So, The Guy That Made The Decision.......

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Spence
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Re: So, The Guy That Made The Decision.......

Postby Spence » Sun Feb 10, 2019 11:52 pm

billybud wrote:Interesting reading...

https://healthcareinamerica.us/we-all-w ... 6a0cb45253


I think most people believe that the business model is bad. All the tests that Doctors order is to protect themselves from lawsuits. Fixing that would be a good start. People sue if they get a bad outcome. We tend to look at everything in hindsight without considering what was going on in the moment. If a doctor is negligent there should be a process to penalize and if needed revoke his/her license. If that doctor did things right and foreseeing the problem wasn't something he should have in the moment then he should not be held to an impossible standard. Still just fixing tort, would not solve the problem.

As far as insurance is concerned, this I know for sure, whenever the government has required insurance the price goes up. I am paying upwards of $4200 a year in car insurance for me, my wife, and two of my kids. It used to be liability insurance was cheap. Full coverage costed more. When the government required everyone to have insurance liability went through the roof. The same people who didn't have insurance before, still do not have it. You can't get blood from a turnip. The more that government requires, the higher the cost of what they require.

I'm not smart enough to know how to fix the problem, but if I know if my car insurance was half what is is now and I could get insulin under $1500 for 3 months, I would have a pretty good nest egg.

I understand I have to pay for my daughter's illness and that should not fall on my neighbor to pay. I just think that when it comes to a product like insulin, a price more in line with the cost of the product would be fair. Actually 5 times the cost to produce would be awesome.
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Re: So, The Guy That Made The Decision.......

Postby donovan » Tue Feb 12, 2019 4:51 pm

The solution is not simple and the changes needed have long been known. There is room for argument of what part the government should play, but with government involvement, which personally I think keeps anything from changing, or without, the principles to me are the same.

A. Care should be centered on what patients need and not the specialties of the providers or how they are reimbursed. When something goes wrong with our bodies, nothing is independent. Co-morbidities need to be addressed and that is best done not through specialties but by comprehensive attention.

B. Standard costs need to be determined. That data is available but not used. A hip replacement costs 'x' amount. That is known, but to use that figure would lower the cost to the patient. Not something corporations want to do.

C. Reimbursement for services should reflect the actual cost of the service and should be bundled. Unbundling prices seems like transparency but it is actually the opposite and drives up costs exponentially. You have a knee replacement it should cost a fixed amount. Includes everything related to hip replacement, You have your car fixed, they look in a book and charge you that. Time, parts, etc are figured in. Medicine can do the same.

D. Treatment should be in fewer large systems. They may not be as close to home, but overnight stays, travel, etc can be figured in. Better care at a lower cost. Don't forget, it is the delivery system that is broken, not the care.

E Electronic Health Records need to be made available to everyone involved. Reduce duplicity.


Pharmaceuticals are a separate issue. Here is the issue. Modern development happens because of research which costs thousands. Much of that is supported by Tax dollars. If taxes are used then the benefit of the research needs to be made available to those that finance it, the taxpayer. This is how it works. The research company, when developing meds no longer own the patents when tax dollars are used, the government does and it is made available to the public without cost. The manufacturer's cost is merely the cost of making the pills. If tax dollars are not used, then the cost is what it is but I can tell you without tax dollars there will be minimal research. Investors cannot get a return on their dollar. I am not for government intervention, but we have to be pragmatic.
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Re: So, The Guy That Made The Decision.......

Postby Spence » Tue Feb 12, 2019 9:59 pm

That has always been my issue with Pharmaceuticals. If they use tax dollars to fund most or part of the research then why do they need to charge unreasonable rates for the drugs? I would gladly pay 5 times the cost of making my daughters insulin to support research. Maybe in 10 times. But when we do this, we still have to pay $7000 for a pump - that lasts 4 years - my daughter has had several and they never last over 4 years. The continuous monitor that supports the pump is (I believe $1500) every 3 months. Then you need infusion sets, strips to test, a meter that connects to the pump and monitor, and then of course the insulin. She is now in a masters of occupational therapy and hopefully if she graduates on time she will be done in two years at 22 with some time to spare to get a job with good enough insurance to have her own insurance before they kick her off mine at 26. It is very frustrating. In most areas of life people have to set prices base on competition and supply and demand. This really has nothing to do with the medical professionals anymore, it is the administrators and insurance underwriters. It is a huge racket that rivals the mafioso only this is fully legal if not ethical.
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Re: So, The Guy That Made The Decision.......

Postby Derek » Thu Feb 21, 2019 1:09 pm

I travel around the country doing consulting in security as you may or may not know. And I have worked with many hospitals and insurance companies on different occasions.

I think you would be shocked to see how many insurance companies also own hospitals.
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Re: So, The Guy That Made The Decision.......

