Why do we need healthcare reform before killing the insurance industry

[The Buddha]

OK here is exhibit #1 in the healthcare debate.

Lets say there is a town that has 2 hospitals. Those 2 hospitals run @ 50% of their bed capacity. OK so now they are opening 2 more hospitals in that town.

Can anyone guess what will happen to your hospital bill when you go to the hospital ?

Cool.
Buddha.

[The Buddha]

OK since no one has answered ...

Your medical bill from a hospital stay will more than double. They cover their operating costs etc with the occupied beds. So going from 50% occupancy to 25% will cost you 2 X.

Nice logic, even more interesting is the fact that if one of the hospitals is more $, obviously they will be, newer = more $, that will make the rest also raise their $.

This is also why hospital companies - yes there are hospital companies, race to open hospitals in well served areas.
Guess what, if we kill medical insurance as it operates now and forced the companies/hospitals to post their prices on the wall and you had to pay that @ the time of the service, you will be able to get an insurance submittal electronically but that is all the hospital does for the insurance.

That would put the surplus hospitals out of business, get the occupancy rates up closer to 75% and cut everyone's medical bills by I dunno say 90%.
It will also clear out the Hospital chains and the "new" hospitals out of the system. Compete on price or perish.

Cool.
Buddha.

[Toogoofy317]

I believe all hospitals should go back to being nonprofit. I did an internship at Death Central ooops I mean Health Central. The week before budgets were due. We had no thermometer probes, Red blood tubes, was running low on gloves. All, because it was the week before the budget so we either had to steal from other floors or due with out. Because at that hospital it was stock holders first not the patients!

For a western country our medical system is pitiful. Where ERs replace your family doctor because of no insurance. When a doctor will not take you on as a patient without insurance. I waited 4 hours in an ER once with a blood clot in my lung while I was slumped over in a chair almost dead the lady next to me had her two kids there getting school physicals. If there isn't something wrong with that picture than I don't know.

Mary

[yamahonkawazuki]

and it will get worse lol. but agreed on the non profit idea. and buddha. on your listed prices idea, what if someone cant afford it, do they do without?

[The Buddha]

I think non profit idea will crash and burn - just the skeptic in me, the reason is, it is non profit after they pay their execs etc. They could do what Charlotte's united way did by paying their CEO several million a year ... heck they were a charity, essentially living off the donations of others.

Prices on the wall will do 2-3 things ... well modern day wall is the internet, so they will have to be on the internet and in advertising bill boards too ... Imagine this "Hospital A says $1000 a night, all services included complete with pic of bed, and apparatus to pull/install any body part" ... drive few miles down the road and you see another sign "hospital B ... 500" ... few more miles and its now 300 ... just like fast food, it will seek its level. It will send the customers to the lowest price till the rest get the message, then it will straight up be a race to the bottom.
Second, if everyone in the area has low income, you obviously are going to lose patients if your prices are too high cos some people who can do without will. You dont expect to find a burger in Manhattan for the same price you would in nebraska.

Thirdly doctors and hospitals now dont get all the $ they try to bill you for, they get a fraction. In fact if you check doctors plans, they get most of their $ via the deductible. You pay 20 and insurance pays 10 for what they bill the insrance @ 200. That means tha t200 is just a random number. The doctor can advertise their proces @ 25 get rid of the whole staff that is needed to send the bill to insurance and still come out ahead.

You cant afford doctors cos now they dont have to publish prices and hence they say its 200 and you're stuck with that bill.

BTW that number is even more glaring in a medical test bill. I once got billed 5 grand which of course I kicked the snot ut of them cos it was labcorp's mistake ... but that test gets reimbursed @ something like $1.25 by insurance.

There is a lot of numbers floating around that really do not need to be ... prices on the wall, internet and a paper will eliminate all that. Even more importantly, you want test a lets say, you cant walkinto a lab and ask for it, you need doctors note, cos they will try to send it to insurance ... You dont have the option of saying screw that, your test is $20 here ... test me.

