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Post by lc on Feb 28, 2006 21:37:21 GMT -6
Everybody needs it. It costs far too much, the insurance that supports it is far too expensive, and it seems like the industry itself has fallen victim to an epidemic of escalating costs and inefficiencies.
Why does a hospital bed cost $2000/day for a single payer, but only $400/day for an insured patient?
Is it even moral to make health care a for profit business?
Unlawful is a doc, I think he might have a LOT to contribute here.
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Post by TAT on Feb 28, 2006 22:22:03 GMT -6
My contention is that one of the best reasons to be a physician is to protect yourself from other Docs. Plus when I screw up my own care what am I going to do? Sue myself? And pay two lawyers!! Screw that.
Surgery on oneself is however rather limited, and I only do it when I dont want to go to the ER for stitches in non-cosmetic areas. An ER visit kills whatever is left of that day. I allways have stuff around as I am never sure when I am going to do something stupid. I call it my "suture self " kit. Real handy for backpacking too when you are a couple of days hike from nowhere.
Now operating on the cats, thats different, cause they will bite and scratch. But when I was younger and broker, the katz got their abcesses lanced under light dissociative anesthesia. $100 just to poke a hole in a skin abscess. Ha! even a pathologist can do that!!
You may get the idea of where I am going, I have no liability risk when I play doctor with myself so my health care costs relatively little. My wife is always saying, "well have you considered seeing a doctor". And my reply is, and what do you think they might do for/to me.
I suspect, from previous experience that there is a cash and carry underground for those without insurance, fortunately few folks sidel up to me and ask me to interpret their kidney biopsy for them.
There were and still are Docs out there that get paid in trade in the black market barter system no taxes.
But just remember more people live off of cancer than die of it, says my friend the oncologist!
I number of physicians have decided to got bare, no malpractise insurance. I am unsure if the pt signs a binding waiver that he cannot sue.
Just tired and rambling a bit, but when we will be living off the land after the crash of the greenback, I guess I would be able to earn some food and services by providing simple services to the not very sick! Everyone would line up to be cared for by a pathologist, what could go wrong?? I could do the post too. Cradle to grave service!
TAT
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Post by lc on Feb 28, 2006 23:35:02 GMT -6
In truth medicine is a hugely important part of our quality of life, and many of the more remote aspects play huge roles in promoting our living standards.
Do you really believe that there are many docs who play bare and work under the table? What a disgrace to our nation if it is true.
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Post by tatuma on Mar 1, 2006 10:43:21 GMT -6
I saw something on TV a while back, when small town docs couldnt afford the insurance to do deliveries. Their options were to stop doing deliveries, or go without. Could signing a waiver during labor be overturned in court as under duress. I can see the scenario now! Well sign the waiver or deliver the baby yourself!! Some choice!
Orthopods, neurosurgeons, obs and other high risk specialties spend more on their insurance than I get paid! So, these docs can never go part time, as they have to amortize their insurance over the whole year, though my brother, a high risk ob specialist, has told me that quite a number of OBs just stop delivering babies.
The problem is that everone seems to think that every baby with anything wrong, doc fault or not, is worth a try at a lawsuit. Gotta fix this, but the Tort reform that Bush has in mind is designed to get rid of trial lawyers who are big donors to the Dems. Now why would the law and order GOP have a problem with trial lawyers? Seems like that is a growth sector in Wash DC lately!
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Post by lc on Mar 1, 2006 11:29:12 GMT -6
Tatuma, one word "Midwives".
So what kind of solutions do you see for the insurance predicament?
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Post by beachbumbob on Mar 1, 2006 13:44:22 GMT -6
the difference in typical hospital costs between "insured" and "uninsured" is the "negotiation" rate that the hospital uses in settling prices with different insurance plans...the larger the plan, lower the cost and with state medicaid plan.....somewhere between, and the poor working sucker, who has no or is underinsured is the "bonus" rate....
