Government Run Healthcare- Good or Evil

It's hard to separate the big issues from the small ones....who wants a good health care system when there are way too many of us consuming way too many rescources, the first world is eating the rest of the world, and the third world has woken up and wants it's share. We are just shuffling the deck chairs on the titanic. Huge structural change needs to occur in the nature of world population and consumption in order to return to anything remotely approaching sustainable.
In the mean time self interest will continue to reign, as has been so beautifully illustrated by the latest round of private profit taking and public loss sharing within the worlds banking and financial system. And all our governments go on letting it happen because they are too scared to consider alternatives.
regards Phill Carter

 

As far as capitalism working for the world....what a joke, 5% of the worlds population owns and consumes 80-90% of it's energy and resources, capitalism works for the rich and middle class and nobody else.
regards Phill Carter

 

Steve,

So was the Mayan empire. look what happened there. Any way. No need to fret. The world as we know it will come to an end on Dec 21, 2012. Good excuse for a party:drinks

 

Right so at least we have got that sorted..... No point the Government changing anything then by the time they get around to making a change it will be after DEC 21 2012 ????

Graham which bunch of crazies said this

 

Michael,

Google 21.12.2012

Nostradamus my man!

 

http://www.endoftime2012.com/

 

ahh him

 

This is an interesting discussion.
I am amused at my friends across the ocean, who are quick to criticize the US system and sing the praises of government-run healthcare. But I know of at least 10 physicians and surgeons from Europe, who have come here for surgical procedures for themselves or family members.

Yes, administrative costs are too high in the US. Yes, changes need to be made. But the government is incapable of directing traffic effectively. I do not want the government involved any more than they are now.
One of my mentors at Yale once told me that every step that lies between the surgeon and the patient is a problem. The most effective, efficient care is between the doctor and patient directly.
I have childhood friends in Washington, DC who are healthy 35-year olds, and they just were called to a meeting with their primary care physicians. The doctors have decided to stop accepting insurance of any kind. They have chosen to accept a limited number of patients (and their families.) The head of household signs a contract with the doctor for treatment. Unlimited access during the year, calls returned by staff within 24-hours, agreement to see them, if necessary, at local hospitals, for a flat rate of $5500 per year.

If the US does end up with socialized medicine, reinbursement will decrease, the best doctors will not accept "government" patients, and fee-for-service will allow wealthy people to see the best doctors and surgeons.
(This is already the case with state Medicaid- hard to find doctors who accept it.)

Did you know that in the US today, if you need a knee replacement, you can negotiate with the hospital and if you pay cash, they will usually discount your fees by 50%? Administrative costs are too high, too many people are involved besides the 2 most important- the patient and the doctor.

 

Evil,

In the U.S. can someone name a government run program that is efficient, equitable, and sustainable? If the Australian system is so great, why did my friend in Melbourne have to beg and borrow $14,000 to save his life from colon cancer? His "free" care would have killed him since he was scheduled for surgery 18 months down the road when his resection by all accounts needed to be performed within one month?

I think a healthy debate on this topic needs to take place point by point. Some of those points would have to do with tort reform, the current status of Medicare and it's future, or possibly what is wrong with the current system in your mind.

I have plenty of real life examples and statistics and would welcome a point by point debate.

Jon Purdy, DPM

 

Thats is easy to respond to.
1. Where do all the uninsured in the USA get their treatment for colon cancer from?
2. Why does the USA healthcare system spend twice as much as other countries on administration costs as a % compared to patient care costs?

 

I may be able to answer those questions-
1. Uninsured patients, at least in LA and MS, can be treated at a state hospital for colon CA. The waiting areas are not as comfortable as private offices, but they receive care from the same Board Certified Oncologists and nationally-renowned surgeons that staff private hospitals. A large percentage of the best oncologists and surgeons have private practices and hold faculty appointments at medical schools. They practice, teach, train, and do research. An illegal immigrant or a poor citizen here receives superior care.