Postby donovan » Thu Feb 21, 2019 4:46 pm

It is appalling and we continue to look to the people that are purposely causing the problem for the solution.
"No, no!" said the Queen. "Sentence first–verdict afterward."
"Stuff and nonsense!" said Alice "The idea of having the sentence first!"
"Hold your tongue!" said the Queen, turning purple.
"I won't!" said Alice.
"Off with her head!" the Queen shouted at the top of her voice."

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Re: So, The Guy That Made The Decision.......

Postby Spence » Thu Feb 21, 2019 9:27 pm

donovan wrote:It is appalling and we continue to look to the people that are purposely causing the problem for the solution.


Yep
"History doesn't always repeat itself but it often rhymes." - Mark Twain

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Re: So, The Guy That Made The Decision.......

Postby Cane from the Bend » Fri Feb 22, 2019 10:20 pm

Derek wrote:I think you would be shocked to see how many insurance companies also own hospitals.



And perturbed to learn how many of those insurance companies were purchased by big banks shortly after the Obama Bailouts were granted.

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Re: So, The Guy That Made The Decision.......

Postby billybud » Sat Feb 23, 2019 7:24 am

In Florida, it gets even more surreal.

Rick Scott was CEO of HCA/Columbia...a conglomeration of hospitals and clinics...

"Scott started what was first Columbia in 1987, purchasing two El Paso, Texas, hospitals. Over the next decade he would add hundreds of hospitals, surgery centers and home health locations. In 1994, Scott’s Columbia purchased Tennessee-headquartered HCA and its 100 hospitals, and merged the companies.

In 1997, federal agents went public with an investigation into the company, first seizing records from four El Paso-area hospitals and then expanding across the country. The investigation focused on whether Columbia/HCA had committed Medicare and Medicaid fraud.

In December 2000, the U.S. Justice Department announced that Columbia/HCA agreed to pay $840 million in criminal fines, civil damages and penalties.

Among the revelations from the 2000 settlement:

• Columbia billed Medicare, Medicaid, and other federal programs for tests that were not necessary or had not been ordered by physicians;

• The company attached false diagnosis codes to patient records to increase reimbursement to the hospitals;

• The company illegally claimed non-reimbursable marketing and advertising costs as community education;

The government settled a second series of similar claims with Columbia/HCA in 2002 for an additional $881 million. The total for the two fines was $1.7 billion.


Now...for the surreal part...

Rick Scott was elected for two terms as the Republican Governor of Florida and, last month started his tenure as Florida's Senator.

In spite of having been the CEO of a corporation indicted for massive health care fraud. A corporation that settled for a $1.7 billion dollar fine.
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Re: So, The Guy That Made The Decision.......

Postby donovan » Sat Feb 23, 2019 8:10 am

..and HCA was started as a privately owned hospital corporation, first or second largest in the US, not including the VA which is not exempt to all of this, and then around 2006 was bought by Merril Lynch, Bain Capital etc for the largest buyout up until them, did what Venture Captalist do and 4 or 5 years later go public for the large IPO ever making close to 4 Billion, largest IPO ever privately funded. All this after what Mr. Billybud state. It now epitomizes hospital that are run to maximize profits and is high subsidize by the US Government, as are all hospitals. You pay for them and can not afford the benefit they provide. And in all fairness, this is not the only hospital corporation that has a checkered history. Possibly the VA is the worse and it is the second largest hospital chain in the US. (I am just estimating the dates, facts etc, but I think the gist is correct.
"No, no!" said the Queen. "Sentence first–verdict afterward."
"Stuff and nonsense!" said Alice "The idea of having the sentence first!"
"Hold your tongue!" said the Queen, turning purple.
"I won't!" said Alice.
"Off with her head!" the Queen shouted at the top of her voice."

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Re: So, The Guy That Made The Decision.......

Postby Spence » Sat Feb 23, 2019 8:56 pm

We at least Scott should know the ins and outs of medicare fraud. :lol:

The more the government gets involved with things, the more they are abused. The federal government doesn't care if they are getting jobbed because whether or not the care and cost are reasonable has nothing to do with them funding it. Most of the government watchdog organizations are about the fines - which are just legal get out of jail free cards for companies flush with cash. Anytime the government decided to fund anything the costs double. Not without some merit either. The amount of paperwork required to keep up with the government requirements to get paid adds a whole layer of bureaucracy to keep compliant. And the government doesn't seem to care if you defraud them as long as you fill out the right forms and you make the numbers add up.

By the way, I just got the bill for my daughters hip surgery. It was $38,000. The insurance price was $8000 of which my part was $6500. $38,000 down to $6500. I think I would rather cut out the middleman and pay them $6500 cash and move on down the road. Imagine how much of that $6500 the surgery center spent for administering the insurance, the reduced rate they had to except for medicare and even more reduced rate of medicaid. I'm betting if we cut the government out of the equation I get that surgery for under $3000. Which to me would be reasonable for the service rendered.
"History doesn't always repeat itself but it often rhymes." - Mark Twain


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