Isn't it the doctors office that submits the claim?

Yes that's true MysteryToy, the fruad link in the second graph explains how crooks most often ripoff Medicare.

Sounds good to me. The public option is all about the consumer. A lot more honest than when the insurance industry started creating health plans that put more of the financial burden to clients out of pocket costs -- they call that "consumer directed health plans."

Yeah, "the consumer option" isn't nearly as honest as Medicare Advantage. WE battle an industry that has used euphemisms for decades, that is great at inventing them and then they get upset because we try to label something in an accurate but consumer friendly way????
We shouldn't be calling it any kind of option, it should be called Medicare Part E...for everyone.

We shouldn't be calling it any kind of option, it should be called Medicare Part E...for everyone.

Heard that on Olberman the other day. It would make more sense than cobbling together a public option. I honestly don't know why they don't try that, give the appearance of strengthening Medicare and provide a coverage option for the uninsured, without adding a new government plan.

"I honestly don't know why they don't try that, give the appearance of strengthening Medicare and provide a coverage option for the uninsured, without adding a new government plan."

Probably politically impossible but instead of giving subsidies to low income people to buy health care insurance it would make a hell of a lot more sense. If people's income is so low they can't afford health care insurance then put them into a new category of Medicare, it would be cheaper for us taxpayers.

So it's okay if a private insurance company refuses a claim.

Thanks for clearing that up.

The insurance fraud in medicare/medicaid is huge. One of the reasons private insurance is more expensive is that they are much more aggressive in looking for fraud. If the gov. would go after fraud the overhead would be much higher.

WHY has it suddenly become an issue that the elderly have beome an issue for claims for the Medicare fund that they have paid for and are entiltied to???
Who is trying to cheat them out of the claims they are entilted to???
The damocrats.
The Damocrats.
The Damocrats.
The sorry lazy, ssob, who who dictate for the rest of society to follow their ignorant idiotcy...

The insurance fraud in medicare/medicaid is huge. One of the reasons private insurance is more expensive is that they are much more aggressive in looking for fraud. If the gov. would go after fraud the overhead would be much higher. #9 POSTED BY MATSOP

That's not logical, at least in the case of Medicare. Going after the fraudsters should pay off big time in reduced fraud, many times the salaries of the investigators. I would like to see a lot more of that, and going aggressively after tax cheats too.

One problem that Medicare has is a law (ill advised, I think) that REQUIRES Medicare to pay on all claims within a short period of time, 15 days I think. This makes it easy for the criminals to submit bogus claims, quickly get some payments, then close up shop before the FBI arrives. Better would be to allow a reasonable time to verify the legitimacy of any new provider before paying any claims.

#11--- You're right, the net after going after fraud would increase; my point is the relative cost before the savings (overhead) would increase since you would in all likelihood add more personnel.

Who is trying to cheat them out of the claims they are entilted to???

#10 | Posted by Dr_Feelgood

The problem is they can't pay the claims because they've spent the "trust fund" on other things. So now they need to get all the young, healthy people into the public option so they have the premium cash flow to fund payments to the boomers.

Since I'm one of these boomers, I find a certain irony that all the 20-30 somethings that are all in favor of government health care for everyone are going to be the ones raped to pay for my health care in my old age.

Well, guess what you have to do to fight insurance fraud -- deny claims.

I see. So when a private insurer denies claims, they are an evil corporation driven by their greedy profit motive. But when Medicare denies claims, they can't help it - they're just trying to combat fraud.

One of the most obvious forms of hypocrisy exercised by liberals is their willingness to give the benefit of the doubt to government at all costs. This is a particularly glaring example of that.

Did anyone watch the 60 minutes segment about medicare fraud. It seem one of the big holes ripe for fraud in medicare is the fact that a very small percentage of the claims are audited. The scammers take advantage of that fact by sending in a bunch of bogus claims betting that most of them will just sail thru the system, and they are right. By the time the medicare inspectors catch on, the crooks have flown the coop.

Can't a smart form of audit software be developed to give some oversight on each claim, say over $1000? It would flag a claim that looked fishy according to a preset algorithm. Any techno wizards out there?

That would be fine TICKYUL if a lot of bogus claims would sail through the system undetected, but that is a rare occurance in actuality, the system is not completely foolproof, but in the longrun all claims come to fruition and are either proved legal by observance of patient, or provider, very few claims are processed that are illegally submitted...

To Dr feelgood:
Wow, then I guess I was in a different dimension when I watched the piece. It was very damning with reference to the amount of fraud being commited against Medicare. The fraud comes to light AFTER the scamming has been committed. And some of the fraud goes on for a long time before it gets detected. I realize that a huge system like Medicare has tons of claims, and there will be fraud no matter what. But they need a remedy for this HUGE (billions) in ripoffs.

I don't wonder why medicare denies so many claims but instead why they pay less for the same services than private insurance companies.

This means private insurance companies are subsidizing the cost for medicare. If medicare payed the same amount for the same services then private insurance would be cheaper.

If private insurers refused to pay exorbitant annual increases vs inflation to health care providers your insurance wouldn't go up.

Maybe Medicare is paying the ACTUAL cost of the procedure than what the Doctor/Hospital are charging.

Right wing logic is an oxymoron

$2,000,000 average cost for an MRI and suite:

$1750-2200 for a scan in a hospital (avg. $2000)
X
24 scans per day
X
7 days per week
X
12 months
=
$4,032,000

Median annual earnings of MRI Techs = $48660

Do the math ... figure they'll have the machine for 4 years.

$16,000,000 - $200,000 tech salaries. Nice tidy profit. Too nice

"Maybe Medicare is paying the ACTUAL cost of the procedure than what the Doctor/Hospital are charging."

You have that right. Even at Medicare rates everyone make a bundle.

