Here's why we need a Public Option tied into medicare repayment: Hospitals, the real culprits.

[rateyes]

My brother just finished his Ph.D. disseration--and, won a national award for it---on the topic of Healthcare in America.

During the writing of his disseratation he had to undergo cornea transplant surgery. The total cost for that surgery was $3600. When he was talking to the person in charge of the bill he asked, "If I didn't have insurance, what would you have charged me for this surgery?" The answer was, "I don't know offhand, but I can look it up for you." Then came the answer, "$16,000."

Now, why would hospitals charge a non-insured person more than 5 times what they would charge an insured person? Because, they figure that if they can't get the low price from them (because they don't have adequate funds) they might as well charge all they can, and count it as a loss. Meantime, they put that bill on the shoulders of the uninsured patient, and make it much more difficult to stay out of bankruptcy.

Criminal bastards.

He went for a follow up to his doctor. He said, (remember he is doing research for his disseration at this time), "I notice that you've added a lot of computers and put your medical records online. That had to cost a lot of money." The doctor said, "We had to." My brother asked, "Why?" The doctor answered, "Well, we were told that if we did not do it that Medicare would cut its payments to us by 15%. That wouldn't have been so bad except for the fact that EVERY INSURANCE POLICY REIMBURSEMENT is tied into what MEDICARE PAYS---usually the rate is what Medicare pays plus 15%."

So, you see, if Medicare cuts its reimbursement rates by 15%, then so would all the rest of the insurance companies.

Right now, insurance companies love the fact that Medicare is in place for the group that gets sicker quicker--they can charge high premiums on the rest of us and pay out minimum amounts (considering high deductibles and copays).

But, those companies don't want a medicare program for all--or for younger folk, because many would choose the medicare option---the public option would get premiums from the healthier patients who use it less, and they would have to lower premiums and give more service to keep the business.

Without the public option, and with mandates, now the insurance companies will get 30 million new customers (most of them who won't have a lot of claims) who have to purchase the high deductible, high co-pay insurance policies that are STILL TIED INTO MEDICARE REIMBURSEMENT RATES.

Add to that the fact that, with the Senate bill, the insurance companies still keep their anti-trust exemptions, and you see why the Senate bill really sucks.

In other words, without a REAL public option, or at least a medicare buy-in---this bill is nothing but a giveaway to the insurance industry who will get more and more of our income each year---and, as for the people--more will have insurance, but a great many will still not be able to afford to USE IT.

We ought not quit screaming about the fact that Obama promised that any HCR bill he signed have a public option.

[amborin]

1. Cost of Afghanistan War = $57,000 per minute

http://motherjones.com/politics/2009/12/afghan-war-cost...

[rateyes]

3. Yep. nt

[rateyes]

2. Wow, unrecs before I know the unreccer had time to read the post.

What an open-minded bunch.

[truedelphi]

7. I have found if I write an OP during the day when I can still

Think somewhat clearly but wait to post till late at night, I get far fewer unrec's.

The trolls go to bed early.

[AwakeAtLast]

20. 9-5 trolls. Hmmmmm.....

:think:

[andym]

4. How universal is the Medicare+15% for insurers?

That is actually a good thing, because while the insurance industry takes their greedy and wasteful 30%, the rapid inflation in health care apparently comes from increasing provider costs (and more costly drugs/medical devices).

Medicare+15% while not ideal, should be holding provider costs down more than it seems to be doing. What does your brother think is the cause? Should the government be more tough in holding the line on Medicare reimbursements to providers? It sounds that if the govt takes a hard line, then cost inflation pressure from the provider side should be lessened across the health care "industry". Still doesn't solve the insurer problem, but it would be important.

[Igel]

17. It varies.

Not all insurance providers reimburse the same. It's one reason some doctors don't take certain kinds of insurance.

[andym]

5. Do you have a link to your brother's dissertation? Rec'd your post.

Is he willing to post it? Sounds like it could be useful to getting better reforms.

[sandnsea]

6. Uh, the House wants the PO tied to Medicare

So it would essentially be the same as private insurance reimbursement rates, according to your theory. How would that help anything?

And please provide the quote where Obama promised that any health care bill he signed would have a public option. Promised it would, not proposed it as an ideal plan.

