Insurers Denying ER Visits Retroactively

[southerndoc]

BlueCross/BlueShield implemented a policy where upon reviewing a patient's chart, they retroactively deny claims for emergency visits when an emergency didn't exist. Now UnitedHealthcare is wanting to do the same, but has delayed it for now due to COVID.

I think it's time we all write our legislators and advocate for our patients. Insurers are doing this solely for their profits. This will be an uphill battle given the amount of contributions given to legislators by the insurers.

I'll repost this from a previous thread 2 years ago:

2017 insurance CEO total compensation:

Michael Neidorff	Centene	$24.9 million (396 times median employee pay at Centene)
Bruce Broussard	Humana	$34.2 million
Joseph Zubretsky	Molina	$19.7 million
Mark Bertolini	Aetna	$58.75 million
Joseph Swedish	Anthem	$26.4 million
Stephen Hemsley	UnitedHealth Group	$27.2 million
David Cordani	Cigna	$43.9 million
David Wichmann	UnitedHealth Group	$83.2 million
Kenneth Burdick	Wellcare	$11.3 million
Gail Boudreaux	Anthem (took over as CEO)	2017: $2.2 million, 2018: $14.2 million

In UnitedHealthcare's defense, Wichmann's salary dropped from $18.88 million in 2019 to only $17.87 million in 2020. After scrounging by with rationing his family meals, he's getting 2 years of salary for his retirement. (His total compensation with exercised stock options was $52 million for 2019.)

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[southerndoc]

Outcry Forces UnitedHealthcare to Delay Plan to Deny Coverage for Some E.R. Visits (Published 2021)

Within days of announcing a policy shift aimed at cutting back on reimbursements for emergency room care, the major insurer retreated — for now.

www.nytimes.com

 

[Frazier]

Disgusting maneuver by big insurance

 

[Mad Jack]

Outcry Forces UnitedHealthcare to Delay Plan to Deny Coverage for Some E.R. Visits (Published 2021)

Within days of announcing a policy shift aimed at cutting back on reimbursements for emergency room care, the major insurer retreated — for now.

www.nytimes.com

A patient doesn't know what constitutes an emergency. This reimbursement change will kill people if it goes through

 

[emergentmd]

Just another bullet towards universal gov healthcare. Docs will kill for a 300K job when this happens.

 

[WilcoWorld]

I don't see the problem with this. I mean, the insurance companies are going to provide all the patients with a magical crystal ball when they implement this, right?

 

[Mofasa]

Out of curiosity, can't physicians just go around this by making sure their diagnosis is vague and not one of the ones that doesn't get paid? For example, putting "chest pain" instead of "costochondritis" or "eye redness/discharge" instead of "Pink eye/viral conjunctivitis"?

 

[southerndoc]

Out of curiosity, can't physicians just go around this by making sure their diagnosis is vague and not one of the ones that doesn't get paid? For example, putting "chest pain" instead of "costochondritis" or "eye redness/discharge" instead of "Pink eye/viral conjunctivitis"?

No, they review the chart and look at what tests you ordered, comorbidities, and what they presented with. They put a lot of work into trying to actively deny claims.

 

[thegenius]

Out of curiosity, can't physicians just go around this by making sure their diagnosis is vague and not one of the ones that doesn't get paid? For example, putting "chest pain" instead of "costochondritis" or "eye redness/discharge" instead of "Pink eye/viral conjunctivitis"?

I don't think they will deny a claim for chest pain. This is for those people who to go the ER because they have an itchy tooth or sneezing and a runny nose.

Maybe if you are 20 and you've had chest pain for 2 weeks and you go to the ER maybe.

While I'm against this, I can't imagine this affecting a lot of charts. Probably a few percent. The ultimate problem is that people these days want to see a doctor right away, they don't want to wait, so what is United Health going to do about that? It's not like PCP's are 1/2 full and trying to get patients. They are full. Urgent cares are full. And people are unwilling to wait.

If I were an insurer I would try to do this. All the more reason why the solution to most of our health care problems lies with the fact that we use "insurance" to pay for stuff that shouldn't require insurance. People have no incentive to ration their resources when it doesn't affect them.

 

[clibby]

I don't think they will deny a claim for chest pain. This is for those people who to go the ER because they have an itchy tooth or sneezing and a runny nose.

Maybe if you are 20 and you've had chest pain for 2 weeks and you go to the ER maybe.

