with the actual providers and treatment received. I feel we have the best healthcare system anywhere.

[Roguish Lawyer]

Originally posted by Sacamuelas
I don't seem much problem with the actual providers and treatment received.

No, of course not. :rolleyes:

[NousDefionsDoc]

Both - the fear comes from the quantity. Its ridiculous that Docs aren't allowed to be human beings. Insurance, litigation - its all a big scam. If there is gross negligence, such as Surgicalcrip doing surigical crycs as an elective procedure, then sure there should be recourse. But not for honest mistakes made with best intentions.

Of course I could be wrong, the Law of Land Warfare doesn't really address malpractice.:D

[Doc T]

Originally posted by Roguish Lawyer
The players:

Patients
Health Care Providers
Insurance Companies
Lawyers
Pharmaceutical Companies
State and Federal Government

I'd say the problem is multifactorial. One is technology just keeps coming up with new and better for more and more money... and patients keep insisting on having it....whether it will give them 2 days more or 2 years more. Transplants, dialysis, meds which cost $10,000 a dose.... even a day in the ICU... people look up stuff on the internet and want to know why not for them....?

And everyday people cross the border simply to seek health care. Some save up enough money to get to the states and go straight to the ER knowing they will be cared for...not sure how to handle this but the price you pay when you have a procedure covers that fact that they don't pay.

Malpractice is getting ridiculous. In Miami i have friends paying upward of $100,000 a year to get coverage... The suits you hear about...some are justified, some are just plain silly....we need some kind of mediator board to listen to possible cases and rule on them prior to them being allowed to be submitted.... and, I hate to say it, but limitations on pain and suffering. $18 million dollars for losing your psychic powers after a CT scan...this is what a jury awards...lets get real. These are a doctors peers???

I think i read somewhere that CEOs of insurance companies and HMOs are some of the highest paid individuals in the country...not surprising.

My collection rate at this time is about 22 cents on the billable dollar....tell me any other field that would accept that. There is none.

This is rambling but don't have time for more...pager is going off.


doc t.

[NousDefionsDoc]

And everyday people cross the border simply to seek health care.

Just had to go there, didn't you?

...pager is going off.

I'll be waiting.:lifter

[Doc T]

Originally posted by NousDefionsDoc
Just had to go there, didn't you?



I'll be waiting.:lifter

I am back...minor nothing.

it happens all the time. You cannot deny it. No need to warm up for a fight.

doc t.

[NousDefionsDoc]

What other choice do they have?

[Doc T]

Originally posted by NousDefionsDoc
What other choice do they have?

that was not the question...the question was why are costs so high...that is one of the reasons. I don't refuse to treat nonfunded patients...I just know I won't get paid or compensated for doing it. Such is life.... but makes for a poor collection rate....and as i said before, there are not many people who work for free.

doc t.

[pulque]

ok now that i've seen what others on here think :D

It costs an incredible amount to get a drug (or investigational device) on the market, maybe more than any other product, so its a good thing that patents expire and generics are available. RL, perhaps there should be another player: regulating bodies (eg FDA).

I dont have any figures but I would not be surprised if HMO and insurance administrators are making bank and draining the system. The bureaucracy tends to proliferate itself. At first I thought that this would just be picking on them since they arent here to defend themselves.

The real problem is that we have this pseudo socialized medicine. Insurance is supposed to be the great homogenizer for care, but does it accomplish that? no. no it doesnt. I think the most we can hope for is to recreate our view of what medicine is for. Maybe there would be less lawsuits if people didnt view health care as a "scarce" commodity. There would be less HMO administrators making the lives of patients and providers into hell, because of a change in perception.

all IMHO

[Sacamuelas]

Originally posted by Roguish Lawyer
No, of course not. :rolleyes:

RL... got any smiles for Doc T's response too?

Let's hear your ideas since you must be the expert with all your experience in the field.
I have unfortunately had the displeasure of testifying as an expert witness in the 5th Circuit over frivolous claims. Here is the COST for just one lawsuit I was involved with two years ago :

1. Cost me two day's productivity due to office shutdown/downtime to testify after having to give a deposition beforehand and then testify in court on his behalf
2. The three ladies that worked for me at the time their pay as I was out of the office
3. My travel expenses
4. The defense lawyers hourly rate for pretrial/during trial work
5. Judge and all the court staff expenses paid by the gov.
6. Defendant Doctors time (several days), untold stress
7. The staff in the defendant Doctor's office that could not work without the Dr. present.

You want to know how much it cost the defendant AFTER the judge ruled that the case was frivolous and completely in favor of the defendant?

NOTHING, his attorney had taken the case for a portion of the verdict/settlement and this jackleg was unemployed and getting a government check.

OR

From your little quote to me, maybe you think the problems are mostly provider and treatment derived. Please elaborate.

[NousDefionsDoc]

Originally posted by Doc T
that was not the question...the question was why are costs so high...that is one of the reasons. I don't refuse to treat nonfunded patients...I just know I won't get paid or compensated for doing it. Such is life.... but makes for a poor collection rate....and as i said before, there are not many people who work for free.

doc t.

What do you think the impact of the Bush immigration proposal will be on this if it goes through?

[Doc T]

Originally posted by NousDefionsDoc
What do you think the impact of the Bush immigration proposal will be on this if it goes through?

you mean the worker programs? Not sure that employers will have to offer insurance to workers.... so they will still be unfunded but working legally. Not sure what it will change. What do you think?

[NousDefionsDoc]

I don't think it will go through, but if it does, the employers should have to pay for insurance.

Let's watch the fight between the vampire and the jawbreaker. LOL

I can't argue with you, I'm scared.

[Doc T]

Originally posted by NousDefionsDoc
I don't think it will go through, but if it does, the employers should have to pay for insurance.

Let's watch the fight between the vampire and the jawbreaker. LOL

I can't argue with you, I'm scared.

from what i understand they will still be deemed "temporary workers".... do employers have to offer insurance under those conditions...i didn't think so...

roguish lawyer? can you comment?

scared to argue with me...does that mean I WIN!

