Healthcare Education and Q&A Thread

[GMScud]

Great post Schneed. I sincerely hope your last line is correct. Obama Care is a train wreck. My father is Cheif Legal Officer and Executive VP of Children's National Medical Center here in DC, and he's beside himself with the idiocy of this plan. I wasn't aware of the Disproportionate Share aspect. I'm having dinner with him on Sunday- I'll find out if his hospital has a lot of Medicaid patients and how this wrinkle will affect them. These individual case studies are a great way to look at the impact on the ground level.

And the fact that Obama wants to force this thing through before the August recess is pretty shortsighted IMO.

[saden1]

LOL...I find it super hilarious the same people against universal healthcare are against it because it would mess with government payments to hospitals. I wonder Mr. S10, how many of your hospital's Medicaid patients are emergency care patients.

I say do it right, raise taxes, insure everyone and keep rural hospitals open but weak-ass Obama isn't going to do that. What kind of a public plan is it anyways if there aren't even government hospitals? Perhaps it's time to let those rural hospitals be taken over by the government? If they can't survive on their on to begin with why not turn them into government hospitals? Alternatively we can let them people go ahead and just die.

[GMScud]

Originally Posted by saden1

LOL...I find is super hilarious the same people against universal healthcare are against it because it would mess with government payments to hospitals. I wonder Mr. S10, how many of your hospital's Medicaid patients are emergency care patients.

I say do it right, raise taxes, insure everyone and keep rural hospitals open but weak-ass Obama isn't going to do that. What kind of a public plan is it if there aren't even government hospitals anyways? Perhaps it's time to let those rural hospitals be taken over by the government? If they can't survive on their on to begin with why not turn them into government hospitals? Alternatively we can let them people go ahead and just die.

Kind of like the way you scoff at American history and advocate gigantic government in the same breath??

We've got a big enough shortage of healthcare professionals as it is. Where are we going to find the bureaucracy (qualified) to create and staff government hospitals?

[saden1]

Originally Posted by GMScud

Kind of like the way you scoff at American history and advocate gigantic government in same breath??

We've got a big enough shortage of healthcare professionals as it is. Where are we going to find the bureaucracy (qualified) to create and staff government hospitals?

I'm flexible and acrobatic enough to point out the hypocrisy of American's history, adore America, and advocate for spending more money caring for our people instead of some of our people all in the same breath. I pray I do not offend your sensibility with my views good sir for I have put quite a bit of effort in formulating my thoughts.

As articulated in my previous post the government can buyout these fledgling private hospitals if they can not stand on their own...and I am sure the current hospitals have somewhat enough staff to care for their current patients.

No one said this is was all going to be a cakewalk. One can not possibly expect to enact universal heathcare without some serious ramification to the current system. Unfortunately we have people wanting the balancing act to go on when the elephant needs to be shot before his handlers gets trampled.

[Schneed10]

Originally Posted by saden1

LOL...I find it super hilarious the same people against universal healthcare are against it because it would mess with government payments to hospitals. I wonder Mr. S10, how many of your hospital's Medicaid patients are emergency care patients.

I say do it right, raise taxes, insure everyone and keep rural hospitals open but weak-ass Obama isn't going to do that. What kind of a public plan is it anyways if there aren't even government hospitals? Perhaps it's time to let those rural hospitals be taken over by the government? If they can't survive on their on to begin with why not turn them into government hospitals? Alternatively we can let them people go ahead and just die.

I'm not sure why you're talking about rural hospitals? Ours are inner city Philadelphia, in the poorest section of town.

To answer your question, about 55% of our Medicaid patients are emergency, 30% are maternity, and the rest elective.

The point isn't that we shouldn't have to take care of them. The point is without the Disproportionate Share payments, there won't be a hospital anymore. Our University can't afford to subsidize losses as massive as this would generate.

Based on your response, which was pretty confusing, I'm not sure you fully understand. My point is we're already a government hospital in a lot of respects. We get an $80 million lump sum payment annually from the government just to keep us in business. We need to keep getting that government payment or we'll go out of business.