2. Administrative costs are high because there are too many entities lying between the patient and the doctor. The government is the fastest growing employer in the US. There are far too many people working in "healthcare" who never see or touch a patient. Cut the waste. Eliminate the multiple steps between doctor and patient. More government involvement= more cost and more problems.

 

So, we have a good system for those who can pay cash. What percentage of the US population can do that?

This is the case against private insurance. Doctors are fed up with dealing with insurance companies and would rather form their own private healthcare system. This works as long as you don't need the hospital. So, now you have to buy a catastrophic policy to go along with your boutique doctor arrangement. I would bet that more "coverage" would fall through the cracks in this system than a government run system. So, if something falls through the cracks you can just sue somebody.

Is reimbursement increasing under private insurance? That's why doctors are starting to refuse to take insurance.

The problem with the cash model is that you need the infrastructure to support it. The 50% discount probably reflects the actual cost of doing the procedure. The hospitals have to inflate the cost to cover those patients who receive treatment and go bankrupt trying to pay the bill. Do we really want a system where if you get sick through no fault of your own, and lose your job, because you can't work, and then lose your insurance coverage and then lose everything.

Regards,
Eric

 

What about those on low incomes needing care of long term conditions in the US, those needing multiple long term medications and treatments. Is this freely available to the uninsured ?

 

The health care insurance model is progressing to a point where it is worse than any government could come up with. See my ingrown toenail story earlier in this thread. Government gets bad when it is run by people who don't think government can do anything right. The private sector can be more inefficient than any government especially when they can make a profit by being inefficient. Have you ever tried to get a refund out of your phone company? It sure is a lot harder than signing up for service.

Why did your friend have to raise the money for the immediate procedure? Was there a disagreement on the prognosis?

Ok lets start the debate. The US spends more per capita on health care and has worse outcomes in infant mortality and many other health measures. Why shouldn't we change?

Regards,
Eric Fuller

 

It is available here.
Primary care, specialists, pharmacy. Based on income and ability to pay-

 

In California's current budget crisis there was talk of cutting AIDS medications. I don't know if it happened. The wait times for an appointment for the local county hospital are in the months.

Eric

 

I again would challenge anyone to debate universal health care point by point rather than sending links to sites like factchecker.org which has strong ties to the democratic party and leftist groups like the Annenberg foundation.

Both sides could argue that either is stuck in their ways and does not see the "facts." Again, give me a couple of points of contention backed by "factual" information and we can begin a nice healthy debate.

 

I detect an element of sensitivity and defensiveness creeping in here.

Gibby feels that non Americans are criticising the healthcare system in the USA and extolling the virtues of state run systems in Europe and Australasia. If you read the OP, Steve asked whether those who had experience of such systems found them 'Good or Evil' and in large part the repondents gave fair and reasoned answers. The thread then seemed to lurch into the area of capitalist versus other political systems and then to centre on the pro and con opinions of those within the American system who did not have any experience of any other method of healthcare delivery. I am sure that there are many people from around the world who have taken advantage of the excellent specialist treatment available within the States. There are likewise many people from the States who have taken advantage of treatment available in specialist centres across the world. This has nothing to do with political systems and to suggest or imply that all Health systems are somehow 'communist' or even 'socialist' because they deliver the best available healthcare to all, free at the point of delivery is at best, delusional.

The fact is that no system is perfect (the U.K. system is far from it!) However, I do take Steve's point concerning speed of implementation, and the UK health service has evolved over centuries. I repeat, I am not qualified to comment on President Obama's proposals, I simply suggest that the objective examinination of models available elsewhere will lead to a more rational outcome than the hysterical outbursts made by some commentators in the USA against all existing systems elsewhere.

