HIPAA costs ?

[mykidslovedogs]

Martha,

I am actually NOT in a guarantee issue state, but in my state ALL EMPLOYER SPONSORED HEALTH PLANS are guaranteed issue so no employees can be denied coverage or have exclusions on their policies, regardless of age, and we have a high risk pool HIPAA plan that anyone who is uninusurable can qualify for. Yes, the rates are higher due to the fact that is is guaranteed issue, but it is still better than having no insurance at all.

The individual and family market in my state is medically underwritten, and that is OK with me.

I guess we will just have to agree to disagree on the personal responsibility issue. I just don't think there is anything wrong with it. If I decide to have kids, then I should be ultimately be responsible for their education, not someone else. If I decide to live an unhealthy lifestyle, then I should be responsible for the healthcare costs associated with that. If I want to retire young, then who better to manage my portfolio than myself and those I pay to help me? If I want to retire at all, then I should be the one to plan in advance by saving money for the future and purchasing the proper insurance to protect my assests as I get older. These are just basic responsibilities. If someone is going to check out because it is so complicated, then let them suffer their own consequenses. We reap what we sowe.

There is already enough goverment regulation in the insurance industry and in the healthcare industry. Medicare and Medicaid, I believe, are two of the primary reasons for extremely expensive health insurance premiums. Here is why I believe that. Just think of the general philosophy. In order to fund Medicare and Medicaid we have to tax people. The amount of money that the government raises to pay for Medicaid and Medicare is not enough to cover our healthcare provider's basic exepenses (overhead, equipment, employees, LIABILITY INSURANCE, and the general costs of doing business.) Therefore, Doctors have to charge more to the PRIVATE sector in order to compensate for the pennies on the dollar that are paid to them by Medicaid and Medicare. The higher prices that are passed on to the private sector trickle down to the INSURED in the form of higher health insurance premiums. Higher health insurance premiums mean fewer people will be insured. Fewer people insured means more people on Medicaid, and more people on Medicaid means higher costs for the private sector, and so on and so on.... the more the government gets involved, the worse the problem becomes...

I believe and agree with you that some regulation is definately necessary, but I think it would be disastrous to nationalize the entire system. There has to be a happy medium in there somewhere. I think it is inexcusable and irresponsible for people to wait until they are in dire straights and then expect someone else to bail them out. We are all going to either live a full healthy life, die, get sick or become disabled at some point. It is irresponsible to pretend we are invinceable and expect someone else to take care of us because we failed to plan ahead.

 

[Rich_by_the_Bay]

These are just basic responsibilities. If someone is going to check out because it is so complicated, then let them suffer their own consequenses. We reap what we sowe.

I have been following this discussion, and have a few words from the front line (Mykids - I'm a doctor with a lot of years in primary care and cancer care). The arguments you give are cogent, but I almost always hear them with such fervor from people who are blessed with good heatlh and adequate resources.

Unfortunately, we're outnumbered. There are millions of hardworking folks who don't choose to get sick, and don't follow a lifestyle that makes them sick. They just get sick. Cancer, heart disease, debilitating diseases, on and on. And despite their best efforts, they go from "gettin' by" and sick to impoverished and sick. Impoverished and sick is not a good thing to be in the current system.

And their are ready-to-retire folks who planned and saved for decades and now are sensibly afraid to retire because of health insurance fears or costs. Lots of gaps in the system. If you don't happen to be caught by any of them, all the better for you. But I feel it is important and right to think about those who are caught through no plausible cause or choice of their own. Yes, we subsidize their care, but they are far from well-cared for.

We need a safety net desperately.

 

[mykidslovedogs]

Rich in Tampa,

I really am not a calloused insensitive person. I understand that there are so very many people that don't choose to get sick, but why oh why can't they have planned better while they were young and healthy? Even paying regularly for a $2000 deductible/100% high deductible healthplan, kept in place for life, is better than going into financial ruin. We pay for our own home owner's insurance, we pay for our own car insurance, some are even smart enough to purchase their own life insurance so their loved ones won't be financially devastated when they die....so why do we think it is up to others to pay for our health insurance/healthcare costs? Most of us will get sick or disabled someday...Especially now that people are living longer and longer...so why is it so bad to ask people to plan for that?

