How We All Got Stuck Paying the Medical Bills of the Woman Who Sued to Kill Obamacare

It is not truly accurate, of course, that that $30 million a year in uncompensated care at Bay Medical Center is, indeed, uncompensated. Somebody has to pay for it. And guess who that is? It is all of us. Even Mary Brown. She and the rest of us cover that uncompensated care either through higher taxes to support the Medicare and Medicaid programs or through higher health insurance premiums. The care that presumably is "absorbed" by the hospitals is, in reality, being absorbed not by those facilities but by us. This is what the term "cost shifting" is all about.
And this irrational way of paying for that so-called uncompensated care has us locked into a dysfunctional system in which costs for both the insured and the uninsured keep spiraling upward.

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http://www.huffingtonpost.com/wendell-potter/how-we-all-got-stuck-payi_b_1338561.html

I don't see how anyone can argue that our healthcare system can be fixed by a few tweaks. It is obviously broken, and it's time for Republicans and anyone else in denial to wake up and see the truth.

Enough with the cost shifting, enough with the libertarian fantasies, enough with the bullshit.

I'm sick and tired of folks who say universal healthcare or individual mandates are not American. I'll make it simple for those people: We have a problem. The American way is to approach a problem honestly, roll up our sleeves and fix it, and move on.

Thats what freedom is all about - freedom from the sick and the downtrodden being able to inflict negative external costs on the rest of us against our will!

Being neck deep in the health care system, I completely agree that it needs radical changes.

However, after seeing how government run health care is so poorly run (Medicare, Medicaid, the VA system) I just don't understand why there's such a clamor for government to then take over everyone's health care.

hey dopa,

How is that 3rd part of that series going? The one where you post some solutions to the problems with healthcare?

Also prove the gubberment healthcare is just so gosh durn poorly run or stop posting.

Have you been in a VA hospital?

Granted, some of the university affiliated ones are reasonable, but some are scary... LVNs are unionized, so no matter how much they suck or how many deaths they cause, they almost never get fired. People who are terrible at their jobs (MDs, RNs, LVNs, etc.) either stay in those jobs or simply get reassigned to different positions. Most clinic tend to run late as they are overbooked and the staff simply doesn't care. Getting in to see specialists can take months and certain clinics are only held a couple of times per week, so there isn't much flexibility in scheduling; also, try getting certain drugs through the VA (lovely non-formulary consults)... all of this is not to say that you cannot get good care through the VA, I've seen people get exceptional care provided by University associated specialists... some people (the service connected ones) can also get quite a lot of resources through the VA)... but, overall, the process tends to be a slow one. From a physician standpoint, its annoying to be there because the support staff sucks and thus you have to do more stuff yourself...

Medicaid (at least in California) sucks because the reimbursements are so low (1/3 to 1/4th of Medicare or private insurance). A standard visit (99213) gets reimbursed at $24... then the physician is still responsible for follow-up of results and liable for missing something... when you factor in costs of running an office, paying LVNs and MAs, it is simply not worth it to see Medicaid patients (same work for 1/4 the pay!)

Medicare has pretty reasonable reimbursements, but the underlying system is not well run. SNFs and LTACs love Medicare because the oversight over what they charge is poor. So BS charges that would be rejected by private insurance are paid out by Medicare... so the facilities have 100 days to run wild, stick G-tubes in people, continue physical therapy on the comatose, etc., etc.

I don't view lower reimbursements as a problem per se and for some reason (I know why but i'm being polite) it seems to be all you two ever talk about.

Anyway, a lot of what you talk about could be solved by more money or rather more money going to actual care. Why you guys blame the government rather than profit making companies that are allowed to cherry pick the wealthiest and healthiest Americans and ignore literally everything else is predictable.

[quote name='BigT']Medicare has pretty reasonable reimbursements, but the underlying system is not well run. SNFs and LTACs love Medicare because the oversight over what they charge is poor. So BS charges that would be rejected by private insurance are paid out by Medicare... so the facilities have 100 days to run wild, stick G-tubes in people, continue physical therapy on the comatose, etc., etc.[/QUOTE]

I won't argue on VA hospitals, but that's more of a military issue then a healthcare issue. It has little (not none, but little) bearing on how a civilian healthcare system would be run.

Doctors need to be compensaited fairly. If that means pouring more money into healthcare, then so be it.

As for the too little oversight issue, you can thank folks like Sarah Palin and her death squad talk for that. We need a fair system that balances budgetary concerns with the goal of providing medical care to everyone that needs it. If the people truly want a successful healthcare system, we need to remove the ignorant and/or disingenuous political players and ignore over-the-top political rhetoric.

