Having insurance 'going to be like Christmas' It actually gets even better!

#26
#26
lawgator1 said:
These situations are inherently complex and dependent on the individual facts. But, it remains the case that hospitals have become the primary care providers for millions of people who end upo in the ER because they have no place to go without insurance or money.

That, in turn, causes an enormous waste of money.

The bill may not be perfect. But something had to be done to get rid of this permanent class of people who treat Bethesda Memorial as though it were Dr. Whosits from down the street.
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agreed. therefore what you do is those than cannot qualify for medicaid only get care when they sign a contract saying they will have to pay back every dollar spent on them. make it like taxes. i.e if they don't pay their wages get garnished. me thinks you will all of a sudden see a nice drop in people using the ER for the common cold and a nice increase in people buying off the shelf catastrophe insuranc.
 
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#28
#28
the dear leader and his lackeys are begging for an uprising if their teat suckers keep talking.

I also can see a possibility of suspeneded elections and extension of term limits as we have seen in Tammany City.

Before we all laugh, let it soak in a bit.
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#29
#29
lawgator1 said:
These situations are inherently complex and dependent on the individual facts. But, it remains the case that hospitals have become the primary care providers for millions of people who end upo in the ER because they have no place to go without insurance or money.

That, in turn, causes an enormous waste of money.

The bill may not be perfect. But something had to be done to get rid of this permanent class of people who treat Bethesda Memorial as though it were Dr. Whosits from down the street.
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A simple GTFO from Bethesda Memorial would work.
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#31
#31
utvolpj said:
it's not complex, give up your cell phone, cable tv, car (since you haven't had a job in 3 years), smoking, drinking, etc and pay for insurance.

See we can all make assumptions



sure things had to be done but this overall bill is a turd. Trying to pass it off as anything other than that makes you a blatant fraud
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GASOUTHERNVOL (or whatever his handle) didn't. He got lucky for that year at Rite Aid and had no problems. But if he was unfortunate and did, I doubt he'd have sat at home waiting to die, thinking to himself "Darn it, should have bought that insurance."

He'd have gone to the hospital and the cost of his care would have been passed onto us, after going through about nine layers of bureacracy, all taking their cut to process his nonpayment.

If everyone has coverage, rates stabilize, the hospitals can project revenues better, and we cut out globs of processing that does nothing meaningful other than take his unreimbursed cost of care and shove it into the bill for the $46 bottle of apsirin you go.
 
#32
#32
$1100 per year of your average family premium goes to cover cost shifting for the uninsured. By 2013, that is projected to be $1300. And up and up and up.

Thankfully, the new legislation eliminates or at least dramatically reduces the need for providers to choose between providing charity care and making you and I pay ofr it that way, or not providing the charity care to begin with.

As has been discussed in other threads, I am completely fine with people advocating ceasing charity care. Just be honest that you are advocating that.
 
#33
#33
lawgator1 said:
GASOUTHERNVOL (or whatever his handle) didn't. He got lucky for that year at Rite Aid and had no problems. But if he was unfortunate and did, I doubt he'd have sat at home waiting to die, thinking to himself "Darn it, should have bought that insurance."

He'd have gone to the hospital and the cost of his care would have been passed onto us, after going through about nine layers of bureacracy, all taking their cut to process his nonpayment.

If everyone has coverage, rates stabilize, the hospitals can project revenues better, and we cut out globs of processing that does nothing meaningful other than take his unreimbursed cost of care and shove it into the bill for the $46 bottle of apsirin you go.
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But insurance adds ZERO quality to health care, only added costs. Health insurance is not required to obtain health care. Instead, the government could give health care vouchers, just like food stamps, to which people could use as they desired. If they didn't use them in one year, they could save them for later. Because of this, they would not have less incentive to over consume because they are paying at the point of sale through the vouchers. Whereas, with insurance, the patient is not even typically part of the payment process (other than a trivial co-pay that does not normally change depeding on the extent of services received).
 