Maybe the people you work with didn't know better, so they depended on employer-sponsored benefits all of their lives and then lost their benefits when they became unemployed. It's too bad that someone didn't teach them about the long-term consequences of depending on employer-sponsored health insurance.

I am fortunate enough to be healthy right now, but I have had in place, for many years, a plan to protect myself in the case that I do become ill, and it is a personal, high-deductible, HSA compatible health savings account. So far, I have saved so much in premiums that I have been able to save, on a tax-deductible basis almost two times my deductible. Therefore, if I get sick, I already have my own safety net in place to protect myself. My deductible is $5150.00. Since I have already been able to save almost $10,000, I basically don't have to worry about any healthcare costs for at least two years if I get sick. Granted, I have made my savings a priority, so I have sacrificed things like vacations and a big, fancy house in order to plan for an early retirement. What is so bad about asking others to do the same thing, so that I don't have to sacrifice even more to pay for their healthcare costs?

I really don't want people to have to suffer. That's why I feel it is so important for us to teach our young to plan ahead. Simply saving for retirement is not enough. We need to teach our young to insure and protect their assets IN CASE the unthinkable happens. Granted, some are sick from birth, but for those that could have planned, why? Why do we need the goverment in everything?

We DO have some safety nets. Unfortunately, they are government-sponsored, so they lack quality. Why do people think that nationalizing health insurance will give us anything better that what we already have? I fear that all "nationalized healthcare" will be is a bigger and even more poorly managed Medicaid system.

What I am saying is that there doesn't have to be gaps in the system. Let's work on changing the cultural entitlement mentality. Let's encourage people to purchase coverage for themselves when they are young and healthy instead of teaching them to depend on employer sponsored benefits. What is so wrong with teaching our young to take care of themselves...to plan for the worst case scenario so that they don't end up like the millions of hardworking folks who never purchased good health insurance while they could qualify for it, and who ended up in financial ruin because of it?

 

[Martha]

Martha,

I am actually NOT in a guarantee issue state, but in my state ALL EMPLOYER SPONSORED HEALTH PLANS are guaranteed issue so no employees can be denied coverage or have exclusions on their policies, regardless of age, and we have a high risk pool HIPAA plan that anyone who is uninusurable can qualify for. Yes, the rates are higher due to the fact that is is guaranteed issue, but it is still better than having no insurance at all.

I misunderstood your post. What state are you in? In any event, federal law does provide that if an employer purchases group coverage, the insurance company cannot exclude someone from the group. However, the insurance company may in fact underwrite the group and decide not to bid on coverage. Also, there is portability in that you can switch jobs and join the new employer's group plan. The same rules do not apply to the individual market, which is for the most part not regulated.

We reap what we sow.

Rich addressed this point well but I feel the need to comment. I have many stories. I know a woman whose husband was killed a few months ago. He was an LPN, and earned not a whole lot. She stayed home with the kids. After he died, she could buy continuation insurance through COBRA for a period of time. She had to cash in his retirement account to pay the premiums and pay living expenses, like the mortgage, while she tries to find work. If she doesn't find a job she is in deep trouble as she will run out of money. She essentially has no work experience. I hope she finds a job with benefits. I hope she finds a job period.

I know a woman who worked in a health food store. No health benefits. Little money in the family. She had a lump in her breast. She delayed going to the doctor because of the cost. It was cancer and she died. Maybe 20 years before she should have bought an individual insurance plan, but she didn't. Hardly anyone does--the individual market is only 4% of the market. Time goes by. You lose the job that provided insurance. You get one that does not and you no longer can afford to buy.

There are a number of people who have jobs that pay $20,000 or $30,000 a year. They get along if they have insurance through work. Some do. Some don't. A job loss, a divorce, a death in the family, can lead to catastrophe. I believe most of them are doing the best they can with the resources they have. There are 46 million uninsured. This number is increasing every year. More and more employers are dropping health plans. This is more than a failure of personal responsibility. This is a national problem.

HSA's are fine if you have money and are healthy.

I understand that there are so very many people that don't choose to get sick, but why oh why can't they have planned better while they were young and healthy? Even paying regularly for a $2000 deductible/100% high deductible healthplan, kept in place for life, is better than going into financial ruin. . . .

