Monopolies are good for the monopolists, not the public

[nobodyknows]

False.

Links? Not anecdotal. Something that shows a pattern.

I looked at one of your links. It was an article about Medicare being billed $11,xxx for physical therapy for someone with "a small wound on their wrist". If the treatment wasn't neccesary then that's fraud and should be prosecuted, it has nothing to do with the cost for the procedure.

 

[nobodyknows]

Here is a prime example of what is wrong with insurance or govt covering everything. A person getting a ct scan with insurance will pay the same copay no matter where they go.

If you want to bring prices under control, the consumer is going to have bear more the cost.

I've been thinking about this and you right, but how does one get around the fact that some people make so much money and some hardly make any money?

Perhaps a scale of some kind where the less they make the less they have to pay, yet they stioll have to pay money out of pocket. that would make people shop a little more, not have unecessary test done, run to the emergency room for nonsense, etc.

 

[blackangst1]

I looked at one of your links. It was an article about Medicare being billed $11,xxx for physical therapy for someone with "a small wound on their wrist". If the treatment wasn't neccesary then that's fraud and should be prosecuted, it has nothing to do with the cost for the procedure.

Which is my point. I guess you didnt figure out I was commenting on how adding 12 million people to the government dole wont reduce cost. (Wait...I think I said that). I wasnt commenting on the cost of proceedures. I was commenting on Craig's incorrect assertion that the government has done a pretty good job of controlling cost. When in fact, they often pay more than we would.

 

[daishi5]

No, the government has done pretty well at keeping costs down compared to private insurance for the same treatment, it seems. In fact, opposition to the public options includes providers for that reason.

I'm not especially well informed about the costs, so someone who is can say if any correction is needed to that, but that's what I've seen.

I meant to follow up on this discussion but some things came up, and now I missed all the fun.

But, to this particular statement, the government has not kept costs down, it has kept prices down, and it is a very big difference between the two. Costs being the actual expense of providing care, price being the amount of money given to the provider to reimburse them for the care.

It has kept prices down because it sets the fee schedule (at least from my experience, this may not be true in all cases). The government tells us what it will pay for procedures and other incidents of care, so when the government itself is setting the price I am not surprised they keep the price down.

They also have had some success with keeping costs down as well, but I don't think you want to shout the success from the mountaintops because it just has "conservative talking point" written all over it. The government is also fighting against doctors about the level of care patients should receive. (Again, personal experience, so this may not be true for all government healthcare.) If you do not know, the government is currently doing what are called "RAC audits" http://www.cms.hhs.gov/RAC/ to recover "overpayments" of medicare. These audits are to recover money from hospitals who either defrauded the government, or provided the patient with a level of care beyond what the government regulations allow. The government has contracted out audits of our patient records. They check the record and compare the diagnosis codes against the codes for the treatments provided, each treatment is only covered if it has a valid diagnosis code to justify the treatment. The list of diagnosis codes is impressive, I browsed through our compliance list once, and it includes something like "injuries from a nuclear incident involving a train." However, the list is not complete, for example someone I know could not find a diagnosis for falling on a boat, it must be in the boat section because of the location, but she couldn't find falling. (It is a diagnosis because falling would justify things like X-rays)

In some cases, hospitals really did screw up, and they owe the government over ten million dollars. Other times, the hospitals actually acted in the best interests of the patient, and the system does not have a way to document it. However, the example we were given in our overview is probably the most common. The example is: a patient comes into the ER, elderly, flu symptoms, high risk category, but low risk symptoms. The doctor believes that the patient requires observation overnight and that her symptoms will get worse, the government tables for her symptoms only allow for observation for a few hours. Before, the hospitals would document everything, listen to the doctor, admit the patient, and bill medicare. Now, we have an extra position in the ER, this person compares the patients diagnosis to the tables, and then I have no idea what happens. I am not sure who wins if the doctor and the tables disagree, and I don't honestly know which should win. I don't believe in the great infallibility of doctors, I know they provide a great service, but in medicine they are really just making very educated guesses.

The problem is that the government is in many cases reimbursing us below the cost of the care provided. I know a few health care metrics rate a low % of medicare patients as a good financial indicator. In other areas the government may be overpaying, I know ortho cases have a good level of reimbursement, so we fight to get all of those we can. But, because the government underpays us in so many areas, the insurance companies are actually subsidizing the government payments. If the government covered it all, we could not provide the level of care we do now at the prices they pay.

 

[Craig234]

Daishi5, that's fine, but I was indeed referring to the costs to the government, to dispell the old right-wing myth 'the government pays fat too much for what can be bought cheaper in the private sector'.

Sometimes there's truth to that - the classic examples, though, are really the private sector, when military conractors make a killing overcharging on corruptly approved contracts (see 'revolving door').

That's not the same for Medicare. I'm a bit concerned too about the imperfections of the system with the government declaring its prices - I'd like to see improvements to thinkgs like you mention.

 

[daishi5]

Daishi5, that's fine, but I was indeed referring to the costs to the government, to dispell the old right-wing myth 'the government pays fat too much for what can be bought cheaper in the private sector'.

