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Started by sophist, August 06, 2009, 09:48:07 AM

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aphineday

#360
Quote from: mirthbeatenworker on March 28, 2012, 10:49:13 PM
Quote from: runawayjimbo on March 28, 2012, 08:53:45 PM


What would be an acceptable level of profit for .... an insurance company?
i don't know the magic number, but one which wasn't accomplished by letting sick people stay sick and die.
/thread.
TL ftmfw
If we could see these many waves that flow through clouds and sunken caves...

nab

Quote from: aphineday on March 29, 2012, 01:25:55 AM
Quote from: mirthbeatenworker on March 28, 2012, 10:49:13 PM
Quote from: runawayjimbo on March 28, 2012, 08:53:45 PM


What would be an acceptable level of profit for .... an insurance company?
/thread.
TL ftmfw
i don't know the magic number, but one which wasn't accomplished by letting sick people stay sick and die.



All but the most heartless would agree (do we need more evidence that they exist or pretend to exist?).


However, at least a number range is going to have to be garnered to change the pace. 

This country already has a number of assumed rights built on platitudes (Life, Liberty, Pursuit of Happiness ring a bell?), and you see how well those are interpreted (anyone in power tells us what they mean).


If we're (and I mean all of us who aren't in the heartless lot bent on pure profit alone) serious about changing the healthcare system in this country, we need to be serious about the cost and our ability to pay that cost. 

Then we have to convince people that the cost is worth their investment. 



DoW

Quote from: runawayjimbo on March 28, 2012, 10:36:50 PM


Quote from: slslbs on March 28, 2012, 09:20:44 PM
docs don't want to get sued. if you do something extra, well you tried. if you didn't, you blew it. this is especially visible in the ED, which even without defensive medicine is the most expensive place to get routine medical care (except the icu and OR)

Up yours, bvaz
except that I'm a lawyer for a hospital you jackass.  I've never been inside a courtroom except for a couple of minor things I had to deal with.  and then funny thing, it is not the lawyers.  it is the people who want to get "easy" money by bringing the suit.  I love how lawyers get blamed.  without greedy clients, there'd be even more unemployed lawyers.

but since you bring it up.  yeah, lawyers suck but let's read some of the threads about people on here who have needed them and gone to them when they needed help.

Quote from: mirthbeatenworker on March 28, 2012, 10:49:13 PM
i don't know the magic number, but one which wasn't accomplished by letting sick people stay sick and die.
I don't even know what that means.  people have no idea what it's like to work in a hospital.  people have no idea what a day costs and that insurance companies want people out as soon as possible.  yeah, you can say the hospital can keep them but read above.  if a hospital loses money, it can't invest in new products and technology.
this shit is so much more complicated than "ending a thread" with one line that has absolutely no meaning.
people don't know what it's like to have to deal with insurance companies that create more overhead for hospitals by originally denying.  people don't know what it's like how some payers try and skim 5% off all black and white contractually agreed fee schedules just to see how they can get away with it and hospitals have to dedicate staff to payment verification.  how would you all feel if your employer paid you 5% less each week because it is a way they thought of trying to make more money.
you can think people in healthcare are padding their wallets.  I am sure it happens some places but trust me, hospitals/doctors offices are far from fantasy land.

now I'm officially out of this thread.  honestly, I don't have the time to keep up with it and chime in.  it's one thing to read these articles.  it's another thing to live in this world every day.
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sls.stormyrider

#363
Quote from: runawayjimbo on March 28, 2012, 10:36:50 PM

Quote from: slslbs on March 28, 2012, 09:20:44 PM
A couple of weeks ago the "doc fix" was in the news. It's a long story, but it's a mess that started in the late 90s and Congress chooses to kick the can rather than fix it once and for all.

I meant to ask you how you felt about that. What was that about? Something about paying for the payroll tax cut?

Quote from: slslbs on March 28, 2012, 09:20:44 PM
-Health care is labor intensive, with highly trained professionals. training is expensive in both time and money.

You went to medical school, I wonder, what's your feeling on making it easier for people to become doctors? The AAMC accepts what, 1 out of every 10 applicants, many of whom will not finish medical school? Shortages raise prices in every market, even healthcare.

