Health Insurance's balanced billing woes - Page 4 - PeachParts Mercedes-Benz Forum

DieselAddict · #46 10-01-2009, 08:56 PM

Quote:

Originally Posted by aklim

That is a private company and should NOT be bailed out at anybody's expense.

Still in love with the 3%, aren't you? Remember I mentioned MIPPA? Think Medicare came out with that of their own? I don't think so. Congress came out with that. Was that included in the overhead? As a businessowner, and I have talked to many, we seem to be unable to understand how a company can operate at a 3% level. Can you explain it? If they could have been so efficient, do you think we would be in such a mess as we are now? Sorry, I don't believe it unless you expect me to believe that "this one time" they are that good while the rest of the time, they are not. Yes, it does boil down to a lot of accounting tricks. How did your 3% number come about? If you simply write the checks and don't do fraud prevention, are you sure you are getting what you paid for? Does that go to the other 97%? Medicare doesn't do any investigation of the providers, do they?

http://www.qando.net/?p=3362

Nothing new in that link and we already discussed it. Nothing in the link changes the fact that Medicare wastes less patient money on profits and administration compared to private insurance. And Medicare certainly does investigate providers. Just recently it was in the news that some doctors were arrested for filing fraudulent Medicare claims. Face it, all you have against Medicare is your ideological hatred of govt and your feeling that their provider forms are too complicated. Big deal.

aklim · #47 10-01-2009, 11:09 PM

Quote:

Originally Posted by DieselAddict

Nothing new in that link and we already discussed it. Nothing in the link changes the fact that Medicare wastes less patient money on profits and administration compared to private insurance.

And Medicare certainly does investigate providers. Just recently it was in the news that some doctors were arrested for filing fraudulent Medicare claims.

Face it, all you have against Medicare is your ideological hatred of govt and your feeling that their provider forms are too complicated. Big deal.

I guess you will believe anything. 3% is a pretty difficult figure for anyone to reach. When you consider the politics, the general inefficiency that govt has shown and you can believe it, I don't know what to say. How do you believe they are 4 fold as efficient as someone who HAS to be efficient? At least, that is what they believed till the bailouts. What is their incentive? The desire to excel? Wanna buy a slightly used, well maintained bridge? As I said, if you take staffing costs and devide it by money doled out and come out with that number, fair enough. Doesn't say much though. How do you account for the crazy notion that while they have a 3% claimed overhead, their administration per patient costs are way more than the insurance companies that are forced to compete with each other and fend off the govt?

What does that show? That they were investigate BEFORE being let in? I think not. The wife was a medicare provider. There was little investigation unless you consider filling up a form investigation.

Past history is considered ideological hatred? Or do you look at it like a video game where you put another quarter and the game starts all over again? How do you explain the Tobacco Windfall money? How about the unbalanced checkbook in spite of the accounting tricks that would make Arthur Andersen wet their pants? How about the states borrowing money when the tax revenues are down so they don't have to do what you and I have to do when income is down? How about their "borrowing" from SS? Care to explain where my road tax money went to and why? How about telling the soldiers what weapon systems they need in spite of the requests simply because the purchase benefits their constituents? Should we even talk about how good the $300 ashtrays were? But you either believe they have changed their bad ways or that a new quarter is in the machine so it is a new game altogether, right?

tankdriver · #48 10-02-2009, 12:06 AM

Quote:

Originally Posted by aklim

The workers still make money, that much is true. Still, my question is why would would volunteer someone else's industry and not your own?

Mine is quite different from the healthcare industry. People don't die if they can't afford kitchen cabinets.

Quote:

If you insist on clogging up the ER with the illegals who obviously don't have the money to pay and the Canadians don't have the Mexican Problem, is that a fair comparison?

What? He brought up Canada.

DieselAddict · #49 10-02-2009, 02:16 AM

Quote:

Originally Posted by aklim

I guess you will believe anything. 3% is a pretty difficult figure for anyone to reach. When you consider the politics, the general inefficiency that govt has shown and you can believe it, I don't know what to say. How do you believe they are 4 fold as efficient as someone who HAS to be efficient? At least, that is what they believed till the bailouts. What is their incentive? The desire to excel? Wanna buy a slightly used, well maintained bridge? As I said, if you take staffing costs and devide it by money doled out and come out with that number, fair enough. Doesn't say much though. How do you account for the crazy notion that while they have a 3% claimed overhead, their administration per patient costs are way more than the insurance companies that are forced to compete with each other and fend off the govt?

