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Re: Americans want universal health coverage
Old 06-13-2006, 10:00 AM   #141
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Re: Americans want universal health coverage

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Social Security and Medicare (which are independent stand-alone insurance programs, not government "handouts")
while not "handouts", i'd guess they don't meet the criteria for "insurance" and when it hits the fan we'll more clearly see they are not "stand-alone" (because it's already clear they are not able to).
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Re: Americans want universal health coverage
Old 06-13-2006, 10:06 AM   #142
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Re: Americans want universal health coverage

Social Security would be stand-alone if we didn't steal its surplus for other (much less useful) purposes. And remember that SS also provides disability, widow/orphan, and non-working/lower-earning spouse coverage in addition to retirement income for workers.
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Re: Americans want universal health coverage
Old 06-13-2006, 10:14 AM   #143
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Re: Americans want universal health coverage

LADELFINA: Thank you. Repeating what Bosco said.

lets-retire:
Quote:
Medical resources are finite.
So when do you "market mavens" start talking about baking a bigger pie? Why give up so easy. Like ledelfina said: WHere's the American "Can-do" spirit?

As far as all your other schpiel about the VA as evil gov medical... I know. I gave up on the VA and sure as hell do not advocate a "military" type Company Store medical system but quite franky you are not pointing out failures inherent in "government" health care. All you are talking about is a management problem. Run it Different. Run it better.

All those F'-ups your VA has I have experienced in a top rated hospital system in a major metro usng fee-for-service insurance.
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Re: Americans want universal health coverage
Old 06-13-2006, 11:09 AM   #144
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Re: Americans want universal health coverage

The quality of care argument is a red herring.

I've had crappy medical care at high fahlutin hospitals and good care from an hmo that has a horrible reputation.

I've gotten a lousy job done changing my cars oil for $40 at a jiffy lube and a pretty good job done for $15 at walmart. Everones got a story, and anecdote and a mindset.

Further, the idea that you would be 'prevented' from receiving additional paid-for care makes no sense. On one hand we have people arguing to let the free markets determine the course, then the same folks argue that the free markets would turn a blind eye to a profit source if one were available.

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Re: Americans want universal health coverage
Old 06-13-2006, 11:35 AM   #145
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Re: Americans want universal health coverage

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Originally Posted by Cool Dood
living in a place like Canada, where most private medicine and most private post-secondary education is banned, I can see that there are even deeper problems that affect all strata of society, including (if not especially) the poor.
I've been wondering why the coyotes aren't smuggling Americans across the border from Maine & North Dakota.

I understand this may have been a CHP, but are you implying that Canada's "deeper issues" are caused by bans on private medicine & post-secondary education?* If so, please dish in a new thread!

Po Bronson's "Why Do I Love These People" had a chapter on a family in Belfast where a university degree was a Very Bad Idea.* There was considerable honor in supporting your family/party/religion by taking an honorable trade, but if you went to university then you were abandoning your family and deserting your politics/religion to the struggles.* Families were actually cutting ties to their traitorous children.

Of course if you were in a Belfast minority and couldn't get into an honorable trade, then the university degree was your ticket out.*
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Re: Americans want universal health coverage
Old 06-13-2006, 11:42 AM   #146
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Re: Americans want universal health coverage

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Originally Posted by Nords
I understand this may have been a CHP, but are you implying that Canada's "deeper issues" are caused by bans on private medicine & post-secondary education? If so, please dish in a new thread!
Um, if you'll explain what a "CHP" is, I'll try to "dish in" a new thread.
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Re: Americans want universal health coverage
Old 06-13-2006, 11:52 AM   #147
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Re: Americans want universal health coverage

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Originally Posted by Cool Dood
Oh, and if I said anything stupid here, well, I've had a few drinks again.
Quote:
Originally Posted by Cool Dood
Um, if you'll explain what a "CHP" is, I'll try to "dish in" a new thread.
"Cocktail-hour post"...
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Re: Americans want universal health coverage
Old 06-13-2006, 12:22 PM   #148
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Re: Americans want universal health coverage

