What is a Liberal?

[Hoss]

Still does, it's called Sooner Care

Oh, and Marland married his adopted daughter.  Blech!

You've obviously never had to deal with SoonerCare, right?  I have.  To call it nightmarish is being kind.  We need something simpler than that.

[FOTD]

Hoss, please tell us about SoonerCare. Make certain these ninnies here get a clue.

So glad the government is going to force tv commercial volume to be the same as the program. Too bad for Big Pharma....they should have never been allowed to advertise in the first place. Some of us recall an age when such nonsense commercials were prohibited. Of course, tv was supplemented by Big Tobackie back then. It was Nixon who freed up the airwaves for viagra et al. That Nixon. In hindsight, probably the most liberal of all our presidents. Just take women's college athletics, the dollar standard, and taping...what else? Lots of change because of Dick Nixon.

[Conan71]

You've obviously never had to deal with SoonerCare, right?  I have.  To call it nightmarish is being kind.  We need something simpler than that.

I said nothing about the quality of it, simply pointing out to HT that we still do have state-sponsored care.  This is pretty close to what a national plan would look like, sorry to say guys/gals.

[Conan71]

Hoss, please tell us about SoonerCare. Make certain these ninnies here get a clue.

So glad the government is going to force tv commercial volume to be the same as the program. Too bad for Big Pharma....they should have never been allowed to advertise in the first place. Some of us recall an age when such nonsense commercials were prohibited. Of course, tv was supplemented by Big Tobackie back then. It was Nixon who freed up the airwaves for viagra et al. That Nixon. In hindsight, probably the most liberal of all our presidents. Just take women's college athletics, the dollar standard, and taping...what else? Lots of change because of Dick Nixon.

EPA, Affirmative Action

[Hoss]

I said nothing about the quality of it, simply pointing out to HT that we still do have state-sponsored care.  This is pretty close to what a national plan would look like, sorry to say guys/gals.

But to call something state-sponsored actually infers it's easy to work wi...wait a minute, it's a government-run program.

I don't have first hand knowledge other than to threaten the ninnies at the state who kept losing my mother's information and threatening to cut off her care.

But other than that, when it works, I'm all for 2 dollar copay prescriptions and free medical checkups, like she gets.

[Conan71]

But to call something state-sponsored actually infers it's easy to work wi...wait a minute, it's a government-run program.

I don't have first hand knowledge other than to threaten the ninnies at the state who kept losing my mother's information and threatening to cut off her care.

But other than that, when it works, I'm all for 2 dollar copay prescriptions and free medical checkups, like she gets.

I had to pick up a scrip for mom last night myself, under $5.00. Not sure if that's medicare or her supplimental insurance that makes that possible.

[we vs us]

All this complaining about government inefficiency completely ignores the fact that what we have -- right now -- is a privately funded and privately run behemoth of a system whose administrative costs are one of the primary reasons healthcare now takes up a sixth of our GDP.

It's free market-style inefficiency and bureaucracy, and it's just as bad if not worse than government inefficiency.  Why worse?  Because 1) it's an industry and it's profit driven and 2) it won't hesitate to use its leverage to grow bigger.

[Conan71]

All this complaining about government inefficiency completely ignores the fact that what we have -- right now -- is a privately funded and privately run behemoth of a system whose administrative costs are one of the primary reasons healthcare now takes up a sixth of our GDP.

It's free market-style inefficiency and bureaucracy, and it's just as bad if not worse than government inefficiency.  Why worse?  Because 1) it's an industry and it's profit driven and 2) it won't hesitate to use its leverage to grow bigger.

How would the government run it with less administration and still provide the same level of service and at a lower cost?

[we vs us]

A lot of it has to do with what comes out of the Senate Sausage Grinder, so i'm not sure what "reform" will look like at this point.  In my perfect world, we go to single payer and many vast bureaucracies become one vast bureaucracy. And I don't know what service you're talking about.  I've sat in some pretty awful waiting rooms, been subjected to some pretty perfunctory walkthroughs by the on duty MD, and not been treated at all well when a bill I thought was paid by my insurance turned out to not be. 

At the same time, I've met some very kind people behind the counter at the post office. 

And as for lower cost, well . . . no one here would want to hear it but I'd take a good chunk of the profit motive out of the equation. That's really what we're talking about with all this reform.  Letting some of the air out of the greed bubble, and moderating the hauls some of these companies can take.  Because it's pretty obvious when you look at how much of our economy is health care (not to mention all of those tried and true metrics that show us declining in quality while our cost skyrockets), that it's an industry waaaay out of control. It's like one of those huge deformities on the Elephan Man's head, making him tilt to far forward when he walks. It distorts everything.

