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  1. KAM1138
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    #2061  
    Quote Originally Posted by davidra View Post
    If you are saying that HSA's should be invested in the government and not subject to access by crooks like Bernie Madoff, then I agree that HSA's are a good idea. You mean it doesn't bother you at all that all this money will be put into the government? Excellent. Because HSA's are seen by many in the investment community as a gold mine. If anybody needs a gold mine, it's our deficit.
    I'm not saying what someone else SHOULD do--that's their choice not mine. What I'm saying is that people CAN choose the level of risk they are comfortable with. They need not invest in high-risk "products". If its my money, I can make that choice. For something like medical funds, I would tend to make a relatively conservative choice, but might also choose to risk a smaller amount on a growth fund.

    Quote Originally Posted by davidra View Post
    Less than a third of doctors accept Medicaid; 75% accept Medicare. On the other hand, Medicaid provides a lot more services to patients than Medicare. That forces the reimbursement rate down so that it really isn't cost-effective to deal with Medicaid patients, again for SOME but not all providers. I know of places that fight for Medicaid patients.

    I know of very few people who have needed their insurance who haven't had some kind of problems with private insurance companies. Not that people don't have bad experiences with Medicare, but all these people that think the private insurance industry gives a damn about them and provides them great service are wolfing down the kool-aid.
    Well, as I've said--I've been disappointed in my insurance coverage and I've talked at some length about concepts on how to minimize their role. I totally believe (and have experienced) that these problems exist. I'm not on medicare or medicaid, but I sat at lunch the other day and listened to an older woman complain the entire time about how medicare screws her and that she has to pay so much extra for supplemental coverage. I really have no idea what her issue was (she wasn't addressing me) only that she was highly agitated.

    I'm quite sure that insurance companies don't give a damn about me, but I'm not really expecting that the government gives a damn about me either. I recently had a (not personal) interaction with a government agency. The difference in dealing with them and with private industry is amazing. They are totally in different world, and its not a good on in my view. Now, this is a totally different area than healthcare, but it is a good illustration of the difference in "culture" between government and private industry.

    KAM
  2. #2062  
    Quote Originally Posted by bclinger View Post
    I knew my taxes were going up!
    Really.....Obama will have no choice but to go back on that "promise".
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  3. #2063  
    Quote Originally Posted by clemgrad85 View Post
    Well.....the first thing I noticed on your "hard data" is that in that survey, only 62% of doctors responded. The fact that 75% are accepting Medicare patients means that 25% are not accepting...at least...based on the 62% response rate.

    Here is a survey of Texas physicians: Fewer Texas Physicians Accepting New Medicare Patients; Payment Cut Would Exacerbate Problem Here is a quote from the article: "Fifty-eight percent of Texas physicians are accepting new Medicare beneficiaries, compared with 90% before 1990, according to a survey by the Texas Medical Association, the Houston Chronicle reports. The proportion of primary care physicians accepting new beneficiaries is 38%, according to the survey. The physicians say treating these patients is no longer affordable because of Medicare reimbursement rates, which have declined by 20% in inflation-adjusted dollars over the last seven years. TMA predicts that the trend will continue unless Congress develops a long-term solution regarding physician reimbursement under Medicare, with debate in Congress continuing over how to eliminate a scheduled Medicare physician payment cut." I know I just went to Clemson, but, I think a drop of 90% to 58% means that their is a decrease? I'll defer to you, doc, since you are so much smarter than me. Is that a decrease?

    So whatever....you have your statistics, I have mine. I will stick by my believe that more and more physicians will continue to stop accepting new patients, nation wide (maybe not in Florida) based on all the info I keep reading.
    As I initially stated, it varies with location.

    Physician Access Stabilizes
    indings from HSC’s 2004-05 Community Tracking Study Physician Survey (see Data Source) show that Medicare access to physicians remains high and has stabilized in recent years, after declining between 1996-97 and 2000-01.

