Government Health Care... Is this what we have to look forward to?

[rudder]

AMA's report card on insurance carriers in 2008


Aetna looks like a crappy company to have insurance with as they deny 6.8% of all claims. The next highest private insurer is 4.62. The rest are in the 2.88% - 3.88% range.

Medicare on the other hand denies 6.85% of all claims.

20% of those denied medicare claims are non-covered services because this is not deemed a medical necessity by the payer. If you look at the reason codes you will see that none of the private insurers list that as a reason. At least I did not see it.

And this comes from the AMA... the medical group that endorses Hr.3200 (Although AMA only represents a fraction of physicians).

 

[cubeless]

uh, yeah... that's how it is... and as soon as they have to cut costs the formularies and services constraints will get tougher and tougher...

but, of course, none of this counts in the (most likely at least) 30% crime based over prescribing of tests, etc...

 

[b0mbrman]

Maybe it's this:

http://content.nejm.org/cgi/content/short/348/22/2218
http://www.annals.org/cgi/content/full/141/4/272

 

[rudder]

Originally posted by: b0mbrman
Maybe it's this:

http://content.nejm.org/cgi/content/short/348/22/2218
http://www.annals.org/cgi/content/full/141/4/272

Maybe something more recent.
Veterans care underfunded
2008 - Article on shabby treatment of female veterans.
House committee of Veteran's Affairs - not enough being done for Gulf War Syndrome
Straight from a Veteran.

etc, etc, etc....

 

[blackangst1]

Look at it this way. Shitty coverage is better than no coverage.

 

[Moonbeam]

Originally posted by: rudder
AMA's report card on insurance carriers in 2008


Aetna looks like a crappy company to have insurance with as they deny 6.8% of all claims. The next highest private insurer is 4.62. The rest are in the 2.88% - 3.88% range.

Medicare on the other hand denies 6.85% of all claims.

20% of those denied medicare claims are non-covered services because this is not deemed a medical necessity by the payer. If you look at the reason codes you will see that none of the private insurers list that as a reason. At least I did not see it.

And this comes from the AMA... the medical group that endorses Hr.3200 (Although AMA only represents a fraction of physicians).

OK some guy is on Medicare and pays nothing for health care having paid in all his working life so his premiums are zero and he gets rejected 7% of the time whereas some other poor soul is paying through the nose for his health care, including profit for the insurance investors he will never see a nickle of, and he gets rejected 4% of the time. Which way are you going for 2%?

 

[Athena]

Originally posted by: rudder
[20% of those denied medicare claims are non-covered services because this is not deemed a medical necessity by the payer. If you look at the reason codes you will see that none of the private insurers list that as a reason. At least I did not see it.

It seems to me, that should be a flag to ask just how the statistics are gathered. If no private insurer ever uses "not medically necessary" as a code, what are they using? Why would there be such a big difference?

It's also interesting that there is much more coverage of patient and doctors complaints about coverage denials from insurance companies (doctors complain about payment rates from Medicare but not actual denials). Again, why the discrepancy?

One thing that I'd say is that providers are much more likely to submit a questionable claim to Medicare than to insurers -- sort of "Let's see if they will pay this". There are also entire industries --think The Scooter Store, and Diabetic supply companies -- built on Medicare coverage. Is it possible that those organizations are submitting a significant number of ineligible claims?

 

[Fern]

Originally posted by: blackangst1
Look at it this way. Shitty coverage is better than no coverage.

No, I look at it like this - shitty coverage is an expensive form of no coverage. And by paying for shitty coverage you'll never be able to afford the HC expenses when you need it.

Fern

 

[b0mbrman]

Originally posted by: rudder

Originally posted by: b0mbrman
Maybe it's this:

http://content.nejm.org/cgi/content/short/348/22/2218
http://www.annals.org/cgi/content/full/141/4/272

Maybe something more recent.

Sure. As long as you compare it to the private sector:

http://www.miamiherald.com/new...ida/story/1268584.html

Veterans care underfunded

The VHA has been underfunded for decades (per the Independent Budget). This is the first year that the level of funding will exceed the amount recommended. The fact that they've been able to achieve the level of satisfaction they do compared with private care in spite of the underfunding is an endorsement of VHA, not a criticism.

2008 - Article on shabby treatment of female veterans.

"Phillip Leveque has spent his life as a Combat Infantryman, Physician, Toxicologist and Pharmacologist. He is an expert in medical marijuana treatment."

But:

http://veterans.house.gov/hear...earing.aspx?NewsID=441
http://veterans.house.gov/hear...earing.aspx?NewsID=384
http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.0293:
http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.1211:

Would a private health care firm deliberate this much concerning a group that currently makes up less than 8% of their patient base?

House committee of Veteran's Affairs - not enough being done for Gulf War Syndrome

Please. I've spoken with VFCS enough times to know that while Paul et al have problems with the claims and appeal process (as it has been limited within the CFR), they happily acknowledge that once in the system, the quality of care in the VA health care system is among the best available publicly or privately in the nation.

Straight from a Veteran.

Did you even read it?

"I spent the last 14 months of my 27 months of hospitalization in a Veterans Hospital. The care was first-rate, the caregivers had true compassion, and the Department of Veteran Affairs (VA) completely carried out its mission statement to ?fulfill President Lincoln?s promise??To care for him who shall have borne the battle?? ?

He's sad about living wills or in FUD language -- Veterans DEATH BOOKS!

And, for what it's worth, here's how VVA feels about that: Health Care Reform Hysteria: ?Death Book? Scare Tactics Inexcusable
How Assistant Secretary Tammy Duckworth feels about it: FOX News Interviews VA's Tammy Duckworth About "Death Book For Veterans"

 

[Athena]

Originally posted by: rudder
[etc, etc, etc....

Did you read the articles you linked? Everyone of them is about how Veterans want more VA care. They talk about the underfunding of the VA by legislators to whom its success is an affront to their own ideology.