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Originally Posted by bosco
Ladelfina, thank you for eloquently stating what I wanted to say but couldn't find the words for! And, you did it without rancor! Good job.
Dito for me -- that post captured a lot of what rattles around incoherently in my head. Ladelfina sounds like what Kos describes as a "libertarian Democrat." No offense, if that is far from where you view yourself.
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Re: Americans want universal health coverage
Old 06-13-2006, 12:26 PM   #149
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Re: Americans want universal health coverage

ladelfina: *Unfortunately the gov't has already figured out that the Medicare type program is more expensive than buying insurance. *That is why the gov't employees and military dependents are covered under a private insurance company. *If a doctors primary source of income is from the gov't who do you think runs the doctor's office? Think of Walmart when contemplating this question. *It is my understanding that the medical schools are fairly well filled up, so where do we train the doctors, nurses, PA's? *We would have to either open more schools or add more teachers. *And where do you get these teachers? *From the treatment rooms, so now there's fewer doctors available to provide treatment. *Do we force people to go to medical school if they show an aptitude for medicine?
Quote:
Social security, Medicare, and Medicaid are not only the most popularly-supported of all government programs, they are also seen objectively as the best-run and most efficient. Whether Medicare has enough money to pay for the services people need is an accounting question and a matter of political will, not an inherent limitation of the system.
Popular support does not equate to the best spent money. *Social Security is one of the best most efficiently run programs??!!? *They are going bankrupt and not just because they are being raided. *The amount being removed is a surplus right now. *Many Medicare recipients now carry their own private insurance, because Medicare fiscally couldn't keep up the the demand so they cut benefits. *Heck if we take all of the "accounting questions" out of the equation then I could retire now. *Too heck with money I don't need that. *Having the gov't just paying the bills won't work. *They will have to hire the insurance companies adjusters and claims handlers, so your savings just went out of the windows. *Unless your just going to give a doctor a blank check, the claims and services will have to be reviewed.

Social Security and Medicare whether they are viewed as gov't handouts or insurance are run by the gov't with little if any private industry oversight.

Quote:
All you are talking about is a management problem. Run it Different. *Run it better.
Ya great idea. *Unfortunately, again pie in the sky. *Talk to people who are complaining about things now and compare them to the complaints from 10, 20 or 30 years ago, you'll see they are very similar complaints.
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Re: Americans want universal health coverage
Old 06-13-2006, 12:50 PM   #150
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Re: Americans want universal health coverage

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Originally Posted by Nords
"Cocktail-hour post"...
Well, yes, that was definitely a cocktail-hour post. But the bans on free exchange of medical and educational service do have very real impact in Canada just like in North Korea or Cuba. Without private colleges the professor-student ratio drops and in the absence of that huge source of research positions, many of the best and brightest Canadians move to the U.S. Same with the absence of private hospitals, and a lot of our best doctors head south. This brain drain has long-lasting and major effects on society. The economy is hurt severely by the bans, leading to fewer and worse-paying jobs, resulting in more poverty. The lower-middle class can't afford the only readily available private care if they need it, i.e. flying to the U.S. -- the ban has just deprived more people of top-tier care by raising the "rich bar" higher, instead of getting rid of two tiers -- which hurts the lower-middle class, as well as putting them in the same line as the poor which makes the poor's access to care even worse. etc., etc... it's a long and sordid tale, not something I can cover comprehensively right now, or perhaps something that I personally am not well suited to cover comprehensively ever.

