Health care - administrative incompetence

[Gandalfs Beard]

Oh lulz, look what I just found.



Source

It's already happening in some states and counties as they consider contracting out managing human services programmes to Private Contractors like HALLIBURTON.

http://www.towardfreedom.com/health/1654-will-halliburton-come-between-you-and-your-health-care

It is sick, sick, sick.

GB

ETA: Some States and Counties have ALREADY privatized their human services.

 

[Garrison0fMars]

But ultimately Medicare and Medicaid are going to pay for the premiums for that "managed care" are they not?

Depends. Yes largely with Medicaid, Medicare charges premiums to it's recipients though (remember, Medicare isn't "Free"). Of course, the state's expense rises since managed care is more expensive than just running the program themselves, and these insurance companies (as I linked to above) are looking to make a profit, thus exacerbating cost.

 

[Uncayimmy]

In the US, you are still free to gamble with your own life. This is insurance you choose.

You would still be allowed to gamble with your life. Universal health care does not force people to get care. What it would do is force everyone via taxes to pay for an infrastructure that is considered a universal need so that should you choose you could access it. You know, like Yosemite National Park.

BTW, your platitude is rather silly. The government prevents you from gambling with your life in many different ways from seat belt and motorcycle helmet laws to building codes and sanitation requirements.

 

[Garrison0fMars]

You would still be allowed to gamble with your life. Universal health care does not force people to get care. What it would do is force everyone via taxes to pay for an infrastructure that is considered a universal need so that should you choose you could access it. You know, like Yosemite National Park.

BTW, your platitude is rather silly. The government prevents you from gambling with your life in many different ways from seat belt and motorcycle helmet laws to building codes and sanitation requirements.

Funny you bring up Yosemite. They're instituting a..wait for it, "socialized" medical system there. http://www.pnhp.org/news/2010/december/socialized-medicine-comes-to-yosemite

 

[kellyb]

You don't understand. Medicare and Medicaid pay next to nothing. You can charge $10,000 for a strep test if you want, you are still only going to get $3.22 and you cannot bill the patient the difference (over Medicare's allowable).

This is where it gets hairy. Take vaccinations for example. A physician might pay $42.50 for 1 specific vaccination. Medicare will only reimburse their established allowable. Often that is, maybe $38.00. Medicare pays 80% = $30.40 and you have to bill the patient for the remaining $7.60. By the time you paid your employee to generate and send a bill (or 2 or 3) you have paid out more than $7.60 to collect that $7.60. And, if you do manage to collect the 20% you still paid more for the vaccine than what you were paid. That is what our government has done with the portion of healthcare they are running.

I know Medicare reimbursement are worse than crap for PCPs. This is the worst health care rationing method ever devised. ALL the US third party payers are trying to screw patients by manipulating physician behavior with reimbursements rates that leave docs operating in the red.

I HATE the way the secretive CMS works. Shine the light of democracy on the whole damn thing, I say!

 

[Ampulla of Vater]

You would still be allowed to gamble with your life. Universal health care does not force people to get care. What it would do is force everyone via taxes to pay for an infrastructure that is considered a universal need so that should you choose you could access it. You know, like Yosemite National Park.

BTW, your platitude is rather silly. The government prevents you from gambling with your life in many different ways from seat belt and motorcycle helmet laws to building codes and sanitation requirements.

That's because they don't want you to end up in the E.R.

 

[Ampulla of Vater]

I know Medicare reimbursement are worse than crap for PCPs. This is the worst health care rationing method ever devised. ALL the US third party payers are trying to screw patients by manipulating physician behavior with reimbursements rates that leave docs operating in the red.

I HATE the way the secretive CMS works. Shine the light of democracy on the whole damn thing, I say!

And let them run healthcare for the entire country!

 

[Ampulla of Vater]

You would still be allowed to gamble with your life. Universal health care does not force people to get care. What it would do is force everyone via taxes to pay for an infrastructure that is considered a universal need so that should you choose you could access it. You know, like Yosemite National Park.

BTW, your platitude is rather silly. The government prevents you from gambling with your life in many different ways from seat belt and motorcycle helmet laws to building codes and sanitation requirements.

But you can't opt out and forego the tax part, that part is mandatory.

 

[Garrison0fMars]

But you can't opt out and forego the tax part, that part is mandatory.

Actually you can. You can move to Somalia.

 

[bookitty]

That's what auto insurance is for.

How many people do you think will spend 22k+ on their health care a year? Very few. And it won't be every year. Your savings build and build and when you need it, it's there.

Now wait a minute - My MIL and her employers paid toward her heath care every year for almost 35 years. In addition, she had a decent amount in savings, was about to buy a house an had a decent job.

Within 6 months she was broke, dependent on the government for health care, jumping through hoops to get even that and it wasn't enough to for everything she needed. If she had lived, she would have been $300,000 in debt.

