Gruss, you don't seem to appreciate that where we are at today is a big fucking smoking crater. The US spends several times more than anyone else per capita and ends up with worse outcomes. Tens of millions of people have no health care coverage and use the least useful and cost effective form of medical care (emergency room visits) as their primary care. The "pragmatist" approach has lead to medical bills being the *leading* cause of personal bankruptcy.
Your claims about the special place of the US in the world of health care is farcical. There is nothing pragmatic about what you style as an approach, it is just throwing shit at the wall to see what sticks and hoping that tossing around technical terms like ICD-9 will make it sound intelligent when paired with feel good phrases like "choice" and "competition". Btw, medically billing doesn't use ICD-9. ICD is for diagnosis. CPT codes are used for categorizing billing items and then they work in conjunction with RVU values in order to arrive at billing rates which are then discounted by contractual write offs involving Customary and Usual charges depending on insurance carrier and then sent to claims adjustment that applies coinsurance and deductible calculations before a balance transfer is done and the (hopefully) correct value is actually billed to both insurance and patient. RVU values are supplied by Medicare and help determine the customary and usual charges for items and each practice applies a multiplier that is usually determined by the market segment and geographical location of the practice. Those RVU values are updated at least once a year and due to budget neutrality rules with Medicare may be updated in the middle of the year to make Medicare reimbursements fit the budget expectations but that also effects the values posted to private insurance carriers who typically all base their values off of RVU as well. I'll try and find a time soon to write a treatise on health care, billing, insurance, consumer choice, rationing, IT interoperability, PM versus EMR's and the tooth fairy. Not really the tooth fairy though, dentistry is its own weird little ball o' wax. In the mean time, no, the United States is not a unique little snow flake, as much as you might want to believe otherwise. Yes, there are experiments even within your precious country that have shown how things could work and pointed out some good bits and not so good bits. Take a look at Massachusetts and Oregon for two forward looking experiments. Yes there are some well thought out initiatives at the NGO level as well. Take a look at the Apollo Initiative which is organized by John Kitzhaber who would probably be the new Secretary of HHS but can't stand DC. He's a good guy, you'd like him. An ER doc and former Govenor with a penchant for suit jacket and cowboy boots. A good guy to drink with and I've learned a lot. On Tue, Feb 17, 2009 at 7:22 PM, Gruss Gott <[email protected]> wrote: > >> >> Seems a bit like the lipstick on the pig Larry mentioned. Here's hoping it >> works. >> > > That's why everyone hates the pragmatists and the pragmatists hate the > idealists. > > However, I'm guessing that you couldn't have possibly read that > article as it casts the UK, Canada, Swiss, and Australian systems is > glowing light but describes exactly why none of those systems will > work in the US: path-dependence. > > Maybe it's the decade I spent in the airlines, but there they teach > you one big thing: when lives are on the line you make damn sure > you've thought of everything, tested everything, and then did it again > before you touch anything. > > So when people assure me that something they don't understand and > haven't thought through will work any ole place, at any ole capacity, > at any ole time with nary a problem I guess my airline voice whispers: > > "A smoking hole is gonna happen." ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| Adobe® ColdFusion® 8 software 8 is the most important and dramatic release to date Get the Free Trial http://ad.doubleclick.net/clk;207172674;29440083;f Archive: http://www.houseoffusion.com/groups/cf-community/message.cfm/messageid:288953 Subscription: http://www.houseoffusion.com/groups/cf-community/subscribe.cfm Unsubscribe: http://www.houseoffusion.com/cf_lists/unsubscribe.cfm?user=11502.10531.5
