Interesting healthcare alternative

[Lennys Tap]

I am on medicare. I go every other month for a vitamin B12 shot because I am B12 deficient. At that 15 minute office visit I have all my vitals checked in addition to the shot. My doctor charges medicare 15 dollars for the visit., which I believe is reasonable. When I get these this is not a bill statements from CMS I see medicare allows only a 45 cents payment to the physician which they pay only 36 cents while my co-insurer pay the other 9 cents. How are doctors suppose manage a practice with those reimbursements? If he pays the nurse 20 buck an hour that visit already costs him 5 bucks. Single payer or medicare for all may sound like a great idea, but we won't have any doctors who will accept it at those rates.

Bingo. My internist loses money every time she sees me.

[forgetful]

I am on medicare. I go every other month for a vitamin B12 shot because I am B12 deficient. At that 15 minute office visit I have all my vitals checked in addition to the shot. My doctor charges medicare 15 dollars for the visit., which I believe is reasonable. When I get these this is not a bill statements from CMS I see medicare allows only a 45 cents payment to the physician which they pay only 36 cents while my co-insurer pay the other 9 cents. How are doctors suppose manage a practice with those reimbursements? If he pays the nurse 20 buck an hour that visit already costs him 5 bucks. Single payer or medicare for all may sound like a great idea, but we won't have any doctors who will accept it at those rates.

One thing to remember is that Medicare/Medicaid also has to deal with avoiding unnecessary treatments.  Vitamin B12 shots are often not needed, but doctors give them because it guarantees monthly visits.  Most can supplement B12 orally if they are deficient.  There are cases where it cannot, because of issues with absorption (which is often a sign of H. pylori infection, which should be treated).

There is a medicare approved condition to assure B12 payment, which is then often miscoded to get paid for something that is not medically necessary.

I do wonder how your doctor is coding this, because the actual reimbursement rate for B12 injections is higher than you are reporting. 

[reinko]

I repeat, please point to free market example in health care that has worked. Americans are becoming more unhealthy, fatter, more heart disease, higher cholesterol, coupled with a society that generally wants people to live as long as possible.  Not trying to be crass or mean, but I don't see how the free market can correct our health care system with more and more unhealthy people, with doctors who need lots of training (and are in the decline?), plus people who want to love as long as possible with exorbitant costs.

Don't know the answers, but not convinced it's as easy as making it open market and allowing folks to buy insurance across state lines.

[Lennys Tap]

I repeat, please point to free market example in health care that has worked. Americans are becoming more unhealthy, fatter, more heart disease, higher cholesterol

If Americans are, as you say, becoming more unhealthy as the government and the PI attorneys get more and more involved I think you just answered your own question.

[brewcity77]

I am on medicare. I go every other month for a vitamin B12 shot because I am B12 deficient. At that 15 minute office visit I have all my vitals checked in addition to the shot. My doctor charges medicare 15 dollars for the visit., which I believe is reasonable. When I get these this is not a bill statements from CMS I see medicare allows only a 45 cents payment to the physician which they pay only 36 cents while my co-insurer pay the other 9 cents. How are doctors suppose manage a practice with those reimbursements? If he pays the nurse 20 buck an hour that visit already costs him 5 bucks. Single payer or medicare for all may sound like a great idea, but we won't have any doctors who will accept it at those rates.

Single payer is the way to go but we need a complete overhaul. Big pharma needs to be strangled for how they treat patients. Price gouging for routine procedures needs to be amended. Unnecessary charges need to be done away with.

If you take a ride with a certain private ambulance company in Milwaukee, you'll notice the crew change their gloves at least once. That's so they can double bill for gloves at a rate that is insanely inflated. Crap like that is common practice for most healthcare providers.

The rest of the world is providing healthcare cheaper, and anyone thinking we have some magically better access or technology is nuts. The system is broken. It needs to be rebuilt, and not just on the insurance end. Saving lives should not be a for profit business.