Let's encourage people to purchase coverage for themselves when they are young and healthy instead of teaching them to depend on employer sponsored benefits. What is so wrong with teaching our young to take care of themselves...to plan for the worst case scenario so that they don't end up like the millions of hardworking folks who never purchased good health insurance while they could qualify for it

And why would you assume that the individual market will be better? It is only 4% of the total market. Given that it is such a small part of the total market I wouldn't call people who didn't buy into it poor planners. The market itself has changed tremendously over the years. Know anyone who has had the same individual insurance plan for 40, 50 years?

 

[mykidslovedogs]

Martha,

I think you are misunderstanding my intentions. We need to change the mentality for FUTURE generations. There is no simple solution for those who are suffering now, and nationalizing health insurance is not going to be a good solution for FUTURE generations. I believe it will only compromise the quality of care that the USA currently has to offer.

What's done is done. We know that employer sponsored benefit plans lead to catastrophe, because spouses of the disabled and of retirees and of those who pass away pre-maturely are left with huge financial burdens. We know the government systems that are currently in place are not working very well. It's very sad that people have had to suffer for it.

Why not teach our young now to plan for their own futures so they don't end up like the ones who are suffering now? Individual insurance is a good solution. High deductible health plans are NOT only for the rich. The premiums are very low. In fact, they are probably less than car insurance if purchased when we are young and healthy. If we buy HSAs while we are young and healthy, we will have plenty of time to save and plan for the unthinkable. It is not that hard to put away a little bit each month to cover our own deductibles. We don't need to wait until we are sick and then hope we have enough money to pay for our deductible. We can save in advance so that we have a safety net in place when it comes time to pay for a deductible expense.

I'm not saying that high deductibles health plans are the perfect solution for those that are already sick or who are currently facing financial burden. What I am proposing is that we teach the younger generations now how to use HSAs to their advantage to plan for their own safety net, instead of counting on the government to take care of them.

In the meantime, yes, there are many that will not have any other choice but to work on obtaining medicaid or work on getting into a guaranteed issue HIPAA plan or who even end up with devastating financial burden until they can qualify for Medicare at age 65. That is very sad. But if we teach the younger generations now how to plan for their futures, surely we can eliminate some of the problems that people face today. If they are financially able, but still refuse to plan for their own futures, then why should everyone else pay for their mistakes?

Granted, there will always be a certain percentage of people who live below poverty level and who will not be able to afford individual coverage, and there will always be a certain percentage of people who will never qualify for individual coverage, so let there be some government-sponsored care for those people. But, let's not force EVERYONE into the same government sponsored programs. By nature, any kind of government-sponsored program is going to lack quality, so why should we force the masses to have low quality care so that the few can have better care than what they are currently getting? It just doesn't make sense to me.

I guess I just don't understand how you would propose to setup a nationalized program so that it will be better than what the free market can offer. I would love to hear your ideas. I challenge you to propose a system that will not be financially disadvantageous to healthcare providers or to people who are already are taking care of their own health care needs.

 

[shiny]

mkld,

Do you have any other interests besides health insurance? I've noticed all of your posts are really long rallies against health care insurance reform - maybe you could introduce yourself in the "Hi" section or tell us about your feelings on LBYM or something.

 

[macnjus]

Mykids - your intentions are fine and it's great to see that you are doing the right thing in planning for your own health care future, but I don't see how things will necessarily turn out as well for you as you seem to think.

Your health plan is a function of the state in which you live, if for some reason, you needed to move to another state, your personal health plan would go away, you would need to re-apply for another in the new state. If you should be so unfortunate as to develop a condition , perhaps as simple as high blood pressure, you might just be deemed unsuitable for new coverage, and you would then find yourself lumped in with the insurance "undesireables". Do you really want to be tied down to your current locale forever ?

This is just one simple example of how the current system just doesn't make sense. I am not trying to say that there shouldn't be some private business incentives there to help make this system work better, but it is my opinion that the current system is horribly broken and we need much stronger Federal regulation.

 

[mykidslovedogs]

Sorry, this whole subject just fires me up! I am a 'free market' person, but I guess I just am not going to be able to convince others.

