The Babylonians are coming

[EctopicFetus]

Single payer: we-e-e-e-l-l-l, maybe.

But we hope not!!!

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[futuredo32]

After hearing how "impossible" it was for people to afford health insurance, I looked it up online. It's really not that expensive. I would hate to lose the quality of healthcare we currently have so that people without insurance don't feel the need to cough up an extra $150-$200 a month so they can buy their own insurance.

 

[toothless rufus]

After hearing how "impossible" it was for people to afford health insurance, I looked it up online. It's really not that expensive. I would hate to lose the quality of healthcare we currently have so that people without insurance don't feel the need to cough up an extra $150-$200 a month so they can buy their own insurance.

What a mess! Couldn't there be some sort of income evaluation that requires those who can actually afford insurance to get it, since they expect to utilize healthcare? At least for their kids? Something involving a legitimate minimum amount of "disposable" income.

 

[efex101]

I think some folks because they "feel healthy" now do not have the urge to get insurance yet they complain about it. I have also seen folks with nice cars, big plasma tv, cell phones (latest and greatest) that CHOOSE not to have insurance.

Now, for the number of folks (working poor) that truly cannot afford insurance and their employer does not provide it either...then yes, something should be available for that population. I think however (please correct me if I am wrong) that those are not the majority of the uninsured.

 

[R-Me-Doc]

sorry -- double post

 

[dutchman]

I think some folks because they "feel healthy" now do not have the urge to get insurance yet they complain about it. I have also seen folks with nice cars, big plasma tv, cell phones (latest and greatest) that CHOOSE not to have insurance.

Now, for the number of folks (working poor) that truly cannot afford insurance and their employer does not provide it either...then yes, something should be available for that population. I think however (please correct me if I am wrong) that those are not the majority of the uninsured.

That is correct. America does not have 40 million people(20%) in poverty. The word "uninsured" is a political tool used to confuse people as meaning "poor". There are poor people that probably need help with that extra $150 a month, but trust me there are some uninsured that are not poor. I was one of them last a couple years ago.

 

[dutchman]

Just wait until all of the boomers qualify for Medicare. The sky won't just fall Chicken Little.... it will crush anything in its downward path.

 

[deleted128562]

That is correct. America does not have 40 million people(20%) in poverty. The word "uninsured" is a political tool used to confuse people as meaning "poor". There are poor people that probably need help with that extra $150 a month, but trust me there are some uninsured that are not poor. I was one of them last a couple years ago.

Bingo. Truth is, just about everyone who is truly "poor" in this country qualifies for Medicaid so there goes that issue. I have plenty of friends who are uninsured and complain how they don't have $200/month to fork over for a policy. And yet, they seem to have no complains about paying $100 a month for premium cable, $100 a month for a cell phone plan, $200 a month on eating out, $150 a month on cigarettes and beer, etc.

The problem in this country is not "accessable healthcare". The problem is too many people who give their health no priority and are happy to budget for cable and booze but not for their own health. If you truly don't have $200 a month for yourself or $800 a month for a family to buy a policy (after cutting out luxeries such as cable, booze, your boat, etc.) then guess what - odds are you already qualify for Medicaid!!

 

[HCE]

Bingo. Truth is, just about everyone who is truly "poor" in this country qualifies for Medicaid so there goes that issue. I have plenty of friends who are uninsured and complain how they don't have $200/month to fork over for a policy. And yet, they seem to have no complains about paying $100 a month for premium cable, $100 a month for a cell phone plan, $200 a month on eating out, $150 a month on cigarettes and beer, etc.

The problem in this country is not "accessable healthcare". The problem is too many people who give their health no priority and are happy to budget for cable and booze but not for their own health. If you truly don't have $200 a month for yourself or $800 a month for a family to buy a policy (after cutting out luxeries such as cable, booze, your boat, etc.) then guess what - odds are you already qualify for Medicaid!!

_____

I'm not sure when Medicaid came into this thread...I thought folks were referring to the Medicare system...the insurance our grandmothers get...

 

[HCE]

Now, for the number of folks (working poor) that truly cannot afford insurance and their employer does not provide it either...then yes, something should be available for that population. I think however (please correct me if I am wrong) that those are not the majority of the uninsured.

__________
What a mess! Couldn't there be some sort of income evaluation that requires those who can actually afford insurance to get it, since they expect to utilize healthcare? At least for their kids? Something involving a legitimate minimum amount of "disposable" income.


___

I think if you combine these two quotes, you're getting close to the Massachusetts plan...

 

[Jejton]

However, I think you misunderstand me on the point of physician autonomy. The point is: what happens when you as a doctor determine that someone ought to have dialysis for example, and the government says: "no, we don't feel that it's necessary in this case so tough luck". As has been said many times about universal healthcare: It is WONDERFUL. That is, until you get really really sick (or are old) at which point you're pretty much screwed. I want my DOCTOR making my health care decisions not my GOVERNMENT (and mark my words, if we go to universal care, the government will be your real healthcare provider).

As somone who has dealt with both Medicaid and private insurance, I can tell you that it is almost always the private insurance and hmo's that reduce doctor's autonomy by refusing to pay for various treatments. As a side note, most of the medicaid/medicare fraud that has been documented has been perpetrated by health care providers...

There is an interesting book I recently read ( I can look up the title if anyone wants it ) that compares the Canadian and US health care systems. It makes a pretty strong case for the Canadian model ( albeit admitting that even that is not perfect ). It is the first writing that I have read which actually uses documented figures, studies, etc. to prove a point rather than emotional outbursts from patient advocates, doctors, insurance companies and politicians.

 

[Jejton]

Yeah, but why Europeans, and Canadians come to U.S when they need some Dx procedure, or a fast Tx? I know ppl in U.K have to wait for a CT SCAN.

Have you read or watched any news in the past few years?


Americans are actually going to Canada to buy meds.

 

[Jejton]

I think most of them are pre meds and pre clinical. I think they just honestly have no idea what it is like in the trenches. you know there are a lot of other areas we should socialize.. Here is an idea.. there should be no private colleges or high schools right socialism.. Oh and everyone should be driving some 3 yr old car and sales of luxury cars should be banned. Dont forget about those "richers" and their big houses. Everyone should be moved into apartments except for the nobles (who will be picked by our bureaucrats).

