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Direckshun
09-28-2009, 02:28 PM
I can't believe we really haven't had this thread yet.

But obviously conservatives support tort reform -- even though that doesn't solve the crisis. That's just one part of a gigantic reform package.

But what conservative solutions have been offered to fix healthcare?

I've gone a couple rounds with a couple folks here, and nothing's made sense to me.

Rep to any conservatives who take an honest whack at it.

The Rick
09-28-2009, 02:36 PM
Here's an idea from who many consider to be a rising star in the Republican Party:

http://www.house.gov/ryan/PCA/index.htm

Here's the "short summary":

http://www.house.gov/ryan/PCA/PCAsummary2p.pdf

Garcia Bronco
09-28-2009, 02:40 PM
Easy. Regulate what can and cannot go in the contract between an insurer and an insuree. Elimnate business coverage denial for pre-existing conditions just like group health plans.

wild1
09-28-2009, 02:43 PM
further regulate contract language per post #3

allow insurance to cross state lines

tort reform

properly fund medicare so it does not drain the rest of the system, because gov't payors are the primary upward cost pressure on the system today.

HonestChieffan
09-28-2009, 02:44 PM
Last i read some 800 ammendments had been proposed in senate and house. Maybe those who voted them down or denied them can explain that best.

Unless they didnt read them either.....

Direckshun
09-28-2009, 02:46 PM
Here's an idea from who many consider to be a rising star in the Republican Party:

http://www.house.gov/ryan/PCA/index.htm

Here's the "short summary":

http://www.house.gov/ryan/PCA/PCAsummary2p.pdf

There are six parts to that reform suggestion: Preventing Disease and Promoting Healthier Lifestyles, which is already addressed by liberal healthcare reform. Creating Affordable and Accessible Health Insurance Options is almost verbatim from liberal reform. Equalizes the Tax Treatment of Health Care, Empowering All Americans with Real Access to Coverage puts a small amount of money in consumers' pockets (where are we getting the money from?), but does nothing to lower costs. Modernizing the Medicaid Benefit and Protecting Medicare Beneficiary Choice involves cutting Medicaid and I have no idea what it wants to do with Medicare? Ensuring Compensation for Injured Patients is tort reform. Establishing Transparency in Health Care Price and Quality is a whole bunch of nothing.

jiveturkey
09-28-2009, 02:46 PM
Here's an idea from who many consider to be a rising star in the Republican Party:

http://www.house.gov/ryan/PCA/index.htm

Here's the "short summary":

http://www.house.gov/ryan/PCA/PCAsummary2p.pdfI don't have any issues with his proposal. Seems pretty much like a common sense approach that would garner broad based acceptance.

Direckshun
09-28-2009, 02:47 PM
Easy. Regulate what can and cannot go in the contract between an insurer and an insuree. Elimnate business coverage denial for pre-existing conditions just like group health plans.

Regulating what goes into insurance contracts, and eliminating discrimination for pre-existing conditions.

And you don't support Obama's reform because?

Direckshun
09-28-2009, 02:48 PM
further regulate contract language per post #3

allow insurance to cross state lines

tort reform

properly fund medicare so it does not drain the rest of the system, because gov't payors are the primary upward cost pressure on the system today.

All four ideas are contained in the reform packages in HR 3200 and the Finance bill.

wild1
09-28-2009, 02:55 PM
All four ideas are contained in the reform packages in HR 3200 and the Finance bill.

That's great. That means I approve of one tiny fraction of the implications the overall plan would have.

Garcia Bronco
09-28-2009, 02:56 PM
Regulating what goes into insurance contracts, and eliminating discrimination for pre-existing conditions.

And you don't support Obama's reform because?

It would depend on which bill you are talking about

I don't support Governemnt being the other end of the contract as an insurer. This is Obama's main goal. I believe governemnt should be there to enforce the contract. Most of the bills have some kind of tax for those not submitting to Government control. I have a problem with that. Governemnt has no business making the financial decisions around someones health. Obama has said himself that the elderly account for 80 percent of the cost of governemnt subsidized health care. Governemnt run healthcare puts companies out of business. Medicare and medicaid cap payouts. In short, they'll pay you whatever they want whenever they want. How can a business in the health industry continue to operate under that? How can they compete if they're are publically traded? They can't.

wild1
09-28-2009, 02:56 PM
Regulating what goes into insurance contracts, and eliminating discrimination for pre-existing conditions.

And you don't support Obama's reform because?

Because he doesn't support socialism I guess.

Chief Faithful
09-28-2009, 02:59 PM
Haven't you been reading the news? They are the party of no and haven't offered any solutions. I can't believe you didn't know this.

Taco John
09-28-2009, 03:04 PM
It would depend on which bill you are talking about

I don't support Governemnt being the other end of the contract as an insurer. This is Obama's main goal. I believe governemnt should be there to enforce the contract. Most of the bills have some kind of tax for those not submitting to Government control. I have a problem with that. Governemnt has no business making the financial decisions around someones health. Obama has said himself that the elderly account for 80 percent of the cost of governemnt subsidized health care. Governemnt run healthcare puts companies out of business. Medicare and medicaid cap payouts. In short, they'll pay you whatever they want whenever they want. How can a business in the health industry continue to operate under that? How can they compete if they're are publically traded? They can't.


That's racist.

Garcia Bronco
09-28-2009, 03:05 PM
That's racist.

LOL

Garcia Bronco
09-28-2009, 03:06 PM
I also forgot to add.....these bills DO NOT add doctors and medical staff to the pool. It would immediately drain the system.

wild1
09-28-2009, 03:19 PM
Haven't you been reading the news? They are the party of no and haven't offered any solutions. I can't believe you didn't know this.

If you support one or two ideas in principle, then of course you should support the entire piece of legislation. Unless you are a racist.

Garcia Bronco
09-28-2009, 03:22 PM
Tort reform is important, but the payouts are small compared to the total cost. However, medical malpractice insurance is not. It's huge. This needs to be addressed as well.

wild1
09-28-2009, 03:27 PM
Tort reform is important, but the payouts are small compared to the total cost. However, medical malpractice insurance is not. It's huge. This needs to be addressed as well.

Both are dwarfed by the cost increases that medicare/medicade directly cause. But they would be a step in the right direction, and a fairer direction.

BucEyedPea
09-28-2009, 03:34 PM
separation of state and medicine with a few, noted below, exceptions:

Repeal HMO Act of 1973 ( or whatever year it was back then)
Allow individual's to write off health care premiums and costs.
Health Savings Accounts
Tort Reform-Allow for free-market purchase of Negative Outcomes Insurance

Chiefshrink
09-28-2009, 03:42 PM
The problem for the radical left in the WH is that the majority if not all the solutions for Healthcare Cost Reform from the "Right" involve and come from the "private sector" and *they(WH) will have NONE OF THAT*!!!!!! because that goes against the very "socialistic marxism" they are trying to transform us to.:shake::shake: Therefore we are "just racists":eek::eek:

Direckshun
09-28-2009, 03:50 PM
That's great. That means I approve of one tiny fraction of the implications the overall plan would have.

Actually that's a big part. The exchange is a popular idea that really drives any legislation forward that does NOT have the public option in it.

So the Finance bill, as long as a public option is not added, should probably win favor with you.

Direckshun
09-28-2009, 03:54 PM
It would depend on which bill you are talking about

I don't support Governemnt being the other end of the contract as an insurer. This is Obama's main goal. I believe governemnt should be there to enforce the contract. Most of the bills have some kind of tax for those not submitting to Government control. I have a problem with that. Governemnt has no business making the financial decisions around someones health. Obama has said himself that the elderly account for 80 percent of the cost of governemnt subsidized health care. Governemnt run healthcare puts companies out of business. Medicare and medicaid cap payouts. In short, they'll pay you whatever they want whenever they want. How can a business in the health industry continue to operate under that? How can they compete if they're are publically traded? They can't.

Great post -- I don't agree with it but it is one of the most sober I have EVER read from you, GB. Kudos.

I'll make these points in response to it, though:

1. You're slightly misrepresenting your point of view. You may want government to enforce the contract, but you also want greater government regulation involved in sculpting the contract.

2. You should be covered, that's all government is telling you. What you do with that coverage is 100% up to you, like all coverage. The government will not be making health decisions for you.