Being run by the government won't solve anything. Believe me, our management has us running lean and mean, our staffing levels are low. A takeover by government management would not yield any expense reductions. We don't need to be run by the government, we just need to be propped up by the government.

That is if you want poor people to have any healthcare at all. That's reality.

[saden1]

Originally Posted by Schneed10

I'm not sure why you're talking about rural hospitals? Ours are inner city Philadelphia, in the poorest section of town.

To answer your question, about 55% of our Medicaid patients are emergency, 30% are maternity, and the rest elective.

The point isn't that we shouldn't have to take care of them. The point is without the Disproportionate Share payments, there won't be a hospital anymore. Our University can't afford to subsidize losses as massive as this would generate.

Based on your response, which was pretty confusing, I'm not sure you fully understand. My point is we're already a government hospital in a lot of respects. We get an $80 million lump sum payment annually from the government just to keep us in business. We need to keep getting that government payment or we'll go out of business.

Being run by the government won't solve anything. Believe me, our management has us running lean and mean, our staffing levels are low. A takeover by government management would not yield any expense reductions. We don't need to be run by the government, we just need to be propped up by the government.

That is if you want poor people to have any healthcare at all. That's reality.

My sentiments also applies to urban hospitals. I understand the problem fully, we have this bastardized hybrid system where hospitals are "basically government hospitals" when they aught to be "fully taxpayer funded government hospitals."


Let me ask you this, are there any type of savings having universal healthcare would yield? I know the AHA was all for saving taxpayers 155 billion no too long ago if 95% of Americans were coverage.

[dmek25]

schneed, what happens at your hospital right now, if and uninsured person comes in that desperately needs help?

[Schneed10]

Originally Posted by dmek25

schneed, what happens at your hospital right now, if and uninsured person comes in that desperately needs help?

When you say "desperately needs help", I assume you mean emergency care. Like if they're shot, or having a heart attack.

We treat them. We have to by law. It is illegal to turn a patient away from an emergency care setting.

If they're uninsured, we try to collect from them directly. We usually fail because people can't pay. We lose nearly $75 million each year on these patients.

[CRedskinsRule]

In the Obama Care thread a question came up, and I want to bring it here for clarification, keeping in mind this thread's original goal of information

Specifically, I asked for a model that was based not on a homogeneous population. It seemed clear to me that a diverse population would have more stresses on the healthcare system than a uniform nation like Japan or Norway.

In Saden's response he stated

Honest, I can't quite comprehend what difference diversity makes in the field of health care? Care to elaborate with something more than "it has, don't you think," specifically why you think it does. Also, France is very good example of a diverse country with a successful universal health care and relatively low poverty rate.

So, I am asking this question:

Does the diversity of a nation make a difference in the field of health care?

Thanks in advance.

[Schneed10]

Originally Posted by CRedskinsRule

In the Obama Care thread a question came up, and I want to bring it here for clarification, keeping in mind this thread's original goal of information

Specifically, I asked for a model that was based not on a homogeneous population. It seemed clear to me that a diverse population would have more stresses on the healthcare system than a uniform nation like Japan or Norway.

In Saden's response he stated


So, I am asking this question:

Does the diversity of a nation make a difference in the field of health care?

Thanks in advance.

I see what you're getting at, certain races and ethnicities deal with varying levels of incidences of different diseases. But all modern nations have to be ready to treat any illness, no matter how prevalent in their society. I don't think certain nations experience a lower level of cost than we do because of this, I think they experience it because their system is set up to encourage a lower level of utilization of healthcare services.

[CRedskinsRule]

Originally Posted by Schneed10

I see what you're getting at, certain races and ethnicities deal with varying levels of incidences of different diseases. But all modern nations have to be ready to treat any illness, no matter how prevalent in their society. I don't think certain nations experience a lower level of cost than we do because of this, I think they experience it because their system is set up to encourage a lower level of utilization of healthcare services.