SGR was part of the Balanced Budget act of 97. The "doc fix" is what has turned into a yearly bill to counter it. Here are a couple of links (I purposely avoided medical publications which may be percieved as biased)

http://www.washingtonpost.com/national/health-science/medicares-sgr-formula-has-snowballed-to-budget-busting-juggernaut/2011/12/13/gIQAXaq3wO_story.html
http://en.wikipedia.org/wiki/Medicare_Sustainable_Growth_Rate

Basically, Congress thought that the way to reduce $ on health care is to just say they'll reduce it. They came up with a formula which has been attacked by all angles and even Medicare and Congress know its wrong. This formula would reduce medicare expenses by reducing payments every year in a progressive manner, basically between 3 - 5% per year each year. Every year there is a big debate over this, so Congress eventually leaves reimbursement flat. The next year, the same thing happens. But the cuts, by law, should have been progressive. By this year, if Congress didn't act, there would have been a 27% reduction to Medicare reimbursement. The results wouldn't have been pretty. There have been several bills to repeal the whole thing. The closest it got was 2 years ago when it passed the house and got fillibustered in the Senate by Jim Bunning (R-Kent). So, every year, Congress time and our $ is spent writing a bill that puts this off for between 6 months and 1 - 2 years, instead of just dealing with it.
If your wondering, the reimbursement that has actually been paid per service since this time has been relatively flat, depending on the service. In general, primary care gets small increases and specialty services of all kinds (office, imaging, operations) get cut. So, the global Medicare expenditures have increased based upon volume of procedures and new drugs / more drugs / new procedures as opposed to paying docs more per service. Essentially, more work for the same money.

As far as making it easier to become a doc, my own opinion is that it certainly shouldn't be easy. I wonder what the reason 1 in 10 people quit school is, based on my experience it's less. People find out once they're in med school they don't like it; making it easier won't help. In Europe, you go to MS for 6 years right after HS, instead of 4 years college and 4 years MS. I think 18 is too young to be picking who will go to med school, but you can argue that a full BA or BS might not be necessary. I liked undergrad, but the expense has grown astronomically, so maybe something to be considered.
Also, training is long. 3 years for internal medicince, fam practice, and peds, medical specialties are another 3 years on top of that. Surgery is 5 years +. The specialty societies have been trying to reduce the requirements from 3 years IM before specialty training to 2, but have met resistance from IM program directors. If that happens, which I think it should, then there will be a labor shortage in medical residency programs. As it is, all positions aren't filled. Increasing the # of MS grads per year would be reasonable, allow an increase in physician work force, and not lower the bar too much for medical training.

also, in the future you will nee more nurse practitioners and physician assistants do primary care. this will lower cost and improve access. the affect it will have on outcome remains to be seen, but a smart NP or PA, who knows their limitations is reasonable.

long winded answers to short questions.


just read your post - bvaz
my comment wasn't "anti-lawyer" but against the current system. I think we both know what the problems are. Of course, docs need to make fewer errors. IMO, people get sued for a bad outcome which may or may not be from a screw up. Sometimes, life sucks, medicine is inexact, diseases are bad, and shit happens. People shouldn't get sued for that, but they do.
I've been an expert witness for the defense 3 times over the past 15 years (one currently). The doc won the first, settled with the 2nd, and the 3rd is ongoing. Won't comment in any way on the current case.  Both results were correct, imo, and both cases were reasonable. The issue is the unreasonable cases that get brought about. Anyway, topic for a different time.
"toss away stuff you don't need in the end
but keep what's important, and know who's your friend"
"It's a 106 miles to Chicago. We got a full tank of gas, half a pack of cigarettes, it's dark and we're wearing sunglasses."

DoW

before runawayjimbo took another shot at me being a lawyer, I thought he should at least be informed of the type of lawyer I am.  not that I take it personally, but I thought I'd give him a better opportunity to take jabs at the actual work I do.

not to get into the malpractice issue too much, but without changing the malpractice system, more coverage just means more lawsuits, both frivilous and legitimate.  that's just plain statistics.  ignoring that issue is just going to cause more problems.  but I agree, it is a whole different topic but just highlight how complicated the after effects of this legislation can be.
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runawayjimbo

Quote from: bvaz on March 29, 2012, 06:45:05 AM
before runawayjimbo took another shot at me being a lawyer

Psst....it was a joke.
Quote from: DoW on October 26, 2013, 09:06:17 PM
I'm drunk but that was epuc

Quote from: mehead on June 22, 2016, 11:52:42 PM
The Line still sucks. Hard.

