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Author Topic: This is reform?  (Read 3341 times)
leighclay
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« Reply #10 on: Sep 10, 2009 at 19:51 »

And that's where one set of rules, streamlined, in the form of single payer, would reduce admin costs and this kind of confusion.  (BTW, nice stress for your father, in the other news, eh?  Related?)

I'm sure it didn't help!!
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« Reply #11 on: Sep 10, 2009 at 19:57 »

I'm gonna have to get the sis to post on this.  She & my dad are independent pharmacists, and what the insurance companies do to them is criminal.  Such as the $30K in retroactively denied claims they just got noticed on.

I don't know enough about all this stuff to effectively argue, but I know that competition among insurance companies and pharmaceutical companies most certainly has not driven down costs.

And that's where one set of rules, streamlined, in the form of single payer, would reduce admin costs and this kind of confusion.  (BTW, nice stress for your father, in the other news, eh?  Related?)

We can have private providers, a public administrator, spend more than other countries to ensure better care, but lower current costs due to inefficiencies in the system.  'Cept that 'Bama punted.

Nothing about the government reduces admin costs.  All it does is reduce care and increase inefficiency.  The government needs to fix medicaid, medicare and the VA hospitals before it touches the rest of it.
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« Reply #12 on: Sep 11, 2009 at 08:59 »

I'm gonna have to get the sis to post on this.  She & my dad are independent pharmacists, and what the insurance companies do to them is criminal.  Such as the $30K in retroactively denied claims they just got noticed on.

I don't know enough about all this stuff to effectively argue, but I know that competition among insurance companies and pharmaceutical companies most certainly has not driven down costs.

And that's where one set of rules, streamlined, in the form of single payer, would reduce admin costs and this kind of confusion.  (BTW, nice stress for your father, in the other news, eh?  Related?)

We can have private providers, a public administrator, spend more than other countries to ensure better care, but lower current costs due to inefficiencies in the system.  'Cept that 'Bama punted.

Nothing about the government reduces admin costs.  All it does is reduce care and increase inefficiency.  The government needs to fix medicaid, medicare and the VA hospitals before it touches the rest of it.

I understand that.  I recommend a streamlining of those programs, too.

But the admin costs of Medicaid is something like 2%, whereas private insurers run closer to 30% (factor in not just admin and paperwork inefficiency, multiple claims re-files, but also profits, advertising, and several million bucks in lobbying efforts).

Believe me, I have over a decade of experience with state government in procurement, so I see the very grist of spending waste and inefficiency.  I've seen agencies close up, or close enough, and know the boondoggle of bureaucracy.  Lazy assed state workers who spend their day on their cell phones and eating chips.  I've also seen some pretty good programs with dedicated workers.  I've seen agencies with no concept of the dollar, and mostly where I've worked we've done the opposite, and saved the state millions of dollars, getting better pricing than you'd think for IT, services, goods.  It does work both ways, but it depends on the system in place, management, and mindset. 

The point is, if the government program under single payer were designed intelligently, paperwork burden shifted out to more IT efficiency, the multifariousness of varying price points by provider would be eliminated and a single set of data would cut admin time dramatically.  Doctors would be able to trim admin staff, and you wouldn't be doing the back-and-forth paperwork nearly as much.  Even if it were 5 times as inefficient as Medicaid, it would save money overall.  Basically, the government would be a payment agency: tax money in, payments to private providers out.  No bullshit paperwork and waiting for patients. 

Cost containment would be the big issue, and tort reform/unnecessary testing would still need overhauled, I agree.  Single payer would need to find a way to incentivize healthy behaviors, but universal coverage would alleviate ER burdens.  I still believe that other government policy -- like Farm Bill subsidies -- needs examined in light of a cohesive food policy, of which this country has none.  I'm not saying we need to tax Doritos, but we sure as hell don't need to indirectly subsidize them (and Coke and Pepsi and every other cheap snack).