At any rate, the effects are very far-reaching, and if you don't believe me then you can still make some empirical observations about the effects on whatever aspect of society interests you from the laws implemented in Canada, N. Korea and Cuba, which I believe are the only three countries that have banned private medicine. (For me personally, I can even compare the quick, effective, universally available service my pets get to the crappy service I can get for myself, and I only managed to snag service at all through personal connections -- current waiting list to get a family physician is around 30,000 in this city of 300,000.)
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Re: Americans want universal health coverage
Old 06-13-2006, 02:20 PM   #151
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Re: Americans want universal health coverage

Cool Dood: if Canada bans private doctors and private education, that is wrong, wrong, wrong! I'm sorry that's the case. If that makes me a 'libertarian Democrat', then I guess that's what I am.

lets-retire: I don't see the big difference between the gov't. regulating some payments versus Wal*Mart beating down their suppliers. Is Wal*Mart more virtuous just because it's private?*

We shouldn't "force" people to go to medical school any more than we should "force" people to become astronauts. But in one case we found the will to produce astronauts.

Right now, it may not be the government that "runs" the doctors' offices, but it is sure as hell IS the private insurance companies!! Either way, health care professionals have to deal with someone who says they won't pay more than 'x' for a particular service. If that ends up being the case, in the public example you have 10%-25% off the top extra to spend, minimum. And the doctor and his/her staff have to deal with one set of regs and forms, not 30 different ones requiring several members of staff to sort out.

Paul Krugman of the NYT (bolding mine):
Quote:
A little background: conservatives have never mounted an attack on Medicare as systematic as their effort to bully the public into privatizing Social Security. They do, however, often talk about Medicare "reform." What this amounts to, in practice, is a drive to replace the traditional system, in which Medicare pays doctors and hospitals directly, with a system in which Medicare subcontracts that role to private H.M.O.'s.

In 1997 Congress tried to take a big step in that direction, requiring Medicare to pay per-person fees to private health plans that accepted Medicare recipients. There was much talk about the magic of the marketplace: private plans, so the theory went, would be far more efficient than government bureaucrats, offering better health care at lower cost.

What actually happened was that private plans skimmed the cream, accepting only relatively healthy retirees. Yet Medicare paid them slightly more per retiree than it spent on traditional benefits. In other words, instead of saving money by subcontracting its role to private plans, Medicare was in effect required to pay H.M.O.'s a hefty subsidy.

The only thing that kept this "reform" from being a fiscal disaster was the fact that after an initial rush into the Medicare business, many H.M.O.'s pulled out again. It turns out that private plans are much less efficient than the government at providing health insurance because they have much higher overhead. Even with a heavy subsidy, they can't compete with traditional Medicare.
http://www.pkarchive.org/column/032604.html

I haven't investigated this yet personally; I am taking him at his word. (plus, it's the cocktail hour!) But I don't see how the government, as an insurer of first resort, rather than an insurer of last resort, can be any worse than the situation we have now. The government, as lets-retire says, has not "figured out" a whole heckuva lot.. The insurance lobbyists dole out big bucks, and that money talks... loudly. My dad, a surgeon, spent several hours each night dealing with BC/BS paperwork, and that was just the predominant insurer of the day in our area. That talent could have been better spent elsewhere. Now it's worse: the last time I saw a PCP in the US, she indicated at least 30 different companies' regulations that she had to contend with before conceding or denying this or that form of treatment. How is that better/desireable? Does it help the patient, or just help employ bean-counters?

It's just like the new Medicare plan D "reform".. how can you choose the plan that will cover your meds based on a private "plan" that can change at any time without informing you (but you have the chance to switch only once a year, during the "open enrollment" conceded by the insurance companies?). I hope Rich can chime in again with his current, real-life, experiences vis--vis Medicare and other insurance providers and their relative performance.
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Re: Americans want universal health coverage
Old 06-13-2006, 05:31 PM   #152
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Re: Americans want universal health coverage

Many years ago, I had a professor criticize the AMA.* He said they specifically did not want universal health care and that they limited the number of doctors graduating with medical certifications.* Do they, can they still do that?* I mean, half the docs in town here are from India, and they are good.* Best heart surgeon in town is from India.* One of the given reasons for AMA's actions was that it took so long and so much money to get through medical school.* Would that not be a way to increase care.* Just pay for their medical schooling, internship, etc. and churn out the doctors.* Just trying to think outside the box, and for all I know somebody has already proposed this.*
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Re: Americans want universal health coverage
Old 06-13-2006, 05:45 PM   #153
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Re: Americans want universal health coverage