Great idea guys! Seriously this whole discussion makes me want to vomit.

Health care isnt a right. Sure improvements are needed but people honestly just shut their eyes regarding the difference between our patients and those in other countries. We are fatter, unhealthier and lazier at the "bottom 20%" of this country than in other countries. Also dont forget that people dont want to wait 6 months for a surgery and on top of that do you think people are gonna wanna let grandma who is 80 die cause she sure wont be getting a stent or a CABG.

As our population (and our voting population) ages do you think they will let this happen?

Can you provide any references for the claims you are making ?

 

[Jejton]

Maybe it's the age of that article that is throwing me off, but I don't see how universal coverage will automatically create a increased supply in primary care physicians and a reduction in the need for surgeons, radiologists, pathologists etc. Unless like every other socialist policy the government forces people to see a primary care physician for every condition under the sun, while refusing them any direct access to specialists.

Yeah um how about its the hmo's and insurance companies that make people see a PCP to get a referral ?

 

[ESPNdeportes]

Please be aware that there are differences between "single payer" medicine (gov't pays the bills, but docs are private entities) and "socialized medicine" (all health care workers are direct gov't employees).

Single payer may be somehow workable, although, yes, the system would not be as we know it today. I still retain some occasional thoughts that it may not be a bad idea, given the redundancy and waste of the current multipayer system we have.

Socialized medicine, now that's a whole 'nother story. If you want to see how "socialized medicine" will work in the US, just visit the military medicine forum and check out the horror stories there. Military medicine is the closest model this country has for an open access, socialized system, and it's a disaster. Why? Well, as one of the other posters astutely pointed out regarding the Canadian system, it only works if you put money into it. Military medicine has been shortchanged for ages and is now pretty much terminal. It's also the future of all American medicine if the gov't takes over the big picture: understaffed, over enrolled clinics; demoralized, underpayed docs contolled by nonmedical bureaucrats; hospitals you would never want your family admitted to. The same brilliant minds that have run military medicine into the ground would be doing the same to the national health system as a whole should we go socialized.

Socialized med : NEVER
Single payer: we-e-e-e-l-l-l, maybe.

I'll venture a guess that most medical students don't know the difference between a single payer system and socialized medicine. People hear what they want to hear, and when people hear "the government would pay......" most will think socialism and tune out whatever else you say.

Healthcare policy is one of my interests. I talked to a LOT of my classmates about our healthcare system in my first two years, and the majority were wholly uniformed about how the system works. Some didn't know the differences between Medicare and Medicaid in terms of who was covered, how it is financed, etc. I led a lunch talk my 2nd year, a roundtable discussion about language barriers in medicine with about 50 people. I asked a question about Medicare plan D (which was about 6 months away from starting) and I got a room full of blank looks. I asked who knew what part D of medicare was, and only about a dozen people in the room knew.

The funny thing is that the people who don't know the basics of how our systems works now are the ones that tend to be the most over-the-top in saying things like "Universal health care is bad and will never work" and the like.

Personally, I think we need to work to get more people covered. Slowly expanding medicare and medicaid coverage to increase the safety net, tax breaks to companies that provide health insurance. Tort reform would be a big step, but I'd like to see us go to a system similar to workers comp where doctors and patients are not pitted against each other in legal battles.

 

[Jejton]

And making it a single payer system will not make it better, but further stiffle competition which leads to excellence in care (pay for performance?) and a minimization of waste. You are indeed correct: the system is broke. And we need to fix it, but I think we need to fix it the way we fixed the airline systems in the '70s. We deregulated them and ended the monopolies. Result: More airlines, lower fares, more choice, and far more efficiently run operations using far more fuel efficient aircraft. Everybody wins. Make it all one airline, and we'll have no control, pay whatever they want and go and come when and if they say so.

The only flaw in that logic is that we have been running under a market system for years now and it hasnt come close to solving any problems, only made them worse. Healthcare cannot be treated like just any ol' commodity such as cars or air travel because there really is very little customer ( read patient ) choice in the matter. Patients are stuck with certain doctors, treatments, etc. dictated by their health plan. If the plan is through work, then people are stuck with that company unless they can find another job with paid healthcare or can pay out of pocket - either scenario is unlikely. When people are diagnosed with a catastrophic illness there is usually no time to shop around. Even if there was, how would someone shop around for an oncologist or emergency cardiac surgeon? Lets not even start with all the underinsured people. These are people who have been paying for health insurance ( either out of pocket or through paycheck deductions as part of their salary ) and one day they are hit with a catastrophic illness. All of a sudden they find out that their insurance company will not be covering their care to a degree that is affordable for the patient. Even if the insurance company covers 80% of the cost of care, for something like cancer where treatment runs into the six digits and up, most people cannot afford to pay that remaining 20%. Yet all this time, that poor bastard was under the impression that he was insured for just this scenario.

 

[Jejton]

After hearing how "impossible" it was for people to afford health insurance, I looked it up online. It's really not that expensive. I would hate to lose the quality of healthcare we currently have so that people without insurance don't feel the need to cough up an extra $150-$200 a month so they can buy their own insurance.

Can you show me where you got that number from ? Right now I am paying app. $750 for my family of three and that is not even the best plan out there in terms of service. I have high copays and deductibles so that $750 is not even an accurate number for what my insurance costs - oh and that is through my wife's school group plan.

 

[ESPNdeportes]

Another thing to consider is the high number of "underinsured" we have in the US. Those people that have insurance, but their coverage would not be sufficient to cover major medical bills. They can be an accident or major diagnosis away from huge financial trouble.

This is just to point out that even though people have insurance, it doesn't mean they can't run into financial problems still.

 

[HCE]

I'll venture a guess that most medical students don't know the difference between as single payer system and socialized medicine. People hear what they want to hear, and when people hear "the government would pay......" most will think socialism and tune out whatever else you say.