Quote from: Gumbo72203 on July 25, 2017, 08:21:56 PM
well boys, we fucked up by not being there.

mbw

Quote from: bvaz on March 29, 2012, 06:08:54 AM
Quote from: mirthbeatenworker on March 28, 2012, 10:49:13 PM
i don't know the magic number, but one which wasn't accomplished by letting sick people stay sick and die.
I don't even know what that means. 

of course you do.  as whistleblowers like linda peeno and others have
made it clear that insurance companies like humana systemically reward 'adjusters'
who deny coverage.  http://www.democracynow.org/2007/6/21/hmo_whisteblower_dr_linda_peeno_on
i'm not going to get into it because it is of course well known and you are just
pretending you have "no idea what i mean"

i never claimed that my statement was so profound that i was "ending a thread."
i just dont feel the need to talk in circles and spin arguments when right vs wrong is so very clear.

VDB

Meanwhile, over at foxnews.com:



And here's an artist's rendering of who those 54.9% are:

Is this still Wombat?

gah

"And let us never return to healthcare reform again"

:hereitisyousentimentalbastard
Sometimes we live no particular way but our own.

runawayjimbo

#369
Quote from: mirthbeatenworker on March 29, 2012, 09:17:31 AM
Quote from: bvaz on March 29, 2012, 06:08:54 AM
Quote from: mirthbeatenworker on March 28, 2012, 10:49:13 PM
i don't know the magic number, but one which wasn't accomplished by letting sick people stay sick and die.
I don't even know what that means. 

of course you do.  as whistleblowers like linda peeno and others have
made it clear that insurance companies like humana systemically reward 'adjusters'
who deny coverage.  http://www.democracynow.org/2007/6/21/hmo_whisteblower_dr_linda_peeno_on
i'm not going to get into it because it is of course well known and you are just
pretending you have "no idea what i mean"

i never claimed that my statement was so profound that i was "ending a thread."
i just dont feel the need to talk in circles and spin arguments when right vs wrong is so very clear.

Dude, does everything you reference have to come from a Michael Moore movie? (insert winkiface so you don't freak out on me like bvaz (just kidding, bvaz))

I honestly have no idea what you mean. While I don't doubt that insurers (like any business) try to reduce their costs, there is very little evidence to suggest that outright rejection of claims is a widespread and abusive practice in the industry. The stat floating around during the healthcare debate was that 1-in-5 claims are denied. You may say that's unacceptable, but the statistic was (some would say purposefully) misleading in that a denial is not the same as a rejection. A claim could be denied for administrative reasons (e.g., claim sent to the wrong insurer, which is not that uncommon in a complex interwoven healthcare system) only to be paid at a later point, usually unbeknownst to the insured. In fact, according to a , the denial rate for 8 of the largest insurers ranged from 2.68%-6.85% (p. 5). Is that fair? Maybe not, but it certainly doesn't suggest to me there is a rampant abuse of "letting sick people stay sick and die."

But I do agree with you (in one respect) that what is very clear is the system is broken. What is not as clear is the best way to fix it (while, as nab points out, being able to pay for it.) sls' discussion on the SGR is a great illustration of why I am so fearful of giving more control to the gov't: I just don't have faith that a politician will be able to focus on anything but their next election instead of making the difficult choices that would be required to control healthcare costs over the long run. Much easier to promise the moon to get elected today without worrying about the long-term effects (not to mention the market distorting forces introduced when a single payer is involved).

ETA: just found a more recent AMA Report Card showing that denials of private insurers range from 0.68%-3.62% while gov't run Medicare denies 2.73%, 60% higher than the average of the 7 private insurers.
Quote from: DoW on October 26, 2013, 09:06:17 PM
I'm drunk but that was epuc

Quote from: mehead on June 22, 2016, 11:52:42 PM
The Line still sucks. Hard.