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Post by graybeard on Mar 1, 2006 19:03:51 GMT -6
I've found the people in accounts receivables at hospitals have a good deal of latitude in forgiving amounts owed. If the hospital stay is planned, it would be smart to negotiate in advance, of course. Just ask. GB
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Post by graybeard on Mar 1, 2006 19:05:10 GMT -6
Uh, as the ads say, you don't get what you deserve; you get what you negotiate. GB
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Post by unlawflcombatnt on Mar 1, 2006 20:35:21 GMT -6
Unlawful is a doc, I think he might have a LOT to contribute here. Oh boy. Do I ever. I want to start by saying I am a recent convert to the concept of single-payor medicine. Though I still think if true market forces were allowed to rule, the result would be better medical care for all. However, I've given up any hope this will ever happen. Corporate control has become too entrenched to ever allow any market forces to come into play. I also want to mention in passing that the 2 worst medical tragedies closest to me had nothing to do with the unaffordability of medical care. They were the result of 2 people who could afford medical care not getting good medical care. Both could have paid for the medical care they needed. But the care wasn't made available to them, because it wasn't covered by insurance. And they weren't made aware of other options as a result. Both died because they weren't informed of those options, not because they couldn't afford them. One of them was my father. The other was a former (and late) girlfriend. A one-party payor would not have saved either one of them. It's still my belief that the biggest problem today is not the unaffordability of health care, but the poor medical care to those who have already paid for it. This is my own personal perspective, and maybe not representative of society's true needs. I suspect the 2 are related, however. Again, I hold out little hope for true market forces to be allowed to come into play. And again, I now am a supporter of a one-party payor. I wrote the following letter months ago when I still believed in private medical care. Though my conclusion has changed, none of the facts or issues I've described have changed. Here's that letter: Originally from 4/9/05: Though I am now a registered "D" (thanks to the insanity of the Neocon-Artists), I still generally advocate free markets. In some cases free markets are blamed for problems that are really due to gross distortions of the free market, not free markets themselves. Health care is one such area.
HEALTH CARE CRISIS & SOLUTION
We definitely have a health care problem in this country. It is certainly much closer to a "crisis" than Social Security solvency. People are dying right now as a result. I have my own solution to the problem. However, I will withhold it until later in this letter. It will make more sense after my description of the current state of health care. I agree with those that believe nationalized health care will be a mess. However, so is our current system of corporatized medicine. Many have not thought of this, but HMO-dominated medicine behaves like socialized medicine in most respects.
My opinion is that we need more "real" free market effect in medicine. The 3rd party-payor system has eliminated most free market dynamics in medicine. Doctors' pay is almost exclusively determined by what Medicare pays. Private insurance companies use Medicare rates to determine physician payments. Physician reimbursement is essentially fixed as a result. If you charge more than Medicare or an insurance company allows, you won't get paid more. Furthermore, the additional amount you can charge is also determined by Medicare or the insurance company. If you don't accept the payor's rate, they will pay you less. However, that's a relatively small problem.
The bigger problem is how you get paid if you don't accept Medicare rates. Instead of the payment being sent directly to the doctor's office, IT'S SENT DIRECTLY TO THE PATIENT.
Let me elaborate. Medicare determines an allowable payment amount for every type of physician visit and procedure. They pay 80% of the allowed amount. The physician can then bill the patient for the remaining 20%. The physician cannot bill for more than that if he wants to get the full 80% of the allowable amount from Medicare. If you don't accept Medicare's payment rate as your full payment, Medicare sends the check directly to the patient. Then the physician has to try to obtain payment from the patient, which is often a disaster. So most doctors accept Medicare and insurance company payment rates. That way payment is sent directly to the doctor's office, instead of to the patient. All private insurance companies base their physician payments on Medicare's allowable amount. Thus, the federal government essentially sets fees for private insurance, as well as for Medicare. This amounts to price controls on physicians. It's essentially impossible for a doctor to survive in California without taking insurance, unless he's doing cosmetic procedures on the rich. Increased physician fees are not driving up the cost of medicine, because the federal government essentially controls physician fees.
In contrast, insurance companies and HMOs can charge as much as they like. They can also merge, so that they eliminate as much competition as possible. So patients have little choice on insurance. There are a limited number of insurance companies. Employers usually offer few choices. Doctors have little choice but to accept all insurance company demands, including their reimbursement.
The largest part of health care spending goes toward administrative costs. Only 9-19% of the healthcare dollar actually goes to paying doctors. The rest is siphoned off by HMOs and insurance companies. A recent article by New York Times columist Paul Krugman describes where the lion's share of the health care dollar actually goes. Here is a quotation from Krugman's April 29th column: "The most striking inefficiency of our health system is our huge medical bureaucracy, which is mainly occupied in trying to get someone else to pay the bills. A good guess is that two million to three million Americans are employed by insurers and health care providers not to deliver health care, but to pass the buck to other people." (The article can be found at the following link: www.nytimes.com/2005/04/29/opinion/29krugman.html?) I would paraphrase this slightly and say that 2-3 million Americans are employed by the health care industry to determine how to deny payment for medical care.
