Healthcare solution thoughts

I understand what you're saying in regards to studies, but who determines the validity. A doctor of medicine receives money to develop and document a study. The study determines something that most people don't like. Who determines that the study is false, or slanted, or that the doctor should be discredited due to some factor? If people don't like a study that is based in fact, isn't it to bad for the people? Do a counter study and let's compare factors to factors, but there has to be discussion and debate.....not slander, or simply claiming a study is wrong because people don't like it.

Here are some, articles.

http://healthcare.dmagazine.com/2016/02/05/why-more-doctors-are-walking-away-from-medicare/
http://healthblog.ncpa.org/one-in-five-doctors-say-no-new-medicare-patients/#sthash.xGFCv7Up.dpbs
http://www.oregonlive.com/finance/index.ssf/2015/10/medicare_2015_more_doctors_rej.html
http://www.kevinmd.com/blog/2015/11/a-physicians-open-letter-to-medicare-patients.html
https://www.hint.com/bestpracticescontent/why-would-a-direct-care-provider-opt-out-of-medicare-1

 

I'm not aware that when the Red Cross aids people after a disaster they hand them a bible also.

According to the Red Cross's website "In order to continue to enjoy the confidence of all, the Red Cross may not take sides in hostilities or engage at any time in controversies of a political, racial, religious or ideological nature."
So it would appear that while they may get much funding from religious based institutions they as an organization strive to remain neutral. Can they police all of their personnel.....of course not.

 

If the people taking that option were willing to pay the significant premium increases necessary to support that sure, but I don’t see what it gains over buy separate insurance coverage for the elderly family members.

If you’re expecting additional coverage for elderly patients at no extra cost you’re obviously on a hiding to nothing.

It can’t be charitable and insurance at the same time. There is no way you’re going to cover healthcare costs (especially not consistently) relying exclusively on charitable giving alone.

We're really just picking at the edges of the fundamental problem facing all western healthcare today. Healthcare is becoming constantly more expensive (for various reasons) and we want more of it than we’re willing to pay for. One side of that equation has to give.

 

I'm not expecting either option to solve the problem, but help lessen the problem with the Medicare/Medicaid.

We are reaching the balance point everywhere in the world I feel like, between what we want and what we can/willing to pay. The cost of everything seems to continue to increase, which means we have to pay more, but people can't/won't pay more. There are many views on how to reduce the cost, but they are 2 opposing philosophies and I'm not sure which is correct.

 

The common theme in all of those articles is that Medicare is raising the standards and accountability for the care provided which is why some doctors are opting out. Why would any self respecting doctor not want higher standards of care for their patients?

One of the articles mentioned that they preferred Medicare patients who have Part C coverage which means that they can also bill the private insurance and Medicare.

To be quite frank what I am reading seems to be more of an indictment of a certain sector of physicians than it is of Medicare.

 

Which is why I excluded Red Cross from the point that I was making.

 

I’m not convinced either of your ideas will do that as I explained though. You’re still working with the same level of available resource and expecting the same (or a better) level of service. Fiddling with how the former leads to the latter isn’t likely to change anything of significance.

To an extent yes but the rate of healthcare inflation is significantly higher than for any other fundamental need.

 

As one link indicated it costs doctors money to process all of the paperwork and jump through the hoops to get paid. At some point the cost of having to do all of the paperwork out weights the cost to do business. Doctors are paid based upon the number of people they see, and if their time is eatin' up by governmental paperwork so they can't make a living I don't straight away blame the doctor.

To be quite frank....what did you expect to see from the articles or even a study......that Medicare doesn't work!? Of course it works......with all of the strings attached. The problem is the regulations and hassle that drive doctors away from the headaches. Hell I can get a 2 hundred year old water powered mill to work if regulations and hassle demanded it, but why would I want to spend the time and money when a new modern turbine would work just as well and way more efficiently.

 

Ironic given that doctors have to hire people to fill out the reams and reams of inane paperwork demanded by all of the private healthcare insurers but a handful are complaining about having to do it for Medicare now?

This is nothing more than the usual whining that occurs anytime something changes that is being reflected in those articles. There are no actual studies showing that N percent of doctors are now refusing to deal with Medicare patients or even that the overhead of Medicare is N times greater than it is for other insurance because that is simply not happening.

Doctors are NOT being "driven away" because of regulations because everything they do is already regulated. That is just an excuse that makes no sense whatsoever. Ask yourself this question. How comfortable would you be going to a medical service provider that wasn't regulated? Is the doctor even qualified in medicine? Does the surgery have the required equipment to keep you alive and safe from infections?

Without actual studies providing statistics and/or facts those articles are just anecdotal and therefore meaningless in the real world.

