Dumber than a box of rocks

Discussion in 'Politics' started by Swamp Donkey, Nov 6, 2018.

  1. Politigator

    Politigator L-boy's Cousin

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    I have no idea what this lady is talking about, but most peoe already pay for health care via employer and employee contribution. If you instead had an additional deductible payroll tax shared by employer and employee for most people it wouldnt be that different.

    I'd rather see it paid with a consumption tax.
     
  2. 5-Star Finger

    5-Star Finger Apex predator of the political forum biome
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    Except that doesn't get you where you need to go with a "Medicare for All." Because the plan would include all uninsured people that either are not wage employees because they have no job or because they retired, or because they do not derive their income from wages (capital gains) you would need to find a way to collect what is essentially a tax among all earners (including the share that will need to go to those that earn nothing) - and that tax would have to be huge. Estimates on the costs range from a laughably low 1.8 trillion (counting on huge amounts of unproven savings by having only one insurer) to north of 3.1 trillion. That's nearly the entire collection of revenue by the feds (3.3) - not just payroll taxes.

    Generally I'm more in favor of consumption taxes than income taxes for the simple reason that you tend to motivate the generation of less income when you tax it. I'd rather they get it and spend it or invest it and collect the tax there. I still don't see the revenue there to support what they are talking about. The problem with health insurance, is that it is insurance no matter who is the administrator. We have to scrap that model and move to one that acknowledges that health issues are going to happen and move the needle back towards cash-based systems. In order to avoid third party rationing (whether that is provider side or insurer side) I still believe the best way is to allow people to control the accounts themselves and self-ration. No matter what people like to imagine; scarcity is a thing and will always be one. There are only so many doctors, nurses, hospital beds, drugs - etc. Wishing it was not so isn't going to somehow cause the universe to rewrite itself. History has shown trying to manage supply from the top down leads to waste as decisions happen too slowly to effectively shadow demand, especially when profit motives are removed. Allow people's own natural competing self-interests to encourage prudence in when they really need to see a doctor. If they don't spend it now, it gathers interest and be used later when needed. Save the insurance model for the things that are less likely like cancer, accidents, etc.
     
  3. Politigator

    Politigator L-boy's Cousin

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    I don't have exact numbers but I think the total payroll tax required would be comparable to FICA.

    If you take into account Medicare, Medicaid, aca subsidies, income exemption given to employee and employer income tax deduction, plus state expenditures that comprises more.thsn half of total health care.

    NHE Fact Sheet - Centers for Medicare & Medicaid Services

    We have the ability to pay for it, and we already are one way or other, but are we willing to switch privately funded health care insurance with a publicly funded tax? Maybe not.
     
  4. AugustaGator

    AugustaGator Junior Member
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    I agree except the socialism allows the inefficiencies you speak of.
     
  5. 92gator

    92gator Well-Known Member

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    Well, besides the fact that you laid out a problem, and not a proposed solution...i get your point.

    My dad was a surgeon, and i used to work in his office. Got my fill of medical billing procedure, and the whole bureaucracy bs.

    Here are my points in response to what you posted. Imho, the complexity in the billing, is no accident. The bureacracy, and the constant changes in the terrain are transparently by design. They exist (and arr constantly altered and expanded) in order to delay payout (buys time to make sure there's enough to pay...). Point being....this is the socialism you said had nothing to do with anything. Hell, you said so right on your post--"...the govmt, in all its wisdom...". I realize you were speaking figuratively, and being sarcastic--but you were actually dead on right, sans the sarcasm. It is litetally, part of the system by design. Has to be.

    Get govmt out of health care, and lo n behold, docs could refer to treatment and conditions according to the nomenclature learned in med school.

    Govmt involved....and you will ALWAYS have to negotiate a bureactatic maze, to get paid. Cest la vie.

    There is simply no way to avoid the bureacracy, as long as govmt is involved.