[rateyes]

8. Here you go:

http://tpmdc.talkingpointsmemo.com/2009/07/obama-demands-the-bill-i-sign-must-include-public-option.php

"Any plan I sign must include an insurance exchange: a one-stop shopping marketplace where you can compare the benefits, cost and track records of a variety of plans - including a public option to increase competition and keep insurance companies honest - and choose what's best for your family."

[sandnsea]

11. Okay, good enough

Hold his feet to the fire on it then.

[rateyes]

9. Yes. And, the Senate bill doesn't. We want it tied to Medicare

as in the PO will pay what medicare pays.

[sandnsea]

12. You're criticizing private insurance for that

so what good will it do to have the public option tied to Medicare. I don't get the economic logic of it.

[rateyes]

13. I'm criticizing private insurance, not for using medicare reimbursement

rates. I'm criticizing private insurance for killing the public option to get 30 million new customers who will use the policies less often, still be able to keep high deductibles and co-pays on those policies to create incentive for people not to use them. I'm criticizing hospitals for charging 5x more for non-insured people than they do for insured people.

[sandnsea]

16. If Medicare reduces its rates

It will cause insurance companies to reduce rates. That's what you're saying. So hospitals are the culprits because they can't function on Medicare rates and say so. You said hospitals are the culprits.

[rateyes]

19. The hospitals make outrageous profits.

[truedelphi]

10. Here is some bad news about "Computerizing the patient info"

For a while I was part of a brigade of loyal citizens who were fighting the "reformation" of our community hospital into the slave unit for Sutter health.

one night, while at a quite heated meeting, one of the pro-Sutter people let it slip that it had cost We the People
some $ 300,000 for them to hire computer programmers and to create the software for turning the patient information into digitized online accessible information.

My friend A went ballistic. I could not understand that at all. After all, if local programmers indeed had been hired, the $ 300K represented only something like 5,000 billable hours of work, and maybe the salary of one overlord to supervise, and I thought it a good deal.

At break, I cornered A.

"C'mon man, our community needs to have its records computerized. You can hardly resent programmers for their 45 to 75 dollar an hour fee when you make 350 as an Attorney. Just what is your beef?"

"That's not what has gotten me so pissed. Here's the thing: Do you know how many hospitals Sutter has in its chain here in California? They are going around to each and every hospital and charging each and every hospital that same $ 300k!

"Even though, if they truly have created the software from scratch, they own it and can simply export it to all the other hospitals from one originating hospital. Instead they are collecting $ 300K a pop!""

And that is the scary thing about those costs!!!!!!!

[rateyes]

14. Bingo.

Hospitals are really big culprits in this thing. And, if they don't have incentive to lower costs, (such as a public option only paying medicare rates that the government sets) then this insurance reform isn't worth much.

[andym]

15. That's why the Hospital and Physician's lobbies worked so hard against the Medicare expansion.

http://www.npr.org/templates/story/story.php?storyId=121234235

[postulater]

18. The doctor can charge whatever he wants to anyone

except Medicare patients.

If he is being forced to accept a fee schedule then he has agreed to it in advance. Unless he has a contractual agreement with the insurance company he is free to charge anyone whatever he wants.

Of course that means he may sacrifice those patients who won't go outside their network and are just looking for the lowest priced doctor.

[KoKo]

21. Howard Dean mentioned that about Hospitals in his appearances this last week and a half...

He also said without "Anti-Trust Legislation" against Insurance Monopoly that Obama's plan would not work.

Hospitals were the big culprit not addressed in Senate Bill, he said. He hoped the House Bill would prevail when all went back for Reconciliation.

Let's hope they hear us.

[ibegurpard]

22. Here's my question:

What's the basis for these figures to begin with?
Everyone just accepts these "costs" as gospel and the insurance costs go up to meet them.
I see NOTHING about keeping costs under control in any of the crap currently being circulated as healthcare "reform."

[spinbaby]

23. Prices are beyond bizarre

A recent trip to the emergency room for stitches yielded a bill for about $2100. Insurance paid about $700. Now it was a good emergency room at a good hospital and we got prompt and professional treatment, but even $700 seems way too high for stitching up a cut. $2100 is just in the Twilight Zone.

[rateyes]

24. My daughter had a kidney stone.

The doctors at first thought it might be appendecitis. The last of several tests, which according to my aunt who is a nurse should have been the first found the stone. Bill for that ER visit: $9500 Three times the cost of my brother's cornea transplant.

[Vidar]

25. K&R.