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Thread: Is health-care reform constitutional?

  1. #21
    Senior Member YardleyLabs's Avatar
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    Quote Originally Posted by M&K's Retrievers View Post
    When all the insurance carriers withdraw from writing health insurance since it will be impossible to make a profit under the health careless requirements, we will be left with the single payer system which is what the Libs wanted all along. Sometimes you have to read between the lines.
    Medicare is a single payer system. Who administer payments? How does the cost per claim and the time required to process compare with commercial health insurance plans?

  2. #22
    Senior Member M&K's Retrievers's Avatar
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    Quote Originally Posted by YardleyLabs View Post
    Medicare is a single payer system. Who administer payments? How does the cost per claim and the time required to process compare with commercial health insurance plans?
    I'm sure your have a butt load of stats but having said that, most of the providers I have visited with complain about Medicare delays and cuts. This includes Docs and Hospitals billing depts.
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  3. #23
    Senior Member JDogger's Avatar
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    Is Health care constitutional?

    I don't know.

    Is undeclared war that goes on and on?

    JD
    One cannot reason someone out of something they were not reasoned into. - Jonathan Swift

  4. #24
    Senior Member dnf777's Avatar
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    Quote Originally Posted by M&K's Retrievers View Post
    I'm sure your have a butt load of stats but having said that, most of the providers I have visited with complain about Medicare delays and cuts. This includes Docs and Hospitals billing depts.
    I'll be the first to complain about their reimbursement rates, but at least you do know your patients will be approved for the care they need, won't be dropped and not be able to follow up anymore, and you will be paid in a timely fashion, and not down-graded and "bundled".....ie NOT PAID.
    God Bless PFC Jamie Harkness. The US Army's newest PFC, but still our neighbor's little girl!

  5. #25
    Senior Member YardleyLabs's Avatar
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    Quote Originally Posted by M&K's Retrievers View Post
    I'm sure your have a butt load of stats but having said that, most of the providers I have visited with complain about Medicare delays and cuts. This includes Docs and Hospitals billing depts.
    No boatload of stats. Claims are processed by pretty much the same companies providing private health insurance with payments typically made within two weeks. The process is completely standardized and integrated into most practice management software systems, with predominantly electronic processing. As with all third party systems, the people who get screwed are the smaller practitioners that process a low volume of claims, do not have automated systems, and attempt to do things manually. My long time family doctor fell into this group and finally made a business decisions not to accept any form of insurance from anyone. Medicare was the last group he shut down.

    For physicians, the fundamental problem of Medicare is that the rates are too low. For other types of providers, Medicare rates are often the highest they receive relative to other insurers. By the way, Medicare claim administration expenses run about 2%, which is a small faction of the cost of most private plans. One of the reasons is that private pans incur substantial costs trying to determine if another payer might be responsible for the cost (coordination of benefits, subrogation of benefits, split claims, etc.).

    For institutional providers, the biggest nightmare of Medicare is uncertainty concerning the rates that will be paid. Prices are based of complex cost analyses and the rates paid are simply estimates pending a future audit. The rate setting process does nt encourage efficiency and can result in significant surprises when audits are complete.

    Medicare actually pays the intermediaries in advance, providing them with trust accounts against which claim payments are drawn pending periodic reconciliations.

  6. #26
    Senior Member dnf777's Avatar
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    Quote Originally Posted by JDogger View Post
    Is Health care constitutional?

    I don't know.

    Is undeclared war that goes on and on?

    JD
    I don't know either. But I do know that if the gov't is going to take away half my paycheck (all taxes together and anticipated increases that are coming) I'd rather it go to American roads and bridges and providing healthcare to American children and families........rather than blowing up Iraqi and Afghan roads and bridges and families, then paying to rebuild them!

    And yes, healthcare is expensive, and will likely recieve 100% of the blame for any forthcoming tax increases, but let's not forget about two wars, one in particular, that has cost more than all this healthcare combined thus far, and has had the net effect of replacing one untrustworthy president with another. Pardon me, replacing TWO untrustworthy presidents with TWO more!
    God Bless PFC Jamie Harkness. The US Army's newest PFC, but still our neighbor's little girl!

