| Subject: Re: Federalizing Medicaid |
Author:
krz
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Date Posted: 10/15/04 2:26:27pm
In reply to:
pa
's message, "Re: Federalizing Medicaid" on 10/15/04 10:42:30am
>krz great story here. one of my 'libertarian'
>arguments against federalized health care is then
>what....are the feds going to tell me what to eat? are
>they going to keep track of how many times I go to
>McDonald's :) and then on the flip side why should I
>pay the same amount of taxes for fed insurance if my
>neighbor (who makes the same as me) doens't take care
>of himself, is overweight, never exercises, smokes
>like a chimney etc.
>
This is my concern as well - I think about it another way, what do we do with the person who gets seriously injured while doing those things that he/she enjoys to remain physically active. I once treated a wonderful man, who sustained a severe head injury in a 40 foot fall off a mountainside while rock climbing. I promise you he was fit -
I actually am not in favor of nationalizing the health care system. I think assuring a minimum is really important - and then the greater issue is making sure that there is care to be provided to that minimum. I'd also like to see health incentives factored into the cost structure for care above this minimum. Oregon did a pilot project about 10 years ago that rank ordered the easiest to treat medical challenges (defining 'easiest' as best responding to treatment with good outcomes). They then had a cut off at some number (like 240-something) and only funded those in the top rank. Never replicated to my knowledge and not sure if it's still going on. What it meant though - was treatment for pneumonia was covered without copay, treatment for breast augmentation - as the newsy example - wasn't.
I'm not sold on the litigation costs being a driving force behind most medicine. Numbers I've heard put it at 2-3% of the total cost associated with health care. My understanding is this is a huge issue for OB/GYN - but not for other specialties, and less for general practitioners.
I do think you fell victim to one of the serious challenges in health care - that being the issue of 'informed' choice. When I go buy a car or TV I have a pretty good change to get informed if I choose to put in the work. Having been both on the inside and the patient side of health care, I know that the only way to really be informed is to know medicine well enough to argue for the care/ask the right questions, under the gun, at the point of service - a really hard job!. I really don't think this is within the grasp of the american general public - nor do I think it should be. The question is, how do you as a consumer get that information (were you told before you were casted, x-rayed, what the cost would be? Did you know the cost would be different based on your payment source?). The answer is, you don't. Would you ever purchase another good or service under those conditions? As long as third party payment drives the system and the recipient never knows how the payment takes place, the consumer never really has choice. Claiming choice is choosing your doc is pandering (Kerry and Bush).
A really great book, but one that takes some time to read is The Social Transformation of American Medicine- Paul Starr. Published in the late 80s early 90s I think. Discusses the rise of the world of medicine and the rank of MD.
The cash discount thing is really tough and in part a Medicare issue. Medicare rules state that what you bill Medicare has to be the minimum you bill everyone regardless of payment source. So if the hospital accepts MEdicare (which they do), then what likely happens is Medicare is the base rate, Medicare charge plus some magnifier is the negotiated rate with other third party agencies. Payment is based on the Medicare multiplier (so Medicaid is say .4 of the Medicare base rate - way too simple, but for example). The actual cost of the service was likely around what you paid in cash - the difference between what you paid and what the other rate was, will be written off as 'bad debt'- seriously.
I teach a couple of classes on Medicare pricing every year to my entry-level PT students - their eyes glaze over within the first 10 minutes and I understand why.
As a final aside, are you aware that medicare has only been around since 1965? People make it sound like it's been here since the dawn of time. We're pretty new at this.
http://www.cms.hhs.gov/medicare/
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