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∞∞∞ wrote:Ones of the best journalistic pieces I've read in a while.

Ibanez wrote:

∞∞∞ wrote:Ones of the best journalistic pieces I've read in a while.

I read this article earlier. It really is incredible that we bitch and moan about this when we live in a capitalist society. We're shocked that someone has taken health care and instead of it being a non profit service to the public, it's turned into a business. Between inflation, price gouging and us insurance holders subsidizing those that don't pay their bills, it's gotten out of control. I wish I knew what the solution was.

∞∞∞ wrote:

Ibanez wrote: I read this article earlier. It really is incredible that we bitch and moan about this when we live in a capitalist society. We're shocked that someone has taken health care and instead of it being a non profit service to the public, it's turned into a business. Between inflation, price gouging and us insurance holders subsidizing those that don't pay their bills, it's gotten out of control. I wish I knew what the solution was.

Most nations that have succeeded in socializing healthcare have done so because money isn't their number one priority. In their culture, the citizens actually want to help each other and are willing to pay the price. I think the US is going to fail because in general, we value the dollar more than the citizen we don't know. I'm not saying that's a bad thing because it reflects on our diverse mindset as a nation, but those different values will make it tough for socialized medicine to succeed because in the end, we actually need to care about the people instead of the money. However, removing the connection to the dollar is a very tough thing to do in the US culture, for any idea (and again, I'm not trying to imply that's a bad thing...I'm simply commenting).

Col Hogan wrote: A broad brush, I know...but if we could somehow lower the expectations in medicine, maybe by somehow lowering their entry costs, then maybe we could get those costs under control...

∞∞∞ wrote:

Ibanez wrote: I read this article earlier. It really is incredible that we bitch and moan about this when we live in a capitalist society. We're shocked that someone has taken health care and instead of it being a non profit service to the public, it's turned into a business. Between inflation, price gouging and us insurance holders subsidizing those that don't pay their bills, it's gotten out of control. I wish I knew what the solution was.

Most nations that have succeeded in socializing healthcare have done so because money isn't their number one priority. In their culture, the citizens actually want to help each other and are willing to pay the price. I think the US is going to fail because in general, we value the dollar more than the citizen we don't know. I'm not saying that's a bad thing because it reflects on our diverse mindset as a nation, but those different values will make it tough for socialized medicine to succeed because in the end, we actually need to care about the people instead of the money. However, removing the connection to the dollar is a very tough thing to do in the US culture, for any idea (and again, I'm not trying to imply that's a bad thing...I'm simply commenting).

Baldy wrote:

∞∞∞ wrote: Most nations that have succeeded in socializing healthcare have done so because money isn't their number one priority. In their culture, the citizens actually want to help each other and are willing to pay the price. I think the US is going to fail because in general, we value the dollar more than the citizen we don't know. I'm not saying that's a bad thing because it reflects on our diverse mindset as a nation, but those different values will make it tough for socialized medicine to succeed because in the end, we actually need to care about the people instead of the money. However, removing the connection to the dollar is a very tough thing to do in the US culture, for any idea (and again, I'm not trying to imply that's a bad thing...I'm simply commenting).

I don't know about that, Trip...

The US is the most benevolent, charitable nation in the world.
The problem with socialized medicine isn't that we don't want to help our fellow man, it's that we don't want to give up even MORE freedom to an overly bloated, overly aggressive, and immensely dysfunctional federal government. We like private health care because it's more efficient and gives us more choices (although too limited) than a one-size-fits-all cookie cutter single-payer system.

Queue kalm in 3...2...1.

The first of the 344 lines printed out across eight pages of his hospital bill — filled with indecipherable numerical codes and acronyms — seemed innocuous. But it set the tone for all that followed.

The hospital’s hard-nosed approach pays off. Although it is officially a nonprofit unit of the University of Texas, MD Anderson has revenue that exceeds the cost of the world-class care it provides by so much that its operating profit for the fiscal year 2010, the most recent annual report it filed with the U.S. Department of Health and Human Services, was $531 million. That’s a profit margin of 26% on revenue of $2.05 billion, an astounding result for such a service-intensive enterprise.1..

The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.

Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.

CAA Flagship wrote:

Col Hogan wrote: A broad brush, I know...but if we could somehow lower the expectations in medicine, maybe by somehow lowering their entry costs, then maybe we could get those costs under control...

