Patient Beware

[dtel's wife]

"Hmm....why is jc putting all this stuff in writing. Well....there are some facts here that I can't change and are a reality. Have you ever thought that those contracts I sign with insurers may have something in there about giving "discounts" to non insured? Such that I could be sued for charging you a "medicare rate"? In fact.....I might not be able to charge you "what is expected as the reimbursed by the insurance"."

JC,

I think you may have just proven Jeff's case for him![:^)] If I am "understanding" what you wrote, there are serious legal issues with insurance companies' practices. That's a bunch of BS...insurance companies can control who and how much of a discount you give a person.

I am not directing the comments towards you....insurance companies disgust me. I worked in the insurance industry for almost twenty years, including owning my own independent insurance agency and I call tell you in the biggest "racket" going. All of it...auto, home, life, health.

Jeff,

I don't think one should be charged one penny more than medicare pays. That's absurd.

[theplummer]

Jeff. My response to this is not a rebuttal that your principles are incorrect. Your logic makes all the sense in the world. Logic has no bearing of what is "right or wrong" in medicine. Typical business principles do not apply to medicine. I didn't make these rules. I don't necessarily like them.

For instance. I performed 5 operations thursday and 3 today. 4 of the ones on Thursday were identical.

One of the patients Thurday has medicaid. For services I rendered, I will get about $600. Same CPT code on another patient with medicare, I'll get about $1000. Those that were insured will be about $1800-2000. In these cases, all the CPT codes are the same.

......so in the scenario where all the codes are the same.....why do I get paid more for one over the other? The code is the same. In fact the hardest case of the 4 was the medicare one that took me twice as long. Just to let you know......the previous week, I did the same procedure on a patient with no insurance.

The answer to this is simple. Don't perform operations on low pay customers. I won't plumb a house if there is a competitive bid that is too low for my level of required payment. I'm not going to cut my own throat just to get the job and take it away from another plumber. Others have tried and they eventually wind up closing up shop.

I don't expect other customers to make it up for the cheap asses that don't want to pay, that's why I have a great reputation, Good work for a reasonable price.

Now, this attitude seems harsh in the medical field, but, if every doctor took the same attitude, the govt. would have to pony up more loot to get the promises to the tax payer serviced, right? Also, isn't there a code that you could insert for complications that arise during the operation. The way you describe the pay is like asking me to give you a iron clad price to dig up your 60 year old sewer that's covered by who knows how many feet of dirt. I won't know the final price until the job is done. I do guarantee what my price per hour will be though, do you?

I'll bet the only reason you take on Medicade patients is because you can double book a daily office schedule and charge Medicaid for 15 minutes of your time that YOU devote about 3 actual minutes to. Do the math. If you only do medicaid surgeries, I'll retract every thing I've already said, and what I'm about to say.

NOW....The "charge" for all the pateints was the same. What is expected to be reimbursed is different depending on your insurance carrier. I don't control this.

Hmm....so where do these reimbursement anounts come from???? Well...medicare rates and medicaid rates are non negotiable. Private insurance rates are negotiable...but I have little power to tell a private insurer to pay me "so much" for a surgery. So I'm kinda stuck with what they will give me.

This makes NO SENSE AT ALL! If you don't like the contracted price that the insurance company is offering, REFUSE their contract! YOU and only YOU are in charge of your business. YOU set the prices, pay the rent, help, insurance, and income taxes, Etc. And only YOU can dictate what the charges SHALL be. Take hold of your business!!!!! If you don't, no one will! But what ever you do, be Ethical about your practice. If your willing to accept $25.00 office visit from UHC, you should be willing to accept that same payment from an uninsured small businessman.

Think about it, there is only one reason for being in business, and that is: TO MAKE A PROFIT!!! If your not, go to work for a hospital in the emergency room.

Hmm....why is jc putting all this stuff in writing. Well....there are some facts here that I can't change and are a reality. Have you ever thought that those contracts I sign with insurers may have something in there about giving "discounts" to non insured? Such that I could be sued for charging you a "medicare rate"? In fact.....I might not be able to charge you "what is expected as the reimbursed by the insurance". Again, if medicaid is too cheap to pay the rent, REFUSE to service those clients!!!