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« Reply #13 on: Sep 11, 2009 at 11:11 »

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DocLogic77
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« Reply #14 on: Sep 11, 2009 at 23:58 »

I'm gonna have to get the sis to post on this.  She & my dad are independent pharmacists, and what the insurance companies do to them is criminal.  Such as the $30K in retroactively denied claims they just got noticed on.

I don't know enough about all this stuff to effectively argue, but I know that competition among insurance companies and pharmaceutical companies most certainly has not driven down costs.

And that's where one set of rules, streamlined, in the form of single payer, would reduce admin costs and this kind of confusion.  (BTW, nice stress for your father, in the other news, eh?  Related?)

We can have private providers, a public administrator, spend more than other countries to ensure better care, but lower current costs due to inefficiencies in the system.  'Cept that 'Bama punted.

Nothing about the government reduces admin costs.  All it does is reduce care and increase inefficiency.  The government needs to fix medicaid, medicare and the VA hospitals before it touches the rest of it.

I understand that.  I recommend a streamlining of those programs, too.

But the admin costs of Medicaid is something like 2%, whereas private insurers run closer to 30% (factor in not just admin and paperwork inefficiency, multiple claims re-files, but also profits, advertising, and several million bucks in lobbying efforts).

Believe me, I have over a decade of experience with state government in procurement, so I see the very grist of spending waste and inefficiency.  I've seen agencies close up, or close enough, and know the boondoggle of bureaucracy.  Lazy assed state workers who spend their day on their cell phones and eating chips.  I've also seen some pretty good programs with dedicated workers.  I've seen agencies with no concept of the dollar, and mostly where I've worked we've done the opposite, and saved the state millions of dollars, getting better pricing than you'd think for IT, services, goods.  It does work both ways, but it depends on the system in place, management, and mindset.  

The point is, if the government program under single payer were designed intelligently, paperwork burden shifted out to more IT efficiency, the multifariousness of varying price points by provider would be eliminated and a single set of data would cut admin time dramatically.  Doctors would be able to trim admin staff, and you wouldn't be doing the back-and-forth paperwork nearly as much.  Even if it were 5 times as inefficient as Medicaid, it would save money overall.  Basically, the government would be a payment agency: tax money in, payments to private providers out.  No bullshit paperwork and waiting for patients.  

Cost containment would be the big issue, and tort reform/unnecessary testing would still need overhauled, I agree.  Single payer would need to find a way to incentivize healthy behaviors, but universal coverage would alleviate ER burdens.  I still believe that other government policy -- like Farm Bill subsidies -- needs examined in light of a cohesive food policy, of which this country has none.  I'm not saying we need to tax Doritos, but we sure as hell don't need to indirectly subsidize them (and Coke and Pepsi and every other cheap snack).



In an ideal world...your ideas make sense.  They are obviously well thought out.  The problem...the government has a terrible track record.  And if we can't learn from the mistakes of the Canadian and British health care systems I don't know what to say.

In order for a government run program to work...something serious would have to change on many levels including management.  Incentivizing employees much like a for profit entity needs to be the cornerstone.

Obviously, I have a vested interest and I am going to be swayed by my own family's needs.  What I know is this...once again the top 5% wage earners will be footing this bill.  If the Canadian and British payment for physicians is any indication...physicia ns here will take about a 40-50% pay cut.  Not to mention we will be hit with higher taxes.  So, we went to school...bought houses...planned our childrens colleges...made sacrifices for 12-16 years...for what?  For the government to steal our services?  For us to be basically bullied into government employment?  It's not right.  I know we won't get a whole lot of sympathy but what motivation is there to strive anymore?