[NousDefionsDoc]

scared to argue with me...does that mean I WIN!

DAMN! LOL - of course it does.

What I want to know is who's teaching all these nasty habits?





Note to self - I hate it when my own material gets used against me - be more careful.

[Surgicalcric]

Originally posted by Roguish Lawyer
OK, me. A little at a time.

What does a doctor or other health care provider do when an insurance company pays only part of an invoice?

The answer would depend on if the health care provider was private practice or 3rd party govt funded (County Hospitals, County EMS).

In either case the patient is generally billed for the remaining balance of the procedure after insurance has paid their predetermined portion.

In the private sector if the bill is not satisfied by the patient after several billing cycles they are generally turned over to collections.

Anyone owing money to either the county hospital system or EMS after several billing cycles here in SC will find their tax refunds, if there is one, garnished for the due amount(s) by the state revenue service.

[Surgicalcric]

Originally posted by Doc T
from what i understand they will still be deemed "temporary workers".... do employers have to offer insurance under those conditions...i didn't think so...

I believe it would fall under the same FWLL's as contract labor?

If so the employer also does not have to pay for worker's comp insurance.

[Sacamuelas]

Originally posted by Surgicalcric

In the private sector if the bill is not satisfied by the patient after several billing cycles they are generally turned over to collections.

Anyone owing money to either the county hospital system or EMS after several billing cycles here in SC will find their tax refunds, if there is one, garnished for the due amount(s) by the state revenue service.

James-
I am sure you are aware of this. Not trying to start an argument but I want to make sure people who have not dealt with this situation are aware.


In the first case, I assure you that providers don't get paid the full amount or anything close to it. That also means that the people owed the money have to pay to get their money collected.

In the second situation, obviously, that leaves out a substantial portion of the "free" healthcare abusers in the system. All of NDD's immigrant friends (errr...legal worker bees or whatever) will be exempt as they mostly fall in the lower wage contracted labor catagory. Lower income contractees usually don't have state and federal taxes withheld out of their checks during the year therefore avoiding this well intentioned law. Obviously, very low income and unemployed citizens are exempt too. That still leaves my favorite group of beggars/cheaters... the scumbags that put down a very large number of exemptions to avoid having taxes withheld from their checks- usually to avoid having delinquent child support taken out of it by the gov.

Met someone in a prison(that's for another thread! ;) ) that bragged about that last scam to me... he was "proud" of himself for getting out of his responsibility for his child and beating the system.

Overall, that law is a good idea. It is just a start though.

[Roguish Lawyer]

Originally posted by Surgicalcric
The answer would depend on if the health care provider was private practice or 3rd party govt funded (County Hospitals, County EMS).

In either case the patient is generally billed for the remaining balance of the procedure after insurance has paid their predetermined portion.

In the private sector if the bill is not satisfied by the patient after several billing cycles they are generally turned over to collections.

Anyone owing money to either the county hospital system or EMS after several billing cycles here in SC will find their tax refunds, if there is one, garnished for the due amount(s) by the state revenue service.

I mean next time you bill the insurance company.

[Roguish Lawyer]

Originally posted by Sacamuelas
RL... got any smiles for Doc T's response too?


Yes. :) I agree with what she said.

[Surgicalcric]

Originally posted by Roguish Lawyer
I mean next time you bill the insurance company.

Next time I bill as a paramedic or filing a claim for myself?

[NousDefionsDoc]

Stop sending aid to Vietnam and use the money to build hospitals on their side of the border. Take Castro out of play and get that great Cuban doctor machine to staff them.

And they're not immigrants, they found the land and killed the Indians fair and square for it, then Mr. Chuck came along and took it away. Or do you think Arizona, Texas, California and New Mexico are the names of gardens in England?

[Surgicalcric]

Originally posted by Sacamuelas
James-
I am sure you are aware of this. Not trying to start an argument but I want to make sure people who have not dealt with this situation are aware.
Why would I presume you were starting an argument by overstating the obvious? ;)

Overall, that law is a good idea. It is just a start though.
Gotta start somewhere.

[Sacamuelas]

Originally posted by Surgicalcric
Why would I presume you were starting an argument by overstating the obvious?

Well, you know how it is James. Due to the ADA requirements, I was making sure my message could be understood by our "special" members too. :D LOL

[Surgicalcric]

OUCH!

Had to pull out the ADA card didnt ya... There is another discussion in itself.

[Roguish Lawyer]

Originally posted by Surgicalcric
Next time I bill as a paramedic or filing a claim for myself?

If the insurance company always cuts 20% off your bills, you're going to increase your bills by 20% to compensate. It is a vicious cycle.

[Roguish Lawyer]

Originally posted by Sacamuelas
RL... Let's hear your ideas since you must be the expert with all your experience in the field.

. . .

From your little quote to me, maybe you think the problems are mostly provider and treatment derived. Please elaborate.

I think some of the problems are the following:

1. Economics. Treatment is given without informing the patient of the price of treatment. I think this generally is wrong. While there obviously are exceptions like emergency treatment, patients should know how much a treatment costs and be permitted to decide whether they want the treatment or not. If they can't afford it, they'll decline it. Even if they can afford it, they'll ask their provider what benefits they'll get for the price (see Doc T's 2 years or 2 days example above). In order to address this problem, I propose that third-party payments (i.e. direct billing to insurance companies) be BANNED. Also BAN group coverage. Allow insurers to sell single coverage only. Make patients pay themselves and seek reimbursement from their insurers. When the insurer won't pay, the insurer will lose business. Today, this does not happen, or at least not very quickly, because the patients don't even choose their coverage -- their employers do.

2. Tort reform. I agree with the comments above. One issue that has been missed is the wasteful "defensive medicine" caused by malpractice lawsuits. Look at the number of C-sections that get done today -- the increase was caused by doctors and hospitals not being willing to take the risk of not doing a C-section. That's just one example.