Physicians cannot collectively bargain. In fact, if physicians even discuss rates among themselves, IT'S AGAINST THE LAW. It's an antitrust violation. Health insurance companies can merge until they completely control the market, and it's legal. But if 10 physicians (who are not in the same group) get together to discuss reimbursement rates, THEY ARE BREAKING THE LAW.
We have a healthcare market that is privately owned. However, it behaves like socialized medicine. Patients have little choice, as well as having little monetary incentive not to overuse services. Doctors have little monetary incentive to provide better service. They won't be reimbursed any more. In fact, they may actually make less. A surgeon who performs more surgery will be removed from most HMO provider lists. He costs the HMO more money. HMOs pick providers based on cost consideration alone. Surgical outcomes have little effect. More surgery means more physician and hospital payments. More payouts mean less profit for the HMO. If the 1st surgery went poorly, HMOs can simply delay or deny further treatment. Eventually the patient just gives up.
I know this, because I was a staff physician at an HMO, as well as one of their patients. When I ruptured a vertebral disc in my back, they referred me to their limited group of spine surgeons. They also knew that none of them would operate, so they'd never have to pay for it. I ultimately bought a 2nd type of insurance and it was eventually paid by them. Interestingly enough, the surgeon who finally performed my spinal fusion had previously been one of the HMO's providers. He was de-selected because he did too much surgery. He was costing the HMO too much money. He was providing too much necessary medical care.
HMOs receive their payment at the beginning of the month. The less of this they spend on patient care, the more they have left. Less medical care increases their profits. HMO's monetary incentive is to provide as little care as possible.
You might think providing bad medical care would cost more money in the long run. It does not. There are several reasons for this. Most HMO physicians receive fixed compensation from the HMO. Most are paid salary, or they receive a capitated monthly payment from the HMO. They are paid the same amount regardless of how many patients they see. It doesn't cost the HMO any more money for the doctor to see the patient. In addition, hospitals are often paid a capitated rate as well. So it doesn't cost much more to re-hospitalize a patient because of bad medical care. So there is little incentive to hire good doctors, only cheap ones.
If a salaried HMO physician spends too much HMO money on medications or lab tests, they fire him. (I was one such physician.) If a specialist does too many procedures, he's deselected. If a patient requires an expensive treatment, the HMO delays treatment as long as possible. The patient may disenroll if the delay is long enough. The patient may also DIE! When an extremely ill patient dies, the HMO SAVES money. They don't have to continue paying for expensive treatment when a patient dies. It's in their best financial interest to let sick patients die. Their "authorization request" protocol was designed exclusively to delay treatment, which saves them money. I had one such patient. Her treatment was delayed through the HMO's "authorization request" protocol. It worked here. The patient died before she cost the HMO much money. They did, however, get her Medi-Cal premiums for a short time.
You might think an HMO would be concerned about medical liabilty for providing poor medical care. You would be wrong. Only doctors can be sued, even if an HMO vetoes their medical decisions. HMOs CANNOT BE SUED FOR MEDICAL MALPRACTICE. They have been excluded by law, first by ERISA, then by Clarence Thomas and the Supreme Court. (The HMO party line is "HMOs don't practice medicine.")
This brings me to my "solution" to the health care crisis. It's goal is simply a return to a level playing field, and a return to a REAL free market. I have posted this letter elsewhere, so I may be repeating myself. Here's my letter:
I DO have a simple solution to the healthcare crisis. But I'd leave it out of the debate because it will not be put through in the near future. Few people would accept my idea as THE solution because it is too simple. It is to repeal one piece of legislation passed in 1974. It is part of the ERISA legislation. It's simple.
REPEAL MALPRACTICE EXCLUSION FOR HMOs. Let me repeat that. REPEAL MALPRACTICE EXCLUSION FOR HMOs.
This was part of the patient's rights legislation proposed in Congress, but opposed by Republicans and healthcare insurers when the Bush plutocracy first came to power. The only part of that legislation that worried HMOs was the part about ending HMO exclusion from malpractice and allowing litigation against them. The same litigation M.D.s face when they are told what medical care they can provide by HMOs that claim they don't practice medicine.
Ending HMO exclusion from medical malpractice would end HMOs. Doctors would control medicine, not CEOs. We would have a medical system that profited from providing care, rather than withholding care. Doctors might err in the direction of overtreatment. But HMOs profit by withholding treatment. Would you rather be in a system that encourages treatment of disease, or one that discourages treatment?
If we reduce the control health insurers have in medicine, we will reduce the amount of money they siphon off. Patients with more freedom of choice can make decisions based on cost vs. benefit, instead of having that choice made for them.