[quote name='Msut77']Anyway, a lot of what you talk about could be solved by more money or rather more money going to actual care. Why you guys blame the government rather than profit making companies that are allowed to cherry pick the wealthiest and healthiest Americans and ignore literally everything else is predictable.[/QUOTE]

Every day it gets harder and harder for the right to do the mental gymnastics required to support corporate-run healthcare while pretending that they care about the health of all Americans.

To the other side: if you support the status quo then you really don't care about the poor or the ill. It's as simple as that. I know the libertarians will wear that as a badge of honor but I wonder how it sits with those that have a soul.

[quote name='BigT']Have you been in a VA hospital?

Granted, some of the university affiliated ones are reasonable, but some are scary... LVNs are unionized, so no matter how much they suck or how many deaths they cause, they almost never get fired. People who are terrible at their jobs (MDs, RNs, LVNs, etc.) either stay in those jobs or simply get reassigned to different positions.[/quote]

Do you have data/evidence to back up your twin assertions that VA staff are (1) less competent than similar staff at comparable hospitals and (2) engage in greater malpractice compared to similar staff at comparable hositals? Also, I'm charitably revising your second thesis; if you want it in its original form, please substitute (2) "are responsible for more patient deaths compared to similar staff at comparable hositals."

Those are bold claims. I suspect you have evidence.

Most clinic tend to run late as they are overbooked and the staff simply doesn't care.

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Vague, boring. You've just described every single experience I've had in a hospital, ever. Is this the result of a government run facility? Nonsense.

Getting in to see specialists can take months and certain clinics are only held a couple of times per week, so there isn't much flexibility in scheduling; also, try getting certain drugs through the VA (lovely non-formulary consults)... all of this is not to say that you cannot get good care through the VA, I've seen people get exceptional care provided by University associated specialists... some people (the service connected ones) can also get quite a lot of resources through the VA)... but, overall, the process tends to be a slow one.

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The main problem of health care is cost.
The problem with VA facilities is that they are slow because not all services are immediately accessible.
...so the answer is then to offer those services more frequently/efficiently? Which (trivia time!) will influence cost how, exactly?

From a physician standpoint, its annoying to be there because the support staff sucks and thus you have to do more stuff yourself...

Medicaid (at least in California) sucks because the reimbursements are so low (1/3 to 1/4th of Medicare or private insurance). A standard visit (99213) gets reimbursed at $24... then the physician is still responsible for follow-up of results and liable for missing something... when you factor in costs of running an office, paying LVNs and MAs, it is simply not worth it to see Medicaid patients (same work for 1/4 the pay!)

Medicare has pretty reasonable reimbursements, but the underlying system is not well run. SNFs and LTACs love Medicare because the oversight over what they charge is poor. So BS charges that would be rejected by private insurance are paid out by Medicare... so the facilities have 100 days to run wild, stick G-tubes in people, continue physical therapy on the comatose, etc., etc.

Click to expand...

I'll keep all this in mind the next time people on the right want to slash teacher benefits and wages. Some of us got into the same level of debt you did in medical school, some of us earn wages that are paid for by the public (i.e., public school teachers). And yet our rights, our wages, our benefits are threatened - yet physicians claim the necessity of exorbitant salaries as a necessary prerequisite in order to work in the first place. Teachers, as a group, show that you can still staff people in positions they are overqualified for, got into too much debt over, work too many hours for, underpaid for, and yet still, despite all that, be universally despised by the public on one side of the political spectrum.

You're not paid enough is a criticism of a government-run system? Come. Let's talk. You have much to learn about that, padawan.

oh oh oh, when do we get to the anecdotes about people dying on waiting lists in Canadian healthcare? Those are the best.

Before any meaningful discussion over health care reform can take place, there needs to be an unequivocal answer to the following question: is the doctor/health care provider's ultimate responsibility to the individual patient under my direct care or is it to society as a whole? If the former, then let me do my job and get the hell out of the way. If the latter, then fine, tell me what your population based guidelines are and provide medicolegal immunity when adverse outcomes occur to patients that suffer as a result since I am unable to use my clinical judgment because care that is deemed not cost effective is withheld.

In general, people say cutting costs is the priority until they need health care themselves then it's do everything you need to do. You can't have it both ways if you want a coherent health care policy.

[quote name='dopa345']Before any meaningful discussion over health care reform can take place, there needs to be an unequivocal answer to the following question:[/quote]

"We" have been having a meaningful discussion. What you are saying is that you are going to stick your fingers in your ears.

@mykevermin

You should stop with your ivory tower BS. Most things in life (and medicine) do not have clear evidence to back them (and, if we look to the pharmaceutical industry and analyze which studies are published vs. not published... we see that it is not an unbiased process). It is especially funny when people in medicine who swear by evidence based medicine, "prove" something with statistics that is impossible by the laws of physics or thermodynamics...