Average cost for initial visit by doctor in hospital (3-5 minutes) = $333

Simple procedure (nationwide averages non-Medicare):

Hernia repair - Cost: $36,000
-------------

Simple procedure (nationwide average):

Appendectomy - $33,600
-------------

Both simple procedures that take under an hour, 1/2 hour in most cases plus prep.

Medicare keeps them honest. And they still make a ton.

TIMEX

You are correct. Medicare pays the actual cost of a procedure. You probably already know this but for some who don't, Medicare assigns a procedural code and a dollar figure to that code.

Doctors who accept Medicare patients agree, by contract, to accept ASSIGNMENT. That's what it's called.

In return, they're guaranteed payment (lacking any fraud, of course) and they have a steady stream of income, mostly unquestioned, from Medicare.

Unfortunately, this sometimes results in the revolving door (quantity over quality) that people complain about. It also results in an enormous amount of fraud by some doctors who try to game the system.

(hospital inpatient rates)

"Unfortunately, this sometimes results in the revolving door (quantity over quality) that people complain about. It also results in an enormous amount of fraud by some doctors who try to game the system."

That's why I like England's system where doctors are on an annual salary. Gouging is impossible.

Also why new efficacy rules are in the Senate conference bill that were in both markups. I'd assume so. Based on results rather than quantity.

Medicare rates are not as low as most people think. Medicare has pretty stringent guidelines about how many similar procedures on the same patient are allowed in a certain period of time before they have to get preapproval. This to prevent abuse of, say, X-rays. At one time there were doctors X-raying people for things like appendectomies 100 times during their 10 day stay. Needless abuse. Lots of changes are coming to prevent abuse and increase results based fees rather than procedure based fees, which, as you say, can lead to abuse.

(A 'total' fee based on actuarial information, i.e. if treatment for diabetes is usually X amount, a fee that covers treatment for X time will be guaranteed ... provided there are positive results. This, again, to prevent fee abuse).

TIMES

Doctors will (sometimes) try to bill patients for the difference between what they charge and what Medicare pays.

I consider this unethical but they operate on percentages . . . a certain number of people, not knowing any better, WILL pay the difference.

When I was in the healthcare business, I advised my clients to return the bill to the doctor with a stern note reminding them of their contract to accept the "assignment" as payment in full.

It always worked.

Next, I hope they'll address the amazing greed written into Medicare Part D. Medicare on average pays 58% more for drugs than the VA. In many cases 600-700% more. Ridiculous the biggest group in the nation pays exorbitant rates.

Medicare Advantage is also getting an overhaul (where the brouhaha the right wing are throwing comes from). Ins. Co's promised to keep their overhead down, but didn't (of course). Instead they're raking 18-30% off the top. So, we're going to fix that and save $400-500 billion over 10 years. Patient care won't be affected one dime. Just lowering overhead fees.

Twinpac

I know what you mean. I've had a good look from the inside. It's sick what some doctors do for more $. Hippocratic oath is garbage once they get out there in the world for the most part. Disconnected from patients, rushed visits, high profit margins, etc. Not so much GP's, but specialists (most doctors) gouge the system.

A disturbing trend the past few years are systems hiring physicians out of med school to a long term contract, who are then essentially required to overcharge and way overdo tests and procedures for that system (Kaiser-Permanente, United Health Care Systems, etc), plus a 'bonus system' once they've reached a threshold that pays off their student debt.

The whole system is sick. Bring back non-profit community hospitals with doctors on salary. Half the battle won.

That's why I like England's system where doctors are on an annual salary. Gouging is impossible.

#28 | Posted by Timex

Next to the Red Chinese Army and The Indian railway system the British health-care system is the third largest employer in the world. I'd say gouging is not only possible, It's been institutionalized on a massive scale. Then think about the size and population of England vs the US.

Uh, huh. Average GP salaries in Great Britain:

England = 103,500 pounds a year
N. Ireland = 91,500 pounds a year
Wales = 92,000 Pounds a year
Scotland = 83,000 Pounds a year

60 million pop. 1.3 million employees (Janitors too).

That '3rd largest employer...' figure may impress you, but not me. The U.S. doesn't have any less % of our population working in our health care system.

The ANA represents 3 million nurses in the U.S.

That's just nurses THEY represent. We have far more people employed in health care as a percentage of our population than Great Britain ever will. Far more.

I, too, am shocked by what I see in the "revolving door" system . . . I have a friend who tells me that she's never seen the same doctor twice and she has never even laid eyes on her Primary Care physician who operates his business (yes, folks, it's a business) with nurse practitioners, med school graduates and, if you're there on a lucky day, one other M.D. on staff to serve the health care needs of hundreds.

The Primary Care physician rarely comes to the office, I'd told. Although he does review the case files, I'm also told.

Doctors in the U.S. earn an average of 33% more than their British counterparts.

Twinpac

The arguments from the right on changing our system are sad. We pay more than any country in the world per capita for worse results overall.

In Great Britain, when you get out of the hospital you go to the "Pay Window", except you don't pay. They make sure you have cab fare to get home.

Most of the naysayers in the U.S. have most likely never been anywhere except perhaps Mexico, if there. They make up the most ridiculous assertions as if they're fact, when facts are they're simply making them up with no real knowledge whatsoever of our system or the 'foreign' system they're knocking.

80% of bankruptcies in the U.S. are from medical bills.

Of those, 65% HAD health insurance!

#37 | Posted by Timex

So Big health care is bad unless it's government big health care. There's no crisis here. Like most of the economy, the governments involvement has done more to "rig" the system than fix it. Before just taking it over why not try other options. Open up the markets to nation wide competition. Stop all the fraud in medicare and medicaid. That is the main reason for the government to exist. To protect the People from force and fraud. Just because they suck at it doesn't mean they get to see if they can find something they like better. How about looking at all of the unintended consequences of all the laws involving health care that are on the books and fix them.

