More of the same from Biden

[dblack]

Thus we are left with a combination of the above for both practical and political reasons. IMHO, all delivery of healthcare should be done by private enterprise. The payment system should be a single payer system with yearly deductibles and co-insurance.

So doctors should just rack up whatever bills they think are warranted and government (taxpayers) should pay up? It's good to be a doctor!

 

[rightwinger]

Biden Plan: Expand Medicaid to more low wage workers and offer a public option

Trump Plan: He will let us know once he is re-elected, but trust him, it will be really, really good

 

[Flopper]

I disagree. I thing medical professionals who understand your medical condition are best equipped to assess your healthcare needs vs other patients. Certainly better than the free market or the government.

How so? Do they have data on the current health care needs of every American? Do they have awareness of the current budget situation?

Again, the problem isn't diagnosis - doctors are pretty good at that. The problem is addressing the fact that, despite the demagoguery, health care isn't "free". It's expensive and none of us can have all we want. So, somehow, we need to figure out how to divvy it up, how to decide who gets what and how much. Traditionally we've done that voluntarily and collaboratively via the market. How does it happen in your ideal scenario?

Using either government or the free market ignores the most important issues, does the person need healthcare, what kind of healthcare, and the priority. Those are critical questions that have to be answered by medical personnel, not the free market nor government.

What I'm suggesting is that the first contact between a patient or would be patient is not an office appointment with the doctor but rather an online appointments with a physician or a physician assistant. The purpose is to arrive at a preliminary diagnosis if possible or schedule tests, or an office visit, or a referral, or for common problems medical advice and or a prescription. In places where this is done, costs are about half of what they are in a clinic setting. Patients love not having to leave home or work for a doctor's appointment and for bedridden patients it's a godsend often eliminating a 911 call and a trip to the ER.

All that's fine, I guess. But you're ignoring the actual problem. We don't have a problem diagnosing and prioritizing health care needs. We have a problem with paying for them.

You mention availability of medical records. Today most large medical clinics have all current patient medical records on line so they can be shared with other medical personnel in the medical center. For new patients electronic transfers of medical records between medical facilities typically only takes a few hours. So before the doctor makes first contact with the patient, he or she has the medical records available for review.

I didn't mention the availability of medical records. I was referring to the fact that doctors aren't accountants. They aren't actuaries. That have no training or expertise in managing an insurance company.

It just seems like you want to pretend the financial side of this problem will just go away if we make it "free". But of course it's not free - we're just paying for it differently.

The financial side of the problem is inseparable from healthcare delivery. For example.

25% of all medical costs is administrative costs and most of the administrative cost is billing. In one large hospitals with 900 beds, there are 1300 billing clerks. Many hospitals have more people doing billing than doctors and nurses caring for patients. The reason for this is the complexity of rules used by multiple payers. In addition to Medicare, Medicaid, VA, Social Security, you have over 300 health insurance companies with dozens of policies all having different rates, different converges, different contractual discounts on over 10,000 billing codes. Add into the mix causality insurance companies that pay only for certain procedures associated with an accident and supplemental insurance plans that pay percentages or balances after primary insurance payment and you have a huge, costly, complex payment system. One of the reason for moving to a single payer system will be to save big bucks in medical billing.

When congress passed legislation that forbid Medicare, Medicaid, and the VA form bidding drugs, it added added 25 billion dollars a year to Americans healthcare bill.

Widely perceived as fierce guardians of health-care dollars, insurers, in most cases today, are not. Their reputation for saving healthcare dollars started in 70's with manage care and formation of networks. However by 2000, most insurance companies had ceased any real management of care do to patient deaths and lawsuits and state regulation which followed.

Insurance contracts with providers are closely guarded secrets because the rates they are paying is often higher than the Medicare reimbursement rates. Today insurance companies are middle men, who add cost to the system and just pass it on to subscribers.

To reduce cost and maintain same level of coverage, we need to eliminate the insurance companies as primary insurers and go to a single payer system. Government should bid drugs, not pay whatever big Pharma want's to charge. As a step toward single payer, a public option could be offered to people over 50 allowing them to join Medicare. This would dramatically reduce premiums for most Americans.

 

[dblack]

I disagree. I thing medical professionals who understand your medical condition are best equipped to assess your healthcare needs vs other patients. Certainly better than the free market or the government.

How so? Do they have data on the current health care needs of every American? Do they have awareness of the current budget situation?

Again, the problem isn't diagnosis - doctors are pretty good at that. The problem is addressing the fact that, despite the demagoguery, health care isn't "free". It's expensive and none of us can have all we want. So, somehow, we need to figure out how to divvy it up, how to decide who gets what and how much. Traditionally we've done that voluntarily and collaboratively via the market. How does it happen in your ideal scenario?

Using either government or the free market ignores the most important issues, does the person need healthcare, what kind of healthcare, and the priority. Those are critical questions that have to be answered by medical personnel, not the free market nor government.

What I'm suggesting is that the first contact between a patient or would be patient is not an office appointment with the doctor but rather an online appointments with a physician or a physician assistant. The purpose is to arrive at a preliminary diagnosis if possible or schedule tests, or an office visit, or a referral, or for common problems medical advice and or a prescription. In places where this is done, costs are about half of what they are in a clinic setting. Patients love not having to leave home or work for a doctor's appointment and for bedridden patients it's a godsend often eliminating a 911 call and a trip to the ER.

All that's fine, I guess. But you're ignoring the actual problem. We don't have a problem diagnosing and prioritizing health care needs. We have a problem with paying for them.

You mention availability of medical records. Today most large medical clinics have all current patient medical records on line so they can be shared with other medical personnel in the medical center. For new patients electronic transfers of medical records between medical facilities typically only takes a few hours. So before the doctor makes first contact with the patient, he or she has the medical records available for review.

I didn't mention the availability of medical records. I was referring to the fact that doctors aren't accountants. They aren't actuaries. That have no training or expertise in managing an insurance company.

It just seems like you want to pretend the financial side of this problem will just go away if we make it "free". But of course it's not free - we're just paying for it differently.