Comparing outcomes among different systems (and studying medical outcomes in general) is notoriously difficult. Anecdotally, lots of vets like the VA cuz its a place for them to hang out; they also tend not to complain about things (often to a fault)... so satisfaction surveys could be skewed. Core outcome measures are also not perfect (you can place someone with heart failure and severe kidney disease on an ACE inhibitor to meet the core outcome and you still look good even though if that person comes back in a couple of months with severe hyperkalemia and v fib). Additionally, other audit measures (such as blood pressure or A1C goals) do not take into account the harm that could be brought about by over-zealous treatment (especially in the elderly).

I can only tell you what I've seen with my own eyes about staff. A lot of the quality issues are subtle... In many populations, 4 persons per room would not fly, but vets tend not to complain about it. Also, good luck trying to sue the VA for malpractice... The VA is probably also the only place I've had nurses flatly refuse to carry out orders, such as placing Foleys on people with a palpable bladder 2/2 obstructive uropathy (mainly because they are lazy) or giving medications (since they claim a patient can't swallow... even though the speech pathologists say otherwise).

RE: Cost. A lot of this is due to a payment and reimbursement structure that favors doing more things. Generalists tend not to manage medical problems very well on their own anymore (since there is no incentive to do so - they get paid the same and may incur more risk). They refer to specialists who make most of their money by performing procedures... so they are apt to recommend more procedures, on average. Both Medicare and private insurances are big culprits. The VA is better about this because there is no large incentive to do more procedures... however, this sometimes pushes the balance in the other direction. The whole issue about limited clinic access does not save as much money as limited access to procedures... for example, medicare pays for colonoscopies, so most people on the outside get colonoscopies at least every 10 years despite the fact that there is no evidence that colonoscopies are much superior to stool cards or sigmoidoscopies... the VA does stool cards first line... it is safer and about as effective (that's something that we can learn from the VA). Easy access to clinics is not.

[quote name='Msut77']I don't view lower reimbursements as a problem per se and for some reason (I know why but i'm being polite) it seems to be all you two ever talk about.[/QUOTE]
The word you're looking for here is GREED. Doctors view patients as a commodity and trade off proper care for seeing how many co-pays and reimbursements they can get in a day by cramming their office schedules to the point of overload. In the end, care suffers since then patients are led through the office on a virtual conveyor belt. Oh. You have an ache here? No time for me to properly diagnose it. Here have a script for pain or something else that the pharmaceutical industry has whored out to me via their sales reps.

I know this all too well since I've been shuffled through and passed off, given bad medical advice from doctors that were more concerned with making their next dollar than taking care of patients.

When doctors forget their hippocratic oath and only care about the money, then it's time for them to find a different line of work.

[quote name='BigT']Most things in life (and medicine) do not have clear evidence to back them[/QUOTE]

:lol:

Woman takes advantage of poorly designed system and forces everyone else pay for her use of it.

Therefore, the only proper answer is for everyone to be forced to pay for everyone else's use of the same poorly designed system.

It solves the free-rider problem, does it not?

By making everyone free-riders?

*sigh*

Who wants to bet that bobby will go full-throttle teabagging birther by the November elections?

This is what amuses me. Those who are all "Oh, noes... people abuse the system by using it for free! Obviously, this overburdens the system and that's why health care in America sucks. Therefore, the answer is to make it free for everyone!"

It's like no one sees the giant gaping hole in that entire train of thought.

If "free riders" are a large part of what's currently bogging down our health care system, adding more doesn't really make much sense.

Also,

[quote name='RedvsBlue']oh oh oh, when do we get to the anecdotes about people dying on waiting lists in Canadian healthcare?[/QUOTE]

As opposed to the anecdote that the OP of this entire thread is based off of?

Anecdotal "evidence" that doesn't support one's POV - Bad.
Anecdotal "evidence" that supports one's POV - A-Okay.

[quote name='camoor']Every day it gets harder and harder for the right to do the mental gymnastics required to support corporate-run healthcare while pretending that they care about the health of all Americans. [/QUOTE]

...So then why do we have so many people who continue with the insanely stupid idea that we should continue to let corporate-ran healthcare continue and just let the government take over the health insurance aspect?

It's like a family of inbred strawmen, lacking a formal education system.

[quote name='UncleBob']Woman takes advantage of poorly designed system and forces everyone else pay for her use of it.

Therefore, the only proper answer is for everyone to be forced to pay for everyone else's use of the same poorly designed system.[/QUOTE]

It's not just some random woman...ironically it's one of the ACA plaintiffs. More interesting, no?

[quote name='dopa345']Before any meaningful discussion over health care reform can take place, there needs to be an unequivocal answer to the following question: is the doctor/health care provider's ultimate responsibility to the individual patient under my direct care or is it to society as a whole? If the former, then let me do my job and get the hell out of the way. If the latter, then fine, tell me what your population based guidelines are and provide medicolegal immunity when adverse outcomes occur to patients that suffer as a result since I am unable to use my clinical judgment because care that is deemed not cost effective is withheld.

