Health care - administrative incompetence

Darat said:
You did check the GP was in your network? Presumably you'll be paying for her co-pay out of the money her grandparents sent her for Christmas?
Click to expand...

For our US cousins this was sarcasm...

Actually this is our local GP, which does reduce their paperwork slightly. Using GPs in different parts of the country is very simple*. Indeed, I have had cause to use French GPs whilst on holiday, and this was also covered by reciprocal agreements between the US and the other EU members.

ETA: I considered stating that the most complex part is looking in the phone directory to find the nearest practice, but that might (willfully and incorrectly) be taken as meaning that this is a difficult task.
 
Last edited:
xjx388 said:
In the case of lapatinib, it is not pointless or untested. Unless, of course, you are the NHS and you want to save as much money as possible -then yeah "pointless and untested!"
Click to expand...

If the NHS wanted to save as much money as possible they wouldn't have treated her at all, you know like Wellpoint did with women diagnosed with breast cancer or Assurant Health did with policyholders who were diagnosed with HIV.

I guess that's ok, but how dare a government with UHC not pay £800 per week for drugs that may keep a woman alive for about 10 weeks.

So a child born in the Democratic Republic of the Congo has no inalienable rights of their own?
Click to expand...

Can you explain what an inalienable right is and what makes it inalienable?

Yet your system lets people die everyday because their treatment isn't "cost-effective."
Click to expand...

Just like the US insurance companies, only the NHS will still do what they can to treat those people.

And who determines cost-effectiveness? Why, your government of course! You know, the ones who hold the purse strings? In this way, your government is no different than a US insurer except for the fact that your poorer citizens have no choice to find an alternative.
Click to expand...

And you think citizens in the US will be able to find an affordable alternative if they lose their coverage because of serious illness?

And that system works for you. But to say that the NHS should be our model for healthcare is wrong.
Click to expand...

And funnily enough I agree with you there. I would have thought that a model based on the German model (the first one) would have been ok among Americans, but it seems that you guys don't even like the possibility of the government getting into the insurance market.

I'd rather look at what countries like Switzerland and yes -Singapore are doing. They've found ways to
  • Provide care to all citizens
  • Make people personally responsible for their healthcare -thus lowering costs
  • Keep medical decision making in the hands of doctors and patients
  • Keep physician pay at acceptable levels.
And it doesn't involve a single government payer solution.
Those are the four things I think we need for America. Everything else is just emotional hand-wringing.
Click to expand...

And all of which are done through heavy regulation by the Swiss and Singaporean governments. Truly their way is the free market way.

kellyb said:
How is a 65% chance of living another 6 months "not medically indicated"? Her own doctors were pushing for it!
Click to expand...

But that doesn't matter because it's involves a liver and not expensive drugs that could have possibly extended the lifespan of someone for three months.
 
Wildy said:
And funnily enough I agree with you there. I would have thought that a model based on the German model (the first one) would have been ok among Americans, but it seems that you guys don't even like the possibility of the government getting into the insurance market..
Click to expand...

Hey, he doesn't speak for us all. In reality, something like 60% of Americans (I can back this up) want some sort of universal system. You're right that most Americans would not want an NHS style system, but many would go for a Single Payer insurance model, or a Bismarck German/Swiss model. In fact, I'd personally prefer the German model over the British model myself, just personal preference though...
 
Garrison0fMars said:
In fact, I'd personally prefer the German model over the British model myself, just personal preference though...
Click to expand...

Hence your avatar? :duck:

I think many of the UK posters would agree that a universal insurance-based system (as used in most of the EU) would probably be easier to implement than the UK system.

Rolfe and I have mentioned this before to my certain recollection.
 
jimbob said:
Hence your avatar? :duck:

I think many of the UK posters would agree that a universal insurance-based system (as used in most of the EU) would probably be easier to implement than the UK system.

Rolfe and I have mentioned this before to my certain recollection.
Click to expand...

Hey now, my association to the Nazi's is strictly coincidental!

But in all seriousness, I agree, a Bismarck insurance model would be easier to implement both culturally and politically. I however don't think this is how the states will achieve universal care. I don't think we can reform the current health insurance companies without taking a fatal stab at their monopoly, and the best way to achieve this would be through some sort of robust single payer public option. I don't think this will happen federally though. I think we'll have to follow Canada's example, and use the power of federalism, and whack them off state by state. This is already happening in Vermont.
 
kellyb said:
Where's that other conservative? She is apparently actually involved in HC (even though she hasn't stated such.)

