Paul Ryan: I don't want to work with Democrats on health care

[Fern]

I don't see where he says that he doesn't want to work with democrats on health care.

Yeah, I don't either.

Lately I've noticed a lot headlines that aren't supported by the content of the article.

Fern

 

[theeedude]

Paul Ryan doesn't want to work, period. He wants to be in the gym.

 

[Jaskalas]

And how would people with two mutually exclusive objectives work together?

 

[ivwshane]

And how would people with two mutually exclusive objectives work together?

They work on the objectives they agree on and find compromises. That's what adults do.

 

[UberNeuman]

Paul Ryan doesn't want to work, period. He wants to be in the gym.

You lie! Paul Ryan wants to be at the local soup kitchen to fake clean pots and pans, bra...

 

[dullard]

Yeah, I don't either.

Lately I've noticed a lot headlines that aren't supported by the content of the article.

Fern

Watch the video from 0:14 to 1:15 and tell us if there is any other interpretation.
http://www.cbsnews.com/news/paul-ry...t-to-negotiate-with-democrats-on-health-care/

Here is the snippet from 1:05 to 1:11:
"Nora: The president of the United States saying that he's going to work with Democrats on this [referring to health care]
Ryan: Yeah I know he's been saying it and I don't want that to happen."

 

[blankslate]

He'd rather see people die.

Simple as that.... he's a sociopath who worships a sociopath and makes his employees read her books.


________

 

[Majes]

Must feel bizarre to take time off from willfully acting a dunce.

Always appreciate your constructive criticism. One day I hope you realize how much you detract from the discussion here at times...

 

[fskimospy]

Watch the video from 0:14 to 1:15 and tell us if there is any other interpretation.
http://www.cbsnews.com/news/paul-ry...t-to-negotiate-with-democrats-on-health-care/

Here is the snippet from 1:05 to 1:11:
"Nora: The president of the United States saying that he's going to work with Democrats on this [referring to health care]
Ryan: Yeah I know he's been saying it and I don't want that to happen."

Yeah the number of people trying to deny the plain meaning of his words is baffling. People like Fern are engaging in a lot of motivated reasoning lately.

 

[Majes]

Yeah the number of people trying to deny the plain meaning of his words is baffling. People like Fern are engaging in a lot of motivated reasoning lately.

I'm pretty sure motivated reasoning is where alternative facts come from.

 

[fskimospy]

I'm pretty sure motivated reasoning is where alternative facts come from.

Research shows pretty much that, yes. It really does make you despair for democracy sometimes when you realize that people generally aren't amenable to rational discourse and instead substitute what they wish were the case.

 

[Majes]

Research shows pretty much that, yes. It really does make you despair for democracy sometimes when you realize that people generally aren't amenable to rational discourse and instead substitute what they wish were the case.

My problem is I tend to think the best of people and their motivations... I'd like to think Paul Ryan and other representatives are really in politics to work together for the betterment of the country. After watching Republicans allow ISPs to sell our data though I don't know that I can think that anymore...

 

[fskimospy]

My problem is I tend to think the best of people and their motivations... I'd like to think Paul Ryan and other representatives are really in politics to work together for the betterment of the country. After watching Republicans allow ISPs to sell our data though I don't know that I can think that anymore...

You don't have to think Paul Ryan has nefarious motives to do what he does, I think he genuinely thinks America will be better off in (possibly) an economic sense than at least in a moral one if we tax rich people much, much less. While I think he is duplicitous in the methods he uses to achieve those goals I genuinely do believe he thinks they are good goals to pursue for the country.

The economic theories he's basing that idea off of are widely discredited but then we're back to motivated reasoning again. I imagine it would be incredibly hard to admit that the thing he's dedicated his adult life to is a scam.

 

[overst33r]

The economic theories he's basing that idea off of are widely discredited but then we're back to motivated reasoning again. I imagine it would be incredibly hard to admit that the thing he's dedicated his adult life to is a scam.

It is difficult to get a man to understand something when his salary depends upon his not understanding it. - Upton Sinclair

 

[agent00f]

Always appreciate your constructive criticism. One day I hope you realize how much you detract from the discussion here at times...

I don't mistakenly assume there's meaningful discussion to be had with folks who've no use for it.

 

[Muse]

If you want some insight into why we need a single payer healthcare system in the U.S.A. read this recently published article in the New York Times:

Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much.

 

[Muse]

[QUOTE="overst33r, post: 38822869, member: It is difficult to get a man to understand something when his salary depends upon his not understanding it. - Upton Sinclair[/QUOTE]This is one of the most prescient remarks ever uttered. It reminds me of the philosophy of Arthur Schopenhauer.