The financial side of the problem is inseparable from healthcare delivery. For example.

25% of all medical costs is administrative costs and most of the administrative cost is billing. In one large hospitals with 900 beds, there are 1300 billing clerks. Most hospitals have more people doing billing than serving patients. The reason for this is the complexity of rules used by multiple payers. In addition to Medicare, Medicaid, VA, Social Security, you have over 300 health insurance companies with dozens of policies all having different rates, different converges, different contractual discounts on over 10,000 billing codes. Add into the mix causality insurance companies that pay only certain procedures associated with an accident and supplemental insurance plans that pay percentages or balances after primary insurance payment and you have huge, costly, complex payment system. One of the reason for moving to a single payer system will be to save big bucks in medical billing.

When congress pasted legislation that forbid Medicare, Medicaid, and the VA form bidding drugs, it added added 25 billion dollars a year to Americans healthcare bill.

Widely perceived as fierce guardians of health-care dollars, insurers, in most cases today, are not. Their reputation for saving healthcare dollars started in 70's with manage care and formation of networks. However by 2000, most insurance companies had ceased any real management of care do to patient deaths and lawsuits and state regulation which followed.

Insurance contracts with providers are closely guarded secrets because the rates they are paying is often higher than the Medicare reimbursement rates. Today insurance companies are middle men, who add cost to the system and just pass it on to subscribers.

Ok, so you DO want to have government making the call. A while ago you said you didn't, and I was wondering what you meant.

I can't get behind that at all. Turning economic struggles into political struggles doesn't seem like a win to me.

 

[Flopper]

I disagree. I thing medical professionals who understand your medical condition are best equipped to assess your healthcare needs vs other patients. Certainly better than the free market or the government.

What do you mean by government making the call?
How so? Do they have data on the current health care needs of every American? Do they have awareness of the current budget situation?

Again, the problem isn't diagnosis - doctors are pretty good at that. The problem is addressing the fact that, despite the demagoguery, health care isn't "free". It's expensive and none of us can have all we want. So, somehow, we need to figure out how to divvy it up, how to decide who gets what and how much. Traditionally we've done that voluntarily and collaboratively via the market. How does it happen in your ideal scenario?

Using either government or the free market ignores the most important issues, does the person need healthcare, what kind of healthcare, and the priority. Those are critical questions that have to be answered by medical personnel, not the free market nor government.

What I'm suggesting is that the first contact between a patient or would be patient is not an office appointment with the doctor but rather an online appointments with a physician or a physician assistant. The purpose is to arrive at a preliminary diagnosis if possible or schedule tests, or an office visit, or a referral, or for common problems medical advice and or a prescription. In places where this is done, costs are about half of what they are in a clinic setting. Patients love not having to leave home or work for a doctor's appointment and for bedridden patients it's a godsend often eliminating a 911 call and a trip to the ER.

All that's fine, I guess. But you're ignoring the actual problem. We don't have a problem diagnosing and prioritizing health care needs. We have a problem with paying for them.

You mention availability of medical records. Today most large medical clinics have all current patient medical records on line so they can be shared with other medical personnel in the medical center. For new patients electronic transfers of medical records between medical facilities typically only takes a few hours. So before the doctor makes first contact with the patient, he or she has the medical records available for review.

I didn't mention the availability of medical records. I was referring to the fact that doctors aren't accountants. They aren't actuaries. That have no training or expertise in managing an insurance company.

It just seems like you want to pretend the financial side of this problem will just go away if we make it "free". But of course it's not free - we're just paying for it differently.

The financial side of the problem is inseparable from healthcare delivery. For example.

25% of all medical costs is administrative costs and most of the administrative cost is billing. In one large hospitals with 900 beds, there are 1300 billing clerks. Most hospitals have more people doing billing than serving patients. The reason for this is the complexity of rules used by multiple payers. In addition to Medicare, Medicaid, VA, Social Security, you have over 300 health insurance companies with dozens of policies all having different rates, different converges, different contractual discounts on over 10,000 billing codes. Add into the mix causality insurance companies that pay only certain procedures associated with an accident and supplemental insurance plans that pay percentages or balances after primary insurance payment and you have huge, costly, complex payment system. One of the reason for moving to a single payer system will be to save big bucks in medical billing.

When congress pasted legislation that forbid Medicare, Medicaid, and the VA form bidding drugs, it added added 25 billion dollars a year to Americans healthcare bill.

Widely perceived as fierce guardians of health-care dollars, insurers, in most cases today, are not. Their reputation for saving healthcare dollars started in 70's with manage care and formation of networks. However by 2000, most insurance companies had ceased any real management of care do to patient deaths and lawsuits and state regulation which followed.

Insurance contracts with providers are closely guarded secrets because the rates they are paying is often higher than the Medicare reimbursement rates. Today insurance companies are middle men, who add cost to the system and just pass it on to subscribers.

Ok, so you DO want to have government making the call. A while ago you said you didn't, and I was wondering what you meant.

I can't get behind that at all. Turning economic struggles into political struggles doesn't seem like a win to me.

 

[Flopper]

I disagree. I thing medical professionals who understand your medical condition are best equipped to assess your healthcare needs vs other patients. Certainly better than the free market or the government.

How so? Do they have data on the current health care needs of every American? Do they have awareness of the current budget situation?

Again, the problem isn't diagnosis - doctors are pretty good at that. The problem is addressing the fact that, despite the demagoguery, health care isn't "free". It's expensive and none of us can have all we want. So, somehow, we need to figure out how to divvy it up, how to decide who gets what and how much. Traditionally we've done that voluntarily and collaboratively via the market. How does it happen in your ideal scenario?

Using either government or the free market ignores the most important issues, does the person need healthcare, what kind of healthcare, and the priority. Those are critical questions that have to be answered by medical personnel, not the free market nor government.

What I'm suggesting is that the first contact between a patient or would be patient is not an office appointment with the doctor but rather an online appointments with a physician or a physician assistant. The purpose is to arrive at a preliminary diagnosis if possible or schedule tests, or an office visit, or a referral, or for common problems medical advice and or a prescription. In places where this is done, costs are about half of what they are in a clinic setting. Patients love not having to leave home or work for a doctor's appointment and for bedridden patients it's a godsend often eliminating a 911 call and a trip to the ER.

