Let's talk about health care

[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)

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.

[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.

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.

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.