posted
What I'm against, previously and still, is forcing the insurance companies to abide by rules that will drive them out of business.
as usual, everybody is skirting the real issue here it's the doctors that are actually spending all the money. The current system is unsustainable. doctors have a very breif window of opportunity to fix the problems or they will become govt employees. all of them...
i think they have about 5 to 7 years to figure this out.
in the 50's and before? doctors typically had a large percentage of patients that just did not pay, because they couldn't. they also lived among their patients instead of gated communities.. Medicare changed that but, they are headed back to that very fast.
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Glass, I've actually thought about this part and would like to hear your take on it...
Why aren't the legislators dragging Hospital Administrators and prominent doctor's up to capital hill and demanding answers as to why they change so much for care?
I've heard some talk about how, by law, they have to take care of people whether they can pay or not. Of course that cost has to be offset through raising the bills of others to pay for it. I've even read that this is a driving factor for wanting to get everyone insured...so that they pay their fair share. (momentary pause for sarcastic effect) The problem that I see with that is in each of the two bills in Congress, low income families\individuals (the ones that aren't paying their 'fair share' of the medical care cost burden now, receive subsidies from the taxpayers to cover the costs. So we're still back to everyone not paying their own way\fair share.
So, given that, by law, doctors HAVE to care for those that can't pay for the service; and given that they have to charge others more to make up for the negative profitability mandated by said law, what is the best way to reduce overall costs without reducing the level of care provided? And why are we, or rather our representatives (longer pause for sarcastic effect) going after those that are already trying to spread the costs around through insurance pools, instead of looking for the actual reasons that costs are so high?
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Why aren't the legislators dragging Hospital Administrators and prominent doctor's up to capital hill and demanding answers as to why they change so much for care?
because the legislators need doctors too... there aren't enough doctors, and that is because the AMA has been controlling the number of enrollees to medical school for decades.
i don't really care if an insurance co is profitable or not.
what i would like to see is doctors not having 2o people in the waiting room at all times.
five to ten consult rooms and ten minutes allotted to each patient.
20 minutes if it's a first time visit.
hasn't this become the norm all over the country?
tests to protect themselves from malpracice hell! the tests are a way of charging your insurance co money.
if your doctor had to tell you that he/she needs to do a test that will cost YOU a weeks pay and you asked them why? they would have to convince YOU why. they don't in this process. they have a blank check and they have a process in deciding just what your insuracne co will tolerate. Heck i have BC BS and i see that the doctor tries to overcharge them on every item. BC BS sends me notes telling me i am not responsible for the difference every time too.. how much does it cost to do this "billing war" that they engage in?
so the game here is that the insurance co's are going to have to be forced to be the "heavy" and ask the doctors to cut back so they can stay in business, instead of the patients asking.
every single drug commercial on TV comes out of our insurance money too... do you actually listen to the side effects? and in the end? those commercials are designed to make you go demand the drugs from your doctor and he/she has two choices, argue with you (even tho they only have two minutes to) or lose your business, either way? the insurance costs go up again.
the insurance co's could stop those commercials by refusing to pay what they feel is the cost of them, they don't (yet) so the insurance co's need to become the "heavy" again and tell the drug co's to stop wasting money advertising to patients instead of the person who actually decides and spends the dough.
-------------------- Don't envy the happiness of those who live in a fool's paradise.
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FEBRUARY 26, 2010.Race to Pin Blame For Health Costs .ArticleComments (60)more in Health ». EmailPrintSave This ↓ More. .facebook Twitter Digg StumbleUpon + More close Yahoo! BuzzMySpacedel.icio.usRedditLinkedInFarkViadeoOrkut Text . By AVERY JOHNSON A battle over who to blame for rising health-care costs is escalating, as groups seek to pin the problem on each other and say none of the health-care legislation under consideration does enough to solve it.
U.S. spending on health care reached $2.5 trillion in 2009, according to federal estimates. It is expected to jump to $4.5 trillion in 10 years.