    About 73 percent of physicians accepted all new Medicare patients in 2004-05, and only 3.4 percent accepted no new Medicare patients (see Table 1). While the proportion of physicians accepting all new Medicare patients in 2004-05 increased from 71.1 percent in 2000-01, the change was not statistically significant.

    An HSC study of Medicare beneficiaries also indicated that access to physician services stabilized between 2001 and 2003, after an earlier decline.2

    Physician acceptance of Medicare patients stabilized between 2000-01 and 2004-05 despite a small net decrease in Medicare physician payment rates between 2002 and 2005.While Medicare physician payment undoubtedly factors into individual physician’s decisions to accept Medicare patients, it’s less clear that changes in Medicare physician payment are a key factor driving changes in the overall proportion of physicians accepting Medicare patients. For example, while physician payment rates rose sharply between 1997 and 2001, the percentage of physicians accepting all new Medicare patients declined between 1996-97 and 2000-01.3
    Reference

    These are not "my" statistics; they are national statistics that answer the question as to whether or not the number of physicians accepting Medicare has decreased or not. And the answer nationally is that it hasn't in any significant way whatsoever. While I have no doubt that it might have in Texas, that isn't the question, unless you live in Texas. Let me restate the obvious: there is no national data that suggests that the number of doctors accepting Medicare has decreased. The decision to accept assignment for Medicare is a business decision, and three out of four physicians are fine with Medicare reimbursement, even if it is 20% less than some insurance companies. I have no idea why you just can't seem to accept the fact that Medicare works for lots of patients and doctors....but it does, whether you accept it or not. And making it more cost-conscious probably won't have any effect on that.
  4. Micael's Avatar
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       #2064  
    Quote Originally Posted by davidra View Post
    The decision to accept assignment for Medicare is a business decision, and three out of four physicians are fine with Medicare reimbursement, even if it is 20% less than some insurance companies.
    Where/how do you think those three physicians are making up the 20% loss?
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  5. KAM1138
    KAM1138's Avatar
    #2065  
    Quote Originally Posted by davidra View Post
    The decision to accept assignment for Medicare is a business decision, and three out of four physicians are fine with Medicare reimbursement, even if it is 20% less than some insurance companies. I have no idea why you just can't seem to accept the fact that Medicare works for lots of patients and doctors....but it does, whether you accept it or not. And making it more cost-conscious probably won't have any effect on that.
    I've got a question for you on this. So, many doctors (75%) are willing to accept lower payments (up to 20% less) for some portion of their business.

    Do you believe they could do that across the board--for all patients? What I mean is charge 80% of what they normally do--while still covering their overhead and making a fair profit. I realize "fair" is subjective here. In short--can they stay in business by charging less?

    Or, are they able to accept lower payments for that segment of patients, because they make up for it by charging 100% to the rest of their patients? If this is the case, then this 20% savings/reduction couldn't likely be applied to everyone.

    Which situation do you think is the actual case--or is neither the case? Is there some other circumstance that I'm not aware of?

    KAM
  6. #2066  
    Quote Originally Posted by KAM1138 View Post
    Hello Davidra,

    I think you might be misunderstanding me. I'm well aware of the extremely high costs of a hospital stay--and not just in the ICU. I think previously I mentioned the overnight stay of a friend that cost nearly $5000--for absolutely nothing special at all.

    I was referring to that money being used to purchase insurance (and pay deductibles) for those people. I referred to this several times earlier in the thread. While you know that I've got many issue with how insurance is currently run, I'm not attempting to address that at the moment.

    To reiterate. I'm asking if the problem is 47 million people without insurance, why we aren't spending that 300 billion to INSURE them--right now, today. $6400 might be wiped out quickly for a stay in the ICU, but it alternatively can buy a pretty good health-insurance policy.

    My quick example cost $4400 for a 40 year old--that had 100% pay after the deductible which I think was $1600 (using the other $2000 for first dollar coverage--by whatever system you wish--HSA or other).