While I'm against this, I can't imagine this affecting a lot of charts. Probably a few percent. The ultimate problem is that people these days want to see a doctor right away, they don't want to wait, so what is United Health going to do about that? It's not like PCP's are 1/2 full and trying to get patients. They are full. Urgent cares are full. And people are unwilling to wait.

If I were an insurer I would try to do this. All the more reason why the solution to most of our health care problems lies with the fact that we use "insurance" to pay for stuff that shouldn't require insurance. People have no incentive to ration their resources when it doesn't affect them.

If insurers paid PCPs more and let them spend more time with patients than 15 minutes to see them and document all the checkboxes so they get paid, then we would have more people becoming PCPs, waits wouldn't be as long, and people wouldn't have to use the ED.

We also see most of our patients from 3-11pm after offices close, likely because that is when people get out of work, so supporting sick leave and employers not requiring emergency sick notes would help patients get in to see their doctor instead of relying on the ED.

We can't just blame patients for a broken system.

 

[nikolaite]

My two cents from another POV: when I got started doing chart reviews and archiving, I had to come up to speed on the billing and coding side. When you see multiple 8-hr oximetry codes for a single 4-hr block, or multi-activity oximetry codes for resting SPO2, or PT codes for evals, bundled imaging coded separately, in a word up-coding, then you get very very suspicious about what is actually going on. I’ve spent large amounts of time with hospital coders trying to decipher things like decisions to add setupand demo equipment charges for ER services as if a tech did these things, when the record shows no tech, but instead that the doc or nurse just rendered the treatment.

Having a lot of experience on this side of the industry, I say confidently that hospital coding departments are likely the source of the issue BCBS has with reimbursing ER visits during non-emergencies. Up-coding is the bane of the industry...and it has nothing to do with decisions to render care on the provider side. It is totally an administrative fault. If it weren’t such a prevalent problem, I doubt BCBS and others would bat an eye over reimbursement.

Docs and nurses ER courses and notes are typically clear about the services rendered, so it’s easy to see the billing/coding discrepancies without much effort.

I am not condoning rejecting all ER visits out of hand for reimbursement, instead just trying to point out that there’s a lot more to the story.

 

[swamprat]

Idk an answer - Im not for this but I worked ER recently for the first time in basically a year and I saw several nasal congestions, toe pain for 4 months - dont rlly see anything emergency like in these cases and their bill will be 1000s I bet - prudent lay person can wait till Monday or go to urgent care

cp, abd pain etc should never be rejected regardless of age

 

[thegenius]

If insurers paid PCPs more and let them spend more time with patients than 15 minutes to see them and document all the checkboxes so they get paid, then we would have more people becoming PCPs, waits wouldn't be as long, and people wouldn't have to use the ED.

We also see most of our patients from 3-11pm after offices close, likely because that is when people get out of work, so supporting sick leave and employers not requiring emergency sick notes would help patients get in to see their doctor instead of relying on the ED.

We can't just blame patients for a broken system.

It's not patients faults that an enormous system costing 3T is set up with insurance to pay for routine things. It's absolutely ridiculous. There should be insurance only for catastrophic events. We have a terrible system that has morphed into the current setup where either 1) you can't afford current health care prices so you rely public assistance or laws obligating doctors to render care (~40 million people) or 2) you can afford current health care prices but they are astronomical and dissuade you from seeing a doctor, and the care you get often sucks and is disjointed (~289 million people). There are about 1M people in the US who can afford anything the health care system throws at them, because they have a net worth > 10M.

You see...if people paid for their care there would be far fewer mandates to check all the boxes and to have a 10 point review of systems and all this other non-sense. If insurers didn't put these mandates in, they would probably lose money. (yup I said it). people would be waltzing into doctors office ALL THE FREAKING TIME because it doesn't affect their pocket books all that much.

You know, we have a more-or-less efficient system with just about everything else in society. Buying cars, real estate, plumbers, buying software, tennis rackets, etc. People pay for this stuff with their own money. There are occasional inefficiences but they are corrected pretty quickly.

 

[nikolaite]

Idk an answer - Im not for this but I worked ER recently for the first time in basically a year and I saw several nasal congestions, toe pain for 4 months - dont rlly see anything emergency like in these cases and their bill will be 1000s I bet - prudent lay person can wait till Monday or go to urgent care

cp, abd pain etc should never be rejected regardless of age

Some probs with directing pts out of the ER to urgent care or clinic is fear of the MedMal industry.

 

[gamerEMdoc]

Just another bullet towards universal gov healthcare. Docs will kill for a 300K job when this happens.