Direckshun
09-28-2009, 03:55 PM
Tort reform is important, but the payouts are small compared to the total cost. However, medical malpractice insurance is not. It's huge. This needs to be addressed as well.

Both are dwarfed by the cost increases that medicare/medicade directly cause. But they would be a step in the right direction, and a fairer direction.

That's fair.

wild1
09-28-2009, 04:01 PM
Actually that's a big part. The exchange is a popular idea that really drives any legislation forward that does NOT have the public option in it.

So the Finance bill, as long as a public option is not added, should probably win favor with you.

Yes, what other objections to a fundamental change in the stated purpose and role of government could I possibly have.

patteeu
09-28-2009, 04:10 PM
Repost

Garcia Bronco
09-28-2009, 04:10 PM
Great post -- I don't agree with it but it is one of the most sober I have EVER read from you, GB. Kudos.

I'll make these points in response to it, though:

1. You're slightly misrepresenting your point of view. You may want government to enforce the contract, but you also want greater government regulation involved in sculpting the contract.

2. You should be covered, that's all government is telling you. What you do with that coverage is 100% up to you, like all coverage. The government will not be making health decisions for you.


Regulating what goes into the contract is in another league compared to having a single payer. Or having a public "option".

Garcia Bronco
09-28-2009, 04:15 PM
2. You should be covered, that's all government is telling you. What you do with that coverage is 100% up to you, like all coverage. The government will not be making health decisions for you.

That isn't all the Governemnt is telling you. And they shouldn't have gotten involved to begin with. Only Governemnt would implement something like medicare and they tell you it's broken and robs from other budgets...and then have the nerve to tell you that it can give you better health care at a lower cost.

KCWolfman
09-28-2009, 05:03 PM
That's great. That means I approve of one tiny fraction of the implications the overall plan would have.
Wow, now you have an inkling of the majority of America feels with the public option and the dem plan in general.
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KCWolfman
09-28-2009, 05:08 PM
That isn't all the Governemnt is telling you. And they shouldn't have gotten involved to begin with. Only Governemnt would implement something like medicare and they tell you it's broken and robs from other budgets...and then have the nerve to tell you that it can give you better health care at a lower cost.

While reimbursing providers at 13% of charged services. In Kansas, a level 5 trauma (immediate life threatening with accompanying invasive procedures) is reimbursed by the state at 14.00 with remainder to be written off. 14.00 won't even cover the gas used to get the provider, nurse, cleaning crew, and admissions clerk back and forth to the hospital.

Government programs rob ALL of us, at least all of us who work for a living.
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KCWolfman
09-28-2009, 05:11 PM
Great post -- I don't agree with it but it is one of the most sober I have EVER read from you, GB. Kudos.


2. You should be covered, that's all government is telling you. What you do with that coverage is 100% up to you, like all coverage. The government will not be making health decisions for you.
Why? What reason do you or the government assume I need coverage.
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Direckshun
09-28-2009, 05:25 PM
Yes, what other objections to a fundamental change in the stated purpose and role of government could I possibly have.

The things you're suggesting are that, they are fundamental changes in what government does.

Direckshun
09-28-2009, 05:26 PM
Regulating what goes into the contract is in another league compared to having a single payer. Or having a public "option".

Yup.

Direckshun
09-28-2009, 05:27 PM
Why? What reason do you or the government assume I need coverage.

1. We've had that debate about 9,000 times already in this forum.

2. That's not what this thread is about. You have yet to introduce what you want healthcare reform to look like.

KCWolfman
09-28-2009, 05:31 PM
1. We've had that debate about 9,000 times already in this forum.

2. That's not what this thread is about. You have yet to introduce what you want healthcare reform to look like.

#1. Maybe, I have yet to read it though. I am 45 years old, I have been to a doc once in 25 years. I have an HSA I roll into my retirement plan every 10 years. I can drop the HSA when I reach 52 years of age. Seesm to me you and the government want to take my money without my permission to pay for things I don't need.

#2 I have already provided you with two links on another thread when you asked.
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Chocolate Hog
09-28-2009, 05:40 PM
I can't believe we really haven't had this thread yet.

But obviously conservatives support tort reform -- even though that doesn't solve the crisis. That's just one part of a gigantic reform package.

But what conservative solutions have been offered to fix healthcare?

I've gone a couple rounds with a couple folks here, and nothing's made sense to me.

Rep to any conservatives who take an honest whack at it.

Go look at what tort reform has done for the cost of health care in Mississippi.

Direckshun
09-28-2009, 05:41 PM
I have already provided you with two links on another thread when you asked.

I gotta be honest, I'm dancing in about 8 threads right now, outnumbered in every single one of them, and I don't remember which one we were talking in. If I run across it I'll bring the discussion here but there's no guarantee.

If you want to copy and paste links who do your thinking for you, go for it. Otherwise you're welcome to actually bring your own ideas to the table.

Direckshun
09-28-2009, 05:42 PM
Go look at what tort reform has done for the cost of health care in Mississippi.

I've seen what tort reform has done in Missouri, and Florida, and Texas. It hasn't made much of an impact here.

I'm not saying it's bad, but it's no silver bullet.

Chocolate Hog
09-28-2009, 05:46 PM
I've seen what tort reform has done in Missouri, and Florida, and Texas. It hasn't made much of an impact here.

I'm not saying it's bad, but it's no silver bullet.

Affordable health care is the solution but what is the answer? Tort reform is part of the equation. The other part is a competive market that will lower prices. Forcing people to buy insruance will only make health care more expensive.

KCWolfman
09-28-2009, 05:52 PM
I've seen what tort reform has done in Missouri, and Florida, and Texas. It hasn't made much of an impact here.

I'm not saying it's bad, but it's no silver bullet.

There is no medical malpractice tort reform in MO. That is why the OBGyNs generally practice in KS
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Direckshun
09-28-2009, 05:53 PM
Affordable health care is the solution but what is the answer? Tort reform is part of the equation. The other part is a competive market that will lower prices.

Yeah, that's fair.

Garcia Bronco
09-28-2009, 07:01 PM
While reimbursing providers at 13% of charged services. In Kansas, a level 5 trauma (immediate life threatening with accompanying invasive procedures) is reimbursed by the state at 14.00 with remainder to be written off. 14.00 won't even cover the gas used to get the provider, nurse, cleaning crew, and admissions clerk back and forth to the hospital.

Government programs rob ALL of us, at least all of us who work for a living.
Posted via Mobile Device

People don't understand that medicare and medicaid pays whatever they want and will cap what they'll spend regardless of how much it costs a doctor, medical company, or hospital.

BigRedChief
09-28-2009, 07:16 PM
It would depend on which bill you are talking about

I don't support Governemnt being the other end of the contract as an insurer. This is Obama's main goal. .And one I oppose.



Obama has said himself that the elderly account for 80 percent of the cost of governemnt subsidized health care. Governemnt run healthcare puts companies out of business. Medicare and medicaid cap payouts. In short, they'll pay you whatever they want whenever they want. How can a business in the health industry continue to operate under that? How can they compete if they're are publically traded? They can't.It's a form of price controls. I'm against that. Along those same lines that Bush medicare medicare prescription bill was passed without even giving the government the right to negioate on the price. Big Pharmacy will tell you what you will pay and you'll like it.

BigRedChief
09-28-2009, 07:20 PM
Tort reform is important, but the payouts are small compared to the total cost. However, medical malpractice insurance is not. It's huge. This needs to be addressed as well.I agree with this. There is a lot of defensive medicene. But you do this be prepared for lots more mistakes and you and or your family being a victim of that. If we do do tort reform we need assurances from insursurs that medical malpractice premiums are going to do down also.

KCWolfman
09-28-2009, 07:23 PM
People don't understand that medicare and medicaid pays whatever they want and will cap what they'll spend regardless of how much it costs a doctor, medical company, or hospital.
That is why this supposed reform will cost more and give less. The docs have two choices, either cut back on care or cut back on employees to make up the loss. Then when neither can be cut back anymore, the docs will move on to other viable professions.

That is why Western Europeans and Canadians come here for sugeries. Those that are left there to perform delicate operations aren't intelligent enough to do so adequately. The same could happen here, easily.
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PunkinDrublic
09-28-2009, 07:38 PM
Haven't you been reading the news? They are the party of no and haven't offered any solutions. I can't believe you didn't know this.

