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  1. #241  
    Quote Originally Posted by bclinger View Post
    ....Well, maybe the truth might hurt a bit - the unions has Congress in their front and back pockets.
    Ya, blame the guy or gal that wakes up every morning and goes to work to support his family. That makes a lot of sense.
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  2.    #242  
    Quote Originally Posted by davidra View Post
    Providing health care to everyone will cost money. If you think we should do it, then we should do it in the most cost-effective way. That excludes insurance companies from the equation. If you don't want to do it, just say so. That's where you appear to be.
    Please name ONE government program that has saved money doing what it was supposed to do at a cost lower than it was supposed to cost? ANY ONE?
  3. #243  
    Quote Originally Posted by Technologic 2 View Post
    Please name ONE government program that has saved money doing what it was supposed to do at a cost lower than it was supposed to cost? ANY ONE?
    '
    Within the limitations of the frantically rising health care costs, Medicare has saved massive amounts of money. That doesn't mean they aren't financially troubled, but that is not because of a flaw in Medicare, it's because of a failure to control medical costs in general. Just by instituting payment using diagnosis-related groups, Medicare saved millions of dollars...and nobody in the lay population knows anything about it.

    This article explains the origins, development, and passage of the single most influential postwar innovation in medical financing: Medicare's prospective payment system (PPS). Inexorably rising medical inflation and deep economic deterioration forced policymakers in the late 1970s to pursue radical reform of Medicare to keep the program from insolvency. Congress and the Reagan administration eventually turned to the one alternative reimbursement system that analysts and academics had studied more than any other and had even tested with apparent success in New Jersey: prospective payment with diagnosis-related groups (DRGs). Rather than simply reimbursing hospitals whatever costs they charged to treat Medicare patients, the new model paid hospitals a predetermined, set rate based on the patient's diagnosis. The most significant change in health policy since Medicare and Medicaid's passage in 1965 went virtually unnoticed by the general public. Nevertheless, the change was nothing short of revolutionary. For the first time, the federal government gained the upper hand in its financial relationship with the hospital industry. Medicare's new prospective payment system with DRGs triggered a shift in the balance of political and economic power between the providers of medical care (hospitals and physicians) and those who paid for it-power that providers had successfully accumulated for more than half a century.
  4. noaxis2's Avatar
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    #244  
    Nice try with the Medi care stuff. IMHO wasting less money is not the same as costing less than it was supposed to cost.

    As a physician, I can tell you that MediCare and MediCaid are the least efficient off all insurance providers that doctors have to deal with. There is more paperwork, more jumping through hoops for approvals and the lowest levels of reimbursement.

    The only way the Federal govt has ever even appeared competitive in a field is when there is no apparent alternative (Amtrak, post office) or they impose rules and regulations that give the govt an advantage or restrict their competitors or simply deny citizens the right to choose (VA, social security contributions, schools, etc)

    In order for many of the Democrat plans to have a prayer of working is by making the cost of private insurance more and more prohibative--tax people willing to pay extra to get the benefits they want; fine people who don't "choose" to purchase insurance (or make it mandatory until it's found unconstitutional--they can't require you purchase something because you exist--car insurance is only for people with cars, taxes are for people with income...this will be a penalty for merely existing within the borders?); charge fees, fines and penalties on businesses that want to offer other insurance plans; place so many requirements on insurance providers that they have difficulty staying in business (only the govt gets to continue to operate while millions or billions in the hole--Blue Cross would eventually be required to make good on financial losses).

    For this to run (I won't even call it work), the party known for "choice" will have to make sure that consumers' choices are quite limited.
  5. noaxis2's Avatar
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    #245  
    I wouldn't worry about too many doctors--I would be more cncerned about how doctors will respond to being thrust into situations where the bulk of their income is supposed to come from seeing patients with govt insurance.

    Many doctors already do not aceept medicare or medicaid because of the low reimbursement and increased paperwork (which cuts further into income by using your time or hiring someone to do the extra paperwork).

    The practice I am at does not accept medicaid or medicare. Many of the people I trained with don't bother with insurance period. The patient pays their full fee and can work it out with their insurer.