Bill Liggins

 

Although it sounds nice, and fits a politically-correct model to suggest people from the US seek treatment "across the world," it is simply inaccurate. I read a report in the Wall Street Journal which showed an increasing occurrence of Europeans seeking advanced care in the US, due to rationing and extended wait times. The number of Americans who leave the country for care is negligible, and this small number includes people who seek cheap, poorly-trained plastic surgery in Mexico and Central America.
Healthcare in the US is clearly the finest in the world. I have travelled the world, have served in the US Army, and have close family in Europe. I have worked in both private practice and in government clinics- there is no comparison. When you nationalize or subsidize something, it eventually eliminates competition and provides less incentive to excel.
If you really think healthcare has nothing to do with political systems, try looking up how many new vaccines, drugs, surgical advancements are coming out of Cuba these days. Cuba has a national crisis on it's hands-- an extreme lack of toilet paper. This sounds funny, but it is true.
If my colleagues and their families who suffer traumatic injuries were being rushed into Canada for surgery and aftercare, I may have a different, more politically-correct outlook. The fact is that history shows a disproportionately high amount of advancements - in medicine, surgery, and life, come from the much-maligned, Capitalist, criticized USA. It is not a result of the government, rather in spite of the government.
I still have not heard a valid argument opposing my view that the best healthcare comes from an uninterrupted link between doctor and patient. Insurance companies, government agencies, special interests, all make the relationship between doctor and patient difficult and expensive.

 

Government programs by their nature are usually running things that the private sector by its nature would not do well. They have different needs and different motives guiding them.

The private sector would build roads, railways, airports and the mail system in large metropolitan areas only because they can do so with the efficiencies and profits that large populations can provide. Fedex and UPS on the other hand, will not deliver a letter from some little town in Maine to the Alaskan outback for 50 cents and get it there in two or three days. The government can and does it very effectively. Rural roads, rural electrification and the building of rural rail lines that made the spread of population and wealth across the country possible are just a few of the things that were made possible by spreading the cost across the entire country even when it was not profitable to do so. To evaluate the utility of such programs based on their profitability alone would mean they would never have happened. Think third world country. That is also why the funding of most basic sciences is government sponsored. Private pharmaceuticals take that work and come up with drug applications. They could not have done it by themselves. While we think of ourselves as rugged individualists, fact is we do better as a nation in many areas when we work together and are a bit less narcissistic and just plain selfish.

In health care, the private, for profit system you are so in love with has brought us a health system that cherry picks the healthy while it leaves those with "preexisting conditions" who actually need health care out in the cold. It rewards doctors handsomely for doing "procedures" but pays little to our internal medicine friends to spend time counseling patients and just figuring things out - i.e. mental gymnastics do not pay nearly as much as invasive procedures. It makes deals with large companies to sell insurance but makes the purchase of insurance by individuals unaffordable unless they are very young, very healthy and unlikely to actually need it or use it. These are all truths that have been conveniently overlooked by those who don't like Big Guvment.

Finally, health care is a necessity not a luxury. The issue of ethics and compassion must play a role. You were lucky enough not to be born with some congenital deformity, diabetes, the genes for heart disease? Good for you. Some of your neighbors and friends were less fortunate. You had the IQ and wherewithal to put yourself through a medical program and make tons of $$? Awesome. Me too. But the folks who wait on your table at that fine restaurant you like, changes your car oil and cleans your swimming pool have a right to health insurance too. Under our current system they cannot afford it and the problem is getting worse not better.

 

Our system has its flaws- major ones. But it is not smart to completely change a system that is working for nearly 70% of people.
Your views on big government are interesting. Do you really want to use the US Postal Service as a positive example, supporting your view? It is one of the largest failures in the US today- local and national media have reported that several post offices are scheduled to close in the next 2 years. It represents, in a nutshell, the abject failure of federal systems. And I happen to know something about roads, railways, and airports. Interstate highways, bridges, ramps, and other federal construction projects are NOT BUILT BY THE GOVERNMENT. They have a bidding system, complex, difficult, and expensive. The larger companies with the cheapest bids get the most contracts. The work is done by these private companies. (Actually- it is done by smaller sub-contractors). Because the government is so heavily involved, the process is slow, very expensive, and full of corruption potential.
I agree that health care is a right, a necessity. I volunteer every week at Free Clinics, at Musicians Clinics, and I do not think our system is always fair. My partner is constantly mad at me for seeing patients without insurance. But I believe in karma, and I want to help people whenever I can.
I agree with your view that internists should get higher reibursement. That health insurance systems need reform. Individuals need to be able to pool their resources and buy group plans, much like large companies are able to do. But involving big government in the solution is a huge mistake, my friend. The government cannot handle a simple process, where rebates are given for trading-in old cars for new, fuel-efficient ones. Do we really want the same process for something as complex as managing people's health?