When the republicans were the majority they did nothing. They are all about protecting the status quo of our current system because like the so called moderate Dems they've prostituted themselves out to the insurance industry. Not saying the cons on this board don't have any ideas but the republicans and DINOS in office don't want to upset their corporate pimps.

patteeu
09-28-2009, 09:38 PM
I've seen what tort reform has done in Missouri, and Florida, and Texas. It hasn't made much of an impact here.

I'm not saying it's bad, but it's no silver bullet.

Is anyone saying it's a silver bullet? By what measure do you conclude that it hasn't had much impact in those states? Based on what I've read about the Texas version, malpractice premiums have taken a nose dive in response to the reform.

If we can agree that some form of tort reform is a good thing, even if it's not a silver bullet, then we should be able to agree that it ought to be a part of any health care reform package.

Here are a few other things that I think ought to be included:

Eliminate/discourage employer provided health care insurance - If we don't ban it outright, we ought to either eliminate the tax break that businesses get for providing insurance (or, less attractive to me, extend the same tax break to individuals who purchase their own).
Require insurance companies to offer a given insurance product to any individual at the same price. No group pricing.
Establish state-wide risk pools. Only allow limited risk-based pricing discrimination if any.
Make catastrophic coverage mandatory. (This won't sit well with many conservatives)
I'm skeptical of letting insurance companies sell across state lines unless it's under a system like Velvet Jones mentioned in another thread.

Direckshun
09-28-2009, 10:38 PM
People don't understand that medicare and medicaid pays whatever they want and will cap what they'll spend regardless of how much it costs a doctor, medical company, or hospital.

Is it possible that's where some of the $500 billion in Medicare savings is coming from?

I'm still trying to figure that one out.

Direckshun
09-28-2009, 10:45 PM
Is anyone saying it's a silver bullet? By what measure do you conclude that it hasn't had much impact in those states? Based on what I've read about the Texas version, malpractice premiums have taken a nose dive in response to the reform.

If we can agree that some form of tort reform is a good thing, even if it's not a silver bullet, then we should be able to agree that it ought to be a part of any health care reform package.

Fair deal.

Here are a few other things that I think ought to be included:

Eliminate/discourage employer provided health care insurance - If we don't ban it outright, we ought to either eliminate the tax break that businesses get for providing insurance (or, less attractive to me, extend the same tax break to individuals who purchase their own).
Require insurance companies to offer a given insurance product to any individual at the same price. No group pricing.
Establish state-wide risk pools. Only allow limited risk-based pricing discrimination if any.
Make catastrophic coverage mandatory. (This won't sit well with many conservatives)
I'm skeptical of letting insurance companies sell across state lines unless it's under a system like Velvet Jones mentioned in another thread.


The Wyden amendment, which last I checked had been added to the Finance bill, provides for your first item.

The other ones sound reasonable, though I have quibbles with a couple others and I don't see how these items put together would have much of an influence on healthcare premiums.

BigRedChief
09-28-2009, 10:46 PM
Is anyone saying it's a silver bullet? By what measure do you conclude that it hasn't had much impact in those states? Based on what I've read about the Texas version, malpractice premiums have taken a nose dive in response to the reform.

If we can agree that some form of tort reform is a good thing, even if it's not a silver bullet, then we should be able to agree that it ought to be a part of any health care reform package.


Here are a few other things that I think ought to be included:

Eliminate/discourage employer provided health care insurance - If we don't ban it outright, we ought to either eliminate the tax break that businesses get for providing insurance (or, less attractive to me, extend the same tax break to individuals who purchase their own).
Require insurance companies to offer a given insurance product to any individual at the same price. No group pricing.
Establish state-wide risk pools. Only allow limited risk-based pricing discrimination if any.
Make catastrophic coverage mandatory. (This won't sit well with many conservatives)
I'm skeptical of letting insurance companies sell across state lines unless it's under a system like Velvet Jones mentioned in another thread.
I'm okay with this. But whats the downside to selling insurance across state lines?

KCWolfman
09-28-2009, 11:08 PM
Is it possible that's where some of the $500 billion in Medicare savings is coming from?

I'm still trying to figure that one out.

Nope, supposedly it is from fraud and preventive testing to remove malfeasance.

Evidently this has been a problem for some time but cannot be addressed until after the bill is passed.....

patteeu
09-29-2009, 07:45 AM
Fair deal.



The Wyden amendment, which last I checked had been added to the Finance bill, provides for your first item.

The other ones sound reasonable, though I have quibbles with a couple others and I don't see how these items put together would have much of an influence on healthcare premiums.

I forgot to add Medical Savings Accounts. The attempt to address healthcare costs would be in the tort reform and the attempt to shift the 3rd party payer paradigm toward catastrophic coverage away from what we have today. People would be expected to pay for their routine care directly.

I'd also have the mandatory catastrophic coverage be based on something less than cutting edge technology. You'd be required to get catastrophic coverage at the basic level, but if you want coverage for the latest and most expensive innovations (e.g. patented miracle drugs, transplants, etc.), you'd have to pay a premium for it. In other words, rationing would be handled by the marketplace instead of government death panels.

Edit: Oh, and by mandating coverage, you also bring the healthy, young people into the insurance pool. By spreading the risk thinner, you reduce the cost per person (while increasing the cost to those who otherwise wouldn't carry insurance, of course). I know many conservatives oppose this, but if we're going to have universal access to healthcare as we already do, we might as well make the funding mechanism explicit rather than forcing healthcare providers to shift costs to paying customers to make up for nonpayment from the deadbeats and underpayment from the government.

patteeu
09-29-2009, 07:49 AM
I'm okay with this. But whats the downside to selling insurance across state lines?

The downside that I'm concerned with is that once insurance companies start selling their products nationwide, regulation of those products is going to be likely to migrate from the 50 state governments to the federal government. That's why I thought Velvet's ideas had some merit. I don't remember exactly what they were, but he had a scheme that would allow insurance companies to sell across state lines while regulation for those companies would remain at the state level. Purchasers would have to accept the fact that they were making themselves subject to another state's legal system and regulatory scheme if they bought an out-of-state insurance product.

Velvet_Jones
09-29-2009, 10:05 AM
When the republicans were the majority they did nothing. They are all about protecting the status quo of our current system because like the so called moderate Dems they've prostituted themselves out to the insurance industry. Not saying the cons on this board don't have any ideas but the republicans and DINOS in office don't want to upset their corporate pimps.

This is why we can't have nice things. You are assuming that the republicans thought it was the place of the federal government to run roughshod over the states and 2 industries. This is a fundamental difference in what the role government should play.

Chief Faithful
09-29-2009, 10:33 AM
When the republicans were the majority they did nothing. They are all about protecting the status quo of our current system because like the so called moderate Dems they've prostituted themselves out to the insurance industry. Not saying the cons on this board don't have any ideas but the republicans and DINOS in office don't want to upset their corporate pimps.

At least it was a bi-partisan do nothing.

BigRedChief
09-29-2009, 11:54 AM
The downside that I'm concerned with is that once insurance companies start selling their products nationwide, regulation of those products is going to be likely to migrate from the 50 state governments to the federal government. That's why I thought Velvet's ideas had some merit. I don't remember exactly what they were, but he had a scheme that would allow insurance companies to sell across state lines while regulation for those companies would remain at the state level. Purchasers would have to accept the fact that they were making themselves subject to another state's legal system and regulatory scheme if they bought an out-of-state insurance product.
Sounds good. You can sell across state lines but each state can set the rules and regulations. :thumb:

You don't want to deal with extra paperwork, another beauracy? stay out of that state. States will then modify approachs to attract business. jeeezzz that does sound awful Republican.....Going to have to go watch a Michael Moore film to cleanse the palete.

KCWolfman
09-29-2009, 01:11 PM
The downside that I'm concerned with is that once insurance companies start selling their products nationwide, regulation of those products is going to be likely to migrate from the 50 state governments to the federal government. That's why I thought Velvet's ideas had some merit. I don't remember exactly what they were, but he had a scheme that would allow insurance companies to sell across state lines while regulation for those companies would remain at the state level. Purchasers would have to accept the fact that they were making themselves subject to another state's legal system and regulatory scheme if they bought an out-of-state insurance product.