3. Health care is a commodity, not a right. I absolutely dispute that anyone is entitled to health care, just like I dispute that they're entitled to food or a job or anything else. If you can't afford it, you shouldn't get it unless someone decides to be charitable. Unless we decide as a society that we want to subsidize health care for the poor -- I might do that under some circumstances, but generally it is a bad idea. I refer back to my filet mignon and '61 Lafite example -- not everyone should get that level of health care.

Out of time. I'll add more later. May edit the above too -- first draft but kids are out of the bathtub.

[Sacamuelas]

Originally posted by Roguish Lawyer
Unless we decide as a society that we want to subsidize health care for the poor -- I might do that under some circumstances, but generally it is a bad idea. I refer back to my filet mignon and '61 Lafite example -- not everyone should get that level of health care. .

RL-

Are you saying that this is how you think our system works today?



With your economics part, you may have just made NDD's "people's list" ! LOL :D

[NousDefionsDoc]

GH - advocating bourgeoisie exploitation of the proletariat
CRad - crimes against Martha
RL - OMG!

[pulque]

your "economics" sounds like tort reform for the insurance industry. how do you get all those insurers to change the way they make their money? back to vocational school for them.

what do civil lawyers do when they get the tort reform bug?

[pulque]

Originally posted by Roguish Lawyer
If you can't afford it, you shouldn't get it unless someone decides to be charitable. Unless we decide as a society that we want to subsidize health care for the poor -- I might do that under some circumstances, but generally it is a bad idea. I refer back to my filet mignon and '61 Lafite example -- not everyone should get that level of health care.


It seems to me that you don't agree that health care costs are a problem.

[myclearcreek]

Health care costs are a problem. If you have insurance and go to the hospital - back in 1982 an aspirin was $5.00 - private pay was $2.50. Over the counter, about $0.02.

Pharmacy markup is hideous. I once asked the pharmacy owner where I worked about the huge markup discrepancy between similar drugs. His explanation was this: Even though one costs much less to produce and wholesale price is low, other pharmacies will be charging $X and we are expected to charge a similar price. Markup was anywhere from 0% to 400%. Yes, there were drugs that he made no money on. Overall, he did very well, but I found it disturbing that pricing was and seemingly continues to be so arbitrary.

[Pandora]

Comparisons to socialized healthcare? (i.e. UK, Canada)

[Doc T]

Originally posted by Roguish Lawyer
If the insurance company always cuts 20% off your bills, you're going to increase your bills by 20% to compensate. It is a vicious cycle.

for the most part we don't chose what we get paid...medicare does. Insurance is based off of medicare rates and no matter what we charge it makes no difference...they pay what they want to. So all our collections are typically based off of adjusted collections since a gross collection rate would be ludicrous...probably less than 10 cents on the dollar.

This is not the case for fee for service specialties like plastic surgery....there if you cannot afford a face lift you don't get one....no special deals, but you can put it on your credit card.

So increasing the bills does nothing but decrease your gross collection rate and keep the adjusted the same. Wish it was that simple...lol.

doc t.

[Ockham's Razor]

How significant is the impact of administrative costs on healthcare? From what I understand, with every HMO having an encylopedia of rules and regs for each procedure, it is adding incredible amounts to the cost of healthcare due to the need to have specialised people to understand their code and differentiation in costs.

When administrators out-numbers health care providers, something is wrong with the system.

I looked for, but can't find, the graph I have seen before that shows a direct correlation between the increase in hospital and HMO administrators and the price increase for health-care.

[Roguish Lawyer]

Originally posted by pulque
It seems to me that you don't agree that health care costs are a problem.

No, that's not true. Quite the opposite. I'm as pissed as everyone else.

[Roguish Lawyer]

Originally posted by Doc T
for the most part we don't chose what we get paid...medicare does. Insurance is based off of medicare rates and no matter what we charge it makes no difference...they pay what they want to. So all our collections are typically based off of adjusted collections since a gross collection rate would be ludicrous...probably less than 10 cents on the dollar.

This is not the case for fee for service specialties like plastic surgery....there if you cannot afford a face lift you don't get one....no special deals, but you can put it on your credit card.

So increasing the bills does nothing but decrease your gross collection rate and keep the adjusted the same. Wish it was that simple...lol.

doc t.

I know of at least one doctor who did this, albeit during the 70s and 80s. Perhaps things have changed. Are you sure this is true in all areas? It is inconsistent with my understanding (which obviously may be wrong).

[NousDefionsDoc]

Originally posted by Roguish Lawyer
No, that's not true. Quite the opposite. I'm as pissed as everyone else.

Well sober up and get on with the debate.

[Roguish Lawyer]

Originally posted by NousDefionsDoc
Well sober up and get on with the debate.

LOL

I actually thought about saying, "and not in the British sense of the word."

[Roguish Lawyer]

I would like some doctors to comment on my health care plan, please. Others too. :munchin

[Roguish Lawyer]

Originally posted by Roguish Lawyer
I would like some doctors to comment on my health care plan, please. Others too.

Three hours and nobody willing to step up to the plate?

OK, I guess we have agreement. I'm right. Somebody go tell Congress we've agreed on a plan. :D

[Doc T]

Originally posted by Roguish Lawyer
I think some of the problems are the following:

1. Economics. Treatment is given without informing the patient of the price of treatment. I think this generally is wrong. While there obviously are exceptions like emergency treatment, patients should know how much a treatment costs and be permitted to decide whether they want the treatment or not. If they can't afford it, they'll decline it. Even if they can afford it, they'll ask their provider what benefits they'll get for the price (see Doc T's 2 years or 2 days example above). In order to address this problem, I propose that third-party payments (i.e. direct billing to insurance companies) be BANNED. Also BAN group coverage. Allow insurers to sell single coverage only. Make patients pay themselves and seek reimbursement from their insurers. When the insurer won't pay, the insurer will lose business. Today, this does not happen, or at least not very quickly, because the patients don't even choose their coverage -- their employers do.

