On 03/11/2006 05:03 PM, Michael Hipp wrote:
Net Llama! wrote:
The true culprit in the health care mess is Medicare. Medicare fixes
costs, not prices, costs, and then demands the providers to function
within that cost structure. The insurance companies are basing their
reimbursements off of Medicare's UCR. The truth is that Doctors can't
keep up with medical practice standards and insurance standards, it is
beyond human capacity. Frequently, the Doctor doesn't know what, or
if, the insurance will pay for a needed procedure.
I don't know whether this is accurate, but it doesn't sound so. The
majority of people in the US are not using Medicare, so I fail to see
how it can be blamed for poisoning the rest of the rest of the medical
industry.
I worked in state government in proximity to that system and can say with
certainty that it is indeed accurate. Note that we're talking about both
Medicare (old people) and Medicaid (not old).
It goes something like this. Medicare sets its rates and hears no arguments.
Doctors must, by law, treat everyone who walks in the door (especially ERs).
If the patient doesn't pay, their bill is spread out over the cost structure
and ends up in every one else's bill.
Say a certain procedure costs the provider $1000. Medicare allows a payment of
$600 for it. So the doctor bills it at $1500 hoping to get lucky or he bills a
lot of peripheral stuff, hoping to get it paid. What he gets and when he gets
it comes from something driven by a random number generator.
Whatever he doesn't get from the non paying patient in the first example and
from the non-paying Medicare/Medicaid in the second, both are tacked onto the
cost structure. So the next uninsured that walks in the door gets billed $1800
for a $1000 procedure. Similarly for someone with a generous insurance plan.
The doctor bills it at the high rate hoping to get lucky. And the poor sap
paying his own bills gets to subsidize everyone else since he isn't able to
set rates like the insurance company or the government. They can refuse to
pay, he can't.
I made up the numbers, but the ratios are about right.
OK, that's interesting, and I was unaware of it.
Hardly. Being insured means that you have access to whatever healthcare
the insurance company is willing to pay for, which is more often than
not, the cheapest, worst healthcare.
Hardly. Remember, there is competition among insurance companies and even in a
bad payout year they make profit we'd all drool over. And there are State
Insurance Commissioners in all 50 states who write rules about such things
(tending to drive costs up, but it does offer a fair level of protection to
the consumer).
We all hate HMOs, often with good reason. But if you're stick or injured,
you'll get the best treatment available in your regional area. And the US has
the most and best facilities/technology/personnel per capita compared to any
of the socialized countries we're compared to. Have high blood pressure, go
see your doctor ($20 co-pay); stop by the pharmacy and get a month's supply of
BP medicine ($7 co-pay). Need hernia surgery costing $5000? They'll book you
in for 3 days from now (not 9 months) and it will cost you your $250 annual
family deductible. You'll have a private room and a veritable army of fairly
competent and motivated people to take care of you. Exceptions notwithstanding.
I don't know where you live, or what insurance you have, but none of the
above has ever been true in my personal experience, and I've lived in
several states and had several different insurance plans over my (short)
lifetime. Quite often, especially in urban & suburban areas where there
are alot of doctors (and patients) the better doctors can afford to be
picky about which health insurance plans they accept, and it tends to be
those that are willing to pay them higher rates. Over time, the better
doctors start dropping the less 'competitive' insurance plans, or just
stop accepting new patients from them. The newer doctors, or those who
are less desirable end up with the crappy health insurance companies
because they are desperate for new patients. I realize that the numbers
you've quoted above were likely just examples, but I think they're poor
examples, and are generally well below the national averages. One
number that you left out was how much is deducted from a person's
paycheck to get this health insurance, which tends to be ridiculous.
One of the better examples is the so-called health insurance that
Walmart offers its employees (and that's only after they've been working
full time for a year or more), which is so expensive that it tends to be
cheaper for them to just pay for healhcare out of pocket. Tacking on
the "exceptions notwithstanding" to the end really is just a cop-out
that your example isn't representitive of reality.
When I worked for a W-2, medical care wasn't even in the top 1000 things I
worried about. It was all taken care of for a very nominal bi-weekly payroll
deduction (at least as compared to the potential benefit.)
Not that it's all perfect here. Far from it. But this is the best it gets.
I'm not at all convinced of that. The healthcare systems in much of
Europe seem to be miles better than Canada from what I've read & heard.
And the Canadians that I've spoken to, never complained about the
quality of healthcare that they're getting either. I'd argue that most
people never need an MRI or CT scan in their lives, so throwing out that
story about how wealthy canadians are the only ones who can get one
seems like a corner case used just to make a point.
That is until the Democrats and Republicans conspire to destroy it.
I'd say this is one of the cases where we need to destroy it to save it.
--
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L. Friedman [EMAIL PROTECTED]
LlamaLand http://netllama.linux-sxs.org
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