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Old 11-01-2014, 08:57 PM   #121
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Originally Posted by daylatedollarshort View Post
Do you have a source for your ten cents on the dollar? Is that a research or survey based figure or just your personal experience?\.
Sorry. Figure of speech, meaning: "a lot less than originally priced".

My point was simple: that there is a lag between the original bill and the time for insurance adjustments, re-adjustments and coding errors to pass through.

I've learned through personal experience that it is wise to wait for all those iterations to clear the paper mill rather than assume that the first invoice is the final invoice.
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Old 11-01-2014, 09:00 PM   #122
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Undercutting the value of many of the existing for-profit healthcare enterprises. I suspect that there would be a significant number of Americans who would threaten to take up arms against the government if that suggestion was operationalized.

Publishing a price for services doesn't reduce costs for everyone. Money doesn't simply come into existence. If there are going to be winners, there are going to be losers. Address yourself to the losers your ideas would create.
Not really undercutting value, just bringing some HC sectors back down to a profit margin world that vast majority of other non-HC businesses operate in
As far as taking up arms, I suspect at some point it may be financially strapped patients (and eventually taxpayers) who would be the ones holding torches and pitchforks at the gates of those responsible for over-priced HC costs, from HC enterprises to overburdening govt regulators to ambulance chasing lawyers

Agree that publishing prices per se does not reduce costs, but may improve competition which tends to reduce prices. More efficient HC providers/suppliers would likely be among the winners, along with patients (hopefully).
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Old 11-01-2014, 09:37 PM   #123
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All the service providers I know of have a published price sheet and some are higher and lower than others. It's all about how you perceive value as to which one you select.

I am a professional engineer and have been for 30+ years and if a client inquires about a cost for service I can provide, I better provide him with one, even if it's a time & material estimate, based on a concept of the project with a not-to-exceed estimate. I can't even imagine not doing this, especially if it's a repetitive type job, like health care providers often are asked to do.
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Old 11-02-2014, 03:49 AM   #124
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Nothing impractical or unreasonable about a $100 fee for a Tylenol tablet? Or not being able to find out what you'll actually pay for a procedure?
You misread my comment.

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Originally Posted by samclem View Post
Market opacity and complexity are the enemy of market efficiency.
You have a pet peeve. I think people have gotten the message. My point to you is both that it doesn't solve the problem and its impracticable anyway.

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So let's see here.... you suggest that we should nationalize healthcare providers and ban profit-making healthcare providers.
No I didn't. I suggested that what you are advocating is an inadequate suggestion for political and other reasons.

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Now that is the ultimate in naivety.
Don't blame me for the fact that you insist on replying to things I didn't say.

Folks: If you are going to reply to something I post, then reply only to what I post, not something easier to argue against. Thanks.
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Old 11-02-2014, 03:56 AM   #125
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Not really undercutting value, just bringing some HC sectors back down to a profit margin world that vast majority of other non-HC businesses operate in
I take it, by the use of the smiley, that you agree with me that what you're advocating would indeed undercut the value of the businesses in that sector.

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Originally Posted by ERhoosier View Post
As far as taking up arms, I suspect at some point it may be financially strapped patients (and eventually taxpayers) who would be the ones holding torches and pitchforks at the gates of those responsible for over-priced HC costs, from HC enterprises to overburdening govt regulators to ambulance chasing lawyers
My speculation was based on my observation of which side of the argument tends to talk about taking up arms versus pitching tents.

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Agree that publishing prices per se does not reduce costs, but may improve competition which tends to reduce prices. More efficient HC providers/suppliers would likely be among the winners, along with patients (hopefully).
Which means that the current providers have all the reason in the world to oppose it and they'll do so on some basis that will help it prevail, something like opposing government interference in business. These changes people want (and I want them too) cannot prevail until the foundation of the arguments against them is taken down.
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Old 11-02-2014, 05:17 AM   #126
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....I suggested that what you are advocating is an inadequate suggestion for political and other reasons....
I don't recall advocating anything. What specifically are you referring to?
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Old 11-02-2014, 05:26 AM   #127
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All the service providers I know of have a published price sheet and some are higher and lower than others. It's all about how you perceive value as to which one you select.
I wonder if a lot of people take this view:
* I am (or my company)/(or the government) paying big bucks for my HC insurance. If the service is covered by insurance, why do I care if X is cheaper than Y. "Someone else is paying for it"

* It's my health; I want the best for me, not some cut-rate items; who wants to cut corners on major surgery to save $500.
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Old 11-02-2014, 05:26 AM   #128
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I don't recall advocating anything. What specifically are you referring to?
You're correct... I mistook you for another poster.