TIMEX

"The arguments from the right on changing our system are sad."

Indeed.

But I think they see the need for change . . . just not on Obama's dime.

Any hint of a successful presidency, from any direction whatsoever, exacerbates the failures of the past administration.

I suppose, subliminally, people might start to think . . . why couldn't the GOP do this?

I think the Right would rather see the United States sprawled out in total ruin, than lift one finger to prevent it.

Stirsumup

"Government" (Medicare/VA) pays reasonable rates for medical services. Everything else is a ripoff.

If you want to continue to pay 130% more in premiums every 10 years, help yourself. Average annual premium for health insurance is $12K now. That'll be $20,000 a year 5 years from today. Seems a rational adult wouldn't want to keep paying more and more, but hey, guess we aren't all rational, are we?

A public option is the only thing that will prevent that from happening. I'd rather not get gouged. But, hey, you can if you prefer to.

"I think the Right would rather see the United States sprawled out in total ruin, than lift one finger to prevent it."

You have that right!!

Wingnuts would rather be gouged than see competition that'll save them money. Sheer stupidity borne of malice.

"There's no crisis here. Like most of the economy, the governments involvement has done more to "rig" the system than fix it." - Stirsumup

What? Are you daft? "No crisis"? Maybe your employer is still footing your tab, but not for long.

"Rig the system?". The health care system has been virtually unregulated, safety standards aside.

It's the health insurers and providers that have the system rigged to the point people are filing bankruptcies at an alarming rate:

80% of bankruptcies in the U.S. are from medical bills. Of those, 65% HAD health insurance!

You are not a rational person. Buh bye.

The Primary Care physician rarely comes to the office, I'd told. Although he does review the case files, I'm also told.

#38 | Posted by Twinpac

What bullshit. Every time i go to the Dr. I always see my PCP.

I think the left wants nothing more than for the USA to become a socialist state. Total nanny care, fucking pussies, afraid to be responsible for their own lives.

I think you raise chickens for nefarious purposes other than selling or cooking them for yourself.

Chicken XXXXer

Gee, your one anecdote is indicative of the whole country? Please. You're just shilling for the GOP. Rational people don't want to pay $20,000 a year in 5 years for health insurance.

Of course, once you're Medicare age you wouldn't dream of using it. Bawk Bawk Bawk Bakaaaaaw!

TIMEX

I don't know who turned their maniacal mind toward the destruction of America's middle class, part of which is lack of health care, loss of jobs, outsourcing, bankruptsies, plan to privatizing Social Security, etc. but we can all see it playing out before our eyes.

I always suspected that Cheney had some vision of a neo-conservative Hundred Year Reign so they could destroy and then rebuild this country in their own image.

That administration made too many moves that, by all standards of bad governance, were headed in that direction. I don't believe any more that it wasn't on purpose.

God Bless Barack Obama!

"Government Run Health Care!" is a jingoistic slogan and an utter fallacy. The right only care to hand the Dems a defeat by any means necessary. 80% of bankruptcies are because of medical bills. Of that, 65% HAVE insurance. They oppose a "Public Option" in opposition to their own best interests.

A "Public Option" is:

1. An 'option' only self employed and small businesses can 'choose' as one of several 'options'.

2. It will provide the only competition to an insurance system that will see average annual premiums rise to $20,000 a year in 5 years, and nearly $30,000 in 10. An unsustainable rate of growth ... especially with stagnant wages. Employers will continue to demand more and more contributions from employees, higher co-pays, and many will just drop it as unaffordable, or outsource millions more jobs overseas because they simply can't afford it and compete as businesses.

3. It will be administered by private entities, not the 'government'

4. People will pay premiums. It is not free

5. There will be dozens of 'options' to choose from; a government plan, and dozens of private plans

6. No one actually receiving Medicare or VA bitches about their care. "Government run health care".

#51 | Posted by Twinpac

Yes! The GOP spend like pigs every time they have control, pile up the largest debt in human history (most of the $12 trillion), and then bitch about debt - their reason 'we can't afford' to help the middle class with anything. And GOP parrots bawk! right along against their own best interests for political points. No wonder they're at 20%. Now they're even opposing their own candidates in elections. Idiots.

Socialism is a great idea, human's are just the wrong species.

#8 | Posted by zulu: So it's okay if a private insurance company refuses a claim.

#14 | Posted by JOE: I see. So when a private insurer denies claims, they are an evil corporation driven by their greedy profit motive.

Fraud is a problem for both private insurers and medicare.

It's when a private insurer denies claims at the same rate as an insurer that is limited to a high-risk fraud population that the problem is clear. Add on top of that the private insurer paid its CEO $24 million at the same time and it becomes obscene.

#54

OK. Don't call the cops or fire dept. Don't drive on roads. Don't drink clean water or eat safe food. Don't breathe clean air. Don't take safe medicine. Don't have a military. Don't fly on safe airplanes controlled by government FAA controllers. Don't work 40 hours, work as many hours as your company demands. Don't make a living wage. Don't have safe working conditions. Don't drive in a safe car. Don't use steady 120v electricity the govt. forced power companies to run. Don't sleep on a fireproof mattress. Don't send your kids to school. Don't collect Social Security. Don't use a fair judicial system. Don't go to a licensed doctor. Don't use anything the WPA built ... bridges, roads, dam powered electricity, national parks, etc.

(The above are all Democrat initiatives)

(except the military. Mandatory public education began in Massachusetts in 1862. Guess who made it so? Public funds pay for fire and police...)

You know it's the same swinging dicks who bitch about Socialism and fight against it are the same SOB's who will be first in line for socialistic types of helps. It never fails. They rail against something that they ultimately use or will use.