In general, people say cutting costs is the priority until they need health care themselves then it's do everything you need to do. You can't have it both ways if you want a coherent health care policy.[/QUOTE]

Sure, I'll answer that for you. Here's your hierarchy of responsibility:
1. Patient
2. Society

I think you know this too. If you're at a restaurant and someone starts choking, do you help out as "the doctor in the house" or do you scoff at the asshole who had the bad taste to go into medical duress while you were enjoying your creme brulee? Right now you sound like the kind of asshole who does the latter. I want you to be the guy that helps out.

I agree with your last two sentences. Personally I think we need to have a baseline of medical care available to everyone. Premium boutique clinics with cutting-edge or experimental treatments could still be available to those that can afford them.

No system is going to be perfect but we can do alot better then the system we have today.

[quote name='mykevermin']It's like a family of inbred strawmen, lacking a formal education system.[/QUOTE]

strawman
noun
1. an argument that brings up points I don't like to think about or discuss [syn: straw man]
mykevermin's Dictionary ® 3.0, © 2010 by mykevermin.

No, seriously. You are so fundamentally flawed in your logic in so many ways that it's not worth pointing out a single one of them. It's like this:

Reasonable person: "Health care costs are too high."
UncleBob: "Purple is not a fruit."

And treating it as if you're on the same level of discourse as the rest of us.

Calling your post a strawman is actually giving it more credit than it deserves - i.e., calling it a strawman indicates some level of coherent though.

If we taxed 400 Americans more tax then the other 400 million Americans then all 400 million Americans would be able to get healthcare problem solved.

The way our health care system is now anyone that goes into large medical debt just lets the 7 year liable debt period pass. I know so many people like this that went in excess of 10k+ medical debt and they just let the 7 years pass. Depending on what state you're in they can't even come for assests on medical debt.

[quote name='UncleBob']This is what amuses me. Those who are all "Oh, noes... people abuse the system by using it for free! Obviously, this overburdens the system and that's why health care in America sucks. Therefore, the answer is to make it free for everyone!"

It's like no one sees the giant gaping hole in that entire train of thought.

If "free riders" are a large part of what's currently bogging down our health care system, adding more doesn't really make much sense.

[/QUOTE]

I don't think that many people want to make healthcare free for everyone. The point is to decrease the number of free riders by making them puchase health insurance.

[quote name='chiwii']I don't think that many people want to make healthcare free for everyone. The point is to decrease the number of free riders by making them puchase health insurance.[/QUOTE]

mind = blown

Then again, that only goes to the for profit health insurance system. I still challenge anyone to show me where actual patient care is better on anything outside of per capita. With 335m or so people in this country, most pretty dim and mired in a three tiered health care system thrown at a medical profession that is 1% of the population so on and so forth.... We're doing alright on that front, it's everything surrounding the whole deal that is utterly wrecked.

[quote name='IRHari']It's not just some random woman...ironically it's one of the ACA plaintiffs. More interesting, no?[/QUOTE]

Here are her latest comments:

Brown, reached by telephone, said the medical bills were her husband's. "I always paid my bills, as well as my medical bills," she said angrily. "I never said medical insurance is not a necessity. It should be anyone's right to what kind of health insurance they have.
"I believe that anyone has unforeseen things that happen to them that are beyond their control," Brown said. "Who says I don't have insurance right now?"

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http://seattletimes.nwsource.com/html/health/2017719854_healthmandate11.html

Haha "the National Federation of Independent Business" picked a winner here. smh

I love nothing better than a hypocrite being exposed.

[quote name='camoor']Sure, I'll answer that for you. Here's your hierarchy of responsibility:
1. Patient
2. Society

I think you know this too. If you're at a restaurant and someone starts choking, do you help out as "the doctor in the house" or do you scoff at the asshole who had the bad taste to go into medical duress while you were enjoying your creme brulee? Right now you sound like the kind of asshole who does the latter. I want you to be the guy that helps out.

I agree with your last two sentences. Personally I think we need to have a baseline of medical care available to everyone. Premium boutique clinics with cutting-edge or experimental treatments could still be available to those that can afford them.

No system is going to be perfect but we can do alot better then the system we have today.[/QUOTE]

I would agree with you. After all, I went into medicine to take care of patients, not to be a pencil pusher rationing care for the "greater good." However, doctors and hospitals are second guessed on every turn and get stiffed if our care somehow doesn't meet some arbitrary guidelines and thus in the opinion of some bureaucrat, the same care could have been administered more cheaply (usually by not admitting the patient to the hospital).