Also....do you realize that medicare has special CPT codes that are only used for medicare and not for anything else? Ditto

The amount of time spent on you in the ER will not help your argument. Nor will how much time was spent on you by a medical personel. But what will help is to find out what is "required" to charge the CPT code that you were charged. Such as......."bullets"....or how many "points" have to be made to meet the criteria of that code. If you broke your rib........did someone actually "push" on your rib...or "listen" to you lungs? It doesn't have to be an MD anymore to do this. Rules not made by physicians now allow for "mid level providers" to fill in for exams and to obtain a history. The public would look upon this as physicians being lazy wanting someone else to do the work. BUT....this is where MD's training is getting diluted. It will continue to happen. Cost will drive this. Lawyers have been doing this same thing for years. Billing ATTORNEY'S rate for a Secretary doing the work. You don't think that the folks that run the Medicaid and the insurance carriers are not wise to that trick? Think again.

Anyway......this is not a disagreement......but typical business principles will not apply to medicine. I didn't make these rules. They will if you choose for them to, Remember, it is your business and no one elses. You are the one liable and that makes you in charge of all of it. Remember Harry Trumann's famous quote, "THE BUCK STOPS HERE".

Good luck. Seriously.

Now, I know that was pretty harsh. But, I have spoken to several doctors over the years and the one thing that they do admit is that medical school is lacking in the business aspect of being a doctor. Remember your negociating with expert lawyers and businessmen, not other doctors. Your hoping that you can make a decent living on what they are willing to negociate with you, make sure you do that! Negociate!!!

In my rural area, AETNA has poor coverage in the dental area. Guess what, covered patients can go anywhere for services like in network coverage, without the dentist being " In Network". That means, the patient only pays the stated co-pay, and the doctor can bill them "REGULAR RATES" and the insurance company has to pay, just to keep the covered patient and it's employer happy. Their dental insurance on the doctor's side is pathetic, therefore no Dentist will accept them in this area.

Now, you want to know what your insurance is really paying for the services that your employer has contracted them to protect you for....... It's a lot less than you think. This is a game that both doctors offices and Insurance companies benifit from .

If you have insurance, you never see what the insurance company pays. Why is that? Because they want you to feel grateful that you have insurance to cover the procedure. If the doctor sends you a WAY inflated price, then the insurance comes to "RESCUE" you, your very happy to pay that premium and continue to be a customer of theirs. Remember Insurance companies are in business to turn a profit. ( Again, the only reason for being in business). And if you want to know the truth, insurance companies operate on a 90%+ PROFIT MARGIN. I know that sounds rediculous, but it's true. Why else would this industry have so much invested in Government Lobbiest's and this one. (why do people rob banks, because that's where the money is) Government creates the laws and that's where the profit is, really!!!

My best advise is, throw your ***, PPO, or whatever in the trash. Go get a HSA, and you'll get a quick education on the real workings of the healthcare industry. Then you'll figure out how to negociate a price with your primary healthcare provider and you'll save a bundle, and you'll no longer be one of the "SHEEPLE".

jc

[jwc]

I have to accept certain problems that come through my doors. If a person comes to the ER with medicaid with a stone at 2 am.....I'm getting out of bed whether I Like it or not. Once there in my lap they stay in my lap.

I can't drop insurancce carriers for negotiating purposes. Can loose lots of money. There is two of us. When we drop a carrier to negotiate we came out worse. We also have upset referring physicians. If we were a large group...we could do this more easily.

Complex codes can't be used for a case that takes long or just "harder". Certain documentation is required...that is tough to meet. Trust me.....I use this code when can.

I am simply powerless. This stand up and fight sounds so go.......but can be devestating.

My partner and I preach all those things to ourselves in our monthy meeting. We can attack them sometimes in small quantites.

"Lawyers have been doing this same thing for years. Billing ATTORNEY'S rate for a Secretary doing the work. You don't think that the folks that run the Medicaid and the insurance carriers are not wise to that trick? Think again."

You know. I typically stay out of threads that get controversial. My comments were to be helpful. With the tone of your post.......This will be my last post here and I won't look back. Telling me in words to "think again" is just rude. I made no arguement of what was right or wrong. I was just trying to explain possibly why Jeff's MD bill was "high" when he only saw the doc for a few or no minutes.

Jeff I hope you get it worked out. I have found that my patients with no insurance can get a "discount" of some kind by being persistent and professional when talking about their bill. Sometimes just inquiring about it will save you money.

