the new health care?

[SmootSmack]

Originally Posted by dmek25

it seems like some of you guys are pissed that we actually have poor people in this country. sometimes shit happens. even a nation as great as ours fails once in a while.some people genuinely need help. what are we to do with them? throw them to the curb? this is one major party difference. and why it seems to many the G.O.P is out of touch with main stream America

I often get the sense you're pissed there are rich and successful people in this country...but maybe that's just me

[Schneed10]

Originally Posted by dmek25

it seems like some of you guys are pissed that we actually have poor people in this country. sometimes shit happens. even a nation as great as ours fails once in a while.some people genuinely need help. what are we to do with them? throw them to the curb? this is one major party difference. and why it seems to many the G.O.P is out of touch with main stream America

I'm not pissed that we have poor people. It's the choices that SOME of the poor make that pisses me off.

And while many of the poor are making those annoying choices, it should be noted that not all do. Most do, but most should not be generalized into all. So I'll say that.

But getting back on topic, I can't stand how many of the poor decide to wait until the sniffles turns into bronchitis which turns into pneumonia before ever going to see a doctor. Hell, if you're going to abuse the ER and not see a primary doctor, at least do it before the illness turns into something serious. By the time it gets to pneumonia and they get off their ass to get to the hospital, they're in such bad shape that they need to stay in the hospital for 7 days. If they showed up at the ER during the bronchitis stage they could be sent home same day with antibiotics.

Happens here at our hospital all the damn time, and we have to write a lot of it off, and then jack up the rates we ask the insurance companies to reimburse us just to get by. So when the poor do that, it directly affects your insurance premium.

[Trample the Elderly]

Originally Posted by Schneed10

I'm not pissed that we have poor people. It's the choices that SOME of the poor make that pisses me off.

And while many of the poor are making those annoying choices, it should be noted that not all do. Most do, but most should not be generalized into all. So I'll say that.

But getting back on topic, I can't stand how many of the poor decide to wait until the sniffles turns into bronchitis which turns into pneumonia before ever going to see a doctor. Hell, if you're going to abuse the ER and not see a primary doctor, at least do it before the illness turns into something serious. By the time it gets to pneumonia and they get off their ass to get to the hospital, they're in such bad shape that they need to stay in the hospital for 7 days. If they showed up at the ER during the bronchitis stage they could be sent home same day with antibiotics.

Happens here at our hospital all the damn time, and we have to write a lot of it off, and then jack up the rates we ask the insurance companies to reimburse us just to get by. So when the poor do that, it directly affects your insurance premium.

Isn't it mandated by law that you can't refuse them service?

[Schneed10]

Originally Posted by Trample the Elderly

Isn't it mandated by law that you can't refuse them service?

If they show up to the ER, that's correct. By law you have to treat them.

[firstdown]

Originally Posted by dmek25

it seems like some of you guys are pissed that we actually have poor people in this country. sometimes shit happens. even a nation as great as ours fails once in a while.some people genuinely need help. what are we to do with them? throw them to the curb? this is one major party difference. and why it seems to many the G.O.P is out of touch with main stream America

You are totaly off. What we have now is a system that allows the lazy people to stay lazy and just get by on what the goverment provides them. The cycle is passed on to their children and then to their children. The problem they are never forced to take responsability for themself and they become dependent on the goverment for everything. What they really need is a hand up not a hand out and the dems. now have all these people dependent on the goverment so they know they have a hugh voting block as long as the Dems are there to protect their goverment programs. These programs have done nothing to help most of these people and their situation stays the same. The conservative approach is to slowly wing them off the programs and let them learn to become dependent on themself and learn some self pride in the process. I know there will always be people who need help but they also need to show a will to help themself. When the wellfair reform act was passed back in the 90's our local paper followed 10 single mothers with children who had always lived under goverment programs. It was pretty amazing how there attitude on life changed over the year they followed these ladies. Yes they had strugles but they learned to over come them and move on with life. After the year of following them I believe 7 ro 8 where living total on their own without any federal money. The biggest thing I took form keeping up with these ladies is their total attitude toward life and how much more positive they had become.

[dmek25]

it doesnt piss me off. but alot of times it seems that they play by a different set of rules

[FRPLG]

Originally Posted by dmek25

it doesnt piss me off. but alot of times it seems that they play by a different set of rules

How so? I here this a lot but I am never quite sure what it means.

[dmek25]

if you were one of Obama's nominations that didnt pay any of your taxes, what would happen to you?

[Trample the Elderly]

Originally Posted by dmek25

if you were one of Obama's nominations that didnt pay any of your taxes, what would happen to you?

I'd get the job? What, I give up?

Hmm, let me use the F Bill Gates thread logic. If I'm smart enough to evade my taxes and get away with it then I should get the job if the President nominates me. People shouldn't be so jealous of my success! I mean shit . . . . who likes paying their taxes anyway? Taxes are for the people who can't afford attorneys and accountants. If I have enough money I can buy enough influence to get the things / jobs that I want. So piss on all of the little people.