Actually, a company could set a dummy headquarter in the state in which they were selling and adhere to the state laws of that office. That would be less mind boggling for the insured, IMO.

KCWolfman
09-29-2009, 01:13 PM
Sounds good. You can sell across state lines but each state can set the rules and regulations. :thumb:

You don't want to deal with extra paperwork, another beauracy? stay out of that state. States will then modify approachs to attract business. jeeezzz that does sound awful Republican.....Going to have to go watch a Michael Moore film to cleanse the palete.

Wow, what a horrid idea that states actually control and regulate themselves.

That concept hasn't been thrown around since Madison, Jefferson, and Hamilton. Someone stop these crazy ideas now before people actually can take care of themselves without federal intervention.

JohnnyV13
09-29-2009, 01:30 PM
Sounds good. You can sell across state lines but each state can set the rules and regulations. :thumb:

You don't want to deal with extra paperwork, another beauracy? stay out of that state. States will then modify approachs to attract business. jeeezzz that does sound awful Republican.....Going to have to go watch a Michael Moore film to cleanse the palete.

Wait, you mean citizens might be able to CHOOSE which regulatory regime they will adhere to?

HEATHEN!!!! What are you thinking! Don't you know that residence in a state means they should have NO CHOICE? They are simply subject to their local county, municipality, state, and federal government???? If you let people think they have a CHOICE...why...why.....they might actually think they can vote for someone besides an incumbent congress candidate!!!!

ANARCY!!!!

Velvet_Jones
09-29-2009, 09:14 PM
Sounds good. You can sell across state lines but each state can set the rules and regulations. :thumb:

You don't want to deal with extra paperwork, another beauracy? stay out of that state. States will then modify approachs to attract business. jeeezzz that does sound awful Republican.....Going to have to go watch a Michael Moore film to cleanse the palete.

Fundamentally, it has to do with states agreeing to deal with extraterritorial law, which most states do not want to deal with which they are already dealing with in several other areas such as vehicle registration rules and taxes on personal property purchases. I think having the Fed involved in trying to organize legislation between states would go along way to opening up across state purchasing and competition.

Hey - WTF? - isn't that what the constitution charters as one of the Fed's enumerated powers? Maybe they should stick to what they are supposed to do for once instead of taking control of an industry in an attempt to nationalize it.

Velvet_Jones
09-29-2009, 09:36 PM
The real problem is that the states want to mandate first dollar benefits and benefit structures such as copays for specific serviced and preventative care. I would probably agree that the consumer also wants that but that is because they are ignorant of what insurance really is for, insuring your wealth against a catastrophic event, not to pay for regular checkups and a trip to the doctor because of a sniffle. For that Dr. visit, the insured only pays, maybe $30, while the insurance company is on the hook for maybe $120 - $170. If the insured had vested financial interest, I can guarantee you that the insured would shop around and the market pressure would force down priced.

The company I work for offers HSA policies to out customers and it is simply amazing how involved and educated a person gets all of a sudden when it’s their money at stake. I have an HSA and really like it as well. Never hurts to put the incentive in the right place.

My last point is that MediCare is artificially affecting the market. For that same Dr. office visit I mentioned above, Medicare may pay only $25-$50 (sometimes close to or less than the provider’s cost to provide this service). This causes the providers to increase their prices for consumers with private insurance to offset those losses. Its as simple as that. I predict that if the lefties get their way, most providers will refuse to service people with the government program unless it is mandated. If it is mandated, they will go do something else. That’s when the liberal utopia will end and the damage will be realized. The libs are just too stupid to understand that.

patteeu
09-29-2009, 11:36 PM
No offense to any of the other posters, but I'm ready to make Velvet Jones the ChiefsPlanet healthcare reform Czar.

JohnnyV13
09-30-2009, 12:56 AM
If the insured had vested financial interest, I can guarantee you that the insured would shop around and the market pressure would force down priced.

The company I work for offers HSA policies to out customers and it is simply amazing how involved and educated a person gets all of a sudden when it’s their money at stake. I have an HSA and really like it as well. Never hurts to put the incentive in the right place.

My last point is that MediCare is artificially affecting the market. For that same Dr. office visit I mentioned above, Medicare may pay only $25-$50 (sometimes close to or less than the provider’s cost to provide this service). This causes the providers to increase their prices for consumers with private insurance to offset those losses. Its as simple as that. I predict that if the lefties get their way, most providers will refuse to service people with the government program unless it is mandated. If it is mandated, they will go do something else. That’s when the liberal utopia will end and the damage will be realized. The libs are just too stupid to understand that.

Exactly, consumers need to benefit by using medical services in a cost effective manner. We also need to force physicians to list fees on an online database. And, include a physician rating system like most insurance companies have internally.

If people can figure out sabermetrics, then they will eventually get used to physician rating data.

BucEyedPea
09-30-2009, 01:27 AM
Exactly, consumers need to benefit by using medical services in a cost effective manner. We also need to force physicians to list fees on an online database. And, include a physician rating system like most insurance companies have internally.

If people can figure out sabermetrics, then they will eventually get used to physician rating data.

That is fascism to force something like that. Sorry but those who do that will just lure in patients or customers over the ones that don't. In fact there was a doctor mentioned on Lew's site who said he posts his, no longer takes insurance or medicare. He's kept it simple and he's doing just fine. Just what the doctor ordered.

KCWolfman
09-30-2009, 01:29 AM
That is fascism to force something like that. Sorry but those who do that will just lure in patients or customers over the ones that don't. In fact there was a doctor mentioned on Lew's site who said he posts his, no longer takes insurance or medicare. He's kept it simple and he's doing just fine. Just what the doctor ordered.

You could still list average fees nationwide and average local fees without asking the providers permission - which would engage the same results

KCWolfman
09-30-2009, 01:36 AM
In fact there was a doctor mentioned on Lew's site who said he posts his, no longer takes insurance or medicare. He's kept it simple and he's doing just fine. Just what the doctor ordered.


Which raises an interesting point not yet addressed. Let's say the public option passes - are providers required to accept the insurance? In the real world today (under a non-assigned, non-HMO plan) a provider can see anyone with any insurance. If the provider is not contracted with the insurance company, the patient or the guarantor must pay the difference of the full charges minus those paid by the provider. For example:


Contracted
Provider Charge
$500
Insurance Pays
$150
Insurance Write Off
$250
Patient Pays
$100


Not Contracted
Provider Charge
$500
Insurance Pays
$150
Insurance Write Off
$0
Patient Pays
$350

Will the public option be mandatory contracted with providers? If so, it is unconstitutional as well. If not, then providers across the nation can say they aren't signing up.

BucEyedPea
09-30-2009, 01:40 AM
Which raises an interesting point not yet addressed. Let's say the public option passes - are providers required to accept the insurance? In the real world today (under a non-assigned, non-HMO plan) a provider can see anyone with any insurance. If the provider is not contracted with the insurance company, the patient or the guarantor must pay the difference of the full charges minus those paid by the provider. For example:

Contracted

Provider Charge Insurance Pays Insurance Write Off Patient Pays $500 $150 $250 $100


Not Contracted

Provider Charge Insurance Pays Insurance Write Off Patient Pays $500 $150 $0 $350


Will the public option be mandatory contracted with providers? If so, it is unconstitutional as well. If not, then providers across the nation can say they aren't signing up.

Well, if you pay cash now, you usually get a third discount ( at least) and I've seen it as high as 50%. The docs charge insurance more. I was offered half off for a planned C-section when I thought I was going to have to pay for it fully. ( I had a high deductible since I only had catastrophic.) So the fee was $15,000 and they said if I paid $7,000 that would be all I'd be billed for. Not bad deal.

KCWolfman
09-30-2009, 01:47 AM
Well, if you pay cash now, you usually get a third discount ( at least) and I've seen it as high as 50%. The docs charge insurance more. I was offered half off for a planned C-section when I thought I was going to have to pay for it fully. ( I had a high deductible since I only had catastrophic.) So the fee was $15,000 and they said if I paid $7,000 that would be all I'd be billed for. Not bad deal.

That was merely a nicety of the facility you visited. Had they wanted, they could have charged full price.