Prices on the wall and no insurance will settle things into the fast food level of prices ... cos they will ahve to compete. Its the funny money that is the problem. In India I could test myself without going to a doctor. Doctor, I pay right on the spot. Simple, no billing the insurance and then they come back a 100 times this and that and the doc needs a hige staff to cover that and I need to fight on the phone ...

It will also as a side note take care of mary's problem ... atleast ... no one will be doing physicals in an ER, they can just pay 25 bucks @ their doc instead of $50 @ the ER.

The reason healthcare costs are so high is due to the secrecy and the staff needed to keep the paper work ...

Cool.
Buddha.

[noworries]

On the wall pricing isn't impossible. Over in my second-favourite place in the world - Sri Lanka - hospitals often post prices. See Lanka Hospitals on:

http://www.lankahospitals.org/data/medical_facilities/special_promotion.htm

Divide the rupees by 100 to get a rough dollar cost. And I gotta say, the standard of care in the SL health system is b****y good. Puts things like our Aussie waiting lists to shame.

[noworries]

Woops, try

http://www.lankahospitals.org/data/medical_facilities/special_promotion.html

[The Buddha]

Where you think I got the idea from - well India, not SL. And India health care is pretty damn good too. There people do surgery like in my aunt's case in spite of her high blood pressure. Indian doctors actually also make good $ and live in the top 5% of society. Unlike here where they make decent $ only if they open their practice etc.

Cool.
Buddha.

[The Buddha]

Ofcourse in India you need to make atleast the top 5% in your graduating class to make medical school, probably live @ home with your parents and grandparents till you're 30 married and have a few kids ... and ride a bicycle to your clinic cos it 2 miles away. You will also live and die and be cremated in the 5 mile circle around the house you were born in.

That makes it a very inexpensive way to live. Any $ you make till you turn 30 will be dropped off into a saving account. After that 90% will be saved.

I cant imagine to live like that now, however @ one time I did. I told my mom I'd rather be unemployed than move to another city. Heck I was more comfortable moving to the US than moving to another state in India. There they dont speak english or tamil. And I dont speak anything other than english or tamil, end of story.

Cool.
Buddha.

[The Buddha]

OK so let me rephrase what I thinnk should happen and the order in which it should ...

Step 1. There should be a legislation cutting off the whole Insurance and medical providers "negotiated rate". Medical field needs to focus on patient care, billing and garbage is not needed to be handled by 100 "staffers". 1 cashier the doctor and the nurse is all you would need. Yea yea a little simplistic, but the "mommy mommy I have a fever" will be addressed by that type of doctor.

Step 2. The doctor office will post the appropriate rate on the wall. You may think they will post their super high price, however remember much like the guy that sells McD's burgers for $2 is going to end up with a lot of rotten burgers ... a doctor that wants $500 for a fever will sit unemployed. They now get 20 bucks form you in a second and spend 2-3 hours chasing another 10 from insurance. They will easily figure out 30 bucks from you in 1 second is a much much better deal and it will quickly get there ... Heck legislate that cos the chase to the bottom may take a month or so, so legislate that too just to get people to not have to worry for that 1 month. Rates need to be set to the negotiated rate of the lowest insurance carrier they accept ...

Step 3. You get the information to submit to insurance on some electronic media. Depending on how good/bad your insurance is you get all/none of it. If you got a crappy insurance and you know it, you will not even bother sending in the $10 ... of course if you need brain surgery and it runs to 1000's ... yea by all means its worth sending it. In that instance the doctor will send the bill to the insurance for you ...

Cool.
Buddha.

[adidasguy]

Insurance industry intentionally wastes money.

A $1400 claim for a new tooth crown. UW Dental Clinic knows what to do, but they have to do a "predetermination" (laymans terms for a high school dropout at a desk stamping everything "DENIED")

1. DENIED - need xrays
2. xrays sent
3. DENIED need to know when root canal done
4. Told 30 years ago
5. DENIED - need xrays

WTF? They already had them!

Now back hands of UW Dental to re-send what they already sent. Bet $100 it comes back again as DENIED because they need to know about the root canal.     

All this expense probably costs more than the claim when you figure everyone's times spent on it.