Healthcare policy is one of my interests. I talked to a LOT of my classmates about our healthcare system in my first two years, and the majority were wholly uniformed about how the system works. Some didn't know the differences between Medicare and Medicaid in terms of who was covered, how it is financed, etc. I led a lunch talk my 2nd year, a roundtable discussion about language barriers in medicine with about 50 people. I asked a question about Medicare plan D (which was about 6 months away from starting) and I got a room full of blank looks. I asked who knew what part D of medicare was, and only about a dozen people in the room knew.

The funny thing is that the people who don't know the basics of how our systems works now are the ones that tend to be the most over-the-top in saying things like "Universal health care is bad and will never work" and the like.

Personally, I think we need to work to get more people covered. Slowly expanding medicare and medicaid coverage to increase the safety net, tax breaks to companies that provide health insurance. Tort reform would be a big step, but I'd like to see us go to a system similar to workers comp where doctors and patients are not pitted against each other in legal battles.

____

ESPN, I agree with everything you said, except that I still have not seen any glaring statistics that indicate that tort reform would have the major impact that the hype would indicate...but I'm open to learning...

 

[ESPNdeportes]

____

ESPN, I agree with everything you said, except that I still have not seen any glaring statistics that indicate that tort reform would have the major impact that the hype would indicate...but I'm open to learning...

You're right. Its very hard to find statistics that show clear support and that tort reform would make a major change. Here's one thing I found. I'd take it with a grain of salt though. http://www.atra.org/wrap/files.cgi/7964_howworks.html

A lot depends on how many "torts" you have in the tort reform. Are we talking about solely limiting caps on noneconomic damages? Or are we including more torts like reducing the statute of limitations and restricting attorney's fees also?

I think tort reform is one change out of many that needs to be made.

 

[futuredo32]

Can you show me where you got that number from ? Right now I am paying app. $750 for my family of three and that is not even the best plan out there in terms of service. I have high copays and deductibles so that $750 is not even an accurate number for what my insurance costs - oh and that is through my wife's school group plan.

https://www.ehealthinsurance.com/ehi/Alliance?allid=Goo18811&sid=NATIONAL+ADD+KWS+QUOTES

The quote was just for a single person and actually it's less than I'm paying for my student health insurance right now and I'm going to switch after this semester. After hearing about the "outrageous" cost of health insurance, I didn't really look into the costs and I thought I was getting such a good deal with my student health insurance. There are plans for a family of three that are much less than you are paying though.

 

[YouDontKnowJack]

we need republicans who will tell america that a good chunk of the uninsured just don't give a crap about their health, and would rather spend their money on luxuries.

And when these same people get sick, they think they are entitled to health care and should pay next to nothing for it.

I used to live with someone who chose not to get health insurance, but was still paying hundreds of dollars for cable/sat tv, and electric bills through the roof because they left the a/c on all day. stupid.


Aren't there enough free clinics in the USA to take care of the truly poor people already?



btw, I'm in my late 20's & paying $53/mo in los angeles for health insurance. It's a high $3500 deductible, but i rarely go to the doc anyway. I only copay $10 for Rx. That's less than your typical cell phone bill. Remove the stupid Text messaging feature, and you're on your way to paying for health insurance.

 

[8744]

we need republicans who will tell america that a good chunk of the uninsured just don't give a crap about their health, and would rather spend their money on luxuries.

And when these same people get sick, they think they are entitled to health care and should pay next to nothing for it.

I used to live with someone who chose not to get health insurance, but was still paying hundreds of dollars for cable/sat tv, and electric bills through the roof because they left the a/c on all day. stupid.


Aren't there enough free clinics in the USA to take care of the truly poor people already?



btw, I'm in my late 20's & paying $53/mo in los angeles for health insurance. It's a high $3500 deductible, but i rarely go to the doc anyway. I only copay $10 for Rx. That's less than your typical cell phone bill. Remove the stupid Text messaging feature, and you're on your way to paying for health insurance.

Another problem is that many people feel that their insurance should cover everything, including routine doctor visits and regular medications. Sort of contradicts the whole idea of insurance which is supposed to be something you use to protect yourself financially from a catastrophic but rare event.

We don't get "food insurance" after all even though we eat every day.

 

[efex101]

http://www.youtube.com/watch?v=X_Rf42zNl9U&eurl

 

[nradsoit3]

If doctors only account for 5% of healthcare dollars, as someone already mentioned, then where does the rest go?!?!

http://www.youtube.com/watch?v=rQug_zheW9c

 

[3dtp]

The only flaw in that logic is that we have been running under a market system for years now and it hasnt come close to solving any problems, only made them worse. Healthcare cannot be treated like just any ol' commodity such as cars or air travel because there really is very little customer ( read patient ) choice in the matter. Patients are stuck with certain doctors, treatments, etc. dictated by their health plan. If the plan is through work, then people are stuck with that company unless they can find another job with paid healthcare or can pay out of pocket - either scenario is unlikely. When people are diagnosed with a catastrophic illness there is usually no time to shop around. Even if there was, how would someone shop around for an oncologist or emergency cardiac surgeon? Lets not even start with all the underinsured people. These are people who have been paying for health insurance ( either out of pocket or through paycheck deductions as part of their salary ) and one day they are hit with a catastrophic illness. All of a sudden they find out that their insurance company will not be covering their care to a degree that is affordable for the patient. Even if the insurance company covers 80% of the cost of care, for something like cancer where treatment runs into the six digits and up, most people cannot afford to pay that remaining 20%. Yet all this time, that poor bastard was under the impression that he was insured for just this scenario.

We have most decidedly not been running under an open market system for years. We stopped doing that in 1944 when the War Production Board established wage and price controls during World War II. The major manufacturers subject to those controls deviced "benefits" as incentives to recruit talented people from competitors. Some of these incentives were paid vacation, pensions, and guess what? Company paid health insurance. Following the war, in the prosperity of the post-WW-II years, gradually the unions, primarily the UAW, Teamsters and Longshoremen and later the AFL-CIO jumped on the bandwagon and health insurance became widespread.