My question is will providers be forced to accept a contract with the public option? They currently are not forced to contract with Medicare. In fact, a provider I worked for in Florida would only accept a base of no more than 36% Medicare patients or he said he could not afford to practice medicine. When we reached the 36% level, we turned away other Medicare recipients.

googlegoogle
09-30-2009, 02:09 AM
hospitals must make prices transparent. Doctors too. The game is up.

Patients should be allowed to leave the hospital and stay in their own beds - if not dangerous to the patient. Bed stays are expensive.

JohnnyV13
09-30-2009, 02:28 AM
That is fascism to force something like that. Sorry but those who do that will just lure in patients or customers over the ones that don't. In fact there was a doctor mentioned on Lew's site who said he posts his, no longer takes insurance or medicare. He's kept it simple and he's doing just fine. Just what the doctor ordered.

This situation is where you show yourself to be an idealogue.

Many times regulation and government interference in markets can cripple businesses; at times, government intervention can speed adoption of rational solutions. And, as the saying goes, time is money.

If we create a system in which consumers get rewarded for cost effective use of health care services, consumers would be greatly aided by a database in which they can quickly compare prices.

The free market will eventually meet this need, but it will take months or years before physicians are virtually all listed on one convenient database.

In the intervening time, your vaunted free market won't operate as efficiently as it should due to the information bottleneck. And, its not like we're going to see business innovation with a phreaking database. (And, if someone CAN do this with a substantial benefit, like FedEx over the postal office, they'll start a company).

2ndly, the "fascist" nature of this regulation isn't exactly onerous. A doctor's office will spend about 30 minutes filling out a form once a year. OH OH OH....how terrible. They're SLAVES!!!!!

BUT BUT BUT...its the HOLY IDEA that's violated!!!!!

First of all, fascist is something of a hot button term. I mean, really, a regulation requiring doctors to provide pricing information is analogous to goose stepping nazi's???

Aside from your attempt at totalitarian fear mongering, use of the term fascist is technically incorrect. The economic component of "fascist" idealogy was premised on the idea of maintaining government run ventures in each market segment to prevent private industry from developing monopolistic markets.

However, free market capitalism solved this issue by government anti-trust regulation (which even you seem to accept as necessary).

THis isn't the only example of your impractical ideology. In another thread, I mentioned that eliminating the complex tax exclusions in our code would cause a deep recession. You ridiculed me as thinking that "our economy can't survive without government spending", based on your presumptions about "keynsians". You assured me that deep sixing the tax code would have nothing but unicorns and rainbows benefits for the economy.

What you didn't understand was I had made a realistic and very pragmatic analysis based in the idea that many accountants, lawyers, and tax specialists would suddenly find themselves out of work, while many businesses built to exploit tax advantages would suddenly become non-viable. Since the tax code is extremely pervasive, the economic disruption would be huge, and ....any analyst with an IQ larger than her shoe size would realize a recession would occur.

Why didn't you see it? You have an IQ larger than your shoe size. What blinded you?

Its called IDEOLOGY.

And, Ideology actually makes you less likely to achieve your goals, because you neglect the practical obstacles to the reality you desire to shape.

In this case, you fail to recognize that even legislators who are your ideological allies won't want to sacrifice their political careers on the altar of your recession just so you can trumpet your ideological victory (and. tangentially, create a long term boost to the US economy).

To win, you're gonig to have to figure out a way to deep six the tax code while minimizing the economic impact. (Realisticially, you won't get rid of all the short term economic consequences, you're going to have to engage in a long term education campaign to persuade the public about the benefits to build a mandate that will overcome the pain. You will also probably require the correct historical "moment".)

BUt, if you talk to a legislator and never see anything but unicorns and rainbows, you're going to get summarily booted out of his office.

BigRedChief
09-30-2009, 07:17 AM
This situation is where you show yourself to be an idealogue.

Many times regulation and government interference in markets can cripple businesses; at times, government intervention can speed adoption of rational solutions. And, as the saying goes, time is money.

If we create a system in which consumers get rewarded for cost effective use of health care services, consumers would be greatly aided by a databased in which they can quickly compare prices.

The free market will eventually meet this need, but it will take months or years before physicians are all virtually all listed on one convenient database.

In the intervening time, your vaunted free market won't operate as efficiently as it should due to the information bottleneck. And, its not like we're going to see business innovation with a phreaking database. (And, if someone CAN do this with a substantial benefit like FedEx over the postal office, they'll start a company).

2ndly, the "fascist" nature of this regulation isn't exactly onerous. A doctor's office will spend about 30 minutes filling out a form once a year. OH OH OH....how terrible. They're SLAVES!!!!!

BUT BUT BUT...its the HOLY IDEA that's violated!!!!!

First of all, fascist is something of a hot button term. I mean, really, a regulation requiring doctors to provide pricing information is analogous to goose stepping nazi's???

Aside from your attempt at totalitarian fear mongering, use of the term fascist is technically incorrect. The economic component of "fascist" idealogy was premised on the idea of government run ventures in each market segment to prevent private industry from developing monopolistic markets.

However, free market capitalism solved this issue instead by government anti-trust regulation (which even you seem to accept as necessary).

Why didn't you see it? You have an IQ larger than your shoe size. What blinded you?

Its called IDEOLOGY.

And, Ideology actually makes you less likely to achieve your goals, because you neglect the real obstacles to the reality you desire to shape.


Filling out paperwork once a year for 30 mintues = facismROFL

patteeu
09-30-2009, 08:15 AM
That is fascism to force something like that.

Good grief.

BucEyedPea
09-30-2009, 08:53 AM
That was merely a nicety of the facility you visited. Had they wanted, they could have charged full price.

My question is will providers be forced to accept a contract with the public option? They currently are not forced to contract with Medicare. In fact, a provider I worked for in Florida would only accept a base of no more than 36% Medicare patients or he said he could not afford to practice medicine. When we reached the 36% level, we turned away other Medicare recipients.

I've had that offered to me at least three times more and I know someone who got some expensive testing completly not charged for due to his circumstances.

One doctor told me right out charging me 30-50% less is only what he's going to be paid by insurance anyway....and there's less paperwork. They love it.

I can't speak for everyplace but here it's more a rule of thumb that if you pay cash it's a third off. I went for a simple physical a couple of years ago and cash patients ( I was back on insurance then) were being charged $175 and the insurance folks $375. Of course the insurance only pays them the discounted rate.

Can't answer your second question. I guess if we're socialized unConstitutionally into a "public option" then I don't see anything wrong with posting rates.

BucEyedPea
09-30-2009, 08:54 AM
I see JohnnyV, the died-in-the-wool Keynesian ( ideology) is projecting again. LMAO

Funny, how many times, have I admitted being a former Democrat and liberal including being for socialized healthcare/insurance.
I didn't change my mind based on ideology, I came to it from living life, having a small business in an extremely competitive profession and finding out
on my own what works...later supplemented by learning more from people who knew more than me on economics to give me intellectual support to my
real world observations. Can't beat the school of hard-knocks....some ideology. You act like the ideology came first without question, when it flowed in the
opposite sequence; and I still change my mind on some things when a good rational argument is made but not when someone is babbling idiocies that don't work.

Johnny is frustrated. Are you having a bad morning Johnny?

BucEyedPea
09-30-2009, 09:07 AM
Filling out paperwork once a year for 30 mintues = facismROFL

No forcing them to do things that are not essential to reasonable safety or fraud prevention, but for egalitarian purposes is fascism. Govt micromanagment violates property rights because ownership is the right to control. This is supposed to be a free country which means the markets are to be free too. This system is also based on private property rights. The Constitution protects the right to "life, liberty and property." It does not protect a right to health insurance, or medical care or cheap goods and services delivered by other industries. That's within the fascist model. Just a fact.

patteeu
09-30-2009, 09:08 AM
BucEyedPea doesn't think she's an ideologue! ROFL

BucEyedPea
09-30-2009, 09:20 AM
At least my ideology matches our Founding more. Freedom, free-markets, anti-big-govt, pro-limited-govt, peace, trade and prosperity.
It is the opposite of fascism, socialism or any other brand of statism ( including the American exceptionalism of neo-conservativism, national greatness, empire or global governance).
Not a bad one to have. Of course I'm biased but so is everyone else here.

Demonpenz
09-30-2009, 09:23 AM
Something needs to be done, too many people not getting the care they need, or at outragous cost.