Larry

Now it's time for some basic truth and observation since I've worked in the health system for years. 1. the primary care physicians, pediatricians, internists work their tails off and have to deal with onerous paper work and make less money then most dentists. #38's comment is totaling nuts. Occupational physicians make less money then a dentist today. The physicians making the big bucks are usually the specialists and mostly in the surgical arena. I've never liked "fee for service" since it usually encourages over-utilization of care and increase costs. It also encourages unnecessary surgeries and abuse by certain physicians that own their own physical therapy or other adjunct services. A salaried system would probably clean up a lot of these issues. Another problem is often the easy access to care and the supposed right by certain patients that spend half their lives in physician offices with physical symptoms masking personality disorders, depression, anxiety, additions and other psychiatric disorders. Physicians because of our malpractice system then order a plethora of expensive tests to protect themselves even though they realize these folks have psycho/social issues or are hypochondriacal or have munchausen's And let me tell you something else (and it has nothing to do with my political affiliation, etc.) John Edwards is not only a philanderer but also a crook in my book--- he is a poster boy for an industry (legal) that is also in a huge need for reform. The guy made millions on using "junk science" in the malpractice area-- while a guy like this is as crooked as a bent stick (but he has a cute smile and is another con) you have many pcps. that are honest as heck working their hind-ends off to make a living that is in the $120,000- $140,000 range. Compare that to wallstreeters, athletes, dishonest lawyers and other physicians, hollywood that don't bring much much of anything of value to this country.

Lets assume Hope and Change will make the Insurance Companies instantly 100% just, fair, caring, etc, etc....

I have a question on healthcare reform that deals with the care ITSELF.

Hope and Change will NOT:
--Create a single doctor
--Reduce the number of hours a doctor is FORCED to work on things OTHER than providing care
--Reduce defensive medicine (about 20% of all medical expenses)

Hope and Change WILL
--Dramaticly increase the overall medical workload

....so....

Take an already strained system, add MORE work, while at the same time doing NOTHING to provide more care providers.

Now, given the 100% core truth of the above, explain how MORE care "and" Higher Quality care will be provided.

If Hope and Change passes, I expect a vast drop in care quality, and a vast spike in INDIRECTLY denied care (the care will not be 'formally' denied, it will simply never be provided).

To actually provide more care, make it POSSIBLE for care providers to spend less time on non-care tasks, less defensive medicine, and encourage more young people to pursue medicine WITHOUT dropping the work/standards/time needed to become a doctor/nurse.

Sixty Minutes just did a story on this. The Target is Government money, because seniors don't have that much. Alert seniors whose statements reflect charges for equipment and services never rendered have watched six years go by with no action by auditors. Most of these phoney businesses work off lists of legitimate patients and their personal data, stolen from doctors offices, which they submit claims to Medicare, close up their office and move on to another place every 90 days or so. It would seem to me you would need some pretty good fake ID to get away with this. The FBI is trying to do what Medicare auditors cannot. SO far, not much has been accomplished.

If Doctors and Pharmacists were on Government payroll, these scams would be impossible.

Doctors in the U.S. earn an average of 33% more than their British counterparts.

#39 | Posted by Timex

As do most other professions. I worked for a large British company for ten years and was embarrassed by how little my London counterparts were paid for doing the same job. And they pay more in taxes and their cost of living is higher. But, they do have free health care, if you don't mind waiting 8 months for a simple hernia operation.

If Doctors and Pharmacists were on Government payroll, these scams would be impossible.

are you saying you would take our healthcare system this far....meaning way past a single pay en route to where the doctors are actually govt employees?

#61 | Posted by USAF242: Hope and Change will NOT:
--Create a single doctor
--Reduce the number of hours a doctor is FORCED to work on things OTHER than providing care
--Reduce defensive medicine (about 20% of all medical expenses)

Right now there are millions of Americans who cannot afford to see a doctor -- no matter how many there are. Every other industrialized nation in the world -- except America -- has guaranteed health care for their citizens. All of these countries are making it work and so can we.

HOPE4HOPE

Good God, I can't believe you actually posted that.

Perhaps I need to be more clear:

Lets say that a doctor can provide proper care for 100 patients a day, and there is 1 doctor in town.

Lets say he is providing care for 100 patients a day.

....so....

if you suddenly send 200 patients a day to his office, what happens? YOU HAVE NO ANSWER, AND HAVE NOT ADDRESSED THE ISSUE.

Possible things that actually COULD help:
--Reduce Defensive medicine (allows about 10% to 20% more patients)
--Reduce government regulation that requires paperwork by doctors or nurses, OR at least make sure the doctor/nurse is NOT the one doing ANY work on the paperwork (this fix is easier said than done)
--Make being a Primary Care provider a more attractive job for young students to pursue.

--Make being a Primary Care provider a more attractive job for young students to pursue.

That is the elephant in the room IMO. We have to address that. If we can manage to address the supply and demand problem then, again IMO, the rest of the problems out there will take care of themselves.

#66 USAF242

You are making good suggestions. I hope that as the government structures the public plan that it will keep these things in mind.

But all the other industrialized nations are guaranteeing health care for their citizens and making it work. I don't think it's unbelievable to write a post suggesting that America will find a way to do the same. And I certainly don't think it is acceptable to say to a portion of our population that you can't have access to America's health care system because there is no room.

eberly,

If you eliminate the billing system, one way or the other, you eliminate the fraud opportunity, and reduce Doctor staffs and cost substantially. The Doctor and patient would be better off, so yes. However, at this time, this change is politically impossible.

If you eliminate the billing system, one way or the other, you eliminate the fraud opportunity, and reduce Doctor staffs and cost substantially. The Doctor and patient would be better off, so yes.

Seriously.....I would rather keep the fraud than do what you suggested.

