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Post by unlawflcombatnt on Dec 2, 2009 2:47:59 GMT -6
Once again, Senator Max Baucus is regurgitating the outright LIE that uncompensated care increases private health insurance premiums.
Uncompensated care does NOT increase health care premiums ANY. The cost of uncompensated care is not ever "transferred" to private insurance premiums. It's a cost born exclusively by those who provide the care--none of whom can transfer it to private health insurers.
How much longer is this asinine and illogical myth going to be perpetuated??
If I, myself, am denied payment on a Medicare claim, I can't "transfer" the cost to Medicare or anyone else. The fee schedules for physicians and hospitals are FIXED. Neither Medicare nor private insurers pay more than these fixed fees when a provider is denied payments on other claims, nor when they provide uncompensated care.
Yes, it does cost someone money to provide care that is uncompensated. But that someone is the provider of the care, not the insurance company. Not ever. Not one single time in all of recorded human history.
In summary, the cost of treating uninsured patients for medical problems does not cost private health insurers a dime. That cost is born entirely by whomever provides the care, without any transference of those costs to anyone else. As such, providing uncompensated care does not raise health insurance premiums one red cent.
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Post by graybeard on Dec 3, 2009 7:57:15 GMT -6
Well, sorta'. The insurers have to pay at least enough to keep the providers in business, so those costs are covered, albeit at a discount. If all the providers went out of business, there would be no healthcare, and no need for insurance. The insurers need the providers and patients, while almost bleeding them dry.
GB
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Post by fredorbob on Dec 13, 2009 9:00:03 GMT -6
Democrats keep saying, "The uninsured go to the emergency room and increase medical costs for everyone, we're just trying to make it more efficient."
Guess who passed the law in the 1990's saying emergency rooms cannot turn away patients regardless of their ability to pay.
You guessed it.
They created the problem, and now they also created the solution to the problem, how wonderful.
Not saying that I disagree with the law which says that if some poor dude arrives at a hospital bleeding profusely can't get medical treatment, the Democrats are just ass licking bastards; the Democrats make it REALLY hard to not vote Republican.
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Post by agito on Dec 13, 2009 15:24:16 GMT -6
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Post by fredorbob on Dec 18, 2009 7:23:01 GMT -6
I remember reading it was passed in the mid 1990's.
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Post by glorybe on Feb 3, 2010 1:14:10 GMT -6
Any business persists by charging what the market can bear. In my area many if not most physicians avoid taking Medicare or Medicaid and refuse to work in public hospitals. This issue is so severe that we even have doctors who refuse to take any form of insurance. They take the position that you will pay in advance and their staff will help you try to recover money from your insurance company. There are also quite a few doctors who over test patients with two motives. The first is that they wish to avoid law suits if you are the one person in one thousand who has a hidden condition. The second is that they make money by sending you to affiliated testing centers. In essence the medical system is broken. The doctors know that they are the ones who broke the system and they do talk about it among themselves. There is no free market argument concerning doctors as they have always had a completely self serving union called the AMA which can reach out and control doctors who wish to reform the system. The only workable solution is total control of the medical industry by government.
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Post by unlawflcombatnt on Feb 3, 2010 5:01:30 GMT -6
There are also quite a few doctors who over test patients with two motives....The second is that they make money by sending you to affiliated testing centers. You're absolutely full of crap. (I happen to be a doctor, in case you weren't aware of that.) Apparently you've never heard of Stark regulations. Clearly you don't know what you're talking about. It's ignorant know-it-alls like you that give doctors a very undeserved bad name, and help perpetuate the myth that the health care crisis is somehow caused by doctors. It's not. It's caused by insurance companies and politicians that are on their payrolls. Doctors don't make any money by sending patients to affiliated testing centers. It's absolutely ILLEGAL for a doctor to accept any renumeration for a referral to ANY lab or testing facility. It's spelled out in Federal law. And doctors are guaranteed to get prosecuted for accepting such renumeration--and even if the Government only thinks they've referred under those conditions. I don't get paid a penny for ordering a lab. Only the lab gets paid. All I get is the information. And if the lab even tried to pay me something for a referral, I'd decline it. If a doctor accepts any such payment, he risks a Federal FELONY charge for accepting kickbacks. (A conviction for which he could get 10 years in the Federal Penitentiary.) And, yes, I'm more than just a little bit familiar with this. I've actually been charged (falsely) for this by the US Justice Dept. Though the charges were ultimately dismissed, I became very familiar with that aspect of the law. Don't just regurgitate some hearsay garbage you "heard" from some nitwit who doesn't know what he's talking about.