Insurers contend that they must pass on ever-higher bills from hospitals and doctors. Hospitals say they are struggling with more uninsured patients, demands by doctors for top salaries, and underpayments from Medicare and Medicaid.
And doctors say they are strong-armed by insurance monopolies and hampered by medical malpractice costs.
In the rush to point fingers, few solutions are emerging.
"It's always someone else's fault," said Robert Laszewski, president of health-care consulting firm Health Policy & Strategy Associates. "There is not an incentive for these people to cooperate because the game they are all playing is getting a bigger piece of the pie."
The issue has come into sharp relief as WellPoint Inc. has sought to defend its plan to raise some prices in California by up to 39%.
In a hearing Wednesday on Capitol Hill, WellPoint Chief Executive Angela Braly singled out dominant hospital systems for demanding 40% rate increases and drug companies for roughly 20% profit margins.
A WellPoint spokeswoman said that at least one hospital had asked for a 220% payment increase.
Many Democrats have cited lack of competition among insurers as a driver of higher prices. On Wednesday, the House of Representatives voted to repeal a longstanding insurance-industry exemption from federal antitrust laws. The bill now heads to the Senate, where its future is less certain.
Doctors complain of a lack of competition among insurers, as well.
A report by the American Medical Association this week argues that 500 insurance-company mergers in the past 12 years have led to markets dominated by one or two health plans.
This year, two insurers control 70% of the market in 24 states, up from 18 last year, the report said.
"There is no other company for doctors to go to" when an insurer comes to them with terms that they find unfavorable, said AMA President James Rohack.
But insurers say is it doctors and hospitals that have gotten too powerful through consolidation.
A study published Thursday in the journal Health Affairs appears to back up their point, saying that insurers are weakened in their negotiations by their inability to exclude prominent doctors and hospitals from networks.
Authors from the Center for Studying Health System Change, a nonpartisan research group, conducted 300 interviews with California doctors and hospital and insurance executives in late 2008.
The study said two big networks of providers now dominate the northern part of the state: Sutter Health owns two dozen California hospitals and medical centers, and Catholic Healthcare West runs 33 hospitals.
In addition, the study said, doctors who are increasingly banding together for negotiating power are commanding yearly double-digit payment increases.
Hospitals and doctors shot back that the study was largely anecdotal and said integration improved efficiency.
Catholic Healthcare West said it took on $1.5 billion in bad debt from government underpayments last year; its size, it added, makes it possible to achieve some savings.
Sutter Health said increases in its reimbursement rates from private insurers have been in the single digits.
"We are doing our best to keep costs down because these health-care premium increases are not sustainable," said Bill Gleeson, vice president of communications a Sutter Health.
Printed in The Wall Street Journal, page A5
-------------------- Wise men learn more from fools than fools from the wise.
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Catholic Healthcare West said it took on $1.5 billion in bad debt from government underpayments last year; its size, it added, makes it possible to achieve some savings.
these are the people that are really driving the argument against single payer.
i am not for single payer, but i think a public option would garantee a minimum level of health care with a wellness program that should lower overall health care costs...
insurance co's work on a percentage of gross receipts to determine their profits. they like seeing gross receipts go up.
-------------------- Don't envy the happiness of those who live in a fool's paradise.
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So isnt tort reform the real problem that needs fixing? Problem is, a lot of these superlawyers are in cahoots with the dem party so we know how that is going to work. Dont destroy the system when you can fix a few things in it.
-------------------- It isn't so much that liberals are ignorant. It's just that they know so many things that aren't so.
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In suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise reexamined in any court of the United States, than according to the rules of the common law.
-------------------- Don't envy the happiness of those who live in a fool's paradise.
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posted
So why are we not going to get the benefits of the new health care plan for another 4 years, but the taxes start immediately? Does anyone trust the government that they will use 4 years of that tax revenue for health care only and not get cherry picked?
-------------------- It isn't so much that liberals are ignorant. It's just that they know so many things that aren't so.
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back Don't pay, don't sell Medicare D Fox Insurance Company loses contract for improperly denying critical prescription drugs
By CATHLEEN F. CROWLEY, Staff writer Click byline for more stories by writer.