    Again--if the problem is that they don't have insurance, and we currently spend enough to provide each and every one of them insurance, why not simply do that? Obviously, there are other issues, but doesn't this address the gross problem immediately, giving those poor (or otherwise uninsured) people coverage right now. That would provide time to find the best solutions for reform, without making these people wait years more.

    KAM
    The primary reason is that Medicaid is very generous. So generous that it is bankrupting states and decreasing physician acceptance. While this varies by state, Medicaid provides a broad selection of drugs, children's preventive services, durable medical equipment, counseling services, backup services to Medicare in some instances, and is relatively uncontrolled. It is very unlikely any insurance policy will provide that level of coverage. Medicaid covers a population that has more illness than one would expect by the age of the population. This means that it is very likely that an insurance company would lose money on this population with that level of payment. As far as I'm concerned, Medicaid is not at all the answer to any problems, in part because it's administered by states with varying policies and philosophies (read about Tenncare or Medical for some differences). Most expansions of Medicaid have failed. Medicare on the other hand is a whole different animal.
  7. #2067  
    Quote Originally Posted by KAM1138 View Post
    I've got a question for you on this. So, many doctors (75%) are willing to accept lower payments (up to 20% less) for some portion of their business.

    Do you believe they could do that across the board--for all patients? What I mean is charge 80% of what they normally do--while still covering their overhead and making a fair profit. I realize "fair" is subjective here. In short--can they stay in business by charging less?

    Or, are they able to accept lower payments for that segment of patients, because they make up for it by charging 100% to the rest of their patients? If this is the case, then this 20% savings/reduction couldn't likely be applied to everyone.

    Which situation do you think is the actual case--or is neither the case? Is there some other circumstance that I'm not aware of?

    KAM
    In most practices I think Medicare money makes up about a third of the income on average. If you drop 20% from 2/3 of the practice income, I suspect that would have a signficant negative effect on practices. On the other hand, if you had a single payor system, or at least a very simplified system of reimbursement, offices would require lower administrative costs. There are way too many people hired to bill multiple different payors, with multiple different requirements. It is too complicated as it stands now. Simplifying reimbursement alone would make a huge difference in many practices.
  8. #2068  
    Quote Originally Posted by KAM1138 View Post
    Hello Everyone,

    I've mentioned this several other times. We've heard the 47 Million uninsured number for a while, and recently the President used 30 million. Other numbers I've heard are 12 million who actually cannot afford it.

    Let's take the higher number--47 million uninsured, which presumably means the rest are insured. We currently are spending about 300 billion a year on medicaid--which is meant to give medical care to the poor. If divided up that would be about $6400 per person per year.

    Even at today's elevated prices for medical insurance, $6400 per person is a pretty healthy amount to cover insurance costs. Has anyone asked why we aren't able to effectively spend this money to cover these uninsured?

    KAM
    That would be like expecting the fox to explain to the farmer how to fix the hole in the fence around the hen-house.

    The bureaucracy will never allow you to analyze it's performance, but will merely scare you with the potential impact of them not being there to "watch out" for you.

    Bottom line: it's unconstitutional and it infringes on individual liberty.
  9. #2069  
    Quote Originally Posted by davidra View Post
    As I initially stated, it varies with location.
    Good answer?