Later, when medical technology actually began to do things, and remember, antibiotics were a recent discovery in the '40s, and began to progress, it became health care became more expensive. And a new problem entered. Lyndon Johnson, successor to John Kennedy had a vision he called the Great Society where povery would be wiped out and universal health care for retirees would be the rule. This was called Medicare and was tacked on to the Social Securty tax. Net result: Initially good. Until the true costs became clear, then they got out the old government pipe wrench, put it on the cash pipe and gave it a twirl. Now, there is a a huge money sucking organzation making decisions globally on what they will and will not pay for, and how much you will be paid for what you do, and you have absolutely nothing to say about it.

Same thing with the insurance companies and HMOs. And you cannot practice medicine today without doing business with them on their terms. The state of Texas sued its major insurance companies for slow/late/nopay and repeated claim denials for trivial or frivolous reasons with the intent to not pay legitimate claims. In Michigan similar things are happening with Blue Cross and its merger with a major HMO. There is a lawsuit pending against BCBS for deciding to require all of its physician contractors to honor all other BCBS contracts, even if they never agreed to their terms.

This is not and has not been a free market for at least 30 years. The patient pays for the insurance by giving the employer money that would otherwise go to compensation. The company negotiates with its buying power with several insurance companies and makes the choice of what and who covers health care. A significant portion of that money goes to paying the insurance company execs who siphon that money out of the health care path, the physician sends a bill to the insurance company and eventually gets paid a small fraction of what the service rendered is listed for. Let's see, this makes the patient who received the service the fifth party payer.

As the fifth party payer, there is absolutely no control of the agents in the line and subsequently very little control over which doctor, which hospital, which procedures will be allowed and disallowed. In fact, no control at all.

This is not a market driven system. Bring on the HSAs.

 

[EctopicFetus]

_____

I'm not sure when Medicaid came into this thread...I thought folks were referring to the Medicare system...the insurance our grandmothers get...

Medicaid is government provided insurance for the poor. So those uninsured you refer to are often on this..

 

[EctopicFetus]

Can you provide any references for the claims you are making ?

Im not gonna do all the work for you.. you know how to use a computer like I do..

Here is some..

We are fatter..

http://xpress.sfsu.edu/archives/news/004551.html

One hundred and nineteen million, or 64.5 percent, of American adults are overweight or obese. For Hispanics and African Americans, the rate is even higher. In 2008, a projected 73 percent of American adults will be overweight or obese.

http://www.annecollins.com/obesity/statistics-obesity.htm

25% of all white children overweight 2001
33% African American and Hispanic children overweight 2001

Hospital costs associated with childhood obesity rising from $35 Million (1979) to $127 Million (1999)

Great site with comps..

http://www.iotf.org/media/euobesity3.pdf

see page 3.. the US is #1 in childhood obesity..

Page 7 the US is #1 in adult obesity....

http://www.fda.gov/Fdac/features/2002/202_fat.html

Health problems resulting from overweight and obesity could reverse many of the health gains achieved in the United States in recent decades, according to former Surgeon General David Satcher.

About 300,000 U.S. deaths a year are associated with obesity and overweight (compared to more than 400,000 deaths a year associated with cigarette smoking). The total direct and indirect costs attributed to overweight and obesity amounted to $117 billion in 2000.

Trauma

http://www.accessmedicine.com/content.aspx?aID=2317640

Data on injury prevalence and costs from the 2000 Medical Expenditure Panel Survey (MEPS) and the National Health Accounts (NHA) reported that injury-attributable medical expenditures cost as much as $117 billion in 2000, approximately 10% of total U.S. medical expenditures. In 2001, there were 157,078 trauma-related deaths, 64% of which were due to unintentional trauma, half of which were caused by motor vehicle crashes.

There is more but.. im done..

 

[toothless rufus]

Same thing with the insurance companies and HMOs. And you cannot practice medicine today without doing business with them on their terms.

How did this happen?! Shouldn't it be the other way around?

the physician sends a bill to the insurance company and eventually gets paid a small fraction of what the service rendered is listed for.

This boggles my mind! How did they decide what to pay! Why was it allowed to develop into this? I can't negotiate on my rent, etc. Grrrr! They should pay 100%! There's a reason that things cost what they do. Total BS!

So, how can we reform the insurance industry?

 

[EctopicFetus]

This boggles my mind! How did they decide what to pay! Why was it allowed to develop into this? I can't negotiate on my rent, etc. Grrrr! They should pay 100%! There's a reason that things cost what they do. Total BS!

Well this is partially true. They negotiate a price (which is usually hidden) and pay you this previously agreed to price. They do need reform but perhaps like Panda said we should instead try to change peoples perceptions of what their insurance should provide. It will also help cut down on the misuse of resources.

 

[OldPsychDoc]

How did this happen?! Shouldn't it be the other way around?



This boggles my mind! How did they decide what to pay! Why was it allowed to develop into this? I can't negotiate on my rent, etc. Grrrr! They should pay 100%! There's a reason that things cost what they do. Total BS!

So, how can we reform the insurance industry?

Perhaps everyone on this thread should read Redefining Health Care: Creating Value-based Competition on Results by Michael E. Porter and Elizabeth Olmstead Teisberg, get themselves informed from a source somewhat deeper than Fox News or talk radio, and then start this discussion over again...

(The authors are coming from a business school perspective, not so much a public policy or health care perspective, so it's kind of a fresh approach for me, like most docs, not highly trained in business-y things.)

 

[EctopicFetus]

Perhaps everyone on this thread should read Redefining Health Care: Creating Value-based Competition on Results by Michael E. Porter and Elizabeth Olmstead Teisberg, get themselves informed from a source somewhat deeper than Fox News or talk radio, and then start this discussion over again...

(The authors are coming from a business school perspective, not so much a public policy or health care perspective, so it's kind of a fresh approach for me, like most docs, not highly trained in business-y things.)

Ill squeeze that in between my works hours, prepping for my in service, my boards, and spending time with my wife. Thanks!

 

[Faebinder]

How did this happen?! Shouldn't it be the other way around?



This boggles my mind! How did they decide what to pay! Why was it allowed to develop into this? I can't negotiate on my rent, etc. Grrrr! They should pay 100%! There's a reason that things cost what they do. Total BS!

So, how can we reform the insurance industry?