  7. #27
    Senior Member M&K's Retrievers's Avatar
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    Quote Originally Posted by dnf777 View Post
    I'll be the first to complain about their reimbursement rates, but at least you do know your patients will be approved for the care they need, won't be dropped and not be able to follow up anymore, and you will be paid in a timely fashion, and not down-graded and "bundled".....ie NOT PAID.
    Dave, I've been writing health insurance coverage for employer groups and individuals for over 35 years and I have never had anyone terminated or dropped for anything other than for non payment of premium. I get real tired of hearing about these horror stories where the insusance company cancels coverage at the first sign of a claim. Yes, there are many fly by night carriers out there that write crap coverage through their company reps, not independent agents.

    I'm quite sure you get pissed off when people outside your profession take potshots at your expertise. I'm sure you'll understand when an insurance professional feels the same way. If insurance companies were making so much money raping and pillaging the public, their would be a lot more of them competing for the gravy. There will be even fewer now.

    By the way, what drives the cost of insurance up? Could it be the cost of the care, the paperwork, the mandates, litagation, CYA testing?
    Last edited by M&K's Retrievers; 03-23-2010 at 01:54 AM.
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  8. #28
    Senior Member dnf777's Avatar
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    Quote Originally Posted by M&K's Retrievers View Post
    Dave, I've been writing health insurance coverage for employer groups and individuals for over 35 years and I have never had anyone terminated or dropped for anything other than for non payment of premium. I get real tired of hearing about these horror stories where the insusance company cancels coverage at the first sign of a claim. Yes, there are many fly by night carriers out there that write crap coverage through their company reps, not independent agents.

    I'm quite sure you get pissed off when people outside your profession take potshots at your expertise. I'm sure you'll understand when an insurance professional feels the same way. If insurance companies were making so much money raping and pillaging the public, their would be a lot more of them competing for the gravy. There will be even fewer now.

    By the way, what drives the cost of insurance up? Could it be the cost of the care, the paperwork, the mandates, litagation, CYA testing?
    You make good points, and I agree with you last sentence wholeheartedly. to support my claims, however, I would point you to recent court decisions that held several major insurance carriers responsible to repay physicians and hospitals for so-called "bundling" of payments as well as downgrading charges at their whim. I didn't have time to research, but the info is readily available. I believe former senate majority leader Bill Frist's Tennessee based company was involved, if not impugned in those cases.

    Yes, I do get peeved when people take unjustified shots at my profession, but not when they are justified, which unfortunatley is sometimes the case. Medicine, especially surgery, is the most regulated, policed (self and otherwise), and scrutinized profession I can think of, except maybe pesticide application under a democratic EPA.

    I wouldn't neglect to include American's fatty, caloric-packed, processed-food diets in the blame game of health care costs. The fact our life-expectancy is anywhere near where it is, is a testament to the miracle of modern medicine! Think of how much that "we" eat that comes in boxes, wrappers, cellophane bags, or handed to us from a teenager in a window wearing a headphone.
    Last edited by dnf777; 03-23-2010 at 06:49 AM.
    God Bless PFC Jamie Harkness. The US Army's newest PFC, but still our neighbor's little girl!

  9. #29
    Senior Member YardleyLabs's Avatar
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    Quote Originally Posted by M&K's Retrievers View Post
    Dave, I've been writing health insurance coverage for employer groups and individuals for over 35 years and I have never had anyone terminated or dropped for anything other than for non payment of premium. I get real tired of hearing about these horror stories where the insusance company cancels coverage at the first sign of a claim. Yes, there are many fly by night carriers out there that write crap coverage through their company reps, not independent agents.