The solution is simple. Make doctors, and insurance companies, compete for business.
Currently, we schedule an appointment, pay a copay, and wait to get the bill which is the remainder of what the insurance company would not pay. The patient (consumer) has absolutely no control of the matter and has no idea what the cost might be before heading to the doctor's office.
We should require doctors to provide a menu of prices for the services they provide. In addition, we should require insurance companies to provide a similar list. Then we can make our choices.
Has anyone ever shopped around? I'll bet very few do. Yeah, I know. Easier said than done, but it's a reasonable goal that would certainly have real results as it does in every other industry.

houndawg wrote:Tired of the punking being laid on him with style by a real conservative, Baldy and the tattered remains of his credibility retreat to higher ground where he immediately begains waving a copy of Atlas Shrugged and barking neo con political slogans...


The simple fact is that insurance companies derive their profit from not paying claims. The customer's health is a distant third on their priority list.

GannonFan wrote:

CAA Flagship wrote: The solution is simple. Make doctors, and insurance companies, compete for business.
Currently, we schedule an appointment, pay a copay, and wait to get the bill which is the remainder of what the insurance company would not pay. The patient (consumer) has absolutely no control of the matter and has no idea what the cost might be before heading to the doctor's office.
We should require doctors to provide a menu of prices for the services they provide. In addition, we should require insurance companies to provide a similar list. Then we can make our choices.
Has anyone ever shopped around? I'll bet very few do. Yeah, I know. Easier said than done, but it's a reasonable goal that would certainly have real results as it does in every other industry.

I like the general idea in this - the transparancy of the costs and making sure the customer knows what things cost and how the insurance companies all compare. I don't think a single payer is necessarily the only way to go, and in many ways the single payer can be inefficient and subject to political pressures, but there's no reason why we couldn't come up with a system where insurance companies and hospitals are required to show how they deviate from, for example, the Medicare rates for comparison. Once people have to justify why something should cost more at their hospital then the better the consumer will be able to determine if they want to pay for that premium. Some places are worth it and will continue to earn handsome profits, and other places will be exposed as free-riders catching a ride on the profit coattails of the industry. But at the core is the idea that customers need to have an option of seeing what people are charging for things ahead of time.

houndawg wrote:

GannonFan wrote:
I like the general idea in this - the transparancy of the costs and making sure the customer knows what things cost and how the insurance companies all compare. I don't think a single payer is necessarily the only way to go, and in many ways the single payer can be inefficient and subject to political pressures, but there's no reason why we couldn't come up with a system where insurance companies and hospitals are required to show how they deviate from, for example, the Medicare rates for comparison. Once people have to justify why something should cost more at their hospital then the better the consumer will be able to determine if they want to pay for that premium. Some places are worth it and will continue to earn handsome profits, and other places will be exposed as free-riders catching a ride on the profit coattails of the industry. But at the core is the idea that customers need to have an option of seeing what people are charging for things ahead of time.

This might work OK in areas where there is competition, maybe not so much in rural areas.

GannonFan wrote:

houndawg wrote:
This might work OK in areas where there is competition, maybe not so much in rural areas.

And that can be handled by establishing a single payer system in areas where this isn't enough competition to go with a broader approach. The key, though, is to avoid the pitfalls of Medicare that we have now, and that the article alludes to - excessive overuse, isolation from any price pressure (extremely low copays for instance), and the great interference of political lobbying and tinkering that aims to curry favor in the ballot box or political coffers.

One interesting idea that could be used to stop the excessive overuse of medical services by the elderly (the article refers to the weekly and many times daily doctor visits many old people make) could be to have a nurse or other care giver act as a call operator and contact these people each day. The elderly, understandably, can be more sensitive about potential medical issues, and today you have them swarm to doctors offices or even ER's and hospitals when they think something is amiss. Especially those with other health issues already. But what they're often looking for is reassurance that someone is listening and ready to take action if there is a problem. If you have a nurse either call or even stop by, in some cases, that would have to be infinitely better than seeing these people in offices or hospitals.

GannonFan wrote:

CAA Flagship wrote: The solution is simple. Make doctors, and insurance companies, compete for business.
Currently, we schedule an appointment, pay a copay, and wait to get the bill which is the remainder of what the insurance company would not pay. The patient (consumer) has absolutely no control of the matter and has no idea what the cost might be before heading to the doctor's office.
We should require doctors to provide a menu of prices for the services they provide. In addition, we should require insurance companies to provide a similar list. Then we can make our choices.
Has anyone ever shopped around? I'll bet very few do. Yeah, I know. Easier said than done, but it's a reasonable goal that would certainly have real results as it does in every other industry.