All that's fine, I guess. But you're ignoring the actual problem. We don't have a problem diagnosing and prioritizing health care needs. We have a problem with paying for them.

You mention availability of medical records. Today most large medical clinics have all current patient medical records on line so they can be shared with other medical personnel in the medical center. For new patients electronic transfers of medical records between medical facilities typically only takes a few hours. So before the doctor makes first contact with the patient, he or she has the medical records available for review.

I didn't mention the availability of medical records. I was referring to the fact that doctors aren't accountants. They aren't actuaries. That have no training or expertise in managing an insurance company.

It just seems like you want to pretend the financial side of this problem will just go away if we make it "free". But of course it's not free - we're just paying for it differently.

The financial side of the problem is inseparable from healthcare delivery. For example.

25% of all medical costs is administrative costs and most of the administrative cost is billing. In one large hospitals with 900 beds, there are 1300 billing clerks. Most hospitals have more people doing billing than serving patients. The reason for this is the complexity of rules used by multiple payers. In addition to Medicare, Medicaid, VA, Social Security, you have over 300 health insurance companies with dozens of policies all having different rates, different converges, different contractual discounts on over 10,000 billing codes. Add into the mix causality insurance companies that pay only certain procedures associated with an accident and supplemental insurance plans that pay percentages or balances after primary insurance payment and you have huge, costly, complex payment system. One of the reason for moving to a single payer system will be to save big bucks in medical billing.

When congress pasted legislation that forbid Medicare, Medicaid, and the VA form bidding drugs, it added added 25 billion dollars a year to Americans healthcare bill.

Widely perceived as fierce guardians of health-care dollars, insurers, in most cases today, are not. Their reputation for saving healthcare dollars started in 70's with manage care and formation of networks. However by 2000, most insurance companies had ceased any real management of care do to patient deaths and lawsuits and state regulation which followed.

Insurance contracts with providers are closely guarded secrets because the rates they are paying is often higher than the Medicare reimbursement rates. Today insurance companies are middle men, who add cost to the system and just pass it on to subscribers.

Ok, so you DO want to have government making the call. A while ago you said you didn't, and I was wondering what you meant.

I can't get behind that at all. Turning economic struggles into political struggles doesn't seem like a win to me.

what do you mean by government making the call?

 

[rightwinger]

I disagree. I thing medical professionals who understand your medical condition are best equipped to assess your healthcare needs vs other patients. Certainly better than the free market or the government.

How so? Do they have data on the current health care needs of every American? Do they have awareness of the current budget situation?

Again, the problem isn't diagnosis - doctors are pretty good at that. The problem is addressing the fact that, despite the demagoguery, health care isn't "free". It's expensive and none of us can have all we want. So, somehow, we need to figure out how to divvy it up, how to decide who gets what and how much. Traditionally we've done that voluntarily and collaboratively via the market. How does it happen in your ideal scenario?

Using either government or the free market ignores the most important issues, does the person need healthcare, what kind of healthcare, and the priority. Those are critical questions that have to be answered by medical personnel, not the free market nor government.

What I'm suggesting is that the first contact between a patient or would be patient is not an office appointment with the doctor but rather an online appointments with a physician or a physician assistant. The purpose is to arrive at a preliminary diagnosis if possible or schedule tests, or an office visit, or a referral, or for common problems medical advice and or a prescription. In places where this is done, costs are about half of what they are in a clinic setting. Patients love not having to leave home or work for a doctor's appointment and for bedridden patients it's a godsend often eliminating a 911 call and a trip to the ER.

All that's fine, I guess. But you're ignoring the actual problem. We don't have a problem diagnosing and prioritizing health care needs. We have a problem with paying for them.

You mention availability of medical records. Today most large medical clinics have all current patient medical records on line so they can be shared with other medical personnel in the medical center. For new patients electronic transfers of medical records between medical facilities typically only takes a few hours. So before the doctor makes first contact with the patient, he or she has the medical records available for review.

I didn't mention the availability of medical records. I was referring to the fact that doctors aren't accountants. They aren't actuaries. That have no training or expertise in managing an insurance company.

It just seems like you want to pretend the financial side of this problem will just go away if we make it "free". But of course it's not free - we're just paying for it differently.

The financial side of the problem is inseparable from healthcare delivery. For example.

25% of all medical costs is administrative costs and most of the administrative cost is billing. In one large hospitals with 900 beds, there are 1300 billing clerks. Most hospitals have more people doing billing than serving patients. The reason for this is the complexity of rules used by multiple payers. In addition to Medicare, Medicaid, VA, Social Security, you have over 300 health insurance companies with dozens of policies all having different rates, different converges, different contractual discounts on over 10,000 billing codes. Add into the mix causality insurance companies that pay only certain procedures associated with an accident and supplemental insurance plans that pay percentages or balances after primary insurance payment and you have huge, costly, complex payment system. One of the reason for moving to a single payer system will be to save big bucks in medical billing.

When congress pasted legislation that forbid Medicare, Medicaid, and the VA form bidding drugs, it added added 25 billion dollars a year to Americans healthcare bill.

Widely perceived as fierce guardians of health-care dollars, insurers, in most cases today, are not. Their reputation for saving healthcare dollars started in 70's with manage care and formation of networks. However by 2000, most insurance companies had ceased any real management of care do to patient deaths and lawsuits and state regulation which followed.

Insurance contracts with providers are closely guarded secrets because the rates they are paying is often higher than the Medicare reimbursement rates. Today insurance companies are middle men, who add cost to the system and just pass it on to subscribers.

Ok, so you DO want to have government making the call. A while ago you said you didn't, and I was wondering what you meant.

I can't get behind that at all. Turning economic struggles into political struggles doesn't seem like a win to me.

Ok, so you DO want your employer making the call on what health insurance you can have

 

[dblack]

How so? Do they have data on the current health care needs of every American? Do they have awareness of the current budget situation?