BucEyedPea
09-30-2009, 09:23 AM
Something needs to be done, too many people not getting the care they need, or at outragous cost.

separation of state and medicine would be a vast improvement

Demonpenz
09-30-2009, 09:34 AM
we should have care for everyone who needs it and raise taxes across the board to pay for it. No one wants to raise taxes, but we are the richest country yet there are still people who can't get coverage.

patteeu
09-30-2009, 09:49 AM
Something needs to be done, too many people not getting the care they need, or at outragous cost.

How much do you think a heart transplant should cost?

BucEyedPea
09-30-2009, 09:50 AM
we should have care for everyone who needs it and raise taxes across the board to pay for it. No one wants to raise taxes, but we are the richest country yet there are still people who can't get coverage.

That's socialism and communism...each according to need and ability to pay.
Oh, and our prosperity is in decline due to similar policies you advocate here.
It would be made worse with a tax rate of over 50% like they pay in some European countries.
Nope, I don't want that. I'll take my chances.

patteeu
09-30-2009, 09:51 AM
we should have care for everyone who needs it and raise taxes across the board to pay for it. No one wants to raise taxes, but we are the richest country yet there are still people who can't get coverage.

What do you mean by "need"? Everyone who gets smashed up in a car accident gets treatment today. Are you talking about "care" or "coverage", because they aren't the same thing?

dirk digler
09-30-2009, 10:05 AM
Edit: Oh, and by mandating coverage, you also bring the healthy, young people into the insurance pool. By spreading the risk thinner, you reduce the cost per person (while increasing the cost to those who otherwise wouldn't carry insurance, of course). I know many conservatives oppose this, but if we're going to have universal access to healthcare as we already do, we might as well make the funding mechanism explicit rather than forcing healthcare providers to shift costs to paying customers to make up for nonpayment from the deadbeats and underpayment from the government.

Holy shit I can't believe you said this. I am shocked and speechless.


No offense to any of the other posters, but I'm ready to make Velvet Jones the ChiefsPlanet healthcare reform Czar.

Since Velvet has slowed the name calling down I agree because he is pretty smart when it comes to this discussion and I appreciate his insight and knowledge.

Velvet_Jones
09-30-2009, 10:43 AM
You could still list average fees nationwide and average local fees without asking the providers permission - which would engage the same results

FYI - that data already exists. Its what Medicare bases its payment schedule on. There are two ways to look at this data, a percentile table of billing practices broken out geographically, or CMS's own relative value tables which is also geographically based. The government already has this data and CMS will sell it to you as well as other outlets such as Ingenix. My company pays CMS a little over $6000 per year for that data.

Would it not be appropriate and a good use of tax payers funds to publish that data?

KCWolfman
09-30-2009, 11:23 AM
we should have care for everyone who needs it and raise taxes across the board to pay for it. No one wants to raise taxes, but we are the richest country yet there are still people who can't get coverage.

There are also people who CHOOSE not to have coverage by having iPhones, cable television, big screen TVs, newer cars.... etc etc etc

KCWolfman
09-30-2009, 11:31 AM
FYI - that data already exists. Its what Medicare bases its payment schedule on. There are two ways to look at this data, a percentile table of billing practices broken out geographically, or CMS's own relative value tables which is also geographically based. The government already has this data and CMS will sell it to you as well as other outlets such as Ingenix. My company pays CMS a little over $6000 per year for that data.

Would it not be appropriate and a good use of tax payers funds to publish that data?

CMS is a horrible sampling as it takes less than 6% of actual providers of a region into account. I worked for emergency medical providers for more than 20 years. I built the expected reimbursement rate into their software database to project returns for more than 10 years.

But if you are gonna use CMS, it doesn't need to be published, it can simply be accessed online with a password. I download annually from www.cms.hhs.gov. You can download as a PDF or XLS or even a TXT file according to the CPT-4.

Velvet_Jones
09-30-2009, 12:03 PM
CMS is a horrible sampling as it takes less than 6% of actual providers of a region into account. I worked for emergency medical providers for more than 20 years. I built the expected reimbursement rate into their software database to project returns for more than 10 years.

But if you are gonna use CMS, it doesn't need to be published, it can simply be accessed online with a password. I download annually from www.cms.hhs.gov. You can download as a PDF or XLS or even a TXT file according to the CPT-4.

The chance that a person is going to know what CPT-4 code the doctor is going to use is unlikely. The data needs to be grouped by some other means, like maybe a type of service and include general relative or average expense. I think they have the data to do that. I just think they need to expose that information for the consumers of healthcare.

As far as the sampling, it maybe only 6% but it is what Medicare bases it reimbursement on and we back-office process claims for a couple Medicare Advantage companies.

Also, we pay for the crosswalk file between ICD-9 and CPT-4/HCPCS codes as well.

For our indemnity plans, we use U&C data from Ingenix.

KCWolfman
09-30-2009, 12:21 PM
The chance that a person is going to know what CPT-4 code the doctor is going to use is unlikely. The data needs to be grouped by some other means, like maybe a type of service and include general relative or average expense. I think they have the data to do that. I just think they need to expose that information for the consumers of healthcare.

As far as the sampling, it maybe only 6% but it is what Medicare bases it reimbursement on and we back-office process claims for a couple Medicare Advantage companies.

Also, we pay for the crosswalk file between ICD-9 and CPT-4/HCPCS codes as well.

For our indemnity plans, we use U&C data from Ingenix.

As a provider, I will let you know, I don't even fight Usual and Customary. I simply call the insurance provider and tell them if they don't pay the full amount billed, we will balance bill patient. And we do. More than 50% of the time, the provider pays

U&C is usually does by lazy outsources who generally don't get the information accurate.

HonestChieffan
09-30-2009, 12:23 PM
There are also people who CHOOSE not to have coverage by having iPhones, cable television, big screen TVs, newer cars.... etc etc etc

No TV? No fancy phone? WTF are you talking about!!!

BigRedChief
09-30-2009, 12:26 PM
There are also people who CHOOSE not to have coverage by having iPhones, cable television, big screen TVs, newer cars.... etc etc etcThats the people that should be taxed, or some kind of penalty done before they crash their car or get cancer and then its me and you picking up their medical bills.

googlegoogle
09-30-2009, 12:51 PM
Filling out paperwork once a year for 30 mintues = facismROFL

Do you do your own taxes?

Try running a business dumbass. Do it. Paperwork surprise for you!

JohnnyV13
09-30-2009, 01:50 PM
I see JohnnyV, the died-in-the-wool Keynesian ( ideology) is projecting again. LMAO

Funny, how many times, have I admitted being a former Democrat and liberal including being for socialized healthcare/insurance.
I didn't change my mind based on ideology, I came to it from living life, having a small business in an extremely competitive profession and finding out
on my own what works...later supplemented by learning more from people who knew more than me on economics to give me intellectual support to my
real world observations. Can't beat the school of hard-knocks....some ideology. You act like the ideology came first without question, when it flowed in the
opposite sequence; and I still change my mind on some things when a good rational argument is made but not when someone is babbling idiocies that don't work.

Johnny is frustrated. Are you having a bad morning Johnny?


Actually, no. Not at all.

What's interesting is you can't see that you and I substantially agree about demolishing the tax code, because its a huge drain on the economy.

Not only do we employ massive amounts of talented people in a non-productive administrative task, we waste huge amounts of the time of common citizens, create numerous management headaches for businesses trying to minimize tax impacts, and create all kinds of secret benefits that favor the powerful vs. their smaller competitors which shelters them from competition.

I don't know how much more of a right wing position I can take. Except that I realize we won't get rid of the income tax, despite all the arguments about its unconstitutionality. THe best we can accomplish is to get rid of all the complex exlusions and benefits and exceptions, which, in reality is a massive power grab by the government to control our behavior.

Even that goal strains the bounds of credulity.

Velvet_Jones
09-30-2009, 02:47 PM
As a provider, I will let you know, I don't even fight Usual and Customary. I simply call the insurance provider and tell them if they don't pay the full amount billed, we will balance bill patient. And we do. More than 50% of the time, the provider pays

U&C is usually does by lazy outsources who generally don't get the information accurate.