That's why we get nothing for our health care dollars.

I had another claim denied for a tooth damage from a fall. DENIED - dentist is not a medical doctor. DENIED - wrong code put on form and I have to find the right code.

Mothers medical: Claim denied because doctor didn't put on her medicare number. The insurance company has her medicare number. WTF? Can't they check their own records?

Endless bureaucracy.

[thecdn]

I believe all hospitals should go back to being nonprofit.

Yes. Health care should not be a for profit industry. It is a grotesque idea that a company can gain profit by denying health service to people, that a bean counter determines what is covered based on a script. It is a grotesque idea that your quality of health care is tied to where you work - or how much you are willing to pay as an individual.

For a western country our medical system is pitiful.

Where else to people declare bankruptcy over health care costs? Here in the land of the free you are free to use the insurance company provided by your employer and then free to see a doctor that takes that insurance.

Where ERs replace your family doctor because of no insurance.

Big problem here. People don't see a doctor to get small things fixed so they become big and expensive when they go to the emergency room.

[The Buddha]

I actually think hospitals can make a profit by putting prices on the wall. In the case of that you will also see nearly no wait times @ the ER's cos there isn't 100 people shuffling paper work before they will let you see a nurse. You also will have nearly no one that is doing routine maintenance @ the er cos they dont have insurance. No one cares about insurance. Seriously the bloated bureaucracy around all of this is why no one makes a profit and it costs the consumer 1000's ...

It is actually cheaper to get on a plane, fly to India, stay @ a hotel and get your root canal done and fly back than it does here with insurance. Seriously, something is very wrong.

And no Government take over isn't the answer, proper free market is the answer.

Imagine this - You walk into a restaurant and order food wihtout any prices listed, and you dont even pay there, you get someone else to pay them like 6-8 months later ... guess what, then a whopper+fries will soon cost 500 bucks and ketchup will not be available at all, it will have been regulated out of existence and if you ask for BBQ sauce instead you will be disqualified for having a pre-existing condtion after the fact ... several months after in fact and then your burger will be 35,000 and you will have to pay that or get harassed by collectors. You do know that liking some kind of sauce with fries is a pre-existing condition right ... yea I thought so.

Cool.
Buddha.

[Toogoofy317]

Don't you know Buddha they are taking the RN out of triage! I went to ORMC on Sunday when my heart started acting up. I walk up to what used to be the registration desk guy points me to a computer. Ur, uhm I'm having chest pain well fill out the info on the computer and we will see you shortly  I went to the computer my brain fuzzy because my bp was crashing the first thing it asked me for was my debit card. I'm like not only no but hell no! So, I pressed I didn't have a card so it scanned my DL instead. Waited about a half an hour and finally got called back to speak with an RN by that point bp was in the 70's she freaked out esp when I told her my cardiac history and wondered why I didn't tell the person at the desk "Uhm, I did he sent me to the computer to register". She stated that damned system is going to get someone killed and ran to get the doctor.

I honestly don't believe the avg patient is smart enough to differentiate costs and what is better etc. Even so my doc in Boston world renowned easy to get a hold of doesn't cost me any more money than my joe schmoe doesn't know his head from a hole in the ground guy because he is in the same network as the local guy.

Now this is just my belief but I think Uncle Sam should cover preventative care and if you don't take care of yourself that is where insurance or you come into play. If we would just stop the obesity pandemic we could save billions in health care. But, insurance wouldn't want that because that is now money out of their pockets. BTW genetic disorders suck!

Mary

[noworries]

And we probably don't need or even want to know this, but there's all that stuff about how, on average,  80% of a punter's total health expenditure occurs in the last six months of life. 

[slipperymongoose]

Government needs to take control and cover everyone for basic healthcare like in Britain, canada or Australia. Over here you can get private health insurance which gets you a private room in hospital and priority with specialists, also stuff like chiro, dental etc is covered. You pay a gap fee depending on your income and yeah there's not much else to it. The system has its flaws but it's like 85% there.