Sometimes there's truth to that - the classic examples, though, are really the private sector, when military conractors make a killing overcharging on corruptly approved contracts (see 'revolving door').

That's not the same for Medicare. I'm a bit concerned too about the imperfections of the system with the government declaring its prices - I'd like to see improvements to thinkgs like you mention.

I am not saying the system is bad, I am just saying the government is not actually keeping costs down, they just refuse to pay over a certain amount, the care providers are the ones struggling to bring their own costs down. (and often failing) The government and care providers face weird incentives in the public health care sector, the government has control of price, providers try to keep costs under the price, and the people who actually use the system have almost no idea of the prices or the costs of the system so they have no good feedback mechanism to help moderate their use of the system.

Pay for performance may be very interesting if they implement it. However, it has a good chance to be interesting in the chinese curse way.

 

[nobodyknows]

Which is my point. I guess you didnt figure out I was commenting on how adding 12 million people to the government dole wont reduce cost. (Wait...I think I said that). I wasnt commenting on the cost of proceedures. I was commenting on Craig's incorrect assertion that the government has done a pretty good job of controlling cost. When in fact, they often pay more than we would.

If the people in the "for profit" medical profession decide to overbill and cheat the goverment they they should be prosecuted to the full extent of the law which should include repayment of the overbilling and jail time. That would solve that problem.

However, it's handled more like the illegal alien situation where we just turn our heads and look the other way or if they absoultely have to they slap somebody on the wrist and tell them to stop it "or else".

 

[charrison]

I've been thinking about this and you right, but how does one get around the fact that some people make so much money and some hardly make any money?



Perhaps a scale of some kind where the less they make the less they have to pay, yet they stioll have to pay money out of pocket. that would make people shop a little more, not have unecessary test done, run to the emergency room for nonsense, etc.

People need to shop more. People need to use minor emergency clinics rather than the ER. We need economy of scale for the consumer for basic medical needs(minute clinics by cvs diagnose common ailments for about $50 without insurance). And most importantly we need transparency in pricing.

 

[blackangst1]

If the people in the "for profit" medical profession decide to overbill and cheat the goverment they they should be prosecuted to the full extent of the law which should include repayment of the overbilling and jail time. That would solve that problem.

However, it's handled more like the illegal alien situation where we just turn our heads and look the other way or if they absoultely have to they slap somebody on the wrist and tell them to stop it "or else".

Although I personally think part of the problem with the high cost of health care is what providers charge, I have to ask...what law are would they be breaking? At least with illegal aliens theyre actually...you know...breaking the law. Get a clue man.

 

[daishi5]

If the people in the "for profit" medical profession decide to overbill and cheat the goverment they they should be prosecuted to the full extent of the law which should include repayment of the overbilling and jail time. That would solve that problem.

However, it's handled more like the illegal alien situation where we just turn our heads and look the other way or if they absoultely have to they slap somebody on the wrist and tell them to stop it "or else".

Do you consider a doctor who believes a patient should be in a nursing home when the patient has not met the government criteria for reimbursement should be prosecuted because he adds an additional diagnosis to get her the care he believes she needs? The health care system, and all that goes into managing it is such a moral quagmire, he is defrauding the government but at the same time he believed the patient would not survive another accident like the one that hurt her before.

 

[nobodyknows]

Although I personally think part of the problem with the high cost of health care is what providers charge, I have to ask...what law are would they be breaking? At least with illegal aliens theyre actually...you know...breaking the law. Get a clue man.

Get a clue?? Fraud is illegal, you get a clue for once.

 

[nobodyknows]

Do you consider a doctor who believes a patient should be in a nursing home when the patient has not met the government criteria for reimbursement should be prosecuted because he adds an additional diagnosis to get her the care he believes she needs? The health care system, and all that goes into managing it is such a moral quagmire, he is defrauding the government but at the same time he believed the patient would not survive another accident like the one that hurt her before.

There are grey areas, but I'm talking about out and out fraud. Charging for treatment that were never given or were nothing but bogus treatments to begin with. I remeber seeing an expose on TV where they would take a bus to the poor section of town and load up a bunch of old people. Then they would haul them down to a clininc, do some "treatments", pay the old geezers $50 and bill the goverment for $100's

 

[Hayabusa Rider]

Billing for services not provided needs to be prosecuted, end of story. I used to believe that trying "creative" approaches to get people care was good. Now I realize that if caught, some people will want the doc hung out to dry. Then those who make these crazy rules will have to take the heat.

 

[Patranus]

One thing citizens of all political orientations shoulbe be able to understand is that monopoly is the achilles heel of capitalism - the inevitable result, if not prevented by outside force, read government.

Ironic that your solution is for government to have the monopoly.
Why not break up the monopoly that is government mandated "progressive" social programs and let the private sector compete?

 

[nobodyknows]

Billing for services not provided needs to be prosecuted, end of story. I used to believe that trying "creative" approaches to get people care was good. Now I realize that if caught, some people will want the doc hung out to dry. Then those who make these crazy rules will have to take the heat.

What does billing for sevices not provided have to do with getting people care?

Right there is proof of how FUBARED our current sytem is.