    Reference

    Quote Originally Posted by davidra View Post
    These are not "my" statistics; they are national statistics that answer the question as to whether or not the number of physicians accepting Medicare has decreased or not. And the answer nationally is that it hasn't in any significant way whatsoever. While I have no doubt that it might have in Texas, that isn't the question, unless you live in Texas. Let me restate the obvious: there is no national data that suggests that the number of doctors accepting Medicare has decreased. The decision to accept assignment for Medicare is a business decision, and three out of four physicians are fine with Medicare reimbursement, even if it is 20% less than some insurance companies. I have no idea why you just can't seem to accept the fact that Medicare works for lots of patients and doctors....but it does, whether you accept it or not. And making it more cost-conscious probably won't have any effect on that.
    The Texas data was based on statistics as well, but whatever. LOL I'm not going to go around and check every state for statistics like you requested. I just find it amazing that doctors throughout the country are happy to take on lower payments for Medicare patients accept in Texas. What's up with Texans....do those physicians have no compassion? Looks like an investigation needs to be done! Boycott Texas!!!!! We'll see what happens when the next reduced reimbursements are done to try and save Medicare.
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  10. KAM1138
    KAM1138's Avatar
    #2070  
    Quote Originally Posted by semprini View Post
    That would be like expecting the fox to explain to the farmer how to fix the hole in the fence around the hen-house.

    The bureaucracy will never allow you to analyze it's performance, but will merely scare you with the potential impact of them not being there to "watch out" for you.

    Bottom line: it's unconstitutional and it infringes on individual liberty.
    Hello Semprini,

    I think it is instructive to look at the logic of claims by their own rules. If someone is claiming a problem, yet avoiding a solution that is apparent (if that is the case) then we need to question their reasoning.

    The issue of unconstitutionality and individual liberty is very important I believe, but I'm doubting that our government is going to worry about that--even though I agree it should be first on their minds. Dealing with that however leads to an argument on those issues, and at the moment I'm trying to get answers for why we cannot better spend 300 Billion we already provide for healthcare for the poor. That's just medicaid BTW--not Medicare.

    KAM
  11. KAM1138
    KAM1138's Avatar
    #2071  
    Quote Originally Posted by davidra View Post
    The primary reason is that Medicaid is very generous. So generous that it is bankrupting states and decreasing physician acceptance. While this varies by state, Medicaid provides a broad selection of drugs, children's preventive services, durable medical equipment, counseling services, backup services to Medicare in some instances, and is relatively uncontrolled. It is very unlikely any insurance policy will provide that level of coverage. Medicaid covers a population that has more illness than one would expect by the age of the population. This means that it is very likely that an insurance company would lose money on this population with that level of payment. As far as I'm concerned, Medicaid is not at all the answer to any problems, in part because it's administered by states with varying policies and philosophies (read about Tenncare or Medical for some differences). Most expansions of Medicaid have failed. Medicare on the other hand is a whole different animal.
    Yes, I recall you not liking Medicaid compared to medicare.

    Ok, they are "generous" but at what cost? Not covering the basic needs of those 47 million? Shouldn't the primary concern be to make sure that people get the basics? It seems we agree that they are not doing a good job with the money they've got.

    As far as them having more illness. Well, isn't that cost absorbed either way? If they had coverage like everyone else, would they likely have a more regular illness pattern? Perhaps nutrition and other elements come into play.

    KAM
    Last edited by KAM1138; 09/14/2009 at 11:00 AM. Reason: Additional Point
  12. KAM1138
    KAM1138's Avatar
    #2072  
    Quote Originally Posted by davidra View Post
    In most practices I think Medicare money makes up about a third of the income on average. If you drop 20% from 2/3 of the practice income, I suspect that would have a signficant negative effect on practices. On the other hand, if you had a single payor system, or at least a very simplified system of reimbursement, offices would require lower administrative costs. There are way too many people hired to bill multiple different payors, with multiple different requirements. It is too complicated as it stands now. Simplifying reimbursement alone would make a huge difference in many practices.
    Well, I agree with the general goal of simplifying any and all administration--it reduces overhead.

    It sounds like you are agreeing that the 2/3 end up subsidizing the 1/3's 20% discount--no matter where the money ends up. You seem to believe that that much or more can be saved on administrative costs at providers. I believe that would be an approximate 13% (2/3 x 20%) savings required there to "break even"--meaning to get to that 80% of current cost for everyone. I think I've got those values right.