2. Tort reform. I agree with the comments above. One issue that has been missed is the wasteful "defensive medicine" caused by malpractice lawsuits. Look at the number of C-sections that get done today -- the increase was caused by doctors and hospitals not being willing to take the risk of not doing a C-section. That's just one example.

3. Health care is a commodity, not a right. I absolutely dispute that anyone is entitled to health care, just like I dispute that they're entitled to food or a job or anything else. If you can't afford it, you shouldn't get it unless someone decides to be charitable. Unless we decide as a society that we want to subsidize health care for the poor -- I might do that under some circumstances, but generally it is a bad idea. I refer back to my filet mignon and '61 Lafite example -- not everyone should get that level of health care.

Out of time. I'll add more later. May edit the above too -- first draft but kids are out of the bathtub.

My 2 cents on your plan:

Economics: Its not a simple fee for service for most things. People are often told what they need to pay...whether it be co=pays or fee for service. If you go to see a surgeon for elective surgery he/she will often have a billing person sit down with you in the office and give you an idea of the cost and refuse to do it if you cannot pay. For emergency stuff that obviously isn't really an option. Physicians can not refuse to treat in an emergency situation unless they can find another accepting MD. Patients are not informed of costs because, for the most part, we have no idea what things will cost. As for deciding for or against treatment, most people assume insurance will pick up the cost and never think twice about it. I cannot tell you the number of patients that ask to stay "just one more day" despite the fact that I tell them insurance WILL NOT pay, that they are fine to go home...but they cannot find a ride or such.... I let them know they will recieve a charge in excess of $400 but they say they don't care.

Not paying via insurance/HMOs/etc would not work. Often the hospital bill is in excess of tens of thousands of dollars... geez, some of my patients reach the multi hundreds of thousands of dollar bills...you cannot ask someone to pay that out of pocket and wait for insurance to reimburse.

As for losing business, they do...on the physician side. Physicians band together (rare but true) and stop offering coverage to a specific insurer until they reimburse at a more reasonable rate.

Tort reform: a necessary thing. I am not certain the increase in sections is because of fear of suit but rather lots of it is public demand...speaking from experience, lol. Patients are more informed of risks and benefits and want an active choice in procedures.

Medical care is a right...at least emergency care...and society has already decided to be charitable on this one and its awfully hard to reverse what is already done. It is as simple as that....and I don't think i'd want it any other way. Most of my patients are indigent... they are appreciative of what I do and show me in ways that they can since they know they cannot pay....with cards, and cookies, and writing letters to the hospital to say how much they love me...lol. And complimenting me by saying I am much too young to run an ICU...lol.... Worth more than money to an aging woman.

doc t.

[Roguish Lawyer]

Originally posted by Doc T
My 2 cents on your plan:

Economics: Its not a simple fee for service for most things. People are often told what they need to pay...whether it be co=pays or fee for service. If you go to see a surgeon for elective surgery he/she will often have a billing person sit down with you in the office and give you an idea of the cost and refuse to do it if you cannot pay. For emergency stuff that obviously isn't really an option. Physicians can not refuse to treat in an emergency situation unless they can find another accepting MD. Patients are not informed of costs because, for the most part, we have no idea what things will cost. As for deciding for or against treatment, most people assume insurance will pick up the cost and never think twice about it. I cannot tell you the number of patients that ask to stay "just one more day" despite the fact that I tell them insurance WILL NOT pay, that they are fine to go home...but they cannot find a ride or such.... I let them know they will recieve a charge in excess of $400 but they say they don't care.

Tort reform: a necessary thing. I am not certain the increase in sections is because of fear of suit but rather lots of it is public demand...speaking from experience, lol. Patients are more informed of risks and benefits and want an active choice in procedures.

Medical care is a right...at least emergency care...and society has already decided to be charitable on this one and its awfully hard to reverse what is already done. It is as simple as that....and I don't think i'd want it any other way. Most of my patients are indigent... they are appreciative of what I do and show me in ways that they can since they know they cannot pay....with cards, and cookies, and writing letters to the hospital to say how much they love me...lol. And complimenting me by saying I am much too young to run an ICU...lol.... Worth more than money to an aging woman.

doc t.

OK, I withdraw the claim of victory. For now.

Good points on emergency care, etc. But here is the problem as I see it:

Hospital/provider bills insurance company.

Insurance company ignores bill.

Hospital/provider rebills insurance company.

Insurance company ignores bill.

Hospital/provider rebills insurance company.

Insurance company pays tiny portion of bill, claims that most of services were unnecessary, excessive, overpriced, etc.

Hospital/provider bills patient.

Patient's blood pressure rises dramatically. Patient calls insurance company and screams bloody murder.

Insurance company ignores patient.

Hospital/provider bills patient again, threatening to destroy credit, etc. if bill is not paid.

Patient's blood pressure rises again. Patient calls insurance company again, is assured that this was "just an error," and that problem will be fixed.

Hospital/provider bills patient again, more threats.

Patient gets employer involved. Employer tries to fix problem. Insurance company makes further partial payment.

Hospital/provider bills patient again, more threats.

Etc, etc.

I think you have to break this cycle somehow. You have to make insurance companies lose business when they refuse to pay what they are supposed to pay. I don't think that happens fast enough when you have third-party payors.

Thoughts?

[Roguish Lawyer]

Originally posted by Doc T
Not paying via insurance/HMOs/etc would not work. Often the hospital bill is in excess of tens of thousands of dollars... geez, some of my patients reach the multi hundreds of thousands of dollar bills...you cannot ask someone to pay that out of pocket and wait for insurance to reimburse.

As for losing business, they do...on the physician side. Physicians band together (rare but true) and stop offering coverage to a specific insurer until they reimburse at a more reasonable rate.


Fair point, but it still seems to me that you need more pressure on insurance companies. They get away with way too much, and patients get screwed because the best doctors don't take the coverage you have and you have a race to the bottom where patients are forced to accept lower quality care because of decisions made by their employers.