Again, the problem isn't diagnosis - doctors are pretty good at that. The problem is addressing the fact that, despite the demagoguery, health care isn't "free". It's expensive and none of us can have all we want. So, somehow, we need to figure out how to divvy it up, how to decide who gets what and how much. Traditionally we've done that voluntarily and collaboratively via the market. How does it happen in your ideal scenario?

Using either government or the free market ignores the most important issues, does the person need healthcare, what kind of healthcare, and the priority. Those are critical questions that have to be answered by medical personnel, not the free market nor government.

What I'm suggesting is that the first contact between a patient or would be patient is not an office appointment with the doctor but rather an online appointments with a physician or a physician assistant. The purpose is to arrive at a preliminary diagnosis if possible or schedule tests, or an office visit, or a referral, or for common problems medical advice and or a prescription. In places where this is done, costs are about half of what they are in a clinic setting. Patients love not having to leave home or work for a doctor's appointment and for bedridden patients it's a godsend often eliminating a 911 call and a trip to the ER.

All that's fine, I guess. But you're ignoring the actual problem. We don't have a problem diagnosing and prioritizing health care needs. We have a problem with paying for them.

You mention availability of medical records. Today most large medical clinics have all current patient medical records on line so they can be shared with other medical personnel in the medical center. For new patients electronic transfers of medical records between medical facilities typically only takes a few hours. So before the doctor makes first contact with the patient, he or she has the medical records available for review.

I didn't mention the availability of medical records. I was referring to the fact that doctors aren't accountants. They aren't actuaries. That have no training or expertise in managing an insurance company.

It just seems like you want to pretend the financial side of this problem will just go away if we make it "free". But of course it's not free - we're just paying for it differently.

The financial side of the problem is inseparable from healthcare delivery. For example.

25% of all medical costs is administrative costs and most of the administrative cost is billing. In one large hospitals with 900 beds, there are 1300 billing clerks. Most hospitals have more people doing billing than serving patients. The reason for this is the complexity of rules used by multiple payers. In addition to Medicare, Medicaid, VA, Social Security, you have over 300 health insurance companies with dozens of policies all having different rates, different converges, different contractual discounts on over 10,000 billing codes. Add into the mix causality insurance companies that pay only certain procedures associated with an accident and supplemental insurance plans that pay percentages or balances after primary insurance payment and you have huge, costly, complex payment system. One of the reason for moving to a single payer system will be to save big bucks in medical billing.

When congress pasted legislation that forbid Medicare, Medicaid, and the VA form bidding drugs, it added added 25 billion dollars a year to Americans healthcare bill.

Widely perceived as fierce guardians of health-care dollars, insurers, in most cases today, are not. Their reputation for saving healthcare dollars started in 70's with manage care and formation of networks. However by 2000, most insurance companies had ceased any real management of care do to patient deaths and lawsuits and state regulation which followed.

Insurance contracts with providers are closely guarded secrets because the rates they are paying is often higher than the Medicare reimbursement rates. Today insurance companies are middle men, who add cost to the system and just pass it on to subscribers.

Ok, so you DO want to have government making the call. A while ago you said you didn't, and I was wondering what you meant.

I can't get behind that at all. Turning economic struggles into political struggles doesn't seem like a win to me.

Ok, so you DO want your employer making the call on what health insurance you can have

Nope. Outside your tiny, binary imagination that's not the only other option.

 

[dblack]

How so? Do they have data on the current health care needs of every American? Do they have awareness of the current budget situation?

Again, the problem isn't diagnosis - doctors are pretty good at that. The problem is addressing the fact that, despite the demagoguery, health care isn't "free". It's expensive and none of us can have all we want. So, somehow, we need to figure out how to divvy it up, how to decide who gets what and how much. Traditionally we've done that voluntarily and collaboratively via the market. How does it happen in your ideal scenario?

Using either government or the free market ignores the most important issues, does the person need healthcare, what kind of healthcare, and the priority. Those are critical questions that have to be answered by medical personnel, not the free market nor government.

What I'm suggesting is that the first contact between a patient or would be patient is not an office appointment with the doctor but rather an online appointments with a physician or a physician assistant. The purpose is to arrive at a preliminary diagnosis if possible or schedule tests, or an office visit, or a referral, or for common problems medical advice and or a prescription. In places where this is done, costs are about half of what they are in a clinic setting. Patients love not having to leave home or work for a doctor's appointment and for bedridden patients it's a godsend often eliminating a 911 call and a trip to the ER.

All that's fine, I guess. But you're ignoring the actual problem. We don't have a problem diagnosing and prioritizing health care needs. We have a problem with paying for them.

You mention availability of medical records. Today most large medical clinics have all current patient medical records on line so they can be shared with other medical personnel in the medical center. For new patients electronic transfers of medical records between medical facilities typically only takes a few hours. So before the doctor makes first contact with the patient, he or she has the medical records available for review.

I didn't mention the availability of medical records. I was referring to the fact that doctors aren't accountants. They aren't actuaries. That have no training or expertise in managing an insurance company.

It just seems like you want to pretend the financial side of this problem will just go away if we make it "free". But of course it's not free - we're just paying for it differently.

The financial side of the problem is inseparable from healthcare delivery. For example.

25% of all medical costs is administrative costs and most of the administrative cost is billing. In one large hospitals with 900 beds, there are 1300 billing clerks. Most hospitals have more people doing billing than serving patients. The reason for this is the complexity of rules used by multiple payers. In addition to Medicare, Medicaid, VA, Social Security, you have over 300 health insurance companies with dozens of policies all having different rates, different converges, different contractual discounts on over 10,000 billing codes. Add into the mix causality insurance companies that pay only certain procedures associated with an accident and supplemental insurance plans that pay percentages or balances after primary insurance payment and you have huge, costly, complex payment system. One of the reason for moving to a single payer system will be to save big bucks in medical billing.

When congress pasted legislation that forbid Medicare, Medicaid, and the VA form bidding drugs, it added added 25 billion dollars a year to Americans healthcare bill.

