Health Care Your Solution?

This is a discussion on Health Care Your Solution? within the Off Topic & Humor Discussion forums, part of the The Back Porch category; Originally Posted by natticarry Hopyard- True for part B but goes to as mentioned before doctors are charging others more to make up for the ...

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  1. #46
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    re: Part B for natticarry

    Quote Originally Posted by natticarry View Post
    Hopyard- True for part B but goes to as mentioned before doctors are charging others more to make up for the costs medicare refuses to pay. They are already anticipating a need to increase premiums rapidly in the coming years and eliminating the patients who are subsidizing the cost by adding them to the cost mandated system is going to exacerbate the problem.
    You know, I thought that what you wrote was basically the situation, that Medicare paid so low, that other insurers were subsidizing the cost.

    I'm not so sure now, due to something we just went through, that the assertion is correct.

    Recently, we had a situation in which we had need to look into
    what was being paid by Medicare, and what the contract rate with a private insurer was.

    It is hard to explain the situation, but I'll try. Please stay with me.

    My wife's primary insurance is Medicare. She has a secondary insurer as well. We discovered that if she did not have Medicare, and used her present secondary insurer as primary (the situation before we turned 65), our secondary insurer's contract with the doc (as a primary insurer) was for LESS than the Medicare contract rate.

    Well we got into a "fight" because Medicare paid their rate minus the deductible. The secondary insurer paid the difference between what Medicare paid the doc and the private insurer's contract rate. Then, the doc realizing that the total paid to him was less than the Medicare allowable, wanted to bill us for the difference.

    Yet, had we been insured only by the private insurer, he would have been "happy" to accept their lower than Medicare contract rate.

    So, I'm not so sure that the claim that Medicare pays less than the private insurers is absolutely true. It wasn't in this instance. I have no way of knowing how frequently it actually happens that the private contract reimbursement payments undercut Medicare, but it certainly happened in this instance.

    It is complicated stuff, and I think we would all be better off with single payer; no complex coordination of benefits, no army of office staff to figure it all out and push paper and paper and more paper, and all the difficulties that go with that.

    It is crazy, that even with two insurance plans (they could both be private for the sake of this discussion) you can still end up with bills because no one really knows how to coordinate the benefits and the contract terms conflict between the two insurers. A single payer plan or a government run option (keep your private one if you like) would get away from this kind of awful complexity and paper pushing cost, none of which provides a cent worth of patient care.

    Oh, BTW, our health insurance costs went up about 2400 dollars when we turned 65 because our former private insurance companies would not continue our coverage past age 65 unless we enrolled in Medicare part B. So actually, we are not only paying 200 dollars or so a month more for the medical care component, but effectively we are subsidizing the private insurance company by being forced to take Medicare Part B. So while many will rightly complain that their insurance company is subsidizing Medicare patient's medical cost, it goes the other way too. Medicare enrollees subsidize private insurance the held before retirement, the day they retire and get Part B.

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  3. #47
    Member Array uncballzer's Avatar
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    I'm new to the board, but may be able to give some input here to help clarify a few things--docdozer has above done a lot already. Currently, I'm a 4th year in medical school--thank goodness May 29th is graduation day (counting the days). Doc may be able to clarify further some more of my points below.

    Quote Originally Posted by Hopyard View Post
    Do you really want a cap? I knew a guy who got the wrong surgery and wound up paralyzed. As it turned out he refused to sue his doc because they had been life - long friends. He'd have prevailed. His son in-law is one of the big-shot attorneys you see on tv once or twice a week.

    But, caring for a paralyzed person for a decade or two or more costs big bucks. Are you so sure you want a cap on awards?

    What about really aggravated mistakes where the doc was stoned or drunk? What about instances where there was gross negligence?

    Just asking for the sake of provoking some thought. 250K caps won't do it I don't think, and a no-fault system won't really solve the problem, though it might
    be something of an improvement.

