This is how a hospital should be run

[MacGyver]

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http://www.latimes.com/news/local/la-fi-reddy8jul08,0,3680369.story?page=1&coll=la-home-center

Finally a group of doctors who are willing to tell the insurance industry to **** OFF!

Most hospitals make their money on patients who have private health insurance. They earn little on those with Medicare or Medi-Cal, the state's insurance program for the poor, because government programs reimburse little, if anything, above the cost of care.

Hospitals sign contracts with insurance companies in part to assure themselves a steady stream of patients. In exchange for that business, however, the hospitals collect as little as 30% of their costs from the insurance companies. As insurers consolidate and get more powerful, hospitals say they have had to accept even less money.

"Somewhere along the line, the insurance industry has gone bad," he said. "They want to pay $1,100 a day for patients that cost $1,700 to treat. They are bilking the system and getting rich at everyone else's expense."

While in his office one night, Reddy had an idea about how to make Desert Valley profitable. If his company canceled the hospital's private insurance contracts, it might be able to make up for the loss in patients by increasing traffic through the emergency rooms and admitting those who needed more care into his hospitals for longer stays.

I really love the screwjob they are putting to the insurers. Basically they are refusing any managed care or insurance contracts and taking their patients thru the back door (via the ER) where the insurance company has to pay much higher rates (via a loophole in state law).

Unfortunately this method seems to work only with hospitals with attached EDs, not small clinics. Otherwise I would suggest that doctors everywhere emulate this practice.

Insurers have been getting rich at our expense for years now.

Of course there are a bunch of ivy tower liberals who dont like this idea:

Dr. David Goldstein, director of the USC Pacific Center for Health Policy and Ethics, said he worried that the company's business model ignored the medical profession's responsibility to care for all patients equally.

"Everyone needs to make money, of course, and we can't fault him for that," Goldstein said. "But this is not like making widgets. In medicine, we have a duty to provide the best care we possibly can."

I'm so ****ing sick of this bull**** idea posited by academic doctors and "health policy" idiots that doctors are supposed to be indentured servants to the public and should not be free to look for profit opportunities. Easy for these dinguses to look down from their ivory towers and wag their fingers when they dont have to deal with insurance reimbursements forcing real working doctors to put patients on a treadmill to get paid properly.

 

[McGillGrad]

Of course Dr. David Goldstein doesn't agree because he is a hypocrite. He collects three paychecks a month and does not practice any one-on-one medicine. He is an administrative ***** that is more similar to an insurance drone than a real doctor.

 

[MacGyver]

Of course Dr. David Goldstein doesn't agree because he is a hypocrite. He collects three paychecks a month and does not practice any one-on-one medicine. He is an administrative ***** that is more similar to an insurance drone than a real doctor.

Well done sir.

He can criticize regular working doctors when he quits his job writing socialist utopia papers on the taxpayer's dime and starts treating patients and dealing with insurance for a living like the vast majority of REAL doctors.

 

[mgdsh]

I'm so ****ing sick of this bull**** idea posited by academic doctors and "health policy" idiots that doctors are supposed to be indentured servants to the public and should not be free to look for profit opportunities.

2nd...

Thanks for the link

 

[deleted4401]

It's interesting to see such glee from future physicians when reading this article. I can't say I feel the same way about a physician who turns away patients, or discharges prior to them being well. It's kind of disappointing, really.

I do think that his view of medicine is not unreasonable - that is to say that health care may be a privilege, not a right, and that one is entitled to what one can afford. I don't believe in that view, but I think one can make a rational argument for it. In the same view, though, if we believe in that model, we ought to become a lot less protectionist and decrease our own regulatory measures - i.e. let CRNAs, NPs, PAs compete along side us, and let the outcomes decide if our MD really matters. That way, if people have to get what they can afford, they oughtta have options ... if you're willing to accept the risk of a worse outcome with a low-cost subsitute, you should actually have the option of a low-cost substitute. In India, you can go to an MBBS (MD) vs. a local homeopath with barely high-school training for a 1/10th of the cost.

In any case, I'd say he is a great businessman if he had a great product/outcomes. All he's doing is making money (which is fine, in and of itself), but if you have a crummy product, what's so great about that? If you told me he quit taking private insurance and charged fair, fixed rates that were affordable because his business model was far more efficient than anyone else's, and made a fortuna off of that, I'd be impressed.

I'd prefer to see businesses/systems that improve outcomes, are efficient, have satisfied customers, and are profitable. Those are sustainable. This guy is a robber-baron, taking advantage of inequities in the market, private insurance loopholes, and the fact the health care system is a mess. Oh, well. If this a physician that we are supposed to look up to, than there is no wonder that the public has a negative view of us. I would.

-S

 

[McGillGrad]

You apparently did not read the same article. The patients receive the same care, albeit through the ED instead of the main hospital.

The only people being hurt are the insurance companies and their cheerleaders (i.e. you).

It's interesting to see such glee from future physicians when reading this article. I can't say I feel the same way about a physician who turns away patients, or discharges prior to them being well. It's kind of disappointing, really.

-S

 

[deleted4401]

Direct quote from the article regarding Prime's services is below regarding the care patients receive.

I certainly did read the article ... one can interpret what is written as they will. You see them as treating patients well; I disagree. I feel that suspending chemotherapy, mental health services and turning away uninsured patients in the ED because they are not lucrative is substandard care. This is clearly left to the reader's interpretation. You may find that to be adequate care. Either way, that hardly equals me supporting the insurer. I can also understand the moral outrage of treating the uninsured for free (though I'd disagree ... ); yet, presently, the law requires hospitals to provide ED care to the indigent until medically stable. Wrong or right, it's the law.

Interesting to note that instead of a debate, there is name calling. I wasn't cheerleading for the insurance companies. How do you make that leap? I'm for abolishing every single one of them. But, that's a different debate altogether. "Screwing people" is just not on my list of ways to make things better.
-S

QUOTE FROM ARTICLE:

"It has suspended services — such as chemotherapy treatments, mental health care and birthing centers — that patients need but aren't lucrative.

Critics say Reddy-owned hospitals routinely turn away uninsured patients, an allegation the company denies.

On four occasions since 2002, inspectors have found that Prime Healthcare facilities failed to meet minimum federal safety standards, placing their Medicare funding at risk.

Records show that in one two-hour period during 2003, three uninsured patients left the emergency room at Desert Valley Hospital in Victorville after waiting up to four hours without being treated. Two of them were under 2 years old, including a 16-month-old girl who arrived with burns on her left hand.

The same year, Reddy discharged an uninsured patient he was personally treating who was in kidney failure, suggesting that the patient go to a nearby county facility where he could sign up for free care. The patient waited until the following day to visit another emergency room, records show.

State regulators found that the medical staff failed to make sure that discharging the patient "would not create a medical hazard."

 

[Llenroc]

Yeah, lets tell the insurance companies to get lost! Go Michael Moore!

Then we can all collect money from Medicare/Medicaid, which pay like ****, and no money from all the uninsured folks.

Yay!

 

[8744]

It's interesting to see such glee from future physicians when reading this article. I can't say I feel the same way about a physician who turns away patients, or discharges prior to them being well. It's kind of disappointing, really.