 

The founder of the Annenberg foundation was appointed as an ambassador by Richard Nixon. I guess, depending on where you sit, you could consider this a left wing organization. It seems rather centrist to me.

What part of universal care do you want to debate. How do feel about Medicare which is Universal care for those over the age of 65?

Eric

 

Are you supporting single payer? Or are you saying that everyone should pay cash to their doctor/ hospital? Gee, some procedures cost more than the median annual income. Maybe we could form a risk pool.... Oh no, the risk pool has come between the patient and the doctor.

Eric

 

Your position is very interesting. So, if as a country we are paying more per capita than any other country for healthcare and covering 85% of the people then we are doing much worse than the post office which delivers a much higher percentage of the mail. If you agree that healthcare is a right how do you foresee the free market providing it to all the people. Who else besides the government can make it happen. Or should the uninsured and under insured have to rely on charity?

Cheers,

Eric

 

Nixon or not, it is a company founded and linked to the main stream media.

Regardless, I think Medicare is one of the biggest scams perpetrated on the American public next to social security and then in turn on doctors. Medicare is insolvent and there is no argument about that. It is a bloated bureaucratic mess. As an employer, why am I paying part of an employee's Medicare withholdings as well as their current medical coverage? Why is it that I could take the money I had to pay into Medicare over a lifetime yet I could have tripled the benefits I would have received had I placed it into a medical savings account? With a medical savings account, if I don't use it on medical care I could have used it for retirement, but with Medicare, if I don't use it I lose it.

As a practitioner, I am now subject to almost being required to accepting Medicare since it has been required and now used by those over 65. I am now subject to governmental requirement and paperwork, extensive and burdensome auditing, and the threat of substantial cuts in reimbursements every year. It also takes a very substantial portion of the population out of the private sector and therefore taking away a competitive force in the market. There are many other things I don't like about it but that's a good start. What exactly do you like about it?

 

Here's a good source of how many US. citizens are really in need of health care? The US Census Bureau, believe it or not, does not distinguish between legal and illegal immigrants. The facts again are that we have a 15.8% uninsured rate, with 10.2 million of those being non-citizens. Thirty seven percent of that figure contains households making incomes over $50,000, and it also includes people who are uncovered for only weeks or months at any given time in a year. Estimates are that only 8.9% of Americans need assistance with medical coverage [http://www.sciencedirect.com/scienc...erid=10&md5=0c137dbef66660ffa31a313c8a94ec63]

You are correct that we spend more than just about every other country on out of pocket health expenses. The real question is what’s behind this number? The answer lies in the fact that Americans are allowed to go directly to higher cost specialists, where in other countries this access is limited. This direct access also affords the consumer some of the latest in medical technology which comes at a higher price. Other countries limit the numbers of, and access to, advanced medical care. Finally, and probably more importantly, is that this figure accounts for us being one of the wealthiest populations in the world. Americans choose to pay for more medical services such as preventive health care and plastic surgery. Statistically, we are more likely to seek medical care. This is no indicator in any sense of the overall cost of "standard medical delivery."

So, with only 8.9% of the population really needing health care coverage, yet living in the best nation in the world with the most opportunity available to get them out of that situation, I'm still not convinced government intervention should even be discussed. I am convinced that if the government would get out of the way and let competition in the free market work, (yes with government oversight and regulation) this number would be much less. There are some you just can't and never will be able to help no matter what the situation, such as the case with the Canadian system.

 

Thank you, Dr. Purdy.