I'll give two real-life examples which I recently had to write written appeals (BW both are Medicare patients). One was a guy with a history of hydrocephalus (lifelong build up of fluid around the brain) which periodically leads to excruciating headaches. Also if the pressure is too high for too long, that could lead to coma and death so it requires urgent evaluation. The guy comes into the ER with "10/10" headaches, absolutely miserable. We work him up and do rule out any imminent danger. However, the guy still has horrible headaches, not responding to anything. I admit him for 2 days of IV pain medications and finally get him on an oral regimen that finally reduces his pain to tolerable levels. Now three months later, we get a claims rejection letter from Medicare. According to them, once I had excluded any imminent worsening of his clinical condition in the ED, I should have discharged him and not admitted him for pain control "which could have be done in an office follow-up visit." that, if the guy is in too much pain to walk, how the hell am I going to kick him out of the ER? Unfortunately, we'll probably not win this one since he wasn't technically at risk and I should of just been a heartless bastard and kick him to the curb.

Second example, the patient is a woman that was visiting her doctor when she suddenly couldn't talk and was immediately sent to the ED due to concerns she was having a stroke. Her symptoms resolved in the ED about an hour after it started. It is standard of care to admit patients with transient stroke symptoms even if fully resolved because risk of permanent stroke if untreated is up to 20% in 90 days and 50% of these patients get the stroke in the first 2 days. We admit her, work her up expeditiously and get her out the door on treatment for stroke prevention the next day. Again three months later, it gets denied because according to Medicare, since her symptoms resolved, she was stable enough to go home, completely ignoring what the standard of care is in this clinical situation; though perhaps from the standpoint of Medicare, it is worth gambling her 20% risk of stroke in the next 90 days in order to cut costs.

This is why, I'm very skeptical of government run health care. When the decisions for care are taken out of the hands of the doctor who is with the patient and instead given to bureaucrats with no medical training only concerned about the bottom line, we should all be very concerned. It's extremely unfair to have our hands tied when making treatment decisions yet we bear all the medicolegal risk for adverse outcomes.

Sorry for the long rant, but this hit a nerve because of these stupid rejections letters I got the other day since nothing pisses me off more than getting second guessed by someone who wasn't there and had no ing clue about what's going on.

This is why, I'm very skeptical of government run health care. When the decisions for care are taken out of the hands of the doctor who is with the patient and instead given to bureaucrats with no medical training only concerned about the bottom line, we should all be very concerned. It's extremely unfair to have our hands tied when making treatment decisions yet we bear all the medicolegal risk for adverse outcomes.

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You make excuses for private companies that do it for profit.

[quote name='Msut77']You make excuses for private companies that do it for profit.[/QUOTE]
Yeah...I'd like to know which private insurance companies don't pull that kind of shit either.

[quote name='chiwii']I don't think that many people want to make healthcare free for everyone. The point is to decrease the number of free riders by making them puchase health insurance.[/QUOTE]

I'd guess that a good chunk of people who don't currently have health insurance coverage are people who couldn't afford it. Mandating it isn't going to increase their income to a level at which they can afford it.

Instead, we're going to give them credits and subsidies that help pay for or pay for all of their insurance.

Making them all free riders - as opposed to the system we have now where they become a free rider once they need to partake in the system. Obviously, preventive care - which they would now have coverage for - will help decrease some of the costs*... but that's only if these people can be convinced to take time out to get the various check ups. I suppose it could be mandated that, in order to receive the benefits, you're required to have various check ups. But man, some of these same folks are the ones who won't even pee in a cup for free taxpayer handouts... are we really going to convince them to let the doctor stick his finger up their butts?

*On the flip side, now they also can go to the doctor's every time they have the sniffles because, what the heck, they aren't paying for it.

What could possibly go wrong?

[quote name='mykevermin']No, seriously. You are so fundamentally flawed in your logic in so many ways that it's not worth pointing out a single one of them. It's like this:

...

Calling your post a strawman is actually giving it more credit than it deserves - i.e., calling it a strawman indicates some level of coherent though.[/QUOTE]

Non sequitor is not just a comic strip Myke, at this point there isn't anything you can say to anyone against healthcare reform. Nothing will penetrate their bubbles of BS and lies.

[quote name='UncleBob']Making them all free riders[/QUOTE]

Explain how, when everyone pays into a system, they are all also "free riders."

[quote name='UncleBob']By making everyone free-riders?[/QUOTE]

Myke, I think he meant the people who are going to get subsidies via ACA, but that's not what he said.

[quote name='dopa345']I would agree with you. After all, I went into medicine to take care of patients, not to be a pencil pusher rationing care for the "greater good." However, doctors and hospitals are second guessed on every turn and get stiffed if our care somehow doesn't meet some arbitrary guidelines and thus in the opinion of some bureaucrat, the same care could have been administered more cheaply (usually by not admitting the patient to the hospital).