Quote from: Gumbo72203 on July 25, 2017, 08:21:56 PM
well boys, we fucked up by not being there.

mbw

Quote from: runawayjimbo on March 29, 2012, 10:57:22 AM
Quote from: mirthbeatenworker on March 29, 2012, 09:17:31 AM
Quote from: bvaz on March 29, 2012, 06:08:54 AM
Quote from: mirthbeatenworker on March 28, 2012, 10:49:13 PM
i don't know the magic number, but one which wasn't accomplished by letting sick people stay sick and die.
I don't even know what that means. 

of course you do.  as whistleblowers like linda peeno and others have
made it clear that insurance companies like humana systemically reward 'adjusters'
who deny coverage.  http://www.democracynow.org/2007/6/21/hmo_whisteblower_dr_linda_peeno_on
i'm not going to get into it because it is of course well known and you are just
pretending you have "no idea what i mean"

i never claimed that my statement was so profound that i was "ending a thread."
i just dont feel the need to talk in circles and spin arguments when right vs wrong is so very clear.

Dude, does everything you reference have to come from a Michael Moore movie? (insert winkiface so you don't freak out on me like bvaz (just kidding, bvaz))

I honestly have no idea what you mean. While I don't doubt that insurers (like any business) try to reduce their costs, there is very little evidence to suggest that outright rejection of claims is a widespread and abusive practice in the industry. The stat floating around during the healthcare debate was that 1-in-5 claims are denied. You may say that's unacceptable, but the statistic was (some would say purposefully) misleading in that a denial is not the same as a rejection. A claim could be denied for administrative reasons (e.g., claim sent to the wrong insurer, which is not that uncommon in a complex interwoven healthcare system) only to be paid at a later point, usually unbeknownst to the insured. In fact, according to a , the denial rate for 8 of the largest insurers ranged from 2.68%-6.85% (p. 5). Is that fair? Maybe not, but it certainly doesn't suggest to me there is a rampant abuse of "letting sick people stay sick and die."

But I do agree with you (in one respect) that what is very clear is the system is broken. What is not as clear is the best way to fix it (while, as nab points out, being able to pay for it.) sls' discussion on the SGR is a great illustration of why I am so fearful of giving more control to the gov't: I just don't have faith that a politician will be able to focus on anything but their next election instead of making the difficult choices that would be required to control healthcare costs over the long run. Much easier to promise the moon to get elected today without worrying about the long-term effects (not to mention the market distorting forces introduced when a single payer is involved).

ETA: just found a more recent AMA Report Card showing that denials of private insurers range from 0.68%-3.62% while gov't run Medicare denies 2.73%, 60% higher than the average of the 7 private insurers.


ok, just gloss over congressional testimony of a phsycian and former humana employee with a chart.
what about the people who were denied coverage to begin with, either becase of age or a previous health issue?  you say its a business protecting agaisnt  a loss, i say its letting sick people stay sick and die.
the original question was how much is an acceptable level of profit.  i say one, a still very 'healthy' one, where these people were able to be made well.  if its such a small number, how much would it have cost to cover those?  what were those procedures? what number of people does that percentage represent?
how many people died because of it?  you see it in terms of $, i see it in terms of the actual people behind those numbers.

sunrisevt

I'm just gonna chime in here and agree that corporate profit motives should be divorced from health care. There's too much perverse incentive in making money off of people being hurt and sick.

And I say this as the grandchild of a surgeon, child of a general internist, and husband of a family nurse practitioner.
Quote from: Eleanor MarsailI love you, daddy. Actually, I love all the people. Even the ones who I don't know their name.

Hicks

I'm not going to pretend to know the actual costs involved but when I take my daughter in for a procedure that literally takes 10 minutes in the OR and it costs $6000 something is very, very wrong. 

What can we do to get these costs under control?
Quote from: Trey Anastasio
But, I don't think our fans do happily lap it up, I think they go online and talk about how it was a bad show.

twatts

#373
Quote from: Hicks on March 29, 2012, 12:55:07 PM
I'm not going to pretend to know the actual costs involved but when I take my daughter in for a procedure that literally takes 10 minutes in the OR and it costs $6000 something is very, very wrong. 

What can we do to get these costs under control?

Don't take her to the emergency room???   I mean, your complaint is the equivalent of bitching about having to buy a lamborghini in order to drive to the mall...  (Yes that was the analogy I told my wife when we took our kid to the ER for a fever...)

If it was truly an emergency, the $6000 would be the least of your worries... 


