Baucus Care

For more than a decade, I made my living by placing consultants with clients on a full time multi year basis. Why did they pay me a significant premium to provide their staff? There were several reasons, but the primary one was to avoid paying for health care costs, pension costs, and severance costs. For most of our customers, those costs totaled 40-50% of payroll. For us they totaled 10% of payroll.

At one point we provided more benefits. However, some of our largest customers (think the mother of all telephone companies and the father of all computer companies) actually imposed caps on how much we could charge in excess of direct salary that were set so low that it was impossible to provide any non-legally mandated benefits at all. The only factor that constrained how many staff were purchased in this manner were IRS regulations that defne employees in a way that opened the buyers to charges that our staff were actually their staff and that they could be found liable for benefit costs.

Over time, the the maximum extent legal, I expect almost every company that competes on a global basis to eliminate benefits for their non-managerial employees. Discrimination laws (by job class, not race or religion) now prevent companies from having one set of benefits for highly compensated staff with another for everyone else. However, lobbyists continue to look for loopholes and continue to have success in creating new ones. In the meantime. moving jobs overseas is the ultimate loophole since it avoids both the discrimination charge and the threat of IRS audits.

The impact of this trend will be the collapse of employer paid health care benefits in most major industries. To save jobs, to make our businesses more competitive in the global economy, and to preserve health benefits for at least the lower 50-60% of our population, I see no alternative to publicly financed health insurance paid through general taxes, not payroll taxes.

I have probably missed seeing this when someone mentioned it but here goes......office help will be increased in all medical offices to do the added paper work if the government takes over the insurance coverages. I'm guessing that will change a lot of things ! I've lived a long life and I have seen a G.P. office go from one nurse and one office worker to at least 5 office workers and one nurse in my life time. No one can tell me that that fact alone is not going to raise costs. Having had a reason to call a government office a few years back in D.C. and hearing the good time they were having during work hours I'm guessing they work very few minutes each day. I'm not very smart but even I know it will take a lot of government workers to take care of "paperwork" (even if said paperwork is on the computer).
charly_t

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Originally Posted by charly_t

I have probably missed seeing this when someone mentioned it but here goes......office help will be increased in all medical offices to do the added paper work if the government takes over the insurance coverages. I'm guessing that will change a lot of things ! I've lived a long life and I have seen a G.P. office go from one nurse and one office worker to at least 5 office workers and one nurse in my life time. No one can tell me that that fact alone is not going to raise costs. Having had a reason to call a government office a few years back in D.C. and hearing the good time they were having during work hours I'm guessing they work very few minutes each day. I'm not very smart but even I know it will take a lot of government workers to take care of "paperwork" (even if said paperwork is on the computer).
charly_t

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As a physician, I spend MUCH more time jumping through hoops and filling our paperwork for private insurance than Medicare. After that, payment is reduced or refused outright more often form private insurance than medicare. Of course, medicare pays roughly 15-20% less. I'm not sure that public option is the solution, but I know SOMETHING has to change.

The first solution to excess paperwork I would propose, is allowing physicians to bill at the local average attorney's rate for filling out forms and require whoever requested said forms, pay! Around here, $250/hr is the going rate for legal work, and at that rate, I would supplement my salary by about $5000/month, less taxes, of course, assuming one hour per workday, which is about accurate. Pretty amazing.

I bet paperwork would disappear overnite.

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Originally Posted by charly_t

I have probably missed seeing this when someone mentioned it but here goes......office help will be increased in all medical offices to do the added paper work if the government takes over the insurance coverages. I'm guessing that will change a lot of things ! I've lived a long life and I have seen a G.P. office go from one nurse and one office worker to at least 5 office workers and one nurse in my life time. No one can tell me that that fact alone is not going to raise costs. Having had a reason to call a government office a few years back in D.C. and hearing the good time they were having during work hours I'm guessing they work very few minutes each day. I'm not very smart but even I know it will take a lot of government workers to take care of "paperwork" (even if said paperwork is on the computer).
charly_t

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Actually, there are three ways to dramatically reduce the paper associated with medical claims:

1. Stop accepting health insurance altogether. Require all patients to pay at the time of service and let the patients seek any reimbursement for care. If claim forms need to be completed, charge a fee for completing them.
2. Institute a single payer health plan. This eliminates all requirements for coordination of benefits between plans (a fancy way of describing the efforts by insurance companies to force other insurance companies to pay all or part of a bill) and guarantees a standard set of rules and procedures for all claims.
3. Allow multiple payers but require all to implement uniform, electronic claim management procedures. This provides some of the benefits of option 2 but requires that insurance companies comply. No one really has the authority to force that compliance.

