Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

[Jim Nickerson]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

Nationalization only will make it worse. The problem is the same as in Finance no disclosure. A simple law mandating that all care providers must provide a good faith estimate similar to a HUD form when purchasing a house would go a long way. All nationaliztion does is perpetuate the system where they can add 69 boxes of baby wipes on a tab. Similar to $500 DOD hammers. No disclosure no one auditing the bill leads to massive cost overruns. The solution is not nationalization but clear regulation of the insurance companies and health care providers to provide up front estimates of costs. If you want to have a new procedure that is not covered by your health care provider you should be able to shop doctors to get a competitive price and find a doctor you are comfortable with to do it. You can then budget the cost overrun of what your insurance policy will cover which was fully disclosed to you in understandable terms when you bought it (another sensible regulation) and pay for the procedure. Your altenative is a one size fits all buerocratic nightmare where individual choice and due diligence is off the table.

I know there are a lot of Canadians here but I am going to relay a recent story. A friend's sister was visiting relatives in Canada for 2 weeks. Her daughter had a spill hurt her elbow pretty bad and went to the emergency room. The attending GP physician took an ex-ray didn't see anything so took another ex-ray of the unhurt arm to compare. He compared the two and diagnosed a hairline fracture. He told the mother she needed to see the specialist to get a cast and the closest apointment was in three weeks. The mother not wanting to wait and having an alternative cut her trip short and came back to America to get her daughter checked out. She immediatly got an appointment with a specialist who took one look at the x-ray and said there is no fracture but the bone is dislocated and if it is not treated right away it could lead to a long term problem. Bottom line is she had surgery right away including 6 pins. If she stayed in Canada she would have had her arm in a sling waiting three weeks to find out the GP misdiagnosed her condition.

One possible problem with your Canadian example is that neither you, I, or maybe even the parent knows who was correct with the differing doctors' opinions. Two different opinions take a third to possibly resolve the conflict.

I have personal experience, or wife was the victim, or getting a useless opinion from one doctor (didn't know what was wrong), and a better one from another (knew what would well explain the problem), but the latter was unwilling to perform an operation based on something restraining him, possibly my being as asshole with regard to two doctors she saw in relation to her problem. Fortunately, with a third opinion from a former colleague of mine via telephone and email over a week or so, wife prevailed upon second doctor to do an operation which resulted in positive findings and positive results through over 4.5 years and perhaps even permanently.

There are good doctors and not so good, or even bad, in the US. The problem, if you are the guinea pig, is finding and knowing who are the good ones. A lot of this, I believe would be resolved with more oversight to the entire system, and greater collaboration between specialists (meaning doctors discuss the hard/unclear cases between themselves to arrive at what might be best) vs. sending patients around for multiple opinions so that numerous guys get to take their hits on the patient's/insurance companiy's pocket books.

There are no easy, no perfect answers, but there has to be a better answer that what exists in the US now as it applies to all citizens, and a good bit of that better answer will come from removal of vested interests with big profit motives from the equation.

[MarkL]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

The poster, in other words me, didn't out of convenience or otherwise forget anything. I'm always searching for the truth. I've no loyalties to party. Keep the posts coming, but skip the editorial next time.

Sorry... I should have said Article and the Author. As you essentially regurgitated the Republican talking points without researching the other side, I will confess that I had mentally assumed you were probably a koolaid drinker.

I believe democracy is well served by a vigorous and honest debate. But the Republicans for the last decade or so have accomplished a lot of their goals through lies, and while I have no problems with discussing honest Republican positions, when the party's talking points are obviously and intentionally misleading... it definitely gets me upset. The public should not intentionally be lied to, and it amazes me that the Republican party continues to actively use lies as a tool, and gets away with it (within their own party).

There are lots of great, and true Republican talking points on this plan, indeterminate cost being the best. Obama's claim that he can pay for most of the new healthcare plan by reducing some projected costs in Medicare is based on lots of shaky assumptions.

But when I see the lies, I call 'em. Sorry you got caught in the crossfire.

[charliebrown]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

oh you are so correct sir!

1 week after my son was born my company, which was self insured, went chapt 7.
So instead of the bills going to my insurance company, they went to me, because now I had to pay. you know it costs 20k to deliver a child in a hospital with no complications? Anyhow the crap that was on that bill that now I had to pay. There was a line item for baby wipes. 7 bucks a box x 69 boxes. There was a head lamp. I assume this is one the doc uses strapped to his head. Aren't these things re-usable? Was I just the unlucky one who gets soaked with the new light? Again on the bill was another 50 items or so, drugs, bandages, instruments, pillows items that I have no idea if they were used or not. I got the wipes and light and several other items negotiated off the bill after arguing with the hospital.

what that crap is the thing with quotes? Call the doctor, and they say call the insurance call the insurance, and one of those robotic voices says costs quotes are no guarantee of benefits. Well then who the hell is responsible?
Go in for outpatient surgery and your rolling the dice with 20k.