I would still love to hear everyone else's ideas on a nationalized system. I am always curious to hear other people's ideas, but no one has ever laid out any ideas for me. They just say we need to 'nationalize it'. What does that mean? It would be nice to be able to move from state to state and have portability of coverage. Maybe that is one good solution, but in the meantime, why would you move if you knew it was going to create a financial burden for you? I'll bet if you checked into it, you would find very few people in that scenario. It is sad to be tied to one place, but, why would you move if it would create a financial burden for you? I don't think people are ever FORCED to move.

 

[mykidslovedogs]

Oh by the way, I am definately NOT against healthcare reform. I am very much FOR it. I am FOR people planning for their own needs instead of relying on the government, and I think that individual coverage is a great solution. I can't wait to retire early! And I believe it will happen someday. I love the idea of not being tied to my employer. Besides, most people don't work for the same company for longer than a few years these days anyways, so it doesn't make sense to have your coverage tied to your employment.

 

[macnjus]

I am probably one of the biggest free market proponents you will ever meet, but in spite of my free market underpinnings, I recognize when it is time to cut losses and move on; the current health care system is failing in many serious respects, one of those being the concept that there is much freedom in the market anyway.

An example of a failing: In a free market, when I want to pay more than somebody else for a given product or service, it will be sold to me before that other person gets to buy it. Not so in health care, a recent example, a friend of mine had a daughter who needed sinus surgery, the list price from the hospital was $30K for this relatively simple outpatient procedure. The negotiated price to the insurance company was $7k. Had he shown up with no insurance, his charge would have been $30K. If he had offered to pay $9k ($2k more than the insurance paid) he would have been told that the price was $30K, take it or we see you in court. If he could not afford to pay, they would either take what he could pay, or perhaps force bankruptcy on the individual. This is not how a free market is supposed to work.

To oppose a Federally mandated restructuring of the Health Care market on Free-market grounds is to ignore what is actually occurring in the market today. What we currently have in no way resembles a free market.

 

[donheff]

Rich in Tampa,

I really am not a calloused insensitive person. I understand that there are so very many people that don't choose to get sick, but why oh why can't they have planned better while they were young and healthy? Even paying regularly for a $2000 deductible/100% high deductible healthplan, kept in place for life, is better than going into financial ruin.

I haven't been following this thread so excuse me if this has already been discussed, but this quote caught my attention floating by on the RSS reader. It seems to me that the US has structured its health care system to prevent people from doing what you suggest. We tie health care to employment so of course people don't buy their own. I will cite my own children as an example. I paid for a relatively low cost policy for my son when he first graduated college but as soon as he became employed and covered by a good policy I dropped the redundant coverage. What efficient ER type would want to dump extra hard earned dollars on a redundant policy when they have a perfectly good one at work.

Why don't we change the COBRA law to make the extension permanent?

EDIT: darn - now I am going to have to floow this extensive thread

 

[Rich_by_the_Bay]

Sorry, this whole subject just fires me up! I am a 'free market' person, but I guess I just am not going to be able to convince others.

Well, if your goal is essentially to convince others, you are probably right.

OTOH, if you are at least open to learning and broadening your perspective on the issues, you may find that there are some shades of gray worth considering.

In my observations, there is a large and rapidly growing group of free market, conservative thinkers who are softening on the issue of universal coverage and even Medicare style solutions. It is no longer just another liberal v. conservative or free market v. socialism issue. Are there some who have done splendidly? Sure. But there are some who made a fortune during the depression, too.

I clung to the traditional system for quite a while (after all, it served my interests quite well ) but ultimately could not deny its frightening inadequacies as I saw friends, patients, and acquaintences pillaged economically, stuck in jobs they couldn't stand, unable to retire for lack of available or adequate coverage, spending hour after hour arguing with some young script reader at the insurance company straightening out claims errors, etc. etc. I won't even get into the games that hospitals have been forced into in order to survive - think Kafka.

BTW, while I have not found myself agreeing with or persuaded by many of your points, I do respect the way you (and others) have kept the tone civil.

 

[macnjus]

To expand on my free market comments earlier, I believe that it is a huge flaw in the system to tie "fair pricing" of services to insurance coverage. Why should one be required to be in an insurance plan in order to get fair pricing ? The decision to buy insurance should not be influenced by that decision's consequence on the ultimate price of the service. The consequence of tieing these issues together is that the insurers get to extract an extra "rent" from the consumer because the consumer can't get fair pricing otherwise.