Good luck

jc

[oscarsear]

Proactive versus retroactive costs analysis. If you investigated in advance what fees would be you would shop them and obtain the best price for the service. You did not shop this service and got billed what they charged for that service for a patient with your type of funding. Medicare is the baseline and Medicare defines the billing codes for the entire industry. But Medicare does not define the billing rate for anyone but Medicare users. Insurance companies independently negotiate their rates and private payers get charged whatever fees the service provider establishes. I have told many here that we all pay for the healthcare costs of tobacco and this is exactly how that happens. The health consequences of tobacco are typically so severe that they quickly bankrupt the victim and they end up on Medicaid and Medicare. As in this case we understand that those entities pay very poorly. To make up for these losses the providers have to charge more to others like insurance companies and private payers. They get over charged because the system gets underpaid by state and federal patients. Another thing to keep in mind is what it does cost to provide medical care. Many feel that MD's make exorbitant salaries. Yet few complain when a real estate agent with very little formal education makes $500,000 per year. What is 12 plus year of college education worth? Every RN is degreed. Every PT, OT, and RT is degreed. That hospital keeps a highly trained professional staff available 24/7 prepared to meet any and all troubles that can arise from any inpatient or might come in through the ER. The public expects the correct care anytime and all the time. And should something go wrong with the care the public can and often do sue. This is what I find so absurd about politicians looking to field national healthcare systems. While national healthcare is possible the way to get there will be extremely complex and these people talk as if just a few tweaks will make it happen. It won't. I am no happier that our healthcare system is at this juncture than is anyone else. But I do understand why. The next time you hear about all the illegals crossing the borders to get free healthcare look in your own wallet for the consequences. When you hear about 450,000 Americans annually dying from tobacco look in your own wallet for the consequences. Healthcare is expensive to provide and expensive to make available and the way coverage is mandated by the government we all pay to care for those unable to pay for themselves. It is not equitable. BTW you can challenge this bill in any way you wish and you will lose. You signed the form stating that you were responsible for the bill before your got service and that is what you will do, one way or another.

[Marvel]

If you have insurance, you never see what the insurance company pays. Why is that? Because they want you to feel grateful that you have insurance to cover the procedure.

Not really true. My insurance provides an EOB on every claim, telling me what they pay. Not what they want me to think they pay.

I couldn't begin to put enough money in an HSA to cover a catastrophic illness or injury. Maybe only high priced attorneys can do that. [] BTW, do you chase abulances?

Bruce

[Jeff Matthews]

BTW you can challenge this bill in any way you wish and you will lose. You signed the form stating that you were responsible for the bill before your got service and that is what you will do, one way or another.

You are wrong on that point. When price is not discussed and agreed to in advance between buyer and seller, the law implies a reasonable price will be charged. For evidence of reasonableness, we compare to the usual and customary charges for the same or similar type goods and services in the market. If you came to my office for a legal consultation, and we discussed your case for 30 minutes without discussing what I would charge for my consultation fee, you would not accept and pay a bill for $10,000. If I sued you to collect it, I would lose, not you.

BTW, signing a form saying "you are responsible for the bill" does not grant carte blanche to charge whatever price they want. The purpose of that form is because some people believe that insurance will pay for everything, and when it does not, they refuse to pay. That language is to instruct the consumer that they will pay whatever insurance does not pay. It does not allow the provider to say "Ha! Gotcha! That'll be $10 million, thank you!"

[oscarsear]

BTW you can challenge this bill in any way you wish and you will lose. You signed the form stating that you were responsible for the bill before your got service and that is what you will do, one way or another.

You are wrong on that point.  When price is not discussed and agreed to in advance between buyer and seller, the law implies a reasonable price will be charged.  For evidence of reasonableness, we compare to the usual and customary charges for the same or similar type goods and services in the market.  If you came to my office for a legal consultation, and we discussed your case for 30 minutes without discussing what I would charge for my consultation fee, you would not accept and pay a bill for $10,000.  If I sued you to collect it, I would lose, not you. 

BTW, signing a form saying "you are responsible for the bill" does not grant carte blanche to charge whatever price they want.  The purpose of that form is because some people believe that insurance will pay for everything, and when it does not, they refuse to pay.  That language is to instruct the consumer that they will pay whatever insurance does not pay.  It does not allow the provider to say "Ha!  Gotcha!  That'll be $10 million, thank you!"