We only U&C if the insured is out of network, then, we use the 80th percentile of U&C tables which is usually at an amount within a few dollars of the normal PPO contractual amount. We very rarely get complaints from the provider or the customer. If we do get a balance billing situation, we will work to correct that. 85% of our claims are in-network. We receive between 2000 and 3000 separate bills per day and normally have a turn-around time within 48 hours of receipt. Some claims are settled within 12 hours depending on the complexity of the bill.

An no - we aren't lazy at all, we are just not going to pay what ever the physicians ask when the amount is out of the norm. And no - we don't outsource anything.

Mile High Mania
09-30-2009, 02:51 PM
http://tlrfoundation.com/beta/files/Texas_Tort_Reform_Report_2008.pdf

Here is a link that speaks to the tort reform that happened in Texas... speaks to the positive results, I think page 12-15 (I didn't read it all) is where it addresses some of the issues/concerns and results in the medical field.

Mile High Mania
09-30-2009, 02:59 PM
I guess I don't understand our policy well enough on illegal immigrants. Why is it so wrong to send people (healthy or not) that we know are here illegally back to their countries of origin?

This is a major area that could help us reform healthcare and other concerns.

http://www.cnn.com/2009/HEALTH/09/22/illegal.immigrants.healthcare/index.html

**Quick Edit**

I wish that everyone could receive assistance when they need it... I feel sorry for this guy and his family, but they're not here legally. It is truly a sad story, but it's really not a concern of mine. That may be viewed as horrible to say... but, we just can't continue to do things like this in the US.

KCWolfman
09-30-2009, 03:28 PM
We only U&C if the insured is out of network, then, we use the 80th percentile of U&C tables which is usually at an amount within a few dollars of the normal PPO contractual amount. We very rarely get complaints from the provider or the customer. If we do get a balance billing situation, we will work to correct that. 85% of our claims are in-network. We receive between 2000 and 3000 separate bills per day and normally have a turn-around time within 48 hours of receipt. Some claims are settled within 12 hours depending on the complexity of the bill.

An no - we aren't lazy at all, we are just not going to pay what ever the physicians ask when the amount is out of the norm. And no - we don't outsource anything.
Didn't you say you used the UC data from another company? That is outsourcing.
Honestly the most dreaded call to make as a provider are the U&C calls to an insurqnce agency. It usually takes 3 to 5 transfers to get to someone who can release prrof of pricing verification only for that person to tell us the data can't be released. So we are just to take the word of the insurance co that the price is a true average of the region? That is why I never fought it. It was much easier to call the guarantor and tell them we are balance billing as their comapny reduced our rates without providing data for doing so. Insured calls insurance bitching up a storm, insurance pays balance. Much easier and better results.
Posted via Mobile Device

BigRedChief
09-30-2009, 04:45 PM
Do you do your own taxes?

Try running a business dumbass. Do it. Paperwork surprise for you!
diesn't matter how much paperwork you have to do. Doing paperwork doesn't = facism.

BTW, name calling is the last resort of a limited mind.

googlegoogle
09-30-2009, 05:56 PM
diesn't matter how much paperwork you have to do. Doing paperwork doesn't = facism.

BTW, name calling is the last resort of a limited mind.

And what happens if you skip the paperwork? Hmmm.

You know what happens.

Velvet_Jones
10-01-2009, 06:50 AM
Didn't you say you used the UC data from another company? That is outsourcing.
Honestly the most dreaded call to make as a provider are the U&C calls to an insurqnce agency. It usually takes 3 to 5 transfers to get to someone who can release prrof of pricing verification only for that person to tell us the data can't be released. So we are just to take the word of the insurance co that the price is a true average of the region? That is why I never fought it. It was much easier to call the guarantor and tell them we are balance billing as their comapny reduced our rates without providing data for doing so. Insured calls insurance bitching up a storm, insurance pays balance. Much easier and better results.
Posted via Mobile Device
Dude - I have never seen any U&C data that is based on averages. They are based on a percentile of providers bill as that level or below. So if you use the 80th percentile, based on the data, 80 percent of all providers bill as that level or lower. So - if you want to charge $100 for a procedure, the insurance company may reduce the eligible amount payable by - lets say $10 because 80% of all providers in your geographic area charge $90 or less.

Just FYI - several states do not allow balance billing if you have accepted an assignment of benefits signature. Might want to keep that in mind.

Why don't you tell the insured what you are going to charge up from instead of hiding it? Afraid that the insured may shop around?

Hehehe - you said U&C is a lazy way of doing business but you keep saying you just threaten to charge the patient more and they will take care of it for you. you say it is "Much easier and better result". That sounds pretty lazy to me.

BigRedChief
10-01-2009, 07:26 AM
And what happens if you skip the paperwork? Hmmm.

You know what happens.Filling our tax returns or paying H&R Block is paper work that I need to fill out or go to jail. Drivers licsense, car insurance etc etc. That doesn't mean I under the thumb of a fascist.

http://edkrebs.com/herb/Fascist-Palin-.jpg

BucEyedPea
10-01-2009, 09:36 AM
Thats the people that should be taxed, or some kind of penalty done before they crash their car or get cancer and then its me and you picking up their medical bills.

Well, in the first place, for an allegedly free country no one should be taxed ( forced) to pick up someone else's medical bills. Nor should anyone be taxed or penalized by the state because of some possible future event like getting cancer. You guys don't make any distinctions that this is force because it's done by the state which is a form fascism. You own your own body....it doesn't belong to the state. You get sick, it harms you not the society.

KCWolfman
10-01-2009, 09:38 AM
Dude - I have never seen any U&C data that is based on averages. They are based on a percentile of providers bill as that level or below. So if you use the 80th percentile, based on the data, 80 percent of all providers bill as that level or lower. So - if you want to charge $100 for a procedure, the insurance company may reduce the eligible amount payable by - lets say $10 because 80% of all providers in your geographic area charge $90 or less.

Just FYI - several states do not allow balance billing if you have accepted an assignment of benefits signature. Might want to keep that in mind.

Why don't you tell the insured what you are going to charge up from instead of hiding it? Afraid that the insured may shop around?

Hehehe - you said U&C is a lazy way of doing business but you keep saying you just threaten to charge the patient more and they will take care of it for you. you say it is "Much easier and better result". That sounds pretty lazy to me.

The insured are informed up front of charges when we send the billing to the insurance. They are ALWAYS informed. However, were are providing emergency medical care. It's not like we can go up to the guarantor and dicuss price while someone is bleeding out.

And if a provider requests the percentile data, do you supply it? Over the course of 25 years, I have yet to receive the data from a single payor. Hardly lazy on our behalf at all. In fact, we inform the guarantor that if they can receive the data from the payor, we will verify the amounts noted and pay accordingly - again over the course of 25 years that has happened 0 times.

KCWolfman
10-01-2009, 09:39 AM
Well, in the first place, for an allegedly free country no one should be taxed ( forced) to pick up someone else's medical bills. Nor should anyone be taxed or penalized by the state because of some possible future event like getting cancer. You guys don't make any distinctions that this is force because it's done by the state which is a form fascism. You own your own body....it doesn't belong to the state. You get sick, it harms you not the society.

:clap::clap::clap:

BigRedChief
10-01-2009, 09:40 AM
Well, in the first place, for an allegedly free country no one should be taxed ( forced) to pick up their medical bills. Nor should anyone be taxed or penalyzed by the state because of some possible future event like getting cancer. You guys don't make any distinctions that such force by the state is a form of fascism. You own your own body....it doesn't belong to the state.
True, but when you get cancer or wreck your car using that freedom, we, the taxpayers, have to pay for your freedom.

So whats your solution? who pays when the citizens who could afford health insurance but used this "freedom" to be uninsured walk into the ER or end up in a hospital?

BucEyedPea
10-01-2009, 09:41 AM
Filling our tax returns or paying H&R Block is paper work that I need to fill out or go to jail. Drivers licsense, car insurance etc etc. That doesn't mean I under the thumb of a fascist.

http://edkrebs.com/herb/Fascist-Palin-.jpg

It can also come from the "do-gooder" planning out the society according to the outcomes the "do-gooder" wants. Like an egalitarian outcome. That too is fascism. Once you see that govt IS force, you will realize that it must be kept limited to a few things like protecting the lives of it's people from aggression of others and basic fundamentals of life, fraud, general safety. Once you start trying to micromanage life's decisions and choices in how one runs their life puts it back into the collectivist/fascist camp which requires extensive govt ( force) using bureaucracy and police tactics ( fines, taxes etc) to manage and enforce it. That's too much force, that reduces liberty and leads to a police state. You've bought into tryanny BRC.