    I think a more significantly tiered system will evolve. Those who can will pay out of pocket rather than wait for approvals for tests and consults and want to see who they want when they want. Then you will have those that have little choice but to be on the govt plan.
  6. #246  
    Quote Originally Posted by noaxis2 View Post
    Nice try with the Medi care stuff. IMHO wasting less money is not the same as costing less than it was supposed to cost.

    As a physician, I can tell you that MediCare and MediCaid are the least efficient off all insurance providers that doctors have to deal with. There is more paperwork, more jumping through hoops for approvals and the lowest levels of reimbursement.

    The only way the Federal govt has ever even appeared competitive in a field is when there is no apparent alternative (Amtrak, post office) or they impose rules and regulations that give the govt an advantage or restrict their competitors or simply deny citizens the right to choose (VA, social security contributions, schools, etc)

    In order for many of the Democrat plans to have a prayer of working is by making the cost of private insurance more and more prohibative--tax people willing to pay extra to get the benefits they want; fine people who don't "choose" to purchase insurance (or make it mandatory until it's found unconstitutional--they can't require you purchase something because you exist--car insurance is only for people with cars, taxes are for people with income...this will be a penalty for merely existing within the borders?); charge fees, fines and penalties on businesses that want to offer other insurance plans; place so many requirements on insurance providers that they have difficulty staying in business (only the govt gets to continue to operate while millions or billions in the hole--Blue Cross would eventually be required to make good on financial losses).

    For this to run (I won't even call it work), the party known for "choice" will have to make sure that consumers' choices are quite limited.
    As another physician, I'm not sure what office you work in. Maybe being in California you only have to deal with Kaiser. When you deal with multiple companies, each with different criteria about forms, approval requirements, even where labs can be ordered, things (such as the need for multiple office personnel) are much much worse with private insurers than with Medicare. And I'm also sure that you're wrong when you say "many doctors do not accept Medicare and Medicaid". That's true about Medicaid...only around a third of doctors accept Medicaid, because it's flawed. 75% of physicians accept Medicare. As the population continues to age, I would suspect that unless they do accept Medicare, many practices will note a decrease in their patient population.

    Since the vast majority of physicians already accept Medicare, and for some it makes up much of their business, I'm not the least bit concerned about "how they will respond" to being paid by an entity like Medicare. They already are being paid that way. And most importantly, there is virtually no difference between the shell you have to deal with with Medicare and that of private insurers. The ONLY difference is that the reimbursement is less. And guess what? That's coming, bucko. Not only can't we afford to throw a quarter of all our health care dollars into the toilet of for-profit insurance company overhead, we also can't afford to pay doctors for unneccessary procedures, excessive testing, and unmanaged access to unlimited specialists. And that's going to be the case whether there's a private option or not, if there are going to be any cost controls applied to stop health care increases. What that translates into for all doctors is that if there is going to be health care reform (and for all I know you love the status quo, which is doomed to failure) it's going to mean less income. And without a public option, and subsidization of private for-profit insurance companies with taxpayer money, that income will be even less. Pick your poison. Even the AMA recognizes this.

    Addendum: I note from your other posts that you are a psychiatrist (at least that's my interpretation of being a doctor in mental health...of course you could be a psychologist). Not surprising your practice doesn't accept Medicare. What's the average age of your patients? Mostly psychotherapy? Outpatient? How about self-pay patients? Have a lot of those? Pretty easy to take these stands when you have a mental health practice in California. But don't allow me to infer....feel free to expound on what your payor mix is.
    Last edited by davidra; 09/23/2009 at 05:50 AM.
  7.    #247  
    Quote Originally Posted by noaxis2 View Post
    The practice I am at does not accept medicaid or medicare. Many of the people I trained with don't bother with insurance period. The patient pays their full fee and can work it out with their insurer.
    Until they make that illegal...and they will.

    Quote Originally Posted by davidra View Post
    ..only around a third of doctors accept Medicaid, because it's flawed....
    I sure hope the government plan won't be flawed. We could have even less.

    I'm not the least bit concerned about "how they will respond" to being paid by an entity like Medicare.... The ONLY difference is that the reimbursement is less. And guess what? That's coming, bucko.
    That quote stands on it's own

    As another physician...
    we also can't afford to pay doctors for unneccessary procedures, excessive testing, and unmanaged access to unlimited specialists.
    Why are doctors doing unnecessary procedures?