I do think that his view of medicine is not unreasonable - that is to say that health care may be a privilege, not a right, and that one is entitled to what one can afford. I don't believe in that view, but I think one can make a rational argument for it. In the same view, though, if we believe in that model, we ought to become a lot less protectionist and decrease our own regulatory measures - i.e. let CRNAs, NPs, PAs compete along side us, and let the outcomes decide if our MD really matters. That way, if people have to get what they can afford, they oughtta have options ... if you're willing to accept the risk of a worse outcome with a low-cost subsitute, you should actually have the option of a low-cost substitute. In India, you can go to an MBBS (MD) vs. a local homeopath with barely high-school training for a 1/10th of the cost.

In any case, I'd say he is a great businessman if he had a great product/outcomes. All he's doing is making money (which is fine, in and of itself), but if you have a crummy product, what's so great about that? If you told me he quit taking private insurance and charged fair, fixed rates that were affordable because his business model was far more efficient than anyone else's, and made a fortuna off of that, I'd be impressed.

I'd prefer to see businesses/systems that improve outcomes, are efficient, have satisfied customers, and are profitable. Those are sustainable. This guy is a robber-baron, taking advantage of inequities in the market, private insurance loopholes, and the fact the health care system is a mess. Oh, well. If this a physician that we are supposed to look up to, than there is no wonder that the public has a negative view of us. I would.

-S

How, exactly, can non-paying patients be considered "customers?" They are most certainly not. If you want to analogize medicine with business non-paying patients are more like shoplifters.

 

[deleted4401]

I agree that non-paying consumers pose a problem (threat) to any business. It's just difficult to compare the health care system to any other. One thing that would allow many 'non-paying' consumers to become paying ones is to charge them the same rates for services as those that are insured.

The fact that the insurer will pay $60 for a study when the sticker cost is $225 and the system accepts that while charging the full $225 to the uninsured patient complicates things greatly. It indirectly allows the hospital to charge different rates to different customers, something that is illegal across all industries. To think that a car company could charge $20,000 for a Camry to a rich person, but charge a poor person $40,000 for the same car would infuriate people.

And don't think I don't understand why the hospital does this - they are getting robbed by insurers, so they stick it to the uninsured. Even if they collect only half the time, they make up a huge amount this way. The insurers continue to make a killing. If the cost to an uninsured patient with some income was reflective of the 'usual and customary' fee schedules created by the insurers, many of the uninsured could afford to pay for health care. Many upper-middle class small business owners and other responsible people could opt out of comprehensive insurance, buy catastrophic coverage only, and pay the rest of the way through MSAs.

And, as anyone can appreciate, costs in the ED are much higher than they are in the clinic; this guy's schtick is driving up costs at an unsustainable level. The reaction from the insurers will be interesting. They've survived through worse and I'm sure they will figure out a way around this, they are quite cunning. They will maintain their profits and things will get only get worse.

I am in full agreement - to start, let's eliminate private insurers. They are the one player that doesn't need to exist and many market solutions could replace them at far lower cost.

-S

 

[3dtp]

I agree that non-paying consumers pose a problem (threat) to any business. It's just difficult to compare the health care system to any other. One thing that would allow many 'non-paying' consumers to become paying ones is to charge them the same rates for services as those that are insured.

Are you sure?

The fact that the insurer will pay $60 for a study when the sticker cost is $225 and the system accepts that while charging the full $225 to the uninsured patient complicates things greatly. It indirectly allows the hospital to charge different rates to different customers, something that is illegal across all industries. To think that a car company could charge $20,000 for a Camry to a rich person, but charge a poor person $40,000 for the same car would infuriate people.

Not really. Negotiating a price/rate/deal between a supplier/consumer is done all the time. It is neither illegal nor improper to charge different prices to different people. It is a function of supply, demand, and regional competition. I have amazed friends and sometimes myself by dickering a price in a bigchain grocery store! And I assure you you do not want to know what I paid for my 25" LCD display! Even I felt guilty when that negotiation was over. Conversely, I test drove a cherry '02 Civic equipped just the way I wanted with low mileage, and when the dealing was done the dealer wanted more for the car than a new Civic would have cost with a warranty and a low interest loan. He wouldn't budge one dime on the price. I'm driving my beater. He's still got the car on the lot. Someone will pay too much for that car, I'm sure.

And don't think I don't understand why the hospital does this - they are getting robbed by insurers, so they stick it to the uninsured.

They are not getting robbed by the insurers. They decided it was in their best business interest to accept the payment on the insurance company's terms. I agree with you that their business model is flawed, but again, willing supplier, willing buyer = offer and acceptance = contract. If they don't like the deal, then bail out next time the contract comes up for renewal.

And, as anyone can appreciate, costs in the ED are much higher than they are in the clinic; this guy's schtick is driving up costs at an unsustainable level.

Why are costs higher in the ER? Do they pay their nurses more? Do they pay their PAs more? Do they have more expensive ultrasound machines? Does the electricity to get a CT scan cost more than the electricity to get it from the clinic? Or is it because they're more poorly run and managed? The procedure for managing an earache or reducing a fracture are very similar whether they're done in the clinic or the ER. And I agree that ERs are capable of more complexity than a clinic, which carries with it some additional overhead, but why charge everyone for that? Just charge the MIs for the monitors and cardioversions.

I am in full agreement - to start, let's eliminate private insurers. They are the one player that doesn't need to exist and many market solutions could replace them at far lower cost.

-S

Let's eliminate public ones too. Actually eliminate direct third party payer arrangements. My deal is between my patient and me/my institution, not GM, not Toyota, not Chase Bank. Whatever arrangements the patient, (not the customer, customers go shopping, patients seek care), has between his employer/government/insurance company are between him and not me.

And you are correct. Insurers (3rd party payers) will be increasingly cunning, and this includes CMS, too.

 

[f_w]

The fact that the insurer will pay $60 for a study when the sticker cost is $225 and the system accepts that while charging the full $225 to the uninsured patient complicates things greatly.

Right. And after 90 days the hospitals accounts receivable dept. will gladly accept a $60 money order and write off the rest.

It indirectly allows the hospital to charge different rates to different customers, something that is illegal across all industries.

What ? This is the US, a company is free to charge customers whatever they are willing to pay.

To think that a car company could charge $20,000 for a Camry to a rich person, but charge a poor person $40,000 for the same car would infuriate people.

That's what KIAs are for 😉

While we are in the world of wildly inappropriate analogies: Another poor person will get the same camry (with the V-6 and leather trim) for 'free' grace of the federal goverment (which buys the car at 10k). And yes, that person is free to re-sell the V6 camry and come back to the dealership every other month to pick up another car (in case you didn't get it: medicaid).

And don't think I don't understand why the hospital does this - they are getting robbed by insurers, so they stick it to the uninsured.

Actually, they do this because the federal goverment requires them to do so. You have to give the feds your 'best price'. If you are offering your services at a price lower than what they have in their payment scale, they will slash your reimbursements retroactively to 60% of that level.

Like it or not, hospital and physicians have to charge uninsured patients list price. They are however free to either have a 'sliding scale' for low income patients (my current hospital considers anyone with less than 100k on their AGI to be low income and slashes the bill by 50%. Less than 50k AGI gets you a 75% discount if you pay within 90 days) or to write off debts after partial payment.