I will give this some more thought.

[Doc T]

perhaps some kind of law that grants insurance companies 90 days to pay for services rendored and if they fail to comply there are penalties. As I said earlier no one except those who have no insurance, medicare, medicaid, etc pay the bill in full...no one.... there are set upon fees.

So maybe if they don't pay on time they have to pay an "interest of sorts" ...maybe 10% more for each month they delay...that would motivate fairness.

As I write this its interesting to note that in my state there is an access plan for those who are unfunded...governmental money to pay for health care and so we bill access...the state is 18 months LATE on payment.... and there will be no penalty... for my surgical group that amounts to about 1.8 million in fees.

that would be my plan.

doc t.

[Roguish Lawyer]

Originally posted by Doc T
perhaps some kind of law that grants insurance companies 90 days to pay for services rendored and if they fail to comply there are penalties. As I said earlier no one except those who have no insurance, medicare, medicaid, etc pay the bill in full...no one.... there are set upon fees.

So maybe if they don't pay on time they have to pay an "interest of sorts" ...maybe 10% more for each month they delay...that would motivate fairness.

As I write this its interesting to note that in my state there is an access plan for those who are unfunded...governmental money to pay for health care and so we bill access...the state is 18 months LATE on payment.... and there will be no penalty... for my surgical group that amounts to about 1.8 million in fees.

that would be my plan.

doc t.

I like it. I think we also should consider making it easier to sue insurance companies for breaching their contractual obligations to policyholders. Although this is not my area, I understand that there are many limitations on the ability to do this.

[myclearcreek]

Inserting a thought here....

Major medical/hospitalization insurance to cover the big ticket items, private pay for well-care visits and checkups seems a better way to go.

[Sacamuelas]

Originally posted by Roguish Lawyer
I think we also should consider making it easier to sue insurance companies for breaching their contractual obligations to policyholders.


AAAHhhhhhh... I knew you would finally get to your point in all this. YOU want to sue the deep pockets!!! surprising....
:rolleyes:

[Roguish Lawyer]

Originally posted by myclearcreek
Inserting a thought here....

Major medical/hospitalization insurance to cover the big ticket items, private pay for well-care visits and checkups seems a better way to go.

I like it.

[Roguish Lawyer]

Originally posted by Sacamuelas
AAAHhhhhhh... I knew you would finally get to your point in all this. YOU want to sue the deep pockets!!! surprising....

No, grasshopper. I want others to do it. I represent the deep pockets. If I were to represent the People, NDD would take me off The List. :D

[Doc T]

do you have any idea how much a well check visit with labwork would actually cost? The idea behind well check visits is to keep bad things from happening by physicians picking things up in the early stages.

If you had to pay $300-400 dollars yearly and felt well would you go?

[Sacamuelas]

Originally posted by Roguish Lawyer
No, grasshopper. I want others to do it. I represent the deep pockets. If I were to represent the People, NDD would take me off The List.
Somehow young jedi... I don't think the solution to our health care situation is MORE lawsuits!! :p

[Roguish Lawyer]

Originally posted by Doc T
do you have any idea how much a well check visit with labwork would actually cost?

Several hundred dollars. I pay my bill and seek reimbursement when I see my primary care physician, and it's usually about $350.

[Sacamuelas]

So your solution is to expect Doctors to be able to squeeze a couple hundred dollars out of every patient that walks in the door?

What effect on regular preventive helathcare assessments and access to care do you think that will have on our country? What would the financial outcome be oin ten years when everyday treatments are not rendered and more hospital/ emergency care is needed to treat these conditions?

[Doc T]

Originally posted by Roguish Lawyer
Several hundred dollars. I pay my bill and seek reimbursement when I see my primary care physician, and it's usually about $350.

edited above with the info...

what about you, your wife, your kids... that would run at least over a thousand a year...and that is if your kids are healthy...no extra visits for an ear infection here, sore throat there...

the average family would not be able to afford healthcare if it was out of pocket for routine stuff.

doc t.

[Sacamuelas]

I see you edited while I did Doc T... Great minds...great minds!! LOL

I think I will stop and let you argue this one. I defer-

[myclearcreek]

Originally posted by Doc T
do you have any idea how much a well check visit with labwork would actually cost? The idea behind well check visits is to keep bad things from happening by physicians picking things up in the early stages.

If you had to pay $300-400 dollars yearly and felt well would you go?

Yes. For my son with asthma, this would be difficult, but I would do it. His meds are not inexpensive, either. Fortunately for me, his Dad has to provide his health insurance, but just changed the policy to a pretty sizeable deductible. It is only March and I have met most of it already.

For myself, I rarely went to the doctor even when it was 100% covered. I'm very healthy, but would go at the first indication of trouble. For preventive well-woman checkups, I will still go annually and pay out-of-pocket.

[Roguish Lawyer]

Originally posted by Sacamuelas
Somehow young jedi... I don't think the solution to our health care situation is MORE lawsuits!! :p

My view is that it should be harder to sue doctors, easier to sue insurance companies, and much, much easier to sue dentists.

[Doc T]

Originally posted by myclearcreek
Yes. For my son with asthma, this would be difficult, but I would do it. His meds are not inexpensive, either. Fortunately for me, his Dad has to provide his health insurance, but just changed the policy to a pretty sizeable deductible. It is only March and I have met most of it already.



at what point do you advocate insurance or some third party payer kicks in?

doc t.

[Roguish Lawyer]

Originally posted by Doc T
edited above with the info...

what about you, your wife, your kids... that would run at least over a thousand a year...and that is if your kids are healthy...no extra visits for an ear infection here, sore throat there...

the average family would not be able to afford healthcare if it was out of pocket for routine stuff.

doc t.

Even if they had a reimbursement right from their carriers?

[Roguish Lawyer]

Originally posted by Doc T
at what point do you advocate insurance or some third party payer kicks in?

doc t.

It should depend on the agreement between the insurance company and the patient. Carriers would have an incentive to pay quickly if the patient was the one buying the insurance. But I like your suggestion of civil or other penalties.