Not to turn this into a universal healthcare debate, bc I see pros/cons on both sides, but perhaps us working to death while healthcare administrators exploit us just to make an extra 100k isn't really worth it. I don't ever want to speak for someone else's money, and maybe universal healthcare would be even MORE stressful, but this metric driven, insurance driven, system is clearly one that is not good for the mental health of doctors and nurses. Let alone the downsides for the patients.

If I knew making 250k would mean a wonderful stress free job, I'd take that. The problem is, there's no guarantee going to universal healthcare as a model would make any difference in the stress of the job, while it will certainly reduce salary, which is really the sticking point in my mind. If universal healthcare meant allowing docs to unionize as govt employees, have complete tort reform, federal pensions, loan forgiveness, etc... then it may be worth it. I just doubt the govt would ever get this right, and we'd more than likely see docs all just taking concessions with little benefit.

 

[GeneralVeers]

Not to turn this into a universal healthcare debate, bc I see pros/cons on both sides, but perhaps us working to death while healthcare administrators exploit us just to make an extra 100k isn't really worth it. I don't ever want to speak for someone else's money, and maybe universal healthcare would be even MORE stressful, but this metric driven, insurance driven, system is clearly one that is not good for the mental health of doctors and nurses. Let alone the downsides for the patients.

If I knew making 250k would mean a wonderful stress free job, I'd take that. The problem is, there's no guarantee going to universal healthcare as a model would make any difference in the stress of the job, while it will certainly reduce salary, which is really the sticking point in my mind. If universal healthcare meant allowing docs to unionize as govt employees, have complete tort reform, federal pensions, loan forgiveness, etc... then it may be worth it. I just doubt the govt would ever get this right, and we'd more than likely see docs all just taking concessions with little benefit.

You are exactly right. Universal healthcare would just mean government is the insurer for everyone. We'd likely still have corporate-owned hospitals, and metrics would now be universal. With decreased reimbursement hospital CEOs will have to make things more efficient, which means less nursing staff, and cramming more patient visits through. I can't see a scenario where we make decent money or see less patient. Likely we'd see a decrease in pay, with increased documentation, and the same overall pts/hour.

 

[southerndoc]

@thegenius, we've had denials for chest pain patients (all of them <45).

The weirdest denial I've heard of was an 18-year-old patient I saw after their aSAH was repaired (coiled). I saw them a few weeks later with a headache, and the mother didn't want a CT. The guy was seen at an outlying ER, identified to have a SAH, and was transferred to my facility bypassing the ER going straight to the neuro ICU. He had his aneurysm coiled. The mother stated their ER bill was denied and they were stuck with a $7500 bill despite the guy having a SAH.

My daughter partially amputated her toe. ER visit was quite expensive as it required a lengthy procedural sedation and plastic surgery to come reattach her toe. Luckily, she's doing well now and you can't even tell it. Even her toenail regrew. However, it was a major hassle with our insurer who denied it twice and finally paid the $17,000 bill when I appealed with threatening language the second time. The insurer claimed we should've went to urgent care. Let's see here: plastic surgeon vs PA/NP. The fact that the ER doc was uncomfortable doing it himself, called in a plastic surgeon, and my daughter subsequently had a ketofol procedural sedation for nearly 60 minutes attests to the fact that a PA/NP at urgent care could not handle the situation no matter how many letters behind his/her name.

Regarding not denying many charts, someone I know who works in the industry said they were told to deny at least 20% of claims no matter what way they can find to deny them.

 

[emergentmd]

Minimal educated person on computer looks through chart. Goes down flow chart and sees an 18 yr old. Have no clue what a SAH is, thinking it was a headache. All this person has is the ER chart. Sees 18 YO with HA, flow chart says to deny.

Your daughter was the exception. Most people would not be educated or have the time to go through the denial maze and just take it on the chin,.

 

[southerndoc]

https://assets.documentcloud.org/documents/4359349/Mo-Rejections.pdf

Here are some common BC/BS denials:

• Cellulitis (various)
• Chest pain on breathing
• Abscesses
• Diarrhea
• Cystitis (ever seen an abdominal pain that ends in a diagnosis of cystitis?)
• Foreign body in ear
• Gonorrhea (ever seen an urgent care treat GC?)
• Gout
• Inflammatory disease of the cervix/cervicitis (PID, seriously? Urgent care?)
• Sciatica
• Nausea
• "Other injury" of various joints/muscles
• Sprains/strains of spinal regions (falls, MVA's with sprains/strains of spinal regions?)
• Sprains/strains of various joints/muscles (patient must have XRay vision to tell if it's broken)
• Viral intestinal infection/gastroenteritis
• Gout
• Morbid obesity with alveolar hypoventilation (Pickwickian syndrome with a pCO2 of 70?)
• Various vaginal bleeding

How many of those do you not workup and just send home? If it involves a workup, then you are trying to rule out an emergency. If one doesn't exist, then the person should've known better and never went to the ER? That's what retroactive denials do.