Compare the example of homeowner's insurance. I have paid off my mortgage and am not required to buy homeowner's. Whether or not I have homeowner's insurance should have no influence on what it costs to rebuild my house. The cost of the insurance represents the market-priced assessment of the risk factors, it has nothing to do with the price to rebuild; whether I pay or the insurance company pays, it is the same. My choice on whether to purchase this insurance is based solely on my willingness to bear the risk and has nothing to do with a price differential to repair/rebuild.........Medical insurance and health care pricing should work the same way.

 

[Martha]

It will be interesting to see what plans are proposed in the legislature.

I have over time come to favor a national plan where everyone is covered, similar to medicare. This would mean that medical professionals are not employed by government but their source of payment would be the government in large part. Copays and deductibles would still exist.

But, I am agreeable to looking at solutions short of that. Minnesota is a pretty good model with its subsidized risk pool that doesn't break the bank and sliding fee plans for the working poor. Maybe we could do something similar on a national level. But, adverse selection is still a problem in Minnesota because people may not get insurance until ill. To avoid this issue, preexisting condition periods exist unless you are HIPAA qualified. A better solution would require everyone to have health insurance and the only practical way I can think of that happening is with a national plan that covers everone.

Another option is to require insurance be guarantee issue with no underwriting. However, that has not worked well in states with guaranty issue plans as the cost has been prohibitively high. You end up with the older less healthy in the plans and others getting their insurance through work. So I favor a solution that covers everyone from the get go to help with adverse selection issues.

I do hope we are ready again for a national discussion on the issues.

 

[Martha]

To expand on my free market comments earlier, I believe that it is a huge flaw in the system to tie "fair pricing" of services to insurance coverage. Why should one be required to be in an insurance plan in order to get fair pricing ? The decision to buy insurance should not be influenced by that decision's consequence on the ultimate price of the service. The consequence of tieing these issues together is that the insurers get to extract an extra "rent" from the consumer because the consumer can't get fair pricing otherwise.

Compare the example of homeowner's insurance. I have paid off my mortgage and am not required to buy homeowner's. Whether or not I have homeowner's insurance should have no influence on what it costs to rebuild my house. The cost of the insurance represents the market-priced assessment of the risk factors, it has nothing to do with the price to rebuild; whether I pay or the insurance company pays, it is the same. My choice on whether to purchase this insurance is based solely on my willingness to bear the risk and has nothing to do with a price differential to repair/rebuild.........Medical insurance and health care pricing should work the same way.

The problem is that the individual has no bargaining power. Medicare, Medicaid, and insurance companies all want a discount. If a provider refuses, they miss out on a lot of customers. An individual is in no position to compete with an insurance company.

 

[macnjus]

Of course the individual has no comparable bargaining power, hence the need for government regulation.

Compare the current situation with individual investors in the stock market. 25 years ago, small investors paid massive transaction costs compared to large institutions. Today, due both to regulatory and competitive factors, an individual's commission costs are not significantly higher than what a large institution would pay. There is no reason that health care costs could not follow this path. In the stock market, if a broker tries to mark up the price of a stock by 300%, he would be fined and perhaps jailed; in the health care market it is simply considered business as usual.

 

[mykidslovedogs]

I am probably one of the biggest free market proponents you will ever meet, but in spite of my free market underpinnings, I recognize when it is time to cut losses and move on; the current health care system is failing in many serious respects, one of those being the concept that there is much freedom in the market anyway.

An example of a failing: In a free market, when I want to pay more than somebody else for a given product or service, it will be sold to me before that other person gets to buy it. Not so in health care, a recent example, a friend of mine had a daughter who needed sinus surgery, the list price from the hospital was $30K for this relatively simple outpatient procedure. The negotiated price to the insurance company was $7k. Had he shown up with no insurance, his charge would have been $30K. If he had offered to pay $9k ($2k more than the insurance paid) he would have been told that the price was $30K, take it or we see you in court. If he could not afford to pay, they would either take what he could pay, or perhaps force bankruptcy on the individual. This is not how a free market is supposed to work.

To oppose a Federally mandated restructuring of the Health Care market on Free-market grounds is to ignore what is actually occurring in the market today. What we currently have in no way resembles a free market.

