National Healthcare

[jerryjg]

Discuss :rock-on:

 

[bpmorton777]

health care is crazy...I pay almost $600 per month for Kaiser...Im always broke.

Brian

 

[kboman]

Let's not?

 

[DocNrock]

Let's not?

Agreed.  Even though I'm a doc and have a lot of insight into this.  I can see this deteriorating into a political disaster.

 

[Lucky #7]

I say we lock this cat and SuperLizard in a cage and see what happens.  It could be fun.

 

[tfarny]

I really wanted to hear Doc's opinion, but have no desire to start yet another poo fight.

 

[Lucky #7]

Hey Doc, how about you shoot me and tfarny a PM?  That way we can hear what you have to say without opening it up to a forum wide fight.

 

[DocNrock]

Hey Doc, how about you shoot me and tfarny a PM?  That way we can hear what you have to say without opening it up to a forum wide fight.

I might.  I'm just coming off of a week of vacation, and I am on call tomorrow.  Perhaps in a couple of days.

 

[Lucky #7]

Cool.  No rush.  I'm definitely interested in the opinion of someone that has an up front view to the possible pros/cons of this bill as opposed to the rest of us.

 

[DocNrock]

Cool.  No rush.  I'm definitely interested in the opinion of someone that has an up front view to the possible pros/cons of this bill as opposed to the rest of us.

I will tell you, that if the proposed public option works as planned, I would welcome it.  The private health insurance market saps way too much money out of the system, and I think this is just the "prescription" to reign them in.  The public option would be a problem if, for example, it became subsidized by taxes.  But if it is to work with premiums alone, with the exception of funds to establish it,  and has to conform to the same rules as the insurance industry, it will be a real game-changer.

One big problem we deal with in dealing with the insurance industry, as you may have heard, is "approvals followed by denials."  I'll recommend an operation, the insurance company approves it, then after it is done, when billed, denies it.  They THEN want to look into pre-existing conditions or other irregularities.  Of course, my contract with them then precludes me charging the patient if they decline payment.  The patient thinks they were covered, when in fact, they weren't.  I'm contractually obliged to NOT bill the patient for the uncovered services, and the patient, and the insurance company, get the service for free.  This is not infrequent.  There have been a number of class-action suits based upon such behavior.  Unfortunately, these have been settled for pennies on the dollar, with most of the settlement going to the attorneys.

This is where we need to get rid of pre-existing conditions and insure everyone, public or private.  There also needs to be a mandate for people to have insurance.  The system also cannot be set up so that private insurers get the people without pre-existing conditions and the public option gets everyone else.  If that happens, the public option will fail and the private insurers will  be laughing all the way to the bank.  If there is a public mandate, risk will be spread to all parties involved, public and private, and all will be playing by the same rules.

I think if the above happens, everyone's health insurance premium costs will drop, because there will be more net input into the system, and there will be a public option letting people know what the premium cost really is, that the private companies will have to approximate.  The private industry's argument against insuring everybody is that they don't get the option of insuring healthy people, as well (if healthy people don't buy coverage).  As such, they cannot effectively cost-shift.  Under this mechanism, they can, and they can compete with a robust public option that approximates MediCare, which by the way operates at a 4% administrative overhead, as opposed to the private insurers 25 to 30% overhead.

About MediCare, I accept MediCare contracts.  They pay better than the majority of private insurers (which usually pay 90% of MediCare), they pay on time, and they don't do random denials.  My only problem with MediCare has been their flawed SGR formula, which promised to drop doc reimbursements in recent years.  However, lobbying efforts by myself in association with my professional associations has not only put those off, but also led to a small increase each year.  I've heard that the proposed "reform" legislation will get rid of the flawed SGR formula and actually put reimbursements in terms of our increasing practice expenses yearly.

That is a start for now.  I hope that helps.

 

[Superlizard]

How 'bout a big F*** no?  :icon_thumright:

 

[Lucky #7]

Interesting to say the least.  If it would work in that way, it sounds like a good option.  My concern is the talk of taxing folks with better coverage, which it sounds like you would oppose. 

 

[dbw]

The only reason to oppose a public option is if you're corrupt and getting paid by the insurance industry.

 

[tfarny]

Actually I can see ways that this reform could turn into a huge windfall for private insurance companies - for instance, a 'mandate' combined with a weak / bad public option that funnels high risk / unprofitable cases into the gov's lap and allows private companies to skim the young and healthy who are now required to own insurance, and then taxing my excellent bennies to pay for the money-losing public option. Lots of ways to get it wrong here, and lots and lots of money to influence folks at every level. At the same time, the current system is a travesty - who doesn't know someone who has been screwed over through no fault of their own under the current system? My sister in law's folks are paying more for their crappy coverage than they pay for their mortgage. And who doesn't know someone who would like to change jobs / careers but can't because of fear of losing insurance? It really is poisoning our economy.

Thanks for the insight Doc. I'd love to hear more when you have the time.

 

[Lucky #7]

dbw, come one.  That's just an absurd statement.  Some of the things they are talking about are ridiculous, not the least of which is taxing people on their coverage......but the line starts just above what Congress gets.  And when you have the President using someone as an example that would in all likelihood be turned down by government insurance too and saying they are who will be helped, you have to start asking some serious questions.  Nevermind that it just isn't that hard to see how the government insurance could run everybody else out and I sure as hell don't want anything to do with that.

 

[Watershed]

The only reason to oppose a public option is if you're corrupt and getting paid by the insurance industry.

Wow, impressive display of open mindedness.
Here, let me leave you with today's example of Government efficiency:
http://www.cnn.com/2009/POLITICS/07/07/federal.buildings.security/index.html

 

[tfarny]

I agree with dbw. Somebody make a convincing argument that private insurance is doing a hell of a job and doesn't need any competition from government. Haven't heard it yet.

 

[Watershed]

Social Security?

 

[Superlizard]

Private ins. isn't doing a good job... but it'll do far better than any lumbering, money-pit, tax-dollars-propped-up monster concoction the gov't comes up with.

Less government!  The bigger it gets, the less freedoms are available for the average Joe.

 

[Watershed]

Don't get me wrong, people should definitely have insurance.
I don't think anyone is against people having health insurance.

I think where we differ is the means by which we do it.
My view is that there is a system, called Medicaid, created by the Social Security act.
http://en.wikipedia.org/wiki/Medicaid

Why not just fix what is already there, instead of creating an entirely new bureaucracy?  We have a HUGE defect right now.  Living and working right outside of DC, and interacting with Federal agencies, I have noticed that they, for the most part, are extremely inefficient.  I think now, more than ever, the Federal Government needs to look into making better use of the resources they are given, and be accountable for the funds they receive.  Frankly, I would like to see the State of Maryland send the citizens quarterly and annual reports.  Now Paul Sarbanes was all to eager to praise the benefits of disclosure for public companies with the Sarbanes-Oxley Act.
http://en.wikipedia.org/wiki/Sarbanes_oxley

Why not apply that same logic to our own Government?  Are the taxpayers not "invested" in their State?
If a public company "looses" millions of dollars, its criminal.  What about the Government?

Hey, that's just my opinion, and if your opinion is different than mine, that's OK, you aren't stupid, you are not evil, and we can remain friends.

James