Obamacare, Brave New World revisited

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Originally Posted by Bob Gutermuth

The govt cannot even run the post office, how in the H#LL are they going to run something as important as health care?

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they've been doing it with medicare, VA, and Tricare. Certainly not perfect, but well enough to invalidate the blanket claim that they can't run anything.

For my money, the government couldn't run a gas station at a profit if they stole the customers cars. Just look at all the fraud running rampant in medicare, I won't even begin to talk about the rippoffs going on in the Dept of Ag's foodstamp boondoggle.

We do know that the government couldn't run that whorehouse out West after they confiscated it :-)

The future of pain management

http://www.telegraph.co.uk/health/he...njections.html

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Originally Posted by HuntsmanTollers

Originally from Yardley "The reason is that a government plan is less likely to rely on "gotchas" to save money. Competition from such a plan would make it harder for insurance companies to continue to play the fine print game in marketing their plans and I believe we would all benefit."

Under our current system who sets the standard for reimbursement rates for insurance companies? Who currently regulates the insurance companies? Why do you think they will do a better job in the future?

Regulation and administrative requirements are a major factor in health care costs. Nothing I have seen in the proposed bills decreases that. If anything it will be increased with the new government agency for oversight of the program.

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Insurance companies set the standards for reimbursement under insurance company plans. States regulate insurance companies but generally only with respect to issues of solvency, conformance with laws concerning cancellations and renewals, and conformance with laws concerning provision of legally mandated services. State regulations have little to no impact on the administration of health benefits.

For many years, I ran a successful national consulting practice designing health claims management systems and reviewing the administration of health benefits by insurance companies and third party administrators on behalf of major corporate clients and the insurance companies themselves (e.g., Mobil, MetLife, First Health Services Corporation, First Health Services). My primary qualifications for doing that when I started were my general background in health services administration and computer systems, as well as my specific background running Medicaid and improving Medicaid payment systems in New York City. The system we implemented in NYC was years ahead of anything existing in the private sector at that time (mid-1970's) allowing both more effective screening for erroneous and fraudulent billings and faster turnaround on payments (under 10 days) than was possible under private sector systems.

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Originally Posted by subroc

The future of pain management

http://www.telegraph.co.uk/health/he...njections.html

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It appears as though they may be attempting to forstall becoming like Broward County (and coming to a neighborhood near you), good oversight if you ask me.

http://www.palmbeachpost.com/news/co...xsvc=7&cxcat=0

I guess I don't understand the comparison.

are you saying that because there may be some evidence of abuse in one part of a system that those in an unrelated part of the system must be made to suffer?

This is how you expect decisions to be made in obama care?

WoW!!!

Yardley,

Technically insurance companies set the reimbursement rates however they base them off the what the government has determined to be 'fair and equitable' rates for medicare and medicaid. Therefore the government sets the standard. FYI both my wife and I have been involved in health care for quite some time. I will say that neither of us were doing it in the 70s though.

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Originally Posted by HuntsmanTollers

Yardley,

Technically insurance companies set the reimbursement rates however they base them off the what the government has determined to be 'fair and equitable' rates for medicare and medicaid. Therefore the government sets the standard. FYI both my wife and I have been involved in health care for quite some time. I will say that neither of us were doing it in the 70s though.

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You're exactly correct. Where the problem arises, is that insurance companies are allowed to collaborate and fix prices, as where physicians must go at it alone. One side can collectively bargain, the other can't. I fail to see any "free market" in existence in health care. The insurance companies screw both docs and patients, all the while strolling to the bank.

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Originally Posted by dnf777

You're exactly correct. Where the problem arises, is that insurance companies are allowed to collaborate and fix prices, as where physicians must go at it alone. One side can collectively bargain, the other can't. I fail to see any "free market" in existence in health care. The insurance companies screw both docs and patients, all the while strolling to the bank.

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Every major insurance carrier uses one of two sources of information concerning reasonable and customary charges: data gathered from payments under the plans they administer themselves or data accumulated by the Health Insurance Assocation of America (HIAA). Neither is associated with either Medicaid or Medicare. Medicaid, because of legal restrictions on it, often pays more for institutional care than private insurance companies while Medicare often pays less. Part of that relates to provisions of the medicare law that link its reimbursement to actual costs of care provided to Medicare recipients who are often cheaper to treat per day of care because a higher percentage of their hospital stays are convalescent.