Is Obama for real? he must think we are stupid….

“Here’s how it works. Physician decides his price for an office procedure–say a complete physical. He figures based on market rates where he (excuse me—of course many are women!!) decides that $150 is adequate income for his business and fair for the patient. He sets the price at $180. Why? Because medicaid will pay him $80. Medicare will pay him $100. Private policies will pay variable amounts between $100 and $150. And the poor schmoe who pays cash gets the $180 charge. For the Doc, it works out close to his goal of $150. For the taxpayer, it’s a bargain. For the private insurers it’s an issue in a negociation. For the uninsured, it’s getting screwed.”

Right you are, Johnny boy!

(*RESPECTFUL NOD*)

And, yes… agreed… “norming” of fee schedules is part of the optimum solution. The problem is… this “norming” would force medicare/medicaid to INCREASE, not decrease, reimbursement schedules since right now they’re basically gaming the system – as you noted.

BILL

…….In other words it’s a shell game……there’s actually a very good piece about it in today’s NYT because AHIP (liv&win will love this) have conducted a survey which they are trumpeting which shows that not they but the doctors/hospitals are the bad guys……..I actually think there’s much truth in this…..despite my efforts to hold liv&win’s feet to the fire on the role of the insurance companies the major cost inflation problem is at the delivery end because basically the providers (doctors, hospitals, the whole lot of them) are running businesses and it is the rational business manager’s task to maximize profit…..nothing wrong with this because it’s how the the competitive economic model functions…….I have two friends who are doctors one is a very succesful surgeon in the south and the other works in an emergency room outside DC…..both are Republicans…..both make no secret of the fact their aim is to maximize income……but over a Glenmorangie both admit the system is pretty f***** up but in any rejig they want to hold onto their piece of the pie.

But really I’m not surprised at the selfishness, these preaching whiteheads are the hatchers of the me generation. We are looking at the crowd that started the never ending preoccupation with – what am I worth today, let me keep score everyday.

Fiscal conservatives have been pleading for years for some sort of cost-containment in Medicare over the phenomenally expensive pricetag we pay for treatment of the elderly on their deathbeds. End of life planning is a societally responsible pathway to helping place the decision for end of life care in the hands of the patient in consultation with their physicians, rather than potentially guilt-ridden kinfolk and profit-seeking hospital managers.

And in fact, the current provisos have been proposed by Republicans. So faced with Democratic healthcare legislation incorporating those provisions as a means to freeing up healthcare dollars to expand coverage through a public option, Republicans opposed to the public option could:

a) continue to oppose the public option, while stating their support for Democrats finally acknowledging that the public till cannot afford uncontrolled expansion of existing programs, and committing to work with Dems after Obamacare goes down on legislation that provides for end of life planning as a means of preventing Medicare costs from continuing to expand and suck tax money.

b) point out to people that this is a place where the free-market could properly regain lost ground in the healthcare debate, as it is a pathway to limiting government expenditures on high dollar end of life care and expanding a private insurance market for those who want greater coverage than the federal government can afford to provide for all.

b) run to the closest camera and start talking about “death boards”

One could argue that the impulse seen in liberalism to have the state provide for the individual is wholly consistent with their embrace of medicare expansions over conservative opposition in the past. There is nothing ideologically consistent with conservatives demonizing with over-the-top language a proposal that is seemingly a necessary pathway to keep Medicare costs from continuing to suck an ever increasing portion of the budget.

For the Doc, it works out close to his goal of $150. For the taxpayer, it’s a bargain. For the private insurers it’s an issue in a negociation. For the uninsured, it’s getting screwed.

If the Doc had much simpler administrative costs (billing M-caid, M-care and all the private plans requires skilled administrative work and plenty of time waiting for the check), he could lower his fee. If he didn’t need to spent $25K/yr for malpractice insurance, he could lower his fee. If there were a common rate for different insurance plans, he could average out his savings and come up with a price of–say–$120.

Thus simply making things more uniform could result in a 20% lowering of costs without anyone being the poorer (except the skilled administrative worker who now has to look for another line of work.)

‘otto, I am not suggesting fraud, fraud is illegal. I am talking about what happens in a free market when the government sets prices…doctors have no choice but to charge what they can where they can. ”

…….Actually you are, if you say they are falsely inflating private insurers claims to compensate for shortfalls elsewhere…..trust me you are(given schedules of charges this would actually be quite hard to do)

“ALMOST happens ALMOST all the time. First, Anthem wasn’t cutting them off, they were cutting themselves out.”

……..By refusing to accepted a dictated …..oops sorry “negotiated”……..schedule of payments…..sorry you’re the one talking out of both sides of your mouth…..firstly you say insurers don’t “dictate” they “negotiate” payments…..then you say they “have to dictate” because they’re running a business and if they didn’t dictate it would result in various bad outcome…..the fact is both medicare and insurers dictate prices

” First, you are always focused on profits. ”

………..not really it’s just often necessary to respond to your continued obfuscations in this area which probably fly over most people’s heads but I find just a little dishonest

“the fact that those margins might be too high in the first place never crosses your mind?” First, you are always focused on profits. Why? retorical question.