[Sacamuelas]

Originally posted by Roguish Lawyer
My view is that it should be harder to sue doctors, easier to sue insurance companies, and much, much easier to sue dentists.

Well, all your solution would end up doing is making Doctor's happier, healthcare insurance premiums go sky high for the average american, more lawyers get rich off the average american, and necessitate a lot more pain than is necessary for every lawyer that happens to like sweets or get trauma to the oral cavity.... :D


All it would do is INCREASE the cost of healthcare for the American citizen...or do you not think the insurace companies would pass the cost of lawsuits or your penalties on to the consumers in the end?

edited: OOPs, Sorry Doc T. I said I was going to quit, but RL keeps pickin on me. haha

[Roguish Lawyer]

http://www.cato.org/research/articles/bandow-030616.html

Two Choices for Health Care Reform
by Doug Bandow

June 16, 2003

Doug Bandow is a senior fellow at the Cato Institute and James Madison Scholar with the American Legislative Exchange Council.

Health care is emerging as a critical political issue. Costs are rising, people are worrying about losing medical benefits, Democrats are pushing for drug coverage for Medicare beneficiaries and universal care for everyone else, and Republicans are scrambling to offer their own "reform" packages.

States are attempting to impose price controls on pharmaceuticals. Ambitious attorneys general and left-wing interest groups have joined to target drug makers for a host of alleged offenses.

Doctors across the nation have sued nine major health insurers over their reimbursement policies. Aetna has broken industry ranks, agreeing to a $300 million settlement, but the rest of the class-action lawsuit continues.

Fixing the health-care system seems more difficult than ever.

The focus of much criticism has been on health maintenance organizations, which are designed to limit care. While they are an important option in a competitive medical industry, government and businesses are increasingly pushing reluctant patients into HMOs.

Doing so is supposed to save money. Yet Hewitt Associates reports that HMO premiums will rise 22 percent this year.

The percentage of the public viewing HMOs as doing a good job fell from 51 percent to 29 percent between 1997 and 2001. This has led nearly half of all states to pass any-willing-provider laws mandating that managed-care networks accept any doctor or hospital agreeing to its fees and rules. Consumers get more choice, but HMOs lose bargaining power to exact lower fees.

Individual managed-care companies have become the target of special disdain. For instance, California's WellPoint Health Networks, the nation's third-largest system (by enrollment), has been criticized for the high salary of its CEO, Leonard Schaeffer – No. 19 among America's top 500 firms – and its takeover of nonprofits, such as Blue Cross/Blue Shield of Georgia and Missouri.

A WellPoint cost-cutting tactic is to lobby the Food and Drug Administration to move drugs from prescription to over-the-counter status. In 1998, the company petitioned to shift the anti-allergy drugs Allegra, Claritin and Zyrtec to OTC. Last year, WellPoint filed a similar motion for Clarinex.

Normally, drug makers lead the push for OTC status; Claritin was moved to OTC in December only after manufacturer Schering-Plough dropped its opposition. But now FDA Commissioner Mark McClellan is considering acting on his own initiative.

By allowing patients to self-medicate, OTC increases consumer choice and reduces costs. However, most insurers, including WellPoint, do not cover OTC medications. So in the near term, at least, only insurers save money – indeed, patients actually may have to spend more money for the same medicine.

Insurers, and especially HMOs, also make it hard for patients to receive competing prescription drugs. For instance, Dr. Lewis Kanter, an allergy specialist in Camarillo, north of Los Angeles, complains that he is "bombarded with paperwork" from insurers if he doesn't direct patients to OTC Claritin.

Some insurers simply drop coverage. Last fall, Aetna requested permission to stop paying for non-sedating antihistamines altogether. California responded by advising insurers not to drop coverage for an entire class of drugs just because one went OTC. This rule, like state any-willing-provider laws, expands choice, but only by increasing insurer costs.

The problem with HMOs is not HMOs per se, but the environment in which they operate. Government policy inadvertently discourages provision of quality health care, as exemplified by the artificial emphasis on HMOs.

Because the federal government doesn't tax employer-provided health insurance, businesses provide insurance, which means they choose providers and plans. Most companies, understandably, are more interested in constraining health care costs than expanding coverage. Thus their ever-stronger push, mirrored by government policy, to get patients into managed care.

The system makes no sense. Employers don't provide auto or homeowner's insurance.

Similarly, people need to be able to tailor health insurance to their own circumstances, and thus choose the right balance between cost savings and coverage limitations. One solution is placing medical savings accounts on a level playing field with traditional insurance, thereby returning health-care decisions to employees.

There are only two reform paths for today's broken system. The first is to fully nationalize the system, which would sacrifice coverage and quality to save money. The alternative is to reintroduce consumer choice and industry competition to medicine.

Congressional Democrats and Democratic presidential candidates want to take the first course. For the American people's sake, the Bush administration and Congress must travel the second.

This article originally appeared in The San Diego Union-Tribune on June 16, 2003.

[Roguish Lawyer]

"Power to the People" -- why NDD should agree with me. :D

http://www.cato.org/dailys/08-11-99.html

August 11, 1999

The Wrong Health Care Debate
by Michael Tanner

Michael Tanner is director of health and welfare studies at the Cato Institute.

Once again Washington has it wrong. The current debate over health insurance reform has been cast as a choice between letting health management organizations (HMOs) control your health care choices or letting the government do it. That's a choice that is guaranteed to make you sick.

But there is a third choice -- a better choice -- that is being left out of the debate: giving consumers control over their own health care decisions.

Today most Americans have no choice of health insurance. They must accept the plan their employer chooses for them. Employers, understandably concerned about rising health care costs, are increasingly choosing managed care plans that hold down costs by restricting access to certain services and specialists. Workers, stuck in plans they dislike, have turned to the government for relief.