She did everything that your conservative little heart could desire and she got shafted. If we had a universal system, every dime that she paid in over the years would have gone towards her care. Instead it was wasted money.

 

[Gandalfs Beard]

Medicare and Medicaid are not subsidies. They are direct payments to physicians, hospitals and ancillary services on a fee-for-service basis. A subsidy is a payment to an insurance plan to pay for part or all of their premium.

Still amounts to a subsidy either way.

What, we should just hand it out on a person's word?

Wouldn't have to if it was a Public Single Payer Plan.

C'mon man, murdering? Exaggerate much? Eliminating Medicaid and Medicare and replacing it with subsidies to cover insurance assures coverage.

Yeah, right! That's gonna' happen. I can hear Glenn Beck screaming about Socialist/Nazi/Commie/Illuminati/Freemason Subsidies already.

I want people to have a say in how their SS funds are invested.

EXACTLY! I knew it. YOU want the SPECULATORS WHO KILLED THE ECONOMY to GAMBLE our money away to make a quick TRILLION Bucks.

Okay. Now I know EXACTLY where you stand. I was wondering if I was engaging in hyperbole, but you have now just categorically demonstrated how unimportant you think people's lives are.

I'm not wasting any more time directly addressing Glenn Beck's talking points through you.

GB

 

[kellyb]

Ya know, Kelly, you spend a lot of time on here bashing my position. Not only that, you really don't even understand what my position is. Yet, I haven't seen you put one idea of your own forth. So let's have it: What is Kellyb's plan for improving healthcare in America. Be specific.

Either put a cap on lab and imaging companies' profits or nationalize them.

The fed gov bargains to reduce pharma prices like every other developed nation.

Get rid of insurance companies "managing" medicare/medicaid.

This and a few other tweaks should reduce prices enough to open Medicare up for all, but with limits.

Medicare covers what it covers, and doesn't what it doesn't (something like NICE would determine this). We vote on how much of our tax dollars go to Medicare vs roads, etc.

People are encouraged to save cash in the event that they hit the "rationing wall". Maybe you'll want that expensive new drug with a small but real chance of helping you that medicare doesn't cover. If you want it, pay out of pocket, if you can. If not, your doc will prescribe what medicare will pay for.

It's not a perfectly egalitarian scenario, but it makes much more sense than what we're doing now, and the lack of "perfect equality" will preserve innovations that will eventually be covered by Medicare.

 

[Garrison0fMars]

Either put a cap on lab and imaging companies' profits or nationalize them.

The fed gov bargains to reduce pharma prices like every other developed nation.

Get rid of insurance companies "managing" medicare/medicaid.

This and a few other tweaks should reduce prices enough to open Medicare up for all, but with limits.

Medicare covers what it covers, and doesn't what it doesn't (something like NICE would determine this). We vote on how much of our tax dollars go to Medicare vs roads, etc.

People are encouraged to save cash in the event that they hit the "rationing wall". Maybe you'll want that expensive new drug with a small but real chance of helping you that medicare doesn't cover. If you want it, pay out of pocket, if you can. If not, your doc will prescribe what medicare will pay for.

It's not a perfectly egalitarian scenario, but it makes much more sense than what we're doing now, and the lack of "perfect equality" will preserve innovations that will eventually be covered by Medicare.

I like the part of saving cash to circumvent the "rationing wall", we could encourage people coupling HSAs with their Medicare plans to achieve this. We could also drastically reduce state Medicaid expenditure if we expanded Medicare eligibility to every American.

 

[Tatyana]

And impartiality is certainly not yours.

Ah, you don't agree with their politics so they are liars. Got it. And 10 years is not that long ago when it comes to governmental matters.

Actually...............

http://www.nejm.org/doi/full/10.1056/NEJMp0906618

When the current government came to power in 1997, it recognized that health care spending was inappropriately low (Britain's total expenditure on health was 6.6% of its GDP, as compared with 13.4% in the United States at that time).1 In the intervening decade, Britain has made major investments in its health care system, raising the total expenditure to 8.4% of the GDP in 2007, as compared with 16% in the United States.

These funds, which effectively doubled NHS spending, from $75 billion to $159 billion per year, have been used to build new hospitals, hire more nurses and doctors, provide an improved base for physicians' salaries linked loosely to productivity, and enhance the research infrastructure in order to generate a stronger evidence base for clinical care guidelines.

The prevailing political philosophy was that introducing competition and patient choice into this monolithic market would be the best means of raising standards — an intellectually appealing concept that was diluted somewhat by the British public's apathy toward becoming health consumers and perhaps by the government's failure to equip people with the necessary information to “shop for health.”