I tend to disagree with you on this point. Insurance companies are able to negotiate huge discounts with providers because of the large volumes that they bring to the table for the providers. It is much like Home Depot would be able to negotiate discounted pricing for purchasing large volumes of lightbulbs from a wholesaler. Providers are willing to negotiate discounts in return for the large volumes of customers the insurance companies can bring to them.

I highly doubt that a provider would completely refuse to PRE-NEGOTIATE a discounted rate with someone who doesn't have insurance. (notice I said PRE-NEGOTIATE). That simply makes no sense.

Rich in Tampa, you were or are a doctor... If someone came to you who didn't have insurance but asked you to PRE-NEGOTIATE a discounted rate and even offered more to you than what an insurance company would have paid, would you refuse the cash payment and even go as far as to destroy their credit by forcing them into bankruptcy?

I have a friend who could afford insurance but chose not to buy it. When his wife had her babies, he PRE-NEGOTIATED with his wife's providers even better rates than what insurance would have paid for the labor and delivery, and made out with a great deal. Fortunately, his wife did not have any complications during the births.

Lastly, if you really want to be able to take advance of insurance companies volume discounts, then why not just purchase a discount plan if you don't want to buy insurance? These discount plans are extremely inexpensive and give you the ability to take advantage of pre-negotiated rates for services and prescriptions.

 

[Rich_by_the_Bay]

Rich in Tampa, you were or are a doctor... If someone came to you who didn't have insurance but asked you to PRE-NEGOTIATE a discounted rate and even offered more to you than what an insurance company would have paid, would you refuse the cash payment and even go as far as to destroy their credit by forcing them into bankruptcy?

I never negotiate my fees (for reasons below), but I might agree to write off nonpayment.

I am not allowed to charge a different fee for non-Medicare patients than I do for Medicare patients, so changing my fee is probably in violation of my MC provider agreement (of course MC pays less than full fee in any event).

And believe it or not, your fees allowed by medicare are based in part on what you billed for those services the previous year, so there is a disincentive to lower fees under any circumstances. It is not a free-market scenario.

And some contracts pay at a percent of fees, so keeping them current and market-consistent is important.

So, for me it's pro bono in the form of writing off part of a patient's balance. Of course there is just so much of this you can do in a private practice, but I did it alot. Still made enough to do just fine back then, but if I were in private practice now, I'd probably not do it -- reimbursement is too low in primary care to support an income I feel is fair (probably lower than most would guess). All this is one reason why I went into academic medicine decades ago.

There is a long tradition of charity care in the profession which is fast becoming another victim of the mess we are in.

 

[mykidslovedogs]

It will be interesting to see what plans are proposed in the legislature.

I have over time come to favor a national plan where everyone is covered, similar to medicare. This would mean that medical professionals are not employed by government but their source of payment would be the government in large part. Copays and deductibles would still exist.

But, I am agreeable to looking at solutions short of that. Minnesota is a pretty good model with its subsidized risk pool that doesn't break the bank and sliding fee plans for the working poor. Maybe we could do something similar on a national level. But, adverse selection is still a problem in Minnesota because people may not get insurance until ill. To avoid this issue, preexisting condition periods exist unless you are HIPAA qualified. A better solution would require everyone to have health insurance and the only practical way I can think of that happening is with a national plan that covers everone.

Another option is to require insurance be guarantee issue with no underwriting. However, that has not worked well in states with guaranty issue plans as the cost has been prohibitively high. You end up with the older less healthy in the plans and others getting their insurance through work. So I favor a solution that covers everyone from the get go to help with adverse selection issues.

I do hope we are ready again for a national discussion on the issues.

Martha, thank you for your comments. I am glad you are open to ideas. I am too! The main reason I don't think a nationalized system will work is because it will be too much like medicare and medicaid. Providers will be underpaid and this will stifle technology and innovation in the marketplace. Even though providers would not be employees of the government, the government will not be able to compensate them enough to make their careers worthwhile. The long-term consequence would be that fewer and fewer people will choose healthcare careers because of all of the problems related to dealing with beurocracy. This will ultimately lead to poor quality of care in our system.