BigRedChief
10-01-2009, 09:42 AM
:clap::clap::clap:I'd like to know who you think should pay? And the individual is not a correct answer. In this scenerio the individual can't pay, has no resources except a big screen TV, Iphone etc.

BucEyedPea
10-01-2009, 09:47 AM
True, but when you get cancer or wreck your car using that freedom, we, the taxpayers, have to pay for your freedom.This right here is the fallacy you don't recognize as one. I am saying the taxpayers shouldn't pay for your freedom. Get rid of that, the rest of us are free.

So people are free to fail or screw up. That has to be part of it if others are to remain free too.

So whats your solution? who pays when the citizens who could afford health insurance but used this "freedom" to be uninsured walk into the ER or end up in a hospital?

The fact that you see it needing some solution is the outpoint. It's based on the flawed assumption that someone must pay for someone. That's the collectivist mindset your arguments revolve on. That's the fallacy. Get rid of that you don't need a solution. Just separate the state from such private choices....then you have liberty. The market will step in and offer solutions which no one can predict as there may be a maverick who comes up with something. Competition will then make those solutions more or less affordable. It's not perfect but it's better than a socialist/fascism model. You never know what you will have if allowing the market with the ingenuity of some players creatively coming up with ideas. Using more govt just crowds that process out....which is why we're in the fix we're in today. The govt crowded that all out.

KCWolfman
10-01-2009, 09:47 AM
I'd like to know who you think should pay? And the individual is not a correct answer. In this scenerio the individual can't pay, has no resources except a big screen TV, Iphone etc.

There are always resources. I donate 10% of my pay biweekly to my church. Catholic charities also assists. The providers in the KC area are linked to several charities including United Way. Payors work out payment plans.

I'd like to you why you think it is okay to tax me for an overweight chain smoking alcoholic who needs a liver translplant?

BucEyedPea
10-01-2009, 09:51 AM
I'd like to know who you think should pay? And the individual is not a correct answer. In this scenerio the individual can't pay, has no resources except a big screen TV, Iphone etc.

It's not your business to decide who will pay. It's not the govt's either.
Where does the Constitution stipulate anything like that? It doesn't. In fact it denies it.
It's a document that keeps such matters OUT of the hands of govt and the busy body do-gooders who just want to steal other people's property to spend on who they think should be spent on.

patteeu
10-01-2009, 10:55 AM
The insured are informed up front of charges when we send the billing to the insurance. They are ALWAYS informed. However, were are providing emergency medical care. It's not like we can go up to the guarantor and dicuss price while someone is bleeding out.

And if a provider requests the percentile data, do you supply it? Over the course of 25 years, I have yet to receive the data from a single payor. Hardly lazy on our behalf at all. In fact, we inform the guarantor that if they can receive the data from the payor, we will verify the amounts noted and pay accordingly - again over the course of 25 years that has happened 0 times.

I'm sure that by "up front" he meant *before* the services are performed. I understand that this might be more difficult to do in emergency situations than in other cases.

Velvet_Jones
10-01-2009, 01:45 PM
The insured are informed up front of charges when we send the billing to the insurance. They are ALWAYS informed.

I call BS.

KCWolfman
10-01-2009, 02:05 PM
I call BS.

Guaranteed my friend.

We not only tell them the services provided, but if the patient is the guarantor, is not a minor, or gives the guarantor the release we give them a superbill with all the CPT-4s of each service provided.

Now I ask you, if a provider called you asking for your data in which you derived your UC would you give it to them? Would you give it to your insured?

BigRedChief
10-01-2009, 02:23 PM
There are always resources. I donate 10% of my pay biweekly to my church. Catholic charities also assists. The providers in the KC area are linked to several charities including United Way. Payors work out payment plans.

I'd like to you why you think it is okay to tax me for an overweight chain smoking alcoholic who needs a liver translplant?
I think its BS and should stop. I know you have been away but I'm against any form of government run health care plan and think the freeloaders that could afford health insurance but spend their money on BS shouldn't be getting a free ride on the taxpayers dime.

Velvet_Jones
10-01-2009, 11:00 PM
Guaranteed my friend.

We not only tell them the services provided, but if the patient is the guarantor, is not a minor, or gives the guarantor the release we give them a superbill with all the CPT-4s of each service provided.

Now I ask you, if a provider called you asking for your data in which you derived your UC would you give it to them? Would you give it to your insured?

Hmmm - a superbill is a skeleton of what actually is produced and sent to the insurance company in the form of a CMS1500 or CMS1450 bill. A superbill is nothing more than a check list - sorta of a menu - of available procedures and diagnoses for people who don't know what a superbill is. It very rarely reflects what is actually billed. If yours match exactly then you are an exception to the rule.

Also, most hospitals use programs to maximize the billing amount. Ingenix is one vendors that offers either a software package or a service to maximize the billable amount. This used to be called "Up-coding" - now it is a more politically correct name "coding standardization".

I am suprised that you think a typical person would be able to decipher a superbill, when the actual bill will look nothing like it. I understand that you are in a emergency situation and that doesn't allow the consumer to shop the price before the procedure is performed.

We most certainly would tell the provider how the allowable expense was derived and if inquired, we would have no problems in telling the provider were the values came from. We tell them on the EOB that the reduction is usual and customary expense reduction.

Now - for non-medicare claims, we could not give the insured or provider the entire geographical database, but we would tell them the source. There are copyright issues to deal with but the source of the data is not some black secret. For medicare claims, we are contractually obligated to use one of two methods of determining pricing, either use the relative value tables from CMS or use the 40 percentile table (yes that's right - 40th percentile) of one of the qualifying databases, which ever allowable amount is greater.

Now I got a question for you - and remember that only about 20% of the claims we process are not re-priced by a PPO, but why would an insurance company agree to pay an amount for a service, when 80% of the other providers in that geographical area change a given amount or less than that amount? Especially if it is an emergency / chronic situation where the consumer has little choice to select a provider?

Another little bit of info for you, Ingenix is a EDI claims clearinghouse and gathers data from millions of transactions for its U&C calculations. One more tidbit, if you submit an itemized bill, you reimbursement is higher than if you submit a rolled up bill that really does not explain fully the procedures that were performed.

I take it you worked through a hospital?

Velvet_Jones
10-01-2009, 11:02 PM
Hey - KCWolfman - your are in KC? - Lets have lunch or something - I work in OP/Leawood area.

KCWolfman
10-01-2009, 11:31 PM
Now I got a question for you - and remember that only about 20% of the claims we process are not re-priced by a PPO, but why would an insurance company agree to pay an amount for a service, when 80% of the other providers in that geographical area change a given amount or less than that amount? Especially if it is an emergency / chronic situation where the consumer has little choice to select a provider?

Another little bit of info for you, Ingenix is a EDI claims clearinghouse and gathers data from millions of transactions for its U&C calculations. One more tidbit, if you submit an itemized bill, you reimbursement is higher than if you submit a rolled up bill that really does not explain fully the procedures that were performed.

I take it you worked through a hospital?
First of all our Superbill procedures were attached to CPT-4s. The SB was forwarded to our MR Coders who used the assigned CPTs and attached the ICD9 according to the notes attached by the provider. The SB always matched the HCFA 1500 (now known as the UB92), not a CMS as that is a hospital bill. If the SB did not match the HCFA, then the lower of the two charges were used to avoid overcharging - in ALL circumstances.

They (payors) agree, almost always, due to PR issues. Do they want to quibble over 30 to 400 dollars instead of mucking through possible PR nightmares created by their consumers? Very rarely would a patient have to pay, but we never ever accepted UCR as we could never receive the data from the payor no matter how hard we tried.

As far as bundling, we never bundle billed. Many times several of the same procedures were used - for example a stitched cut under 20 cm - but our coders and providers (APNs, DOs, and MDs) were very accurate in marking every single procedure completed in the bundled procedure.

KCWolfman
10-01-2009, 11:31 PM
Hey - KCWolfman - your are in KC? - Lets have lunch or something - I work in OP/Leawood area.

Would love to. I worked at Overland Park Regional Med for years so I am very familiar with the area.