How far is your office from Lafayette?
I have a brother-in-law with what sounds like Achilles tendonitis, and he does not like the idea of coming all the way to New Orleans to see me.

Excellent points.
Old classmates of mine, in practice in southern CA, are joining multi-specialty groups and signing contracts to treat wealthy people in a limited partnership, where they only have about 200-250 patients/families. I wonder if this is where we are headed-
-John

 

Gee, you would think that people in the USA are just out of luck if they are not working for a big company or the government.

I call bull.

My daughter-in-law is out of work and has no insurance. Three weeks ago, she had a gall bladder attack and went to an emergency room. They had a special program (not a government program) for her situation. She was set up with a surgeon, given meds and one week later had her gall bladder removed. She was back looking for employment in less than a week after the surgery.

Total cost= $200.00

My point is that no one is denied care in the USA. We need a system that encourages more competitive rates (let insurance companies operate nationwide) and lessens expenses for medical practitioners (esp. mal-practice insurance and tort reform); and make it sensible for the individual to buy insurance with pre-tax dollars like the companies do; but, we don't need to totally destroy our healthcare infrastructure in order to add coverage for 10-15% of our population..

Sure, the system would collapse if everyone was in that category. But, they are not. And, the ones that are, get help when they need it.

Don't ever feel sorry for Americans, unless we end up with our healthcare decisions being made by a government bureaucracy; and, a bunch of sorry, thieving politicians.

Now, you may flame me if you wish. But, that's the facts, friends.

 

The scare about the "public option" here in the U.S. is ridiculous.......Out of all my payors....at least with Medicare....one has rights.....the private market seems to do what they want and it often seems to be not paying the doc

 

From what I've heard, a vast majority like Medicare. Remember "don't let the government get a hold of my Medicare." I think you are out of the mainstream on this one. I would agree that there is a problem with Medicare drug benefit where it was written into law that the government couldn't use its market clout to lower drug prices.

As a patient you have to sign up for Medicare. It is not required. You can also opt out of the Medicare as a practitioner. When you do, you collect directly from the patient and then the patient is reimbursed at Medicare rates. So the insurance companies in your area don't require paperwork? They don't audit? They don't cut reimbursement?

I don't understand how removing population from the private sector changes the competitive forces acting in the free market? Could you explain?

Medicare is simpler than private insurance. The economic incentive of insurance companies is to delay or deny payment. I recently called an insurance company to find out if a particular drug was covered. (They didn't have it on a website) It was the worst automated phone maze ever. Worse than any government automated phone maze that I've ever tried to navigate.

Cheers,

Eric

 

The general public is naive. This is the reason that taxes are withheld from paychecks. If the general public had to pay a check each quarter to the government like companies do, they would soon realize how much of what they earned was leaving their hands. We would have a potential government overthrow on our hands. Instead, they have become accustomed to just looking at "all" they get to keep and accepting it. They are generally naive about pre-tax status, double taxation, and the fact that government fees are the same as taxes. If you took everyone who thinks Medicare is great and showed them on paper, that had they placed the money they paid over their lifetime into Medicare into a medical savings account, they would not only have insurance coverage, they would have three times more earning on their money they could have used for retirement or to pass on to their children I think you have a much different response of how they think the government did for them. Of course the inheritance and death tax takes care of a portion of that but that's another subject. This is only one point in why Medicare is a scam.

Medicare on average around the country is 30% of a physician's payer mix, and in many states much more than that. For those that don't like monopolies they aught to think about that. With competition, there are those that would not chose to pay you out of pocket (many don't have it to pay) and will go to the doctor down the street.

The government imposes a lifetime 10% penalty for not enrolling. For the physician, you are confusing non-participating with opting-out. What you are referring to is non-participating. One is still subject to the Medicare fee schedule and all rules. The only difference is they collect from the patient. Very few Medicare recipients tolerate that. Opting-out is not simple and actually requires an attorney to accomplish to avoid serious penalties. It is also a two year commitment which is not something you do as a "test." Is the government seemingly on your side yet?