In a three-state region in the first 6 months BlueCross/BlueShield implemented this in 2017, there were more than 12,000 denials with average ER bills of more than $5,000.

During the pandemic, UnitedHealth doubled its income from $3.4 billion to $6.7 billion. Anthem increased from $1.1 billion to $2.3 billion. Insurers are required to refund some of their profits back to its customers, but it won't be until 2023 until they are required to refund some of that money.

California recently fined Aetna over $500,000 for denying ER claims against state law/standards. They found that 93% of claims should have been paid. Aetna was also fined in 2015 and 2016. They will continue to deny claims because its cheaper to pay the fine than to pay the claims.

 

[southerndoc]

Minimal educated person on computer looks through chart. Goes down flow chart and sees an 18 yr old. Have no clue what a SAH is, thinking it was a headache. All this person has is the ER chart. Sees 18 YO with HA, flow chart says to deny.

Your daughter was the exception. Most people would not be educated or have the time to go through the denial maze and just take it on the chin,.

I've read that the majority are reviewed by physicians, but I doubt they are paying a physician to review charts... maybe review it upon appeal, but the initial person is probably someone not trained in medicine or minimally trained in medicine (an MOA).

 

[bravotwozero]

$500,000 to an insurance company is peanuts. Not even enough for a slap on the list. They should be fined hundreds of millions at the minimum.

 

[southerndoc]

$500,000 to an insurance company is peanuts. Not even enough for a slap on the list. They should be fined hundreds of millions at the minimum.

The first two fines were even smaller.

 

[nikolaite]

Just like the docs and nurses are not trained in billing and coding, it usually is not people trained in medicine reviewing the charts. However, it is people who are familiar with the terminology and know what the notes mean; they just don’t know the “whys” of what is there. Some insurers do require denial quotas for internal reasons, just like hospitals have pro forma “policies” about denying some patients full treatment for their ER presentation. I know everyone will likely deny that, but when you’ve read the chart patterns for these specific patients and compared transfer charts, and outpatient follow ups, conducted patient, physician, triage, and nurse interviews, the patterns do not reveal negligence or incompetence, but rather clear policy of rationing care. To be clear, I’m talking about level V ER, not an ambiguous presentation that may be better suited to urgent care.

In order to choose which cases insurers will deny, they look for billing patterns based on time recorded after admission and a basic read of the chart. For example, if RT services are billed on more than two lines of the ER bill and no RT eval is recorded in the chart, it is an automatic denial. Another example is ER IVP charges for a patient with no recorded IV access; automatic denial. It has to go back to the hospital or the patient to get sorted out. Problem is that usually no one tells the patient why a claim was denied so they can get it cleared up for the second submission; the same claim just gets resubmitted. Then it’s down to who is nastier on the reimbursement point, the insurer, the hospital or the patient. If the patient is unpleasant enough with the insurer, they will set someone to the task of crossing off the inappropriate billing, fixing the up codes and making the hospital a settlement offer. This is typically done by 120 days from dispute and the hospital ultimately receives about 1/4 of what they billed.

On a personal note: When I had to take my husband to the ER last, we got a crazy bill, and there were all sorts of inappropriate charges on the itemized statement. I knew to get it fixed, though; most people don’t know they can dispute charges with the hospital and not their insurer.

 

[thegenius]

@thegenius, we've had denials for chest pain patients (all of them <45).

The weirdest denial I've heard of was an 18-year-old patient I saw after their aSAH was repaired (coiled). I saw them a few weeks later with a headache, and the mother didn't want a CT. The guy was seen at an outlying ER, identified to have a SAH, and was transferred to my facility bypassing the ER going straight to the neuro ICU. He had his aneurysm coiled. The mother stated their ER bill was denied and they were stuck with a $7500 bill despite the guy having a SAH.