Widely perceived as fierce guardians of health-care dollars, insurers, in most cases today, are not. Their reputation for saving healthcare dollars started in 70's with manage care and formation of networks. However by 2000, most insurance companies had ceased any real management of care do to patient deaths and lawsuits and state regulation which followed.

Insurance contracts with providers are closely guarded secrets because the rates they are paying is often higher than the Medicare reimbursement rates. Today insurance companies are middle men, who add cost to the system and just pass it on to subscribers.

Ok, so you DO want to have government making the call. A while ago you said you didn't, and I was wondering what you meant.

I can't get behind that at all. Turning economic struggles into political struggles doesn't seem like a win to me.

what do you mean by government making the call?

Somehow, we have to figure out how to divvy up limited health care resources. You don't seem to want to do that freely through markets, so what did you have in mind? It sounds like you want government doing that, but you keep denying it. What gives?

 

[Flopper]

Using either government or the free market ignores the most important issues, does the person need healthcare, what kind of healthcare, and the priority. Those are critical questions that have to be answered by medical personnel, not the free market nor government.

What I'm suggesting is that the first contact between a patient or would be patient is not an office appointment with the doctor but rather an online appointments with a physician or a physician assistant. The purpose is to arrive at a preliminary diagnosis if possible or schedule tests, or an office visit, or a referral, or for common problems medical advice and or a prescription. In places where this is done, costs are about half of what they are in a clinic setting. Patients love not having to leave home or work for a doctor's appointment and for bedridden patients it's a godsend often eliminating a 911 call and a trip to the ER.

All that's fine, I guess. But you're ignoring the actual problem. We don't have a problem diagnosing and prioritizing health care needs. We have a problem with paying for them.

You mention availability of medical records. Today most large medical clinics have all current patient medical records on line so they can be shared with other medical personnel in the medical center. For new patients electronic transfers of medical records between medical facilities typically only takes a few hours. So before the doctor makes first contact with the patient, he or she has the medical records available for review.

I didn't mention the availability of medical records. I was referring to the fact that doctors aren't accountants. They aren't actuaries. That have no training or expertise in managing an insurance company.

It just seems like you want to pretend the financial side of this problem will just go away if we make it "free". But of course it's not free - we're just paying for it differently.

The financial side of the problem is inseparable from healthcare delivery. For example.

25% of all medical costs is administrative costs and most of the administrative cost is billing. In one large hospitals with 900 beds, there are 1300 billing clerks. Most hospitals have more people doing billing than serving patients. The reason for this is the complexity of rules used by multiple payers. In addition to Medicare, Medicaid, VA, Social Security, you have over 300 health insurance companies with dozens of policies all having different rates, different converges, different contractual discounts on over 10,000 billing codes. Add into the mix causality insurance companies that pay only certain procedures associated with an accident and supplemental insurance plans that pay percentages or balances after primary insurance payment and you have huge, costly, complex payment system. One of the reason for moving to a single payer system will be to save big bucks in medical billing.

When congress pasted legislation that forbid Medicare, Medicaid, and the VA form bidding drugs, it added added 25 billion dollars a year to Americans healthcare bill.

Widely perceived as fierce guardians of health-care dollars, insurers, in most cases today, are not. Their reputation for saving healthcare dollars started in 70's with manage care and formation of networks. However by 2000, most insurance companies had ceased any real management of care do to patient deaths and lawsuits and state regulation which followed.

Insurance contracts with providers are closely guarded secrets because the rates they are paying is often higher than the Medicare reimbursement rates. Today insurance companies are middle men, who add cost to the system and just pass it on to subscribers.

Ok, so you DO want to have government making the call. A while ago you said you didn't, and I was wondering what you meant.

I can't get behind that at all. Turning economic struggles into political struggles doesn't seem like a win to me.

what do you mean by government making the call?

Somehow, we have to figure out how to divvy up limited health care resources. You don't seem to want to do that freely through markets, so what did you have in mind? It sounds like you want government doing that, but you keep denying it. What gives?

If healthcare is available only through the free market, millions are going to die and more will be suffering from treatable diseases. 39% of American have only enough savings to cover a $1,000 emergency and 34% have nothing at all set aside for emergencies. 7% of Americans have a net worth of less than $1,000 and no employment.
Surely, you're not suggesting these pay for all their healthcare costs.

 

[Flopper]

Using either government or the free market ignores the most important issues, does the person need healthcare, what kind of healthcare, and the priority. Those are critical questions that have to be answered by medical personnel, not the free market nor government.

What I'm suggesting is that the first contact between a patient or would be patient is not an office appointment with the doctor but rather an online appointments with a physician or a physician assistant. The purpose is to arrive at a preliminary diagnosis if possible or schedule tests, or an office visit, or a referral, or for common problems medical advice and or a prescription. In places where this is done, costs are about half of what they are in a clinic setting. Patients love not having to leave home or work for a doctor's appointment and for bedridden patients it's a godsend often eliminating a 911 call and a trip to the ER.

All that's fine, I guess. But you're ignoring the actual problem. We don't have a problem diagnosing and prioritizing health care needs. We have a problem with paying for them.

You mention availability of medical records. Today most large medical clinics have all current patient medical records on line so they can be shared with other medical personnel in the medical center. For new patients electronic transfers of medical records between medical facilities typically only takes a few hours. So before the doctor makes first contact with the patient, he or she has the medical records available for review.

I didn't mention the availability of medical records. I was referring to the fact that doctors aren't accountants. They aren't actuaries. That have no training or expertise in managing an insurance company.

It just seems like you want to pretend the financial side of this problem will just go away if we make it "free". But of course it's not free - we're just paying for it differently.

The financial side of the problem is inseparable from healthcare delivery. For example.

25% of all medical costs is administrative costs and most of the administrative cost is billing. In one large hospitals with 900 beds, there are 1300 billing clerks. Most hospitals have more people doing billing than serving patients. The reason for this is the complexity of rules used by multiple payers. In addition to Medicare, Medicaid, VA, Social Security, you have over 300 health insurance companies with dozens of policies all having different rates, different converges, different contractual discounts on over 10,000 billing codes. Add into the mix causality insurance companies that pay only certain procedures associated with an accident and supplemental insurance plans that pay percentages or balances after primary insurance payment and you have huge, costly, complex payment system. One of the reason for moving to a single payer system will be to save big bucks in medical billing.