To the lefties here who are focuses on providing care:

Your intent to have care provided for those who have none is commendable. No joke.

What is driving me (and others) up the wall:

HOW will the care be provided?

If you have 10 million cars and 20 million drivers, will making a law that says every driver will have his/her own car suddenly make the the extra needed cars appear????????

#62 | Posted by nutcase: If Doctors and Pharmacists were on Government payroll, these scams would be impossible.

#66 | Posted by USAF242: Make being a Primary Care provider a more attractive job for young students to pursue.

Maybe there is a way to combine those two thoughts into a single solution. Raising capital to start a practice is difficult for young doctors. Maybe young doctors could partner with the government and get seed money to start their own primary care practice.

Reduce incsurance companies to zeroe.

Medicare is cutti9ng deserved payments to doctors loosing money each year, and the paymenst are decreasing not allowing them to stay in business( small honest independants)

the large group scammers do even better with these large systems the few there are.

So again, it is only going to hurt the quality of honest doctors out there by reducing just a few crooked workers.

but, we knew that. EVery change is always worse for the honest person.

Gotta love the health care debate.

If an insurance company charges market rates they are price-fixing.

If an insurance company charges above-market rates they are illegally gouging.

If an insurance company charges below-market rates they are engaging in illegal predatory pricing.

The Shermann Anti-Trust Act was implemented to break up monopolies and collusions in order to create true competition. Lefties, if they had their way, would set up a true monopoly, with government being the only player, and they seem to believe that this will create a better overall system.

The Shermann Anti-Trust Act was implemented to break up monopolies and collusions in order to create true competition. Lefties, if they had their way, would set up a true monopoly, with government being the only player, and they seem to believe that this will create a better overall system.

Posted by JeffJ at 2009-10-27 01:31 PM | Reply

It sure would be better because it wouldn't be ran by Greed fucks in corporate suits. You can service more people cheaper the Government way then You can the Private Sectolr because service is what drives the engine. NOT Greed. No profit necessary.

Larry

It sure would be better because it wouldn't be ran by Greed fucks in corporate suits.

yeah. we know Larry. we know.

It sure would be better because it wouldn't be ran by Greed fucks in corporate suits.

You're right - it would be run by greed fucks in beaurocratic suits.

Nice logic.

Taking it to its logical conclusion, why have a private sector at all?

Centrally-controlled economies performed 'so' well in the workers' paradises of the world.

You're right - it would be run by greed fucks in beaurocratic suits.

Nice logic.

Taking it to its logical conclusion, why have a private sector at all?

Centrally-controlled economies performed 'so' well in the workers' paradises of the world.

Posted by JeffJ at 2009-10-27 01:59 PM | Reply

No it wouldn't be run by greed fuck beaurocrats in suits because the people running the thing would be answering to US the Employers You know the average Voter instead of being sadd,led with a Private insurance company where the consumer isn't the boss. Common sense JeffJ look into it.

Larry

No it wouldn't be run by greed fuck beaurocrats in suits because the people running the thing would be answering to US the Employers You know the average Voter instead of being sadd,led with a Private insurance company where the consumer isn't the boss. Common sense JeffJ look into it

Larry, there is no question that there are greedy and corrupt people in the private sector but you are saying that all the "greed fuck beaurocrats" are in the private sector. Our politicians NOW answer to the US voter? oh.....my......God.

common sense Larry. dont' even bother looking for it. it could bite you in the ass and you would ignore it.

Larry, there is no question that there are greedy and corrupt people in the private sector but you are saying that all the "greed fuck beaurocrats" are in the private sector. Our politicians NOW answer to the US voter? oh.....my......God.

common sense Larry. dont' even bother looking for it. it could bite you in the ass and you would ignore it.

Posted by eberly at 2009-10-27 02:06 PM | Reply

If we were worth a shit then Yes they would answer to us. Of course You can't comprehend that the voter is the boss. We just too fucking lazy stupid etc etc etc to make sure they are doing their jobs.

Larry

No it wouldn't be run by greed fuck beaurocrats in suits because the people running the thing would be answering to US the Employers You know the average Voter instead of being sadd,led with a Private insurance company where the consumer isn't the boss. Common sense JeffJ look into it.

Larry

When both parties engage in the same shenanigans, your 'accountability' argument falls flat.

True competition is what drives prices down, not government monopolies.

True competition is what drives prices down, not government monopolies.

Posted by JeffJ at 2009-10-27 02:12 PM | Reply

Is that why gas prices are so high is that why doctors prices are so high?? Too fucking funny.

Larry

Is that why gas prices are so high

who said gas prices were high?

we compare our medical expenses to everyone around the world to say it is high priced here.

do the same with gas and tell me our gas prices are high.

LOL

"do the same with gas"

Abu Dhabi, or downtown London?

you get my point Danforth.

Virtually all of Europeans pay more for gas.

#74 | Posted by JeffJ: The Shermann Anti-Trust Act was implemented to break up monopolies and collusions in order to create true competition. Lefties, if they had their way, would set up a true monopoly, with government being the only player, and they seem to believe that this will create a better overall system.

Health insurance companies are exempt from the Sherman Anti-Trust Act.

#16 Dr Feelgood: You are a blithering idiot.

You should have watched the 60 minutes story. The one guy has processed $20M in fraudulent claims alone.

Post 11 nailed it:

One problem that Medicare has is a law (ill advised, I think) that REQUIRES Medicare to pay on all claims within a short period of time, 15 days I think. This makes it easy for the criminals to submit bogus claims, quickly get some payments, then close up shop before the FBI arrives. Better would be to allow a reasonable time to verify the legitimacy of any new provider before paying any claims.

#11 | Posted by mad_as_hell at 2009-10-26 08:53 PM | Reply | Flag:

Why is it that they have quick pay? This is the only government agency that does that. In my business I have had to wait as long as 18 months to get paid by the govt GSA with no recourse.