One of the biggest problems here is that what we're dealing with is not insurance in the classic sense of the term.  It's not like boat insurance or car insurance or house insurance.  You're not necessarily insuring yourself and your loved ones against a once-in-a-lifetime catastrophe.  In actuality it's an employer supported discount club for all medical care.  It's there for you to be covered in case you're diagnosed with a brain tumor (that's the catastrophic part) but it's mostly there to discount the costs of a teeth cleaning, or a physical, or visits to your shrink.  It's there to discount the costs of meds or your prosthetic leg or a crown on your back molar. When you start using an erstwhile financial product as a way to afford basic treatment, that's another sign that something fundamental is broken. 

At heart I just think that private companies that don't care about me are running this thing into the ground.  I think the private companies have too much power and need to be reigned in.  The only entity out there that can approach the problem is government.  At this point I think those problems outweigh the possibility that government healthcare will be as bad. 

And hey, govt healthcare works like a charm in other places.  Forget Canada.  Look at most anywhere in Europe.  Better results, no burden on private business to fund it, and cheaper care overall.  Are we really truly saying that our we think our government is worse than any of the ones in the Eurozone?

[Red Arrow]

Hoss, please tell us about SoonerCare. Make certain these ninnies here get a clue.

That Nixon. In hindsight, probably the most liberal of all our presidents. Just take women's college athletics, the dollar standard, and taping...what else? Lots of change because of Dick Nixon.

Humphrey (68) and McGovern (72) made Nixon look like a Goldwater by comparison.

Don't forget one of my least favorites, the 55 MPH speed limit. (On the Interstate my car got its best gas mileage at about 62 mph, NOT 55.)

[Hoss]

How would the government run it with less administration and still provide the same level of service and at a lower cost?

Do you know anyone that works in the medical profession?  I have several relatives that do; doctors especially complain about multiple paperwork filings that cost them and arm and a leg to have assistants prepare.  I thought the single-payer system would be best, not because I'm a bleeding heart liberal (I'm not really), but because, like someone said, the administrative costs are killing the system now as it stands.  Medicare is the case in point, Coco...a single point of paperwork, as opposed to hundreds.  Either that, or figure out a way to have a clearing house for paperwork to relieve the physicians of the huge paper trail they are beholden to.

[Conan71]

Do you know anyone that works in the medical profession?  I have several relatives that do; doctors especially complain about multiple paperwork filings that cost them and arm and a leg to have assistants prepare.  I thought the single-payer system would be best, not because I'm a bleeding heart liberal (I'm not really), but because, like someone said, the administrative costs are killing the system now as it stands.  Medicare is the case in point, Coco...a single point of paperwork, as opposed to hundreds.  Either that, or figure out a way to have a clearing house for paperwork to relieve the physicians of the huge paper trail they are beholden to.

No, I don't know anyone who works in healthcare Hoss.    In the mood for a who has the biggest schlong game tonight?

My doctor friends and I don't usually discuss billing when we are on the back nine at SHCC, so I don't consider myself an expert on medical billing.  Truth be known, most doctors aren't and wouldn't have the time to be experts on medical billing even if it were a single-payer system.  At this point, single payer doesn't seem like it's going to happen unless there's some sort of "nuclear" option which kicks in a few years after "reform" starts if certain conditions are or aren't met.  There's far too much ink from insurance money staining the hands of most DC politicians for a true single payer system to happen and for an entire industry to be shut down over night, speaking figuratively.  So what would happen to those hundreds of thousands of jobs that would be lost if health insurers are basically written out of existence?

Moving to single payer still doesn't solve the problem for providers of needing billing clerks to bill the government and justify charges which are sent back, just like the insurance companies do and just like Medicare/Medicaid does now.  As far as multiple billings, I can only assume you are referring to filing insurance with different companies and/or government agencies.  When I go to the Dr. I pay my deductible, they bill my single insurance company.  If a Dr. (or I should say his business manager) does not like a particular insurance plan, they don't take it, pretty simple.  Billing is all computerized, so I really don't get what the complication is once a doctor's office is set up on an insurer's system.  Doctors do not have to hire an additional person for every single insurance plan they take.  I'm willing to bet there are at most 5 to 10 different plans which cover about 90% of Tulsa's insured.

My skepticism of a single-payer system being more cost-effective and streamlined than the current system arises from the whole point that insurance companies are for-profit.  That assures there has to be efficiency in the system in order for it to be profitable.  Insurance companies answer to share-holders and policy-owners.  They can't afford to have useless bureaucrats sitting around with nothing to do or duplicating responsibilities across three people that could be done by one.