#34
#34
lawgator1 said:
$1100 per year of your average family premium goes to cover cost shifting for the uninsured. By 2013, that is projected to be $1300. And up and up and up.

Thankfully, the new legislation eliminates or at least dramatically reduces the need for providers to choose between providing charity care and making you and I pay ofr it that way, or not providing the charity care to begin with.

As has been discussed in other threads, I am completely fine with people advocating ceasing charity care. Just be honest that you are advocating that.
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We are still paying for it. Whereas before we paid for it in higher premiums, now we are paying for what would be shifted through taxes. It isn't like that money comes out of thin air.
 
#35
#35
paul1454 said:
We are still paying for it. Whereas before we paid for it in higher premiums, now we are paying for what would be shifted through taxes. It isn't like that money comes out of thin air.
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Ideally, the same dollars spent on actual medical care would be gathered up and passed through to the medical providers, with minimal cost of transaction included.

But the GOP and the insurance lobby, in their shortsightedness, killed that possibility.

And so we were left with two options:

1) Continue the status quo, with a few minor tweaks, but which perpetuates a combination of government and private payors and the providers dancing on the heads of pins trying to juggle the reimbursement they can get from each. And also passing onto to us downstream increased costs associated with indigent care;

or

2) Ensure that all people have coverage, thereby dramatically reducing the waste inherent in a system that dissuades sick people from getting care until it is really expensive. And which at least begins the process of migrating some of the most at risk population to Medicare and Medicaid.

The system is headed into one of two inevitable outcomes. Either it completely collapses, or the costs have to be driven down by emphasizing front end care and minimal burden of cost shifting.
 
#36
#36
No matter what kind of coverage people have, those that want to abuse it, will. Those who feel entitled to treatment for their runny nose right now will go to the ER every time no matter what. That simply will not change. Ever.
 
#37
#37
"reducing the waste inherent in a system "

the gov't taking over is going to reduce the waste? what world do you live in?
 
#38
#38
lawgator1 said:
Ideally, the same dollars spent on actual medical care would be gathered up and passed through to the medical providers, with minimal cost of transaction included.

But the GOP and the insurance lobby, in their shortsightedness, killed that possibility.
All I can say is wow! You really are sipping the kool aide here aren't you?
And so we were left with two options:

1) Continue the status quo, with a few minor tweaks, but which perpetuates a combination of government and private payors and the providers dancing on the heads of pins trying to juggle the reimbursement they can get from each. And also passing onto to us downstream increased costs associated with indigent care;

or

2) Ensure that all people have coverage, thereby dramatically reducing the waste inherent in a system that dissuades sick people from getting care until it is really expensive. And which at least begins the process of migrating some of the most at risk population to Medicare and Medicaid.

The system is headed into one of two inevitable outcomes. Either it completely collapses, or the costs have to be driven down by emphasizing front end care and minimal burden of cost shifting.
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You are making the huge assumption that this bill does much if anything to drive costs down. In reality all it will do is give many more people the free pass to abuse the system as they see fit with no repercussions IMO.
 
#39
#39
KB5252 said:
You are making the huge assumption that this bill does much if anything to drive costs down. In reality all it will do is give many more people the free pass to abuse the system as they see fit with no repercussions IMO.
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exactly. in what world do we live that giving people more of something means they will consume less? I'd be willing to bet that the 3 hour emergency room wait for small procedures in and of itself stops a certain % of pointless visits.
 
#40
#40
KB5252 said:
You are making the huge assumption that this bill does much if anything to drive costs down. In reality all it will do is give many more people the free pass to abuse the system as they see fit with no repercussions IMO.
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I am with you in the sense that I wish it did a lot more to control costs. But it was a squeaker to get it through, as is. If they'd done things to really cut costs, they'd have had to fend off even more interests and could not have gotten it done.
 