 

[brycejones]

If you want some insight into why we need a single payer healthcare system in the U.S.A. read this recently published article in the New York Times:

Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much.

Per the GOP she could have just chosen to not have health care or she should have been a more careful shopper while seeking care.

She brought it on herself by not doing her research in advance of getting sick.

 

[hardhat]

If you want some insight into why we need a single payer healthcare system in the U.S.A. read this recently published article in the New York Times:

Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much.

The person who wrote that article has at best a very basic understanding of health care reimbursement, and sensationalizes and indicts the healthcare coding system when it in fact is not the driver for increased healthcare costs. The real reason why that person received such ridiculous bills is because the physicians the hospitals she stayed at had an absurd cost basis for their services. This is a negotiating tactic with insurance companies. If a physician says that he is worth $5000 per RVU, the insurance company can negotiate with him for a rate of $500 per RVU. This makes the insurance company look good to their customers ("Look at the cost savings! $4500 saved"), and the physician still has plenty of wiggle room to negotiate his contract. This is also a benefit for the physician when he bills for medicare patients as a NPP. There are a LOT of technical details in healthcare billing. But, the downside to that situation is if you don't have insurance, he will initially charge you for whatever absurd amount he wants. Of course, virtually everyone qualifies for some type of insurance or assistance program, which limits fees. And those who don't usually are able to negotiate with the provider or have their debts forgiven (this is a tax write off for providers, absurdly).

But getting back to this example, this is a very odd case. Most providers use a standard between 2 and 2.5 multiplier based on Medicare's physician payment system rate for their standard pricing. It certainly makes the news look scary when someone uses a different rate, though. The second allusion was that physicians can game the system by doing things like taking the patient's weight. This claim has a little more truth to it. The level of service is based on the physician's services. The more services he performs, the higher his reimbursement is. But taking a patient's weight isn't a medical procedure. A more realistic example would be a physician ordering and reviewing laboratory tests. And physicians often practice what is called 'defensive medicine' in the current system, which requires them to investigate virtually all conditions to ensure he does not miss something. If he does miss something, he can be sued for it. But, there are controls in place, and they become stronger every day to prevent unnecessary tests from being performed. Look into medical necessity for more information.

The article goes on to make more scary and mostly groundless claims, such as the different coding languages requiring different degree tracks (absurd), and different professional organizations (there are two with any relevance in the US, and which is relevant is mostly a matter of locality). And the reason the AAPC numbers are up is because they are expanding outside the US. Oh, and the AMA does NOT levy a licensing fee on billing companies for use of CPT.

The article does make a good point that organizations should be required to make their bills more decipherable to laymen. But I personally don't think that is realistic in most cases. The way providers are reimbursed is incredibly complicated. Having people who have no idea what a realistic charge is trying to argue about each line item on a bill does not do any good.

The article also says that the coding information for individual bills is treated as a trade secret by organizations. That is patently false. Patients have absolute access to their bills as they are submitted to their insurance company including all codes. If the providers in that case did not submit the bill to the payor (in this case, the patient) with that information, she would not be obligated to pay it. On the other hand, the charge master IS a trade secret. It includes the pricing for all supplies and services for an organization. Individual payors do not need that information, nor should they have it.

As for the claim that "Multiple legal requests to review Wickizer’s chart and complete bill — with its coding elucidated — were refused", the payor must make that request. This is legally protected information. If the provider had released that information without consent from the patient, they could have been sued and liable for fines from the OIG.

As for the claim that "Twenty-five percent of United States hospital spending — the single most expensive sector in our health care system — is related to administrative costs, “including salaries for staff who handle coding and billing,” according to a study by the Commonwealth Fund.", that is grossly misleading. Medical billing and coding generally constitutes less than 5% of total expenses for healthcare facilities. The rest of administrative costs would include Quality Improvement, Administration, Utilization Review, Information Systems, Legal, HR, and other related activities. Billing and coding usually not even considered an administrative service. It is considered an ancillary service.

The article goes on and on, making false allegation after allegation. It is honestly disgusting, and it tries to scapegoat the ridiculous cost of care on a system that actually limits costs by allowing insurance companies and public payors to negotiate for individual services, instead of the even worse system that existed before the fee for service system was instituted.

Honestly, you absolutely need to be wary of what you read about on the internet. This article is such a hit job it is disgusting. The author paints a picture of healthcare providers as uncaring and greedy, doing everything they can to exploit a patient. While there may be a few bad actors in the system, they are very rare, with extensive systems in place designed to catch them. If you want to know why your bills are so high, you would best look elsewhere. I've posted about what measures could be taken that would actually reduce costs in the past.