The Federal government answers to no one because it can and does operate at a deficit and apparently can keep borrowing unlimited amounts of money to stay afloat.  They have zero incentive to trim down and take administrative costs out of healthcare.

Having a single-payer system does nothing to cut out positions in the business offices at hospitals or doctors offices.  There's no reason why it would unless we went to an all cash basis and there were no health care benefits to anyone.

FWIW, I was married to someone who worked as an intake coordinator for a large hospice for four years so I had a front row seat to her venting on Medicare, Medicaid, pay cap issues, charge-backs by Medicare, abuses of the system, less than altruistic motives by healthcare providers (attitudes which will not change under any sort of reform), and all the fleas and other parasites which presently feed off the Federal system now.  Therein lies a lot of my skepticism of a single payer system.  Hospice is an interesting breed unto itself and I don't claim to be an expert on it by any means but I did gain some great second-hand knowledge from someone who was on the front line of government-funded healthcare every day.

Finally, one last anecdote and I'll hand the floor over to someone else:  My mother has knee and hip issues and had a great knee specialist, but he quit taking Medicare and she was forced to find another specialist.  Don't think there aren't more and more doctors who could follow suit if the government starts dictating what every procedure is worth without taking into consideration what it actually costs to provide that treatment or service. 

[Conan71]

Here's an interesting read:

http://biggovernment.com/2009/12/14/is-it-always-better-to-have-health-insurance/

[Hoss]

No, I don't know anyone who works in healthcare Hoss.    In the mood for a who has the biggest schlong game tonight?

My doctor friends and I don't usually discuss billing when we are on the back nine at SHCC, so I don't consider myself an expert on medical billing.  Truth be known, most doctors aren't and wouldn't have the time to be experts on medical billing even if it were a single-payer system.  At this point, single payer doesn't seem like it's going to happen unless there's some sort of "nuclear" option which kicks in a few years after "reform" starts if certain conditions are or aren't met.  There's far too much ink from insurance money staining the hands of most DC politicians for a true single payer system to happen and for an entire industry to be shut down over night, speaking figuratively.  So what would happen to those hundreds of thousands of jobs that would be lost if health insurers are basically written out of existence?

Moving to single payer still doesn't solve the problem for providers of needing billing clerks to bill the government and justify charges which are sent back, just like the insurance companies do and just like Medicare/Medicaid does now.  As far as multiple billings, I can only assume you are referring to filing insurance with different companies and/or government agencies.  When I go to the Dr. I pay my deductible, they bill my single insurance company.  If a Dr. (or I should say his business manager) does not like a particular insurance plan, they don't take it, pretty simple.  Billing is all computerized, so I really don't get what the complication is once a doctor's office is set up on an insurer's system.  Doctors do not have to hire an additional person for every single insurance plan they take.  I'm willing to bet there are at most 5 to 10 different plans which cover about 90% of Tulsa's insured.

My skepticism of a single-payer system being more cost-effective and streamlined than the current system arises from the whole point that insurance companies are for-profit.  That assures there has to be efficiency in the system in order for it to be profitable.  Insurance companies answer to share-holders and policy-owners.  They can't afford to have useless bureaucrats sitting around with nothing to do or duplicating responsibilities across three people that could be done by one.

The Federal government answers to no one because it can and does operate at a deficit and apparently can keep borrowing unlimited amounts of money to stay afloat.  They have zero incentive to trim down and take administrative costs out of healthcare.

Having a single-payer system does nothing to cut out positions in the business offices at hospitals or doctors offices.  There's no reason why it would unless we went to an all cash basis and there were no health care benefits to anyone.

FWIW, I was married to someone who worked as an intake coordinator for a large hospice for four years so I had a front row seat to her venting on Medicare, Medicaid, pay cap issues, charge-backs by Medicare, abuses of the system, less than altruistic motives by healthcare providers (attitudes which will not change under any sort of reform), and all the fleas and other parasites which presently feed off the Federal system now.  Therein lies a lot of my skepticism of a single payer system.  Hospice is an interesting breed unto itself and I don't claim to be an expert on it by any means but I did gain some great second-hand knowledge from someone who was on the front line of government-funded healthcare every day.

Finally, one last anecdote and I'll hand the floor over to someone else:  My mother has knee and hip issues and had a great knee specialist, but he quit taking Medicare and she was forced to find another specialist.  Don't think there aren't more and more doctors who could follow suit if the government starts dictating what every procedure is worth without taking into consideration what it actually costs to provide that treatment or service. 