Wait till you pre-authorize a procedure with an insurance company.... they approve it.... you do it... then bill them... they refuse it saying it aint covered! #@$$#@%$# (That's what the pre-authorization is for!)

 

[LanceArmstrong]

Rufus, I'm not just talking about money (though I'd challenge you to show me one universal healthcare country where docs make nearly what they do here in the USA) - I'm talking about ownership. I'm talking about the decision making process (what's left of it at least) being taken away from doctors and put into government hands. If government pays for medicine, they can also decide what gets done. You decide a patient needs a certain treatment, the government disagrees, guess who wins on that one?

Listen to the stuff congress has been saying about doctors lately - if you really think that they won't decrease compensation and/or increase work load over time, you'd better think again. Much of American politics anymore is about class warfare - and there's no one much easier to go after than the "rich, pampered" doctors.

Ireland has universal healthcare ... consultants have a base pay of $160k euros (which is about $190k) and plus any money they make of private patients in their offices/practices which sometime triples and quadruples their income.

 

[toothless rufus]

Wait till you pre-authorize a procedure with an insurance company.... they approve it.... you do it... then bill them... they refuse it saying it aint covered! #@$$#@%$# (That's what the pre-authorization is for!)

You...have...got...to...be...kidding!

So then what? I am assuming that they faxed over some forms showing the pre-authorization, right? Then they still refuse? What a bunch of sad, evil pranksters!

Don't insurance companies know how uncool their behavior is? Are their employess all nerds who were pushed in a circle in high school, and now they're getting even with the world!! I realize it is a business, but when your business is dealing with the wellbeing of people, you must respect this, and pull some punches. They are ruining peoples health and livelihood! Arsestuffingfartboxmunchers!

 

[3dtp]

How did this happen?! Shouldn't it be the other way around?

This boggles my mind! How did they decide what to pay! Why was it allowed to develop into this? I can't negotiate on my rent, etc. Grrrr! They should pay 100%! There's a reason that things cost what they do. Total BS!

So, how can we reform the insurance industry?

It happened because we (or the same "old timers" who think working 110 hours a week during residency is the best way to learn medicine) were seduced. Initially health care was a contract between you and the patient. You did what was medically necessary and what the patient agreed to (informed consent) and gave the patient a bill. The patient was responsible for paying that bill. End of story between you and the patient.

Enter the insurance. The patient then sent the bill to the insurance company who cut a check to the patient. Patient is satisfied, doctor is satisfied.

Phase II: Insurance companies: We'll add a benefit, direct pay. That way, you the patient don't have to concern yourself with filing a claim. So, you and the patient agree on a medically necessary procedure, you now have to fill out the insurance claim and get a check directly from the insurance company. You are happy, the patient is oblivious and the insurance company is "more efficient."

Phase III: The insurance companies now directly pay many doctors for many patients and their shareholders and execs are "paying too much." Profits would be better if we could negotiate discounts to all those doctors since we now control the bulk of the cash flow. We can pay late/slow, pay reduced amounts and they'll have to take it since we and our buddies are the only game in town. We lobby congress and get anti-trust laws to cover doctors banding together in the usual divide and conquer operation while we work together to insure they do business with us or not at all.

Phase IV: Now that we, the insurance companies and Medicare/Medicaid have control of the cash flow, we are now in a position to demand they do things our way. To use SimulD's example, we insist that all radiation treatments be given in 5 fractions without regard for the potential morbidity in potential longer term survivors. We deny Duragesic because of the expense in a chronic cancer pain patient, despite its proven advantages. We require board certification for everything you do if you want to do business with over half of the potential patients in town,and our colleagues who control the other half do likewise. And if you want to get paid, you have to prove to us that what you did was really necessary by giving us all of the confidential details of your patient's medical history, who is, in reality "our" client, which we will then share to make sure anyone with a past medical history cannot get insurance from anyone else and we rule.

How do we fix it?

There are probably dozens of ideas.

Mine: Get rid of direct payments between any "third party" payer. Make the patient-doctor relationship sacred. Make it illegal for any third party to pay a physician directly on behalf of a patient. That way the patient will pay the bill, and deal with getting paid from the insurance company. Doctors and patients will negotiate their own individual deals, patients and doctors will be satisfied.

Insurance companies will then have to negotiate with a much more formidable adversary. Their client. When a bad insurance company screws its clients by late/slow pay, denying previously approved claims and the myriad of games they pay offices full of staffers to play to avoid/delay payments, and the person they are not paying is their client, how long do you think it will be before Consumer Reports puts it on the Cover?

Bad insurance companies will be "outted." Better ones will prosper and eventually a better balance will be had.

This includes Medicare. I'm not so sure what to do about Medicaid, since these folks have demonstrated they are not, for whatever reasons, able or willing to be responsible for themselves.

 

[sirus_virus]

Politicians need to shut the f#ck up.

The united state ranks #1 in obesity.
http://www.nationmaster.com/graph/hea_obe-health-obesity

The united states ranks #2 in tobacco consumption
http://www.sk.lung.ca/ca/articles/19991201tobacco.html

Americans rank higher than europe in work related stress
http://www.acountrythatworks.com/fact_2
http://en.wikipedia.org/wiki/Working_hours
"Between 1974 and 1997 the average time spent at work by prime working-age Australian men fell from 45 to 36 hours per week"

"The European Union's working time directive imposes a 48 hour maximum working week that applies to every member state except the United Kingdom (which has an opt out). France has enacted a 35-hour workweek by law, and similar results have been produced in other countries such as Germany through collective bargaining."

"However, if long workweeks become the norm in a society, these hours almost certainly are not voluntary, and it represents a drought of leisure and a threat to public health."

How the hell do you expect us to rank high in health ratings. Insurance is not going to make people stop smoking or over-eating, nor is it going to reduce stress.

 

[badgas]

It happened because we (or the same "old timers" who think working 110 hours a week during residency is the best way to learn medicine) were seduced. Initially health care was a contract between you and the patient. You did what was medically necessary and what the patient agreed to (informed consent) and gave the patient a bill. The patient was responsible for paying that bill. End of story between you and the patient.

Enter the insurance. The patient then sent the bill to the insurance company who cut a check to the patient. Patient is satisfied, doctor is satisfied.

