"Let's stomp on Constitutional Amendments" thread

Canon 12x IS USM (S3 IS built-in Lens) -- 36-432mm (35mm EQ)

10/04/2013 02:39:40 PM · #451

Originally posted by DrAchoo:

It is also assumed the government can negotiate with doctors or pharma companies to pay them less (they already do however compared to private insurance).

This is private insurance -- we will all be paying premiums to private insurance companies unless we are so poor as to qualify for Medicaid or so old as to qualify for MediCare ... those are government programs. Incidentally, I believe the "administrative overhead" for the MediCare program is about 5%, while the new law seeks to limit those of the private companies to about 15%. I'm also curious as to why a system which has to cover care + overhead + profit can be cheaper than a non-profit one which only has to charge enough to cover the first two.

And, the pharmaceutical industry overall has traditionally ranked first or second in profitability (alternating with big oil) -- maybe the shareholders can extract just a little less and still get along without having to go on Food Stamps ...

Judith Polakoff

Nikon D7000

Nikon AF-S DX NIKKOR 18-200mm f/3.5-5.6G ED VR II

10/04/2013 02:41:05 PM · #452

Originally posted by bohemka:

Judith, you've probably seen this. Some are hopeful, at least.

I hadn't seen that article; thank you. There is one not-for-profit insurance company operating on the NY exchange in my part of the state. We are probably going to buy our insurance from them as their policies are at least 30 percent cheaper than the others.

bohemka

Nikon D700

Sigma 12-24mm f/4.5-5.6 EX Aspherical DG HSM for Nikon

10/04/2013 02:42:06 PM · #453

Originally posted by DrAchoo:

Originally posted by Bear_Music:
Jason, isn't there a third category? Hypothetically, tremendous gains can be made in administrative costs.

Possibly, but tell me how that works? The government adds millions of people who are otherwise costing the government zero (or nearly zero) in administrative costs (ie. they have no insurance). How is that providing efficiency?

Where does the burden of unpaid medical bills currently fall? The care needed in situations that arise because the uninsured don't practice preventative medicine; or the emergency services that are never paid for because the uninsured don't have the money. Do hospitals eat those costs? Does the government currently subsidize it? Insurance? A mixture?

This is a big thing, and if insurance costs/subsidies/unpaid bills can be drastically cut down, that surely has to help eliminate waste.

Judith Polakoff

Nikon D7000

Nikon AF-S DX NIKKOR 18-200mm f/3.5-5.6G ED VR II

10/04/2013 02:43:28 PM · #454

Originally posted by DrAchoo:

BTW, I always need to state these disclaimers because people always make assumptions about what I believe. I'm not starkly against the ACA. I think we need to do something and if this is the best we can come up with, then we need to try. HOWEVER, if people are against it because they fear the train will go off the rails, I'm not one to say they are completely irrational for holding that position. I do not have the faith of the party loyal (to throw the term back to Shannon).

Whether the train goes off the rails might depend, in part, on whether the Republicans keep trying to sabotage the law.

10/04/2013 02:48:24 PM · #455

Originally posted by bohemka:

Originally posted by DrAchoo:

Originally posted by Bear_Music:
Jason, isn't there a third category? Hypothetically, tremendous gains can be made in administrative costs.

Possibly, but tell me how that works? The government adds millions of people who are otherwise costing the government zero (or nearly zero) in administrative costs (ie. they have no insurance). How is that providing efficiency?

Where does the burden of unpaid medical bills currently fall? The care needed in situations that arise because the uninsured don't practice preventative medicine; or the emergency services that are never paid for because the uninsured don't have the money. Do hospitals eat those costs? Does the government currently subsidize it? Insurance? A mixture?

This is a big thing, and if insurance costs/subsidies/unpaid bills can be drastically cut down, that surely has to help eliminate waste.

Good question. The answer is typically the doctor/hospital eats it. ED's are particularly vulnerable because they are required, by law, to treat people (ie. they can't turn people away). Market forces would typically dictate that the ED responds by charging everybody else more although the medical world in the US is at best a bastard child of market forces and government regulation. "Market forces" often do not work in the same way they work in other settings.

10/04/2013 02:49:09 PM · #456

Originally posted by Judith Polakoff:

Originally posted by DrAchoo:
BTW, I always need to state these disclaimers because people always make assumptions about what I believe. I'm not starkly against the ACA. I think we need to do something and if this is the best we can come up with, then we need to try. HOWEVER, if people are against it because they fear the train will go off the rails, I'm not one to say they are completely irrational for holding that position. I do not have the faith of the party loyal (to throw the term back to Shannon).

Whether the train goes off the rails might depend, in part, on whether the Republicans keep trying to sabotage the law.