With my CT scan, Since I was on the hook for 20% of the bill I thought it worth while to call around and shop for price. Now I have the exact procedure names and diagnostic codes. Two hospitals say $7200, the other says $3600. So naturally I go to hospital with 3600, as my oop is going to be 720 less. Get my bill and guess what?? price = 7200. Of course I call up and argue, hospital says oh that was our mistake in quoting you 3600, but guess what you owe 7200 anyway, pay up!.

I understand that if you open someone up, things that are unexpected can happen, but if this is just cut and dry stuff, remove and appendix, a mole, hernia etc with no complications, it should be like going to a car repair place.
Get and estimate and the estimate has to be honored.

[Jim Nickerson]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

Of course they are ripping off people with all this smoke and mirrors. After 20 years in business, I can assure you, its always easier to present a bill AFTER the fact than have to compete by giving a clear up front estimate of fees. I told my wife that a lot of these doctors wouldn't have the balls to tell you to your face what they are going to charge you for some of these minor procedures. Instead they plead ignorance or pass you off to an underling, who then says, "we can't tell you what the cost is until we submit it to your insurance company". I recently canceled a procedure because the surgeons office literally would not tell me what it was going to cost. I started a month in advance and after being put off for 3 weeks, I canceled rather than go ahead and put myself at their mercy. I asked for a ball park, " $100? $5000?" Not a peep. They want a blank check is what they want. This goes for hospitals too. Then they find a way to max out what the insurance will pay and that miraculously is exactly what the bill turns out to be. :rolleyes:

The insurance statements are unreadable and they know it. I'd love to see my customer's reaction if I submitted a bill for " $2500 code 14". Then make them stay on hold for an hour just to find out . What we have now is not "Free enterprise". What other free market business could exist with that kind of service?

All good points, flintlock. When I practiced, I did not always ask patients if they would mind bringing me a copy of their hospital bills, but for periods I did ask that they do so. I believe I did that because I was interested in what I was doing was costing someone. It's hard to recall any details from over 20 years ago, but I think correctly almost always if not always when I went over bills I could check 10 or more charges from the OR for trays, supplies that were not used and probably a few lesser items for things patients had not received due to any orders I had written. It was always to me unfuckingbelieveable.

I used to buy burrs (drill bits to cut bone) or blades and take them to the hospital for my cases because they were perfectly autoclaveable and reuseable, and not to do so resulted in the patient (insurance company) getting charged 4-5 times at least what I might pay for them.

I applaud your action to have cancelled your surgery because no one would tell you what cost it might approximate. One can sure as shit not apply any notion of capitalism to receiving healthcare on a competitive pricing basis if one cannot get an honest quote.

The entire system should be nationalized yesterday.

[flintlock]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

EDIT: And in my generally cynical assessment of things, someone in financially benefitting (perhaps ripping off is better) from a patient's inability to determine exactly for what charges are on any type of a hospital bill or EOB.

Of course they are ripping off people with all this smoke and mirrors. After 20 years in business, I can assure you, its always easier to present a bill AFTER the fact than have to compete by giving a clear up front estimate of fees. I told my wife that a lot of these doctors wouldn't have the balls to tell you to your face what they are going to charge you for some of these minor procedures. Instead they plead ignorance or pass you off to an underling, who then says, "we can't tell you what the cost is until we submit it to your insurance company". I recently canceled a procedure because the surgeons office literally would not tell me what it was going to cost. I started a month in advance and after being put off for 3 weeks, I canceled rather than go ahead and put myself at their mercy. I asked for a ball park, " $100? $5000?" Not a peep. They want a blank check is what they want. This goes for hospitals too. Then they find a way to max out what the insurance will pay and that miraculously is exactly what the bill turns out to be. :rolleyes:

The insurance statements are unreadable and they know it. I'd love to see my customer's reaction if I submitted a bill for " $2500 code 14". Then make them stay on hold for an hour just to find out . What we have now is not "Free enterprise". What other free market business could exist with that kind of service?