Many upper-middle class small business owners and other responsible people could opt out of comprehensive insurance, buy catastrophic coverage only, and pay the rest of the way through MSAs.

I don't know how it works in your part of the country, where I practice, holder of a HSA+high-deductible-plan pays the respective insurers negotiated rate, not the list price.

 

[deleted4401]

Negotiating better prices on the used car lot is one thing, but charging different prices to different people without a reasonable differential to justify the cost is a violation of anti-trust laws, and it has been for years. The product is no different, the service is no different, and yet the price is. This isn't finnagling a good deal on a plasma TV where a sticker price is lowered if you decide to pay cash. This is a straight out higher price for one group vs. a straight out lower price for another.

As far as ER costs, anything in medicine costs more if it has to be done now or STAT or whatever. Always is. A scheduled CT will cost less than a STAT CT. I shouldn't have to explain that - that's resource allocation, and that will drive up costs. I don't think all EDs are poorly managed. A gunshot wound requires far more expensive care (equipment, personnel) emergently than any equivalently mortality reducing affliction that is non-emergent. In the same vein, a URI seen in the ED requires more resources than a URI seen in clinic. It's a matter of resource allocation, scheduling, urgency, and utilization of inputs. If the ER was built to be a primary care clinic, it would just be a primary care clinic. It would cost less, have less resources for life threatening issues, and would function well for non-urgent issues and stink at GSWs. Some ERs have a so-called 'fast track', and they function and charge as an urgent care clinic would, because they are built for this capability. Not a bad idea, and I think many are going this way. The idea that an ED should be prepared for a GSW but have the overhead costs of a FP is ludicrous. There is a reason a checkup costs more at 2am in the ED than it does at Jones Family Practice center.

I think direct pay is a great idea. The exchange should be between customer and provider. And I again say customer, because I think a majority of the population in the U.S. believes that health care is a privilege, not a right. If you can afford it, you should be able to utilize it. If you cannot afford care, you need to make arrangements to have it subsidized somehow or deal with substandard care. Now, in my worldview, something should be done to help those who are in minimum wage jobs to pay for their care (subsidization of premiums, employer based coverage, whatever your choice), because someone has to work the register at Giant Eagle or serve me Dogfish at happy hour and I don't think he/she should not be able to afford health care.

Now, if you believe that patients are not customers, but citizens needing care, then your argument collapses a bit about how they should pay for it. If they are not customers, than they should receive care, at least to stablize their condition, regardless of their ability to pay for it. Children and the elderly retired fit in this group, too. As customers, they may be SOL. As citizens, I think we can do a little better than expecting that some 6 year old ALL patient with idiot broke-ass parents should have to foot his own chemo bills. There may still be a need for a third party, though it probably doesn't need to be a private insurer. No need for someone to profit other than the doctor, hospital, and staff.

I don't think it is as easy as you make it to be ... price discrimination is a big problem. Private insurer rates (U&C fees) are basically extortion that lead to the uninsured and doctors getting gouged. The 'Emergency Department' is equipped to serve 'emergencies', and every minute spent treating a UTI or headache is revenue loss if they charge PCP rates. Direct pay is a good model for 85% of problems (if costs are fair for all), but we can't forget about the young, elderly, disabled, catastrophic illness, and chronic disease.

-S

 

[deleted4401]

I hate writing this again, but I know this is America and a free market, but a basic tenet that is federal law is that you have to charge the same amount for the same service to all people. You can't charge $1 for a banana to a tall guy and $6 to a short guy. It is price discrimination and subject to anti-trust laws.

Now, I can reasonably debate that the fact a person pays for insurance makes them eligible for a 'better price', but that isn't the argument that the hospitals make. What happens is that everyone gets charged the same price, but the hospital will accept the lower price from Blue Cross, but 'f' up your credit if you try to send a money order for that lower price 90 days past due if you are uninsured. There is no negotiation or reduction of fees for most people unless you go through a lenghty process with customer relations. This is price discrimination and anti-American.

Even if you disagree with everything else I say (which is fair, b/c I'm definitely on a limb on much of my thinking, and I think I've explained my areas that are clearly debatable), I think this is ground I stand firmly on. Hospitals are being screwed on "U&C" fees, so they screw the uninsured. Someone said it before - if they lower their sticker prices, the insurers will pay even less. The price discrimination is a necessity, but not the right thing to do, and it is a reasonable argument to call that an anti-trust violation. If "usual and customary" is deemed "acceptable" to a medical institution as full payment, then it should be acceptable for an uninsured person to pay that amount. If that was the case, many more of the healthy, upper middle class would be able to spend their own money and eschew insurance altogether.

-S

 

[f_w]

but charging different prices to different people without a reasonable differential to justify the cost is a violation of anti-trust laws, and it has been for years.

If you are the only provider for that particular service maybe. But as long as the 'customer' has a choice between different providers (e.g. hospitals), they are free to charge someone who affiliated himself with a buying organization (e.g. a non-profit health insurer like BC/BS) less than someone who comes as individual. Think Sams Club.

The product is no different, the service is no different, and yet the price is.

If the hospital told you : You'll have to pay more because you are black/jemeni/female, the feds might get interested. Other than that, they don't really care as long as they get their services on the cheap.

A scheduled CT will cost less than a STAT CT.

Where is that ? (We bill exactly the same, whether the CT is done during bankers hours or at 2am. The 'cost' to the system is different, the price is not.)

I think direct pay is a great idea. The exchange should be between customer and provider.

You 'think' that that is a good idea. So far, the trend is that the young wealthy and healthy buy HSAs, further 'concentrating' the pool of 'risks' that will continue to buy regular insurance. While I like the idea, it seems to work a lot better when proclaimed from some right leaning 'think tank' than on the ground.

and I don't think he/she should not be able to afford health care.

Actually, before the days of ChinaMart, retail grocers where known for their good health coverage and benefits. And if you are willing to pay a buck or two more for your fish'n chips, there won't be a problem providing coverage for the server (the guy mowing my grass has A a green card B health insurance. I pay a bit more than if I bought the service in cash from a pickup full of friendly mexicans and I don't get as good a service, but I know he'll be able to pay his bill if he ever hits the hospital).

If they are not customers, than they should receive care, at least to stablize their condition, regardless of their ability to pay for it.

Newsflash: There is a law called EMTALA. Google it, you might learn something.

Private insurer rates (U&C fees) are basically extortion that lead to the uninsured and doctors getting gouged.

How is that ? (on average, I still collect more on any commercial insurer than on the self-pay crowd. While we do gouge the uninsured according to federal requirements, in the end they are a loss business)

Hospitals, medical groups IPAs negotiate with insurers and come up with a pricing scheme based on their market and negotiating position. If you are Missoula, MT, your negotiating position as a medical group is naturally a bit better than if you are in the burbs of Boston where the insurer can route his subscribers to your competitor 1 mile down the road for 10% less.

 

[mgdsh]

Let me start by saying most of us are into an idea like this because it screws the insurance companies who continually try to screw patients AND doctors/hospitals in order to improve their bottom line and please their investors.

You also make it seem like the uninsured and people who can't afford to pay for health care are helpless and no one is doing anything for them. The vast majority of those people pay very little to next to no taxes. They (most of them) also have the right/ability to do something about where they are in life. Those people that you consider middle/upper class are fitting the bill for these people. They are the ones who are paying for not only their insurance directly, but also for the uninsured indirectly.

