Impeding changes to our Health Care system

[Spexxvet]

Originally Posted by TheMercenary

You do understand that most private insurance pays much more than Medicare rates don't you?

I don't know anything of the sort. I know that Medicare pays the highest for an annual eye exam. I also know that most for-profit insurance companies use Medicare guidelines for their cataract surgery reimbursement. Where do you get your information that for-profit insurance pays the provider more than Medicare?

Originally Posted by TheMercenary

...Each state is different for reimbursement amounts.

Yes, that's why I bagan with:

Originally Posted by Spexxvet

In New Jersey, Medicare pays 80% of $110ish ($88ish) for a complete eye exam by an ophthalmologist. Most for-profit insurance companies pay $40 - $50 for the same service. And here's the kicker: some patients pay a $40 copay, and their insurance company contributes zilch, nada, nil, zip, zero. But we're all better off with health insurance companies running things...

[Clodfobble]

Originally Posted by Spexxvet

I'm not a doctor, and I don't play one on television. But I do work in an ophthalmologist's office, and work with insurance programs every day.

Ah, that's why you were giving out such helpful advice for free...

[ZenGum]

[Griff]

... but I don't own any people.

[Shawnee123]

You don't really "own" your critters either.

We just think of it that way.

[TheMercenary]

Charlie Rangel plays the race card as his own ethics probe heats up. What an idiot.

http://wcbstv.com/local/charles.rang...2.1162895.html

[TheMercenary]

Originally Posted by gadfly

Mercenary - When you said that everyone pays the same percent into the system - I had a flashback to Steve Forbes ---Flat Tax campaign.

Awesome!

[TheMercenary]

Originally Posted by DanaC

One of the purposes of socialised medicine is to ensure that everybody gets access to healthcare regardless of their income. It equalises service, not input. A 1% tax on someone earning $20k a year, whilst it is mathematically less than a 1% tax on someone earning $200k a year, has a far greater impact on that person's finances: they're the ones on the breadline; the ones struggling to put food on their family's table and the ones with the least capacity to borrow in times of trouble. The lower the earnings, the less surplus there is to tax.

Taking larger contributions from people who are earning larger incomes goes some way to equalising the impact of the cost of healthcare. If you equalise the contributons by some kind of flat tax approach, then you are taking from the wealthy man's surplus and the poor man's food cupboard.

I fully understand that. And to that I say tough. If you want to get it, you need to pay your portion. No one gets a pass. I am quite sure that friends of mine who make $400 a month would gladly pay $16 a month (4%) of their income if they knew that they would have health insurance.

[TheMercenary]

Originally Posted by Spexxvet

I don't know anything of the sort. I know that Medicare pays the highest for an annual eye exam. I also know that most for-profit insurance companies use Medicare guidelines for their cataract surgery reimbursement. Where do you get your information that for-profit insurance pays the provider more than Medicare?

I get my information not from cataract surgery but from other procedures, GYN surgery specifically, but I was thinking of reimbursement in the larger sense. For example in bariatric surgery Medicare pays 28% less than private insurance. http://www.springerlink.com/content/m52w62k100j21n71/
. For choclear implants Medicare paid 57%, and Medicaid 46% of what private insurance paid for the surgeon. For the hospital Medicare paid 80% of what private insurance pays for outpatient services and less for inpatient services. http://www.rand.org/pubs/research_br...-1/index1.html . For anesthesia services the difference is huge. For GYN procedure is in our outpatient surgery center the differences are huge. Bottom line is that Medicare pays significantly less than what private insurance pay for reimbursement. Cataract surgery may be the exception, not the rule when it comes to differences between private insurance reimbursement and Medicare.

[classicman]

Trauma reimbursement is along the 80% of what the private insurers pay.

[TheMercenary]

Originally Posted by classicman

Trauma reimbursement is along the 80% of what the private insurers pay.

And among the most expensive care not covered because of lack of insurance and other issues. It is a huge issue in our state and the topic of much discussion as of late as we try to address the holes in care.

http://grady.healthstatgeorgia.org/f...aumaSystem.pdf

Deteriorating Trauma Medical Staff Support
Maintaining medical staff participation in trauma
care is increasingly difficult in both community
and academic hospitals. There are many
contributing factors:
• Reductions in resident support
• Shortage of trauma surgical specialists
• Incompatibility with private practice
• Increasing burden of uninsured patients
• Undesirable lifestyle due to trauma call
• Demise of community ED call panels
• Specialty hospital trend
• Increasing physician sub-specialization
• Malpractice market turmoil
• EMTALA changes encourage dumping
• Physician payments penalize trauma
• Managed Care does not pay its share
Inadequate Trauma Center Financing
Trauma centers collectively experience a
$1 billion loss, and with increasing costs, this
problem will worsen over time. Key factors in this
crisis:
• A disproportionate and increasing share of
patients without the means to pay.
• Cost shifting to finance Trauma Center
operations is no longer working.
• Problematic relationships with Managed Care.
• Medicare does not cover high standby costs.
• Poor reimbursement rates under state
Medicaid programs.
• Auto insurance does not pay its share.

Trauma Centers Already Under Siege
The fundamental economic threats faced by
trauma centers need to be addressed to assure
they are available in the event of a terrorist
attack. These threats are continuing and will
result in a significant portion of the nation’s
trauma centers closing unless they receive
increased support.

Without corrective action, the current rate of
closures among the nation’s 600 regional trauma
centers will increase and 10-20% will close
within 3 years. Trauma centers provide an
essential public service that affects everyone.
They treat all patients within a common system
of care, so if a trauma center closes, it closes to
all.

http://www.traumacare.com/download/N...port_May04.pdf

[classicman]

Trauma reimbursement is set up on a "per diem" basis. The hospital charges for each thing independently. Nursing staff, medication, supplies.... The total could be somewhere in the $1,000,000 range for three weeks. However, the hospital has a "deal" with the insurance company, so they only pay out about $66,000. The hospital writes off the rest. . . or so I've heard.

[TheMercenary]

Originally Posted by classicman

The hospital writes off the rest. . .

Translated: Charges everyone else for the difference.

[xoxoxoBruce]

More than one of every five requests for medical claims for insured patients, even when recommended by a patient's physician, are rejected by California's largest private insurers, amounting to very real death panels in practice daily in the nation's biggest state, according to data released today by the California Nurses Association/National Nurses Organizing Committee.

CNA/NNOC researchers analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, the six largest insurers operating in California rejected 31.2 million claims for care - 21 percent of all claims.

Reuters

[Kitsune]

Franken, of all people, actually manages to calm a mob of tea baggers and encourage rational discussion.