[Jim Nickerson]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

i can relate to your x-ray story. I have had similar problems with a very expensive CT scan. With the new hippa b.s., EOB's come with virtually no information. Your bill comes with no information. Spend a few days in the hospital and you get many bills (hospital, anethesia, doctor, lab, imaging etc.) for $$$ with now way to reconcile them against your eob.

Now one fundamental problem that your question misses is why does something like an x-ray have to go through insurance at all? a routine x-ray ought to be cheap. i know many times they are not. that is one of the points of this whole debate. my son had a 7 lead ekg run at a walk in clinic. it was needed for pre-op certification. bill to insurance $500.00. was reduced to 250 by insurance, then I paid 20% out of pocket. The test should have cost $50.00 in the first place. The person running the test was not a doctor, the device was no more than a glorified p.c. the whole procedure took 5 minutes. the majority of that was attaching the leads to my son. wth?? that is why so many of us have insurance, is that even cookie cutter simple things cost way too much.

Regarding the HIPPA shit, a while ago I asked BC/BS regarding wife's plan why are there not CPT codes on EOB's? Answer was something to do with privacy bullshit.

I won't go to the trouble to copy and paste one of my Medicare EOB's, but it is a fact that it shows a CPT (treatment code) for every charge.

EDIT: And in my generally cynical assessment of things, someone in financially benefitting (perhaps ripping off is better) from a patient's inability to determine exactly for what charges are on any type of a hospital bill or EOB.

It is not critical to mankind, but I wonder if others here receive EOB from commercial insurance companies that have a CPT code by whatever else it shows for services rendered.

Not important to me what kind of insurance anyone has, but as mentioned somewhere else for many people who have insurance today through their employment, the protection from the insurance only lasts as long as one's employment (plus 18 months of Cobra if affordable), so to me there is some fantasy with the notion that everyone with insurance at the moment does not potentially face not having insurance in the future. Unless one is quite wealthy (whatever that is) the issue of being able to obtain affordable healthcare applies to us all, and the current system does not achieve such a status.

[charliebrown]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

i can relate to your x-ray story. I have had similar problems with a very expensive CT scan. With the new hippa b.s., EOB's come with virtually no information. Your bill comes with no information. Spend a few days in the hospital and you get many bills (hospital, anethesia, doctor, lab, imaging etc.) for $$$ with now way to reconcile them against your eob.

Now one fundamental problem that your question misses is why does something like an x-ray have to go through insurance at all? a routine x-ray ought to be cheap. i know many times they are not. that is one of the points of this whole debate. my son had a 7 lead ekg run at a walk in clinic. it was needed for pre-op certification. bill to insurance $500.00. was reduced to 250 by insurance, then I paid 20% out of pocket. The test should have cost $50.00 in the first place. The person running the test was not a doctor, the device was no more than a glorified p.c. the whole procedure took 5 minutes. the majority of that was attaching the leads to my son. wth?? that is why so many of us have insurance, is that even cookie cutter simple things cost way too much.

[Ghent12]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

The Government officials always come up with a reason to intervene.

Look at the Minimum Wage - forced through in decades ago to prevent Textile Jobs from leaving the Northeast for the South.
Decades later we are stuck with a Federal Minimum Wage Standard and the how many Textilte Manufacturers are in the Northeast?????

There is always a Good Reason for the Politicians to help out the Private Citizen and t he control is rarely returned to the Citizens -

I wasn't aware of the origin of minimum wage, just the effects of it. I guess that eventually all forms of government control change and morph, take on a life of their own, and the unintended consequences be damned.

Kind of like how, regardless of IBD's reporting of it, the section it references on H.R. 3200 will ultimately make private insurance illegal. I would liken it to Indian casinos, actually. Only where private insurance is grandfathered in, or in small law vacuums, will there be any semblance of our current private insurance.

Of course, the death of private insurance isn't itself a bad thing, as it long ago shed any semblance to what insurance is, and instead became a pooled cost ticket to the doctor. The cost of health care is already mostly socialized; changing the ownership of it will simply enrich different people at the expense of other people. The causality of the enormous cost will still be there, unaffected; yet the causality will remain strangely absent in the same industry for things that will remain uncovered by "insurance" like nose jobs, breast implants, etc. I wonder why.:rolleyes:

[flintlock]

Re: Investor's Business Daily fucks up.

http://www.theregister.co.uk/2009/08...ish_and_alive/

Great entertainment, truly.

That's a funny story. What an idiot that author must feel like. We are seeing how good the insurance industry's campaign of misinformation has worked. People just assume every bad story about NHS is true. I don't doubt there are some horror stories, but I can tell you of some horror stories that happened to me personally right here in the good ole USA.