Think what would happen if you went to buy a new car and were told that just one model was available. Since cost was an issue, the sole choice was a stripped-down model without any options. If you wanted a stereo or power steering, even if you could afford to pay for it, you'd be out of luck. It wouldn't be long before Congress started a movement for a car buyers' bill of rights, with Democrats and Republicans arguing over what color the one model of car should be painted.

Of course that doesn't happen with cars, because you can always go to the lot next door and pick a different model. Why can't you do that with health insurance?

The reason lies in an anomaly in our tax code. If your employer gives you health insurance, it is tax-free for you. But if you purchase health insurance on your own, you receive no such tax break. That means that if you don't like the insurance plan your employer offers, you cannot go elsewhere and buy your own coverage without incurring a substantial tax penalty.

Here's an example: Let's assume that you earn $30,000 and your employer supplies a health insurance plan with the local HMO that has a value of $5,000. You pay taxes on only $30,000. What if you don't like that HMO and want to go someplace else for your health care? You could tell your boss to give you that $5,000 he was spending on your HMO coverage and then go out and buy your own insurance. But if you did, you would have to pay taxes on $35,000 instead of on $30,000. That could cost you an additional $2,000 or more in taxes. You are effectively stuck with your boss's policy, like it or not.

In health insurance, as in so many other things, whoever controls the money controls the game. If the government controls health care spending, the government will control health care. If your boss controls your health care money, your boss will control your health care. But if you control the money, you can control your own health care.

Rather than debating how to best regulate your boss's policy or whether you should be able to sue the HMO that your boss chose for you, Congress should be seeking ways to give you a greater choice of health plans. In short, Congress should put the money back in your hands so that if you don't like your boss's plan you can simply go someplace else and buy one you do like. Some people will stick with HMOs, accepting slightly fewer services and less choice of doctors, while pocketing the extra money. Others will choose to spend a little more to get more choice and extra services. The choice would be up to each individual worker.

Congress can do this by changing the tax code to give individually purchased health insurance, or for that matter health care you pay for out of your own pocket, the same tax break as you get for employer-provided health insurance. Congress should create a universal health care tax credit available to all Americans, regardless of where they buy their health insurance. That would empower individual Americans to choose the health insurance plan best for them.

It doesn't have to be more power to the government or more power to the HMOs. It could be power to the people.

[Doc T]

Originally posted by Roguish Lawyer
It should depend on the agreement between the insurance company and the patient. Carriers would have an incentive to pay quickly if the patient was the one buying the insurance. But I like your suggestion of civil or other penalties.

carriers would still not have the incentive to pay quickly...after all they make interest on money that is within their grasp...

lots of america does buy their own insurance, more today than ever i would imagine...and the companies don't pay any quicker on their claims...

the red tape would still exist only the sick and injured patients would pay the price by being bankrupt instead of the MDs sucking up the costs.

just don't see this as a solution.

eventually we will probably see some kind of socialized system with private insurance for the rich that will pay so that they can receive over and above what is deemed necessary medical care. It will be the definition of NECESSARY care that will interesting to me.

t.

[Sacamuelas]

Those articles don't solve anything. They are a proposed solution for a reality that doesn't exist except in a think tank vacuum.

You take away health care provided by the employer and let people check into the cost of "private" insurance policies. Making 30k a year and the author thinks that people will shop around for the most inclusive and best optioned plan??? YEah right, if you make 30 k a year, you take the cheapest premium plan you can get so that your kids can still obtain the things they need for survival. Mom and DAD end up skipping all their routine medical visits to save cash and even the kids don't go in early for common ailments. You end up with an emergency/acute driven healthcare system that studies show is less cost efective in the long run than a preventitive medicine approach in which diagnosis and treatment of the disease is accomplished at an earlier and easier to treat stage. common ex. diabetes

Exactly what happens to the probably 50% of the people that don't carry a policy that adequately pays for the medical care that is going to be needed jsut to save a few bucks? In this new law, will Congress pass a tort reform act that dissolves all liability to a physician or other HCP that denies treatment to someone based on inability to pay. After all, in this perfect world, I am going to demand payment up front since everyone is going to be wealthy from all this imaginary savings. :p

[myclearcreek]

Originally posted by Doc T
at what point do you advocate insurance or some third party payer kicks in?

doc t.

When hospitalization or intensive home-care is required. By intensive, I mean requiring home-health visits. One friend has seven children from 20s to about 10 and only major medical health insurance. She is on her third round of cancer treatment within a decade.

They chose this route rather than driving new cars and a larger house. They live debt-free on a modest income.


Edited for spelling.

[pulque]

How does that tax credit actually reform the HMO-patient-provider triad? the article doesn't say.

Some employers offer a flexible spending account as an alternative. It means that the employee decides how much they want to spend on health care that year (copays, deductables, premiums, prescription and OTC meds), and they get that amount taken out pre-tax.

[Ockham's Razor]

Do these institues, CATO, Heritage, and others, propose more than just a glossing over of the problem, or actual solutions. I have yet to see a sentient argument from any DC or other Think Tank.

Not even one argument about the administrative costs of health care and their costs to the sector? I hear a lot about this free market lassiez faire thing, but see no realisation in the lowering of healthcare costs.

Perhaps a solid question would be why is it that most western governments bargain for lower drug prices and we say, screw that, let the market decide?

The only counter-argument I hear is this.. "But you don't understand how high the costs are for R&D to manufacture new drugs!" etc... Well, considering that they are a business, would they not limit their extensive advertising campaigns and throw that money at R&D considering that a pharmaceutical company is only as good as the last drug they roll out?

Why should the United States foot the bill for the totality of R&D and other countries get the same drugs for a fraction of the cost?

The argument over the importation of drugs from Canda astounds me, considering that many of the companies that are saying this are those that sell to Canada. Are they saying that they sell an inferior product to Canada and therefore we can't trust importation? Sounds like a load of BS to me.