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Post by agito on Feb 3, 2010 16:29:55 GMT -6
I definitely respect UnLCs comments on the matter, but I do remember a dKos diarist (who was a doctor) explaining how frustrated he was when he sent his patients to a specialist and came back with the verdict that "more tests were needed." So he was forced to send them right back for more tests. I would agree that there is some substance to the overtesting claims, but not for the reasons glorybe claims and it's difficult to assess what the costs are.
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Post by unlawflcombatnt on Feb 3, 2010 17:02:47 GMT -6
I do remember a dKos diarist (who was a doctor) explaining how frustrated he was when he sent his patients to a specialist and came back with the verdict that "more tests were needed." So he was forced to send them right back for more tests. Let me shed some light on that point. The ordering of more tests by a specialist is often required by the insurer. The insurer would rather pay for additional tests, instead of a far more expensive procedure or surgery. For example, if I were to refer a patient to a spine surgeon for back pain (after ordering only a $60 lumbar spine X-ray), and the surgeon decided the patient needed a $10-20K spinal fusion, an insurance company would probably deny authorization for the fusion, and require a $500 lumbar MRI be performed first. Neither the surgeon nor myself want the MRI. But the insurance company does want it because it's a nice way to delay the procedure. And if the MRI doesn't look bad enough, the insurer has an excuse for denying the $10-20K spinal fusion. Many specialists, knowing that their request to authorize a procedure will be denied if further tests aren't done, will go ahead and order the tests--the tests they anticipate the insurance company will require. And as I've stated previously, neither the surgeon nor I get paid for ordering the MRI. We get the information only. And the surgeon may find further justification for the surgery--or have the surgery denied due to lack of pathology reported on the MRI. Also realize that private insurers get paid in an essentially capitated manner. They get paid a fixed amount in premiums, and profit by keeping that money from being spent on medical care. They also have monthly balance sheets. And if an insurer can delay a $20K procedure for several months by requiring more tests, it improves the monthly balance sheet by $20K during those months. It also reduces the chance the patient will ever have the procedure. The patient may improve and decide not to have the surgery. Or the patient may get mad at the insurer and dis-enroll. Or they may lose their health insurance entirely. It's a win-win situation for the insurer if they can delay or prevent a very expensive surgery or procedure—simply by requiring additional, comparatively inexpensive tests. The insurance companies are the major reason that specialists order additional tests, not the referring physician or the specialists.
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Post by agito on Feb 3, 2010 17:08:51 GMT -6
thanks for the explanation on that end UnLC. So while you and the surgeon don't get money from the additional tests, the specialist does right? And you have to agree that the inflationary compensation for specialists is caused by this (more demand for an excuse to get out of an operation means more money for those specialists) is corrosive on our healthcare costs?
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Post by unlawflcombatnt on Feb 3, 2010 17:39:57 GMT -6
thanks for the explanation on that end UnLC. So while you and the surgeon don't get money from the additional tests, the specialist does right? And you have to agree that the inflationary compensation for specialists is caused by this (more demand for an excuse to get out of an operation means more money for those specialists) is corrosive on our healthcare costs? In the case I was describing, the specialist involved would be the radiologist who reads the MRI. In theory, that should drive up the price of MRI's by increasing demand. But those prices are restricted by 2 major factors: 1) Private Insurance Oligopolies 2) Medicare Reimbursement Rates. Due to the expense of even the less-expensive MRI, few patients pay out of pocket. They rely on their insurance company. The insurance company sets the rate. If the MRI is too expensive at one center, the insurer won't contract with them and won't pay for the MRI performed. Private insurance reimbursement is usually based on a % of the Medicare reimbursement rate. Usually private insurers pay a slightly higher rate than Medicare. But if Medicare reduces reimbursement rates, private insurers do the same. Doctors can either accept what private insurers and Medicare pay, or not get paid at all. There is no private individual market for medical procedures or tests. The payor, who functions as the consumer in regards to price, is the insurance company or Medicare. If the price is too high for the insurance company or Medicare, the provider doesn't get paid. It's not a free market regarding the price of medical care, because the payer (who determines the actual demand and price), is the insurance company. So ordering more procedures and tests doesn't really raise the price of the procedure, because the actual payor controls the price paid by millions of patients. And that gives them almost absolute pricing power in most markets. If a provider charges too much, whether for an office visit or procedure, he simply won't get paid. And since a handful of insurers control ALL of the market, they have complete control of prices.