First published: Saturday, March 13, 2010
The federal government took an unprecedented step Tuesday when it terminated the contract of a Medicare prescription drug insurance company that was unfairly deterring beneficiaries from using expensive drugs. Medicare cut off Fox Insurance Company, which provided Medicare Part D coverage to 10,000 New Yorkers over 65 years old. About 400 people in the Capital Region are affected, according to state officials.
According to the Centers for Medicare & Medicaid Services, which oversees Medicare, Fox improperly denied critical drugs to people with HIV, cancer and seizure disorders. In many cases, Fox enrollees were required to get invasive medical procedures to prove they needed the drugs even though they had a doctor's prescription.
Michael Burgess, director of the state's Office for the Aging, said it's a sign that the Obama administration should review the Part D program that was introduced in 2006.
"It is the only part of Medicare where you have to have a private operator for the coverage," Burgess said. "It has been a beef of mine that we have allowed all these plans to come in. They come in because they smell a profit and they think they can do this on the cheap by restricting people and, as (the Medicare statement about Fox) said, 'jeopardizing their health and safety.' "
There are 50 companies that offer Part D coverage in New York. Burgess said the number should be reduced to a few high-quality plans.
Fox, which is based in New York City, entered the New York insurance market just this year and was one of 10 "benchmark" plans. The designation means that it was priced at less than $33.32 a month -- a price tag low enough to allow the federal government to fully subsidize low-income beneficiaries enrolled in Fox.
"Being a benchmark plan is a sure way for these plans to get membership," said Linda Petrosino, coordinator of the state Health Insurance Information Counseling Assistance Program.
Indeed, Fox was able to enroll 10,000 people even though the plan is new to New Yorkers. Nationwide, the company has 123,000 Part D participants. The company could not be reached for comment.
Petrosino called the company's behavior "egregious."
The Centers for Medicare & Medicaid Services has arranged for Fox participants to receive their prescriptions through LI-NET, a program run by Medicare and administered by the health care corporation Humana. Even through open enrollment for Part D programs ended on Dec. 31, Fox enrollees will be allowed to select a new program. If they don't choose one by April 30, CMS will enroll them automatically in another plan.
Cathy Roberts, senior paralegal at the Empire Justice Center, said that there were few complaints about Fox in New York because the state's Elderly Pharmaceutical Insurance Coverage program pays for drugs if a Medicare enrollee's plan denies coverage.
However, Roberts said Gov. David Paterson has proposed cutting this "wrap" coverage to save $4 million.
"If this happens again after July, people won't have that kind of protection," Roberts said.
For help
Medicare beneficiaries who were enrolled in Fox Insurance Company's Part D plan can still get prescriptions filled at their pharmacy through a federal safety-net program. If you have problems filling a prescription, call Medicare at (800) MEDICARE. Fox enrollees must choose a new plan by April 30.
For guidance, go to http://www.Medicare.gov to see what plans are available, or get advice from an insurance counselor through the state insurance assistance hotline at (800) 701-0501.
-------------------- Wise men learn more from fools than fools from the wise.
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March 12, 2010 Op-Ed ColumnistHealth Reform Myths By PAUL KRUGMAN Health reform is back from the dead. Many Democrats have realized that their electoral prospects will be better if they can point to a real accomplishment. Polling on reform — which was never as negative as portrayed — shows signs of improving. And I’ve been really impressed by the passion and energy of this guy Barack Obama. Where was he last year?
But reform still has to run a gantlet of misinformation and outright lies. So let me address three big myths about the proposed reform, myths that are believed by many people who consider themselves well-informed, but who have actually fallen for deceptive spin.
The first of these myths, which has been all over the airwaves lately, is the claim that President Obama is proposing a government takeover of one-sixth of the economy, the share of G.D.P. currently spent on health.