Private payer are numerous and cutting the lowest paying ones is not an issue. That is what drives them out of business. Here is the beauty of competition in the private sector. If they don't pay well or have good benefits, doctors don't take them, and people don't sign up for them. Good luck with that even now at 30% let alone as a monopolistic single payer. Audits do occur but are far less and fewer than Medicare. They also don't come with federal felony charges for cutting nails. But, Medicare does have it often used internal auditing system. It also has private headhunters call the RAC that get a percentage of what Medicare recoups have vowed to hit every doctor's office in the nation in due time. Our government also provides and incentive for "whistler blowers" to turn in their employers or doctors for a reward. Do we have that in the private sector?

Medicare is easy to deal with? Here is a direct quote from a study performed by the United States General Accounting Office (GAO) concerning Medicare. “Customer service representatives rarely provided appropriate answers to questions, answering only 15 percent of our test calls completely and accurately. In addition, only 20% of the carrier Web sites we reviewed contained all of the information required by CMS.” [http://www.gao.gov/new.items/d02249.pdf]

So you don't think our own government is praying upon us and it only happens with private payors? As a practitioner, when I come out of residency and have loans and no patients, I can sign up with multiple private payers and be seeing their patients inside a month. With Medicare, part of our government who gave me loans to become a doctor and is making money on my interest, it takes me six months of starving before I can start submitting claims. And, that's only if I crossed every last T and dotted each I appropriately.

I did misspeak. I meant to say that Medicare, by taking 45 million people away from private insurance, has taken away competition from private industry. There is a reason there is a saying "healthy competition."

Keep in mind, this is the current system and people are advocating more monopolistic governmental power? I think we lost our minds. With your scenario, at least you have the choice to drop a carrier. Good luck with universal health care.

Keep em coming.

Jon

 

The general public is naive. This is the reason that taxes are withheld from paychecks. If the general public had to pay a check each quarter to the government, like companies do, they would soon realize how much of what they earned was leaving their hands. We would have a potential government overthrow on our hands. Instead, they have become accustomed to just looking at "all" they get to keep and accepting it. They are generally naive about pre-tax status, double taxation, and the fact that government fees are the same as taxes.

If you took everyone who thinks Medicare is great and showed them on paper, they would see that had they placed the money they paid Medicare over their lifetime into a medical savings account, they would not only have insurance coverage, they would have three times more earnings on their money. They could have used that money for retirement or to pass on to their children instead of sitting somewhere in the government coffers not earning them dividends and just waiting for them to get sick. With that information I think you would have a much different response of how they think the government did for them. Of course the inheritance and death tax takes care of a portion of that but that's another subject. This is only one point in why Medicare is a scam.

Medicare on average around the country is 30% of a physician's payer mix, and in many states much more than that. For those that don't like monopolies they aught to think about that. With competition among doctors, there are very few that would chose to pay you out of pocket (many don't have it to pay) and will go to the doctor down the street who accepts Medicare.

For individuals, the government imposes a lifetime 10% penalty for not enrolling with Medicare. For the physician, you are confusing non-participating with opting-out. What you are referring to is non-participating. One is still subject to the Medicare fee schedule and all rules. The only difference is you collect from the patient. Very few Medicare recipients tolerate that. Opting-out is not simple and actually requires an attorney to accomplish to avoid serious penalties. It is also a two year commitment which is not something you do as a "test." Is the government seemingly on your side yet?

Private payers are numerous and cutting the lowest paying ones is not an issue. That is what drives them out of business. Here is the beauty of competition in the private sector. If they don't pay well or have good benefits, doctors don't take them and people don't sign up for them. Good luck with not accepting Medicare at 30% let alone as a monopolistic single payer. Audits do occur but are far less and fewer than Medicare. They also don't come with federal felony charges for cutting nails. But, Medicare does have its often used internal auditing systems that you the tax payer paid for. It also has private headhunters call the RAC that get a percentage of what Medicare recoups, and have vowed to hit every doctor's office in the nation in due time. Our government also provides and incentive for "whistler blowers" to turn in their employers or doctors to Medicare for a reward. Do we have that in the private sector?