But what they will learn is that the fee for this service is not out of the realm of normal. It will not be out of line with fees charged by ER docs in other parts of that city and may actually be less than fees charged for similar services in other cities. When medical bills go out the total fee is assessed then discounts are applied to that bill as they pertain to the individual patients funding source. So every patient gets billed at the same rate but the final fee the patient is responsible for is determined by which insurance they use, etc. The fee will not be construed as extreme. I have a personal example. My wife is an RN and carries insurance. I am disabled and have Medicare plus her insurance. We both had exactly the same midlife colonoscopy (oh joy) done by the same MD in the same setting. Her final bill was $250 and mine was $0.00. Because I had Medicare the provider had to accept what was paid by them and the insurer as full payment. But both procedures cost the same and were billed the same. But, at the end of the day hers cost more because I had different guidelines applied to my service fees. The disparity can be enormous. That is a symptom of how far out of whack the system has gotten.

[Jeff Matthews]

BTW you can challenge this bill in any way you wish and you will lose. You signed the form stating that you were responsible for the bill before your got service and that is what you will do, one way or another.

You are wrong on that point. When price is not discussed and agreed to in advance between buyer and seller, the law implies a reasonable price will be charged. For evidence of reasonableness, we compare to the usual and customary charges for the same or similar type goods and services in the market. If you came to my office for a legal consultation, and we discussed your case for 30 minutes without discussing what I would charge for my consultation fee, you would not accept and pay a bill for $10,000. If I sued you to collect it, I would lose, not you.

BTW, signing a form saying "you are responsible for the bill" does not grant carte blanche to charge whatever price they want. The purpose of that form is because some people believe that insurance will pay for everything, and when it does not, they refuse to pay. That language is to instruct the consumer that they will pay whatever insurance does not pay. It does not allow the provider to say "Ha! Gotcha! That'll be $10 million, thank you!"

But what they will learn is that the fee for this service is not out of the realm of normal. It will not be out of line with fees charged by ER docs in other parts of that city and may actually be less than fees charged for similar services in other cities. When medical bills go out the total fee is assessed then discounts are applied to that bill as they pertain to the individual patients funding source. So every patient gets billed at the same rate but the final fee the patient is responsible for is determined by which insurance they use, etc. The fee will not be construed as extreme. I have a personal example. My wife is an RN and carries insurance. I am disabled and have Medicare plus her insurance. We both had exactly the same midlife colonoscopy (oh joy) done by the same MD in the same setting. Her final bill was $250 and mine was $0.00. Because I had Medicare the provider had to accept what was paid by them and the insurer as full payment. But both procedures cost the same and were billed the same. But, at the end of the day hers cost more because I had different guidelines applied to my service fees. The disparity can be enormous. That is a symptom of how far out of whack the system has gotten.

Your point brings up an evidentiary matter, and the jury will determine fair value. So, let's look at your position. If enough private-pays are gouged, then that must be a fair price. Fair value is what a willing buyer will pay a willing seller.

Your evidence will be the 6-10 fold price charged to people who did not know in advance what they would be charged, did not negotiate, and just received a bill. The charge to insurance companies has been negotiated by the buyer and accepted by the seller.

Now, what is a better indicator of market value? A negotiated or non-negotiated price? Sure the doc does not have much negotiating power with the insurers, but at least he knows the prices up-front before he signs the contract. That's a lot more of an indication of market value than a person who just receives a bill in the mail at some unexpected, unilaterally-set price.

I think my evidence would be more persuasive.

[oscarsear]

BTW you can challenge this bill in any way you wish and you will lose. You signed the form stating that you were responsible for the bill before your got service and that is what you will do, one way or another.

You are wrong on that point.  When price is not discussed and agreed to in advance between buyer and seller, the law implies a reasonable price will be charged.  For evidence of reasonableness, we compare to the usual and customary charges for the same or similar type goods and services in the market.  If you came to my office for a legal consultation, and we discussed your case for 30 minutes without discussing what I would charge for my consultation fee, you would not accept and pay a bill for $10,000.  If I sued you to collect it, I would lose, not you. 