It's a requirement to have auto insurance in this world, why can't we do the same thing for health insurance in someway?

Not only is it illegal for someone who doesn't have car insurance to drive around, but if they do get into an accident you can bet they pay a far greater price for someone who gets into an accident that's insured.

And your theory about people paying the same rate for some type of service is a bunch of ****. When it comes to life insurance, most people of younger ages pay lower premiums than those of older ages. The more health problems you have and/or if you smoke, etc you'll have higher premiums too. The same is said for auto insurance. When a younger driver is insured he/she is more likely to pay a higher premium than an older driver. They also further discriminate on what type of car you drive. Someone driving a sportier car (even if it is safer on the road than say an SUV that could easily flip over) is also more likely to pay a higher premium. Even credit card companies/banks/house loans/auto loans/etc/etc charge higher interest rates to those people with good credit (usually have more $$) vs. bad (usually have less $$). The list of similar examples could go on and on, spanning virtually any industry you can imagine in the US.

It's really amazing how people are ok with insurance companies paying fractional amounts of what they are billed. People also don't really want to pay co-pays or any reasonable deductible. If you take the same situation to auto insurance or any other type of insurance, that almost never happens.

 

[f_w]

, but 'f' up your credit if you try to send a money order for that lower price 90 days past due if you are uninsured. There is no negotiation or reduction of fees for most people unless you go through a lenghty process with customer relations.

That is right. You do have to ask for it (while I can't speak for every commercial hospital in the country, most medical providers will not send an account to collections as long as the debtor is in contact with the business office and either makes partial payments or negotiates for a write-off. It is the people that don't answer bills and try to play possum who will get their accounts sold to collections agencies).

 

[3dtp]

I hate writing this again, but I know this is America and a free market, but a basic tenet that is federal law is that you have to charge the same amount for the same service to all people. You can't charge $1 for a banana to a tall guy and $6 to a short guy. It is price discrimination and subject to anti-trust laws.

Now, I can reasonably debate that the fact a person pays for insurance makes them eligible for a 'better price', but that isn't the argument that the hospitals make. What happens is that everyone gets charged the same price, but the hospital will accept the lower price from Blue Cross, but 'f' up your credit if you try to send a money order for that lower price 90 days past due if you are uninsured. There is no negotiation or reduction of fees for most people unless you go through a lenghty process with customer relations. This is price discrimination and anti-American.

Even if you disagree with everything else I say (which is fair, b/c I'm definitely on a limb on much of my thinking, and I think I've explained my areas that are clearly debatable), I think this is ground I stand firmly on. Hospitals are being screwed on "U&C" fees, so they screw the uninsured. Someone said it before - if they lower their sticker prices, the insurers will pay even less. The price discrimination is a necessity, but not the right thing to do, and it is a reasonable argument to call that an anti-trust violation. If "usual and customary" is deemed "acceptable" to a medical institution as full payment, then it should be acceptable for an uninsured person to pay that amount. If that was the case, many more of the healthy, upper middle class would be able to spend their own money and eschew insurance altogether.

-S

The antitrust laws do not work that way. I've never heard of such a federal law, and I am reasonably well versed in the law. Please cite the statute/authority to which you refer. I'd really like to read it. {Lawyers out there, help us out here!}

These laws, in particular, the Sherman Act do not allow me and you to get together at the pub, the club or anyplace else and decide what we, together will charge. Smith and Roberson's treatise on business law has a whole chapter devoted to this. The Sherman Act allows me, independently and as a competitor of you to pick what price I set.

If I have a pile of bananas, and I chose to sell them, and I can convince a blonde to pay $6 a banana but can only convince a brunette to pay $1, and I'm willing to sell it for a buck, then a deal's a deal. Of course, I'd be happiest if all of my customers were blondes. But of course, most are brunettes err insurance companies.

Likewise, if I have a gallon of gas to sell and can convince you to pay $6 for it, but can only convince f_w to pay 2.50 for it, a deal's a deal.

It only becomes anti trust meat if I get together with all the other gas sellers and say, let's take a commodity that costs us $0.25 and all agree to sell it for $3 to any idiot willing to pay that much.

I think f_w is correct, in that medicare changes this somewhat due the the "best and final offer" policy.

And I do agree with you that hospitals are being screwed by the U/C fees which they do have a choice not to accept in the contracts they sign. In which case, if enough hospitals say no more, then the insurance companies will have a real problem since they will not be able to sell insurance because they can't get anyone to accept their terms, no wait, they don't since our "employers" pay and they don't care about anything except the premium.

 

[f_w]

Likewise, if I have a gallon of gas to sell and can convince you to pay $6 for it, but can only convince f_w to pay 2.50 for it, a deal's a deal.

I drive a diesel 🙂

It only becomes anti trust meat if I get together with all the other gas sellers and say, let's take a commodity that costs us $0.25 and all agree to sell it for $3 to any idiot willing to pay that much.

I actually do believe that if not the marketers, but the refiners of petro products do get together and time the maintenance shutdowns in a way to maximize market volatility (so much for my share of conspiracy theories).

In which case, if enough hospitals say no more, then the insurance companies will have a real problem since they will not be able to sell insurance because they can't get anyone to accept their terms, no wait, they don't since our "employers" pay and they don't care about anything except the premium.

In Missoula,MT the local radiology group dropped their contract with BC/BS as they didn't get a fair deal. Patients where charged list price and had to duke it out with their insurer. Guess what, the 'poor' insurer ran to the court and sued the group for their 'monopolistic' behaviour. In the end it was just posturing during multi-million $$ negotiations and everyone settled, but it made clear that the 'law' doesn't want us to charge everyone the same.

 

[TraumaCheers]

If the ER was built to be a primary care clinic, it would just be a primary care clinic. -S

And that's the rub -- the ER was never built as a primary care clinic but is utilized as one.


This is a fascinating thread, folks. Keep it rolling👍

 

[Jejton]

How, exactly, can non-paying patients be considered "customers?" They are most certainly not. If you want to analogize medicine with business non-paying patients are more like shoplifters.

This whole analogy is crap. Medicine is not, nor has it ever been, just like any other business. Noone - not the insurers, the gov't, the patients and - gosh should I say it? - practitioners. I am pretty sick about all this whining about physicians going to the poor house. While I dont advocate doctor's being forced to work for free or substandard wages or forced gov't employment, but if you do some research you will see that doctor's are not exactly at the bottom of the income pile. Besides, to quote from my mentor ( a respected physician with many many years on the job ) -
" If you are going into medicine to get rich, find another career. "

 

[f_w]

While I dont advocate doctor's being forced to work for free or substandard wages or forced gov't employment, but if you do some research you will see that doctor's are not exactly at the bottom of the income pile.

The guy who owns that independent car repair shop that I bring my vehicle to is doing quite well and certainly not at the bottom of the income pile. Still, if I drove off without paying for a repair, he would have every right to be ticked off.

I certainly don't mind providing some charity care. I also don't mind if the business office writes off a charge on one of the locals with 'social issues'. I do mind if people with paying jobs who could get health insurance give us the uninsured story (how do I know they could get insurance: because some of our staffs relatives work at the same company and do buy the insurance).