Rather: You agreed with the essence what I wrote and made it sound like a disagreement, claiming that I was supporting something which instead was something I was saying was impracticable.

Sorry for my confusion about which poster you were.
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Old 11-02-2014, 05:41 AM   #129
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Apology accepted. I went back and your post I responded to that you referred to above was as clear as mud . You might have mistaken me for another poster more than once. Whatever.
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Old 11-02-2014, 06:08 AM   #130
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My nephew came home recently and found his toddler with an open bottle of Tylenol. Taking no chances, he took the kid to ER and they gave the kid a test to see if he had taken any capsules, then kept him overnight for observation. The bill was $55,000.

My point is that even a minor event can have crushing medical expenses attached.

There's a mistake somewhere in that bill. And in the care. You do a acetaminophen level 4 hours post ingestion. If the level is zero he should have gone home.

My son got billed for critical care in ER for a broken arm. I raised a big stink. There are 5 levels of care in the ER. We were charged a level 5. I got it down to a level 3. It would have been a level 2 if they hadn't given him an unnecessary dose of Tylenol with codeine.

There's either a mistake in that bill or there is fraud. If he needed no therapy they charged too much and did too much. If he needed therapy he would have had a 3 day stay for the antidote and more tests.

I hope the family challenges the bill. Up-coding is illegal; it is fraud.


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Old 11-02-2014, 06:10 AM   #131
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+1 glad to see a pro's view - it smelled very fishy to this layman.
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Old 11-02-2014, 06:43 AM   #132
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Apology accepted. I went back and your post I responded to that you referred to above was as clear as mud . You might have mistaken me for another poster more than once. Whatever.
I think anyone expecting only comments taking a side with regard to what to do would think that my comment was "clear as mud". The reality is that I was commenting on only those things that are reasonable to discuss in this forum, i.e., whether something being suggested has a snowball's chance in hell of being enacted and therefore possibly having an impact (positive or negative). In that context, my comment was clear as glass. But like you said, "Whatever."
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Old 11-02-2014, 06:46 AM   #133
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That is clear as mud too.
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Old 11-02-2014, 06:52 AM   #134
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Writing from a country with universal healthcare (and having lived in another one).

Some observations from across the pond:
  • It is very easy to see where a lot of waste is in the US healthcare system: it is in the billing procedures, insurance and administration. The stories here make that very clear. Going universal healthcare is one way to reduce that confusion (not eliminate it mind you).
  • In a single payer system the public still worries about high costs, also when your own life is on the line. We realize others are paying for our health, and that it shows up in your own taxes too. People aren't that greedy and self-centered.
  • There are no multi-million dollar hospital CEOs or surgeons here. Many still make a million a year though, still nothing to sneeze at.
  • Salaries of non-essential procedures are not regulated and free market (cosmetic surgery). The others are, usually through maximum cost of certain procedures.
  • Malpractice insurance is virtually a non-issue. This is good as it allows more time and money to go to actual care and improving it. Doctors still lose their license and go to jail when they are negligent.
  • Having your life depend on your employment status and your specific employer seems so wrong on every level. Slaves have had better.
From an outsider it is mind boggling and slightly frustrating to see that the best care can be had in the US, but the whole system is so damn inefficient that millions cannot access it.

Whether or not a single payer or universal healthcare system is your best solution, I wouldn't dare say. Fact remains that most countries that have much better outcomes do have such a system.

So if Obamacare helps millions get healthcare and in the long run streamlines the administration a bit, I'd say the whole of the US wins.