"NO PUBLIC OPTION TO PROVIDE COMPETITION!! I want premiums to cost $20,000 in 5 years, and $30K in 10. I want my employer to make me pay more, drop it altogether, or outsource my job because premiums are averaging $12K now. I'm very happy with insurance companies, who are nothing but money bundlers, raking off 18-25% of every premium dollar and denying procedures to make profits".

- The Naysayers

To that GP statement somewhere above, most med students are going into specialties these days.

"This makes it easy for the criminals to submit bogus claims, quickly get some payments, then close up shop before the FBI arrives."

#87 | Posted by boojiboy

As you probably know medical equipment suppliers are the main problem where fraud is concerned.

- Require them to be bonded for big $'s. Bonding Co puts them through the ringer to be a provider.
- Set max profit. Markup on medical equipment is astronomical, and much of it comes from China.
- "Made in USA" should be required as a % of sales.

Require them to be bonded for big $'s. Bonding Co puts them through the ringer to be a provider.

Cool!!! Another insurance product involved in reform. You gotta love the irony.

I love it!!!!

Actually I agree, financial stability should be screened.

gimme a break. first, the stuff about insurers making obscene profits has been shown to be utter bullshit. they are around 6%, part of the lower end of profits.

second, medicare claims aren't denied due to fraud prevention, it's because whoever submitted the form didn't put some piece of information (i.e. a social security number, etc) required of the patient when the bill was submitted, and it got kicked back for a totally technical reason unrelated to some fraud investigation.

any chink in the submission will cause a kick back, and many hospitals have retarded staff doing the inputs, and never do get it right. after a certain period of time, it becomes uncollectible.

any of you thinking it's due to some super fraud detection system are misguided.

#91 | Posted by somoco: the stuff about insurers making obscene profits has been shown to be utter bullshit.

What I called obscene is Aetna's CEO getting paid $24.3 million in 2008. With compensation like that going out the door no wonder profits are low.

second, medicare claims aren't denied due to fraud prevention

Some certainly are, just the same as some claims by private insurers are denied for fraud. My point is, Medicare is limited to a high-risk fraud population. Thus when comparing denial stats to private insurers, plans that are not limited to a high-risk fraud population, that should be taken into account.

LarryMohr wrote,

"It sure would be better because it wouldn't be ran by Greed fucks in corporate suits."

The health insurance industry has an annual average profit margin of 2.2%. So tell us oh great Larry how are they greedy?

They ranked 86th on this list of industry in terms of profit percentage.

Some certainly are, just the same as some claims by private insurers are denied for fraud. My point is, Medicare is limited to a high-risk fraud population. Thus when comparing denial stats to private insurers, plans that are not limited to a high-risk fraud population, that should be taken into account.

#92 | Posted by hope4hope

Fair enough. However, Medicare and Medicaid patients are serviced at a loss. Every time. That's because the federal government dictates reimbursement rates.

"Fair enough. However, Medicare and Medicaid patients are serviced at a loss. Every time. That's because the federal government dictates reimbursement rates."

And still they are going broke.

#94 | Posted by JeffJ: Medicare and Medicaid patients are serviced at a loss. Every time. That's because the federal government dictates reimbursement rates.

I think a public option is the best chance to get costs under control and thus loosening the purse strings of government. I know you will disagree :) so I must point out that with our current system - cost projections are sky rocketing.

#95 | Posted by MSgt: And still they are going broke.

It is a scam:

The reason they deny so many claims is so they don't have to pay.
(*Light goes on*)

Each month they CHANGE certain rules by so much percent and the old way of filing doesn't work now so they send 11% back, lets say. YOU DIDNT FILL IT OUT RIGHT!
so you get it back pay more office people , go to classes learn the new way and fill it out again send it back and now it is filled out again.

now they pay (maybe) if another rule hasnt changed this month

ask ANY OFFICE the backclaims are 1-2-3 months old

that is three months they didnt have to p[ay, drawing interest on it

AND a certain percentage of offices will not remit, because it is too much trouble, paying office personel etc etc

so in effect some they dont have to pay

THEY AHVE NEW RULES for 2010

they have promised to change the system so that every month at least 25% of the procedure will change

this will save them three times as much

If a private business worked this way you would go to jail.

it is called stealing in some honest countries.

its a scam they are stealing the doctors rightfully worked for money.

In any other businesses people are paid what their employers are willing to pay. Patients and their insurers have that right.

What I called obscene is Aetna's CEO getting paid $24.3 million in 2008

But you'd have no problem if it was some dumbass with a football, baseball or basketball.

Redman the difference is sports stars aren't taking someones health insurance monies nor are they the same assholes who deny service to their customers while banking mega bucks.

Larry

As the article linked points out: "Lawmakers say they would never allow Medicare's trust fund to run out of money.

Wake up. The money has already been spent and replaced with Treasury notes that can't be redeemed without new tax collections. That's why they need healthy young people to pay premiums into a public option, so they can replace the "trust fund" they've already squandered without the political hit they would get from raising taxes. And you would trust these same people with a public option "trust fund"?

Redman the difference is sports stars aren't taking someones health insurance monies nor are they the same assholes who deny service to their customers while banking mega bucks.

In a broader sense they are still providing a product, Larry.

All private enterprises need to be profitable in order to prosper long-term. In this regard, the insurance industry is no different than the health-insurance industry. And while we are on health-insurance, this site just had a thread posted that pointed out that a higher percentage of Medicare claims are denied than private insurance claims.

It's troubling to me that you seem to feel that those who choose to enter into the insurance arena should not be afforded the opportunity to be prosperous.

Redman the difference is sports stars aren't taking someones health insurance monies nor are they the same assholes who deny service to their customers while banking mega bucks.