Well, if having the government regulate and subsidize health insurance is a “takeover,” that takeover happened long ago. Medicare, Medicaid, and other government programs already pay for almost half of American health care, while private insurance pays for barely more than a third (the rest is mostly out-of-pocket expenses). And the great bulk of that private insurance is provided via employee plans, which are both subsidized with tax exemptions and tightly regulated.
The only part of health care in which there isn’t already a lot of federal intervention is the market in which individuals who can’t get employment-based coverage buy their own insurance. And that market, in case you hadn’t noticed, is a disaster — no coverage for people with pre-existing medical conditions, coverage dropped when you get sick, and huge premium increases in the middle of an economic crisis. It’s this sector, plus the plight of Americans with no insurance at all, that reform aims to fix. What’s wrong with that?
The second myth is that the proposed reform does nothing to control costs. To support this claim, critics point to reports by the Medicare actuary, who predicts that total national health spending would be slightly higher in 2019 with reform than without it.
Even if this prediction were correct, it points to a pretty good bargain. The actuary’s assessment of the Senate bill, for example, finds that it would raise total health care spending by less than 1 percent, while extending coverage to 34 million Americans who would otherwise be uninsured. That’s a large expansion in coverage at an essentially trivial cost.
And it gets better as we go further into the future: the Congressional Budget Office has just concluded, in a new report, that the arithmetic of reform will look better in its second decade than it did in its first.
Furthermore, there’s good reason to believe that all such estimates are too pessimistic. There are many cost-saving efforts in the proposed reform, but nobody knows how well any one of these efforts will work. And as a result, official estimates don’t give the plan much credit for any of them. What the actuary and the budget office do is a bit like looking at an oil company’s prospecting efforts, concluding that any individual test hole it drills will probably come up dry, and predicting as a consequence that the company won’t find any oil at all — when the odds are, in fact, that some of the test holes will pan out, and produce big payoffs. Realistically, health reform is likely to do much better at controlling costs than any of the official projections suggest.
Which brings me to the third myth: that health reform is fiscally irresponsible. How can people say this given Congressional Budget Office predictions — which, as I’ve already argued, are probably too pessimistic — that reform would actually reduce the deficit? Critics argue that we should ignore what’s actually in the legislation; when cost control actually starts to bite on Medicare, they insist, Congress will back down.
But this isn’t an argument against Obamacare, it’s a declaration that we can’t control Medicare costs no matter what. And it also flies in the face of history: contrary to legend, past efforts to limit Medicare spending have in fact “stuck,” rather than being withdrawn in the face of political pressure.
So what’s the reality of the proposed reform? Compared with the Platonic ideal of reform, Obamacare comes up short. If the votes were there, I would much prefer to see Medicare for all.
For a real piece of passable legislation, however, it looks very good. It wouldn’t transform our health care system; in fact, Americans whose jobs come with health coverage would see little effect. But it would make a huge difference to the less fortunate among us, even as it would do more to control costs than anything we’ve done before.
This is a reasonable, responsible plan. Don’t let anyone tell you otherwise.
-------------------- Wise men learn more from fools than fools from the wise.
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posted
Then debate my main concern, Ray. Seriously.
If the final version of this bill becomes law...
If it forces insurance companies (private companies) to accept pre-existing condition patients...
If it imposes limits on premium hikes...
How is this NOT going to drive them out of business and onto government roles?
It's one thing to sit there and blindly copy and paste from ThinkProgress.org and stick your head in the sand and dream of a Utopia that will never exist...
It's quite another to rationally look at things and debate them...
Which is it going to be for you?
I don't mean this to sound as angry as I'm sure its going to come accross...but NOONE has ever offered an answer to this for me.
Again...
How is this NOT going to drive private insurers out of business?
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SF, the insurance co's are being put on the spot here.
fact is? the insurance co's have not done enough in the past to look out for their customers. in fact? they have treated their customers pretty badly.
who represents you, the customer, in all this? your doctor? heck, he/she is milking the insurance co's not (milking) you, right? somebody somewhere has to be bringing some accountability to the table.
the insurance co's have the purse strings.
this isn't about running them out of business, this is about putting the bite on the real spenders of the money without having to be the bad guy and tell the doctors they have to go on a diet.