    OTOH, I don't know (either way) how well no-fault auto insurance works.
    Almost forgot what I wanted to say here--but these cases are the ones you hear about--and usually rare in occurrence. It has come from these though, the time factor for doc's. It has cause a TON MORE PAPERWORK! There's one quote been thrown around in my current rotation that "These patients are getting in the way of my paperwork." I'm sure Docdozer can agree to this in some way. Doctors are starting to practice "Legal medicine"--basically a term I've come to define as practicing medicine to rule out things that will kill a patient or severely harm the patient to start with; once that's out of the way, we can then treat the more likely diagnosis. Because of this, the "shotgun" pattern of diagnosis has come about--running a ton of labs to make sure we don't miss that one zebra among thousands of white and black horses. Thus, more money spent that shouldn't be.

    Oh, and before I forget, the doc in your quote should have never been treating his friend in the first place; I'm rotating thru my hometown, and there has been a ton of things I forget to ask about when a far-off relative comes into the office that I would have asked anyone else about. #1--don't treat Family and Friends--you're bound to get burned (of course in very small towns/old time docs, this is a little hard to stay clear of if you're the only doc in town).

    Quote Originally Posted by tinkerinWstuff View Post
    I think I can agree with this part of your statement. But again, the question is "WHY?" aren't doctors and nurses getting in? Because the system isn't friendly to them with all the insurance requirements and a person has to spend how long in school with how much debt? There needs to be profit motive for a person to be willing to become a doctor.

    I'm going to be just at $320,000 in school loan debt when I finish in May.


    Quote Originally Posted by Hopyard View Post
    My opinion only, but I think the doctor shortage has nothing whatsoever to do with no ability to make money in the field. The shortage is manufactured by the very very very limited number of seats available in the medical colleges. We simply don't produce enough physicians to affect the supply in a significant way. Even with letting in a bazillion foreign trained docs (not good for keeping quality up) we continue to have shortages. The problem isn't finding people to go into the field, it is lack of capacity to produce sufficient number of docs.

    I'm not being xenophobic with my comments about foreign trained docs and nurses. I'm just of the opinion that our schools do a better job. I also think that it is hard enough to communicate about health issues with people who are native speakers of our language. Stuff gets lost when the person across the desk or the bed is silently translating into their own language and back.
    Actually, many medical schools are being newly built, and class size drastically enlarged. I'm actually in a class size newly expanded to 200 from about 100 or so the year before me. It's not really this, but just the amount of time it takes to go thru is one factor. The big one lately, the number of residency spots--residency (ie the old term being intern) is what you train in post-med school. This is a screw up because (docdozer, please correct me if i'm wrong) this is where GOVERNMENT is involved--they limit the number of residency spots a hospital can provide. If they want to start a new residency program at a hospital that already has residents, they have to take away positions from that first program. Plus, there are not enough new hospitals opening programs for the current supply of graduates. MD programs have a flood of carribean and non-US medical school graduates applying. Plus, MD programs also have DO students applying (I'm an osteopathic medical student--very similar to MD, can do anything an MD can, just differences in philosophy/etc--entirely different story for some other time).

    Quote Originally Posted by docdozer View Post
    Right now, the places that need physicians are rural areas that can't attract them because there isn't enough money there. I recently saw something that said the average medical student loan is 140k at graduation. That's the average. I had colleagues graduating at well over $200K. I will be paying my loans right up to the day I retire as it stands right now.

    IF reimbursement and doctor cost were the driving force AND we set the price, then maybe something would change. However, the number of doctors and the price are separated.

    For what its worth, I didn't pay myself for the first half of this year and neither did several of my colleagues, it's been stressful.

    There is a huge disparity between physicians salaries. I have a colleague who bills in one month what I bill in one year. Some of that is because he is as busy as can be and has several people working for him, but his reimbursement rate is much higher because of his subspecialty.

    It is really a complex problem and personally I would like to see a well thought out effort to develop a cogent system rather than try to ram bandaids through legislation. It would take more than a few months to work out the details me thinks.
    Doc, I'm there with ya--I'm from rural NC; I want to practice in a small hospital as a critical care/pulmonologist/hospitalist. There's no way I could deal with a teaching hospital's size. I can only hope they still do tuition reimbursement.....