And
http://jnci.oxfordjournals.org/content/99/5/346.full
Governments Move To Improve Quality and Cut Costs

Now I have to question your reading comprehension. It's not primarily about Scotland. And the only thing it says about Mid Essex is this


The only thing it says about appeal mechanisms is this:

The report also has this little gem:

So you can twist and reinterpret it all you want, but it won't change the fact that cancer drugs are denied to people every day.

I've already linked to a CIGNA guidance approving lapatinib. Here it is for the drug in question in the article. And CIGNA is one of the worst. Of course, you still won't find it compelling even though it proves my point.

Some of the biggest names in UK Medicine and they are echoing exactly what I'm saying here. They live your system everyday and know it better than any of us on here. You can dismiss them if you want, but that's just your ideology talking.

Again, you can dismiss the report, which was published in a peer-reviewed journal, if you want to. Doesn't make it any less true.

Now it's your turn. Cite me an article, journal, etc. that shows NHS has comparable clinical outcomes. Not life-expectancy, not infant mortality. Clinical outcomes.

Better yet, cite me some real evidence that shows the NHS covers everyone's medical needs equally throughout the country.

I won't hold my breath.

http://www.rsm.ac.uk/media/downloads/j06-09diabetes.pdf
Diabetes management in the USA and England:
comparative analysis of national surveys

SUMMARY
Objectives To compare diabetes management in adults
between England and the United States, particularly focusing on
the impact of a universal access health insurance system.
Design Analysis of the nationally-representative surveys Health
Survey of England, 2003 (unweighted n =14 057) and the
National Health and Nutrition Examination Survey, 2001–2002
(unweighted n =5411).
Setting and participants Adults 20–64 years of age;
individuals 465.
Main outcome measures Glycaemic, lipid and blood pressure
control and medication use among individuals with
previously diagnosed diabetes.
Results Among those aged 20–64 the prevalence of diagnosed
diabetes was lower in England (2.7%) than in the USA
(5.0%). The proportion with diabetes receiving treatment was
similar for the two countries. However, the mean HbA1c in
England was 7.6%: in the USA it was 7.5% for those with
insurance and 8.6% for those without insurance. The proportion
of individuals on ACE inhibitors in England was 39%: in USA it
was 39% for those with insurance, and 14% for those without.
Conclusions Individuals in a healthcare system providing
universal access have better managed diabetes than those in a
market based system once one accounts for insurance.

 

[Gandalfs Beard]

Ya know, Kelly, you spend a lot of time on here bashing my position. Not only that, you really don't even understand what my position is. Yet, I haven't seen you put one idea of your own forth. So let's have it: What is Kellyb's plan for improving healthcare in America. Be specific.

I don't know about Kelly B, but my plan is NHS, clean and simple. Let the Private Insurers fend for themselves like you want individuals to do.

GB

 

[Uncayimmy]

But you can't opt out and forego the tax part, that part is mandatory.

I'm pretty sure everyone here is aware of that, so I don't understand why you would mention it.

 

[kellyb]

And let them run healthcare for the entire country!

"They" already do! The insurance company policy makers and the CMS all institute the same crap policies! Fire them all! Start over from scratch!

 

[xjx388]

Still amounts to a subsidy either way.

If you want to look at it that way. But the current "subsidy" is a little high, don't ya think? It would be much lower if it was just covering premiums.

Wouldn't have to if it was a Public Single Payer Plan.

This is true. Doesn't mean Single Payer is the best. We can eliminate the humiliation any number of ways.

Yeah, right! That's gonna' happen. I can hear Glenn Beck screaming about Socialist/Nazi/Commie/Illuminati/Freemason Subsidies already.

Screw Glenn Beck. He's kind of a wacko.

EXACTLY! I knew it. YOU want the SPECULATORS WHO KILLED THE ECONOMY to GAMBLE our money away to make a quick TRILLION Bucks.

Okay. Now I know EXACTLY where you stand. I was wondering if I was engaging in hyperbole, but you have now just categorically demonstrated how unimportant you think people's lives are.

No offense, GB, but you are starting to sound a little wacko yourself! So, in your view, only the government can take care of us. We shouldn't trust anyone who wants to make a profit. Don't invest your money, don't choose your own healthcare, let the benevolent government take care of everything. You would have loved Soviet Russia.

I'm not wasting any more time directly addressing Glenn Beck's talking points through you.

Not a Beck fan. Don't know much about what he says.

 

[kellyb]

I like the part of saving cash to circumvent the "rationing wall", we could encourage people coupling HSAs with their Medicare plans to achieve this. We could also drastically reduce state Medicaid expenditure if we expanded Medicare eligibility to every American.

I can't tell if you're joking or not.

 

[xjx388]

I like the part of saving cash to circumvent the "rationing wall", we could encourage people coupling HSAs with their Medicare plans to achieve this. We could also drastically reduce state Medicaid expenditure if we expanded Medicare eligibility to every American.

OK, so we've all agreed that Medicare sucks.

Why in the world would we expand it to everyone.