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Post by proletariat on Feb 3, 2010 19:59:24 GMT -6
WTH, let's hope so. My doctor recently referred me to a specialist and she ordered some blood work, CAT scan, more blood work, then a liver biopsy etc. The point is that my doctor referred to a specialist with a question - why do I have elevated liver tests. The specialist began in the least evasive way to answer the question and then moved to the more evasive tests. It seems to me if your dkos doctor had his way one would go for the biopsy before any blood work was done. I would not take dkos or that crack pot doctor on Huff Po too seriously. I definitely respect UnLCs comments on the matter, but I do remember a dKos diarist (who was a doctor) explaining how frustrated he was when he sent his patients to a specialist and came back with the verdict that "more tests were needed." So he was forced to send them right back for more tests. I would agree that there is some substance to the overtesting claims, but not for the reasons glorybe claims and it's difficult to assess what the costs are.
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Post by kramer on Feb 3, 2010 20:47:39 GMT -6
On a somewhat related note, my son gashed his head last summer and I brought him to an emergency room at a local hospital. While there, I called our ins company and told them what was going on. Anyway, while there, he was seen by two doctors and one nurse. The first doctor just asked him a few questions and looked at his gash. The second one actually stapled it up. Long story short, a few months later, we got a bill for over $800 dollars while the hospital billed our ins. company almost 2 thousand dollars. The whole time we were there wasn't more than 3 hours (including sitting in the waiting room). Looking back, I wish I would have paid cash or brought him to one of those small medical centers where they can treat these things.
I wanted to dispute this cost with the hospital but I doubt I'd get anywhere.
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Post by waltc on Feb 4, 2010 11:28:17 GMT -6
ULC wrote: Once again, Senator Max Baucus is regurgitating the outright LIE that uncompensated care increases private health insurance premiums.
You know that lie has been around for decades. I never found who originated it(I suspect it was some GOPer) but its quite pervasive. I've seen it in print and heard it repeatedly on talk radio.
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Post by unlawflcombatnt on Feb 6, 2010 0:14:16 GMT -6
It was again stated on PBS that total US health care spending is $2.5 trillion annually (or $2,500 billion). Total annual physician pay is $97 billion. Thus physicians' fraction of the health care cost is only 3.9% of the total health care cost of $2.5 trillion. Below is how I calculated physician compensation, using numbers from the Bureau of Labor Statistics: [/font] Here's the breakdown in numbers: All physicians & surgeons not individually listed: 262,850 @ $165K/yr. Family Practitioners: 106,000 @ $161K/yr. Pediatricians 29,000 @$153K/year. Surgeons 47,000 @ $207K/year. OB/GYNs 20K @ $193K/year Internists 47K @ $176K/year. Psychiatrists 22K @ $154K/year. Anesthesiologists 34K @ $197,570/year Total: $97 billion/year[/ul]
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Post by graybeard on Feb 6, 2010 6:00:21 GMT -6
Is that $165K before or after their insurance costs? Where does clinic overhead fit in?
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Post by agito on Feb 6, 2010 12:19:33 GMT -6
graybeard - the BLS surveys ignore overhead. I'm sure it's a bigger pain in the ass when the BLS surveyor encounters doctors with their own practice and they have to figure out what their actual take home pay is compared to doctors that get a paycheck from a hospital for example.
not sure on the malpractice insurance costs though. like the example above, it's probably a pain in the ass again because hospitals have it covered while independents go it alone or join a group. UnLC?
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Post by jeffolie on Feb 6, 2010 13:06:14 GMT -6
I belong to an HMO, Kaiser Permanente. When my primary care doctor discusses getting lab work she does not hestitate to order blood work. She only recently hestitated to order a stress test and then did the referral when I asserted that I wanted it. I am ingnorant of how Kaiser doctors are paid. I assumed they were salaried, but I have no idea how and if they have other pay incentives.
My family has been satisfied with Kaiser. Although we have not had any major medical problems. I have read of problems with Kaiser and have been lucky enough not to run afoul of such problems.