Ok, I accept this. I was not necessarily thinking cost when I was asking the questions as much as the difficulties in setting up a national healthcare system, if that is the same thing then i will leave it at this.

[JoeRedskin]

Originally Posted by Schneed10

I see what you're getting at, certain races and ethnicities deal with varying levels of incidences of different diseases. But all modern nations have to be ready to treat any illness, no matter how prevalent in their society. I don't think certain nations experience a lower level of cost than we do because of this, I think they experience it because their system is set up to encourage a lower level of utilization of healthcare services.

Sorry, can you explain walk me through what you mean by the bolded statement?

Saden asserts we can learn something from these systems in revamping the US healthcare system. In your opinion, is that a reasonable assertion?

[Schneed10]

Originally Posted by JoeRedskin

Sorry, can you explain walk me through what you mean by the bolded statement?

This post may help. Essentially the influx of covered patients causes a logjam with wait times, and eventually a lot of people decide going to the doctor isn't worth it (unless it's a serious issue). The longer the wait time for appointments, the more you have people deciding that going to the doctor isn't worth it.

http://www.thewarpath.net/parking-lo...tml#post566223

Originally Posted by JoeRedskin

Saden asserts we can learn something from these systems in revamping the US healthcare system. In your opinion, is that a reasonable assertion?

Yes there are things they do which would be intelligent moves for us to adopt:

1) Other nations don't allow malpractice awards like the US does. Consequently their physicians don't have to pay $50,000 - $100,000 a year in malpractice premiums like ours do, so their lower physician salaries afford them a nice standard of living.

2) I think one source of major excess expense in the US is our overabundance of the best technology. When you have a government-run healthcare system, the government decides how to allocate expensive technologies in hospitals all throughout the country. They decide how many Gamma Knife machines the country needs, and where to put them. However, American hospitals are in business competing with one another, so they tend to go after the latest technology to remain competitive and attract physicians to direct their patients there. This results in a technology "arms race", and lots of technologies get underutilized. Then of course, naturally hospitals put pressure on physicians to make more use of the equipment, and you end up with expensive procedures and treatments in lieu of tried & true methods that may be much cheaper.

If the government could find a way to allocate the technology and equipment without oversaturating, but without jamming appointment times out for weeks and weeks, then I think we'd be in great shape.

[JoeRedskin]

Also, I am curious. What would the costs involved be in simply expanding Medicaid to cover these 45 Million. In your opinion, would it be more or less than the costs anticipated by Obama's legislation.

[Schneed10]

Originally Posted by JoeRedskin

Also, I am curious. What would the costs involved be in simply expanding Medicaid to cover these 45 Million. In your opinion, would it be more or less than the costs anticipated by Obama's legislation.

It's really tough to say without knowing what the reimbursement to hospitals would be under the government plan. My instinct says covering all 45 million under Medicaid would be cheaper.

However to cover the 45 million you'd have to raise the limit on the income level that qualifies people for Medicaid. In doing so, you'd end up covering a lot more than 45 million people, which would get exceedingly expensive.

But in a vacuum, if you covered the 45 million under Medicaid, I think it would be cheaper for the government. However, as discussed in previous posts in this thread, Medicaid reimbursement to hospitals blows, and commercial insurance companies are asked to pay rates to hospitals high enough to cover the losses on Medicaid patients. Adding Medicaid patients (without boosting Medicaid reimbursement rates) would mean an even greater burden would be placed on commercial insurance companies.

Those of us who are insured through the Blue Crosses of the world would pay even higher premiums to make up for even more horrendous Medicaid reimbursement. So while the federal government saves money by covering the 45 million through Medicaid, the ultimate cost on the citizenship is the same.

That's the thing, no matter how you configure the reimbursement and coverage part of the equation, healthcare costs what it costs. You're just debating over who pays for it, and how much. The only way we can make the system better is by actually attacking the cost of delivering care.