[FRPLG]

Please don't answer a question with a question. It doesn't actually answer the question. And I meant the question genuinely and not in a smart-ass way. I'd really like to hear the reasons for the frustration with the rich. I don't hold them but perhaps I should and just don't know it. I'd really like to understand it more. My uninformed opinion on it is that jealously plays a huge role but upon more reasoned thought I doubt that theory a lot.

[Daseal]

I'm not pissed that we have poor people. It's the choices that SOME of the poor make that pisses me off.

And while many of the poor are making those annoying choices, it should be noted that not all do. Most do, but most should not be generalized into all. So I'll say that.

But getting back on topic, I can't stand how many of the poor decide to wait until the sniffles turns into bronchitis which turns into pneumonia before ever going to see a doctor. Hell, if you're going to abuse the ER and not see a primary doctor, at least do it before the illness turns into something serious. By the time it gets to pneumonia and they get off their ass to get to the hospital, they're in such bad shape that they need to stay in the hospital for 7 days. If they showed up at the ER during the bronchitis stage they could be sent home same day with antibiotics.

Happens here at our hospital all the damn time, and we have to write a lot of it off, and then jack up the rates we ask the insurance companies to reimburse us just to get by. So when the poor do that, it directly affects your insurance premium.

Schneed -- the current health care system not only works like this, it promotes it. I am not insured. There is no way I'm going to the doctor at the first hint of being sick like I may with insurance. A simple doctor's visit for us uninsured can easily cost 250 bucks just to get in the door.

I was uninsured and went through treatment for Lyme disease. Each blood test cost me out of pocket 550 bucks to get the labs necessary to tell if I had Lyme and how to treat it. How much does this exact same test cost for the insurance company? That's right, 225 bucks. That's not how much the insured person pays, it's how much the lab charges. How in the hell is this fair? A service should cost a set amount regardless of if a person is insured or not.

45 minutes in a hospital left me with a 9000 dollar bill. Not including the 900 dollars a week for medicine x 8 weeks.

People are petrified of getting these types of bills for a reason. Hospitals are ridiculously expensive, there's a reason why people don't come in when they're starting to feel bad. Granted it compounds the issue the longer you wait, but you have to understand that people sit down and have to weigh bankruptcy with getting fairly basic health care in this country. That is not okay, in my book.

[Schneed10]

Originally Posted by Daseal

Schneed -- the current health care system not only works like this, it promotes it. I am not insured. There is no way I'm going to the doctor at the first hint of being sick like I may with insurance. A simple doctor's visit for us uninsured can easily cost 250 bucks just to get in the door.

I was uninsured and went through treatment for Lyme disease. Each blood test cost me out of pocket 550 bucks to get the labs necessary to tell if I had Lyme and how to treat it. How much does this exact same test cost for the insurance company? That's right, 225 bucks. That's not how much the insured person pays, it's how much the lab charges. How in the hell is this fair? A service should cost a set amount regardless of if a person is insured or not.

45 minutes in a hospital left me with a 9000 dollar bill. Not including the 900 dollars a week for medicine x 8 weeks.

People are petrified of getting these types of bills for a reason. Hospitals are ridiculously expensive, there's a reason why people don't come in when they're starting to feel bad. Granted it compounds the issue the longer you wait, but you have to understand that people sit down and have to weigh bankruptcy with getting fairly basic health care in this country. That is not okay, in my book.

Right but the difference between you and the "poor" I'm talking about is the poor qualify for Medicaid coverage, you do not. You are simply uninsured or underinsured, which is a totally different conversation. Which you are very right about.

But, that doesn't speak to how the poor handle their healthcare. They have coverage granted to them through the state Medicaid program, so they use the ER as a "frequent flier". They know if they show up to the ER they can't be refused treatment, so they use it for every little thing. Then you have other poor folks who refuse to get treatment until they're very sick, like the pneumonia thing I mentioned. I'm saying the Medicaid programs need to be tweaked to incent the poor to use the system wisely.

As for uninsured patients who make too much money to qualify for Medicaid, that's a totally different discussion. To make that fair, you're talking about a radical change to the way hospitals get reimbursed all throughout the country. Idealogically I 100% agree with your point, however knowing the business like I do, it seems like an unrealistic pipe dream.

[Trample the Elderly]

Originally Posted by Daseal

Schneed -- the current health care system not only works like this, it promotes it. I am not insured. There is no way I'm going to the doctor at the first hint of being sick like I may with insurance. A simple doctor's visit for us uninsured can easily cost 250 bucks just to get in the door.

I was uninsured and went through treatment for Lyme disease. Each blood test cost me out of pocket 550 bucks to get the labs necessary to tell if I had Lyme and how to treat it. How much does this exact same test cost for the insurance company? That's right, 225 bucks. That's not how much the insured person pays, it's how much the lab charges. How in the hell is this fair? A service should cost a set amount regardless of if a person is insured or not.

45 minutes in a hospital left me with a 9000 dollar bill. Not including the 900 dollars a week for medicine x 8 weeks.