I like the general idea in this - the transparancy of the costs and making sure the customer knows what things cost and how the insurance companies all compare. I don't think a single payer is necessarily the only way to go, and in many ways the single payer can be inefficient and subject to political pressures, but there's no reason why we couldn't come up with a system where insurance companies and hospitals are required to show how they deviate from, for example, the Medicare rates for comparison. Once people have to justify why something should cost more at their hospital then the better the consumer will be able to determine if they want to pay for that premium. Some places are worth it and will continue to earn handsome profits, and other places will be exposed as free-riders catching a ride on the profit coattails of the industry. But at the core is the idea that customers need to have an option of seeing what people are charging for things ahead of time.

Cluck U wrote:Prices should be advertised, but that won't help people who need immediate medical service...they are just going to have to pay whatever the rate is. OR, they can go in without any identification, speak Spanish, and get treated for free.

Congress should change the definition of "non-profit". Seriously, hospitals make ridiculous money and pay their CEO's multiple millions...and the Church makes gobs of money...yet those institutions enjoy tax free status.

And don't give me the "charity angle". The article tosses that weak sauce down the toilet.

GannonFan wrote:

houndawg wrote:
This might work OK in areas where there is competition, maybe not so much in rural areas.

And that can be handled by establishing a single payer system in areas where this isn't enough competition to go with a broader approach. The key, though, is to avoid the pitfalls of Medicare that we have now, and that the article alludes to - excessive overuse, isolation from any price pressure (extremely low copays for instance), and the great interference of political lobbying and tinkering that aims to curry favor in the ballot box or political coffers.

One interesting idea that could be used to stop the excessive overuse of medical services by the elderly (the article refers to the weekly and many times daily doctor visits many old people make) could be to have a nurse or other care giver act as a call operator and contact these people each day. The elderly, understandably, can be more sensitive about potential medical issues, and today you have them swarm to doctors offices or even ER's and hospitals when they think something is amiss. Especially those with other health issues already. But what they're often looking for is reassurance that someone is listening and ready to take action if there is a problem. If you have a nurse either call or even stop by, in some cases, that would have to be infinitely better than seeing these people in offices or hospitals.

kalm wrote: You should try reading this article.

The first of the 344 lines printed out across eight pages of his hospital bill — filled with indecipherable numerical codes and acronyms — seemed innocuous. But it set the tone for all that followed.

kalm wrote:Yeah, cause the current system ain't "overly bloated, overly aggressive, and immensely dysfunctional"

The hospital’s hard-nosed approach pays off. Although it is officially a nonprofit unit of the University of Texas, MD Anderson has revenue that exceeds the cost of the world-class care it provides by so much that its operating profit for the fiscal year 2010, the most recent annual report it filed with the U.S. Department of Health and Human Services, was $531 million. That’s a profit margin of 26% on revenue of $2.05 billion, an astounding result for such a service-intensive enterprise.1..

The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.

Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.

Nope, not bloated at all.

(and these quotes were just from the first page. Great read but loooooong. Probably too long for knuckle dragging conks. Better sit this one out fellas)

Baldy wrote:

kalm wrote: You should try reading this article.

That is the ICD-9 or ICD-10 coding system.

Something that is...wait for it...mandated, required, and regulated by the government.

kalm wrote:Yeah, cause the current system ain't "overly bloated, overly aggressive, and immensely dysfunctional"



Nope, not bloated at all.

(and these quotes were just from the first page. Great read but loooooong. Probably too long for knuckle dragging conks. Better sit this one out fellas)

As someone who used to audit dozens of the major health insurance companies, I can attest they are not the epitome of efficiency by any stretch, but unlike Medicare and Medicaid, I never saw one of those companies pay the same claim more than twice. Not sure how it is now (very seriously doubt it's better), but it was not uncommon at all the see Medicare and/or Medicaid pay the same claim 3, 4, 5 times. I even saw Medicaid pay a claim on one hospital visit 17 times.

Prior to 1965, healthcare costs counted for 6% of the US' GDP. Now, healthcare accounts for almost 20%. Any idea why there has been exponential growth in costs since 1965?