Phase II: Insurance companies: We'll add a benefit, direct pay. That way, you the patient don't have to concern yourself with filing a claim. So, you and the patient agree on a medically necessary procedure, you now have to fill out the insurance claim and get a check directly from the insurance company. You are happy, the patient is oblivious and the insurance company is "more efficient."

Phase III: The insurance companies now directly pay many doctors for many patients and their shareholders and execs are "paying too much." Profits would be better if we could negotiate discounts to all those doctors since we now control the bulk of the cash flow. We can pay late/slow, pay reduced amounts and they'll have to take it since we and our buddies are the only game in town. We lobby congress and get anti-trust laws to cover doctors banding together in the usual divide and conquer operation while we work together to insure they do business with us or not at all.

Phase IV: Now that we, the insurance companies and Medicare/Medicaid have control of the cash flow, we are now in a position to demand they do things our way. To use SimulD's example, we insist that all radiation treatments be given in 5 fractions without regard for the potential morbidity in potential longer term survivors. We deny Duragesic because of the expense in a chronic cancer pain patient, despite its proven advantages. We require board certification for everything you do if you want to do business with over half of the potential patients in town,and our colleagues who control the other half do likewise. And if you want to get paid, you have to prove to us that what you did was really necessary by giving us all of the confidential details of your patient's medical history, who is, in reality "our" client, which we will then share to make sure anyone with a past medical history cannot get insurance from anyone else and we rule.

How do we fix it?

There are probably dozens of ideas.

Mine: Get rid of direct payments between any "third party" payer. Make the patient-doctor relationship sacred. Make it illegal for any third party to pay a physician directly on behalf of a patient. That way the patient will pay the bill, and deal with getting paid from the insurance company. Doctors and patients will negotiate their own individual deals, patients and doctors will be satisfied.

Insurance companies will then have to negotiate with a much more formidable adversary. Their client. When a bad insurance company screws its clients by late/slow pay, denying previously approved claims and the myriad of games they pay offices full of staffers to play to avoid/delay payments, and the person they are not paying is their client, how long do you think it will be before Consumer Reports puts it on the Cover?

Bad insurance companies will be "outted." Better ones will prosper and eventually a better balance will be had.

This includes Medicare. I'm not so sure what to do about Medicaid, since these folks have demonstrated they are not, for whatever reasons, able or willing to be responsible for themselves.

Best post so far. Physicians have been getting pushed around for too long now because of the people that think "I need to help everyone, especially the pt without insurance over there texting on the PDA phone that pulled up in a Caddy." F that. WE are the ones that hold all the chips here but we are too dumb to realize it. No one can FORCE us to practice. If we could all work together and quit being such a bunch of wimps then more would get accomplished. When the insurance companies say they'll pay us 20% of what we bill... then we say NO. When the government says, guess what, you work for us now... then we say NO. The system is gonna crash anyways, so I dont want to hear any ultra altruistic premeds bitching about pt care. It's gonna suffer anyways when the system all comes down... but when it comes down, I want to be the one in control. This has gone on for way to long and we all need to grow a pair. Yes, everyone getting on one page would hurt us and patients in the short term, but would be infinitely better for everyone (except insurance companies) in the long run.

 

[EctopicFetus]

Canadian healthcare in 5 mins..

http://www.youtube.com/watch?v=X_Rf42zNl9U

Their system sucks

 

[toothless rufus]

Thanks for the nice post, 3dtp!

 

[xylem29]

Rufus, I'm not just talking about money (though I'd challenge you to show me one universal healthcare country where docs make nearly what they do here in the USA) - I'm talking about ownership. I'm talking about the decision making process (what's left of it at least) being taken away from doctors and put into government hands. If government pays for medicine, they can also decide what gets done. You decide a patient needs a certain treatment, the government disagrees, guess who wins on that one?

Listen to the stuff congress has been saying about doctors lately - if you really think that they won't decrease compensation and/or increase work load over time, you'd better think again. Much of American politics anymore is about class warfare - and there's no one much easier to go after than the "rich, pampered" doctors.

Actually, Canadian physicians have more autonomy than American physicians. You are so ignorant to make assumptions about something you obviously don't know anything about. Everything is covered by the provincial government. And profits is not the government's motivation. So I a doctor feels that performing treatment A is best for the patient, then they will bill the goverment for treatment A, whose cost is predetermined. In Canada, what you claim (bolded) does not occur, I have no clue where you are getting that from. This does however, occur in the US (below).

In the US, Insurance companies priorties are profit. So if a doctor feels that treatment A is best, but treatment B is cheaper, and is close enough to A, the insurance companies do everything they can to force the doctor to do treatment B.

The legal issues in medicine is also worse in the US - the difference is so large that Canadian clerks (3rd and 4th year students) attain the clinical comptency of US PGY-1's because residents and attendings have no problems letting the students get their hands dirty. A saying in Canada goes like this - "In the US, without clerks hospitals continue to function. In Canada, the hospitals would come to a halt."

 

[xylem29]

Canadian healthcare in 5 mins..

http://www.youtube.com/watch?v=X_Rf42zNl9U

Their system sucks

Also if our system sucks - since this video of ONE example must be the end all and be all of our system - it's funny that the Quality of Life rankings has put Canada above America, for god knows how long now.

Anyway, this doesn't suprise me - most intelligent folks don't go into medicine.

 

[EctopicFetus]

Also if our system sucks - since this video of ONE example must be the end all and be all of our system - it's funny that the Quality of Life rankings has put Canada above America, for god knows how long now.

Anyway, this doesn't suprise me - most intelligent folks don't go into medicine.

LOL.. what you are doing is making an illogical conclusion. Those Quality of life rankings are a joke.. Anyways.. I am sure since you are so wise you have heard of the Economist. It is one of the most well respected mags out there. For those of you who dont know much about business this is the case..

Anyways here is the article..

http://www.economist.com/media/pdf/QUALITY_OF_LIFE.pdf

See page 4.. America ranks higher than our 2 toothed brethren to the north.

Thanks for playing xylem..

next time bring a little data..