Guaranteed issue never works because it stifles competition in the marketplace. Whenever you force insurance companies to cover everyone, they simply drop out of the market, leaving only one or two carriers to compete in the area. This leads to extreme inflation in the pricing of coverage. If we forced insurance to guarantee issue coverage in the entire USA, we would drive many insurance companies out of business, leaving the few that are left to charge exhorbitantly high prices in order to protect themselves from adverse selection.

So what can we do? I guess we could work on improving the existing medicaid system, while still encouraging our young folks to plan better for their futures.

Perhaps the government could create something like a national HMO for those who choose not to purchase their own coverage. The idea would be that the members (people who don't want to buy insurance) would be limited only to physicians practicing in the nationalized HMO facilities, so the services would probably not be as good as services given to people that have their own insurance, but it would be better than having nothing. How would we convince providers to work in the national facilities? Well, my thoughts on this are that the providers that would choose to work in the national facilities would be ones that are just beginning their careers and need practice. They would be the interns and lower quality doctors that aren't really good at marketing their practices. These doctors would the ones that accept lower levels of income in order to come into a career that has an immediate clientelle and average pay. What do you think about this idea?

 

[mykidslovedogs]

I never negotiate my fees (for reasons below), but I might agree to write off nonpayment.

I am not allowed to charge a different fee for non-Medicare patients than I do for Medicare patients, so changing my fee is probably in violation of my MC provider agreement (of course MC pays less than full fee in any event).

The point you made above is precisely why i think nationalizing care is a bad idea. Even you admit that you moved to academic medicine. It simply wasn't worth it to continue your career with the way things were going. Nationalizing care will eventually lead to poor quality of care, because fewer and fewer people will choose careers as doctors.

 

[Martha]

I have concerns about the idea of a national HMO for people who don't buy insurance. In part because of Mississippi's bad experiences with charity hospitals and having two dramatically different levels of care.

 

[mykidslovedogs]

I have concerns about the idea of a national HMO for people who don't buy insurance. In part because of Mississippi's bad experiences with charity hospitals and having two dramatically different levels of care.

I don't see how you can get around a little bit of unfairness in a free market. Of course a national HMO would have a lower level of care, but if we force everyone onto a system like that, then we will ALL have a lower quality of care. Which is worse? I would venture to say that it is better to have the few have a poorer level of care with the option to upgrade when they can, vs. having the whole country have to suffer with a lower level of care just so everyone can be equal.

If we go the other extreme, we are going to hurt the quality of care in our country for ALL people.

 

[Rich_by_the_Bay]

The point you made above is precisely why i think nationalizing care is a bad idea. Even you admit that you moved to academic medicine. It simply wasn't worth it to continue your career with the way things were going. Nationalizing care will eventually lead to poor quality of care, because fewer and fewer people will choose careers as doctors.

You are drawing inappropriate inferences from my reply.

I see tons of patients in my academic role. The difference is that billing is centralized and handled by others. All I do is submit a billing card for each patient. It's a pleasure.

Just like they do in Canada.

 

[mykidslovedogs]

You are drawing inappropriate inferences from my reply.

I see tons of patients in my academic role. The difference is that billing is centralized and handled by others. All I do is submit a billing card for each patient. It's a pleasure.

Just like they do in Canada.

Please elaborate on how academic medicine differs from "regular" medicine. I am unaware on how the system works and what makes it better than insurance. I would love to understand the Canadian system better...Please elaborate....I really do want to understand.

 

[Rich_by_the_Bay]

Please elaborate on how academic medicine differs from "regular" medicine. I am unaware on how the system works and what makes it better than insurance. I would love to understand the Canadian system better...Please elaborate....I really do want to understand.

Mydogs,

Academic medicine is simply a career option for some doctors. We teach, research, see patients, and so on in a university hospital setting. We are the ones who teach the doctors of tomorrow (students, residents, etc). Billing-wise it is essentially a very large group practice so it is probably similar to working for any large group. The individual doctor relegates the billing to a team of administrators.

Between actual billing, coding, compliance with complex regulations and so forth, this is an extremely large and expensive enterprise, but I just don't have to spend much time worrying about it as long as I proceed ethically and cooperatively.

The Canadian system I leave for others to explain in detail but from a billing standpoint, any doctor in the system simply fills out a uniform bill for services, submits it to the appropriate provincial authority, and gets reimbured a predetermined about. The system is not without its advantages and disadvantages, but billing is clearly nothing like the nightmare it is here.