-------------------- Don't envy the happiness of those who live in a fool's paradise.
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If it's really the Doc's milking the public (indirectly) then take them to task. Don't destroy an entire market because you don't want to tell "the doctors they have to go on a diet."
I seem to remember that being a reason why many doctor's didn't like taking Medicare\Medicaid patients now...
So if they bankrupt the private insurers and we're all forced into Medicare\Medicaid then they can lowball the doctors for all of us!
What a way to bring down the cost of medical care!!
Sheesh...
WOW! You are quite the naive imbecile SF. If a Doc charges $500 for a test, and Medicare/Medicaid pays $200, that means the Doc is getting lowballed? You need to drop the crackpipe, and realize that Docs are WAY overcharging. I hate to think you are actually that dense. But per your recent posts.....it's looking like you are.
-------------------- It is impossible to make anything foolproof because fools are so ingenious.
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Pagan...please stop insulting people and think for a minute...
If the Doctors ARE overcharging (and I'm not saying they aren't), and the Insurers have to pay for those tests regarless of how high the price goes, why are we regulating the insurers out of business instead of going after the doctors?
And yes, the Gov is lowballing the doctors if they are making them accept a price that is below market value for their services. That's what lowballing means. Whether you think it's warranted or not does not change the definition of the term.
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quote:Originally posted by SeekingFreedom: Pagan...please stop insulting people and think for a minute...
If the Doctors ARE overcharging (and I'm not saying they aren't), and the Insurers have to pay for those tests regarless of how high the price goes, why are we regulating the insurers out of business instead of going after the doctors?
And yes, the Gov is lowballing the doctors if they are making them accept a price that is below market value for their services. That's what lowballing means. Whether you think it's warranted or not does not change the definition of the term.
Quit posting non-sense then SF. What is fair value from a Doc? Please explain in detail for all procedures/tests they proscribe. Next, how will the insurance industry be ruined? Actually specific facts this time....not just fear mongering SF. Answer those 2 questions.
-------------------- It is impossible to make anything foolproof because fools are so ingenious.
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quote:Originally posted by SeekingFreedom: Pagan...please stop insulting people and think for a minute...
If the Doctors ARE overcharging (and I'm not saying they aren't), and the Insurers have to pay for those tests regarless of how high the price goes, why are we regulating the insurers out of business instead of going after the doctors?
And yes, the Gov is lowballing the doctors if they are making them accept a price that is below market value for their services. That's what lowballing means. Whether you think it's warranted or not does not change the definition of the term.
Quit posting non-sense then SF. What is fair value from a Doc? Please explain in detail for all procedures/tests they prescribe. Next, how will the insurance industry be ruined? Actually specific facts this time....not just fear mongering SF. Answer those 2 questions.
-------------------- It is impossible to make anything foolproof because fools are so ingenious.
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posted
Some kind of healthcare is coming to America I would like to see Ins co's taken out of the picture all togrther. They are weak pain in the azz always whinning about making know money yet fighting like a crazy man to keep the system the same they are crooks and thieves and should be in jail. They do not seve the heath market any more and have live out there use.
Obama's plan will work as he said. if the Republican obstructionist have something better to offer bring it to the table.Instead of acting very foolish none of them have shown any thing better.
-------------------- Wise men learn more from fools than fools from the wise.
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I HAVE posted the actual text from the Senate Bill. That's right, the one they're trying to force the House to swallow.
They WILL force Insurance Co's to accept people with pre-existing conditions...
Do you disagree with this part?
They WILL limit how much the Insurance Co's will be able to raise their premiums to compensate...
Do you disagree with this part?
This will bankrupt the Insurance Co's because they will be paying out more than they will be bringing in...
Is this the part you don't agree with?
On both of the first two points I have listed the text of the actual bill and the last point is a forgone conclusion based on the Insurance Co. business model (and Economics in general).
So, where exactly am I posting nonsense?
As far as fair market pricing for Doctors, what do you think is fair market? Whatever the market will bear...just like any other industry, either product or service based.