BTW, signing a form saying "you are responsible for the bill" does not grant carte blanche to charge whatever price they want.  The purpose of that form is because some people believe that insurance will pay for everything, and when it does not, they refuse to pay.  That language is to instruct the consumer that they will pay whatever insurance does not pay.  It does not allow the provider to say "Ha!  Gotcha!  That'll be $10 million, thank you!"

But what they will learn is that the fee for this service is not out of the realm of normal. It will not be out of line with fees charged by ER docs in other parts of that city and may actually be less than fees charged for similar services in other cities. When medical bills go out the total fee is assessed then discounts are applied to that bill as they pertain to the individual patients funding source. So every patient gets billed at the same rate but the final fee the patient is responsible for is determined by which insurance they use, etc. The fee will not be construed as extreme. I have a personal example. My wife is an RN and carries insurance. I am disabled and have Medicare plus her insurance. We both had exactly the same midlife colonoscopy (oh joy) done by the same MD in the same setting. Her final bill was $250 and mine was $0.00. Because I had Medicare the provider had to accept what was paid by them and the insurer as full payment. But both procedures cost the same and were billed the same. But, at the end of the day hers cost more because I had different guidelines applied to my service fees. The disparity can be enormous. That is a symptom of how far out of whack the system has gotten.

Your point brings up an evidentiary matter, and the jury will determine fair value.  So, let's look at your position.  If enough private-pays are gouged, then that must be a fair price.  Fair value is what a willing buyer will pay a willing seller.

Your evidence will be the 6-10 fold price charged to people who did not know in advance what they would be charged, did not negotiate, and just received a bill.  The charge to insurance companies has been negotiated by the buyer and accepted by the seller.

Now, what is a better indicator of market value?  A negotiated or non-negotiated price?  Sure the doc does not have much negotiating power with the insurers, but at least he knows the prices up-front before he signs the contract.  That's a lot more of an indication of market value than a person who just receives a bill in the mail at some unexpected, unilaterally-set price. 

I think my evidence would be more persuasive.

Jeff, this is not my position. I am not defending the way the system is set up and its burden on private payers. I am just advancing what I know and that it has been this way for quite sometime. It is the primary reason why so many people want the system reworked. There are millions of Americans unable to pay for health insurance who understand how costly private pay healthcare is. They simply choose to go without healthcare often until it is too late. It is truly pathetic that a country as advanced and wealthy as ours cannot take care of the basic health needs of its citizens. It is a huge and very complex problem without simple solutions.

[WMcD]

There is a lot of voodoo economics.

It came home to me in a small way when buying eyeglasses at Lenscrafters.

I have a Blue Cross policy through work. Lenscrafters gave me a 50% discount compared to the guy off the street. Sometimes I write a check or pay on a credit card. There is no real risk of Lenscrafters of a non collectable account..

I asked whether there is a flow of money from Blue Cross to Lenscrafters to cover this. I'm told by the workers at LensCrafters that there is no such flow, Maybe there is some kick back in another way. (People from Chicago suspect such things.) Perhaps Lenscrafters pays BC for this benefit, overall.

None the less. Myself and my twin could go into Lenscrafters. Both, ready, willing, and able to pay. One gets gouged, for no reason.

Gil

[oscarsear]

It is truly pathetic that a country as advanced and wealthy as ours cannot take care of the basic health needs of its citizens.

Ain't that the truth! 

It is a huge and very complex problem without simple solutions.

Here, I disagree in concept. There are numerous longstanding working models in similar countries to mimic, adopt or modify. (C'mon..we are 30th in the world.....what's to lose?) Nothing new needs to be invented here at all. In fact, our very own MediCare model works with satisfactory efficiency. With nothing much more than a stroke of a pen, the USA could join EVERY other developed nation in providing universal healthcare. The "complexity" and "no simple solution" are made up stumbling blocks to keep everyone thinking it is an intractable problem. Remember all the private money that went into paying private scientists to "object" to global warming and present it as "controversial science" at best or junk science at worst? That very same process is now working in the exact same way to present "complexity" in healthcare hoping to maintain the status quo forever. Hundreds of spin doctors are being paid vast sums of money to create news out of thin air that will get their face on MSM saying, "It's too complex!!!!" "It's not possible in the USA!!" "No one want's Government Doctors!!" (Nevermind the inconvenient truth that MediCare employs NO doctors!) And, the final bullet if you can squeeze it out, "It's SOCIALISM!!!" The only true complexity is how to get all this money off the playing field.