Medicare is easy to deal with? Here is a direct quote from a study performed by the United States General Accounting Office (GAO) concerning Medicare. “Customer service representatives rarely provided appropriate answers to questions, answering only 15 percent of our test calls completely and accurately. In addition, only 20% of the carrier Web sites we reviewed contained all of the information required by CMS.” [http://www.gao.gov/new.items/d02249.pdf]

So you don't think our own government is praying upon us and it only happens with private payors? As a practitioner, when I come out of residency and have loans and no patients, I can sign up with multiple private payers and be seeing their patients inside a month. With Medicare, which is part of our government who gave me loans to become a doctor and is making money on my interest, it takes me six months of starving before I can start submitting claims. And, that's only if I crossed every last T and dotted each I appropriately.

I did misspeak. I meant to say that Medicare, by taking 45 million people away from private insurance, has taken away competition from that private industry. There is a reason there is a saying "healthy competition."

Keep in mind, this is the current system and people are advocating more monopolistic governmental power? I think we lost our minds. With your scenario, at least you have the choice to drop a carrier. Good luck with universal health care.

Keep em coming.

Jon
__________________
Jon Purdy, DPM

 

I'm thirty minutes south of Lafayette. I'd be happy to see him. Are you part of the LPMA?
I drafted the state's bylaws.

We are headed that way if this passes. In France, although the public pays in over 18% of their income toward the health system, 90% of doctors don't accept it and the public lays out more cash for good care. It's interesting that their out of pocket costs are just as much as ours.

My best,
Jon


How far is your office from Lafayette?
I have a brother-in-law with what sounds like Achilles tendonitis, and he does not like the idea of coming all the way to New Orleans to see me.

Excellent points.
Old classmates of mine, in practice in southern CA, are joining multi-specialty groups and signing contracts to treat wealthy people in a limited partnership, where they only have about 200-250 patients/families. I wonder if this is where we are headed-
-John
________

 

Their children would get the money if the parent died quickly and chose not to spend any of their saved money on end of life care. How much does it cost to house an Alzheimer's patient in a nursing home per year. What about the 30 year old who has been saving for five years and develops a melanoma and does not have enough money to pay for treatment. If all they had was a saving account they would die penniless. The problem with pooling risk is that some pay and get no service. Others pay in less than they cost.

So these patients that don't have enough money to pay you out of pocket for your service are now coming to your office and you get paid for seeing them. Is this a problem? Would you rather be competing with all the other doctors for those patients who can pay out of pocket?

So, it's not mandatory as you said in your earlier post.

So having the lowest paying plans go out of business is not a problem. Someone has paid the insurance company for their coverage and their coverage is no more.

Others have complained about bloated government programs. How do you propose to eliminate fraud in a fee for service system. You are not accused of fraud for cutting toenails. You are accused of fraud for not properly charting what you bill.

See my story above about checking an insurance company's drug coverage. It was designed to discourage use of drugs. With something as complex as health care it's not possible to get everything right. I still question that the private sector has more incentive to do it better.

Interesting. Over six months ago another podiatrist and I who work for multi provider clinic applied to join a local insurance panel. We have been told that we would be placed on the panel, but have not yet been placed on the panel. That fact that there is a panel limits patient's choice of doctors. This arrangement limits competition.

I don't understand how this addressed my question on how removing a subset of the population stops others from competing.

Cheers,

Eric

 

Here it is consolidated. I'm not smart enough to break it into quotes like you did.


Eric, It's fairly obvious that you don't understand the workings of HSA or MSA. These are in conjunction with private health policies that cover what you are talking about. This is a medical savings to cover co-pays, deductibles, and other out of pocket costs. In the event that one passes peacefully without having major medical problems, guess who gets to keep the money they earned over all those years? Their family.

I'm not sure what you mean. My point was that in this day and age, practitioners are tied to Medicare and not taking it is not an option for the majority of practitioner. See my other points about why Medicare is not a good system.