    So much for freedom of choice. If I prefer a specialist, I should have the right to choose one. My insurance allows it, and if it didn't (like my dental insurance) I would still like the choice...I just pay for it. And, I guess that would also become illegal.


    Not only can't we afford to throw a quarter of all our health care dollars into the toilet of for-profit insurance company overhead,
    .
    No, it's much better to throw it into the overhead of a government program.
  8. #248  
    Quote Originally Posted by Technologic 2 View Post

    Why are doctors doing unnecessary procedures?

    So much for freedom of choice. If I prefer a specialist, I should have the right to choose one. My insurance allows it, and if it didn't (like my dental insurance) I would still like the choice...I just pay for it. And, I guess that would also become illegal.




    No, it's much better to throw it into the overhead of a government program.
    1. There are three reasons for unnecessary procedures: lack of education, financial self-interest, and defensive medicine. In my opinion, the first is the primary reason, but the others may contribute a small part.

    2. Preferring a specialist and being able to go to any one you want is why fee for service and the traditional ways of insurance falied. That's one major reason by HMO's were implemented (by Nixon, by the way). You sprain your ankle and go to a primary care doc and you'll probably be treated conservatively with few tests. You go to an orthopedist and you're much more likely to get an MRI for $1000 and guess what? Your outcome will be same whether you get it or not unless your symptoms persist. So the right way to do it is to wait, treat conservatively and if there's no improvement, consider an MRI. But many specialists will get the MRI right away and there is no evidence that makes any difference longterm. If you insist on paying for it, go ahead. But all the other members of your health plan will be paying for it in higher premiums if the insurance company pays for it....and there's no reason to even have it done. But noaxis is aiming for a tiered system, and that's fine with me. Go ahead and pay higher premiums and get exactly what you want. Just don't make taxpayers pay for it.

    3. Take your pick. Single digit overhead for Medicare, 25-30% overhead for private insurers. But hey, 15% of the billions we spend on health care isn't really that much, is it? It will line the coffers of insurance companies, that's for sure. And that's what our goal is, right? Not cost control, not providing care to people who can't get it....we want to subsidiize insurance companies. It's only right. They do so much for us.
  9. #249  
    Quote Originally Posted by davidra View Post
    ..only around a third of doctors accept Medicaid,
    Not sure where you're getting that number. I'm finding that, "In 2004-05, 14.6 percent of physicians reported receiving no Medicaid revenue."

  10. #250  
    Quote Originally Posted by daThomas View Post
    Not sure where you're getting that number. I'm finding that, "In 2004-05, 14.6 percent of physicians reported receiving no Medicaid revenue."

    My bad. That old double negative.

    Depends on definitions. Accepting Medicaid money is different than accepting new Medicaid patients. Some practices used to take Medicaid, then stop accepting new Medicaid patients. The real problem is that even if some practices do accept new patients, they usually limit the number of them, even academic hospitals in some specialties. Small practices are less likely to accept Medicaid patients. From the same reference you used, for instance:
    For example, 35.3 percent of physicians in solo and two-physician practices were not accepting new Medicaid patients in 2004-05, up from 29 percent in 1996-97.
    That's where my estimate of a third came from, and what the data really show (and what I meant to type) is that a third DON'T take Medicaid funding for new patients. But it is getting worse, with the numbers down to less than 30% in some areas accepting new patients, even though the national average is much higher.
    Last edited by davidra; 09/23/2009 at 02:40 PM.
  11.    #251  
    Quote Originally Posted by davidra View Post
    Take your pick. Single digit overhead for Medicare, 25-30% overhead for private insurers.
    It is hard to argue with those figures if it was a complete picture. A lot of the overhead for private insurers is the cost of complying with Federal and State Regulation, underwriting policies, investigating fraud, etc. If there was a way of knowing the cost of Medicare/Medicaid fraud and cost of doctors and hospitals compliance it would be easier to compare.
  12. #252  
    Quote Originally Posted by noaxis2 View Post
    In order for many of the Democrat plans to have a prayer of working is by making the cost of private insurance more and more prohibative--tax people willing to pay extra to get the benefits they want; fine people who don't "choose" to purchase insurance (or make it mandatory until it's found unconstitutional--they can't require you purchase something because you exist--car insurance is only for people with cars, taxes are for people with income...this will be a penalty for merely existing within the borders?); charge fees, fines and penalties on businesses that want to offer other insurance plans; place so many requirements on insurance providers that they have difficulty staying in business (only the govt gets to continue to operate while millions or billions in the hole--Blue Cross would eventually be required to make good on financial losses).