 

The vast majority of my insurance premiums go to subsidize those who have been less fortunate than me. My insurance premiums this month went to: those who got into car accidents, those who's homes burned down, those who's business's were sued, etc. It's all about exposure mitigation.

 

Your post reads like something straight out of Solzhenitsyn's "Gulag Archipelago".

Of course, in theory, governments, businesses and charities all have different motives. However, in practice, the actual people in governments, businesses and charities are motivated by the exact same spectrum of incentives, except one. The legal use of force is reserved to those in government. You see, the problems are not primarily systemic; they are primarily endemic to human nature. That is why we should be very circumspect about vesting the legal use of force is such corrupt beings.

 

The Constitution restricts the "legal use of force" against individuals.

But you are only deluding yourself if you don't see corporations exploiting the "legal use of force" for their own benefit.

Look at how Trump exploited the "legal use of force" to steal millions from hardworking Americans via lawsuits. Other corporations use patents to eliminate competition. Walmart bankrupted their Mom & Pop competitors. How about corporations effectively shutting down unions by outsourcing union jobs.

All of the above are examples of exploiting the law in order to eliminate competition and maximize profits.

So your allegation that the "legal use of force" is "reserved" for government only is bogus!

 

True, but the Private Insurance companies pay better so it makes the lost time in seeing paying customers over paperwork even out. Most Doctors don't go to school (and pay for the school) for 6 to 8 years to live in the burbs in middle income home. They have twice the school loan debt as most. The doctors office I use cycles through doctors often and most of the time it's because they are moving off to "specialties" because of "less headaches and better pay." I put that last part in quotes because that is word for word what the most recent doctor I saw told me when I asked about the turnover.

Again we're back to the studies that you only trust if done buy specific people or funded by specific groups. As I have pointed out there will no doubt be many studies that contradict each other. Which is the truth, which will you choose to believe?

This is a no win situation. People want doctors to deal with all of the red tape and paperwork for no more money......which doesn't equate to being worthwhile for the doctors. Can/is there just as much paperwork in Private Insurance.....possibly, but the doctors are at least compensated for their time.

 

Every insurance company has different paperwork and a different drug schedule.

 

Corruption is better than communism. Capitalism is better than cronyism. Free markets are better than centralized distribution.

 

How about we look at a study related to the overhead of paperwork and how it breaks down between the private and public sector insurance.

http://www.cnbc.com/2015/01/13/health-insurance-paperwork-wastes-375-billion.html

So now we have ACTUAL NUMBERS that we can discuss instead of just the opinions of article writers.

Total paperwork overhead for BOTH private sector and public sector comes to $471 billion per year.

Of that $436 is from the private healthcare insurance corporations and a mere $35 billion is from Medicare and Medicaid.

So even though Medicare covers the 20% of the population that is the most expensive to insure it is only responsible for 7.4% of the paperwork overhead for medical service providers. The remaining 92.6% is all from the private sector healthcare insurers.

No wonder the study concluded that it could effectively save $375 billion a year just be switching over to Single Payer.

And let's take a worst case scenario where the study was wrong about the public overhead by 100% and that it cost twice as much as they claimed. That would still only be a piddling 15% of the paperwork with 85% still coming from the private insurers.

Whichever way you look at this study the facts are obvious. It is the PRIVATE health insurers that are creating the largest paperwork burden on medical service providers by many orders of magnitude greater than the public sector.

FYI here is the link to the study being quoted;

http://download.springer.com/static...49dfcff0aa972bb6419d3d2a89119192b360bca5e7a09

 

Inane non sequitur response!

 

This article with studies attached seems to disagree.

http://healthaffairs.org/blog/2011/08/09/is-medicare-more-efficient-than-private-insurance/

 

Did you actually follow the links to the cited studies and find out who did them?

The first link is bogus and does not work.

The second link takes you to a study by the extremely conservative Manhattan Institute that was done in 2007.

The third link takes you to a study done in 2009 by the extremely conservative Heritage Foundation who invented the Obamacare concept and have a vested interest in disparaging Medicare.

The article even admits that one of the "studies" was never even published which means the findings were never peer reviewed.

Even if you eliminate the all too obvious bias the data was outdated and therefore the findings are no longer relevant.

Credibility matters when it comes to studies and even by the most charitable of interpretations those studies are suspect.

 

The fundamental problem is the cost of healthcare, not insurance company costs and profits. You have to do a little work with the financial pages of annual reports as I did with Wellpoint since insurance companies manage plans for self-funded company employee plans, consult, etc. When I looked at Wellpoint, before ACA was passed, they were at 85% of premiums going to medical payments. I'm thinking that insurance companies negotiate at least a 15% discount with service providers, probably more. The law, BTW, stipulates 80%.