Do you honestly feel this is the ONLY way it can go off the rails? If you do, you have a tremendous amount of faith.

10/04/2013 02:51:07 PM · #457

Originally posted by GeneralE:

Originally posted by DrAchoo:
It is also assumed the government can negotiate with doctors or pharma companies to pay them less (they already do however compared to private insurance).

This is private insurance -- we will all be paying premiums to private insurance companies unless we are so poor as to qualify for Medicaid or so old as to qualify for MediCare ... those are government programs. Incidentally, I believe the "administrative overhead" for the MediCare program is about 5%, while the new law seeks to limit those of the private companies to about 15%. I'm also curious as to why a system which has to cover care + overhead + profit can be cheaper than a non-profit one which only has to charge enough to cover the first two.

And, the pharmaceutical industry overall has traditionally ranked first or second in profitability (alternating with big oil) -- maybe the shareholders can extract just a little less and still get along without having to go on Food Stamps ...

It IS private insurance in one regard, but it's "public" in the sense the government is helping you pay premiums. BUT, if it IS private insurance, how are administrative savings going to help the government? It would be administration by private companies.

Canon 12x IS USM (S3 IS built-in Lens) -- 36-432mm (35mm EQ)

10/04/2013 02:52:22 PM · #458

Originally posted by bohemka:

A mixture -- people who currently have insurance pay higher premiums than "necessary" in order to cover the cost of care for the uninsured, which causes hospitals to charge more than "necessary" to cover services for which they'll never recover the cost. Some of the uncollectable charges are written off the facilities taxes, and so are subsidized by other taxpayers (i.e. you).

I'll give you a real example later on, but I don't have time to write it up right now ...

scalvert

Canon EOS-5D Mark III

10/04/2013 02:55:01 PM · #459

Originally posted by Judith Polakoff:

Whether the train goes off the rails might depend, in part, on whether the Republicans keep trying to sabotage the law.

Yep.

scalvert

Canon EOS-5D Mark III

10/04/2013 02:58:38 PM · #460

Originally posted by DrAchoo:

It is also assumed the government can negotiate with doctors or pharma companies to pay them less (they already do however compared to private insurance).

Thanks to Republicans, the government isn't allowed to negotiate lower prices.

Nikon AF-S DX NIKKOR 18-200mm f/3.5-5.6G ED VR II

10/04/2013 02:59:09 PM · #461

Originally posted by DrAchoo:

Originally posted by GeneralE:

Originally posted by DrAchoo:
It is also assumed the government can negotiate with doctors or pharma companies to pay them less (they already do however compared to private insurance).

This is private insurance -- we will all be paying premiums to private insurance companies unless we are so poor as to qualify for Medicaid or so old as to qualify for MediCare ... those are government programs. Incidentally, I believe the "administrative overhead" for the MediCare program is about 5%, while the new law seeks to limit those of the private companies to about 15%. I'm also curious as to why a system which has to cover care + overhead + profit can be cheaper than a non-profit one which only has to charge enough to cover the first two.

And, the pharmaceutical industry overall has traditionally ranked first or second in profitability (alternating with big oil) -- maybe the shareholders can extract just a little less and still get along without having to go on Food Stamps ...

It IS private insurance in one regard, but it's "public" in the sense the government is helping you pay premiums. BUT, if it IS private insurance, how are administrative savings going to help the government? It would be administration by private companies.

Only if you're under, what is it? $40k or so a year? Above that and you're paying full price.

Judith Polakoff

Nikon D7000

10/04/2013 03:05:18 PM · #462

Originally posted by DrAchoo:

Originally posted by Judith Polakoff:

Whether the train goes off the rails might depend, in part, on whether the Republicans keep trying to sabotage the law.

Originally posted by DrAchoo:

Do you honestly feel this is the ONLY way it can go off the rails? If you do, you have a tremendous amount of faith.

Hello?? Did I say "the ONLY way," or did I say "in part"??

10/04/2013 03:06:02 PM · #463

Originally posted by Cory:

Only if you're under, what is it? $40k or so a year? Above that and you're paying full price.

Family of four qualifies for some assistance under $96,000/year.

10/04/2013 03:06:53 PM · #464

Originally posted by Judith Polakoff:

Hello?? Did I say "the ONLY way," or did I say "in part"??

It was the only one you cared to mention.

10/04/2013 03:10:46 PM · #465

Originally posted by scalvert:

Specifically you are correct about pharma, but not with doctors. Medicare already pays somewhere in the range of .60 cents on the dollar (a rough number) for services provided by physicians which is why a number of physicians do not take Medicare.