This is just unreal. The federal government doesn't prosecute abuse and fraud? Most MDs live in fear of being falsely accused of fraud by the feds! I have never, ever, ever heard a different story from a confirmed MD. Not even left wing MDs.
Click to expand...

I was in bed - sorry. Yes, there are what are called RAC audits which have now expanded into every state. They are audits by companies hired by Medicare to try and find 'fraud and abuse'. What they are doing is randomly auditing physicians (maybe others in healthcare, I only know about the physician part) to see if what they are billing meets the documentation guidelines. It is really quite silly.

A quick boiled-down example is if Ducky comes in for a visit, since his condition is complicated, a physician could bill a level 5. But if that physician has not documented at least 4 of 8 specific areas describing the condition, WHAMMO - the RAC audit will fine him $10,000 per incident.

Many physicians are not aware of the RAC audits because they just spread beyond the first few test states last year. I also find physicians are completely unaware of the consequences of failing an audit, which include federal prison time.

This is so silly because it is punishing good doctors who just do not write down the exact bulleted items required by the government. But it has become a way for the feds to make good money in punishments.
 
PDiGirolamo said:
This is so silly because it is punishing good doctors who just do not write down the exact bulleted items required by the government. But it has become a way for the feds to make good money in punishments.
Click to expand...

Just so I have this straight. The government sucks at running medical care because of all the fraud. When they take steps to reduce fraud, they are simply trying to make money.

I wonder why nobody is mentioning the Veterans Health Administration, which as best as I can tell is kicking the ass of every program in the USA. They decided several years ago to get their **** together, and it seems they have done so.
 
Garrison0fMars said:
Hey, he doesn't speak for us all. In reality, something like 60% of Americans (I can back this up) want some sort of universal system. You're right that most Americans would not want an NHS style system, but many would go for a Single Payer insurance model, or a Bismarck German/Swiss model. In fact, I'd personally prefer the German model over the British model myself, just personal preference though...
Click to expand...
A disadvantage of the German model is that it is not universal. Public health insurance in Germany is mandatory for the low and medium incomes; high income people must seek out private insurance (and the public insurers may offer private insurance as well). Holland had the same system as well from 1941 until 2006. There are several problems with such a dual system. Those who'd pay the highest tax burden do not contribute to the public system. People may swap in and out of the public system depending on their income, leading to more bureaucracy.

jimbob said:
I think many of the UK posters would agree that a universal insurance-based system (as used in most of the EU) would probably be easier to implement than the UK system.

Rolfe and I have mentioned this before to my certain recollection.
Click to expand...
Provided you first put all the current C*O's of the insurance companies against the wall. ;) A system as you advocate works only, IMHO, if all or most of the insurers are non-profits and also have the mindset of a non-profit. You'd first have to abolish the pervasive mindset of trying to screw your own customers.
 
PDiGirolamo said:
I was in bed - sorry. Yes, there are what are called RAC audits which have now expanded into every state. They are audits by companies hired by Medicare to try and find 'fraud and abuse'. What they are doing is randomly auditing physicians (maybe others in healthcare, I only know about the physician part) to see if what they are billing meets the documentation guidelines. It is really quite silly.

A quick boiled-down example is if Ducky comes in for a visit, since his condition is complicated, a physician could bill a level 5. But if that physician has not documented at least 4 of 8 specific areas describing the condition, WHAMMO - the RAC audit will fine him $10,000 per incident.

Many physicians are not aware of the RAC audits because they just spread beyond the first few test states last year. I also find physicians are completely unaware of the consequences of failing an audit, which include federal prison time.

This is so silly because it is punishing good doctors who just do not write down the exact bulleted items required by the government. But it has become a way for the feds to make good money in punishments.
Click to expand...

I bet you feel exactly the same way about welfare claimants who forget to declare income.
 
I just wanted to point out one of the arguments that xjx keeps forwarding, that 'the government' is making our health decisions.

This really couldn't be further from the truth. The government funds the various health bodies, but it doesn't make many decisions at all.

For example, let's look at NICE.

It is made up of medical experts and members of the public and it is independent, and is one of the world's first bodies to be the most prolific in producing science-based clinical evidence.