 

[LADoc00]

This whole analogy is crap. Medicine is not, nor has it ever been, just like any other business. Noone - not the insurers, the gov't, the patients and - gosh should I say it? - practitioners. I am pretty sick about all this whining about physicians going to the poor house. While I dont advocate doctor's being forced to work for free or substandard wages or forced gov't employment, but if you do some research you will see that doctor's are not exactly at the bottom of the income pile. Besides, to quote from my mentor ( a respected physician with many many years on the job ) -
" If you are going into medicine to get rich, find another career. "

Im baffled why the hell I would care what motives other docs have in pursuing their goals. Do people question professional atheletes why they make 10 million dollars a season? Do they all do it for the love of the game with no interest in the biz side? How about attorneys? Or what about TEACHERS? Surely teachers never strike because they are undercompensated relative to their effort and education.

Please pull your head out of your rear, LIFE IS BUSINESS. Economics overshadows every single aspect of public and private affairs.

Why are people berating docs who want to provide a nice home for their family and pay for the ever rising cost of college education for their kids? Why is any doc who wants to afford a nice house and good vacation a bad guy?

I want my fellow MDs to be financially successful. I want kids to see this is a rewarding career choice.

 

[dutchman]

Original

to quote from my mentor ( a respected physician with many many years on the job ) -
" If you are going into medicine to get rich, find another career. "

Fixed

to quote from my mentor ( a respected physician with many many years on the job ) -
"I have seen the hay days of medicine and I have enough money in the bank. As for you my dear pre-med, If you are going into medicine to get rich, find another career."

 

[McGillGrad]

Priceless fix...lol

Original

Quote:
Originally Posted by Jejton
to quote from my mentor ( a respected physician with many many years on the job ) -
" If you are going into medicine to get rich, find another career. "

Fixed

Quote:
Originally Posted by Jejton
to quote from my mentor ( a respected physician with many many years on the job ) -
"I have seen the hay days of medicine and I have enough money in the bank. As for you my dear pre-med, If you are going into medicine to get rich, find another career."

 

[mgdsh]

I am pretty sick about all this whining about physicians going to the poor house.

No one's whining about 'going to the poor house.' We are fed up with insurance companies who pay sometimes half or less than half of what we bill at. We are fed up with insurance companies finding any excuse they can to deny a claim. We are fed up with medicare and medicaid constantly slashing our reimbursements.

Maybe you should see what life as a doctor really is like before you speak up so loudly as a pre-med.

 

[bulgethetwine]

This whole analogy is crap. Medicine is not, nor has it ever been, just like any other business. Noone - not the insurers, the gov't, the patients and - gosh should I say it? - practitioners. I am pretty sick about all this whining about physicians going to the poor house. While I dont advocate doctor's being forced to work for free or substandard wages or forced gov't employment, but if you do some research you will see that doctor's are not exactly at the bottom of the income pile. Besides, to quote from my mentor ( a respected physician with many many years on the job ) -
" If you are going into medicine to get rich, find another career. "

Sorry kid, but to make a blanket statement like "medicine is not...like any other business" is just trite drivel. No one suggested all businesses are alike, comparing medicine to another or otherwise. But to be sure, medicine IS a business, and it wasn't us docs who made it this way.

Since you invited some salary research, I suggest next time you do yours you add up what it costs in terms of opportunity cost for 8 years of undergraduate education, at least 3 years in indentured servitude as a resident, all the hours studying for tests and board exams above and beyond the "work day". Go ahead - work out hourly wage of a resident working 80-100 hours a week, no 401K, no separate retirement benefits, etc. Don't forget to figure in the compound interest that your buddy who took the job straight out of university after 4 years has been getting. What about the costs of the board exams, my medical license, my board certification, my professional memberships, etc? What about the fact that unlike almost every other profession, the pay of a physician actually goes DOWN in markets where the cost of living is high like New York, Boston, and California?

Your view is typical of someone at your level of training. But it is also harmful as it signals complacency within our profession which is why we collectively have been so limp to resisting the erosion of conditions when it comes to salary, professional autonomy (go to the Gas forum and ask them what they think of nurse anesthetists), malpractice and the like.

I'm not trying to flame you, but you sound EXACTLY like I did 5 years ago... 🙄

 

[McDoctor]

http://www.latimes.com/news/local/la-fi-reddy8jul08,0,3680369.story?page=1&coll=la-home-center

Finally a group of doctors who are willing to tell the insurance industry to **** OFF!



I really love the screwjob they are putting to the insurers. Basically they are refusing any managed care or insurance contracts and taking their patients thru the back door (via the ER) where the insurance company has to pay much higher rates (via a loophole in state law).

Unfortunately this method seems to work only with hospitals with attached EDs, not small clinics. Otherwise I would suggest that doctors everywhere emulate this practice.

Insurers have been getting rich at our expense for years now.

Of course there are a bunch of ivy tower liberals who dont like this idea:



I'm so ****ing sick of this bull**** idea posited by academic doctors and "health policy" idiots that doctors are supposed to be indentured servants to the public and should not be free to look for profit opportunities. Easy for these dinguses to look down from their ivory towers and wag their fingers when they dont have to deal with insurance reimbursements forcing real working doctors to put patients on a treadmill to get paid properly.

a few more excerpts:

Free of most contracts, Prime Healthcare's hospitals can collect the patient's entire bill, calculated at the higher rate, whether the patient has insurance or not. And, under state law, insurers must pay up.

At Desert Valley, for example, the hospital collected about $4,100 per patient per day in 2002, according to state data. In 2005, it took in about $10,000 per patient per day.

and later in the article...

Prime Healthcare Services is rewriting how hospitals make money, bycanceling managed-care contracts, collecting more from insurers andshuttering unprofitable services. At Desert Valley Hospital inVictorville, the company raised the bottom line by:

Examples of price changes for selected services and products at Desert Valley Hospital

2005 2006 Percent
Service charge charge change
Use of mechanical ventilator, first day $256 $6,144 +2,298%
CL drug-eluting stent, to prevent blood clots $16,000 $63,900 +334%
Vaginal delivery in maternity ward $1,475 $4,061 +175%
One-hour ambulatory surgery $2,500 $4,000 +60%
Blood test (CBC) $54 $76 +40%
Pacemaker, single chamber $32,500 $22,500 –31%
Angiogram $5,211 $2,957 –57%


Note: Hospitals prices reported to the state may not reflect the final charge on a patients bill.

To me, it sounds very similar to the Tenet "Outlier plus Stop-Loss" scandal a few years back, wherein Tenet hospitals grossly inflated their charges to bilk medicare's outlier reimbursement system. The system uses a formula that looks at hospital charges and reimburses those hospitals with higher charges beyond just the standard DRG reimbursement, under the assumption that these hospitals with excessive charges are caring for more complicated patients. Its designed to prevent "cherry picking" of just uncomplicated patients for admission.

The California medicaid program probably has a similar reimbursement system. So do many private insurance plans.

Obviously, the Tenet scheme didn't last long. Here's a link:
http://www.uow.edu.au/arts/sts/bmartin/dissent/documents/health/tenet_med_fraud.html

Bottom line, if I had stock in Prime Healthcare...I'd sell.

 

[f_w]

Pacemaker, single chamber $32,500 $22,500 –31%
Angiogram $5,211 $2,957 –57%

Gee, those wheren't highlighted for some reason.