 

Mark, I must disagree. First of all Medicare does not work. If the national healthcare system was forced to employ Medicare tomorrow most of your providers would quit and do something else. That is part of the problem noted in this post. Medicare pays way too little so private pays get charged too much. Then consider the obvious. Our current healthcare infrastructure could not meet the demands of the entire country. It is set up to care for those who can pay for healthcare. If everyone got free healthcare tomorrow the wait to get any healthcare would make Canada's lengthy delays seem minimal. Then what do we do with non-citizens getting free healthcare? They are hamstringing the system now. Who pays for malpractice insurance when MDs are required to accept massive caseloads? Do we eliminate insurance carriers to cut out spending wastes? Would those willing to pay more for healthcare get the best and fastest service? Seriously, I want some sort of national healthcare system. I wholly agree that profit and healthcare are contrary partners. Yes, it could be done but it will not be a simple solution to do it right and have it run satisfactorily. It will take a lot more than a simple tweaking.

[LarryC]

Mark, I must disagree. First of all Medicare does not work. If the national healthcare system was forced to employ Medicare tomorrow most of your providers would quit and do something else...

Medicare pays way too little so private pays get charged too much.

Then consider the obvious. Our current healthcare infrastructure could not meet the demands of the entire country. It is set up to care for those who can pay for healthcare.

Huh? Medicare has been highly satisfactory in many parts of the country -- it's simply not true to say it "doesn't work." Perhaps you are thinking of some local or regional differences in how satisfactory Part B (physician) payments are to physicians in their geographic areas. I NEVER hear such complaints from physicians in the MD-DC area.

Be sure you aren't equating it with some state MediCAID (i.e., welfare) programs, many of which do in fact underpay, sometimes severely.

Medicare does NOT pay "way too little." While this has been a frequent complaint by hospitals who would like Uncle's deep pocket to pay more or much more, many studies by credible researchers have repeatedly shown that Medicare neither UNDER nor OVER pays for hospital care.

BTW, secondary payers are often the face of Medicare to beneficiaries, so perhaps there are problems with some of those you are familiar with.

The system may well be inadequate if everyone were insured, which would show the fallacy of any claims that every one gets sufficient care now. That's not much reason not to insure the uninsured. What IS a major problem IMO is the inability to control cost escalation at the present time, which suggests it would become much worse with increased insurance coverage. Medical care cost inflation has been the great thief that for nearly 50 years has stolen our ability and willingness to insure everyone.

[Mighty Favog]

BTW, signing a form saying "you are responsible for the bill" does not grant carte blanche to charge whatever price they want. The purpose of that form is because some people believe that insurance will pay for everything, and when it does not, they refuse to pay. That language is to instruct the consumer that they will pay whatever insurance does not pay. It does not allow the provider to say "Ha! Gotcha! That'll be $10 million, thank you!"

Hi Jeff,

I was admitted back in February for chest pains and very shallow breathing. Turns out it was pneumonia with pleurisy. After the people at the ER check-in desk immedeatly wanted money before anything was done, I too signed same form you speak of. I would love to present my case in court with the phrase "contract signed under duress".

I'm still getting all these piddly bills (and I mean piddly!! The last one one was for $1.96) from people I keep asking the hospital who they are and "what did they do?" I never get a real answer from anyone. The last one I paid was for $7.64. The office was near my house so on a Sunday I drove over and slid a baggie full of loose coins (the most numerous I could come up with) into their mail slot with a note "mail me the receipt". Got one later that week.

I was getting bills from everyone I did and didn't meet; even the nursing staff. I'm surprised I didn't get one from each one of the kids that brought me my meals. This is all seperate from the grand hospital bill. I filled out the back of that one saying that "I am in the legal business and due to federal tort reform laws my salary has been cut by 23%......". Meaning that I am applying for monitary relief.

To go along with me being in the legal business, it was very peculiar that once someone asked what I did for a living (trying to get to know you better - bedside manner and all) I never ever saw that person again. EVER! Hhhmmmmmmm..........

[JohnA]

Anyone ever see the 60-Minutes program where it was revealed that the medical charges billed to insurance providers were only a small fraction of what you would be billed if you were uninsured - i.e. gouging the uninsured? Well, anyway, here's a real case....