 

[mattpegher]

The current system of billing is very complicated. You must have the right diagnosis (ICD9 code) to justify every test, often the list is incomplete. For example, you have to put the working diagnosis of lyme disease down to justify a test for lyme disease when polyarthritis or monoarthritis, is more accurate but not allowed, and the if the patient has the rash (erethema chonica migrans) the ICD-9 code is the same as that of lyme disease but the code for just rash isn't allowed. The vast majority of medicare dollars paid back to the government are for these kinds of errors not for intentional fraud. Sure fraud occurs but the system is not designed to seek out and prosecute only these cases.

As for costs, ie the cost of actually providing care, the current state of hospitals is in collapse. Most hospitals are losing money. The care they give costs them more than the money they recieve.
Nurses and techs make less than equally trained and experienced comparitors in other fields.
Most hospitals are a bit top heavy because that level of administration is necessary to fight for the money that the hospital is owed.
Machines are expensive to have and maintain.
Regulations and inspections cause each hospital hundreds of thousands of dollars each year (much is necessary for safety but it is increasing yearly and draws funds away from care).
Unreimbursed care drives up the costs to the insured and the cash patient but frequently insurers are refusing to cover the difference.
Medicare rates have not increased porportional to operating expenses and for most areas of care produce a loss. Medicaid is a joke, they pay aproximately 1/10 of the cost.
Hospital CEO's are on the bottom rung of pay compared to other CEO's, a few hundred thousand, a drop in the bucket. (although I tend not to be too fond of them, I don't think they're paid too much)

In theory, we need to:
decrease unreimbursed care,
decrease over-utilization of care both that of when and where patients seek care and allow physicians the freedom not to order test that they find are unnecessary
encourage prevention - support primary care (there is no reason that a CVT surgeon should make up to 50x that of a pmd)
encourage healthy tobacco-free lifestyle

 

[nobodyknows]

encourage healthy tobacco-free lifestyle

LOL, spoken like a true health care professional. If only everybody would quit smoking. You forgot to mention tort reform though.

My doctor just died of lung cancer about 2 or 3 weeks ago. He had never smoked a cigarette in his life. His parents didn't smoke either.

 

[Hayabusa Rider]

What does billing for sevices not provided have to do with getting people care?

Right there is proof of how FUBARED our current sytem is.

I figured that since you are being such a dumb schmuck I'd hammer you a bit more.

Remember this?

Do you consider a doctor who believes a patient should be in a nursing home when the patient has not met the government criteria for reimbursement should be prosecuted because he adds an additional diagnosis to get her the care he believes she needs?

To which you responded:

There are grey areas, but I'm talking about out and out fraud.

That was the reason for my response. The only way some people to get services they need is to fudge things.

You think the doc says "er oh yeah he or she has X" and they let them in? No, they looking at everything, including what was billed.

I'm saying that since you would crucify a doc who did this with the intent of giving someone care they couldn't otherwise get, providers need to do just what you want, deny proper care.

 

[BoberFett]

Hayabusa

Gotta admire your perseverance here. It can't be easy trying to reason with a brick wall.

 

[Hayabusa Rider]

Hayabusa

Gotta admire your perseverance here. It can't be easy trying to reason with a brick wall.

I'm not doing it for him. People who aren't involved in health care or have had a case where they had a loved one who desperately needed something but was excluded for some technicality simply don't understand all that can happen. That's another reason I cringe at the thought of politicians running medicine.

Some even believe that government health care is what is needed to combat political corruption even though it is the corrupt politicians who would be making the law

See my sig

 

[blackangst1]

Get a clue?? Fraud is illegal, you get a clue for once.

Apperently what you think is fraud and what the law says is fraud are two entirely different things

 

[nobodyknows]

I figured that since you are being such a dumb schmuck I'd hammer you a bit more.

Remember this?


To which you responded:




That was the reason for my response. The only way some people to get services they need is to fudge things.

You think the doc says "er oh yeah he or she has X" and they let them in? No, they looking at everything, including what was billed.

I'm saying that since you would crucify a doc who did this with the intent of giving someone care they couldn't otherwise get, providers need to do just what you want, deny proper care.

Go ahead and try to put words in my mouth, I really could carf less you arrogant fuck. As I've said several times already I'd put your lying fuclionmg ass on my ignore list if I could.

This is just some stupid internet disscussion forum and your fragile little ego has been hurt. Boo Hoo, boo hoo.

Grow up

 

[nobodyknows]

Apperently what you think is fraud and what the law says is fraud are two entirely different things

Apparently the system is fubared if it a doctor can't have the free reign he needs to give proper care. Someone has to make decisions. Hell just 2 weeks ago a doctor wanted to send me to the hospital for 2 CT scans to see if I had a bowel obstruction and if so where. hell, even I knew all I needed was a couple of x-rays. $150 instead of $3000.

Yeah, the docotrs are greedy fucks too, just like the politicians and the people who suffer fbecause of all this greediness are the patients, particualrly the uninsured patients. But all you DUMB ASSES would rather argue about dumb shit.

I guess that is what dumb asses are noted for.