I like the thought of multiple entities competing...but real competition.  If the government wants these companies to compete against non profit co-ops great!  New rules...new world...no more insurance companies or drug companies running unchecked.  Lets re-write the rules...add new competition and let the insurance companies fight it out.  
« Last Edit: Sep 12, 2009 at 00:03 by DocLogic77 » Logged

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« Reply #15 on: Sep 12, 2009 at 09:38 »

But wait.  We're ALREADY paying tone and a half, two, three times more for healthcare than other Western countries.  So I am not suggesting cutting doctors' pay at all, nor do I think that would be feasible.  And since we are ALREADY paying this -- we don't all see it, but it's taken out of our wages invisibly in the form of employer-provided healthcare -- we're not really looking at adding to the top earners' tax burden.  Government has a terrible track record in certain areas, but not others, and it's an overgeneralization to say the government could not act as a payment administration system.

And again, single payer does NOT mean doctors are working for the government.  Hospital systems remain private and use cost containment measures as they do now; it's just who they would receive money from.  Instead of a morass of insurers, all haggling different rates and refusing to pay for some procedures until the 7th time it gets billed, SP would be one payer, one rate, no bullshit.   

Laissez faire capitalism is great... unless profit undercuts the concerns of doctors and patients.  When companies can and do drop people who are "too sick" to be coverable, at will, and tell Congress they will continue to do so... and will continue to not pick up people with "pre-existing conditions"...  the system is broken.  Time to really fix it.
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SCacalaki
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« Reply #16 on: Sep 12, 2009 at 17:59 »

I don't believe that it's simply where hospitals will get their money from (private/M'care/M'caid v. single payer)

If the single payer follows M'care and M'caid, it means a significant reduction in reimbursement (as doclogic mentioned early on).  Private don't reimburse well but gov't M'care is far below private.

So while there will be one rate, my guess is it will be much closer to the M'care reimbursement rate.  Which affects things like available capital to expand hospital wings/bed, purchase new equipment, hire additional physicians to meet an increased demand, etc. 

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DocLogic77
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« Reply #17 on: Sep 12, 2009 at 20:35 »

I don't believe that it's simply where hospitals will get their money from (private/M'care/M'caid v. single payer)

If the single payer follows M'care and M'caid, it means a significant reduction in reimbursement (as doclogic mentioned early on).  Private don't reimburse well but gov't M'care is far below private.

So while there will be one rate, my guess is it will be much closer to the M'care reimbursement rate.  Which affects things like available capital to expand hospital wings/bed, purchase new equipment, hire additional physicians to meet an increased demand, etc. 



Exactly...we already know what the government feels physician services are worth.  That won't increase with them taking things over.  Who do you want taking care of your health?  You'll see a migration much like you have seen in Canada and in England.  The best minds will go elsewhere.  Research will slow to a crawl...fewer people will apply to medical school and access will be limited due to lower reimbursements to hospitals and providers.  Seriously, do you think people will want to put in the kind of time, money and work it takes to become a physician for 70-80k/year?  Why not become an engineer, business owner, lawyer or the numerous other professions that take less time and money.  Will it be worth 12-16 years of your life, long long hours and the stress of getting your head kicked in during training?  It makes no fiscal sense no matter how much you love taking care of patients.
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« Reply #18 on: Sep 17, 2009 at 04:52 »

The best minds will go elsewhere.  Research will slow to a crawl...fewer people will apply to medical school and access will be limited due to lower reimbursements to hospitals and providers.

For that reason, if Barack Obama's health care plan passes, Pittsburgh's economy will be directly -- and severely -- impacted. Sure, it won't be the 1980's all over again, but whatever positive momentum has been built since 2000 will be lost. This is one of many reasons why I oppose the President's plan. Does there need to be health-care reform? Yes. Is this the way to do it? No.
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« Reply #19 on: Oct 22, 2009 at 08:15 »

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Does there need to be health-care reform? Yes. Is this the way to do it? No.

That's pretty much it.  But there are too many people saying that nothing needs to be done, at least down here in my very "red" neck of the woods.  Something really needs to change, but there is clearly a lot of debate about exactly what that "something" is.
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