My daughter partially amputated her toe. ER visit was quite expensive as it required a lengthy procedural sedation and plastic surgery to come reattach her toe. Luckily, she's doing well now and you can't even tell it. Even her toenail regrew. However, it was a major hassle with our insurer who denied it twice and finally paid the $17,000 bill when I appealed with threatening language the second time. The insurer claimed we should've went to urgent care. Let's see here: plastic surgeon vs PA/NP. The fact that the ER doc was uncomfortable doing it himself, called in a plastic surgeon, and my daughter subsequently had a ketofol procedural sedation for nearly 60 minutes attests to the fact that a PA/NP at urgent care could not handle the situation no matter how many letters behind his/her name.

Regarding not denying many charts, someone I know who works in the industry said they were told to deny at least 20% of claims no matter what way they can find to deny them.

Well I didn't realize how prevalent it was. That link to a PDF with denials above, what is that of? BC/BS denials just from your hospital?

 

[RustedFox]

The insurer claimed we should've went to urgent care. Let's see here: plastic surgeon vs PA/NP. The fact that the ER doc was uncomfortable doing it himself, called in a plastic surgeon, and my daughter subsequently had a ketofol procedural sedation for nearly 60 minutes attests to the fact that a PA/NP at urgent care could not handle the situation no matter how many letters behind his/her name.

southerndoc for the win.

These insurers need to live and die by their own rules. If it were Dick McDickerson, CEO's daughter, I'm sure it would have been somehow different.

 

[RustedFox]

Regarding not denying many charts, someone I know who works in the industry said they were told to deny at least 20% of claims no matter what way they can find to deny them.

Sounds like its whistleblower time.

 

[southerndoc]

Well I didn't realize how prevalent it was. That link to a PDF with denials above, what is that of? BC/BS denials just from your hospital?

From a US Senators office investigating it. There is a push for the DOJ to pursue criminal charges.

 

[Birdstrike]

No, they review the chart and look at what tests you ordered, comorbidities, and what they presented with. They put a lot of work into trying to actively deny claims.

What insurance companies do, is criminal. I'm in the outpatient setting, but I could tell you stories all day long about their criminal exploits in robbery. They demand you get pre-approval for procedures, then refuse to pay for them anyways. They'll refuse to pay for an MRI or procedure for a patient and give the reason, "Patient must do PT first." Then you order PT and a denial comes back, "PT denied. Patient has had too much PT." All to screw the patient out of healthcare they need.

I've had them approve procedures, pay for them, then six months later refuse payment and demand a refund with the threat that if you don't send their money back they're not going to pay you for outstanding money they owe you on other patients. Anything and everything they can do to refuse to give patients the healthcare benefits they've paid for, or to screw the doctor out of their rightfully earned payments, they'll do, and get away with.

The system is set up so that you bleed and leak money at every turn, and to screw the patient and doctors out of what's theirs. The only silver lining I can see in total socialized medicine would be if it put these criminal 100% out of business and into bankruptcy. Some things are too good to be true.

 

[GeneralVeers]

What insurance companies do, is criminal. I'm in the outpatient setting, but I could tell you stories all day long about their criminal exploits in robbery. They demand you get pre-approval for procedures, then refuse to pay for them anyways. They'll refuse to pay for an MRI or procedure for a patient and give the reason, "Patient must do PT first." Then you order PT and a denial comes back, "PT denied. Patient has had too much PT." All to screw the patient out of healthcare they need.

I've had them approve procedures, pay for them, then six months later refuse payment and demand a refund with the threat that if you don't send their money back they're not going to pay you for outstanding money they owe you on other patients. Anything and everything they can do to refuse to give patients the healthcare benefits they've paid for, or to screw the doctor out of their rightfully earned payments, they'll do, and get away with.

The system is set up so that you bleed and leak money at every turn, and to screw the patient and doctors out of what's theirs. The only silver lining I can see in total socialized medicine would be if it put these criminal 100% out of business and into bankruptcy. Some things are too good to be true.

Birdstrike, I'll be Devil's Advocate and tell you that insurer non-payment is the only barrier and break we have on the system. Needy, self-absorbed Americans would consume an unlimited quantity of "free" healthcare otherwise. There will always need to be a roadblock in the system that frustrates people, and we just have to pick our poison. It's going to be government refusals of care, insurer refusals of care, or high co-pays and deductibles. I lean towards the last one as well as a healthy cash-only medical system that competes on price.

 

[Birdstrike]

Birdstrike, I'll be Devil's Advocate and tell you that insurer non-payment is the only barrier and break we have on the system. Needy, self-absorbed Americans would consume an unlimited quantity of "free" healthcare otherwise. There will always need to be a roadblock in the system that frustrates people, and we just have to pick our poison. It's going to be government refusals of care, insurer refusals of care, or high co-pays and deductibles. I lean towards the last one as well as a healthy cash-only medical system that competes on price.