I'll give two real-life examples which I recently had to write written appeals (BW both are Medicare patients). One was a guy with a history of hydrocephalus (lifelong build up of fluid around the brain) which periodically leads to excruciating headaches. Also if the pressure is too high for too long, that could lead to coma and death so it requires urgent evaluation. The guy comes into the ER with "10/10" headaches, absolutely miserable. We work him up and do rule out any imminent danger. However, the guy still has horrible headaches, not responding to anything. I admit him for 2 days of IV pain medications and finally get him on an oral regimen that finally reduces his pain to tolerable levels. Now three months later, we get a claims rejection letter from Medicare. According to them, once I had excluded any imminent worsening of his clinical condition in the ED, I should have discharged him and not admitted him for pain control "which could have be done in an office follow-up visit." that, if the guy is in too much pain to walk, how the hell am I going to kick him out of the ER? Unfortunately, we'll probably not win this one since he wasn't technically at risk and I should of just been a heartless bastard and kick him to the curb.

Second example, the patient is a woman that was visiting her doctor when she suddenly couldn't talk and was immediately sent to the ED due to concerns she was having a stroke. Her symptoms resolved in the ED about an hour after it started. It is standard of care to admit patients with transient stroke symptoms even if fully resolved because risk of permanent stroke if untreated is up to 20% in 90 days and 50% of these patients get the stroke in the first 2 days. We admit her, work her up expeditiously and get her out the door on treatment for stroke prevention the next day. Again three months later, it gets denied because according to Medicare, since her symptoms resolved, she was stable enough to go home, completely ignoring what the standard of care is in this clinical situation; though perhaps from the standpoint of Medicare, it is worth gambling her 20% risk of stroke in the next 90 days in order to cut costs.

This is why, I'm very skeptical of government run health care. When the decisions for care are taken out of the hands of the doctor who is with the patient and instead given to bureaucrats with no medical training only concerned about the bottom line, we should all be very concerned. It's extremely unfair to have our hands tied when making treatment decisions yet we bear all the medicolegal risk for adverse outcomes.

Sorry for the long rant, but this hit a nerve because of these stupid rejections letters I got the other day since nothing pisses me off more than getting second guessed by someone who wasn't there and had no ing clue about what's going on.[/QUOTE]

I think you make a number of fair points.

However they are anecdotal. I could respond with cases where the government effected positive change - such as the case where a government official supplanted hospital visits with a community-based outreach for a guy who was suicidal.

Also I don't think a transition to individual mandates (and a soft form of socialized healthcare) would be easy, or that mistakes wouldn't be made, but we can learn, we can lobby for fixes, we can do better.

I'm trying to be real here - so let me ask you a question. What would have happened if Medicare didn't exist. What would have happened to the 10/10 guy?

[quote name='mykevermin']Explain how, when everyone pays into a system, they are all also "free riders."[/QUOTE]

You are correct. If everyone pays equally into a system, then there are no free riders.

We could discuss how someone would essentially be a free rider if they're paying a piddly amount into the system. But that would be a long, varied discussion.

Instead, let's discuss those who don't pay into federal taxes.

Remember all the gnashing of teeth when Herman Cain was pushing his 9/9/9 plan and, when asked about the poor folks who can't afford to pay taxes, he replied that everybody should pay something?

Now, are you proposing a system where everyone has to pay into the health insurance system - no matter their income? Because I really don't think you are.

Don't change the message. You said, on two occasions at a minimum, referred to everyone in the system as a free-rider:

http://www.cheapassgamer.com/forums/showpost.php?p=9469528&postcount=18

http://www.cheapassgamer.com/forums/showpost.php?p=9471832&postcount=36

You don't get to respond to my question based on changing what you said. You said everyone was a free rider in a system where everyone is required to have insurance. That's what, therefore, you should explain the logic of.

Stand by your words or GTFO.

I don't know if you guy's noticed, but dopa345's location is listed as Boston. This means that he, as do I, live in a state with Romneycare. While many people are covered with Medicare, Medicaid(and CHIP) is re-branded as MassHealth in MA which is completely state operated. Not only that, but people with Medicare can also be covered by MassHealth and Medicare acts as supplemental insurance. His anecdote is more than a little deceptive with his framing when contracts with any insurer clearly states what is and what isn't covered with the ability to appeal, which isn't that uncommon. He's either bitching about having to do paperwork and mostlikely has no other dealings with insurance beyond those appeals because he sounds like a doctor or nurse in the ER of a hospital. And even then, there's a fully staffed department dedicated to handling all insurance claims which includes pulling files and packaging the appeals to be sent to the insurers.