If you look at how the NHS has been organised, budgets have been given to various hospitals (trusts) and groups of GP surgeries/PCTs (primary care trusts), to manage as they see fit for their population (of course, within science based clinical evidence).

The Tories are proposing a phenomenal shift in how the entire NHS is financially managed, which is going to putting all of the PCTs, so that means all of the GPs, in charge of the entire NHS budget.

The GPs, as the primary users of the hospitals, will say how it is funded.

Traditionally, they have had a huge chunk of the budget, this is a controversial change in policy. It is going to be interesting.

So now, tell me more about how the government is making our medical decisions.
 
kellyb said:
You live in fear of the fed gov accusing you of abuse and fraud because you know how common false accusations are, but think a main problem with US health care is abuse and fraud because the US gov doesn't prosecute/has no incentive to prosecute it.

Right, dude.

Whatever.
Click to expand...

I'm trying to be patient with you because you obviously have no clue about the extent of Fraud and Abuse against Medicare. You also seem to have no clue about how the OIG enforces the law. Let's just say it's a little different from what you read in blogs or discussion forums.
 
xjx388 said:
How do we determine what anyone is worth, pay-wise?
Click to expand...

In a functioning market, suppliers are price takers. But when a market fails (as a market in healthcare without significant regulation by government always will), suppliers set the prices. The answer to the question of how much a doctor or drug is worth is equal to how much people would pay to save their own lives/suffering or the lives/suffering of their loved ones. For most people this is far in excess of every penny they currently own.
 
jimbob said:
As an aside, I have just phoned (at 8:40 this morning) to make a GP's appointment for my daughter, and have got a 4pm slot.


This is a non-emergency appointment.
Click to expand...

I typically go into my GP surgery at 8 am when they open (it is a 7 min walk from my house), and have an appointment by 8:30 am, so I am only typically 30 min late for work (which isn't an issue at all, as we are given two hours when we have medical appointments).
 
xjx388 said:
Yet most insurers in the US provide lapatinib to their patients with very few restrictions. Can you explain how a profit monster ($307mil in Q3 '10)like CIGNA can provide it yet the wonderful NHS will not?
Click to expand...

Well, a quick search reveals that
a) NICE are reviewing it as we speak

b) It was included on the Black Triangle scheme in July 2008 (top result)

c) It's not in the Black List

Therefore it's prescribable. So what restrictions are you talking about?
 
xjx388 said:
Private insurance companies, who want to make a profit, must put a stop to these thing or else they'll go out of business.
Click to expand...

You would think so, but that's not actually the case. I've tried to explain this to you before. They have a short term interest in keeping costs under control but a long term interest in seeing them rise because their profits are based off the amount required for health care. In terms of bang for the buck, it's much more cost effective to do what was done in Bookitty's MIL's case. That is, when faced with a very expensive condition to treat, carefully review the records to see if there's any way possible to deny coverage. That one case can save hundreds of thousands of dollars. It's a lot more effort to root out $500,000 in fraud committed $50 to $500 at a time. They just need to keep it in check.

Take a look at the charts on this site. Health care as a percentage of GDP has risen from about 4.5% in 1960 to about 14% today. At the same time private insurance spending as a percentage of all expenditures has risen the most sharply (25% to 35%) while public spending has gone from 41% to about 45%.

While this is not direct evidence, it's exactly what you would expect the long term trends to be under these conditions.
 
Mongrel said:
Therefore it's prescribable. So what restrictions are you talking about?
Click to expand...
He has no idea, actually. Here's an interesting quote from Mrs. Lunden:

'What is amazing is I was previously taking five drugs which weren't doing anything and they were more expensive than lapatinib.'

xjx388 also seems to ignore the fact that Mrs. Lunden had more than just breast cancer. She had a breast removed, but not before the cancer had spread to her lymph nodes, liver and brain. If you go to the Lapatinib website, the first thing you see is a big warning that reads, "Lapatinib may cause liver damage which can be severe or life-threatening. Liver damage can occur as soon as several days or as late as several months after the start of treatment with lapatinib."

I'm not a doctor, and I don't know all the specifics, but this case is far more complex than deciding a policy to use this drug for breast cancer treatment, which is complex enough as it is.
 
You must log in or register to reply here.

Back
Top Bottom