[Benny B]

We don't need single payer... we need no-payer.  As in stop paying for unnecessary treatments.  Prohibit transplants for anyone over 55.  Ban drugs that don't materially postpone death or improve quality of life.  Legalize euthanasia and marijuana.  Put Dr. Oz in jail.  Etc.

[WarriorFan]

In my humble opinion the biggest problem is people don't see the cost of things... they just 'claim it to insurance'.  This is the first thing that needs to be fixed...  how to fix it?
a) put the power in the hands of the consumers - eliminate corporate insurance and make it mandatory (like Switzerland or Netherlands) for people to buy their own insurance
b) make consumers understand the cost of the treatment they desire.  Even in countries with mandatory insurance, the consumer can choose their medical provider based on what they can afford and what their insurance will pay.
c) Put better regulations about medical malpractice in place.  Eliminate frivolous claims that drive up insurance rates for providers which drives up costs.
d)  Eliminate all forms of government sponsored health care.  No government is capable of managing something this big.  I've lived in England and the reason BUPA exists is because the NHS is a clusterf*&K.  Government can subsidize insurance rates for the poor, but should have no hand in care decisions, reimbursement amounts, or even the quality of care provided.

I've lived in lots of countries and seen lots of medical and insurance systems.  After all that experience, "cash and carry" is still my favorite, but the above works in a large society and takes care of the poor as well. 

[Lennys Tap]

Benny and Warrior Fan get my vote for HHS co-czars.

Brew, not so much.

[Pakuni]

Prohibit transplants for anyone over 55.

Why 55?

[rocket surgeon]

Why 55?

yeah-that's only 5 years in to the champions tour

[rocket surgeon]

in what other business, other than attorneys, can you walk out of the place, getting some sort of service or tangible good(s) and not knowing what it cost until you open the bill a few days later?  like a box of chocolates, enn'a so?  i've heard where 2 people, on the same day, having the same issue attended to and getting 2 completely different bills...by a lot!

[forgetful]

We don't need single payer... we need no-payer.  As in stop paying for unnecessary treatments.  Prohibit transplants for anyone over 55.  Ban drugs that don't materially postpone death or improve quality of life.  Legalize euthanasia and marijuana.  Put Dr. Oz in jail.  Etc.

I agree with this...except for maybe the choice of age 55.  How about 65.

[GooooMarquette]

Put Dr. Oz in jail.

+1

[reinko]

A significant issue is that we are a country that values long life.  With long life, comes high high costs, but as a society we have generally accepted the fact that we want to live as long as possible.  A three month stint in intensive care for a 95 year old person costs more than cancer treatment for a toddler.

Before you call me granny killer, I support families to make the best decisions for themselves, but all the econ wizards on this board who think we can solve this problem by selling insurance across state lines or using "free market" principles are kidding themselves.

[rocket surgeon]

A significant issue is that we are a country that values long life.  With long life, comes high high costs, but as a society we have generally accepted the fact that we want to live as long as possible.  A three month stint in intensive care for a 95 year old person costs more than cancer treatment for a toddler.

Before you call me granny killer, I support families to make the best decisions for themselves, but all the econ wizards on this board who think we can solve this problem by selling insurance across state lines or using "free market" principles are kidding themselves.

i get your point, BUT the 95 year old would be covered by medicare-yes i know that's you and i.  the toddler would be covered by hopefully private insurance/mom and dad's.  that is the risk insurance companies must take and is spread around within the pools they create. 

   selling insurance across state lines is like geico vs progressive, etc etc  should have good actuaries to create the competitive pools which should be competitively priced for all involved;both the company and the enrolled. 

one more thing as i alluded to previously-the medical field needs to be compelled to transparency of fees like most other businesses.  in the dental world, we can't have multiple fee schedules.  get rid of the ala carte crap.  i.e. charge per glove, piece of gauze, box of kleenex(nasal discharge apparatus)