Larry

#100 | Posted by LarryMohr

I have nothing to back up this statement, but I wonder how many people that pay $200 to go to a playoff game or buy endorsed sports products will also tell you they can't afford their health care because of greedy CEOs.

Wake up. The money has already been spent and replaced with Treasury notes that can't be redeemed without new tax collections. That's why they need healthy young people to pay premiums into a public option, so they can replace the "trust fund" they've already squandered without the political hit they would get from raising taxes. And you would trust these same people with a public option "trust fund"?

#101 | Posted by Redman

Amen.

That is what is so chilling about what is being proposed. Young people are being told, by the point of a gun, that they either:

1. Purchase insurance
2. Pay a fine for NOT purchasing insurance
3. If 1 or 2 are not meant, face prison

If that isn't anti-liberty, I don't know what is.

It's troubling to me that you seem to feel that those who choose to enter into the insurance arena should not be afforded the opportunity to be prosperous.

Posted by JeffJ at 2009-10-28 08:50 AM | Reply

NOBODY should profit over someones health. NOBODY. Just like I have a serious problem with Funeral Homes and Funeral directors. They are profitting off of someones grief and that's totally wrong too.

Larry

Just like I have a serious problem with Funeral Homes and Funeral directors.

That's why I make sure I pay my Waste Management bill and keep a 6 foot plastic garbage bag in the garage. :)

NOBODY should profit over someones health. NOBODY. Just like I have a serious problem with Funeral Homes and Funeral directors. They are profitting off of someones grief and that's totally wrong too.

Larry

#105 | Posted by LarryMohr

That is SO arbitrary, Larry.

You could apply your logical construct to just about anything.

NOBODY should profit over one's need for access to the internet.

NOBODY should profit over one's need to put a roof over their head.

NOBODY should profit over one's need to feed oneself.

NOBODY should profit over one's need to clothe oneself.

NOBODY should profit over one's need to have running water.

NOBODY should profit over one's need to have electricity.

NOBODY should profit over one's need to have gas for cooking and heat.

NOBODY should profit over one's "need" to watch a sporting event live.

NOBODY should profit over ______________

Seriously, where do you draw the line? And, more importantly, who are you to dictate what people should and shouldn't be able to profit over?

I see JeffJ is being rididculous again. Sighhhhhhhhhhhhhh I should pray for Him.

Larry

see JeffJ is being rididculous again. Sighhhhhhhhhhhhhh I should pray for Him.

Larry

#108 | Posted by LarryMohr

What's ridiculous about it. I expect to make a profit when I provide a service. It's called getting up and going to work. Don't you expect the same? And do you want the government to tell you how much you should be allowed to make, regardless of how good you are at what you do?

I am not being ridiculous at all, Larry.

Seriously, where do you draw the line?

You can not, with a straight-face, argue that access to "free" medical care is MORE critical than access to free food, clothing and housing (and all of the other services that are part and parcel with housing).

Did I move to the 'absurd' on a couple of examples?

Perhaps.

But I did so in order to illustrate how slippery of a slope you were creating with your advocacy.

Larry,

Profit-motive is what drives DOWN prices through robust competition; regardless of the service being provided AND it's 'necessity'.

Profit-motive is what drives DOWN prices through robust competition; regardless of the service being provided AND it's 'necessity'.

Posted by JeffJ at 2009-10-28 09:10 AM | Reply

Is that why medical care costs are SOARING because of a robust competitition?>??? Even I know better than that. They have all the competitition in the world but yet their prices are soaring. Funny dat Be JeffJ.

Larry

You can not, with a straight-face, argue that access to "free" medical care is MORE critical than access to free food, clothing and housing (and all of the other services that are part and parcel with housing).

Did I move to the 'absurd' on a couple of examples?

Perhaps.

But I did so in order to illustrate how slippery of a slope you were creating with your advocacy.

#110 | Posted by JeffJ at 2009-10-28 09:09 AM | Reply | Flag: Flag: (Choose)
FunnyNewsworthyOffensiveAbusiv
e

Tell that to some kid dying of a disease that could be cured if only He had 150,000.00 to pay to get it taken care of. Tell that to some old guy that needs a lung transplant or else He will die that lives on SSI. Sure You can borrow clothing and food. You can't go to Your neighbor and ask for a medical operation.

Larry

Medical care costs are soaring because new technologies allow people to live longer and the legal system requires doctors to practice defense medicine. Competition in the insurance business, which is a different issue, is artificially constrained by federal government regulations that do not allow the consumer to shop for health insurance across state lines.

Medical care costs are soaring because new technologies allow people to live longer and the legal system requires doctors to practice defense medicine. Competition in the insurance business, which is a different issue, is artificially constrained by federal government regulations that do not allow the consumer to shop for health insurance across state lines.

Posted by Redman at 2009-10-28 09:20 AM | Reply

You know I have heard of this balderdash but yet many times when My old man made a claim on His insurance it was either forwarded to delaware or South Carolina and we live in Kansas. Explain THAT to me.

Larry

My old man made a claim on His insurance it was either forwarded to delaware or South Carolina and we live in Kansas

The location of their claims processing center has nothing to do with where they are licensed to sell insurance. Even if a company sells in all 50 states they are required to have a different legal entity and policy for each state and have different rates and claim payments based upon the overall experience rates and charges for that state.