[mister]

Government needs to take control and cover everyone for basic healthcare like in Britain, canada or Australia. Over here you can get private health insurance which gets you a private room in hospital and priority with specialists, also stuff like chiro, dental etc is covered. You pay a gap fee depending on your income and yeah there's not much else to it. The system has its flaws but it's like 85% there.

Yeah, for our US friends....

We pay 1.5% tax for Medicare. Everyone has a Medicare Card even if they do not work. When you want to go to a Doctor, you show them your Medicare Card. The Dr has the option of accepting the money the govt pays for services or charging more. Eg. if the Govt pays $30 for a 15 minute consultation the Dr can accept that, at which point you pay nothing - or - he will charge you $40, in which case you pay the $40 then go to the Medicare office and get $30 back from them.

ALL Public hospitals only charge what the card gets them, so you walk in, show your card and get treatment - standard hospitals stuff plus dental (long wait for Free dental).

If you do like Aussie suggests and Also have your own Private Health Cover, your Govt Medicare Levy is reduced as a slight offset. Some Private Coverage offers free dental, discount athletic goods, cheaper eyewear, etc., as well a paying for specialists Outside of the Hospital (you can always see a hospital based specialist at hospital for free (who usually have a Private Practice where they charge a bomb) and so on.

*I* don't bother with the Private Coverage. I haven't been sick since 1992 and if I am in such an emergency state I am also in no condition to Choose my Dr.

OH... we Used to have Subscription Ambulance here. Like motorvehicle roadside breakdown assistance but for Ambulance. But now, it is compulsory and the fee is tacked onto your powerbill. So any time you need an Ambo, call and they come and you pay No Additional Cost.

Michael

Michael

[slipperymongoose]

Except they've scraped the ambo levy, and I forget how it's gonna be covered weather were taking out our own subscription again or the government is just gonna cover it. Either way our state government touted it as a saving on our skyrocketing power bills, then announced an increase to the power price that makes the saving virtually redundant. But that's another topic for another time.

[Toogoofy317]

At least here in Central Florida you pay all kinds of taxes one for 911 service, another for fire department, and then you get a charge from the private ambulance companies then charge you on top of that! I do wish they would give you a roll of duct tape to make holding your ankles a bit easier They are also petitioning to get rid of BLS all together where if it is a basic life support call an EMT can ride in the back but since a call can turn ALS Advanced Life Support they weeded us out for EMT-P so they can say all calls are ALS therefore it is like $100 per mile vs $50 a mile! Now, back in February I had myocarditis I didn't realize how bad I was so I went to my PCP she put the O2 sat on me and I was at 83% so she freaked had the rescue come out took me 1/4 mile to the hospital when I got there my troponins had skyrocketed and so I got life flighted. The bill from Florida Hospital Kissimmee to Florida Hospital Orlando was $28,900. Wellcare, denied my flight coverage because of the ER doc didn't get prior auth. Sorry, that he was busy saving my life so I've been fighting since February to get them to pay.

Being sick is a full-time job in itself. Yet, I'm also a full-time student and work. I have a college degree yet it takes every shred of intelligence that I have to negotiate the quagmire of Medicare.

Mary

[The Buddha]

Govt health care is far worse ... ever been to the dmv ? yea that times 1000.

Mary your heart episode - guess what in India you'd have had a number you'd call for your doctor or in some cases eve nthe hospital. See there is an item in the price list that says "house call" ... remember those ... yea ...

I cant understand how this system got this screwed up. heck we had house calls before there were phones.
I got some severe typhoid when I was like 10. Every other day the doctor would come home ~9 pm. We knew it, no one called ahead, the first time my dad went to the doctor to get them notified cos I was too sick to be taken there.

Sorry this is going to come as no use to you Mary but if you were in India in 1980 I'd have delivered the best doctor I could find to your house. I am saying 1980 cos that was about when it happened that I recall fondly. The next house call I had to my house was @ the death of my dad in 1990. In between no one for sick enough to not be able to get to the doc.

Govt out of healthcare, insurance out of health care ... get rid of all the middle men. They only prevent people from talking to each other.
Cool.
Buddha.