Tilted Forum Project Discussion Community - View Single Post - cost of health care up close and personal

greytone · 04-10-2005, 03:11 AM

Let me respond to a few of the good points that were made above. We really can't tell you what your costs will be ahead of time because we really don't know. There are so many variables. We have a very complicated way of charging for our services which was forced on us by medicare. I have tried to understand how to "code" according to these rules for the past ten years and I still can't get it right according to people who come in to audit. I am constantly told I undercharge according to the rules that eveyone uses ( medicare and all the private payors) and when I try to correct it I get audited by medicare and told my charges have to fit a bell curve or they are going to prosecute. The complex nature of my patients who all have multiple diagnoses just doesn't matter. When I walk in a patient room I really don't know what level of charge is going to be appropriate. More importantly I don't know what tests I am going to have to order.

The real problem with health care is that there a lot of problems. In general people get very good health care here in the US and in other countries. Where we compare poorly with other industrialized countries is often due to cultural differences we have here.

Normal economics just don't work in healthcare because the purchace choices are not made by the payor. Managed health plans try and correct this to some degree, but we hate that as patients and providors. Where the money is spent by patients and doctors but the overwhelming portion of the money comes from insurance companies (including medicare and medicaid). Many patients pressure providors for care that is really not necessary and is not cost effective. Sometimes this is caused by advertising. More often it is based on what they know from the popular press or friends and family.

Insurance is not affordable for individuals because of our income tax laws. Insurance is tax deductible for your employer but not for private people. Decades ago employers got around rising tax rates by offering other benifits. This has led to people finding it inconcievable that they are responsible for their own healthcare. More importantly, those that want to get a plan are priced out of the market by insurance companies who only want healthy customers or big contracts.

I honestly don't know what the answer is. Socialized medicine is the easy answer, but I don't believe it is the best. We need an overhaul of laws overseeing insurance plans. They can not be allowed to cherry pic only the best patients and leave the rest for government after they are forced in bankruptcy. We need a populace with better science education so they are better health care consumers. We need more of the money going directly from employers to employees and letting them make choices. We need tort reform to prevent CYA test ordering and lower malpractice costs in a number of states. We need an overhaul of much of the private and public bureaucracatic nonsense that doctors and hospitals have to deal with. You would not beleive how much of our time and recourses go to making nonproductive pencil pushers happy.

04-10-2005, 03:11 AM	#15 (permalink)
greytone Junkie	Let me respond to a few of the good points that were made above. We really can't tell you what your costs will be ahead of time because we really don't know. There are so many variables. We have a very complicated way of charging for our services which was forced on us by medicare. I have tried to understand how to "code" according to these rules for the past ten years and I still can't get it right according to people who come in to audit. I am constantly told I undercharge according to the rules that eveyone uses ( medicare and all the private payors) and when I try to correct it I get audited by medicare and told my charges have to fit a bell curve or they are going to prosecute. The complex nature of my patients who all have multiple diagnoses just doesn't matter. When I walk in a patient room I really don't know what level of charge is going to be appropriate. More importantly I don't know what tests I am going to have to order. The real problem with health care is that there a lot of problems. In general people get very good health care here in the US and in other countries. Where we compare poorly with other industrialized countries is often due to cultural differences we have here. Normal economics just don't work in healthcare because the purchace choices are not made by the payor. Managed health plans try and correct this to some degree, but we hate that as patients and providors. Where the money is spent by patients and doctors but the overwhelming portion of the money comes from insurance companies (including medicare and medicaid). Many patients pressure providors for care that is really not necessary and is not cost effective. Sometimes this is caused by advertising. More often it is based on what they know from the popular press or friends and family. Insurance is not affordable for individuals because of our income tax laws. Insurance is tax deductible for your employer but not for private people. Decades ago employers got around rising tax rates by offering other benifits. This has led to people finding it inconcievable that they are responsible for their own healthcare. More importantly, those that want to get a plan are priced out of the market by insurance companies who only want healthy customers or big contracts. I honestly don't know what the answer is. Socialized medicine is the easy answer, but I don't believe it is the best. We need an overhaul of laws overseeing insurance plans. They can not be allowed to cherry pic only the best patients and leave the rest for government after they are forced in bankruptcy. We need a populace with better science education so they are better health care consumers. We need more of the money going directly from employers to employees and letting them make choices. We need tort reform to prevent CYA test ordering and lower malpractice costs in a number of states. We need an overhaul of much of the private and public bureaucracatic nonsense that doctors and hospitals have to deal with. You would not beleive how much of our time and recourses go to making nonproductive pencil pushers happy. __________________ I was there to see beautiful naked women. So was everybody else. It's a common failing. Robert A Heinlein in "They Do It With Mirrors"