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  1.    #41  
    Quote Originally Posted by ninjab View Post
    the problem is this reform doesn't decrease what government is paying, who do you think is going to pay for all those subsidized health insurance policies?

    Two reasonable ways to decrease healthcare costs:
    A) Give accountability for payment to the consumer, market forces will produce a sustainable expenditure on health care. (requires market rationing)

    B) Government control and the government dictating prices. Government sets expenditures at a sustainable level. (requires government rationing)

    -Either method requires the "evil" rationing. Current health care reform leaves insurance companies still in charge of determining a good deal of the costs, and has minimal attempt to ration care to a maintainable level. So with this route we will maintain a catastrophically unaffordable expenditure on health care until we eventually end up with fulfillment of option B, or a melt down.
    Can't argue with that. In fact, I think it's what we just said. Given current costs, though, I don't think A will work at this point...which is why B is going to be the final outcome of all this. If both parties had any sense whatsoever, they would recognize this and actually work together to get a well-designed national plan for the future....but they won't.
  2. #42  
    This may or may not be relevant to THIS thread but how many hc threads do we need?

    From my local paper. MEDICAL MAVERICK: Quick care? Pay cash - News - ReviewJournal.com

    This bit in the article caught my eye and says alot IMO.

    They come from across the country, the uninsured who have been enticed, say, by his $5,000 total charge for a hernia repair, about a third what they've been quoted by other medical professionals or facilities.

    "We were a little nervous at first because Dr. Petersen's price for the uninsured was so much lower than anyone else," Kathy Younghusband said.

    But the couple researched the surgeon's background and had a free half-hour consultation with Petersen over the phone. The cost of treatment of the hernia repair included lab work, a pre-operation electrocardiogram, the fee of an anesthesiologist and the rental cost of a surgical center.

    So many hospitals want $15,000 to $20,000 for the same service for someone who is uninsured, Kathy Young*husband said.

    Petersen said he is able, on behalf of the uninsured, to negotiate fees for anesthesia and an operating facility just like plastic surgeons, who never receive insurance payments for cosmetic procedures. He does not reveal the names of the providers he negotiates with, arguing that such information is proprietary.

    Petersen said 25 years ago, before private insurance companies started basically using the Medicare rate as their reimbursement benchmark as well, he would receive about $2,000 for a hernia repair on a privately insured patient. Back then, Petersen said, Medicare already paid physicians what he said was far too little for the procedure, about $800.

    "Gradually along the way private insurance started reimbursing about the same as Medicare, which has made physicians increase their volume to just stay in the same (financial) place," he said. "That's why patients have felt so rushed and why physicians are even more worried today when they hear talk that the Medicare rate is going to be cut another 20 percent."
    “There are four boxes to be used in defense of liberty: soap, ballot, jury, and ammo. Please use in that order.”
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  3. #43  
    Quote Originally Posted by davidra View Post
    Can't argue with that. In fact, I think it's what we just said. Given current costs, though, I don't think A will work at this point...which is why B is going to be the final outcome of all this. If both parties had any sense whatsoever, they would recognize this and actually work together to get a well-designed national plan for the future....but they won't.
    Unfortunately that seems to be the road we are taking. I see both plan A and B as viable in theory, but in practice government control usually goes hand in hand with stagnation and inefficiency. Also my views on life are based on individual liberties, and plan B defecates on those ideals. (these are my views, I accept that view B is a perfectly acceptable ideal)

    I also wish that we could make this ideological decision (A vs. B) on a state by state basis, that way if you don't like one states choice, you can move to a state that supports your ideology. This would be the ideal (and doable) way to go, but that is never going to happen with our power hungry federal government.
  4. #44  
    Well....no one can seem to confirm or deny whether the CBO numbers included the assumption that these Medicare reimbursements to providers were to be reduced. I've tried to find it online and all I've found so far was that it was initially in there, but I haven't found that the bill passed actually made these assumptions. If the CBO numbers included these reduced reimbursements as a cost savings, then it sounds as if everyone is believing they won't ever occur. What am I missing here? I guess this goes to the articles that Groovy posted yesterday where former heads of the CBO pointed out all the "what ifs" that were going to be needed for the numbers to work. It sounds as if that is already beginning, and the CBO numbers are close to taking their first step upward. If anyone can provide info saying otherwise, I sure would be interested.
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  5.    #45  
    Quote Originally Posted by ninjab View Post
    Unfortunately that seems to be the road we are taking. I see both plan A and B as viable in theory, but in practice government control usually goes hand in hand with stagnation and inefficiency. Also my views on life are based on individual liberties, and plan B defecates on those ideals. (these are my views, I accept that view B is a perfectly acceptable ideal)

    I also wish that we could make this ideological decision (A vs. B) on a state by state basis, that way if you don't like one states choice, you can move to a state that supports your ideology. This would be the ideal (and doable) way to go, but that is never going to happen with our power hungry federal government.
    I'll avoid your defecation example if that's OK. Government control does not have to "go hand in hand with stagnation and inefficiency". It doesn't in many Western countries with a health care system (oh....that's all of them isn't it?). Most developed countries are quite happy with their government plan. Of course, that's because they're all commie pinko socialists. All of 'em. Right?