    One thing that has been happening here--competition between hospitals. Hospitals/groups from differing counties have been buying out private practices in other counties to attract patients--it's effectively doing away with private practice--and it's actually good for the patients more. The doc I'm with loves it--the patient gets to chose where he/she wants to go (stay here at home, or go the next county over which has much more specialties and can deal with more critical care). As a medical student with my kind of loan debt, I doubt there is any way I could have started a private practice as a family physician and been able to survive. I believe this is one reason why there are not enough family doc's around--and I feel they should be paid much much much more for what they do--family practice does so much more than some specialties and get paid 1/4th as much. Someone mentioned PA/NP's above--I'm all for their participation, but with oversight by a physician. Granted some are much better than others and even some physicians, but believe me, not all are equal. (opps, gonna stop now before going on a longer rant and off topic).

  4. #48
    Member Array uncballzer's Avatar
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    Oh, there was something else I wanted to share in regards to the "last three months" of life expenditure. I'm also a member of cigar/pipe forums, and we've passed the numbers around on this. This may tick some ppl off, though, but if you want to decrease the amount spent--make sure everyone starts to smoke cigarettes. One, you'll be paying for children's healthcare (damn SCHIP). Second, you'll be less likely (according to numbers) to live as long as health-nuts (no offense)--but strictly by the numbers, the healthnuts cost more in the long run because they live longer (somewhere along the lines of $100K). So, if you want to cut expenses--have everyone smoke! Plus there will be an increase in revenue from the enormous amount of taxes already on tobacco, and it'll be increasing jobs/income from more tobacco farming! (Just got to get rid of those smoking bans now that everyone loves to be passing, even NC.......not happy about that).

  5. #49
    Member Array natticarry's Avatar
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    the inefficiency of push papers around is absolutely correct, but if you think the government is going to reduce the paper work take a look at the tax code which is thousands of pages long for something that could be very simple. It is in governments nature to continually further complicate matters because one interest group or another are lobbying them to try and create an advantage for a particular group.

    People claim that lobbyists are the problem with the government but they are simply a symptom. Before the government started getting heavily into regulation and markets (pre-1930's) there were less than 100 lobbyists in Washington. Since then it has exploded because businesses and groups have figured out you can convince politicians to give you artificial advantages through legislation. (see most of the tax code). The more areas the government gets involved with the more it pays off to wine and dine its employees.

  6. #50
    Member Array natticarry's Avatar
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    Quote Originally Posted by Hopyard View Post
    the general welfare clause in the preamble seems to me to apply.
    .
    I am a little late on this one but the preamble is a statement of purpose. It does not actually contain any rules, rights or powers.

    It falls along the lines of why the 2nd amendment doesn't just apply to militias. The founding fathers writing style was to state some reasoning behind what they were doing before actually laying out the plan. The first half of the amendment was a partial explanation for the second half. Just as the preamble states the reason for the whole document.

    Its like putting a statement in at the beginning of a rule book that says "the rules of this sport are designed to prevent people from getting hurt and encourage fair play." That doesn't mean a reff can decide that tackling could hurt people so there is no tackling allowed in football, or that one team has a much better set of players so they should mix up teams to make for more fair play.

    This does not mean I really think government health care is necessarily unconstitutional but I do think it creates some logical problems in court rulings. If abortion is a constitutional right under the 14 amendment because of the right to privacy. Then how does it follow that the government is able to have access to any of your medical information including what care you get which is necessary for them to know if they are going to pay for it or deny payment for it.

  7. #51
    Distinguished Member Array mr.stuart's Avatar
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    This is a good topic. It is not political. All of us need health care that is affordable,that does not need to be free. My wife and I are self employed,we cut ours off at 1200.00 per month. We are in good health,wife had two minor out-patient procedures,doctor gave me a script for acid reflux meds. that I really did not need. Up goes the price. I hope we find a solution. To me,this is not a conservative/liberal topic. If we can afford to have regular check-ups, we will probably save the system money.

  8. #52
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    You'll be my kind of doc

    Quote Originally Posted by uncballzer View Post
    . So, if you want to cut expenses--have everyone smoke! Plus there will be an increase in revenue from the enormous amount of taxes already on tobacco, and it'll be increasing jobs/income from more tobacco farming! (Just got to get rid of those smoking bans now that everyone loves to be passing, even NC.......not happy about that).
    OK, you'll be my kind of doc. Pass the cigars and bourbon.

    We'll see what gets me first, my polycystic kidney disease or lung cancer. I know which one will cost Uncle less, that's for sure.