When congress pasted legislation that forbid Medicare, Medicaid, and the VA form bidding drugs, it added added 25 billion dollars a year to Americans healthcare bill.

Widely perceived as fierce guardians of health-care dollars, insurers, in most cases today, are not. Their reputation for saving healthcare dollars started in 70's with manage care and formation of networks. However by 2000, most insurance companies had ceased any real management of care do to patient deaths and lawsuits and state regulation which followed.

Insurance contracts with providers are closely guarded secrets because the rates they are paying is often higher than the Medicare reimbursement rates. Today insurance companies are middle men, who add cost to the system and just pass it on to subscribers.

Ok, so you DO want to have government making the call. A while ago you said you didn't, and I was wondering what you meant.

I can't get behind that at all. Turning economic struggles into political struggles doesn't seem like a win to me.

what do you mean by government making the call?

Somehow, we have to figure out how to divvy up limited health care resources. You don't seem to want to do that freely through markets, so what did you have in mind? It sounds like you want government doing that, but you keep denying it. What gives?

I believe the best method for allocating healthcare dollars is by medically necessary costs. The free market should only be used for non-medically necessary cost such as cosmetic surgery.

For medical necessary healthcare the decisions should be made by the patient assisted by the doctor. Costs should not be a determining factor. Government's role would be the same as it is now, to review treatment costs. Where treatments fall outside medically recommended guidelines or for certain procedure, advance approval would be required. This is exactly what insurance companies, Medicare, and Medicaid do today.

 

[dblack]

All that's fine, I guess. But you're ignoring the actual problem. We don't have a problem diagnosing and prioritizing health care needs. We have a problem with paying for them.

I didn't mention the availability of medical records. I was referring to the fact that doctors aren't accountants. They aren't actuaries. That have no training or expertise in managing an insurance company.

It just seems like you want to pretend the financial side of this problem will just go away if we make it "free". But of course it's not free - we're just paying for it differently.

The financial side of the problem is inseparable from healthcare delivery. For example.

25% of all medical costs is administrative costs and most of the administrative cost is billing. In one large hospitals with 900 beds, there are 1300 billing clerks. Most hospitals have more people doing billing than serving patients. The reason for this is the complexity of rules used by multiple payers. In addition to Medicare, Medicaid, VA, Social Security, you have over 300 health insurance companies with dozens of policies all having different rates, different converges, different contractual discounts on over 10,000 billing codes. Add into the mix causality insurance companies that pay only certain procedures associated with an accident and supplemental insurance plans that pay percentages or balances after primary insurance payment and you have huge, costly, complex payment system. One of the reason for moving to a single payer system will be to save big bucks in medical billing.

When congress pasted legislation that forbid Medicare, Medicaid, and the VA form bidding drugs, it added added 25 billion dollars a year to Americans healthcare bill.

Widely perceived as fierce guardians of health-care dollars, insurers, in most cases today, are not. Their reputation for saving healthcare dollars started in 70's with manage care and formation of networks. However by 2000, most insurance companies had ceased any real management of care do to patient deaths and lawsuits and state regulation which followed.

Insurance contracts with providers are closely guarded secrets because the rates they are paying is often higher than the Medicare reimbursement rates. Today insurance companies are middle men, who add cost to the system and just pass it on to subscribers.

Ok, so you DO want to have government making the call. A while ago you said you didn't, and I was wondering what you meant.

I can't get behind that at all. Turning economic struggles into political struggles doesn't seem like a win to me.

what do you mean by government making the call?

Somehow, we have to figure out how to divvy up limited health care resources. You don't seem to want to do that freely through markets, so what did you have in mind? It sounds like you want government doing that, but you keep denying it. What gives?

I believe the best method for allocating healthcare dollars is by medically necessary costs. The free market should only be used for non-medically necessary cost such as cosmetic surgery.

For medical necessary healthcare the decisions should be made by the patient assisted by the doctor. Costs should not be a determining factor. Government's role would be the same as it is now, to review treatment costs. Where treatments fall outside medically recommended guidelines or for certain procedure, advance approval would be required. This is exactly what insurance companies, Medicare, and Medicaid do today.

It would indeed be nice if costs weren't a "determining factor" when it comes to health care. But that's denying reality. And you've been denying it for several posts in a row. The point I keep making, and you keep ignoring, is that there is not enough money in the federal budget, not enough money in circulation, to provide everyone with all the health care they need.

We need some mechanism for figuring out who gets health care and who doesn't. Right now, society makes these decisions via the free market. But you don't like that, so what are you suggesting as an alternative?? You keep focusing on giving doctors the authority to make the call, but they have neither the power nor expertise to do so. It's not a question of determining what is medically necessary. It's a question of how to pay for it.

 

[Flopper]

The financial side of the problem is inseparable from healthcare delivery. For example.

25% of all medical costs is administrative costs and most of the administrative cost is billing. In one large hospitals with 900 beds, there are 1300 billing clerks. Most hospitals have more people doing billing than serving patients. The reason for this is the complexity of rules used by multiple payers. In addition to Medicare, Medicaid, VA, Social Security, you have over 300 health insurance companies with dozens of policies all having different rates, different converges, different contractual discounts on over 10,000 billing codes. Add into the mix causality insurance companies that pay only certain procedures associated with an accident and supplemental insurance plans that pay percentages or balances after primary insurance payment and you have huge, costly, complex payment system. One of the reason for moving to a single payer system will be to save big bucks in medical billing.

When congress pasted legislation that forbid Medicare, Medicaid, and the VA form bidding drugs, it added added 25 billion dollars a year to Americans healthcare bill.

Widely perceived as fierce guardians of health-care dollars, insurers, in most cases today, are not. Their reputation for saving healthcare dollars started in 70's with manage care and formation of networks. However by 2000, most insurance companies had ceased any real management of care do to patient deaths and lawsuits and state regulation which followed.