I know most of you guys haven't worked in a medical office environment, specifically dealing with insurance, so his truthiness is hard to evaluate. Unfortunately for him, I have and can call him out on his bullshit because he doesn't seem to know jackshit about insurance claims at all, especially when those issues aren't isolated to public health insurance. It's especially ing ridiculous when the billing department is the one that's going to take the hit with the debt and not the ER. From the framing, I also highly doubt that he's as concerned with the patient being put in serious debt as he wants his department paid.

[quote name='UncleBob']I'd guess that a good chunk of people who don't currently have health insurance coverage are people who couldn't afford it. Mandating it isn't going to increase their income to a level at which they can afford it.

Instead, we're going to give them credits and subsidies that help pay for or pay for all of their insurance.

Making them all free riders - as opposed to the system we have now where they become a free rider once they need to partake in the system. Obviously, preventive care - which they would now have coverage for - will help decrease some of the costs*... but that's only if these people can be convinced to take time out to get the various check ups. I suppose it could be mandated that, in order to receive the benefits, you're required to have various check ups. But man, some of these same folks are the ones who won't even pee in a cup for free taxpayer handouts... are we really going to convince them to let the doctor stick his finger up their butts?

*On the flip side, now they also can go to the doctor's every time they have the sniffles because, what the heck, they aren't paying for it.

What could possibly go wrong?[/QUOTE]


I would guess that many people who choose not to buy health insurance have no idea if they can afford it. They don't even get quotes, because they know that they want to spend their money on something else. But that's totally anecdotal. Have you seen any data on this?

Regarding those who really can't afford health insurance - I think that responsible Americans shouldn't need to deny themselves necessary medical care because they can't afford it. I also don't think that Americans should be forced to declare bankrupty because of medical bills. So, I think the subsidies and credits to help these people purchase health insurance are better than just leaving them to fend for themselves.

[quote name='mykevermin']Don't change the message. You said, on two occasions at a minimum, referred to everyone in the system as a free-rider:

http://www.cheapassgamer.com/forums/showpost.php?p=9469528&postcount=18

http://www.cheapassgamer.com/forums/showpost.php?p=9471832&postcount=36

You don't get to respond to my question based on changing what you said. You said everyone was a free rider in a system where everyone is required to have insurance. That's what, therefore, you should explain the logic of.

Stand by your words or GTFO.[/QUOTE]

Well, since we're going full-on mode, if the government is going to provide health insurance for everyone who falls within a particular group and every single American can put themselves in that group of their own free will, then would not everyone have the potential to be free riders?

But you're correct. When I said "everyone", I did not mean everyone. Good job pointing that out. It's like when I said "Hey everyone in the pool!" then the whole world's population died because everyone tried to jump into the pool and we suffocated under the mass pile of bodies.

[quote name='chiwii']I would guess that many people who choose not to buy health insurance have no idea if they can afford it. They don't even get quotes, because they know that they want to spend their money on something else. But that's totally anecdotal. Have you seen any data on this?[/quote]

Off the top of my head, the only thing that comes to mind is the "47 million uninsured" and the "30 million who can't get insurance" quotes from Obama - so, no, I don't have any data off hand.

I think the big question remains, will the penalty for not having coverage be more than the cost of coverage? If it's not significantly more, then I see these same folks (the ones who choose not to have coverage so they can spend their money on something else) continuing in their ways. Of course, if these folks don't tend to get much back on their taxes, they might say screw it all, since, you know, we're supposedly not going to put anyone in jail if they don't pay and all.

Regarding those who really can't afford health insurance - I think that responsible Americans shouldn't need to deny themselves necessary medical care because they can't afford it. I also don't think that Americans should be forced to declare bankrupty because of medical bills.

Click to expand...

Agreed.

So, I think the subsidies and credits to help these people purchase health insurance are better than just leaving them to fend for themselves.

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Disagree.
Get rid of the health "insurance" industry and socialize health care. Why screw around with middle men and red tape?

wank wank. big man can't stand by his words, so now we're stuck defining the meaning of "everyone" because you were called on your bullshit.

I agree with eliminating private insurance as a portion of the problem. Guess which party you can blame *entirely* (and remain accurate) for keeping it in the PPACA? Hint: Ben Nelson deserves some blame, too, but he's not a member of that party.

As someone who was born with asthma and living with it for 27 years, I'm always going to need to insurance to buy monthly medicine + inhalers + coverage for the ER if/when that happens.

I've always had insurance, because my parents explained to me that I'm going to have to eventually take care of myself one day.. and I have been.

The costs of things are pretty gross, but, people tend to make a big deal because someone earned profit. Yes, insurance companies are going to make profit. This should not be considered a bad thing. However, IMO, the real issue lies soley on the fact that Doctors (because of the pressure from lawyers snooping around) have to send people for tests after tests and do a bunch of nonsense ---when all I did was walk in with a sore throat! But what about the costs of these things? Why are they so high?