    Unfortunatley they keep the tax on the cigars too high for me to make it out of this world on a cloud of smoke. So Uncle is going to lose.

    Congrats on entering the home stretch.

    P.S. We need to be doing debt forgiveness on some of these insanely high student loans in exchange for some formalized repayment scheme through indigent care. The heck of it is if you are in a state supported medical school, the taxpayer has also run up a huge expense keeping you there. Maybe we need to find some way to cut the costs (and time) of medical education. I think in some other countries like Australia it is only 6 years within an integrated undergrad/medical curriculum.

  9. #53
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    Defensive Medicine is what most of us call ordering tests to cover ourselves in case of lawsuit. It is very real, and is not going to go away short of some massive shifts in tort law. So long as you can sue a doc for simply having a bad outcome, docs will practice defensive medicine.

    As soon as you come up with an accurate way to predict every complication a person will develop, medical bills will be crystal clear. Until then only God knows what you will need when you show up for "a cold". People are not machines, yes docs use the machine analogy to explain every procedure and disease, but truly the human body is about as similiar to your pickup as cave art is like a flat screen television. No two people face the same disease the same way, and if you don't believe me then sit and listen to people talk about their medical ailments.

    When a person doesn't pay for a service, he/she doesn't value that service.

    When a person is free to pursue thousands of dollars because a family member died of lifestyle related illnesses, people will go for the gold. They'll tell you they're entitled to it.

    We have a massive wave of medical expenses entering onto the field now, they're called the Boomers. They're millions of them. When the Boomers were born, people just did not have the procedures that the Boomers are expecting nowadays (artificial hips, knees, heart valves, bypass surgeries, dialysis, chemotherapy, radiation therapy, etc).

    It's going to be a rough ride. There are no simple answers for the "health care issue".

  10. #54
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    Quote Originally Posted by Hopyard View Post
    It is complicated stuff, and I think we would all be better off with single payer; no complex coordination of benefits, no army of office staff to figure it all out and push paper and paper and more paper, and all the difficulties that go with that.
    Everytime I deal with govt. there is no paperwork what so ever.

    In regards to the end of life care, I have a major problem with govt. run eugenics. For a family to make end of life decisions amongst themselves is one thing but having big brother saying yes or no is a dangerous precedent. I know this is an extreme example but isn't eugenics kind of what the nazis did? Getting rid of the undesirables to purify the population? I really am not trying to offend or inflame the topic it is just a legitimate concern I have about govt. deciding who lives and who dies.

    It has cause a TON MORE PAPERWORK! There's one quote been thrown around in my current rotation that "These patients are getting in the way of my paperwork." I'm sure Docdozer can agree to this in some way. Doctors are starting to practice "Legal medicine"--basically a term I've come to define as practicing medicine to rule out things that will kill a patient or severely harm the patient to start with; once that's out of the way, we can then treat the more likely diagnosis. Because of this, the "shotgun" pattern of diagnosis has come about--running a ton of labs to make sure we don't miss that one zebra among thousands of white and black horses. Thus, more money spent that shouldn't be.
    I wonder how much money is wasted because of this. I know it has personally cost me many thousands over the past 3 or so years.
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  11. #55
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    Ok... Most of the ideas I see here still seem to revolve around the Gov. is some way shape or form. Yet the question is can we come up with a private solution to a public problem? Here is one idea I had. Let hospitals/Doctors provide packaged care. For example, if you paid X amount of money they would provide X amount of preventive checkups and labs that go with it (nothing special just the standard stuff), and X amount of urgent NON-emergency appointments (i.e. same/next day appointments). Then maybe packages for specialized care, end of life care, catastrophic care, or a combination of these. Here is just some numbers to look at. If I paid $50 a month for X package I would pay the hospital $600 a year for that package. If all 55,500 people of Panama City went to that one hospital for the same $50 dollar package the hospital would gross 33.3 million a year. Now let’s look at what the numbers would be if your employer also paid a share in your health care. When I had to quit my job this year because of my back problems I got a letter from cobra stating that if I wanted to keep my insurance I would have to pay $1000 a month. I’ll use this number because I have no idea how much my employer ways paying, but it seems close to what most self employed people are paying. So using that number adds $ 950 to the amount that could go to the hospital. Again if every person in Panama City went there they would now gross 666 million dollars. With this much money coming in I would care to guess that there would be an influx of highly qualified doctors and nurses trying to get on staff there. This just might keep more doctors in family care instead of the rush to specialize to make any real money.