    Does that sound reasonable to you? Can a provider can reduce its overall costs by 13%--by savings from reduced billing overhead? Do you know (roughly) what the percentage of overall income goes to billing issues? Obviously to save 13% of the total, it would need to be at least 13%. And naturally, this is assuming just this one area of savings. I'm just trying to get a handle on how these overall savings could be realized.

    KAM
  13. #2073  
    Quote Originally Posted by 1thing2add View Post
    Understanding the difference between 47M uninsured and 30M uninsurable is an elementary proposition. It is through no fault but your own that you are unable to rise above petty politics and internet gamesmanship to recognize. If this is the "loyal opposition", Republicans have more to fear from within their ranks than from any external force.
    Who's obfuscating now? Oh sorry I put that in the form of a question and you clearly have an issue with those.

    You sure assume alot in your posts. When did I say I was a Republican? (ooh 'nother question, sorry) I think the guy in your mirror is just as guilty of "petty politics as anyone else in this thread. But you're sure fun to watch.
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    #2074  
    Quote Originally Posted by Woof View Post
    Who's obfuscating now? Oh sorry I put that in the form of a question and you clearly have an issue with those.

    You sure assume alot in your posts. When did I say I was a Republican? (ooh 'nother question, sorry) I think the guy in your mirror is just as guilty of "petty politics as anyone else in this thread. But you're sure fun to watch.
    Simple math and comprehension in order to follow the OMB's logic is hardly obfuscating. However, being devoid of either renders you and buddy pretty much castrated on the subject. Except in the false-reality of Conservative-internet politics. Who do "neuvo"-Independents vote for? Either Republicans (if they are trying to win an election) or a 3rd-party candidate who won't ultimately make any difference.

    Yes, I assume alot. Such as that internet clowns are the minority, not the majority. You clearly challenge that premise.
  15. KAM1138
    KAM1138's Avatar
    #2075  
    Oh, I guess that "civility" isn't needed anymore.

    KAM
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    #2076  
    Quote Originally Posted by KAM1138 View Post
    Oh, I guess that "civility" isn't needed anymore.

    KAM
    In fact, you ended "civility" when you began your crusade on Friday and continuing it last night by making multiple posts regarding me, primarily in the recent ACORN thread, personal and completely unrelated to the thread. You will note that they remain unresponded to, as they should, despite all your bait.
  17. #2077  
    Interesting article at WSJ regarding the Prez's speach last week. I'm not sure this link will work since I stay logged on, but it is: Scott Harrington: Fact-Checking the President on Health Insurance - WSJ.com

    Some interesting comments from the article:

    In his speech to Congress last week, President Barack Obama attempted to sell a reform agenda by demonizing the private health-insurance industry, which many people love to hate. He opened the attack by asserting: "More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care. It happens every day."

    Clearly, this should never happen to anyone who is in good standing with his insurance company and has abided by the terms of the policy. But the president's examples of people "dropped" by their insurance companies involve the rescission of policies based on misrepresentation or concealment of information in applications for coverage. Private health insurance cannot function if people buy insurance only after they become seriously ill, or if they knowingly conceal health conditions that might affect their policy.
    You'll recall in his speech, he gave a couple of examples of health issues that he was aware of and that shouldn't happen in our country:

    To highlight abusive practices, Mr. Obama referred to an Illinois man who "lost his coverage in the middle of chemotherapy because his insurer found he hadn't reported gallstones that he didn't even know about." The president continued: "They delayed his treatment, and he died because of it."

    Although the president has used this example previously, his conclusion is contradicted by the transcript of a June 16 hearing on industry practices before the Subcommittee of Oversight and Investigation of the House Committee on Energy and Commerce. The deceased's sister testified that the insurer reinstated her brother's coverage following intervention by the Illinois Attorney General's Office. She testified that her brother received a prescribed stem-cell transplant within the desired three- to four-week "window of opportunity" from "one of the most renowned doctors in the whole world on the specific routine," that the procedure "was extremely successful," and that "it extended his life nearly three and a half years."
    Oops....kind of left off the part about him living three and a half more years. I was under the impression that he died shortly thereafter....I doubt that was his intention, to mislead us, huh?