Insurance contracts with providers are closely guarded secrets because the rates they are paying is often higher than the Medicare reimbursement rates. Today insurance companies are middle men, who add cost to the system and just pass it on to subscribers.

Ok, so you DO want to have government making the call. A while ago you said you didn't, and I was wondering what you meant.

I can't get behind that at all. Turning economic struggles into political struggles doesn't seem like a win to me.

what do you mean by government making the call?

Somehow, we have to figure out how to divvy up limited health care resources. You don't seem to want to do that freely through markets, so what did you have in mind? It sounds like you want government doing that, but you keep denying it. What gives?

I believe the best method for allocating healthcare dollars is by medically necessary costs. The free market should only be used for non-medically necessary cost such as cosmetic surgery.

For medical necessary healthcare the decisions should be made by the patient assisted by the doctor. Costs should not be a determining factor. Government's role would be the same as it is now, to review treatment costs. Where treatments fall outside medically recommended guidelines or for certain procedure, advance approval would be required. This is exactly what insurance companies, Medicare, and Medicaid do today.

It would indeed be nice if costs weren't a "determining factor" when it comes to health care. But that's denying reality. And you've been denying it for several posts in a row. The point I keep making, and you keep ignoring, is that there is not enough money in the federal budget, not enough money in circulation, to provide everyone with all the health care they need.

We need some mechanism for figuring out who gets health care and who doesn't. Right now, society makes these decisions via the free market. But you don't like that, so what are you suggesting as an alternative?? You keep focusing on giving doctors the authority to make the call, but they have neither the power nor expertise to do so. It's not a question of determining what is medically necessary. It's a question of how to pay for it.

The point I keep making, and you keep ignoring, is that there is not enough money in the federal budget, not enough money in circulation, to provide everyone with all the health care they need.

I think you're exaggerating the cost of providing enough money to meet demand for healthcare. Of course it's more than we are currently spending. However, it will not bankrupt the nation. People do not have an inexhaustible demand for healthcare. They don't use healthcare simple because it's free.
If that were true, you would expect a large increase in the number colonoscopies when Medicare, and Medicaid made the procedure completely free. However the fact is their was only a 4% increase. When vaccinations for common diseases such as flu and childhood diseases became free of copays and deductibles, the CDC was expecting a big increase in utilization, but it didn't happen. You would expect Medicaid patient utilization to be huge compared to private insurance with high deductibles and copays, yet utilization is lower, not higher. How can this be if the cost is the determining factor? People would over utilizing free services.

The reason free healthcare to the patient does not result in high utilization is very easy to understand. People do not like to go to the doctor, dentist, or other healthcare providers. They stick needles in you, drill holes in your teeth, put you on diets that excludes the foods you love, and tell you that you have terrible diseases that require long painful treatment.

Lowering the cost of healthcare will make it possible for more people to use it but it does not mean people will over utilized. People go to the doctor because they feel they must go, not because they want to. I have never heard anyone say, they had a great time in the hospital. I just can't wait to go back. It was so much fun.

 

[Flopper]

Thus we are left with a combination of the above for both practical and political reasons. IMHO, all delivery of healthcare should be done by private enterprise. The payment system should be a single payer system with yearly deductibles and co-insurance.

So doctors should just rack up whatever bills they think are warranted and government (taxpayers) should pay up? It's good to be a doctor!

For almost every diagnosis, there are commonly accepted treatments. If a doctor deviates from these, he is going to have to justify to a utilization committee in the clinic or hospital he works and to the insurance company or government agency he is submitting the claims. Fees he receive are limited by medicare, medicaid, and insurance company reimbursement rate.

For example, a cardiologist in the hospital my wife worked decided that all of his patients should wear heart monitors. The hospital utilization committee require him to submit evidence that this was medical necessary for all patients. He backed off on this immediately.

 

[dblack]

I think you're exaggerating the cost of providing enough money to meet demand for healthcare.

I guess that's an article of faith. I think each of us has a pretty much infinite demand for health care. But you're not answering the question. When three different patients can all be saved with a ten million dollar procedure, but there's only enough money in the budget for one - who decides?

 

[Flopper]

I think you're exaggerating the cost of providing enough money to meet demand for healthcare.

I guess that's an article of faith. I think each of us has a pretty much infinite demand for health care. But you're not answering the question. When three different patients can all be saved with a ten million dollar procedure, but there's only enough money in the budget for one - who decides?

No, we do not have an infinite demand for healthcare. That's silly. Are you telling me you would go to the doctor just because it's fee? You would spend your evenings in an emergency room when you're not sick. I don't buy that.

I have Medicare with a supplement that pays all deductibles and coinsurance. I've been to one doctor this year and haven't been in the hospital or ER in many years.

First, there is no ten million dollar procedure. Second, all 3 patients will get the life saving procedure if they have government insurance. Even if they have private insurance, they will still get the procedure, but they will have to meet their deductibles and copay. If they have no insurance, they may still get the procedure but will probably be driven into bankruptcy.

The way insurance works, either goverment or private, the subscribers make up an insurance pool. Actuaries use the demographics and health history of members of the pool to determine yearly budget for healthcare payments. For private insurance this budget plus other expenses and profits is used to calculate premiums. For goverment insurance, it becomes part of the yearly federal or state budget request less any funds paid by subscribers.

 

[dblack]

I think you're exaggerating the cost of providing enough money to meet demand for healthcare.

I guess that's an article of faith. I think each of us has a pretty much infinite demand for health care. But you're not answering the question. When three different patients can all be saved with a ten million dollar procedure, but there's only enough money in the budget for one - who decides?

No, we do not have an infinite demand for healthcare. That's silly. Are you telling me you would go to the doctor just because it's fee? You would spend your evenings in an emergency room when you're not sick. I don't buy that.

You're so fixated on this over-utilization nonsense you're not listening. I'm not saying people will be going to the doctor just because it's "free". I'm saying that when your life is on the line, your demand for health care is, for all intents and purposes, infinite. But our capacity to pay for health care is not infinite. Someone has to make the call for whether it's worth a life's fortune to keep one person alive. If government is footing the bill, ultimately, government will be making this decision. I don't see how you can continue to deny that.