    ...and they seek to guide HC pros to the *inevitable* conclusion, that single payer is best and even necessary, in order to simplify the whole process, by coordinating it through one unified, coordinated provider.

    There is no ready solution, though id like to see us start with some significant steps in the order of deregulation, permitting ins co's to work across st lines and such, and seeing the govmt pull steadily out of HC (I know... wishful thinking...).

    Jmho/fwiw.
     
  6. gator1946

    gator1946 Senior Member
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    Good points all. I didn't lay out a solution because solutions are not simple and that would start another debate that I'm not willing to spend time on. I started to underline your salient points and then realized I'd underline them all. One in particular I had to bold. I would change one thing in your sentence. 'Is designed to change the rules so that providers can't keep up and get paid less'. Every fricking year it's something new. Then there's a mad scramble to re-program retrain and redo. That ain't cheap. But the insurers, Medicare and Medicaid don't care. It's not their nickle.

    I do not believe that single payer is the only solution. The government would do what it always does.
     
    #46 gator1946, Nov 7, 2018
    Last edited: Nov 7, 2018
    • Bushmaster

      Bushmaster Well-Known Member

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      Not entirely accurate. For disclosure, I ran the audit department for a CPA firm that specialized in hospital auditing and wrote the accounting manual for the major healthcare system in my state. We also had a medical billing department. I contract it out for my own firm now for.the providers I work with.

      Expanding the codes by a few digits was not that big of a deal. Levels of care couldn't be captured with what existed a few years ago. Charts aren't sent anywhere. It's online. Billers go on everyday and see what has not been paid and can fix it online. well, at least if you know what you are doing. My hospitals have clinical auditors that review charts before they go to billing. Eliminates a lot of rejects.

      Someone hit on a significant problem earlier. Hospitals can't tell you how much something will cost you. Think about it. You aren't paying the billost likely. Everyone gets charges a different price. Medicare and Medicaid get charges a rate. Different insurance companies get charged a different rate based on the contract. Negotiated every three years here. Self pays, or no pays, pay full rate.

      Goverent pays about 90% of COST as they define cost. Insurance is about 110% of cost as they define it. So your patient mix is very important. If Medicare Medicaid mix is high , you will get a disproportionate share distribution from the state to get you covered for losing money on the government payers so you can keep the doors open.

      My solution is run it like car insurance. Pay out of pocket for everything unless you get hospitalized. Fully deduct on front of return all medical expenses.

      We don't file insurance for oil changes or flat tires, we shouldn't be filing insurance for the sniffles. Then we would know how much a doctor's visit costs and can keep them in check. When the insurance company is picking up the tab, no one cares about the bill.
       
      • gator1946

        gator1946 Senior Member
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      • gator1946

        gator1946 Senior Member
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        I rarely get into it with somebody. But I'm getting into it now. A few digits? What do you think a few digits mean to the possible permutations and combinations for ICD-10 codes. Do the math. Tell that to my programming team. Tell that to the coders who had to be completely retrained. Tell that to the people who have to deal with muti-tiered selection lists rather than a simple selection. Tell that to the people who don't know what the hell to select because of the huge new set of possibilities. Levels of care couldn't be captured? BS. There are trade offs between drilling down to a finer grained level of care and the effort required to get there. It's the overall cost of the system (all systems) that's important.

        You had a problem with my use of the word sent. Of course they are not sent physically. We send them electronically. That doesn't mean that the process is efficient. Oh and believe it or not some provider clerks still hand enter charts into an electronic system. Drives me crazy.

        Yeah most, not all entities, review charts, pre-submission. Is it possible that the resources for review are extensive because the rules are too complex. Your hospitals are spending money to review charts. Depending on whether they "know what they are doing" or not they may be getting decent results. Knowing what you're doing gets more complex every year. We gonna keep that up or stop the complexity?