The truth is these "Quality of life" surveys are just social science bs.. Oooh Ill weight factor x more than factor Y etc. Therefore you can reach whichever conclusions you choose.

Anyways with all that said.. Our QOL is higher next time bring data.

 

[EctopicFetus]

Oh and your system does suck..

 

[3dtp]

Michael Leavitt talking to the Great Detroit Area Health Council, Michael Leavett, Sec, HHS unvealed Bush's next plans:

"Connecting the System: Every medical provider has some system for health records. Increasingly, those systems are electronic. Standards need to be identified so all health information systems can quickly and securely communicate and exchange data."

"Measure and Publish Quality: Every case, every procedure, has an outcome. Some are better than others. To measure quality, we must work with doctors and hospitals to define benchmarks for what constitutes quality care."

" Measure and Publish Price: Price information is useless unless cost is calculated for identical services. Agreement is needed on what procedures and services are covered in each 'episode of care.'"

" Create Positive Incentives: All parties - providers, patients, insurance plans, and payers - should participate in arrangements that reward both those who offer and those who purchase high-quality, comptetitively priced health care."

Secretary Leavitt also states, "Providing reliable cost and quality information empowers consumer choice. Consumer choice creates incentives at all levels, and motivates the entire system to provide better care for less money. Improvements will come as providers can see how their practice compares to others."

Sources: http://www.hhs.gov/transparency/ and http://www.wcmssm.org/dmn/2k7/e-edition/dmnjanuary292007.htm

Hang on boys and girls, it's coming. Reading between the lines here and paying special attention to the phrase: "Agreement is needed on what procedures and services are covered in each 'episode of care." tells me that the government is planning to regulate precisely what can and cannot be done. The alternative is to raise taxes to make Medicare sustainable. This is unpalatable to everyone who looks at 3% of their income being spent on Medicare taxes now.

In another article in the same newsletter, the editor discusses a recent editorial in the NY Times by the past editor of the NEJM calling for “fee-for-service payments to physicians, and investor-owned facilities need to be replaced by salaried physicians working in prepaid medical groups run by non-profit ownership.”

Now, just who would be the "non-profit ownership?" and just how is this different from "investor owned health care?"

And who would set the salaries?
And who would set the working conditions?
And how strongly could an "employed physician" be able to advocate for the correct and proper care of a "pre-paid medical group" patient tI hat is more expensive than the group has budgeted without fear of being fired, branded and banished?

Single payer system indeed. I for one would rather have an honest 15% overhead from a system that insures movement toward maximum efficiency and independence of decisions than one which sets a specific formula for a loosely similar set of circumstances. But we must get rid of the abusive ones that do interfere with proper care and right now the system is organized to protect abuses of everyone but the doctors.

 

[deleted4401]

It's not altruism or liberalism or marxism or any nonsense like that. I don't advocate single payer or a system like Cuba's, but I do like to think that one could concede some points about certain well-functioning systems of present or past eras. That just wouldn't happen here, I think ...

I think increasing access is important because I think it benefits me. I think the idea of mandating that people with a certain income have to buy basic insurance (covering PCP visits, meds, catastrophes, immunizations, screenings), with a significant tax credit/benefit is something that can benefit us all. There is too many people with the money to afford health care that make it more expensive for the rest of us. I.e. b/c they use the ED instead of a PCP, my rates go up, so it's in my benefit that everyone that can afford coverage does buy it, sort of like automobile insurance. The risk is further spread out, and it lowers cost for all. Outcomes are worse with 14% uninsured, b/c people present later with worse problems (fungating, bleeding mass coming out of breast), and again, that makes things worse for me, b/c I'd spend less time curing and more time palliating.

Medicine and health is not a widget or an airline company or like any other competitive industry. Why?

1. In most markets, the demand is created by the buyer. I want a banana, so I go buy one. In medicine, the demand is created by the seller. I.e. the physician says you need an MRI of your knee. If you trust your doctor, like a good patient, you get it.

2. Demand for health care is mostly inelastic. With bananas, the seller fixes a price, the buyer decides if it is a good price, and either buys it or says screw it, I'm eating apples. With insulin, whether it's $3/unit or $2000/unit, I'm gonna need it and will likely buy enough until I run out of money and are on the dole.

3. There is not a direct exchange between buyer and seller. That's because of the insurer.

4. The value of the products/services does not equal the amount paid by the seller, so it is too easy to overutilize. If I only had to pay $5 the first time I had a banana, and then 20% of each add'l banana forever, I'd eat hundreds of them and get sick.

5. There is morality involved. If you don't buy my bananas because they cost too much, that's fine, I'll find some other chimp. If a patient can't afford my treatment, I'll bring the price down. Sometimes, I'll have to give away my services for free, because I feel bad. Most of us feel that way, but it seems like more and more of us don't.

6. There is so much information assymmetry. I know a good banana when I see one, as does 3dtp. But, if a patient comes to a doctor and doc says "You need surgery," usually they don't argue. I will concede that this is changing quickly b/c of the internet.

So, we are trying to use free-market solutions on an industry that cannot be a free market. That's why I think some market mechanisms are a good idea, but many others can't work.

There's other big problems - like the fact that you can opt out of insurance, but still have access to care (in the ED). The pool of insured people have to pay higher premiums because of all FEMLA-based claims that will never go paid. Again, morality is involved. Yeah, it is stupid to be uninsured, but either way, it breaks my heart to say no.

I don't know - it doesn't seem like we get through much to each other, anyway. I think those that want it to be a market driven system will not listen about any sort of regulation/safety net, and those that want a universal access system won't listen much about market mechanisms. Seems like we're blowing a lot of hot air.

-S

 

[Faebinder]

The problem is not the doctor costs.... the problem is the facility costs..

A hospital costs a lot of money... People are too sue friendly.. Sue the hospital, the company that made the IV line, the company that insured the hospital, the company that cleans the area outside the ED, the company that makes the needles...etc etc etc.

Hospital costs are high... The cost of a hospital room a lone for 1 day in a place in New York Queen (just the room, no other services like nurses or food or doctors) is over $1000. That's a 1 month studio apartment rent in the same area. There needs to be a way of controlling all this disaster... unfortunately, physicians are not powerful enough of a force to influence these costs... universal healthcare might control hospital costs... but in the process hurt physicians. Hopefully, we can all adapt.. I dont see physicians being able to stop the oncoming tidal wave aka "Universal Healthcare".