Strike all that, I read "OR" as "ER"...  And yeah, $6000???  Sounds pretty cheap to train doctors and nurses that are attempting to better (or SAVE) your kid's life through an invasive surgical procedure...  But if you want to pay less for surgery, I have a butcher knife soaking in rubbing alcohol out in the garage...  I'll only charge you half that amount...

Terry
Oh! That! No, no, no, you're not ready to step into The Court of the Crimson King. At this stage in your training an album like that could turn you into an evil scientist.

----------------------

I want super-human will
I want better than average skill
I want a million dollar bill
And I want it all in a Pill

runawayjimbo

#374
Quote from: mirthbeatenworker on March 29, 2012, 12:22:58 PM
ok, just gloss over congressional testimony of a phsycian and former humana employee with a chart.

The point is that one person's experience is not indicative of the entire industry. I'm not disputing that there are some bad people in the industry following immoral business practices. There's bad cops too. And don't get me started on the 20-something yr old teachers who take advantage of those poor teenage boys by buying them booze and weed and having sex with them!! All I'm saying is that, when you look on the aggregate, 2% doesn't seem like unfounded denials are as commonplace in the private health insurance industry as Dr. Peeno would have us believe. Is 1 person too many to be denied a potentially life saving procedure? Of course. But that doesn't, IMO, invalidate the millions of people who have directly benefited from having relatively easy access to the (expensive) technological advances that have drastically improved people's quality of life.

Quote from: mirthbeatenworker on March 29, 2012, 12:22:58 PM
you see it in terms of $, i see it in terms of the actual people behind those numbers.

This is a very important point and one that makes it very difficult for many people to consider the healthcare market as they would any other. There is a human element that makes us identify with the horrific stories of people who have a serious condition and get dicked around by their insurance company or just give up because of the bureaucratic horseshit. I fully acknowledge that. But we also need to balance that desire to make things better for everyone with the ability to fund these procedures while still encouraging innovation or else we'll all be worse off. I don't think we should just let people die, I think we should try lower costs to make sure everyone can get the care they need.

Quote from: sunrisevt on March 29, 2012, 12:36:44 PM
I'm just gonna chime in here and agree that corporate profit motives should be divorced from health care. There's too much perverse incentive in making money off of people being hurt and sick.

Do you think there wouldn't be as many perverse incentives by interjecting the gov't into personal healthcare decisions? Look at the contraception issue. I just can't believe that both sides wouldn't continue to play political games with people's lives. And it's easy for you to say when the Ds control the policies, but what happens if there's a GOP administration in charge of your healthcare. I think I asked you this before, but would you really be comfortable with Pres. Rick Santorum setting the agenda of the single payer healthcare system? Cause that would scare the fuck out of me. We could just pray the sickness away.

Quote from: Hicks on March 29, 2012, 12:55:07 PM
I'm not going to pretend to know the actual costs involved but when I take my daughter in for a procedure that literally takes 10 minutes in the OR and it costs $6000 something is very, very wrong. 

What can we do to get these costs under control?

As sls laid out above, it's a ridiculously complex problem. If you want to argue a single payer would be the best way to reduce administrative costs and provide the best outcomes, I can understand that argument (not that I subscribe to it). I would argue that more competition is critical to driving down costs and continuing to foster innovation that is obviously so important in the field. But to steer this back to the current issue, what I don't understand is how Obama can say we are going to keep the same system with some more gov'tal distortions and that things will get better. There is nothing in the law that would "bend the cost curve" as he was so fond of saying. Is it good that more people will have coverage? Of course, but if it doesn't address the root cause of rampant medical inflation across all segments of the industry, we'll just keep spending more and making it more complicated for people to get the care they need.

ETA:
Quote from: twatts likes ghoti on March 29, 2012, 01:20:32 PM
But if you want to pay less for surgery, I have a butcher knife soaking in rubbing alcohol out in the garage...  I'll only charge you half that amount...

:hereitisyousentimentalbastard

See, we heartless libertarians can still have a sense of humor!
Quote from: DoW on October 26, 2013, 09:06:17 PM
I'm drunk but that was epuc

Quote from: mehead on June 22, 2016, 11:52:42 PM
The Line still sucks. Hard.

Quote from: Gumbo72203 on July 25, 2017, 08:21:56 PM
well boys, we fucked up by not being there.