[NousDefionsDoc]

Every graduate medical student does one year of social service before getting fully licensed. They work in family practice clinics, ERs in depressed areas, etc. 10% of all social/ welfare payments no longer goes to the individual for cigarettes and crack - it goes to the pool to pay for the program. Pay rates for the young doctors in love are established by COLA determinations for the area. Same program for administrators. Before they get to administrate Peyton Place General Hospital, they have to administrate the Poor Folks Unit for COLA pay as a train up.

Consideration for government payment of medical school costs after graduation and successful social service time.

No more foreign aid to silly countries and no more funding porn as art. That money goes to cover catastrophic illnesses and border hospitals/clinics.

Insurance regulations completely overhauled.

Penalties against plaintiffs for frivilous malpractice suits.

FDA completely overhauled.

[Roguish Lawyer]

Questions for providers:

Is it not true that there are very substantial mark-ups of drugs provided at hospitals, lab tests, disposables, etc.?

If the recovery rate is only 10% and we don't have widespread bankruptcies, doesn't that mean that there is excessive billing on the provider side as well? If so, why? If not, why not?

:munchin

[Doc T]

Originally posted by Roguish Lawyer
Questions for providers:

Is it not true that there are very substantial mark-ups of drugs provided at hospitals, lab tests, disposables, etc.?

If the recovery rate is only 10% and we don't have widespread bankruptcies, doesn't that mean that there is excessive billing on the provider side as well? If so, why? If not, why not?

:munchin

without a doubt there is excessive markups in some things... the price you pay for a drug though includes it being mixed up into solution in the pharmacy, transported to the floor, given by the nurse,etc...not just the drug but what goes into it from time its ordered to time its given.

most county hospitals mark up more than the private ones...why? to cover for non-funded patients. I brought this up earlier I believe. The county hospital where I trained was the most expensive hospital in city when I was there and many insurance companies wouldn't cover being an impatient there.... And it was done purposefully to have the paying patients offset some of the costs of the nonpayers. The hospital was still going broke...and yes, hospitals often run with a bare minimal margin...usually less than what it costs to run for less than a week ...in the public market.

So no, not a lot of surplus like you might think...hence things like taxing alcohol and cigerettes to give money to money to indigient care, 1/2 cent tax in Miami, extra fines for drunk drivers to go into a trauma fund in texas... every little bit helps hospitals from going BROKE.... it is a real thing. Jackson Memorial Hospital used to run 20-30 million in debt each year prior to the 1/2 cent tax.... it threatened the existence of something that couldn't go away.

doc t.

[Roguish Lawyer]

Originally posted by Doc T
without a doubt there is excessive markups in some things... the price you pay for a drug though includes it being mixed up into solution in the pharmacy, transported to the floor, given by the nurse,etc...not just the drug but what goes into it from time its ordered to time its given.

most county hospitals mark up more than the private ones...why? to cover for non-funded patients. I brought this up earlier I believe. The county hospital where I trained was the most expensive hospital in city when I was there and many insurance companies wouldn't cover being an impatient there.... And it was done purposefully to have the paying patients offset some of the costs of the nonpayers. The hospital was still going broke...and yes, hospitals often run with a bare minimal margin...usually less than what it costs to run for less than a week ...in the public market.

So no, not a lot of surplus like you might think...hence things like taxing alcohol and cigerettes to give money to money to indigient care, 1/2 cent tax in Miami, extra fines for drunk drivers to go into a trauma fund in texas... every little bit helps hospitals from going BROKE.... it is a real thing. Jackson Memorial Hospital used to run 20-30 million in debt each year prior to the 1/2 cent tax.... it threatened the existence of something that couldn't go away.

doc t.

I think this is part of the problem too.

[dickens]

Medicare was doomed to failure from the onset. It is simply socialized medicine and socialized medicine doesn't work. Our medicare system needs to be totally overhauled as an umbrella for the ones that need it....the poor. There is no reason why the taxpayer should pay for Bill Gates' mothers medical care or medication. It should be available to people, based on income and financial need. One size does not fit all and paying the medical care for the rich only takes the limited available funds away from those that need it.
We also need reforms in the tort system to stop some of these lawsuits. A woman drinks and uses drugs her entire pregnacy and then blames the MD when the baby is born is fetal alcohol syndrome. If this kind of thing doesn't stop, we won't have to worry about the medical care because all the doctors will have left the profession because they can't pay their malpractice insurance.

[The Reaper]

Originally posted by dickens
Medicare was doomed to failure from the onset. It is simply socialized medicine and socialized medicine doesn't work. Our medicare system needs to be totally overhauled as an umbrella for the ones that need it....the poor. There is no reason why the taxpayer should pay for Bill Gates' mothers medical care or medication. It should be available to people, based on income and financial need. One size does not fit all and paying the medical care for the rich only takes the limited available funds away from those that need it.
We also need reforms in the tort system to stop some of these lawsuits. A woman drinks and uses drugs her entire pregnacy and then blames the MD when the baby is born is fetal alcohol syndrome. If this kind of thing doesn't stop, we won't have to worry about the medical care because all the doctors will have left the profession because they can't pay their malpractice insurance.

dickens:

First welcome to PS.com and congratulations on being the 500th member.

As to your post, you believe that those who fail to save or plan for their future should be supported by those who are working and trying to save?

From each, to each, eh? Sounds like Socialism to me.

TR

[dickens]

Not really, but that is the simple fact now. Something given by the Government is never taken back so we have to deal with it. There are some who just never made enough to save. Being a home care nurse, I see a lot of them. One man's wife was badly burned in a house fire. He gave up everything they had to take care of her...he lost his home, his job, everything. That was 20 years ago and he was never able to recover from that. If the money was used only for those that need it, we would have more than enough and probably a lot left over. The vast majority of Seniors in this country do very well.
I am a firm believer in get your butt out of the house and get a job! But when it comes to the elderly...it's just to late for them to correct their mistakes now. What are we to do? Let them starve? Believe me, many don't have kids that would take care of them. That's the way it used to be. One generation took care of the next. Sadly, that too, seems to be gone from our culture.
Medicaid....that's a whole different thing....