    For this to run (I won't even call it work), the party known for "choice" will have to make sure that consumers' choices are quite limited.
    The more I read of your ideas the more ludicrous your statements become. You really think democrats need to make the cost of private insurance prohibitive? Doctors and private insurance have been doing a fine job of that all by themselves. In fact, that's why we're in the latrine we're in. I'm totally in favor of choice, but not without cost controls. Hopefully it doesn't take a whole lot of insight to realize that without cost controls somewhere, of some kind, we will not solve rising health care costs. Why is that so hard to understand?
  13. Micael's Avatar
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    #253  
    Quote Originally Posted by daThomas View Post
    Not sure where you're getting that number. I'm finding that, "In 2004-05, 14.6 percent of physicians reported receiving no Medicaid revenue."

    That sounds to me like Medicaid didn't send them a check!
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  14. Micael's Avatar
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    #254  
    Quote Originally Posted by davidra View Post
    3. Take your pick. Single digit overhead for Medicare, 25-30% overhead for private insurers. But hey, 15% of the billions we spend on health care isn't really that much, is it?
    Thanks for the lesson in fuzzy math.

    Medicare patients have a much higher average patient care costs, so expressing administrative costs as a percentage of total costs gives a misleading picture of relative efficiency. Your numbers are misleading, so therefore your point and argument is false.
    It will line the coffers of insurance companies, that's for sure. And that's what our goal is, right? Not cost control, not providing care to people who can't get it....we want to subsidiize insurance companies. It's only right. They do so much for us.
    And this is just your personal rant. Insurance companies actually DO help control costs. We keep "greedy doctors" and "revenue hungry hospitals" from charging willy nilly rates for their services. You go on and on about the moral values of insurance companies. Hospitals and doctors are in business to MAKE MONEY. And last I checked, business has been barry barry good to them.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  15. #255  
    Quote Originally Posted by Micael View Post
    That sounds to me like Medicaid didn't send them a check!
    Hey! I bet you're right. Ya think that might be because they didn't see any Medicaid patients?
  16.    #256  
    Quote Originally Posted by davidra View Post
    I'm totally in favor of choice, but not without cost controls.
    Not sure of your age, do you remember Richard Nixon? Study what government price controls can do. We didn't recover from that until Reagan.
  17. #257  
    Quote Originally Posted by Micael View Post
    Thanks for the lesspon in fuzzy math

    Medicare patients have a much higher average patient care costs, so expressing administrative costs as a percentage of total costs gives a misleading picture of relative efficiency. Your numbers are misleading, so therefore your point and argument is false.

    And this is just your personal rant. Insurance companies actually DO help control costs. We keep "greedy doctors" and "revenue hungry hospitals" from charging willy nilly rates for their services. You go on and on about the moral values of insurance companies. Hospitals and doctors are in business to MAKE MONEY. And last I checked, business has been barry barry good to them.
    Talk about fuzzy math. Only you could make the statement that because Medicare patients are sicker (which they are; they're much older), and they use more resources, have more visits and more hospitalizations, that their adminsitrative costs are artificially low. Show your work, please.

    Insurance companies do no such thing. Their control of rates exactly mimics Medicare changes and you know it. If Medicare institutes a reimbursement effort it is immediately parroted by insurance companies. Insurance companies have done one good thing in the history of US health care (IMO, of course) and that is that HMO's, primarily only because of Kaiser, began offering routine evidence-based preventive screening services. Medicare and Medicaid were criticized incessantly until they offered the same services. In spite of this, the latter-day HMO's (which were HMO's in name only, not in performance) would have gladly dropped those services because they really weren't interested in health maintenance.