Many physicians have elected to implement option 1. My family physician for 25 years recently shifted to a concierge practice. Each patient pays a flat fee of $2000/year. The doctor sees them as needed with same day appointments and 24 hour accessibility. There are no other charges for his service and he does not accept any form of insurance or complete any paperwork beyond the annual bill. He reduced his practice to 300 patients generating $600,000 in billings. He employs a single part-time nurse (his wife). His office is in his house. His net income has almost doubled and he is working fewer hours per week. He has coverage agreements with other physicians with similar practices so that he can still take vacations.

Option 2 is the great boogeyman of socialized medicine. It is the approach that has been implemented in many countries and is the de facto approach for care to Medicare patients (explaining the very low administrative costs for medicare), but is unlikely to be implemented for anyone else.

Option 3 is the approach taken in HR 3200 and will probably be part of any health reform. To be deemed to be "qualified" plans, health insurance companies will be required to conform with a uniform standard for electronic submission and management of all claims. This has the potential for reducing administrative costs significantly and for reducing medical errors (particularly related to prescriptions) and the incidence of duplicate testing.

Jeff,
My hat's off to your physician. I hope that both he and you are happy with the new arrangement. I would love to follow suit, but I can't remove gall-bladders in my garage! The ambulance (I mean gator 4x4) takes up too much room. :p

edit: emoticon added so nobody would think I'm serious!

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Originally Posted by dnf777

Jeff,
My hat's off to your physician. I hope that both he and you are happy with the new arrangement. I would love to follow suit, but I can't remove gall-bladders in my garage! The ambulance (I mean gator 4x4) takes up too much room. :p

edit: emoticon added so nobody would think I'm serious!

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I'm not crazy enough to pay him $2000 for what used to cost me $200! I switched doctors immediately.:rolleyes:

Too bad there isn't a way to force Congress and all federal and state employees to be a part of any health care reform. Then I bet we'd get some constructive ideas.

Yardley

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Many physicians have elected to implement option 1. My family physician for 25 years recently shifted to a concierge practice. Each patient pays a flat fee of $2000/year. The doctor sees them as needed with same day appointments and 24 hour accessibility. There are no other charges for his service and he does not accept any form of insurance or complete any paperwork beyond the annual bill. He reduced his practice to 300 patients generating $600,000 in billings. He employs a single part-time nurse (his wife). His office is in his house. His net income has almost doubled and he is working fewer hours per week. He has coverage agreements with other physicians with similar practices so that he can still take vacations.

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While this might not work for you, Jeff, it might work pretty well for a family with 2 or 3 young'uns. And isn't that sort of the way an HMO works? The dr gets paid for the # of patients on his "roster", whether he sees them or not, but still collects each month.

Perhaps the legislative proposals should have made a provision for this type of program?

Yardley

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I see no alternative to publicly financed health insurance paid through general taxes, not payroll taxes.

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Bingo! The reason that the legislators are having a problem is that they keep wanting to tax only those in higher income brackets. They don't want to be accused of raising taxes for low & mid income people, because O said he wouldn't do that. He will ultimately have to admit he didn't have a full grasp of the situation, period, when he made such a promise. So they are doing all this tap dancing around the costs that cannot possibly be funded without more taxes for everyone. If they told the truth, the reform they propose would be dead in the water.

Medved referenced the phone tapes between Johnson and then-Senator Kennedy, where he flat-out admitted that Medicare would never get done if they revealed what the costs would be more than 2 years into the future. They knew doggone well it was a losing proposition when it came to funding.

Michael Medved interviewed Henry Waxmann (CA congressman) about health care. No matter how you slice it, there is no way that they can make this come out as a "break even" proposition. While Waxmann showed some courage in being willing to field some of the tough questions, I'm sure that Medved's audience had a raw nerve hit when Waxmann stated, " ... and people making $1 million should pay more taxes ..." Medved did comment on that premise just briefly.

I believe that the politicians have a problem because they took the one solution that I feel we will inevitably arrive at off the table before they even began.

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Originally Posted by Gerry Clinchy

Yardley


While this might not work for you, Jeff, it might work pretty well for a family with 2 or 3 young'uns. And isn't that sort of the way an HMO works? The dr gets paid for the # of patients on his "roster", whether he sees them or not, but still collects each month.

Perhaps the legislative proposals should have made a provision for this type of program?

...

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His pricing is for an individual, not a family.... It also only covers his personal services, not any tests or costs of referrals. He only accepts patients with comprehensive health insurance. He just won't accept it for payment of his own services.