Having the government give money to health insurance companies to pay their CEOs higher salaries is not the answer. Insurance companies make money by taking your premiums. They lose money paying for medical services. What kind of incentive do you suppose they have? The profit motive of insurance companies is in complete conflict with providing healthcare.
Additionally, we have more than just a problem with the high cost of healthcare. We have a problem with receiving medical care when we pay the high cost. I see THAT as a bigger problem. What good is low-cost health insurance if it denies essential medical care? What good is an insurance card if it provides no real coverage?
The current healt care crisis has not been caused by "free" markets. It's been caused corporatocratic policies that have eliminated the free market. It's the result of government regulations that protect the corporate interests controlling the medical field, at the expense of doctors, patients, and the general public.
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Post by unlawflcombatnt on Mar 1, 2006 21:10:49 GMT -6
the difference in typical hospital costs between "insured" and "uninsured" is the "negotiation" rate that the hospital uses in settling prices with different insurance plans...the larger the plan, lower the cost and with state medicaid plan.....somewhere between, and the poor working sucker, who has no or is underinsured is the "bonus" rate.... Bob, Good points, and thanks for joining the Economic Patriot Forum What you've described is one of many ways that health insurance companies game the system. In almost all cases they pay less for services than a private individual does. Contracted health insurers may pay as little as 10% of the cost for lab tests that an individual would pay. I was recently charged $379 for lab tests, which I later had repeated. The 2nd time they were paid by my insurance company. The insurance company was billed only $30, I was billed a $30 co-pay, and the lab wrote off the remaining $319. So the insurance company was required to pay less than 10% of what I had to pay for the same lab tests. Medications are handled the same way. When I worked for an HMO, they got tremendous discounts on drugs. We had a list of oral contraceptives we could prescribe, at least 8 of which cost the HMO only $2/month. This is not heresay, these price lists were actually pinned to the wall over my desk. Those same contraceptives would have cost a patient $25-30 if they had to pay themselves. The list of insurance company discounts goes on and on. But in general, due to their oligarchic/monopolistic control of the markets, they receive greatly reduced prices. Though I may have mentioned this elsewhere, I'll mention it again. Doctor's are NOT allowed to charge a cash patient less than an insurance-paying patient. IT IS AGAINST THE LAW. But a lab, hospital, or pharmaceutical company can charge an insurance company less than they charge a cash-paying customer. That is legal. Apparently it's perfectly acceptable for an insurance company to engage in monopolistic and collusionary practices. But M.D.s are forbidden from collaborating on anything, even if it involves offering a cash-paying patient a discount. This is Corporate Medicine at its most idiotic extreme. And the Bush plutocracy will do everything within its power to make it worse.
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Post by lc on Mar 1, 2006 21:35:54 GMT -6
Unlawful,
in another discussion we discussed ways to offset taxes by allowing Government to assume specific industries. I suggested health care, insurance, banking, military contracting, utilities, transportation infrastructure and energy as industries the Government could own to generate revenue to replace taxation which always has a negative economic effect. I would add education to that list in a heartbeat.
I listed my reasons for selecting those industries included because the industries were essential for national security, necessary to maintain self reliance, or because the business itself was one in which it is immoral to operate a for profit business venture.
You proved my point regarding medicine and insurance.
And I am sorry to hear about your belated father and girlfriend.
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Post by unlawflcombatnt on Mar 2, 2006 15:30:14 GMT -6
LC,
Thank you for your condolences.
Again, I agree with much of your nationalization suggestions, but not all of them.
I do want to briefly summarize the conflict in motivation with today's health care system.
If it's controlled by insurance companies, the monetary incentives are exclusively to provide less care. Insurance companies are paid a fixed premium amount to begin with. Their profits depend exclusively on how much of that money they don't spend on health care. A majority of enrollees have essentially no choice in what plan they enroll in. (Their main choice is to pay for the insurance, or not have insurance at all.) Since HMOs and insurance companies are exempt from malpractice, there is no disincentive to deny care. The monetary incentive is clearly to provide as little medical care as possible. Providing less medical care increases profits. Profits are 100% dependent on how much or how little medical care is provided.
If doctors controlled medical care, the incentive is to provide MORE care. There is some incentive to provide excess medical care. But there are some limitations. Doctors can be sued for malpractice. And performing an unnecessary procedure or service is an excellent way to get sued. And lose. A lot. And doctor's do get sued. So the threat of malpractice action is a very real deterrent. (I was sued for malpractice and forced to settle -- for a patient I had never even seen. This action resulted in the loss of my malpractice insurance, as well as a medical board review. You better believe that served as a deterrent and an incentive to distance myself from that endeavor in the future.)
