GolfHos

Interesting. If 49% are overwhelmed by red tape now what happens if the government gets more involved?*

http://www.cnn.com/2008/HEALTH/11/17/primary.care.doctors.study/index.html




*I'm on record as saying we need reform in the health care industry and need to do much better in providing care for those in need and government should play a role. But I'm skeptical our government can do what needs to be done.

I'd also be interested in joining a revolution against the insurance companies.

no red tape
 ;D

While I take your point, it's off target.


Not having any red tape to deal with because you don't have health insurance is no bargain.

But now we have entire companies (Aetna, United Health) whose sole existence is for the purpose of creating and collecting red tape.  The gubmint can't *fudge* it up worse than those companies already have. 

Yet another industry that's getting too big for itself?

It's not off target at all. Just doesn't align with where you wanted it to go.  ;)   Read my whole post. I agree with your second sentence.

My point is that if 49% of doctors want to leave because of all the red tape how does it get better with more government involvement? It's a serious question I have and I believe how our government works today that universal healthcare + insurance companies = complete cluster*fudge*.

I don't see the two as that interdependent.

In my cynical and somewhat informed(*) view, health insurance carriers WANT that red tape.  (Insert "A Few Good Men" riff here.)  Every time a health care provider gives up on the claim, the insurer doesn't have to pay out.

(*)
1. For a time, my mother worked as secretary for a psychiatrist (we needed the discount!), secretary/bookkeeper for a gastroenterologist, and bookkeeper for a 3-man orthodonics practice.  The GE guy actually DID fold up his practice because of the hassle of trying to get insurance companies to pay on the claims.  She had tons of stories about ridiculous paperwork burdens, refusals for the slightest error (e.g. entries straying almost imperceptibly outside the box), repeated bounce-backs each for a different "error").

2. I did significant work for a start-up developing an electronic data model for medical practices.  Simplified data input and diagnoses, worked with existing carriers' billing rules to export the proper forms for insurance payments.  Couldn't sell it.  Not that the medical offices didn't want it (the business model was to sell it to insurance carriers, and let them hand it down to the relevant practices).  The insurance companies wouldn't play ball and let the software generate compliant forms.  If it made it likelier that they'd have to honor a form and pay out, they weren't interested.

My naive view was that what government would do in the health care arena was (a) let me voluntarily sign up for the health insurance that government workers can get, and (b) push for simplified billing practices so that the crap I talked about above wouldn't happen so much and be so burdensome.

Do you have statistics that show that Dr's are opting out of Gubment health care plans like Blue Cross/Blue Sheild?

Medicare operates on something like a 2 pct administrative overhead vs. private companies 20 plus pct, which suggests to me at least that there may be LESS red tape in Gubment sponosored care than in purely private insurance.

Also, if you don't have ANY INSURANCE AT ALL like 45 million or so Americans, all of this is pretty academic, doncha think?

exactly

Funny this was brought up. 

While 'telecommuting' this morning, I overhear Mrs Blader in the kitchen in a phone conversation with our insurance.   Ms Blader needs a surgical procedure in another week or two.  Today, Mrs Blader says something to the effect, "What do you mean it isn't approved?  It was approved months ago, before I scheduled this appointment?"

Anyway, I'm sure she spent a few hours on the matter today, getting it all re-sorted out.

Plus, we have a really, really nice insurance plan.  We get the best possible care we choose.

My point is, government is not going to make it any easier.... or harder. 

What is going to happen is the exact same people (mostly nurses who couldn't hack it on the floors) manning the phones with almost no qualifications are going to be making well-intentioned but wrong-headed clinical judgments and coverage miscues, thereby gunking up the system.

The only difference should be, with any luck, people won't go bankrupt for life from having a health problem that sort of spirals out of control for a few weeks before everything sort of settles back to normal.

I mean, our expectations of the health care system are already so low, all that really matters is we get treatment when we need it and hopefully the treatment won't kill us.

Not hard to find evidence of doctors going cash only but I don't have exact numbers at my fingertips.

It appears my initial point about doctors leaving the profession has been missed and/or hijacked into a discussion of uninsured and that was not my intent.

That's part of my point. It was just interesting for me to see a study and see that 49% surveyed were thinking of leaving the profession. In the long run that's not real good news.

A lot of these guys have had static or declining incomes over the past 10 years or so.  I think that's what the number mostly reflects.

For example, it used to be an orthopod could make decent money doing shoulders and hips and *feces*, but now, if he wants a little profit for the end of the year, he's better screening workman's comp cases.

I simply don't believe (a) and (b) will ever happen in today's environment of lobbyists/power/money. Your example in #2 says it best "insurance companies wouldn't play ball".

I really wish it could be done but I'm in the see it to believe it camp.

I took your initial point to be that Gubment run health care would be even more unweildy than privately run health care has apparently become to providers.

It doesn't appear to stand up under any kind of analysis.

Having a discussion on health insurance without discussing millions of uninsured is disingenuous at best.

May I suggest that Karma has run over your Dogma, to paraphrase Bill Lee.

Serious question as I don't hang with a lot of doctors - where is the money going? I'm guessing insurance companies and plan providers??

I know my premiums haven't been static and declining the past 10 years.

O.K.

I was coming at it from adding government to the existing system. I should have stated very clearly that I don't see how it will be less unwieldly. I simply don't believe the existing system will go away if government takes over.

May I suggest you don't need to take shots to make your point.

Are we adding Gubment to the existing system at the provider level?

I've not seen that.

I've seen where we MAY add it at the patient level.

Just freewheeling:

The operating costs keep climbing: lease, utilities, malpractice insurance, admin labor, insurance filing (there are companies who offer this specialized service!), ...

OTOH, Doc performs a colonoscopy, charges $500.  Insurance says they won't pay more than $350 for a colonoscopy.  Doc battles insurance forms department, which repeatedly spits out claim for failure to properly pronounce a word, poor penmanship, and so on.  Meanwhile, the patient -- usually some elderly gent with loose bowels -- is billed for the remaining $150.  He ain't paying.  So twenty years ago, Doc could do the 'scope, charge $400 and collect it.  Now he charges $500 to cover his higher costs of running his practice, and he collects maybe $350.  (Numbers conjured for illustrative purposes.)

The GE my mother worked for shut down his practice after he started working TWO DAYS PER WEEK reviewing hospital medical care for an insurance company.  He earned more in those two days than he did in five at his practice, and with ZERO billing headaches in the bargain.

Enjoy the boobs.

Wasn't intended to be a 'Shot', but the dogmatic position that Gubment involvement is always odious is just that: Dogmatic.

I agree that it isn't always odious.

But once in a while I swear I smell something.  :)

Clive has pretty much got it right. 

Reimbursement rates for medical procedures haven't well kept up with the costs.  The way the system operates, practices/hospitals/whatever are reimbursed on a per procedure basis, and the physicians pretty much are last in line and only get to keep what is left over after everyone else has received their cut.

Where has all the money gone?  Well, into the rabbit hole, of course.