People are petrified of getting these types of bills for a reason. Hospitals are ridiculously expensive, there's a reason why people don't come in when they're starting to feel bad. Granted it compounds the issue the longer you wait, but you have to understand that people sit down and have to weigh bankruptcy with getting fairly basic health care in this country. That is not okay, in my book.

Uninsured Unite!

[JoeRedskin]

Originally Posted by Daseal

I was uninsured and went through treatment for Lyme disease. Each blood test cost me out of pocket 550 bucks to get the labs necessary to tell if I had Lyme and how to treat it. How much does this exact same test cost for the insurance company? That's right, 225 bucks. That's not how much the insured person pays, it's how much the lab charges. How in the hell is this fair? A service should cost a set amount regardless of if a person is insured or not.

The reason the insurance companies pay less than uninsured patients is that they negotiate bulk rates and ensure payment. The cost to you, an uninsured patient, reflects not just the cost of the service but, also, the expected returns and additional collection costs when extrapolated over a large population of patients. It's just good business.

Individuals w/out coverage get the same service, true. On average, however, the rate of collection for people w/o insurance is significantly lower. From ten insured patients, the hospital will always collect (and collect relatively promptly) $2,250. From ten uninsured paitients, the hospital may collect $5,500 but will likely collect significantly less and will collect it over a longer time (so it is worth less - 1.00 today is worth more than 1.00 tomorrow) and will incur additional costs in trying to collect it.

Universal insurance with good coverage, good care and cost effective solutions is a chimera. The current system is a Gordian's Knot of insurers, self-insurers, lawyers, doctors and multiple regulatory agencies. Health insurers are subject to regulation by each of the 50 states AND the federal govt. Additionally, doctors and insurers are regulated by different agencies. In the case of doctors, much of the regulation is self-regulation i.e. doctors regulating doctors. One of the reasons malpractice insurance and, thus fees, are so high is b/c bad doctors are allowed to continue practicing by other doctors.

Obama's stated desire to build on the current system sounds wonderful except the idea that he will simply create a govt. "insurer of last resort" is extremely expensive. If it can refuse no one, then it will get all those people too expensive to insure through the traditional coverages.

A national health policy will also have a huge impact on the cost existing coverages. Currently, insurance is a giant ponzi scheme (shhhhhhhh!!) with the healthy funding treatment for the unhealthy. One of the effects of a national policy will be to remove the funding mechanism of traditional employer provided coverages because it allows people to "coverage dip" i.e. otherwise healthy people can dip into universal coverage for benefits but not provide the majority of its funding b/c they generally aren't taxed nearly enough to cover the costs. These large group consists, generally, of people who are young, healthy, w/out children or chronic health issues. If the govt. creates a universal catastrophic care system, then all those essentially healthy people will opt out of the already expensive coverages offered through their employers and rely on the universal national coverage. This then reduces the pool of people who pay premiums from the traditional coverages w/out really reducing the cost to provide for the remaining insureds. Guess who makes up the difference.

Ultimately, IMO, any national healthcare policy will end up being the world's biggest HMO with govt. bureaucrats as medical gatekeepers. To ensure the current number of uninsured for even just catastrophic coverage, I am betting that tax for "premium" would be significant and, further, as a side cost, the premiums for traditional insurance would increase for those who don't rely on the "National HMO".

So yes, universal coverage is absolutely possible. For the lower incomes it will provide minimal coverage where no coverage existed. For the vast number of middle incomes it will, IMO and in the long run, reduce coverage and quality of care and increase costs. For those with high incomes, their will be little or no effect other than to decrease their disposable income.

[Schneed10]

Originally Posted by JoeRedskin

The reason the insurance companies pay less than uninsured patients is that they negotiate bulk rates and ensure payment. The cost to you, an uninsured patient, reflects not just the cost of the service but, also, the expected returns and additional collection costs when extrapolated over a large population of patients. It's just good business.

Individuals w/out coverage get the same service, true. On average, however, the rate of collection for people w/o insurance is significantly lower. From ten insured patients, the hospital will always collect (and collect relatively promptly) $2,250. From ten uninsured paitients, the hospital may collect $5,500 but will likely collect significantly less and will collect it over a longer time (so it is worth less - 1.00 today is worth more than 1.00 tomorrow) and will incur additional costs in trying to collect it.

Pretty good synopsis. Also, I'll add that assessing the cost of a certain procedure is incredibly difficult, even for financial wizards.

If you manufacture a widget, you know how much it cost to purchase supplies, how much you pay the people to make the widget, and how much overhead you need to cover. It's pretty easy.

But with hospitals and procedures, one knee replacement procedure for a 55 year old otherwise-healthy male may take 45 minutes in the OR and be fairly simple, requiring little in the way of resources. The same knee replacement for a 75 year old female with osteoperosis may be incredibly complicated, take 3 hours in the OR, and require more in the way of resources.

We have methods of averaging out costs for various procedures, but in the end they are just estimates. Hospitals have to cover their costs on patients who they can collect from to help subsidize the losses on patients who can't/won't pay a dime.