Years ago I had my appendix removed and I got a bill for $250 (because I had insurance). I had to LOL because the bill was like $20,000+...with the anesthesia costing like $10,000 alone.. lol! Perhaps theres a logical reason as to why it's expensive.. maybe things like this are the most profitable? I mean, go to a restaraunt and order a soda at $3.50..they are making huge (percentage wise) on that cup of soda you are consuming.

I guess my answer won't be a popular one since I'm just throwing in my opinion, I'm not on the "government has to pay for HC for everyone, or you are wrong ::insert rude comment because I disagree with you::"....but to be honest, a little personal responsability also goes a long way.

But things happen. I get this.

Just wish there was a way to cut the cost down and not have to pay a lot another way (like higher taxes).

[quote name='mykevermin']wank wank. big man can't stand by his words, so now we're stuck defining the meaning of "everyone" because you were called on your bullshit.[/quote]

But I admitted you were right. It's a big score for you. I totally admit that, although I used the word "everyone", I did not mean, literally, "everyone". You should be proud that you called me out on that and was correct in doing so.

I agree with eliminating private insurance as a portion of the problem. Guess which party you can blame *entirely* (and remain accurate) for keeping it in the PPACA? Hint: Ben Nelson deserves some blame, too, but he's not a member of that party.

Click to expand...

Was it this guy?
http://www.youtube.com/watch?v=aDAPLb-HVcM

[quote name='dopa345']I would agree with you. After all, I went into medicine to take care of patients, not to be a pencil pusher rationing care for the "greater good." However, doctors and hospitals are second guessed on every turn and get stiffed if our care somehow doesn't meet some arbitrary guidelines and thus in the opinion of some bureaucrat, the same care could have been administered more cheaply (usually by not admitting the patient to the hospital).

I'll give two real-life examples which I recently had to write written appeals (BW both are Medicare patients). One was a guy with a history of hydrocephalus (lifelong build up of fluid around the brain) which periodically leads to excruciating headaches. Also if the pressure is too high for too long, that could lead to coma and death so it requires urgent evaluation. The guy comes into the ER with "10/10" headaches, absolutely miserable. We work him up and do rule out any imminent danger. However, the guy still has horrible headaches, not responding to anything. I admit him for 2 days of IV pain medications and finally get him on an oral regimen that finally reduces his pain to tolerable levels. Now three months later, we get a claims rejection letter from Medicare. According to them, once I had excluded any imminent worsening of his clinical condition in the ED, I should have discharged him and not admitted him for pain control "which could have be done in an office follow-up visit." that, if the guy is in too much pain to walk, how the hell am I going to kick him out of the ER? Unfortunately, we'll probably not win this one since he wasn't technically at risk and I should of just been a heartless bastard and kick him to the curb.

Second example, the patient is a woman that was visiting her doctor when she suddenly couldn't talk and was immediately sent to the ED due to concerns she was having a stroke. Her symptoms resolved in the ED about an hour after it started. It is standard of care to admit patients with transient stroke symptoms even if fully resolved because risk of permanent stroke if untreated is up to 20% in 90 days and 50% of these patients get the stroke in the first 2 days. We admit her, work her up expeditiously and get her out the door on treatment for stroke prevention the next day. Again three months later, it gets denied because according to Medicare, since her symptoms resolved, she was stable enough to go home, completely ignoring what the standard of care is in this clinical situation; though perhaps from the standpoint of Medicare, it is worth gambling her 20% risk of stroke in the next 90 days in order to cut costs.

This is why, I'm very skeptical of government run health care. When the decisions for care are taken out of the hands of the doctor who is with the patient and instead given to bureaucrats with no medical training only concerned about the bottom line, we should all be very concerned. It's extremely unfair to have our hands tied when making treatment decisions yet we bear all the medicolegal risk for adverse outcomes.

Sorry for the long rant, but this hit a nerve because of these stupid rejections letters I got the other day since nothing pisses me off more than getting second guessed by someone who wasn't there and had no ing clue about what's going on.[/QUOTE]
You make good points, there is something that wasn't mentioned that I think needs to be. Insurance companies also have their own doctors whose sole job it is to second guess you. I should know, my doctor has had to write letters to my insurance company stating why I need medication A even though medication B is cheaper. So that's a problem with either system, not just one of them. However, even if Medicare isn't perfect, what would have happened to those two patients of yours had they not had any coverage at all?

[quote name='UncleBob']But I admitted you were right. It's a big score for you. I totally admit that, although I used the word "everyone", I did not mean, literally, "everyone". You should be proud that you called me out on that and was correct in doing so.[/quote]

http://www.cheapassgamer.com/forums/showpost.php?p=9469528&postcount=18

So explain this post. You've yet to do so.

Was it this guy?
(Obumma video, you can see it above)

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Yes, because he is the decider.