Obama administration claims record $4.1 billion in Medicare fraud savings
By Julian Pecquet - 02/14/12 01:45 PM ET

The Obama administration saved the federal Medicare program $4.1 billion last year thanks to its investments in efforts to prevent fraud, waste and abuse, according to a new report from the Justice and Health and Human Services departments.

That's almost twice the $2.14 billion in fraudulent claims recouped in 2008, according to the report, while the number of individuals charged with fraud increased 75 percent — to 1,403 — over the same time period.

The report credits investments made in the healthcare reform law, including tougher sentencing guidelines, enhanced screening for Medicare providers and suppliers, better coordination between health and law enforcement officials and technological investments.

"The Obama Administration is doing more to stop fraud before it happens," HHS Secretary Kathleen Sebelius said in a blog post announcing the report. "For example, before this Administration a fraudster could swindle Medicare for millions of dollars in Florida, close up shop, move to Detroit, and attempt to reestablish the same scheme without ever being noticed. Now, [Centers for Medicare and Medicaid Services] and Department of Justice officials are tracking fraud scams as they move across the country, so that criminals are spotted when they try to re-enroll into Medicare or Medicaid."

The release of the new report comes the same day as the administration proposed new regulations setting a deadline for Medicare providers and suppliers to report and return self-identified overpayments. Before passage of the healthcare reform law, providers did not face an explicit deadline for returning taxpayers' money.

"Any failure to report and return the overpayment within the applicable time frame could be a violation of the False Claims Act," the Medicare agency warned in a memo to congressional staffers, explaining the new regulation. "Providers also could be subject to civil monetary penalties or excluded from participating in federal health care programs for failure to report and return an overpayment."

Read more: http://thehill.com/blogs/healthwatch/me ... z2Lv65WKke" onclick="window.open(this.href);return false;
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D1B wrote:

Baldy wrote: That is the ICD-9 or ICD-10 coding system.

Something that is...wait for it...mandated, required, and regulated by the government.



As someone who used to audit dozens of the major health insurance companies, I can attest they are not the epitome of efficiency by any stretch, but unlike Medicare and Medicaid, I never saw one of those companies pay the same claim more than twice. Not sure how it is now (very seriously doubt it's better), but it was not uncommon at all the see Medicare and/or Medicaid pay the same claim 3, 4, 5 times. I even saw Medicaid pay a claim on one hospital visit 17 times.

Prior to 1965, healthcare costs counted for 6% of the US' GDP. Now, healthcare accounts for almost 20%. Any idea why there has been exponential growth in costs since 1965?

You know exactly how it is now.

Obama administration claims record $4.1 billion in Medicare fraud savings
By Julian Pecquet - 02/14/12 01:45 PM ET

The Obama administration saved the federal Medicare program $4.1 billion last year thanks to its investments in efforts to prevent fraud, waste and abuse, according to a new report from the Justice and Health and Human Services departments.

That's almost twice the $2.14 billion in fraudulent claims recouped in 2008, according to the report, while the number of individuals charged with fraud increased 75 percent — to 1,403 — over the same time period.

The report credits investments made in the healthcare reform law, including tougher sentencing guidelines, enhanced screening for Medicare providers and suppliers, better coordination between health and law enforcement officials and technological investments.

"The Obama Administration is doing more to stop fraud before it happens," HHS Secretary Kathleen Sebelius said in a blog post announcing the report. "For example, before this Administration a fraudster could swindle Medicare for millions of dollars in Florida, close up shop, move to Detroit, and attempt to reestablish the same scheme without ever being noticed. Now, [Centers for Medicare and Medicaid Services] and Department of Justice officials are tracking fraud scams as they move across the country, so that criminals are spotted when they try to re-enroll into Medicare or Medicaid."

The release of the new report comes the same day as the administration proposed new regulations setting a deadline for Medicare providers and suppliers to report and return self-identified overpayments. Before passage of the healthcare reform law, providers did not face an explicit deadline for returning taxpayers' money.

"Any failure to report and return the overpayment within the applicable time frame could be a violation of the False Claims Act," the Medicare agency warned in a memo to congressional staffers, explaining the new regulation. "Providers also could be subject to civil monetary penalties or excluded from participating in federal health care programs for failure to report and return an overpayment."

Read more: http://thehill.com/blogs/healthwatch/me ... z2Lv65WKke" onclick="window.open(this.href);return false;
Follow us: @thehill on Twitter | TheHill on Facebook