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Originally Posted by Eagle43
Many years ago, I had a professor criticize the AMA. He said they specifically did not want universal health care and that they limited the number of doctors graduating with medical certifications. Do they, can they still do that? I mean, half the docs in town here are from India, and they are good. Best heart surgeon in town is from India. One of the given reasons for AMA's actions was that it took so long and so much money to get through medical school. Would that not be a way to increase care. Just pay for their medical schooling, internship, etc. and churn out the doctors. Just trying to think outside the box, and for all I know somebody has already proposed this.
Contrary to popular belief, the AMA is, well, irrelevant. No one I know used them for anything but their journal JAMA, and for group insurance for members. The don't set policy, they don't really speak for any identifiable constituency, and are a dinosaur in many ways. They have no control over medical school size or specialty selection. I have not belonged in decades. Maybe through the early 1970s it was a different story.

To be fair, they are a great source of manpower surveys and physician demographic analysis and do lots of good things regarding voluntarism, etc. But as far as the political landscape, nada. Specialty societies have largely replaced them, IMHO.
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Re: Americans want universal health coverage
Old 06-13-2006, 06:12 PM   #154
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Re: Americans want universal health coverage

Back a bazillion years ago when the govt first wanted to implement DUI laws, they went to the AMA for guidelines. The laws being kicked around proposed a .14 BAC as the point where an average driver would become impaired. After presumably extensive analysis the AMA came back and...surprise...found that .14 was where a driver in fact became impaired.

A few years later, the newer laws called for .10 as the limit. The AMA was consulted and...wow...in just a few short years american drivers lost some of their ability to hold their liquor and were now impaired at .10.

Guess what happened when MADD pushed new legislation for .08 and the AMA was consulted...

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Re: Americans want universal health coverage
Old 06-13-2006, 06:42 PM   #155
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Re: Americans want universal health coverage

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Originally Posted by ladelfina
I hope Rich can chime in again with his current, real-life, experiences vis--vis Medicare and other insurance providers and their relative performance.
Happily, someone else does my billing for me these days, but here is a quick primer:

1. MD has to choose whether to be a "participating provider" or not. No, means that you bill the patient and the patient pays you, then the patient tries to get reimbursed from MC. Yes means that you agree to accept as payment in full anything MC decides is OK for your services, i.e. a humungous discount approaching your actual costs in some ways. Then you have to separately bill the patient for the 20% usual copay up to the "allowable" amount.

2. If you do NOT participate you can accept assignment (i.e. MC's approved rates) on a case by case basis. You get paid slower and...

Medicare automatically takes 5% off their approved amount for NON-participators when you do accept assignment, so you take another hit. It is routine for MC to deny claims with messages to your patient that MC has determined that the test you just had is "medically unnecessary." Imagine the calls this generates, with patients very unwilling to pay their copay in this instance. So you appeal, resubmit with more or different information. 90-120 days later you may get your $20 for a $50 office visit for which MC "approved" $20.

Then you get to bill the Medigap carrier.

There's more, but you get the idea.

Kafka, anyone?
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Re: Americans want universal health coverage
Old 06-14-2006, 03:48 AM   #156
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Re: Americans want universal health coverage

Urgh! Sorry, Rich.. that sounds like a total drag. You would be tempting me to rethink my position, but I've also had surprise bills show up from my HMO for things that, six or eight months after the fact, they decided not to cover.

How can we, either as doctors or as patients, prevent being blindsided by rejected claims?

What would your vision be of how we could improve the system?

Thanks for taking the time to share your expertise with us!