I don't want government run healthcare. At the same time, I'll continue to hate health insurance companies with the hot white heat of a thousand suns.

 

[GeneralVeers]

I don't want government run healthcare. At the same time, I'll continue to hate health insurance companies with the hot white heat of a thousand suns.

It's tough when you have to somehow provide an essential and very expensive service like healthcare, to balance it with the human penchant for greed and getting "free stuff".

 

[southerndoc]

I don't want government run healthcare. At the same time, I'll continue to hate health insurance companies with the hot white heat of a thousand suns.

A third-party non-profit non-government organization that is a single payer (or maybe 2-3 payers) would be a welcome change to healthcare in my opinion.

 

[RustedFox]

It's tough when you have to somehow provide an essential and very expensive service like healthcare, to balance it with the human penchant for greed and getting "free stuff".

 

[nikolaite]

A third-party non-profit non-government organization that is a single payer (or maybe 2-3 payers) would be a welcome change to healthcare in my opinion.

Seems to me that if there were simply a market restructure to wipe out the medical insurance system and force an open hospital or private practice pricing based on free market capitalism, ordinary care and basic services prices would drop to an affordable rate to pay out of pocket. Medicoes and hospitals wouldn’t have to depend on insurance for payment as payments for affordable service could be more readily collected directly from a larger body of patients. Though, there will always be a specific body who are deadbeats...and collecting from people like that or marking their debt as uncollectable is just part of the cost of doing business.

The real dough would have to be generated by extraordinary or elective procedures which could be covered by healthshare schemes, philanthropic donations or independently wealthy individuals....or research studies covered by government grants, medical device companies or pharmaceutical companies.

At the end of the day, if a medical practice or hospital is going to be a business, it should be just as free market as any other business.

This would relax the practice of medicine to a dignified profession once again, as it could remove the impetus to treat everyone with extraordinary measures regardless of their ability to pay. ...As opposed to, for example, continuing the same general care schemes with 24/7 on-call for 12-days, etc. schedules.

I don’t believe it will ever happen, but what we have now isn’t working, and I don’t have any hope in a modified version of the same curing the problem.

 

[doctalaughs]

Government should collect taxes to cover services that include
- basic healthcare that benefits society (vaccines, birth control, maternity)
- catastrophic hospitalization (car accident etc—. But heavily rationed not 90yo grandmas on the vent)
- basic generic drugs

Everything else should be self-pay directly to the people that provide the services. No middle-men, 100% price transparency.

I could make a very good living charging each of my patients 100 dollars per visit including all procecedures/diagnostics etc. Instead they pay probably $250 in copays and deductibles just for my visit, plus their monthly premiums (which can run into 1000+ per month). Where does all that money go?

 

[GeneralVeers]

Seems to me that if there were simply a market restructure to wipe out the medical insurance system and force an open hospital or private practice pricing based on free market capitalism, ordinary care and basic services prices would drop to an affordable rate to pay out of pocket. Medicoes and hospitals wouldn’t have to depend on insurance for payment as payments for affordable service could be more readily collected directly from a larger body of patients. Though, there will always be a specific body who are deadbeats...and collecting from people like that or marking their debt as uncollectable is just part of the cost of doing business.

The real dough would have to be generated by extraordinary or elective procedures which could be covered by healthshare schemes, philanthropic donations or independently wealthy individuals....or research studies covered by government grants, medical device companies or pharmaceutical companies.

At the end of the day, if a medical practice or hospital is going to be a business, it should be just as free market as any other business.

This would relax the practice of medicine to a dignified profession once again, as it could remove the impetus to treat everyone with extraordinary measures regardless of their ability to pay. ...As opposed to, for example, continuing the same general care schemes with 24/7 on-call for 12-days, etc. schedules.

I don’t believe it will ever happen, but what we have now isn’t working, and I don’t have any hope in a modified version of the same curing the problem.

Agree with above, but healthcare is 16% of the U.S. Economy and politicians can't resist power, and getting their hands on that amount of money is irresistible to them.

We should have low cost, basic public service hospitals runs by residents with attendings overseeing......like....county hospitals. They would provide basic services and basic care to people who can't pay.

Agree with getting rid of employer-sponsored insurance. Probably the single worst thing that ever happened in healthcare. Interestingly it's more proof that government shouldn't meddle in the economy. Employer-sponsored insurance was a natural reaction to the Wage and Prices controls enacted.....by government!