Unless you snow in through the ED, you have a choice as to where you deliver you kid. Also, most ambulatory surgery procedures are elective and you have a choice of where to go.

As they have cancelled their managed care contracts, no patient is forced to go there for elective procedures and pay their prices.

Posting someones price list and pointing to it as something evil is the same diversion tactic used by community hospitals in wisconsin to discredit the Aurora health system that is putting up nice new little hospitals there.

 

[LurkNoMore]

Not really in response to any previous post in particular, but my suggestion.... NO MORE CORPORATE HEALTH CARE PLANS!! Plans will be purchased by the individual for his/her family alone and he/she will be in charge of choosing the terms, coverage, deductable, etc. Of course, companies could still include a stipend or something along those lines for an employee to purchase their own insurance, but it would be the individual, not the corporation choosing.
Ok, why would this work? ABC inc. is not buying a group healthcare plan for what is best for its 20,000 employees (that is bad business), it is buying the plan that is best for its 30,000 STOCKHOLDERS (this is real life, maximizing the return on investment to encourage corporate growth) and shuts its employees up enough that they show up for work and don't strike. Let us all remember what the insurance company answers to: money. Now, most plans are being purchased by corporations and are purchased for reasons other than those that matter to employee # 12,296 and his wife and 2 kids.... So, when the corporation is no longer the one buying the plan, and only individuals are, insurance companies would have to begin listening to the individual (employee #12,296) b/c if they didn't, this empowered CUSTOMER would leave and buy insurance from the GEICO, ALL-STATE, or the 1-800-SAFE-AUTO equivalents of the insurance market. This is closer to a free market economy for the patient then what we have now. I mean, think about it, how many car insurance commercials do you see on TV talking about great rates, service, etc. vs. commercials for HEALTH INSURANCE (duh, it's b/c you are the one buying one of them, while someone else in a higher up position is being wooed to buy it for you in the other).
And while I'm ranting instead of reading for tmo, and before anyone says anything.... Yeah, something like what some dude said above about mandatory insurance for everyone (kinda like car insurance in most states), but with some sort of a income/hardship cutoff and..... (as much as I hate it) governmental regulations (say, perhaps tied in through the IRS, where if you claim to not meet the cutoff, and you really do, and they find out through your income taxes, they come after your ass IRS-style...). And sure, maybe some governmental minimum requirements for bare-bones insurance plans (I'm pretty sure it is like this in the auto-insurance industry). One more thing, no more doctors offices filing all of the paperwork for you and pre-approving this, and special authorizing that... your insurance, your problem... (end the end, this would eliminate most of the run-arounds insurance companies have created b/c the average Joe out there wouldn't tolerate all this BS and would say, Screw you BSInsure corporation, I'm switching to the Gecko b/c my buddy Phil says they don't make him do all that crap...)... Any way, my 52 cents.

 

[f_w]

- individual health insurance. employers may offer plans, but consumers are allowed to take the plan with them when they leave.

- remove health insurance from state regulation and have the feds oversee it (common commerce clause)

- make healthcare expenses (premium, out of pocket) tax exempt up to 25% of gross income

- allow part of the tax exempt money to be put into a healthcare investment account (to be stashed away and grow for the enormous healthcare expenses during retirement). Also allows coverage of premium expenses during times of unemployment/furlough (that way loss of a job in combination with health challenges doesn't have to end in homelessness).

Would this work ? Don't know, surely not worse than the employer based mess we have right now.

 

[deleted4401]

I understand that you can't make a comment without getting flamed or insulted, but the idea that I don't know that there is a federal regulation on providing ED care is ridiculous. It was in reference to exalted businessman and physician's Reddy's practice of not treating patient's in the ED. I was saying that if one were to make a consumer financed system without a third party, that coverage would still need to be included. I believe that health care is somewhere in between a privilege and a right (a right to AT THE LEAST emergency care). I have no need to google that law. Geez. The whole point of the post was in reference to Dr. Reddy's shoddy care that he provides.

Anyway, as far as the legal reference for the violation of anti-trust by price discrimination, the Robinson-Patman Act is one example. It prohibits the selling of goods at different prices solely on the basis of volume of products purchased. That is exactly what a hospital does when it accepts one price from privately insured patients and one price for the uninsured. I don't think it would be unfair to charge everyone the same price. One can make the argument that the insurers would just drive the price lower, but that is besides the point. Everyone should get the same price. Private insurers should be left out of the equation. The only people profiting should be the hospitals, physicians, and other staff. The idea that a third party should benefit is insane, especially when they do nothing but drive up costs.

-S

 

[f_w]

but the idea that I don't know that there is a federal regulation on providing ED care is ridiculous.

Well, your comments didn't seem to indicate knowledge of that fact. Sorry if I insulted your intelligence there.

I was saying that if one were to make a consumer financed system without a third party, that coverage would still need to be included.

'Included' as in 'provided for free' ?

I believe that health care is somewhere in between a privilege and a right (a right to AT THE LEAST emergency care).

And so does the federal goverment.

(the 'healthcare is not a right' police will come after you soon, brace yourself).

Anyway, as far as the legal reference for the violation of anti-trust by price discrimination, the Robinson-Patman Act is one example. It prohibits the selling of goods at different prices solely on the basis of volume of products purchased.

Sorry, this is from wiki:

These are the elements required for a RPA violation:

* discrimination in price;
* on at least 2 consummated sales;
* from the same seller;
* to 2 different purchasers;
* sales must cross state lines;
* sales must be contemporaneous;
* of "commodities" of like grade and quality;
* sold for "use, consumption, or resale" within the United States; and
* the effect may be "substantially to lessen competition or tend to create a monopoly in any line of commerce."

None of them applies to healthcare (it is a service not a commodity, rarely provided accross state lines, the healthcare is necessarily individualized .......)

The idea that a third party should benefit is insane, especially when they do nothing but drive up costs.

They also provide something called 'insurance' by pooling subscribers contributions so the guy with the 250k liver transplant is covered.

Nothing wrong with third party insurers. I would strongly favour if they where non-profit mutual insurers (like the 'sickness funds' in some of the goverment sponsored health systems). That way, the profits don't go into $6000 vodka pi$$ing ice sculptures of 'David'....

 

[McDoctor]

Pacemaker, single chamber $32,500 $22,500 –31%
Angiogram $5,211 $2,957 –57%

Gee, those wheren't highlighted for some reason.

Unless you snow in through the ED, you have a choice as to where you deliver you kid. Also, most ambulatory surgery procedures are elective and you have a choice of where to go.

As they have cancelled their managed care contracts, no patient is forced to go there for elective procedures and pay their prices.

Posting someones price list and pointing to it as something evil is the same diversion tactic used by community hospitals in wisconsin to discredit the Aurora health system that is putting up nice new little hospitals there.

Gee, I guess I didn't highlight them because they don't make my point. I selectively highlighted the potions that did. Nice work, Woodward. Or is it Bernstein?

Whatever. Invest in Prime Healthcare. I've got some Enron stock to sell you while you're at it.

My point is that this guy is stupid. I couldn't care less if he's evil or rude or mean to kittens...etc. His success will be short lived. You don't fall that far outside of the bell curve and turn that many hospitals excessively profitable that fast without commiting some form of fraud. If he was smart, he'd be laying low, making small gains, and staying off the pages of the LA Times.