        As for the fact that you wrote a manual for a state. Let me tell you about some states. The business/audit rules were so egregiously bad and unrealistic (meaning that when applied to the real world they couldn't handle many patient encounters) that after an attempt to program them into the system and present them to the providers they had to be abandoned and it was necessary to start over...more than once.

        But the good news is your solution ain't bad.

        Look I'm not trying to insult you but have you really spent time in the trenches? All the trenches? It's a big system. The problem is that there are multiple cost centers and they are fighting each other. Sub optimization is the current name of the game.
         
        #49 gator1946, Nov 9, 2018
        Last edited: Nov 9, 2018
        • gator1946

          gator1946 Senior Member
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          "Someone hit on a significant problem earlier. Hospitals can't tell you how much something will cost you. Think about it. You aren't paying the billost likely. Everyone gets charges a different price. Medicare and Medicaid get charges a rate. Different insurance companies get charged a different rate based on the contract. Negotiated every three years here. Self pays, or no pays, pay full rate."

          Yep. Typical conversation if you go in for lets say an out patient procedure.

          Patient: What's my out of pocket cost?
          Hospital: Huh?????
          Patient: Let me repeat that. What's my out of pocket cost?
          Hospital: Who's you insurance company.
          Patient: Answers
          Hospital: Your co-pay is x
          Patient: What about the anesthesiologist. Is he in or out of network.
          Hospital: We don't know
          Patient: Seriously you cant tell me?
          Hospital: We don't have that information
          Patient: Since that can mean my out of pocket can be thousands more you better find out.
          Hospital: Sorry, we don't have that information.
          Patient: I'll sit here and I won't have the procedure until you give me an answer
          Hospital: 1 hour later. Clerk answers with exasperation. We have an answer.

          And you still don't know what the negotiated cost for in network was.

          God help the people who don't know how the system works.

          Oh and by the way you know this. Self pays can negotiate. Most don't and a high percentage don't pay at all. How do your ER docs feel when they see a self pay come in? I've had ED partners. They just roll their eyes and do their job.
           
          #50 gator1946, Nov 9, 2018
          Last edited: Nov 9, 2018
        • AgingGator

          AgingGator New Member

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          As a man with first-hand knowledge of two of these countries that you are talking about, YOUR WRONG. If a book is where you got your very very misguided opinion from, might I suggest that you broaden your reading horizons a bit to include the Reality Department.
           
          • itsgr82bag8r

            itsgr82bag8r Political Forum Fire Starter
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            [​IMG]
             
            • Bushmaster

              Bushmaster Well-Known Member

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              You can get into with me if you want to. It didn't take long for billing folks to learn an expanded system. They learned the first one.

              Maybe you should find smarter people to do billing.
               
            • gator1946

              gator1946 Senior Member
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              Not our job to find them. However, we deal with hundreds of billing entities. And it's not our job to help them either, but in the interest of customer relations, we do. What that means is ultimately we bake in the cost. Never had to do that with the other system. More complexity, more cost.

              Let me get this straight.

              Development of the new code structure didn't cost anything. It just magically appeared even though countless people worked on it. The code dictionaries that are available for a fee really are free. The literally hundreds of software applications that were developed to handle writing the new charts were done gratis. The Software developed to invoice the insurers and allow review was also free. Multiple insurance companies were able to upgrade their systems with a snap of the finger. The training courses for coders were offered at no charge. The time the coders spent in those classes were on their on dime. Training for the insurance companies also cost nothing. And the codes never change so there's no more cost. And from the chart writer to the reviewer to the coder to the insurance company; using these systems takes no longer. Ok it's no big deal.

              Oh and even if were our job to find smarter folks. Smarter folks usually cost more money.
               
              #54 gator1946, Nov 10, 2018 at 9:18 PM
              Last edited: Nov 10, 2018 at 9:41 PM
              • itsgr82bag8r

                itsgr82bag8r Political Forum Fire Starter
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                Ouch, that left a mark.
                 

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