[Jim Nickerson]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

By ATUL GAWANDE, DONALD BERWICK, ELLIOTT FISHER and MARK McCLELLAN
Published: August 12, 2009

10 Steps to Better Health Care http://www.nytimes.com/2009/08/13/op...13gawande.html

So we invited physicians, hospital executives and local leaders from 10 of these regions to a meeting in Washington so they could explain how they do what they do. They came from towns big and small, urban and rural, North and South, East and West. Here’s the list: Asheville, N.C.; Cedar Rapids, Iowa; Everett, Wash.; La Crosse, Wis.; Portland, Me.; Richmond, Va.; Sacramento; Sayre, Pa.; Temple, Tex.; and Tallahassee, Fla., which, despite not ranking above the 50th percentile in terms of quality, has made such great recent strides in both costs and quality that we thought it had something to teach us.

If the rest of America could achieve the performances of regions like these, our health care cost crisis would be over. Their quality scores are well above average. Yet they spend more than $1,500 (16 percent) less per Medicare patient than the national average and have a slower real annual growth rate (3 percent versus 3.5 percent nationwide).

The way things strike me as currently going with the healthcare debate, it seems that the country (politicians and oligarchal interests) is about to shoot the citizens in the foot, i.e. fail to produce anything toward remedy.

Good article, worth reading unless you think the status quo is some sort of nirvana.

[Jim Nickerson]

Re: Investor's Business Daily fucks up.

In perhaps the most amusing effort to discredit US President Barack Obama's plan for nationalized health care - if not the most ridiculous - US financial newspaper Investor's Business Daily has said that if Stephen Hawking were British, he would be dead.

"People such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless."

"I wouldn’t be here today if it were not for the NHS," Hawking told The Guardian. "I have received a large amount of high-quality treatment without which I would not have survived."

The best you can say about Investor's Business Daily is that unlike US radio talk host Rush Limbaugh, it has not compared Obama's health care logo to a swastika.

http://www.theregister.co.uk/2009/08...ish_and_alive/

Great entertainment, truly.

[Jim Nickerson]

HASSLE OF PRIVATE INSURANCE--micro-micro-microcosm



What I hope is that anyone interested in this bullshit can discern the details from the copy of a BC/BS EOB (explanation of benefits) for a chest x-ray (not apparent from the EOB) wife had. The EOB is for one of two charges submitted by the physician's office. On the other EOB the charge was $53 and was designated on the EOB as "X-ray Services" just as in the first box on the form above where the "X-Ray Services" shows the charge as $34.00 followed by the code (1).

Code (1) provides the reason for denial which, if the person paying the premiums is to attempt to understand the denial's basis, would require perusing the Health Care Plan contract. Though it is not apparent to anyone reading this, the reason for the x-ray charges being denied is that BC/BS is telling wife that the x-ray(s) of her chest were considered as a "rountine" chest x-ray. You know like you go to the doctor every year or two and have a rountine examination, lab work, chest x-ray, ECG, etc. Now how BC/BS would arrive at that assessment of these studies being "rountine" probably would depend upon the diagnostic code submitted by the physician's office. However, because that information--diagnostic code(s)--is not included on the EOB, the patient cannot determine, if he/she is even interested in trying, on what basis the denial rests. Perhaps (and this is my cynical speculation) BC/BC denies ALL chest x-rays done within a doctor's office as opposed to the same action of those done in an emergency room. Doing so could save a lot of money unless every such denied claim involved the policy holder going to the trouble to question the denial.

Neither we nor you can determine anything specific about the "X-Ray Services" that were performed. There are probably nine different CPT (treatment codes) that pertain to chest x-rays. Because BC/BS does not write the exact treatment code on the EOB, the patient cannot assure (assuming a certain level of intelligence and curiosity on the part of the patient) that what was submitted to BC/BS was in fact what was done in the doctor's office. The doctor could do one thing, say a single posterior-anterior chest x-ray, but submit the treatment code as that for doing the A-P x-ray as well as a lateral view, and odds are likely gigantically in favor of the doctor that the insurance company would never know that the procedure was overcoded--so insurance company gets "frauded." The simplest check on such that even begins to exist is for the patient to be able to determine for what the charge submitted to the insurance company was. Impossible to do with BC/BS of Texas which is also I believe the largest insurance provider in Texas and the State's contractor. A failure of an insurance company to put the treatment code on the EOB favors fraud on the part of doctors, and does nothing to insure the correct assessment of the claim.