#41
#41
droski said:
exactly. in what world do we live that giving people more of something means they will consume less? I'd be willing to bet that the 3 hour emergency room wait for small procedures in and of itself stops a certain % of pointless visits.
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Ha ha! No, but think about it. If a previously uninsured person can go to the doctor when he has a little bronchial thing going and get some antibiotics (at a total cost of $200) then they are certainly more likely to do that than wait for it to be pneumonia, go for that three hour wait, and stay a few nights for $5,000, which you and I end up paying for anyway.
 
#42
#42
lawgator1 said:
I am with you in the sense that I wish it did a lot more to control costs. But it was a squeaker to get it through, as is. If they'd done things to really cut costs, they'd have had to fend off even more interests and could not have gotten it done.
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What did they do to cut costs as is?
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#43
#43
lawgator1 said:
Ha ha! No, but think about it. If a previously uninsured person can go to the doctor when he has a little bronchial thing going and get some antibiotics (at a total cost of $200) then they are certainly more likely to do that than wait for it to be pneumonia, go for that three hour wait, and stay a few nights for $5,000, which you and I end up paying for anyway.
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why are they staying a few nights? these people aren't waiting till they are dead to go to the emergency room.
 
#44
#44
lawgator1 said:
I am with you in the sense that I wish it did a lot more to control costs. But it was a squeaker to get it through, as is. If they'd done things to really cut costs, they'd have had to fend off even more interests and could not have gotten it done.
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What interests would they have to fend off here? I know for a fact that the lobbying group that represents people in your profession cut a deal to make them immune from the start.

The insurance lobby turned to republicans for help because they shared a common interest in this particular matter. Insurance companies wanted to keep from being undercut and republicans wanted to keep this monstrosity of bill from becoming law. Democrats made a deal to protect their interest and keep money flowing, in fact since Obama has been in the white house he has done nothing but cut sweetheart deals to special interest. The republicans cut a deal to protect their interests.

If you try to argue this from a special interest point of view the democrat side is guilty as sin.
 
#45
#45
lawgator1 said:
Ideally, the same dollars spent on actual medical care would be gathered up and passed through to the medical providers, with minimal cost of transaction included.

But the GOP and the insurance lobby, in their shortsightedness, killed that possibility.

Umm, the insurance lobby contributed to the bill.

And so we were left with two options:

1) Continue the status quo, with a few minor tweaks, but which perpetuates a combination of government and private payors and the providers dancing on the heads of pins trying to juggle the reimbursement they can get from each. And also passing onto to us downstream increased costs associated with indigent care;

The bill that just passed perpetuates a combination of govt and private payors...with the same reimbursement problems only exacerbated by trying to squeeze money out of providers through reduced reimbursements. All this at the same time of ramping up demand.

or

2) Ensure that all people have coverage, thereby dramatically reducing the waste inherent in a system that dissuades sick people from getting care until it is really expensive. And which at least begins the process of migrating some of the most at risk population to Medicare and Medicaid.

The bill does not accomplish this.

The system is headed into one of two inevitable outcomes. Either it completely collapses, or the costs have to be driven down by emphasizing front end care and minimal burden of cost shifting.
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Costs will not be driven down by this - you are conflating insurance costs with healthcare costs. My bet is that increased utilization will dwarf any reduction in HC costs from prevention and reduction in ER visits.

The bill may equalize insurance costs by shifting premiums among buyers but it does very little to address HC costs; the real problem.

Alternatively, reducing HC costs could reduce insurance costs and thus grow access. Nah, let's do it this way.
 
#46
#46
lawgator1 said:
What a blatant fraud you are.

You managed to cut off the key part of that sentence. He got $100,000 of free care by going to the hospital as his primary caregiver!!

Do you not comprehend that this is the problem? That over three years maybe the system could have arranged for regular checkups or even significant doctor's office care for the guy at a MUCH lower cost?