    ....and this one:

    The president's second example was a Texas woman "about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne." He said that "By the time she had her insurance reinstated, her breast cancer more than doubled in size."

    The woman's testimony at the June 16 hearing confirms that her surgery was delayed several months. It also suggests that the dermatologist's chart may have described her skin condition as precancerous, that the insurer also took issue with an apparent failure to disclose an earlier problem with an irregular heartbeat, and that she knowingly underreported her weight on the application.
    To blame insurance companies....and make them out to be villains when clearly, in the example of the woman, she lied on the application I think is just wrong.

    So, while we don't like any of those things to happen, I think the actual circumstances were not quite as he portrayed them. Did he lie? Well....I won't say that....but conveniently left off some important facts of those cases for sure.
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  18. #2078  
    Quote Originally Posted by clemgrad85 View Post
    Interesting article at WSJ regarding the Prez's speach last week. I'm not sure this link will work since I stay logged on, but it is: Scott Harrington: Fact-Checking the President on Health Insurance - WSJ.com

    Some interesting comments from the article:



    You'll recall in his speech, he gave a couple of examples of health issues that he was aware of and that shouldn't happen in our country:



    Oops....kind of left off the part about him living three and a half more years. I was under the impression that he died shortly thereafter....I doubt that was his intention, to mislead us, huh?

    ....and this one:



    To blame insurance companies....and make them out to be villains when clearly, in the example of the woman, she lied on the application I think is just wrong.

    So, while we don't like any of those things to happen, I think the actual circumstances were not quite as he portrayed them. Did he lie? Well....I won't say that....but conveniently left off some important facts of those cases for sure.
    No. We don't like any of those things to happen. And the solution? Do away with pre-existing conditions so patients aren't tempted to lie so their diseases can be treated. A skin condition not reported should affect whether an insurance company provides life-saving treatment? Yes...only because insurance companies, as was noted in many testimonies by former employees, have a goal of non-payment, and in fact success is determined by non-payment. Simple solution.
  19. #2079  
    Quote Originally Posted by davidra View Post
    No. We don't like any of those things to happen. And the solution? Do away with pre-existing conditions so patients aren't tempted to lie so their diseases can be treated. A skin condition not reported should affect whether an insurance company provides life-saving treatment? Yes...only because insurance companies, as was noted in many testimonies by former employees, have a goal of non-payment, and in fact success is determined by non-payment. Simple solution.
    I have agreed with you, and I personally have no problem with pre-ex issues being waived. To be honest, and up front, that actually helps my wallet I have many times put a lot of work into getting a client quotes, or spent time arguing with insurance companies about a health condition, only to not get a case issued. Sooooo, I'm cool with that!

    My point....the Prez didn't exactly explain the situations and painted a different picture. Were you not also under the impression that the man died shortly after the "late" surgery and that it was totally related to the delay? It sounds like the surgery was done within the window and his death was not necessarily from the situation discussed. I think you will agree, that many people often die after timely cancer treatment....huh? Anyway....you just keep spinning things the way you want them spun.
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    #2080  
    Quote Originally Posted by clemgrad85 View Post
    Oops....kind of left off the part about him living three and a half more years. I was under the impression that he died shortly thereafter....I doubt that was his intention, to mislead us, huh?
    There was no indication that the patient died shortly thereafter in the president's remarks. If that was your assumption, it was your mistaken impression. Furthermore, what evidence exists to demonstrate that the patient "lived" versus survived another 3 1/2 years? I'd be curious to read nonpartisan information regarding his story.

    To state the female patient flatly "lied" is completely out of the bounds of reason. Any patient would not normally consider a case of acne to be prohibitive to receiving treatment for cancer. Furthermore, as I'm certain you are fully aware, treatment for cancer is an extremely time-sensitive issue which, if that window of opportunity is missed, can sentence a patient to an agonizing, slow death.

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