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Re: Americans want universal health coverage
Old 06-14-2006, 07:51 AM   #157
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Re: Americans want universal health coverage

Quote:
Originally Posted by ladelfina
lets-retire: I don't see the big difference between the gov't. regulating some payments versus Wal*Mart beating down their suppliers. Is Wal*Mart more virtuous just because it's private?*

Right now, it may not be the government that "runs" the doctors' offices, but it is sure as hell IS the private insurance companies!! Either way, health care professionals have to deal with someone who says they won't pay more than 'x' for a particular service. If that ends up being the case, in the public example you have 10%-25% off the top extra to spend, minimum. And the doctor and his/her staff have to deal with one set of regs and forms, not 30 different ones requiring several members of staff to sort out.
You got the Walmart reference correct in your first sentence, so I won't address your second. Heck they ever were able to force concessions from Coke, a major company. Would you as a business owner like to have one major company (being the gov't in this case) giving you money or several smaller ones (being several insurance companies). Yes it is a pain that you have to know each comapnies policies, but I'm sure each one has a different payment amount. Some you make from others not so much. Personally I'd rather have 100 different income sources than just one (wasn't that idea in the Millionaire Next Door?).

On a related note I just saw this want ad: F/T MEDICAID/ MEDICARE Representative needed. Must have minimum 2 yrs. experience in followup of denials and aging reports. So the feds still have denial of payments just like the private companies.
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Re: Americans want universal health coverage
Old 06-19-2006, 08:26 PM   #158
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Re: Americans want universal health coverage

Thought this might be fitting under this category, it's an e-mail that's being passed around.

American Health Care

Two patients limp into two different American Medical clinics with the same complaint. Both have trouble walking and appear to require a hip replacement.

The first patient is examined within the hour, is x-rayed the same day and has a time booked for surgery the following week.

The second sees the family doctor after waiting a week for an appointment,
then waits eighteen weeks to see a specialist, then gets an x-ray, which isn't reviewed for another month and finally has his surgery scheduled for 6 months from then.

Why the different treatment for the two patients?

The first is a Golden Retriever.....

The second is a Senior Citizen.
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Re: Americans want universal health coverage
Old 06-20-2006, 01:59 AM   #159
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Re: Americans want universal health coverage

Quote:
Originally Posted by ladelfina
How can we, either as doctors or as patients, prevent being blindsided by rejected claims?
It seems to me this is a problem that has to be solved by legislation and enforcement. There needs to be "safe harbors" where if a certain set of conditions have been demonstrably met, then the claim cannot be rejected. And for situations where the "safe harbors" don't apply, the insurance companies need to be held responsible for evaluating the evidence in a timely fashion and coming to a decision before the procedure happens.

The absolute worst part is the way doctors require patients to sign a statement saying if the insurance company rejects a claim the patient has to pay. Even if the doctor is "in network" for their insurance company.

If the doctor and insurance company have established a contract for working together to decide what procedures are covered, why should the patient bear the fallout when they can't agree? It's really extortion on the doctor's part... they are saying "we won't give you the covered treatments we've agreed to provide to your insurance company, unless you agree to pay if we disagree with your insurance company." They can get away with it simply because the healthcare industry isn't sufficiently competitive. No matter whether you think it should or shouldn't be more competitive, the fact is that right now it's not competitive and legislation needs to address the tyranny of the weak (consumer) by the strong (insurance and medical establishment).
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Re: Americans want universal health coverage
Old 06-20-2006, 06:56 AM   #160
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Re: Americans want universal health coverage

I just received two pieces of mail illustrating the exact point here.

BlueCrossBlueShieldIL sent me a statement of what they paid to Northwestern. For services that have been under review since Oct1, 2005.

Couple of days later Northwestern (which has 3 divisions that charge seperately) sent me something saying BCBSIL paid $3400ish, and they discounted $$2,500ish and some of the total of $9500 is still under review.

I looked it over and have no idea what either is talking about, they use different dates of treatment, different #s. Absolutely no way to know what's going on.

Something is very wrong with healthcare vs insurance.
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