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Post by unlawflcombatnt on Feb 6, 2010 13:15:52 GMT -6
not sure on the malpractice insurance costs though. like the example above, it's probably a pain in the ass again because hospitals have it covered while independents go it alone or join a group. UnLC? I paid $13,000 for malpractice last year, but I have the bare minimum in coverage ($250K coverage per event, and $500K total/year). I've paid as much as $34,000/year. If I had typical coverage, which usually covers $1 million/event and $3 million/year, I'd be paying at least $25,000/year. And this is in California, which has a $250K cap on pain-and-suffering awards. (The cap seems to have some effect on rates, but not a lot.) Also, I'm an internist and don't do invasive or surgical procedures. Malpractice is much higher for a surgeon or a physician doing invasive procedures (like a Cardiologist who does angioplasty). I'm not sure whether the BLS wage total includes malpractice or not. It's a little tricky to determine that. If a physician works for an HMO or a group, malpractice is often paid by the HMO or group. If a physician works solo, or as an independent contractor, he has to pay his own malpractice. Locum tenems services usually pay the physician's malpractice, but those doing locum tenems have usually bought their own malpractice already. Personally I've had several bad years income-wise (thanks to the FBI and an overzealous US Justice Dept). In 2006 I made roughly $10,000, and paid $15,000 in malpractice. In 2007 I made $0.00, but still paid $15,000 in malpractice. (You're penalized and have your rates raised if you go without malpractice entirely, even if you weren't practicing). In 2009 I made ~$40,000, out of which I paid out $13,000 in malpractice. I think the $97 billion total is interesting in comparison to some other figures: The AIG bailout was $127-180 billion (depending on which source is cited). Wall Street financial industry bonuses are over $100 billion. TARP: over $700 billion. Fannie Mae and Freddie Mac: $300-400 billion Fed Reserve purchase of toxic MBS's: $1,250 billion The Medicare Prescription Drug Plan costs are $50-100 billion/year. (Here's a good link to an April 4, 2009 article from CNN Money that assigns $$ figures to the various programs used to bail out the financial industry: money.cnn.com/news/specials/storysupplement/bailout_scorecard/index.html) Some other points about insurance premiums and doctors' pay are worth mentioning. In 1994, the standard rate for a locum tenems doctor (a doctor doing temporary work) was $60/hour. In 2010, the going rate is $65-70/hour. Medicare reimbursement rates for many procedures--especially ones I'm familiar with--are lower now than they were in 2003. If inflation is factored in, they're much lower. Yesterday on the Ed Schultz show Ed stated his own health insurance premiums had been raised by 20% this year. Both my wife's and my own health insurance premiums were also raised by 20% this year. It's very hard to make the case that doctors' $97 billion/year in salaries is the major cause of the nation's $2,500 billion/year in health care costs.
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Post by unlawflcombatnt on Feb 27, 2010 15:28:09 GMT -6
Here's another interesting Health Care Statistic from the Bureau of Labor Statistics: The total income of all Health Care Professionals in $480 billion/year. This comes from the total of 7,076,800 x mean income of $67,890 = $480 billionThat's less than 1/5th of the total $2,500 billion ($2.5 trillion) spent on health care per year. Maybe the focus of lowering costs should be on the other 4/5ths of the cost--the $2 trillion that does not go to paying health care professionals.
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Post by unlawflcombatnt on May 8, 2010 2:42:24 GMT -6
This is certainly a repeat of previous posts I've made. But once again, after visiting economist Dean Baker's site, I feel it's necessary to restate this again. The cost of medical care is not being driven by physician compensation. PERIOD. Claims to the contrary are not just misinformed, they are INSANE. OK. Here I go again: [/url] where I've done the calculations for you (assuming anyone is actually interested in knowing the truth.) unlawflcombatnt.proboards.com/index.cgi?action=gotopost&board=medical&thread=6441&post=20866The total compensation of physicians in the US in 2005 was $97 billion. The total spent on health care is ~$2,500 billion. As stated above, this comes out to less than 4% of the total. As such, if physicians worked absolutely for free, costs would be reduced less than 4%. Doctors are most certainly NOT the cause of increased health care costs. Their share of the health care dollar is minimal. Let me give you a real life example of 1 physician's compensation (my own). In 1994, when I finished my Internal Medicine residency, the going rate for locum tenems physicians (temporary physicians) was $65/hour. I actually worked on several jobs for that amount. In 2010, the going rate for locum tenems physicians is...$65/hour. In 1994, rent for my 2-bedroom apartment in Orange County, California, was $600/month. In 2010, rent for my 2-bedroom apartment in Orange County, California, is $1,250. There's been a 100%+ increase in my cost of lodging since 1994. At the same time, there's been a 0% increase in physicians' compensation in California. Since I'm actively seeking employment at present, I'm very up-to-date on this information--having applied for over 400 jobs in the last 2 years. If you think the increased cost of health care is being driven by physicians' compensation, you are wrong. VERY wrong.[/ul]
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