If you speak to the factual points I raised, just saying "so it isn't mandatory" sounds silly. That's like saying "so you're saying earning a living isn't mandatory." Please try to counter my points with relevant and realistic counter points.

So having the lowest paying plans go out of business is not a problem. Someone has paid the insurance company for their coverage and their coverage is no more.

Again, it is obvious that you don't understand the fundamentals about the insurance industry or economics. These plans are bought out by other companies and people are not kicked out into the streets. I can't spend my day educating you on the basics.

Fraud can not be eliminated ever, it can only be controlled. The biggest perpetrators of fraud are within our own government and they are the one's you would like to run health care.

When the general public gets to keep more of what they make and use it to make personal and informed decisions, they will be able to pick a policy that is affordable and provides the coverage they need. As competition builds between insurance companies, this is the driving force that causes them to lower rates and present a better plan. It's called market capitalism and is THE reason why we are the success we are as a country today. Now we are trying to steer it in the other direction. I'm not so sure why that is so difficult of a concept to get.

If you are a doctor moving into an area, you have the freedom to contact the insurance companies and see what panels are open, closed, or otherwise. If the area is saturated with podiatrist and the payer mix is poor, why would you move there and then complain about it? If you are a patient signing up with an insurance and you see that they limit the doctors you can go to, why would you chose that policy and then complain about it. That IS competition. What is so difficult to understand about that?

This is straight forward economics. I am speaking about competition among the private payer and that helping to drive down costs and increase coverages. I can't possibly get you to understand if it's difficult at this point. In the insurance industry it is a numbers game. The more you have in the system, the healthier the company, and the more leverage you have to increase benefits and decrease coverage amounts. So in your opinion, our largest medical insurer in this country, Medicare, isn't monopolistic? How, and why?

I would love to hear your take on Medicare internal audits, their additional external RAC auditing system, and the "whistle blower" incentives. You didn't comment here. Do you think this is fair? Do you think there is potential for corruption and harassment when someone has a cash reward incentive for turning you in to the "authorities?"

I didn't get your rebuttal about the study showing non-cooperation and the passing of bad information from our government directly to your office. I also didn't hear your comment regarding letting new practitioners starve as they are caught up in reimbursement red tape and the application process when the government facilitated the loans to make them a doctor and now wants the money back immediately. Did you know that our government has now done away with medical loan deferments on repayment? Please comment on these points and I think we will be getting somewhere.

Also, what is the point of my providing real numbers, studies and statistics when all I get back are anecdotal stories and opinions? Someone please step up to the plate with some real backing to their points.

This is a great debate, but if the information to your points is lacking we get nowhere.

My best,
Jon

 

Jon:

If you look at the bottom-right of every posting you will see a "quote" box. Click on "quote" and the whole posting will be quoted starting with bracket ( [ ) QUOTE=jpurdydpm] and ending with bracket /QUOTE].

If you want any sentence or phrase to be in quotes, then, after you have highlighted the sentence or phrase, click on the icon for quotes in the row of icons at the top edge of the dialogue box (4th from the right on my monitor) and the pre- and post- quoting commands will be framed around your sentence or phrase.

Good to see you contributing to Podiatry Arena, Jon. Have enjoyed many of your articles over the years.



Guess you didn't vote for Obama??

 

We should also consider one simple idea-
it has not been stated but I think it is true-

people who get something for nothing do not value it-
if you give someone free care, they will treat it as such- without value

something like a MSA empowers patients, and they take an active, participatory role in their care

The US could cover all uninsured under a Medicare-like plan if illegal immigrants were not being covered, and there would be a huge surplus

 

Absolutely agree with that. One of the problems with a dual public/private system of care is the low value patients place on their care - which has a knock-on effect for those in private practice. Frequently patients baulk at the thought of paying £50 for podiatric intervention for painful lower extremity conditions - yet are happy to pay in excess of this for cosmetic acrylic nail art. A never ending task of educating an uninformed and unlightened public.

 

You bet your bippy.

Jon