I NEVER watch 60 minutes.

It has been my impression that I and my insurance were paying for everybody else. Often the Doctor's will bill will be over $100 but the insurance write-offs will get it down to maybe $30.

Of course, if Medicade didn't pay so little, the doctor wouldn't be as interested in overcharging the rest of us to mae up the difference. It's never fair, or accurate, to describe the federal government as "negotiating" any price. If there WERE a doctor's "union" with which the government could negotiate, I can't see it as a real 2-way street. The feds are just so big and can pass a law if they don't get what they want.

Still, it's unfair to overbill others to pay for Medicare shortfalls or other "no pays".

I bookmarked your page and I plan on using it on my Dr. until I can line up another one. He told me a few months ago that I could afford something, I had good insurance.

[JohnA]

I couldn't begin to put enough money in an HSA to cover a catastrophic illness or injury. Maybe only high priced attorneys can do that.

Bruce

Bruce Health Savings Accounts work much better than that. You put back some amount of money, up to a max of, say $3500 (or whatever the amount is thede days). You can take 1 or 3 or 7 years to get to $3500 You pay the first 3500 of all medical expenses each year and have insurance that covers everything over that. The insurance is quite cheap; they skip the nickel and dime expenses. If you don't spend $3500 this year, you only put in enough to get back to $3500, next year.

I like it.

[JohnA]

Huh? Medicare has been highly satisfactory in many parts of the country -- it's simply not true to say it "doesn't work." Perhaps you are thinking of some local or regional differences in how satisfactory Part B (physician) payments are to physicians in their geographic areas. I NEVER hear such complaints from physicians in the MD-DC area.

We have several doctors in SE TN that clearly advertise they do not accept Medicare/TennCare patients.

[JohnA]

2. MediCare has a very low administration and overhead - about 1/6th of private insurance, and equal to that experienced in many national systems. Administration, overhead and profit are the leading inflationary effects on healthcare costs.

You assert that, but I've never heard it before today. The insurance program I have at work is run for 3% of the payments going out. There is no believable way Medicare can administer it's program for 0.5% of payouts.

3. Treatment of so-called "non-citizens" is a red herring used only in political arguments. Healthcare professionals and public health studies do not show this to be the problem it is made out to be.

Again, news to me. Where's your evidence?

4. MediCare is NOT FREE - - nor is anyone suggesting free healthcare of anykind in any place for anyone. MediCare is paid by taxes - just like wars are paid for. Would you say, "we're fighting a FREE war in Iraq?" Or, "we're building free F-16's for the Navy?" (Air Force [] )

5. Taking politics out, and relying upon profressionals in public health, it has been determined we can cover EVERYONE for less total money that we know spend where 45M aren't covered.

Again, please provide evidence. On it's face, the statement is ludicrous. WHO determined this, Hillary? Bah!

6. Why worry about what rich people can do? Don't they have money and minions enough to worry about their affairs? Of COURSE they can go spend whatever amount of money they choose, anywhere in the world for whatever care they want - - JUST LIKE THEY DO NOW. I will never understand how so many "average" people can be so perpetually worried about taking care of the rich.

Average people worry about "the rich" bcause the federal government declares they are "the rich".

10. In reality, the biggest problem MediCare has is with privateers RIPPING THEM OFF. Private corporations, with only the intent to defraud the government are the cause of the largest waste in MediCare. I say start tossing these white collar pirates in jail with more enforcement.

Where on Earth did you come up with THIS Blarney?!

[Jeff Matthews]

Government health care? Shriek!!!! Socialism!!! Communism!!!!

It's really funny how people are brainwashed into believing the country will fall if we taxed for and provided health care, but on the other hand, we can afford a war that costs about as much as it would to give every college-aged kid a full scholarship to any university of his or her choice. Not that this means we should send all kids to college on the government nickel, but if we are going to spend that kind of money blowing up things half-way around the world, I'd much rather see it spent on something productive at home. Same goes for health care.

Moreover, a government health system would not likely have nearly as many "outs," or exceptions to coverage. What a horrible situation where carriers make coverage decisions separate and apart from health care. Health care became expensive because they learned over the years that they could do things for people who, years ago, would have been inevitably dead from what is now a treatable situation. Yes, it's expensive, but obviously worth it. How do you put a price on the survival instinct? Let's get past the money issue.