Sorry for the rant.
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Old 11-02-2014, 11:32 AM   #135
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Teddy Roosevelt said "Politeness is a sign of dignity, not subservience". Let's keep it civil and friendly, even when we don't always agree.
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Old 11-02-2014, 12:09 PM   #136
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So if Obamacare helps millions get healthcare and in the long run streamlines the administration a bit, I'd say the whole of the US wins.
No question that more have HI with ACA. Also no question among most US providers and facilities that ACA has NOT "streamlined the administration" but INcreased it, at least to this point in time. Understandable for a law 974 pages long with implementation regulations spanning approx 10,000+ pages and growing.
How many pages of regulations for ‘Obamacare’? - The Washington Post

IMHO It is best to view US HC reform as a process, not a single law.
https://en.wikipedia.org/wiki/Health..._United_States
Only time will tell how much ACA actually increases access to HC in the long run. Many are concerned about long-term financial stability of the laws' provisions, but concerns over funding increasing costs of HC is certainly not unique to the US.
http://www.ecipe.org/media/publicati...-disease_1.pdf
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Old 11-02-2014, 01:30 PM   #137
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No question about it. Obamacare has helped millions of previously uninsured people.

UNFORTUNATELY!!!!! it has helped insurance companies, companies that provide information technology services, countless regulatory agencies, countless for profit medical corporations, and big pharma to name just a few special interests to a greater degree IMHO as a practicing MD.

In my particular practice environment the combined effect of the past decade of changes is that it cripples my real productivity. I cannot provide quality care to as many patients. I am so busy dealing with regulations, documentation, and navigating terribly cumbersome information technology systems that it forces me to work to the edge of burnout every day.
It wouldn't hurt so much if I didn't love helping patients, the essence of what has driven my practice for 30 years.

The youngsters that have joined our practice the past 5 years appear less stressed. This is all they have known. They have much lower productivity than Geezer Drs like me, have no interest in serving on committees or charity work. Their first questions during interviews are about salary, benefits, vacation and then practice parameters. Each one we have hired and kept are truly nice people. They have had the best training you can get, much better than what I received. Most are highly sub specialized, with limited skill sets that correspond to the most lucrative procedures. If I ever had any doubts in the conclusions of Darwin the transitions I have witnessed in my little microenvironment have extinguished them.

Ironicly Darwin has smiled on me. Myself and a handful of like minded Geezers in my field of practice are in the final stages of forming a megagroup that has the potential to be a dominant player on the west coast in my specialty. Thankfully this may allow us to have enough control to bring down some costs and improve service to our patients. That still remains the goal for my cohort. Hope the culture we create will rub off on the youngsters in the group.
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Old 11-02-2014, 01:52 PM   #138
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Ironicly Darwin has smiled on me. Myself and a handful of like minded Geezers in my field of practice are in the final stages of forming a megagroup that has the potential to be a dominant player on the west coast in my specialty. Thankfully this may allow us to have enough control to bring down some costs and improve service to our patients. That still remains the goal for my cohort. Hope the culture we create will rub off on the youngsters in the group.
I hope you are successful at this and hope not only that it works for you but is picked up by others. Unfortunately, I am on the east coast.
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Old 11-02-2014, 01:57 PM   #139
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A the bottom of this article is a map of Who Remains Uninsured showing where the uninsured rates are still high. Many of the low uninsured rate states are not surprisingly those with expanded Medicaid programs.

Finding out where Obamacare hasn't reached shows just how far it*has

"The Medicaid expansion difference is most starkly portrayed on the map between Kentucky—which expanded—and Tennessee, which did not. Overall, the data shows that states that expanded Medicaid reduced the uninsured rate from 14.9 percent to 9.2 percent, averaged out. In the non-expansion states, the uninsured rate in 2013 averaged 18.2 percent, and has been reduced substantially to 13.8 percent, but these states clearly lag far behind their neighbors."
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Old 11-02-2014, 02:02 PM   #140
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Regarding the ACA as presently experienced here:

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So if Obamacare helps millions get healthcare
The jury is still out on this one. "Health care insurance" is very different from "timely, high-quality health care". (e.g. every resident of North Korea or Haiti has health insurance. They have access to free health care as a legal right. Still, I'd bet there's a long wait for coronary bypass surgery in Pyongyang.) Before the ACA there were millions of Americans who got health care who didn't have insurance, and there were many more who technically had health insurance but had poor access to health care (long wait times for Medicaid services, etc). Under the ACA, more people may officially have coverage, but it's not clear if, overall, Americans are receiving better health care services.

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and in the long run streamlines the administration a bit
There's not much to indicate that this is happening under the present law.

The overall health care cost issue in the US can be addressed in two ways: Top-down imposed price controls (which invariably lead to shortages, so steps would be needed to allot care in some centralized manner) or market-based competition among health-care insurers, who in turn would put pressure on providers and seek efficiencies to limit costs. Universal care can occur under either model.
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