    The best part of this is YOU pick the Doc/Hospital. If YOU don’t like the care or pricing you can pick up and go somewhere else. Plus the money goes directly to those PROVIDING the service and not the middle man (insurance co. or the Gov.) who can dictate what is paid for, what isn't, and how much they will pay. The Doc/Hospital can set the pricing where they need it. This would also create competition by keeping the pricing manageable. You could even go across state lines if you wanted. Let’s start coming up with more ways to keep the Government out of our lives!!!
    I hope this I food for thought, but it’s a starting place that does not involve those that have no BUSINESS in our lives!!
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  12. #56
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    Quote Originally Posted by packinnova View Post
    The only true and simple solution is to pull the government out of the decision process all together.
    Amen Brother, The Government IMHO would be better served by serving "The People". I have written no less than a dozen letters to my reps over health care, Cash for clunkers, and the Sotomayor confirmation.
    My main message was to "SSS": Simply Stop Spending. If left alone the free enterprise system will solve the problems. I have found that if the government gets involved it will be screwed up.

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    Quote Originally Posted by boerep View Post
    n.
    My main message was to "SSS": Simply Stop Spending. If left alone the free enterprise system will solve the problems. I have found that if the government gets involved it will be screwed up.
    Exactly, The argument many who advocated single payer now is that the Government is not doing anything now and that's why its a mess. In this instance as well as many others the government IS already involved and is often times the problem. Its easy to make it look like the private market is not capable of handling the situation if you throw up enough road blocks and complications. The soviets did this to us every time they bought grain from us. If you know how the market works you can also figure out how to screw everyone in the market.

  14. #58
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    re: Smatt

    Quote Originally Posted by SMatt View Post
    Ok... Most of the ideas I see here still seem to revolve around the Gov. is some way shape or form. Yet the question is can we come up with a private solution to a public problem? Here is one idea I had. Let hospitals/Doctors provide packaged care. For example, if you paid X amount of money they would provide X amount
    I appreciate that you are thinking out loud about solutions. However, this particular solution is not novel. It was actually in place in Central Texas from the turn of the 20th century to the present (in a modified form). A group of docs made a pact with a railroad company. Pay a flat fee and we will take care of your workers and their families.

    My wife was on that plan, still is except now it is secondary to Medicare. The premiums have become insane and the choice of doctors is very limited. Moreover, there is essentially no coverage away from this tiny geographic center.

    The private market place has failed to provide any solution to a growing problem and has made things worse and worse each year for many years now.

    Even if we don't have a government run program, we certainly need to have insurance reform.

    The idea you put forward about coherent packages of care being pre-paid is interesting, but what if you didn't buy the right package? What if you bought the basic care package and your wife has a problem pregnancy or your kid G-d forbid wakes up one day with leukemia?

    Whatever we do, everyone needs skin in the game. Everyone should be paying some sort of premium price one way or another except for the most indigent. That is the only way to spread the pain to everyone, which is a necessary thing to do as absolutely no one can foretell whether they will or will not one day be the one needing care.

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    Quote Originally Posted by Hopyard View Post
    This is of course true no matter who the payer is unless it is charity. Even your own family may at some point be quite willing to toss you on the heap to save themselves.
    So, this justifies codifying the practice in the law?

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    Regardless of what health care options we come up with, under no circumstances can I see it being the business of the federal government.

    My gut reaction is that if you use medical services, you should pay for them.
    If your neighbor uses medical services and can't afford them, you can help if you're feeling charitable.

    Now, my gut reaction isn't exactly how I feel, but it's where my opinion starts.

    I can also see where certain services (e.g. serious injury, infectious disease) could be considered essential to the public well being. As such, I could see a heath service department operated by a local government and funded out of general taxes (like police or fire services). Government run health insurance however is one of the dumbest ideas ever.

    Even at the best case scenario, an entity that collects money, then redistributes it is wasteful. This applies to both public and private insurance.
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