Also, the divisiveness is just horrific. If everyone was covered, then, we wouldn't have all the finger-pointing about "illegals who show up in emergency rooms." Honestly, if I was an illegal and had an emergent need for health care, guess where I'd go. You can't blame them for showing up in emergency rooms, even if you can blame them for being illegal. Next, is the doctor. If you were a doctor, would you really have the disposition to turn an illegal out on the streets who needed an emergency by-pass surgery? I hope not. "Excuse me sir..... Yes, yes, I see you are dying.... but first, I need to see your papers. I know..... I know.... You're dying. Okay? You've said it ten times, now. No papers? I'm sorry, sir. You need to leave." I don't think so.

[oscarsear]

I too won't digress into a plethora of specifics but will address a few issues. I state that the wait for healthcare would be enormous if healthcare were made available to our entire population. That simply has to do with the number of available practitioners and the physical limits of the available facilities. I'll cite an example. In East L.A. they closed down Martin Luther Hospital for violations. Consequently those people it used to serve had to shift to adjacent facilities. Just that overburden has resulted in wait times of up 8 hours for an ER visit for everyone each surrounding hospital serves (and that's if they can find an ER open to accept the patient). There are just not enough clinicians and buildings around to immediately meet the needs of everyone. Then consider that there will be many people who can an would still pay for better and more accessible healthcare. If allowed to do so their money will command priority in time and quality. I am not worried abut their welfare I'm saying that we could end up with a tiered system where the wealthy still secure better service to the detriment of everyone else. So do we force everyone to use the same system or will the wealthy be allowed to command a part of a fixed asset limiting what remains for the rest? Illegals literally have hospitals all along the southern border on the verge of financial ruin. I worked at the University of Cal Irvine Med Center. 30 to 40% of the daily census was nonpaying illegals. Medicare does pay but it pays slowly, it pays by very stringent guidelines and NO the rate of reimbursement does not cover the costs of service. Yes, it is a payor system and yes it could be reworked to overcome those problems. BTW I really do not view this from a political perspective. I do think it can be accomplished. We do have many such systems in other countries we can examine when restructuring ours. But do not think that anyone is going to flip a switch and easily fix healthcare in America.

[Jeff Matthews]

I too won't digress into a plethora of specifics but will address a few issues. I state that the wait for healthcare would be enormous if healthcare were made available to our entire population. That simply has to do with the number of available practitioners and the physical limits of the available facilities. I'll cite an example. In East L.A. they closed down Martin Luther Hospital for violations. Consequently those people it used to serve had to shift to adjacent facilities. Just that overburden has resulted in wait times of up 8 hours for an ER visit for everyone each surrounding hospital serves (and that's if they can find an ER open to accept the patient). There are just not enough clinicians and buildings around to immediately meet the needs of everyone. Then consider that there will be many people who can an would still pay for better and more accessible healthcare. If allowed to do so their money will command priority in time and quality. I am not worried abut their welfare I'm saying that we could end up with a tiered system where the wealthy still secure better service to the detriment of everyone else. So do we force everyone to use the same system or will the wealthy be allowed to command a part of a fixed asset limiting what remains for the rest? Illegals literally have hospitals all along the southern border on the verge of financial ruin. I worked at the University of Cal Irvine Med Center. 30 to 40% of the daily census was nonpaying illegals. Medicare does pay but it pays slowly, it pays by very stringent guidelines and NO the rate of reimbursement does not cover the costs of service. Yes, it is a payor system and yes it could be reworked to overcome those problems. BTW I really do not view this from a political perspective. I do think it can be accomplished. We do have many such systems in other countries we can examine when restructuring ours. But do not think that anyone is going to flip a switch and easily fix healthcare in America.

That was an intelligent post. There is no doubt that there will be wait time increases. I have no problem with that. There already are wait times. Emergency care is not doled out on a first-come, first-served basis. They rank the patient according to the level of immediacy required. No big deal. It's already that way; I don't think it will change. I doubt it well get worse. You will get the care you need. For care you would prefer to get more quickly for matters of convenience or comfort, you may have to wait. Se la vie! The problem is where people get no care at all. Also, I do not doubt there would still be some form of tiered health-care where the wealthy get ahead in line. Money buys a lot of things.