If you (or Government) don't like the prices address those charging the prices...not those already trying to spread the cost around. Tell me, Pagan, what part of this, specifically, do you find logically lacking?
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quote:Some kind of healthcare is coming to America I would like to see Ins co's taken out of the picture all togrther.
And what good does that server, Ray? You will be left with two choices...medicare\medicaid or dealing directly with the Doctor yourself (which you can already do if you feel so inclined).
Removing them doesn't change what the Doctors' are charging...just removes the ability to collectively bargain for lower prices (which is all the insurance companies do) for a set fee.
Again...what purpose is served by bankrupting them?
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posted
They WILL force Insurance Co's to accept people with pre-existing conditions...
Do you disagree with this part?
They WILL limit how much the Insurance Co's will be able to raise their premiums to compensate...
Do you disagree with this part?
This will bankrupt the Insurance Co's because they will be paying out more than they will be bringing in...
Is this the part you don't agree with?
On both of the first two points I have listed the text of the actual bill and the last point is a forgone conclusion based on the Insurance Co. business model (and Economics in general).
So, where exactly am I posting nonsense?
As far as fair market pricing for Doctors, what do you think is fair market? Whatever the market will bear...just like any other industry, either product or service based.
we've been over this before SF. when the insurance co's reject or rescind patients, we end up paying for them with our tax dollars.
i called it subsidization, you disagreed, but the fact is? they get to keep th e"profitable" people and the unprofitable people either die, so we have private, for profit death panels at the insurance co's or the taxpayers pick up the tab and we get death panels in the govt.
by telling the insurance co's they have to take on these patients? the insurance co's will be forced to demand that the doctors and the hospitals and the drug co's will have to bear the costs too.
you say medicare lowballs doctors? well, actually before medicare? the doctors still took on those patients without getting paid.
back in the day? they took a chicken for pay and they lived on the same block as their patients.
they didn't NEED malpractice cuz they didn't get sued because the lawyers would not bother to sue them.
creating this huge insurance pool (private or public) is what gave them the incentive to charge so much.
it's just like the fees universities charge. they were still relatively cheap back in the late seventies and early 80's... i think i payed 600$ for fulltime tuition for my first semester at my state university.... then the Govt started this huge lending program and NOW? you can't get a semester at a major State University for less than 5000$ that i know of, and that's instate....
do they offer more now than they did then? hell no...
-------------------- Don't envy the happiness of those who live in a fool's paradise.
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Technologically, Glass, they can offer a hell of a lot more. But that's a debate for another day.
You're right though on one point...we have been through this already. And I'm still not sure why you think that it's a good idea to try and strong arm the Insurance Co's in an attempt to drive down prices. What's going to happen is that they WILL go out of business. Period. They will have no way to offset the increased costs that are guaranteed by the(forced) acceptance of pre-existing conditioners. If they try to 'lowball' the Doctors one of two things will happen.
1) Doctors will start dropping insurance companies that they accept making people pay the higher prices themselves.
or
2) Fewer people will become doctor's based on the lowered projected income possibilities. This one creates higher demand for the services of those that remain again raising prices.
posted
1) Doctors will start dropping insurance companies that they accept making people pay the higher prices themselves.
it's not just doctors, it's also hospitals and drug co's and manfacturers... and they will all have to accept lower profit margins/ cut costs no matter what happens you don't really beleive that doctors want to be suing patients to get paid do you? cuz they won't be able to get paid what they have been accustomed to if the insurance co's fail
this whole situation has been outofhand for a couple decades. or
2) Fewer people will become doctor's based on the lowered projected income possibilities. This one creates higher demand for the services of those that remain again raising prices.
the AMA already striclty controls how many doctors they train...
they could train twice as many for a lower cost per doctor and still have very high standards, getting into med school is extremely cuthtroat and many good people do not get accepted. they mainatin a very high graduation rate once they are accepted...
the doctor supply/demand ratio is one of the reasons we pay so much now.
-------------------- Don't envy the happiness of those who live in a fool's paradise.
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