An enormous part of the problem here has been that the uninsured stay home when they get sick. They continue to stay home as they get sicker. Then, when they are REALLY sick, they end up in the ER, which has to treat them, by law. The cost could have been a fraction of what it was had we had the foresight to provide a chance for care before it became a hundred thousand dollar problem.
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Or he didn't go to the ER every time his tummy hurt or he got a hang nail.
 
#47
#47
kiddiedoc said:
In my estimation, probably 90% of ER visits by my patients are really not "emergencies." That's some costly care right there.
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considering the entire patient population, i'd put the number at greater than 90%.

it is entirely at the discretion of patients (who have a wide variety of motivations) to decide to make their entry into the health care system the most expensive portal available in the world -- the USA ER. and once they, and they alone, make that decision, the cascade starts ...

the ER doc wants to "rule out, rule out" on the off chance that this is the 1 in 1000 that actually has a serious problem ...

thousands of dollars of radiology and lab tests have to be done, just in case ...

and when all is normal (whew!) a pat on the back, out the door, only to return 2 weeks later with another "problem" and the cycle starts again.
 
#48
#48
lawgator1 said:
What a blatant fraud you are.

You managed to cut off the key part of that sentence. He got $100,000 of free care by going to the hospital as his primary caregiver!!

Do you not comprehend that this is the problem? That over three years maybe the system could have arranged for regular checkups or even significant doctor's office care for the guy at a MUCH lower cost?


An enormous part of the problem here has been that the uninsured stay home when they get sick. They continue to stay home as they get sicker. Then, when they are REALLY sick, they end up in the ER, which has to treat them, by law. The cost could have been a fraction of what it was had we had the foresight to provide a chance for care before it became a hundred thousand dollar problem.
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Actually, I think he has hit the nail on the head. Uninsured and Medicaid patients hit the ER on a regular basis for non-emergent "problems." You wouldn't believe the number of people that show up with cold symptoms, earaches, non-emergent injuries, etc. The cost of a single ER visit and the multiple unnecessary tests that are often run due to time constraints, fear of missing something, lack of patient history, and (in my profession) lack of Pediatric expertise is immense. Most of my patients could have waited to see me the next morning for a fraction of what it costs to visit the hospital. The majority of the expenses are eaten by the hospital or never collected, or they are paid by the government insurance programs.
 
#49
#49
lawgator1 said:
Ha ha! No, but think about it. If a previously uninsured person can go to the doctor when he has a little bronchial thing going and get some antibiotics (at a total cost of $200) then they are certainly more likely to do that than wait for it to be pneumonia, go for that three hour wait, and stay a few nights for $5,000, which you and I end up paying for anyway.
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No offense, but medical knowledge is not your area of expertise. First of all, most "bronchial things" do not require antibiotics. $200 for antibiotics is also quite high and would not help the vast majority of upper and lower respiratory infections that are caused by viruses. Secondly, most pneumonia is not preventable and empiric treatment is both costly and unwarranted. In addition, most pneumonia can be treated on an outpatient basis by a primary care provider and would not need hospitalization.

The idea that people without insurance don't get care until it's "too late" is simply absurd.

As a side note, I entirely agree that preventative care should be emphasized, as wellness education, immunization, and regular checkups HAVE been shown to decrease your chances for serious illnesses (as opposed to megavitamins, fad diets, and all the other garbage people seem very willing to spend their money on).
 
#50
#50
kiddiedoc said:
Actually, I think he has hit the nail on the head. Uninsured and Medicaid patients hit the ER on a regular basis for non-emergent "problems." You wouldn't believe the number of people that show up with cold symptoms, earaches, non-emergent injuries, etc. The cost of a single ER visit and the multiple unnecessary tests that are often run due to time constraints, fear of missing something, lack of patient history, and (in my profession) lack of Pediatric expertise is immense. Most of my patients could have waited to see me the next morning for a fraction of what it costs to visit the hospital. The majority of the expenses are eaten by the hospital or never collected, or they are paid by the government insurance programs.
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LG may have put you on 'ignore', he tends to do that if you try to talk sense to him.
 
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