Not what I was getting at, huffy...sheesh.  My point is, the administrative costs force doctors to hire and pay for people they normally wouldn't have to if the paperwork wasn't such a b!tch.  I've seen my brothers wife come home with STACKS of paperwork she's had to deal with, and her employer asked her to do it outside of her regular hours and without taking on overtime pay.  This was five years ago when she actually worked in that profession.  Her mom is a nurse and knows it too.

I'm not saying this (what my sis in law got caught up in) happens on a regular basis.  What I am saying is that somehow the system MUST be changed.  How is it, as was noted earlier, that health care costs are 1/6 of the GDP of this country, yet it's barely 1/10 of most other industrialized nations?

Will nationalizing healthcare be the solution?  Probably not.  But doing something about the administrative fees AND making sure doctors don't feel like they're getting bent over on their malpractice insurance is a good start.

And the reason why most doctors aren't experts at medical billing is because if they were the ones left to do the billing that they get from the insurance companies, they'd have no time left to be doing what they spend 12 years of their lives training for -- doctoring.

[Conan71]

A simple Google search will tell you quite a bit that government-provided health insurance is a huge PITA for providers:

"Under Medicare regulations, physicians must comply with numerous federal rules and local contractor policies to complete claim forms, provide advance beneficiary notices, certify medical necessity, file enrollment forms and comply with code documentation guidelines. Yet, there is no single source that physicians can access to learn Medicare's rules and policies.

A preliminary finding that a physician did not follow Medicare's complex rules can result in an extraordinarily time-consuming series of subsequent events. Medicare may deny the claim and/or demand more paperwork documentation. It may institute an audit of the physician's Medicare claims, causing a virtual shutdown of a physician's practice. It may deny payments for similar claims based on a statistical sampling of claims submitted, without even looking at the actual records for those other claims. If the physician appeals a denial, this launches yet another complex process with its own set of time-consuming rules and paperwork requirements."

http://www.acponline.org/pressroom/merfa.htm

If you think government healthcare reduces paperwork, have a read of this, it's long, but what an eye-opener:

http://www.aha.org/aha/content/2001/pdf/FinalPaperworkReport.pdf

If you read nothing else in the .pdf, read pages three and four.

"A Medicare patient arriving at the emergency department is required to review and sign eight different forms- just for Medicare alone"

They estimate that one hour of emergency patient care equates to one hour of paperwork,

One hour of surgery and in-patient care equates to 36 minutes of paperwork

Skilled nursing care requires 30 minutes and home health care 48 minutes for every hour of patient care.  T

his much I do know to be true as it's not simply billing work which is required, there is documentation of care required to obtain reimbursement.  When my ex left the admin desk and went back out into the field, she spent roughly 1/2 her day seeing patients and 1/2 completing patient care paperwork.  Part of that paperwork was for continuity of care between the different nurses, aides, and doctors, but a good part was required by Medicare for payment. 

Big, deft systems are fraud magnets, therefore, they require tons of documentation paperwork to justify procedures.  Making government healthcare even bigger means it becomes even more deft and even more of a fraud target if all claims for healthcare clear through a government bureau.  Can anyone see a scenario as to how a bigger bureaucracy will manage to trim paperwork? 

It's not as simple as sending a bill to the government as a single payer, it's about making sure the procedure is covered, documenting what was done to the patient and generating and retaining volumes of records to justify payment and then long term retainage for future audits and inquiries should they come up.  Making medical records electronic does nothing to save time on patient documentation, it simply makes record retrieval much easier.  The nurses and doctors I know who are presently using electronic systems say input time is still about the same, worse if they are not computer savvy.  Again, purely anecdotal and I may know the only people who aren't finding it quicker and more efficient.

Call me dense but I simply cannot comprehend how a single-payer system run by the Federal Government will result in less paperwork.  Someone explain to me their theory on how that will work after you read the AHA article I posted, because I'm sure not seeing it.  My understanding this study was authored by Price Waterhouse in 2001 so the context is not in rebuttal to the current healthcare reform initiatives.

Poke around the www.aha.org website, it's got some interesting reading material.

Here's an interesting tidbit:

"New data released at today's Medicare Payment Advisory Commission (MedPAC) meeting show that Medicare payments for hospital services fall woefully short of covering costs, further fueling concerns about adding more patients to Medicare through a "buy-in" under reform, the American Hospital Association (AHA) said.

Medicare covered significantly less patient care costs in 2008 than it did in 2007, according to information released at today's commission meeting. The drop in Medicare margins from negative 6 percent to an estimated negative 7.2 percent marks an historic low in how Medicare covers the cost of care for America's seniors, continuing a trend of declining Medicare payment adequacy over the past seven years."

That also helps explain why private insurance costs keep rising.  The government keeps squeezing the hospitals and therefore they must raise their rates on everyone else to stay afloat.