    And if we could actually trust the states to provide coverage for those that need it, state by state would be fine by me. Unfortunately they don't always have the plight of the uninsured at heart. Or the less fortunate. Or minorities. Of course, there's always Texas, a special case among states that don't much give a damn. We can hope for secession, however.
  6. #46  
    Quote Originally Posted by davidra View Post
    I'll avoid your defecation example if that's OK. Government control does not have to "go hand in hand with stagnation and inefficiency". It doesn't in many Western countries with a health care system (oh....that's all of them isn't it?). Most developed countries are quite happy with their government plan. Of course, that's because they're all commie pinko socialists. All of 'em. Right?

    And if we could actually trust the states to provide coverage for those that need it, state by state would be fine by me. Unfortunately they don't always have the plight of the uninsured at heart. Or the less fortunate. Or minorities. Of course, there's always Texas, a special case among states that don't much give a damn. We can hope for secession, however.
    I would say yes it is possible for government control not to result in stagnation an inefficiency, but it often does. Most of Europe has been pretty stagnate, the US is doing the bulk of medical advancement.

    I like how your go to defense is to sarcastically call people commies, yes they are socialists, so what?
  7.    #47  
    Quote Originally Posted by ninjab View Post
    I would say yes it is possible for government control not to result in stagnation an inefficiency, but it often does. Most of Europe has been pretty stagnate, the US is doing the bulk of medical advancement.

    I like how your go to defense is to sarcastically call people commies, yes they are socialists, so what?
    Because being called a socialist on this forum is an easy lie and a way to include anything that provides for those that don't have. Every country is a socialist country. They only differ by degree.

    Research funding is very good in the US, which is a good thing. And in fact, I don't think there's any doubt that they lead in "advancement". But there are lots of contributions from other countries, including France, Germany and Japan. This shouldn't be too surprising when you realize that most large pharmaceutical companies are not based in the US and they do support a lot of research. And here's some data about clinical advances in only one field. In basic research, other countries contribute relatively more (for example, France in the discovery of the HIV).


    Rationale and ObjectivesTo determine different countries’ trend of contribution to clinical radiology journals and its relationship with impact factor.
    Materials and MethodsAll the journals, which publish articles on clinical radiology, were selected from the category of Radiology and Nuclear Medicine group of journals, and articles published in these journals between 1991 and 2000 were searched for the authors’ affiliation using the Medline database. Then, share of research output of the top-ranking 20 countries was determined along with the trend over time. Also, the relationship of different countries’ contribution with the impact factor of journals was examined by cross-sectional time-series linear model.
    ResultsOf total articles (38,359), the United States’ share for the selected journals in clinical radiology was 43.2% (16,582 articles) and ranked top in the world, followed by the United Kingdom (9.9%) and Japan (8.0%). The recent increase in the share was statistically significant for Japan, France, Germany, Italy, South Korea, Turkey, Spain, Switzerland, Austria, and China. On the other hand, the United States, United Kingdom, and Canada showed a significant negative trend. Among the top-ranking 10 countries, the US contribution was significantly higher to journals with high-impact factors, whereas the opposite was true for France.
    ConclusionThe United States, United Kingdom, and Canada showed a negative trend over the last decade in terms of proportion of contribution of articles to the clinical radiology journals. However, only the United States published more articles in high-impact factor journals.
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    #48  
    Quote Originally Posted by zelgo View Post
    No one likes that kind of pay cut, but you are mixing up Medicare treatment reimbursement with office expense reimbursement. Medicare pays them separately.

    In fact, this 21% Medicare cut (which I predict will not happen) does not affect the office expense part--Medicare has actually increased the office expense part for a number of different specialty types this year.

    Over and above the supposed Medicare cut, the health reform law has an increase in salary specifically for primary care practitioners.
    Zelgo, I am not mixing up anything. Medicare pays me one amount for a particular service. If they pay me $100, I get to keep $50. If they cut that 20%, to $80, I get to keep $30. Simple math.
  9.    #49  
    Quote Originally Posted by sweaner View Post
    Zelgo, I am not mixing up anything. Medicare pays me one amount for a particular service. If they pay me $100, I get to keep $50. If they cut that 20%, to $80, I get to keep $30. Simple math.
    Redundant post. Removed.