The hospitals are making money by a subtle form of medicare fraud. They are jacking up prices and pillaging medicare's convoluted outlier reimbursement formula.

 

[f_w]

You don't fall that far outside of the bell curve and turn that many hospitals excessively profitable that fast without commiting some form of fraud.

Ah, interesting. He is successful, so he must be commiting some sort of fraud.

(wasn't there a senate majority leader who made his money flipping hospitals ?)

The hospitals are making money by a subtle form of medicare fraud. They are jacking up prices and pillaging medicare's convoluted outlier reimbursement formula.

So Sherlock Holmes, the guy is doing this since the early 90s. You don't think the feds or medical haven't figured out his evil scheme yet ?

 

[mgdsh]

I believe that health care is somewhere in between a privilege and a right (a right to AT THE LEAST emergency care).

Most people would argue that food, clothing and shelter are "rights" too (and probably bigger/more important "rights"), but I see myself having to pay for all three.

Everyone should get the same price.

Do we live in the same capitalistic free market society?

Private insurers should be left out of the equation. The only people profiting should be the hospitals, physicians, and other staff. The idea that a third party should benefit is insane, especially when they do nothing but drive up costs.

That's quite possibly the first thing you've said that I can agree with.

 

[McDoctor]

.

 

[McDoctor]

So Sherlock Holmes, the guy is doing this since the early 90s. You don't think the feds or medical haven't figured out his evil scheme yet ?

No.

Maybe if he was making phone calls to Saudi Arabia or Pakistan they'd look into it. Or if he was a pot smoker. Otherwise, medicare fraud is low on the government lists of priorities.

BTW I don't know that he's actually committing fraud, obviously. But I think it's likely occuring on some level, and probably by a method similar to the Tenet scheme. On a whole, I don't really care and can't believe I've posted on this topic this many times.

 

[f_w]

Otherwise, medicare fraud is low on the government lists of priorities.

I guess you have never worked at a place 'visited' by the OIG.

 

[deleted4401]

I can't believe I'd have to argue to colleagues that emergency care, health care for destitute and ailing children, and retirees is not a 'right', especially in a country as rich as ours. I know you have to pay for food and shelter. I think that is a smart-a$$ remark in comparison to a kid with neuroblastoma with no money or a person in an MVC and is bleeding out that may or may not have insurance.

Capitalism has no relation to the prices people should be charged. Using wiki as a source is probably not the best way to make an argument; anyway,I wasn't referring to that as a specific reference for health care, although I do think it can be interpreted to fit. If not a service, then the facility charge can be interpreted as a good (or the prosthetic hip or the valve that is replaced or the tongue depressor or whatever ... ), most insurers are based out of state, there are clearly more than two purchasers, and I believe the general intent of insurers is to create a oligopoly, if not a monopoly.

Not the point, really. I said below that it was 'an example' of a situation where you could not charge different prices to different people, as decreed by federal law. It was in response to the 'knee jerk' responses received about how 'un-American' it was to not be able to do that. That law has been 'American' since the 1930s, I think.

The AHA actually has a policy statement released to the public that they are trying to be in compliance with federal law that "seek to ensure that a hospital charges all patients receiving the same services the same price," and they are having trouble getting hospitals to be in compliance (b/c of private insureres driving the price down). The actual law, I'll come up with it, gotta look it up.

I'm still not understanding why one would think it's fair that those who are neediest get charged the most, and those that are protected pay the least. It's the working-poor that deserve a price break, isn't it? That's how you keep them out of the emergency room.

As far as pooling, I'm not ignorant about that. Risk-pooling is crucial to the success of our system. The idea of multiple private insurers is what I've been bemoaning. If you want to really spread out risk, multiple private insurers obviously don't do the job properly. In fact, most of the for-profit insureres do the opposite. They don't pool risk. They pool 'non-risk' - only having on their panels healthy, young, people without pre-existing conditions. There can be 'insurance' without multiple providers of it that are trying to make a profit ... I've heard of the 'insurance' concept.

My major issue is that guy is not the hero that the original poster makes him out to be. He's not providing a good service and he's eliminating badly needed ones. He's preying on the weak. He's turning away sick patients. He's treating shoddily. I'd rather defend OJ than this guy.

-S

 

[JMK2005]

I can't believe I'd have to argue to colleagues that emergency care, health care for destitute and ailing children, and retirees is not a 'right', especially in a country as rich as ours.

Healthcare CANNOT be declared a right by society without a system in place to fund it. The way I see it, hospital and doctors are currently shouldering the burden of indigent care because it's hard for us to turn away patients in need. Remember though, insurance companies have been denying "essential" care to patients for years, just that they do by fax, mail, and phone. No need for that face to face stuff.

 

[f_w]

or a person in an MVC and is bleeding out that may or may not have insurance.

The person with the MVC will get care before anyone knows whether he/she has insurance or not.

Capitalism has no relation to the prices people should be charged.

You'll have to explain that one to me.

Using wiki as a source is probably not the best way to make an argument;

Quoting a law that has absolutely nothing to do with healthcare pricing is probably not a good way to make an argument.

If not a service, then the facility charge can be interpreted as a good

Hoh ?

most insurers are based out of state,

Again, don't know where you practice (if at all), but around here the various insurers have local companies that license a national name. They might be owned by out of state entities, but in order to be licensed by the state insurance commissioner, they have to set up a local shop.

and I believe the general intent of insurers is to create a oligopoly, if not a monopoly.

Ah, I thought it was the hospitals violating the law by offering different prices to different buyers ? (the insurer is the buyer, not the seller covered under that law)

I said below that it was 'an example' of a situation where you could not charge different prices to different people, as decreed by federal law.

That law is intended that Ford can't drive business to his corporate owned retail outlets over his franchisees.

It was in response to the 'knee jerk' responses received about how 'un-American' it was to not be able to do that. That law has been 'American' since the 1930s, I think.

And probably rarely if ever enforced.

The actual law, I'll come up with it, gotta look it up.

I'm all ears.

I'm still not understanding why one would think it's fair that those who are neediest get charged the most, and those that are protected pay the least.

Nobody said it was fair. It's what the goverment requires us to do.

It's the working-poor that deserve a price break, isn't it?

Glad to give that price break (and in fact, a whole network of federal healthcare centers and community health centers does just that, provide services on a sliding scale basis).

That's how you keep them out of the emergency room.

By providing access to primary care, however that is done.

(what would actually keep some people out of emergency rooms would be a repeal of EMTALA and a reintroduction of the wallet biopsy)

If you want to really spread out risk, multiple private insurers obviously don't do the job properly.

They do just a marvellous job when it comes to homeowners insurance or car insurance. Smaller insurers will buy re-insurance to spread risks too large for them to carry. Why should the economy be different for health insurance ?

My major issue is that guy is not the hero that the original poster makes him out to be. He's not providing a good service and he's eliminating badly needed ones.

He is running a business and apparently successfully so.

 

[mgdsh]

Let me start off by saying I think you'd be much better off in some socialistic country. You seem to have alot of values/thoughts towards that direction. That is in no way an insult or an attack, just an observation.

I can't believe I'd have to argue to colleagues that emergency care, health care for destitute and ailing children, and retirees is not a 'right', especially in a country as rich as ours.