Take a plastic brace for a broken arm. I had one a few years ago while paying cash for healthcare. While in the Orthopedist's office a person who sells medical devices came in and asked if I wanted to pay $50 / month or $312 cash. I chose the cash option and paid her on the spot. After the fact, I spoke to my son-in-law, a prosthesist who deals wholesale with the medical device peddlers, and he said he could have gotten the same brace for $49. I looked online and found the very same brace for $149. A few weeks later, the healthcare group the doctor was affiliated with tried to hit me for $595 less the $312 I paid. Needless to say, I told them to pound sand.

The orthopedist told me I needed surgury and referred me to a surgeon in his group --- not the same office. Happened to be a guy with the same last name as someone my daughter / son-in-law know. I called the wrong surgeon and set an appointment. He asked what I used the arm for --- to which I answered, "golf". He said I could still play golf, what else? He advised that, being in my early 60's and retired, I didn't really need surgury. Who knows what an operation, plates and screws would have cost if I didn't have family in the medical field to send me to the wrong guy in the right field with the right name.

Aside from the cost of medical devices, drugs are outrageous in this country. Pharma's costs are front loaded with investment in development, clinical trials, etc. The production costs are minuscule in comparison. We shouldn't tell drug companies what they can charge us ,,, except they shouldn't be allowed to charge anymore than the minimum they charge for the same drug in another country. Since other countries dictate prices for drugs, we end up subsidizing their healthcare. If they can't sell their drugs overseas for the prices they need to do business, perhaps the drugs shouldn't be on the market and they should find another business.

 

You should probably take a very close look at that study ,,, in particular the fact that they are comparing apples and oranges. On the private side, they use SEC filings which account for everything. On the government side, they use numbers for cost described in footnote 6 as:

6 Includes all administrative costs (federal and state and local employees' salaries, contracted employees including fiscal intermediaries, rent and building costs, computer systems and programs, other materials and supplies, and other miscellaneous expenses) associated with insuring individuals enrolled in the following health insurance programs: Medicare, Medicaid, Children's Health Insurance Program, Department of Defense, Department of Veterans Affairs, Indian Health Service, workers' compensation, maternal and child health, vocational rehabilitation, Substance Abuse and Mental Health Services Administration, and other federal programs.

Where's HHS management? Treasury? Employee benefits? OPM? CSRS? ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

The author's 'assume' alot of stuff like BIR + profit are the sum total of admin expenses. Built into every hour accounted for in the private sector is every manager and every executive and every overhead function all the way up the line. The author discussed a 'blended average' to determine the BIR for Medicare & Medicaid ,,, use a blended average based on total annual cost versus total spending to determine how much government overhead function should be attributed to M&M.

For example, no doubt GSA arranges the facilities ,,, and rental and probably HVAC & other costs are attributed to M&M. But where are GSA employees? How about Congress? GAO? Congressional Budget Office?

You can log into the medicare website. You think that's a Medicare employee that built and maintains the website or an HHS employee or contractor?

Just look at the numbers ,,, how can anyone claim Medicare coding and and coding for private insurance are that different?

 

All of the assumptions used were fully documented and accounted for. e.g.

As far as your coding question goes that is a red herring. It isn't the coding that makes a difference to the massive overheads involved albeit the private sector doesn't even have a standardized one between themselves. The paperwork burden stems from the private sector creating bogus networks and procedures and red tape that must be followed to the letter in order for the medical service providers to get paid.

Ask anyone who has ever had to deal with the private sector paperwork and they will tell you what kind of a nightmare it is just to figure it out, nevermind get it right.

Lastly I made the point that even if all of the study assumptions were off by 100% regarding the public sector it would still only amount to a piddling 15% of the paperwork overhead instead of just 7.5%.

Do you seriously believe that the study was off by 700% because that is the amount of error that would be needed to just have the study show that the paperwork burden was the same. There is nothing to suggest that being the case and the onus would be entirely on you to produce a credible study to support your position.

 

It's a Federal task to provide universal healthcare.
If you leave it up to the states it will hamper buying across state's lines and adding competition to lower prices.
You'll also have elected governors retarding a working system. The same thing that created problems for ACA Healthcare.

 

The government only provides healthcare for the VA.. Medicare is private delivery.. Its single-payer funded by payroll taxes.

 

It would be suitable for a federal government IF it was in its defined powers. But healthcare for the general population is not within those powers.Insurance is not sold across state lines at this point either so you cannot even stretch the commerce clause (which is abused like a red headed stepchild on poker night.) Each state on the other hand can do it and it is within their powers. Also they can tailor it to fit their citizens individual needs. If the federal government was not taxing for it they could even afford to do it.

If on the other hand our Congress would do their job they could amend the Constitution and grant the power to provide healthcare as a single payer or even this bastardized thing we have now. But the Republicans and Democrats would rather compare their wiener sizes then actually legislate.