    The SGR needs to be removed because it is never used. It is overturned every year. Basically it's a waste of time and effort. Some better way needs to be devised.
  10. #50  
    Quote Originally Posted by zelgo View Post
    The ugly secret to healthcare in the whole world is rationing is necessary. No country can sustain paying for everything for everybody. (Of course, the US rations by leaving 1/6th of the country uninsured.)
    Okay.....if rationing is necessary, why does everyone get bent out of shape when a private insurance company denies something? So, it is okay for rationing to occur by the government, but not okay by an insurance company?

    What will happen is insurance companies will come out with supplemental plans to cover everything, and that only the wealthy can afford and then that will be held up as unfair. Unfortunately, some people will never believe that another person should get better coverage because they happen to have more money. Is it unfair?....yup....it sure is....and it does suck....but....it is simply the way things work as long as some folks have more money than others. But give Obama time, he is working on that....trying to get everyone on equal footing....passing the wealth around.
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  11.    #51  
    Quote Originally Posted by zelgo View Post
    I agree that Medicare payments don't keep up with COLA.

    They threaten a 20% cut, but then only raise reimbursement by 1%.. Docs rejoice because they beat the cut, but forget that 1% is (usually) less than inflation.

    In fact, doctors' salaries have not kept up with inflation for at least the last 10 years.

    Since much of the population thinks doctors salaries are too high, this is often the target of those who want to reduce healthcare costs but cannot reduce services without facing an uproar.
    Everything you stated is true. The only thing I would say about this is that there is what I consider to be a ridiculous variability in specialty-based reimbursement rates. Although things are a little less extreme now, I remember being at a party with a vascular surgeon in private practice who was railing about government intrusion into his practice, and I know for a fact that he made $6 million that year. When primary care docs are making $140,000 a year, with the same $150,000 student loan debt, and delayed earning years until their thirties, you have to consider that something isn't right. And that's one of the strengths of the health care reform bill in that it rewards people with higher reimbursement rates if they are willling to practice primary care in rural or underserved areas. I have seen many doctors trained over the years, and the disparity between specialties in terms of income is ridiculous. In many ways it is a antitrust issue. Several specialties (specifically dermatology, radiation oncology, and to some extent ophthalmology) limit the number of residency training positions so there will continue to be a shortage of those specialists and they can continue to charge excessively for their services. It would be one thing if the training was particularly more rigorous or lengthy, but that really isn't the case. So yes, for most physicians their income has not changed significantly upward...but for some, it needs to change downward to correct the disparities. This has actually happened with reimbursements for cataract procedures over the years, and as someone pointed out ophthalmologists still make plenty of money. And no, this isn't a socialist agenda....it's what's fair.
  12. Micael's Avatar
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    #52  
    Quote Originally Posted by zelgo View Post
    Costs are rising like crazy (mainly because doctors and hospitals are paid by the procedure, so, naturally, they do lots of procedures...).
    I missed the part of this bill that addresses this in any kind of cohesive way. And I thought it was all the fault of the insurance companies.....
    The federal government is trying to decrease the costs it has to pay.
    And we have all seen time and time again how good the fed is at decreasing costs.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  13.    #53  
    Quote Originally Posted by Micael View Post
    I missed the part of this bill that addresses this in any kind of cohesive way. And I thought it was all the fault of the insurance companies.....

    And we have all seen time and time again how good the fed is at decreasing costs.

    And as I've said time and time again, Medicare has dramatically reduced hospital costs by using diagnosis-related groups (Medicaid does not, and decreases costs by reimbursing at ridiculously low rates). Any doctor will tell you that if they are being honest. If all the uninsured had their hospitalizations paid for using DRG's like Medicare, instead of begin reimbursed in the standard fashion like private insurers, a lot of money would be saved. Doctors, however, are indeed paid by procedures. Applying DRG's to doctor payment would be one way to cut costs. If you want to see the AMA mobilized, that would happen...
  14. Micael's Avatar
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    #54  
    Quote Originally Posted by zelgo View Post
    The reform law isn't perfect, nor is it the final word on healthcare. I fully expect changes to happen frequently as 77 million baby boomers hit the Medicare system within 20 years.
    Damn the torpedoes! Full speed ahead!
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  15. #55  
    Quote Originally Posted by zelgo View Post
    It's not just insurance companies; it's not just tha way docs are paid; it's not just that people don't make the correct health decisions for themselves--The cause of rising costs is multi-factorial.
    Fat tax is coming in the near future.
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