I know you have to pay for food and shelter. I think that is a smart-a$$ remark in comparison to a kid with neuroblastoma with no money or a person in an MVC and is bleeding out that may or may not have insurance.

You know yourself that it's not a "right." Theres a difference between what you are calling emergency health care and what you are calling a right. In most instances emergency health care is taken care of irregardless of whether the pt has insurance or not, as f_w pointed out.

While it would be nice to provide for all ailing children or retirees, it's definitely not a right. Those children have parents, and those retirees definitely had worked their entire lives. Now if they spent their money on something their health care, they wouldn't really have to worry about it.

Capitalism has no relation to the prices people should be charged.

Well see thats the fortunate and unfortunate thing about medicine in certain situations. Usually you worry about the bill after and are treated first. But this is a free market capitalistic country. Someone offers a product and a service, a buyer accepts that at a price he/she agree to. If they don't agree, there's no transaction/sale. You are free to set any price you want to, providing there is someone to pay for those prices.

I mean honestly after thinking about it for a bit, not only do hospitals charge more to uninsured people to help make up for the large number of uninsured that never pay, but also to somewhat encourage these people to get health insurance in the first place.

Now that can easily turn into a whole different argument about if/how these people can afford health insurance. Personally I feel like in this country especially most people have the opportunity to make something of themselves. I have know people that have come from other countries, lived in some bad neighborhoods, barely spoke much english when they came here, had parents who were educated enough just to get by in jobs like working at taco bell or similar minimum wage jobs, only to make it in this country as doctors, engineers, businessmen/women etc. I whole heartedly believe that everyone can do well for themselves if they are willing to work hard.

On the contrary I've also seen rich spoiled kids who've had everything their entire lives, living in luxury, only to amount to next to nothing aside from hanging on their parents coattails, because they didn't want to work hard and didn't find the desire inside themselves to work hard.

I'm still not understanding why one would think it's fair that those who are neediest get charged the most, and those that are protected pay the least. It's the working-poor that deserve a price break, isn't it? That's how you keep them out of the emergency room.

I agree with you to some extent. On a direct level those needier people probably pay a bit more, but most of them actually don't pay to begin with. They also don't pay nearly as much in taxes as those insured people you are talking about. Those insured people do basically pay for the health care of the uninsured indirectly (through taxes, etc).

My major issue is that guy is not the hero that the original poster makes him out to be. He's not providing a good service and he's eliminating badly needed ones. He's preying on the weak. He's turning away sick patients. He's treating shoddily. I'd rather defend OJ than this guy.

I'm really not sure how you can judge the quality of the service he's providing. He's eliminated some services yes, but he's running a hospital which is still a business. He needs to stay in business or he won't be able to provide any services at all. If anything I see the point of the article is that he's hurting insurances more than anyone else. He's basically stopped dealing with insurance companies that will not even cover the cost of their own patients, yet you make him look like the bad guy. I'm sure he would love to treat all the patients he can, but why is he supposed to take the loss. Why is it OKAY for the insurance company to push the loss off on him?

 

[mgdsh]

Just a random thought...

Maybe a lot of our problems with insurance companies/medicare/medicaid would go away if we were simply able to write off what we weren't paid for.

In any other business/industry, when you aren't paid for your services by a customer, or someone defaults on what they owe you, they can be written off... so why can't we do something like that?

That would solve almost all the problems hospitals and doctors have with insurance companies. While those companies would continue to do business the way they are, we would make up for our losses on that end by paying less in taxes?

Of course they could continue to squeeze us even more. But then I thought, why not have them pay that portion, or run all health insurance companies as non-profit organizations?

But alas, that's nothing but a dream. That would never happen. There's far too much $$ going from the pockets of the big boys who run these insurance companies directly into the pockets of the congress men/women who run this country.

 

[deleted4401]

Only here do you get told "you'd be better off in some other country" if you disagree with some of it's policies. Everyone has similar goals for our country (and our health care system), but they may have different views on how to get there. We all want to treat patients with autonomy, see everyone get treated to the best of our technology, and make a good living. It doesn't mean you'd be better off in some "socialist" country if you disagree with others ... So much for discourse. It's "like or leave it", I guess.

By the way, it's not only 'socialist' countries that have eliminated third party insurers - Japan, South Africa, Hong Kong.

-S

 

[3dtp]

Sim,
As usual you have given us food for thought. I think it arose as part of the Teddy Roosevelt "Trust-busters" activities early in the 20th century. At that time, the Carnegie/US Steel empire was working with the rail roads to drive out competition and nearly did so through a practice known as "predatory pricing." By dumping steel on the market at money losing prices they were able to force competition to cut prices further or lose sales. Either way the competition lost, either by bleeding a slow economic death by losing money on each sale or rapidly by selling out to USS at a bargain price. This is what the Robinson Act was supposed to halt, and to enhance the other antitrust laws.

Robinson is, as you pointed out, a federal law, but it is only applicable to commodities and since it is federal, the Interstate Commerce clause applies. Since you don't practice medicine across state lines, it fails both of those tests. You are free to compete and negotiate a fair price with any and all comers. Now imagine if it did apply? We could all tell the insurance companies and medicare to stuffit. Here's our price, pay or leave.

Now, boys, please be nice to Sim. She's bright, articulate, has the qualities of the good Samaritan. She and I disagree on a number of important issues, but we do agree that we should be encouraged to speak out and debate interesting and challenging issues without being told, "My country...right or wrong" and "If you don't like it here go somewhere else." I will defend to the death the right of Sim or anyone else to debate, in this forum or anywhere else reasonable, what we are doing right and what needs fixing. If we can't do this, we become like those other countries, and having lived in some of them I really don't want to go there.

And besides, I learned something here today.

 

[mgdsh]

Only here do you get told "you'd be better off in some other country" if you disagree with some of it's policies. Everyone has similar goals for our country (and our health care system), but they may have different views on how to get there. We all want to treat patients with autonomy, see everyone get treated to the best of our technology, and make a good living. It doesn't mean you'd be better off in some "socialist" country if you disagree with others ... So much for discourse. It's "like or leave it", I guess.

By the way, it's not only 'socialist' countries that have eliminated third party insurers - Japan, South Africa, Hong Kong.

-S

Nah see, It was never like that and I'm sorry if it came off like that. It was a thought and thats it.

I do see that you have a very noble perspective on all of this, but I also feel like you are making the Dr. in question from the main story out to be the villain when in fact all he's doing is fighting the real villians (the insurance companies).

I also can see that it bothers you that on a direct basis the uninsured and lower class are getting charged more for similar care. I think that if you'll take a look at a bigger picture, you can see that they are getting paid for in more ways than they realize and on a much larger scale.

I've mentioned this in another thread: Most of us would love to see everyone taken care of and for there to be no disease/suffering. But part of that is life. The other part of it is that if you give everyone something for free, they are also more likely to take it for granted (not just the health care, but their own health), which wouldn't be a good thing. Most of us would also agree that some type of emergency blanket coverage should be provided, and some of us would even say that it already basically is. But defining exactly what falls into what category is very difficult.

Right now every time a patient can't pay / doesn't pay, or an insurance company doesn't / won't pay the full amount bill its doctors / hospitals that shoulder the burden. I'm sure we all can agree that is clearly a huge problem with the state of health care today.