"If we have the power to simply order Americans to
buy certain products, why did we need a Cash-for-
Clunkers program or the upcoming program providing
rebates for purchasing energy appliances? We could
simply require Americans to buy certain cars,
dishwashers or refrigerators."
-Sen Orin Hatch, 10-01-2009, on the
upcoming healthcare bill requiring
Americans to buy healthcare insurance

NOBODY should profit over someones health. NOBODY. Just like I have a serious problem with Funeral Homes and Funeral directors. They are profitting off of someones grief and that's totally wrong too.
Larry

#105 | POSTED BY LARRYMOHR AT 2009-10-28 08:52 AM | REPLY | FLAG

OMG. If we had leaders that think the way you do, we'd have no doctors, nurses, hospitals, drug companies, medical hardware makers, along with nobody to bury the bodies that would pile up due to the aforementioned problems. You need to move to Cuba or something.

#101 | Posted by Redman: Wake up. The money has already been spent and replaced with Treasury notes that can't be redeemed without new tax collections.

Maybe Medicare is paying the ACTUAL cost of the procedure than what the Doctor/Hospital are charging.

#20 | Posted by LarryMohr at 2009-10-27 03:29 AM

Tell it to all of the regular hospital workers that are getting laid off (and I don't mean doctors).

Posted by LIVE_OR_DIE at 2009-10-28 01:25 PM | Reply

Maybe the Hospital Board is being too greedy and wanting more money bfor themselves. Ever think about THAT instead of rallying against Medicare????????

Larry

Maybe the Hospital Board is being too greedy and wanting more money bfor themselves. Ever think about THAT instead of rallying against Medicare????????

Larry

#121 | Posted by LarryMohr at 2009-10-28 01:27 PM

I don't "rally" against Medicare. I rally against the government deciding not to pay the full cost of service. Hell, I've even voiced support for Medicare + over the "public option" being batted around Congress.

Posted by LIVE_OR_DIE at 2009-10-28 01:29 PM | Reply

Maybe they ARE p[aying the full cost of the procedure and the Hospital/Doctor is charging triple of what it actually costs. They do that shit all the fucking time. 200 Dollar mucus Removal Devises a 99CENT box of kleenex 10 to 20 dollars for a SINGLE Tylenol. They cut all that shit out and only pay what the actual services cost.

Larry

Maybe they ARE p[aying the full cost of the procedure and the Hospital/Doctor is charging triple of what it actually costs. They do that shit all the fucking time. 200 Dollar mucus Removal Devises a 99CENT box of kleenex 10 to 20 dollars for a SINGLE Tylenol. They cut all that shit out and only pay what the actual services cost.

Larry

#123 | Posted by LarryMohr at 2009-10-28 01:32 PM

Treasury notes due are being redeemed and are still considered an extremely conservative investment.

#119 | Posted by hope4hope

I never claimed they were not being redeemed or considered a bad investment, yet. But ask youself what are they being redeemed with? Some secret bank account that the government keeps? With money that they just print out of thin air? Or, more likely, with the revenue from new notes that we sell to the Chinese? And what happens when no one wants to buy the new notes because our currency has collapsed?

It's a ponzi scheme at it's best.

#125 REDMAN, I would consider a ponzi scheme a bad investment.

#121----" Maybe the hospital board is being too greedy"---- Larry, just a suggestion--- to quit posting on this subject. I think you're out of your league on this one---been in health care for years-- most hospitals are nonprofit in fact the largest one in our city is nonprofit (huge hospital system) Having been involved with them I'll assure you that the board members are from the community and DONATE their time on the board-- I'll repeat that so there is no misunderstanding-- they ARE NOT PAID for their services (no greed). I would suggest this is one subject matter you should avoid unless you do some research on it.

#121----" Maybe the hospital board is being too greedy"---- Larry, just a suggestion--- to quit posting on this subject. I think you're out of your league on this one---been in health care for years-- most hospitals are nonprofit in fact the largest one in our city is nonprofit (huge hospital system) Having been involved with them I'll assure you that the board members are from the community and DONATE their time on the board-- I'll repeat that so there is no misunderstanding-- they ARE NOT PAID for their services (no greed). I would suggest this is one subject matter you should avoid unless you do some research on it.

#127 | Posted by matsop at 2009-10-28 07:31 PM | Reply | Flag: Flag: (Choose)
FunnyNewsworthyOffensiveAbusiv
e

Is that why the so called Noprofits charge 200 bucks for a 99cent box of kleenex or charge 10 to 20 bucks for a tylenol??? Don't tell Me I don't know what the fuck I am talking about I get the fucking bills in the mail. Oh and these ARE so called Nonprofits. Now what say You??

Larry

#128-- Larry, now for your next lesson-- the reason why your charge is greater then the cost (called cost-to charge in the system) is often due to what is called "cost shifting". There are some hospitals that treat a large number of individuals that are uninsured and that then translates to a loss on their books-- when you have a large number of these individuals the losses can be huge. To make up for those losses, the hospitals will often increase the fees for procedures, medications, X-rays, etc. on those folks with insurance and therein lies cost shifting. The auto companies have been screaming about this for years-- back when the cost of medical care/car was $1500/car it was not the actual cost of care for the auto workers but was due to this concept of "cost shifting" to the insured.

Since I'm one of these boomers, I find a certain irony that all the 20-30 somethings that are all in favor of government health care for everyone are going to be the ones raped to pay for my health care in my old age.

#13 | Posted by Redman at 2009-10-26 09:22 PM | Reply |

Its a good solid principle to look after your elders. Although I'm sure the 20 - 30 somethings would like something a bit smoother than rape occur. And that is the challenge.

CONCERNING: "our intent to have care provided for those who have none is commendable. No joke.What is driving me (and others) up the wall:HOW will the care be provided?If you have 10 million cars and 20 million drivers, will making a law that says every driver will have his/her own car suddenly make the the extra needed cars appear????????"

Well, the truth is, they will throw the ones without cars in jail.

absolutely true.

A clause in the insurance schem says you have to buy insurance.
If you don't buy it you get fined.
If you don't pay your fines you go to jail

absolutly true.

Time to fire our senators... They are no longer working for us.