 

[chucky2]

Making bills more decipherable is an understatement. The system in place is frankly not workable for sick people. If there is one thing that could have come out of the ACA is a common billing format and process, one that makes sense for patients first and everyone else second. Sitting down and looking at the parents bills is nuts. I use a spreadsheet and have to cross check between Medicare, doctors, HMO, etc. There is no way some older person, much less an older sick person, could keep all this sh1t straight. It's no wonder old people who feel responsible for their debts and can afford to write checks go broke paying off bills, or, people who can't afford it or just say 'F it, this is too complex' just don't pay.

 

[hardhat]

You are right. But how do you explain to someone that the physician charged critical care of 85 minutes during the ER visit, which means code 99291 + 99292, the admitting physician charged for a moderate initial visit (99222), the anesthesiologist charged for 60 minutes of care (which can only include time from administration to completion, not other time), there were 17 separate administrations of drugs, the room fee was X, there were two x-rays of the right knee performed, both of which were payable because the second was for greater characterization of the injury, the orthopedist charged for an ORIF + vascular repair, the patient was at a higher level of care because of persistent hypotension, the supplies such as medications and implants were X, etc.? Even if the bill was decipherable, how can someone know if the charges are reasonable? How could someone identify an error if they don't know anything about standard practices, what is included in each service, etc. Billing is complicated. Because healthcare is complicated. There's no easy 'one size fits all' solution.

 

[chucky2]

Yep, totally get it. One of the main reasons I'd wish the Dems would have actually used their spine and done Single Payer, but, we know how that turned out. That way sick people wouldn't be getting bills, those would be going to a Gov that is setup to pay for it. Nothing is perfect, not even Single Payer, but at least it's easier on the patient. My dad was a factory worker his whole life, didn't even graduate high school. Had I nor my mom been around to take care of billing, I honestly don't know what he'd have done. Probably paid and gone into a home because the doctor charged $5000 so that's what I owe. The system we have in place right now is when there is no advocate for the patient, but every other player has one. It's backasswards...

 

[dank69]

You are right. But how do you explain to someone that the physician charged critical care of 85 minutes during the ER visit, which means code 99291 + 99292, the admitting physician charged for a moderate initial visit (99222), the anesthesiologist charged for 60 minutes of care (which can only include time from administration to completion, not other time), there were 17 separate administrations of drugs, the room fee was X, there were two x-rays of the right knee performed, both of which were payable because the second was for greater characterization of the injury, the orthopedist charged for an ORIF + vascular repair, the patient was at a higher level of care because of persistent hypotension, the supplies such as medications and implants were X, etc.? Even if the bill was decipherable, how can someone know if the charges are reasonable? How could someone identify an error if they don't know anything about standard practices, what is included in each service, etc. Billing is complicated. Because healthcare is complicated. There's no easy 'one size fits all' solution.

We all know every charge on that bill is unreasonable.

 

[hardhat]

We all know every charge on that bill is unreasonable.

Yes, the bills from the article are unreasonable. But the explanation given in the article is wrong and grossly misleading.
The first thing they should do to fix situations like these is remove individually negotiated rates between providers and insurers. Then everyone will be charged the same amount for the same service. Then they should create a reasonable cost basis for any service. CMS has already attempted to do that with Medicare. From there, we can start doing other things that will actually reduce costs, like paid wellness visits that are tax deductible, expanding the number of people entering medical school, and other such things. Insurance companies can compete on a level playing field and offer their clients incidental services like having private rooms for stays past 24 hours, or offering full time telemedicine encounters with nurses for non-emergent situations. Or we could cut out the middle men and go to single payer.

 

[dank69]

Yes, the bills from the article are unreasonable. But the explanation given in the article is wrong and grossly misleading.
The first thing they should do to fix situations like these is remove individually negotiated rates between providers and insurers. Then everyone will be charged the same amount for the same service. Then they should create a reasonable cost basis for any service. CMS has already attempted to do that with Medicare. From there, we can start doing other things that will actually reduce costs, like paid wellness visits that are tax deductible, expanding the number of people entering medical school, and other such things. Insurance companies can compete on a level playing field and offer their clients incidental services like having private rooms for stays past 24 hours, or offering full time telemedicine encounters with nurses for non-emergent situations. Or we could cut out the middle men and go to single payer.

Why do you hate capitalism? Why don't you go live in France with the rest of the communists?