    ....
    How's this for an example? My company purchased its health insurance through Guardian for a period of several years when we received notice that services in the future would be provided through a joint venture of by Guardian (providing hospital coverage) and HealthNet (providing major medical). There were some problems in transition, but it stabilized. After two years we received another notice that the joint venture was being terminated and that responsibility for our coverage would come through HealthNet in the future. This was followed by a letter of non-renewal. At the same time we received a letter saying that the renewal letter would be coming from HealthNet and asking us to be patient. It also said that all future premium payments needed to be sent to HealthNet and that we would receive an invoice. No invoice or renewal letter came prior to the renewal date. Repeated phone calls went unanswered. Guardian indicated that they could not accept premium payment because the joint venture had been dissolved.

    Five weeks following the renewal date we received a letter from HealthNet stating that all coverage had been terminated effective as of the prior renewal date because of "non-payment of premium" and a decision not to renew policies with small businesses. At its annual meeting that year, HealthNet announced the successful strategy they had followed to terminate coverage for unprofitable small business accounts and awarded a bonus to the staff person who had come up with the idea.

    To rub salt in the wound, the fact that the cancellation was made retroactive meant that everyone covered had been without coverage for more than 30 days. Given my own medical problems, I went without insurance for four months until I managed to join an association plan during an open enrollment period. Everyone else obtained policies but with prior condition exclusions.

  10. #30
    Senior Member Gerry Clinchy's Avatar
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    Nobody has specifically mentioned what this does to our personal freedoms.

    1) We presently can choose to purchase health insurance or not. That option will be removed with a tax penalty. (Although if you're going to have a penalty, I think it should be upon an individual rather than their employer. And the penalty should be a substantial one, no a slap on the wrist compared to the cost of actually purchasing coverage).

    2) If someone wants to buy catastrophic coverage only, with a high deductible or a co-pay, it will simply no longer be available. Even Medicare has a co-pay.

    Private insurors supplement Medicare with policies that absorb the co-pay. No need for that kind of private industry support with a program that has no co-pay.

    3) A young, healthy person who is not married; or unable to have children; or doesn't want to have children, will not be able to purchase a policy without maternity or pedicatric care. Neither will a woman who is past child-bearing age.

    4) Since there will no longer be any financial advantage for those people who don't smoke, stay slim, and avoid substance abuse (no pre-existing conditions are excluded), I'd bet the farm that the govt eventually comes up with some kind of "tax" or "penalty" for smoking, obesity, and alcohol consumption. In Japan, there is already a monitoring of waist-size with a penalty attached.

    I thought this provision was interesting (if accurate)
    If you are a physician owner and you want to expand your hospital? Well, you can’t (Section 6001 (i) (1) (B). Unless, it is located in a county where, over the last five years, population growth has been 150% of what it has been in the state (Section 6601 (i) (3) ( E)). And then you cannot increase your capacity by more than 200% (Section 6001 (i) (3) (C)).
    Why would this not also apply to non-physician owners? This provision is ancillary to the limitation of physicians owning hospitals unless they are approved Medicare providers by Feb. 2010 (oops, too late under the Senate bill, but extended to Dec. 2010 under the "reconcilation").

    The Senate bill provided for $750/employee penalty for employers of 101 or more) for not providing insurance, but that is raised to $2000 or $3000 under the reconcilation. Quite a difference between the two.

    Do we really expect that taxes on medical device mfrs and pharma companies will yield a long-term cost reduction? Costs of additional taxes are usually passed onto the consumer of the products. Of course, govt holds the purse-strings in determining reimbursements or Medicare and Medicaid; and likely, at least indirectly, under these new programs (via the rate restraints on private insurors as long as the private insurors remain in this business).

    So, those companies producing those goods, if compelled to offset those penalty charges on their balance sheet & unable to raise prices ... it seems logical that they will have to trim other expenses. R&D maybe? Lay off some employees maybe?

    No problem those people can always go to work for the IRS, which will need 16,000 more employees to make sure everyone pays their penalties or for their health insurance.

    In addition to the 10% tax on tanning salon services, there is a 5% tax on cosmetic surgery. That last tax is likely only to affect those that can afford elective cosmetic surgery .. the rest of us will just stay ugly
    G.Clinchy@gmail.com
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