In addition, doctors are subject to state medical board actions, as mentioned above. Perceived improper (or excessive) care may result in disciplinary action, including the loss of a doctor's medical license. And doctor's do have their licenses revoked. Again, this is a very real deterrent.
Also, doctors are subject to prosecution for fraud. Such action can result in medical board action, license revocation, fines, and prison time. And some doctors have gone to prison for alleged fraud.
The point here is this. Is it better to have doctors control the purse-strings in medicine? Or is it better to let insurance companies control them? Are we better with an incentive to provide more care, or with an incentive to provide less?
There are many disincentives to keep doctors from providing excessive care. Are there any for insurance companies not to provide insufficient care? Which incentive "direction" would be best for the public?
None of the costs of medical care are regulated, except for one. Doctor's reimbursement.
Medical costs are not skyrocketing due to physician fees. They're controlled by the government. Costs are rising due to the insurance and pharmaceutical cartels, and the governments' support of these cartels by protective legislation and taxpayer-funded subsidies.
The true "cost" of medicine is not out of control. What is out of control is the greed of the insurance and pharmaceutical industries. The actual reimbursement for medical service has not skyrocketed. The need for increased profits by the insurance and pharmaceutical cartels has skyrocketed. Americans aren't paying more for the actual health care provided, because reimbursements are fixed They're paying more for the greed and increased profits demanded by the Corporate management of medicine.
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Post by graybeard on Mar 11, 2006 7:15:26 GMT -6
MEDICAL INSURANCE EXPLAINED (Research done by the AARP Legal Department) Q. What does HMO stand for? A. This is actually a variation of the phrase, "HEY MOE." Its roots go back to a concept pioneered by Moe of the Three Stooges, who discovered that a patient could be made to forget the pain in his foot if he was poked hard enough in the eye. Q. I just joined an HMO. How difficult will it be to choose the doctor I want? A. Just slightly more difficult than choosing your parents. Your insurer will provide you with a book listing all the doctors in the plan. The doctors basically fall into two categories: those who are no longer accepting new patients, and those who will see you but are no longer participating in the plan. But don't worry, the remaining doctor who is still in the plan and accepting new patients, has an office just a half-day's drive away and a diploma from a third world country. Q. Do all diagnostic procedures require pre-certification? A. No. Only those you need. Q. Can I get coverage for my preexisting conditions? A. Certainly, as long as they don't require any treatment. Q. What happens if I want to try alternative forms of medicine? A. You'll need to find alternative forms of payment. Q. My pharmacy plan only covers generic drugs, but I need the name brand. I tried the generic medication, but it gave me a stomach ache. What should I do? A. Poke yourself in the eye. Q. What if I'm away from home and I get sick? A. You really shouldn't do that. Q. I think I need to see a specialist, but my doctor insists he can handle my problem. Can a general practitioner really perform a heart transplant right in his/her office? A. Hard to say, but considering that all you're risking is the $20 CO-payment, there's no harm in giving it a shot. Q. Will health care be different in the next century? A. No, but if you call right now, you might get an appointment by then
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Post by graybeard on Mar 15, 2006 7:02:50 GMT -6
while not US healthcare, this from Norm Chomsky on today's www.Guardian.co.uk shows the upheaval of relationships today, thanks in large part to Busch's Quixotic misadventure in Iraq: "Cuba-Venezuela relations are becoming ever closer, each relying on its comparative advantage. Venezuela is providing low-cost oil, while in return Cuba organises literacy and health programmes, sending thousands of highly skilled professionals, teachers and doctors, who work in the poorest and most neglected areas, as they do elsewhere in the third world. Cuban medical assistance is also being welcomed elsewhere. One of the most horrendous tragedies of recent years was the earthquake in Pakistan last October. Besides the huge death toll, unknown numbers of survivors have to face brutal winter weather with little shelter, food or medical assistance. "Cuba has provided the largest contingent of doctors and paramedics to Pakistan," paying all the costs (perhaps with Venezuelan funding), writes John Cherian in India's Frontline magazine, citing Dawn, a leading Pakistan daily. President Pervez Musharraf of Pakistan expressed his "deep gratitude" to Fidel Castro for the "spirit and compassion" of the Cuban medical teams - reported to comprise more than 1,000 trained personnel, 44% of them women, who remained to work in remote mountain villages, "living in tents in freezing weather and in an alien culture", after western aid teams had been withdrawn." Where's our "compassionate conservatism?" GB
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