 

[toothless rufus]

I really really hope that we prevent Universal Healthcare from becoming a reality! We need to lose the "deer in the headlights" mentality! The gov't, the insurance industry, and anyone else involved in the scheming need to stop doing the bizarre and ultimately inhumane sheet that they so callously implement. People should respect people. How hard is it to follow "The Golden Rule"? Sheesh!

 

[xylem29]

As a former Canadian citizen, I can tell you that Canada still has a universal health care system and it is still much harder to get into medical school there than it is in America. The amount of Canadians in US/Caribbean medical schools is quite overrepresented. Canadian doctors make less than what we do, but the exodus that you would consider hasn't happened. In fact, the opposite is true - many people want to practice there, but there are major restrictions in doing so.

As far as health care there, until the late 80s - early 90s, there wasn't many complaints about the Canadian system. Excellent primary care, excellent specialty care, good outcomes, universal access, happy physicians. Why? Because the system was and is structurally sound - when it was funded, it worked. Like any enterprise, if you don't fund it, it won't work. (i.e., if I try to open up a fast food restaurant, but refuse to fund it enough to have good lighting and pest control, it will have poor business). What changed? A far right government, a populace that became more 'individualistic'/American-minded, and they starved the system. Of course it doesn't work now! They spend far less than us, so it can't work. So the populace pushes for an American style system. Yet, if we spent as little as they do, our system would be even more broken.

The reason our system seems to work is because we fund it better. And by this I mean in sum total - we make less wages so our companies can provide us gold-plated health plans ($1400 of the money from the sale of one car produced by the big 3 goes towards health care), we pay taxes for our elderly, poor, and children's health care, we pay high premiums and co-pays, we spend an inordinate amount on prescription medications, we don't consider costs when making medical decisions (i.e. we treat whole brain radiation in 10 fractions, when major studies show non-inferiority compared to 5 fractions). However, physician salaries are a pittance compared to the rest of the waste. We pay a lot more, we get a little more, without necessarily better results.

If we shifted the amount of money we paid through the lower wages, health system CEO bonuses, ED care because of lack of primary care physicians, lost days due to illness b/c of lack of health care, duplication of paperwork secondary to 1000+ insurance companies, we could offer the same level of care to each and every American, and possibly pay doctors better. But instead, we pretend that our system is better and that any change is "socialized medicine".

Study the Canadian system in the 70s, the Nordic models of the same era - it's a beautiful example of the private and public sector joining together to provide a service at a high level and a low cost. If you take the money out of any enterprise, it will not work. If you fund it how it is supposed to be funded, and it is structurally sound, it will work. Please leave out the examples of people waiting 8 months for a hip replacement. Like I said - they have starved the system. If our automakers paid 30% less for their employees health care, Detroiters would have to wait 8 months for a hip replacement, as well.

And as far as our system, there's concrete examples of 'socialized medicine' that work - we've all rotated/worked in the VA system. Does it have it's problems? Absolutely. Do they have good outcomes? You bet - check out their outcomes measures from the big diabetes study a few years ago comparing to private health systems (the VA did better in almost every measure). Does it cost a lot of money? FAR, FAR less then a private health plan. Medicare? Ask a senior citizen if they are willing to go private - you'll get punched in the teeth by some of the feistier ones if you even talk about it.

I'm just frustated with the knee-jerk "ALL UNIVERSAL MEDICINE IS BAD" from anyone in the world of health care. I majored in economics. I spent a year in Northern Europe studying this stuff, comparing health systems. I've looked at the OECD data, and read about the plans developed at Stanford in the 80s-90s, by Alain what's his name. I've read the modern UHC proposals. Hillary-care had it's caveats, but economists across the world regarded it as structurally sound. We have such a great opportunity here - the money is already in the system, gads of it; we just have to utilize it efficiently, and people will get better access, and better outcomes.

System's broke, boys and girls. We at least have to able to evaluate other policies without the horse-blinders of "ALL UNIVERSAL MEDICINE IS BAD". It may not be the Swedish model or the Canadian model or the South Korean model (which is quite solid, for a poorer nation). It may even entail more market-based solutions. But, if we work for the system, we should have a less biased, more analytic way to look at the problems and the possible solutions.

-S

Finally an educated one here.

 

[dutchman]

Like I said in another thread, it is time for doctors to put their hands up and fight, and get ready to fight anybody(democrat or republican) who intends to sacrifice you and your family's walfare for political leverage.They don't mess with other labor unions at will, the don't mess with insurance companies at will, why should they have the luxury of stumping physicians whenever they choose.

No need to use phrase like "it is inevitable" or "we are going to get screwed". Put your hands up and fight. Whatever policies they choose, universal or no universal, they need to factor you into the whole equation.You did not rack up decades of education and debt so that you could get pushed arround by some political thug who works 26hr/week but thinks you are underworked, overpayed and incompetent. They know what is causing the rising healthcare costs(and since physicians income has been declining, I dare to say that is not the problem), but they still attack physicians' pay like that is the problem. Yes, we need to cover the poor and uninsured, but why must that be at the expense of physicians. Why do physicians always have to be the sacrificial lambs? Healthcare costs are rising, but isn't it mysterious that everyone in the medical community except doctors are experiencing increased pay? Do not let them use your compassion to hold you hostage.

It is time to stare the politicians in the eye and say "there will be consequencies if you continue to push us". Force them to factor your feelings into their decision making, because right now, they are not. You are the rightfull custodians of the healthcare system, don't allow those f#ckers hijack it from you. In a democracy, no one is going to fight for you if you don't fight for yourself, and the last time I checked, doctors have rights too. How much more ground do you plan on loosing before you wake up? It is time to stop hiding behind patient care and start fighting for your own rights. Put away that idealist sophistication that makes you justify your own beat-down and fight.

Doctors need to come together under one voice and send a clear message to
both political parties. Let them know that "enough is enough". You need to demand to get treated like key members of the healthcare community, right now, you are not.