[reinko]

i get your point, BUT the 95 year old would be covered by medicare-yes i know that's you and i.  the toddler would be covered by hopefully private insurance/mom and dad's.  that is the risk insurance companies must take and is spread around within the pools they create. 

   selling insurance across state lines is like geico vs progressive, etc etc  should have good actuaries to create the competitive pools which should be competitively priced for all involved;both the company and the enrolled. 

one more thing as i alluded to previously-the medical field needs to be compelled to transparency of fees like most other businesses.  in the dental world, we can't have multiple fee schedules.  get rid of the ala carte crap.  i.e. charge per glove, piece of gauze, box of kleenex(nasal discharge apparatus)

No doubt RS, but their are really old and really sick people in every state across the country.  Not too mention I live in a statically "healthy" state (Massachusetts, I know surprise surprise), you think my state wants anything to do with "unhealthy" states like West Virginia, Alabama, Mississippi...) when it comes to helping to bring down costs? 

I get it, it's super complicated, and not too mention emotional when it comes to care, but I have yet to see a realistic free market solution to health care.

[Eldon]

solid article right here (from earlier today)

https://finance.yahoo.com/news/frustration-mounts-over-premiums-individual-120517040.html

most relevant part, IMO:

A suggestion that she could qualify for financial assistance by earning less only irritates her more. "My whole beef is that the government is telling me: 'If you work less, we'll give you more,'" said Thornton, who's in her 50s.

If people such as Thornton drop out, they not only gamble with their own health. Their departure also means the group left behind gets costlier to cover as healthier customers bail out. That's counter to the whole idea of insurance, which involves pooling risk.

[rocket surgeon]

No doubt RS, but their are really old and really sick people in every state across the country.  Not too mention I live in a statically "healthy" state (Massachusetts, I know surprise surprise), you think my state wants anything to do with "unhealthy" states like West Virginia, Alabama, Mississippi...) when it comes to helping to bring down costs? 

I get it, it's super complicated, and not too mention emotional when it comes to care, but I have yet to see a realistic free market solution to health care.

 "I live in a statically "healthy" state"  don't ya hate having to keep up with the jones's too?

   i find it kinda weird that we have some of the "smartest" people in the world working on this for us too   funny thing what money does to muck things up for us.

[reinko]

"I live in a statically "healthy" state"  don't ya hate having to keep up with the jones's too?

   i find it kinda weird that we have some of the "smartest" people in the world working on this for us too   funny thing what money does to muck things up for us.

Yeah, I had a typo, but Massachusetts has one of the lowest uninsured rates, mandatory youth coverage, one of the lowest rates from obesity/heart disease, yadda yadda...why would MA (or really its insurers) or any other of the statistically healthy states open up its market to  states that have more unhealthy people?

[rocket surgeon]

Yeah, I had a typo, but Massachusetts has one of the lowest uninsured rates, mandatory youth coverage, one of the lowest rates from obesity/heart disease, yadda yadda...why would MA (or really its insurers) or any other of the statistically healthy states open up its market to  states that have more unhealthy people?

not poking you about typo-knew what you meant.  i was saying as you live in a healthy state puts more pressure on you to just say no to culvers, et.al.   i see what you mean though-only thing i can say is, sprinkle in a few unhealthy with more healthy and try to cover their arses.  put some incentives in...? 

[real chili 83]

Anyone believe physician compensation is messed up?

[real chili 83]

Also, healthcare employees are very high users of healthcare in general. 

[rocket surgeon]

Also, healthcare employees are very high users of healthcare in general.

do you mean the pharmaceuticals part of healthcare?

[MU82]

plus people who want to love as long as possible with exorbitant costs.

I want to love at least a half-hour, but I admit I rarely last that long.

As for the cost, you'll have to ask Mrs. 82!

[GooooMarquette]

Also, healthcare employees are very high users of healthcare in general.

Do you have any evidence to support this?