Canon 12x IS USM (S3 IS built-in Lens) -- 36-432mm (35mm EQ)

10/04/2013 03:33:08 PM · #466

Originally posted by DrAchoo:

Medicare already pays somewhere in the range of .60 cents on the dollar (a rough number) for services provided by physicians which is why a number of physicians do not take Medicare.

But remember that that "dollar" has its value set by a system distorted by uninsured patients, over-insured doctors, a fee-for-service based billing system, etc. You don't (shouldn't) lose money accepting MediCare, just not be able to take as much out of the taxpayer's pocket for placement in your own ...

10/04/2013 04:05:44 PM · #467

Originally posted by GeneralE:

Originally posted by DrAchoo:
Medicare already pays somewhere in the range of .60 cents on the dollar (a rough number) for services provided by physicians which is why a number of physicians do not take Medicare.

But remember that that "dollar" has its value set by a system distorted by uninsured patients, over-insured doctors, a fee-for-service based billing system, etc. You don't (shouldn't) lose money accepting MediCare, just not be able to take as much out of the taxpayer's pocket for placement in your own ...

??? I don't quite get what you are saying Paul. What I mean is if you can see 20 patients a day and you generally fill your schedule, you will earn more money if you have zero Medicare patients compared to if you had five or ten of those on Medicare.

Canon 12x IS USM (S3 IS built-in Lens) -- 36-432mm (35mm EQ)

10/04/2013 04:12:38 PM · #468

I'm saying that when you say "sixty cents on the dollar" you are suggesting that the dollar is indeed the "proper" amount to be paid for that service, and that I find that to be a false assumption because the the current value of that "dollar" is distorted by various factors within the system. If it wasn't for waste, fraud, abuse, profiteering, and having to pay for the uninsured, that "dollar" might only be sixty-five cents.

10/04/2013 04:13:22 PM · #469

Originally posted by DrAchoo:

Originally posted by GeneralE:

Originally posted by DrAchoo:
Medicare already pays somewhere in the range of .60 cents on the dollar (a rough number) for services provided by physicians which is why a number of physicians do not take Medicare.

But remember that that "dollar" has its value set by a system distorted by uninsured patients, over-insured doctors, a fee-for-service based billing system, etc. You don't (shouldn't) lose money accepting MediCare, just not be able to take as much out of the taxpayer's pocket for placement in your own ...

??? I don't quite get what you are saying Paul. What I mean is if you can see 20 patients a day and you generally fill your schedule, you will earn more money if you have zero Medicare patients compared to if you had five or ten of those on Medicare.

Or, you can give them slightly substandard care, see 40 patients a day, hire a PA or seven, 'see' another 190 patients a day, and profit. Yay.

Canon 12x IS USM (S3 IS built-in Lens) -- 36-432mm (35mm EQ)

10/04/2013 04:21:50 PM · #470

I respectfully ask that you retract your implication that care by a PA (or NP, or any other provider qualified to provide that level of care) is "slightly substandard" ... I assure you my clients do not think so.

RayEthier

Canon EOS-5D Mark II

Canon EF-S 18-55mm f/3.5-5.6 USM

10/04/2013 04:24:12 PM · #471

Originally posted by Cory:

Weird. I'm on Sneezy's side about a 'faith' issue and against Shannon's position on it.. NEVER saw this day coming. ;)

Stranger things have happened you know... Just the other day I made reference to Matthew 7.3 when discussing a matter in one of the threads. :O)

Ray

Message edited by author 2013-10-04 16:24:57.

10/04/2013 04:29:32 PM · #472

Originally posted by GeneralE:

Given a reasonable workload, and appropriate cases, yes, a PA is just fine. No issues there.

Given an unreasonable workload, and inappropriate cases where a fully qualified physician should be involved, then I'd say that "slightly" might be extraneous. And profit may well demand exactly that, who knows.. Hard to say right now what we'll find to be the new normal in a few years. Might be rainbows and unicorns. Might not.

10/04/2013 04:33:18 PM · #473

Originally posted by GeneralE:

I took it that he meant the doctor's care was substandard because he/she was spending less time per patient by seeing 40 instead of 20...

10/04/2013 04:35:17 PM · #474

Originally posted by DrAchoo:

Originally posted by GeneralE:
I respectfully ask that you retract your implication that care by a PA (or NP, or any other provider qualified to provide that level of care) is "slightly substandard" ... I assure you my clients do not think so.

I took it that he meant the doctor's care was substandard because he/she was spending less time per patient by seeing 40 instead of 20...

Quite right.

Decrease profitability, increase demand.. Where do those forces tend to lead? It's nothing against PA's, it's entirely about economics.

Message edited by author 2013-10-04 16:45:57.