    By the way, my "revenue-hungry hospital" is non-profit, as are three of the four hospitals in my town. Not that that makes a huge difference, but at least we don't have to provide excuses to shareholders when we can't line their pockets with money taken from patients and providers. Everybody would like to be profitable; it keeps you in business, and when your business is providing care, you'd like that to continue. When your business is being a money shuffler with little to add to the equation except increasing costs, and your responsibilities are to a board of directors and shareholders, things aren't quite the same. IMO, of course.
  18. #258  
    Quote Originally Posted by Micael View Post
    Thanks for the lesson in fuzzy math.

    Medicare patients have a much higher average patient care costs, so expressing administrative costs as a percentage of total costs gives a misleading picture of relative efficiency. Your numbers are misleading, so therefore your point and argument is false.

    And this is just your personal rant. Insurance companies actually DO help control costs. We keep "greedy doctors" and "revenue hungry hospitals" from charging willy nilly rates for their services. You go on and on about the moral values of insurance companies. Hospitals and doctors are in business to MAKE MONEY. And last I checked, business has been barry barry good to them.
    Here's your status quo, insurance guy. Stick with it.

    Economists have found that rising health care costs correlate with significant drops in health insurance coverage, and national surveys also show that the primary reason people are uninsured is due to the high and escalating cost of health insurance coverage.8
    A recent study found that 62 percent of all bankruptcies filed in 2007 were linked to medical expenses. Of those who filed for bankruptcy, nearly 80 percent had health insurance.9
    According to another published article, about 1.5 million families lose their homes to foreclosure every year due to unaffordable medical costs.10
    Without health care reform, small businesses will pay nearly $2.4 trillion dollars over the next ten years in health care costs for their workers, 178,000 small business jobs will be lost by 2018 as a result of health care costs, $834 billion in small business wages will be lost due to high health care costs over the next ten years, small businesses will lose $52.1 billion in profits to high health care costs and 1.6 million small business workers will suffer “job lock“— roughly one in 16 people currently insured by their employers.11

    The status quo....enjoy it while you can
  19. Micael's Avatar
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    #259  
    Quote Originally Posted by davidra View Post
    Show your work, please.
    It's pretty simple math. I'll let you work it out on your own. After all, you're the one making the false argument. Let's see your work.
    Insurance companies do no such thing. Their control of rates exactly mimics Medicare changes and you know it. If Medicare institutes a reimbursement effort it is immediately parroted by insurance companies. Insurance companies have done one good thing in the history of US health care (IMO, of course) and that is that HMO's, primarily only because of Kaiser, began offering routine evidence-based preventive screening services. Medicare and Medicaid were criticized incessantly until they offered the same services. In spite of this, the latter-day HMO's (which were HMO's in name only, not in performance) would have gladly dropped those services because they really weren't interested in health maintenance.

    By the way, my "revenue-hungry hospital" is non-profit, as are three of the four hospitals in my town.
    Bologna. I work at a non-profit insurance company. I still make comparable wages to someone else doing the same work in any other "for profit" industry in my area. The doctors at your "non-profit" hospitals still drive luxury cars.
    Not that that makes a huge difference, but at least we don't have to provide excuses to shareholders when we can't line their pockets with money taken from patients and providers.

    Everybody would like to be profitable; it keeps you in business, and when your business is providing care, you'd like that to continue. When your business is being a money shuffler with little to add to the equation except increasing costs, and your responsibilities are to a board of directors and shareholders, things aren't quite the same. IMO, of course.
    So, how is it the government needs to be the big money shuffler, and not private industries? Because Medicare and Medicaid are such stellar performers? Seems to me the government has gotten far too good at shoveling our money away from us already.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  20. Micael's Avatar
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    #260  
    Quote Originally Posted by davidra View Post
    Here's your status quo, insurance guy. Stick with it.




    The status quo....enjoy it while you can
    You just won't get it. You see NO correlation between "rising health insurance premiums" and "rising health care costs". We just raised the premiums to line our stakeholders pockets. You are so far out in left field it's mind boggling. This whole argument about insurance being the main culprit in cost escalations is such a crock. And it seems that nothing I say will set you on the right path. You're on your own, dear davidra. I tried. I'll pray for your recovery, someday.
    Last edited by Micael; 09/23/2009 at 03:39 PM. Reason: diction
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.

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