You note I have written there were two EOB's. Both denoted services as "X-Ray Serices." Patient does not know if there were two charges for services one of which was not performed, or just why the fuck are there two charges? The answer here is one was for the physical act of taking the x-rays, film, processing, owning the equipment, and the second is for the doctor apparently having reviewed the x-ray and dictated his/her interpretation of the x-ray(s).

Assuming wife and husband work daytime jobs, pursuing answers to these issues becomes more difficult. Wife so far between BC/BS, doctor's office that did the chest x-rays, and doctor's office that made the recommendation that wife should have chest x-rayed (looking for a zebra having to do with a skin complaint) so far has entailed nine phone calls by her back and forth, and at least three phone calls by employees of the doctors' offices, and it remains to be seen whether or not the disallowance for wife's non-rountine chest x-rays will be reversed.

One thing about unifying and simplifying the US healthcare into a single provider system (which unfornately is not going to happen) would be it would put a lot of people out of work in the private health insurance industry. But what the fuck, those people are largely an impediment to efficient and cost effective delivery of health care to all the legal citizens of the US, and acting as impediments is how they manage to survive in the workforce.

I want to make another point about inefficiency in the current system, that pays the providers (doctors primarily), as I see it, doubly considering what the patient gets as benefit. Say wife had gone to a radiology clinic for her chest x-rays (shopping might have resulted in doing that). X-rays taken--charges generated, radiologist interprets--charges generated, faxes or mails report to doctor who ordered the study who reads the report and discusses it with the patient--charges again generated in all likelihood based on time spent with patient discussing findings. So in some real sense as I see it there are two charges to the patient (or patient and insurance company) for getting the information and possible benefit of x-ray findings to the patient. Anyone thinking my thought on this is invalid is encourage to show me that I am wrong.

One final point. As I grew up after age 5 or so, I never went to the doctor except in late teens and early twenties to get a couple of head lacerations sewn up. For two such lac's I saw two different doctors--they were both doctors and they were both equal in my and my families perceptions.

Whatever they were, odds are they were not actually equal. I think most people, the majority, look upon doctors as being equal if they practice in the same field. If you think you are smarter than average and say you know that all doctors are not equal in education, diligence in performance and keeping abreast of unending changes in whatever are the specialties, then I say you still have a problem with ever determing just how good any one doctor actually is. If my thoughts on this are correct what you get and are charged and hopefully from the doctor's perspective gets collected may not be well justified. You almost cannot know how good some service is unless you get multiple opinions--which for average people only comes about when what was tried by the last doctor fails and new options are sought elsewhere.

Did the doctor (internist) in whose office wife's chest x-rays were taken do as good a job in interpreting her films as would a radiologist? Impossible to answer, if not impossible, then highly impractical to answer.

[BK]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

The Government officials always come up with a reason to intervene.

Look at the Minimum Wage - forced through in decades ago to prevent Textile Jobs from leaving the Northeast for the South.
Decades later we are stuck with a Federal Minimum Wage Standard and the how many Textilte Manufacturers are in the Northeast?????

There is always a Good Reason for the Politicians to help out the Private Citizen and t he control is rarely returned to the Citizens -

[dcarrigg]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

One reason the US system is so expensive is the rot at the top (Scrushi types).

Richard Scrushi - for those who are not familiar.

Thanks for bringing this up -

[dcarrigg]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

I'm not sure how contributions are defined here, but EJ just posted this web site:

http://maplight.org/map/us/bill/8471...committees/430

Note that there are several HR 3200 bills. I don't know enough about the legislative process to say why that is.

H.R.3200
Title: To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.
Sponsor: Rep Dingell, John D. [MI-15] (introduced 7/14/2009) Cosponsors (8)
Latest Major Action: 7/31/2009 House committee/subcommittee actions. Status: Ordered to be Reported (Amended) by the Yeas and Nays: 31 - 28.
COSPONSORS(8), ALPHABETICAL [followed by Cosponsors withdrawn]: (Sort: by date)

Rep Andrews, Robert E. [NJ-1] - 7/14/2009
Rep Kildee, Dale E. [MI-5] - 7/16/2009
Rep Maloney, Carolyn B. [NY-14] - 7/17/2009
Rep Miller, George [CA-7] - 7/14/2009
Rep Pallone, Frank, Jr. [NJ-6] - 7/14/2009
Rep Rangel, Charles B. [NY-15] - 7/14/2009
Rep Stark, Fortney Pete [CA-13] - 7/14/2009
Rep Waxman, Henry A. [CA-30] - 7/14/2009