 

[Flopper]

I think you're exaggerating the cost of providing enough money to meet demand for healthcare.

I guess that's an article of faith. I think each of us has a pretty much infinite demand for health care. But you're not answering the question. When three different patients can all be saved with a ten million dollar procedure, but there's only enough money in the budget for one - who decides?

No, we do not have an infinite demand for healthcare. That's silly. Are you telling me you would go to the doctor just because it's fee? You would spend your evenings in an emergency room when you're not sick. I don't buy that.

You're so fixated on this over-utilization nonsense you're not listening. I'm not saying people will be going to the doctor just because it's "free". I'm saying that when your life is on the line, your demand for health care is, for all intents and purposes, infinite. But our capacity to pay for health care is not infinite. Someone has to make the call for whether it's worth a life's fortune to keep one person alive. If government is footing the bill, ultimately, government will be making this decision. I don't see how you can continue to deny that.

Ok, I understand
Because you may demand medical procedures does not mean you're going to get them. There has to be sound evidence that a treatment will improve your condition or extend your life. For a hospital to ignore this means they will not be paid and may even be sued.

My experience with family members that are facing death with serious illness absolutely do not want infinite amounts of healthcare. They want relief from pain both physical and mental and just want it all to end.

 

[dblack]

I think you're exaggerating the cost of providing enough money to meet demand for healthcare.

I guess that's an article of faith. I think each of us has a pretty much infinite demand for health care. But you're not answering the question. When three different patients can all be saved with a ten million dollar procedure, but there's only enough money in the budget for one - who decides?

No, we do not have an infinite demand for healthcare. That's silly. Are you telling me you would go to the doctor just because it's fee? You would spend your evenings in an emergency room when you're not sick. I don't buy that.

You're so fixated on this over-utilization nonsense you're not listening. I'm not saying people will be going to the doctor just because it's "free". I'm saying that when your life is on the line, your demand for health care is, for all intents and purposes, infinite. But our capacity to pay for health care is not infinite. Someone has to make the call for whether it's worth a life's fortune to keep one person alive. If government is footing the bill, ultimately, government will be making this decision. I don't see how you can continue to deny that.

Ok, I understand

No, you're still ostriching.

Because you may demand medical procedures does not mean you're going to get them. There has to be sound evidence that a treatment will improve your condition or extend your life. For a hospital to ignore this means they will not be paid and may even be sued.

"evidence that a treatment will improve your condition or extend your life" is irrelevant if there isn't enough money in the bank. You seem committed to the delusion that government can provide everyone with all the health care they "need". I've point out, several times that all of us will face a point where we need more health care than we can afford. Does that just not register with your brain?

 

[Flopper]

I think you're exaggerating the cost of providing enough money to meet demand for healthcare.

I guess that's an article of faith. I think each of us has a pretty much infinite demand for health care. But you're not answering the question. When three different patients can all be saved with a ten million dollar procedure, but there's only enough money in the budget for one - who decides?

No, we do not have an infinite demand for healthcare. That's silly. Are you telling me you would go to the doctor just because it's fee? You would spend your evenings in an emergency room when you're not sick. I don't buy that.

You're so fixated on this over-utilization nonsense you're not listening. I'm not saying people will be going to the doctor just because it's "free". I'm saying that when your life is on the line, your demand for health care is, for all intents and purposes, infinite. But our capacity to pay for health care is not infinite. Someone has to make the call for whether it's worth a life's fortune to keep one person alive. If government is footing the bill, ultimately, government will be making this decision. I don't see how you can continue to deny that.

Ok, I understand

No, you're still ostriching.

Because you may demand medical procedures does not mean you're going to get them. There has to be sound evidence that a treatment will improve your condition or extend your life. For a hospital to ignore this means they will not be paid and may even be sued.

"evidence that a treatment will improve your condition or extend your life" is irrelevant if there isn't enough money in the bank. You seem committed to the delusion that government can provide everyone with all the health care they "need". I've point out, several times that all of us will face a point where we need more health care than we can afford. Does that just not register with your brain?

I think what you want to discuss is paying for healthcare.

My plan is relatively simple. Older adults would have the option to join Medicare at an earlier age than 65. For example starting in 2021, adults who qualified for Medicare would have the option of joining at age 64. Each year the minimum age would drop by one year until it reaches age 50. Key benefits are:

• The more costly people to insure, older adults begin leaving the private insurance pools in employer sponsored health plans and individual insurance reducing costs.
• For those who get insurance through the exchanges, they will certainly find Medicare a better option at an average premium of $135/mo with a low deductible and a coinsurance about the same as on the exchanges. For those that have high medical costs, they would opt for a Medicare supplement sold by private insurance companies which eliminates all deductibles and coinsurance for about $150/mo additional
• For those with employee sponsored insurance, Medicare would be a better option for some but not all. It depends on how much the employer subsides the insurance and the benefits.
• Employers would see their spending on health insurance premiums reduce.
• Employees could have truly portable insurance with Medicare that they could carry from one employer to the next.
• Employees would be be able to go to almost any hospital in the US and 98% of all doctors with no concern for referrals or networks.
• Those with low income would be able to get help paying premiums.
• For those that are eligible that want to stay on their employer plan, they could assign their Medicare benefits to their employer which would significantly reduce their premium.
• Unlike many of the healthcare proposals, stopping and modifying the plan is easy without major repercussions. There is little impact on the healthcare industry and there are no new government regulations on the healthcare industry.

The not so good stuff:

• The goverment cost of the plan would increase as more people join it. The cost would be payed partially by the subscriber premiums, taxes on employers who benefit from savings of insuring less employees, the medicare trust, and congressional budget appropriations paid by increases in income tax and corporate tax.
• There is no drug benefit to Medicare so most people would sign up for a drug plan which would likely cost $20 to $60/mo.
• There is no coverage outside the US so people would have to buy coverage before traveling abroad or select foreign coverage on a Medicare Supplement.