What does that show? That they were investigate BEFORE being let in? I think not. The wife was a medicare provider. There was little investigation unless you consider filling up a form investigation.

Past history is considered ideological hatred? Or do you look at it like a video game where you put another quarter and the game starts all over again? How do you explain the Tobacco Windfall money? How about the unbalanced checkbook in spite of the accounting tricks that would make Arthur Andersen wet their pants? How about the states borrowing money when the tax revenues are down so they don't have to do what you and I have to do when income is down? How about their "borrowing" from SS? Care to explain where my road tax money went to and why? How about telling the soldiers what weapon systems they need in spite of the requests simply because the purchase benefits their constituents? Should we even talk about how good the $300 ashtrays were? But you either believe they have changed their bad ways or that a new quarter is in the machine so it is a new game altogether, right?

You are grasping at straws. Out of your whole post only one sentence actually addresses what we were talking about, the rest is just unrelated anti-govt ranting.

Quote:

How do you account for the crazy notion that while they have a 3% claimed overhead, their administration per patient costs are way more than the insurance companies that are forced to compete with each other and fend off the govt?

Easy. Medicare's patients are the sickest and most costly patients. Naturally their paperwork will take more resources to process than the paperwork of some healthy 20-year-old who rarely sees a doctor. That's why private insurance won't touch most of the elderly with a 10-foot pole. They know with their big overhead and the need to make huge profits covering the elderly wouldn't make any sense. Only Medicare which is optimized for delivery of care rather than outrageous profits can cover them.

aklim · #50 10-02-2009, 09:02 AM

Quote:

Originally Posted by tankdriver

Mine is quite different from the healthcare industry. People don't die if they can't afford kitchen cabinets.

PRINCIPLE is the same though.

aklim · #51 10-02-2009, 09:17 AM

Quote:

Originally Posted by DieselAddict

You are grasping at straws. Out of your whole post only one sentence actually addresses what we were talking about, the rest is just unrelated anti-govt ranting.

Easy. Medicare's patients are the sickest and most costly patients. Naturally their paperwork will take more resources to process than the paperwork of some healthy 20-year-old who rarely sees a doctor. That's why private insurance won't touch most of the elderly with a 10-foot pole. They know with their big overhead and the need to make huge profits covering the elderly wouldn't make any sense. Only Medicare which is optimized for delivery of care rather than outrageous profits can cover them.

Simply put, it shows a pattern of deceit and not just incompetence. IF you gave someone 2 $50s instead of 2 $5, it is a mistake. If you gave someone the change less $5 which you pocketed, it is theft. The govt has shown it excels at the latter. Why do you trust them with even more opportunity for theft if not so you can have your butt wiped by someone else besides yourself and be tucked into bed with a bedtime story? Instead of dismissing it as simply "anti-govt", why don't you look at it, see if there is truth and then tell me why you think we should trust them again other than you want your butt wiped by someone else and to be tucked into bed.

My point is that at 3%, I'd have to hire some moron to be writing checks and pay them min wage to do it. Little else if I want the lights, building and what not to be there in the morning.

Edit: Just a thought. Based on what your 2nd paragraph says, how does that 3% even factor into anything then? For the sake of argument, lets say that the 3% is accurate. (I'd have to be on some GHB to believe that). Aren't we comparing 2 totally different sets of clients? How would that even suggest that the govt can duplicate that effort with full blown insurance?

Yeagersocs · #52 10-02-2009, 09:51 AM

Quote:

Originally Posted by aklim

PRINCIPLE is the same though.

While I am not in favor of most iterations of the public option, the principle here is NOT the same.

The privatization of any good or service has the potential to make it more efficient, and possibly less costly to the consumer. It is only human nature that when provided with incentive, we find a way to make things better. The carrot of profit makes us work hard; no one denies that.

People fail to realize, however, that capitalistic motives cause us to work hard for PROFIT, not results, nor to provide a good product. Now, normally providing a good product, or getting results is what leads to profit, so they are all associated as a common "good thing" that people can agree on. We can all agree that the power of capitalism--both economically and ethically-- stems from the fact that in essence, we are given a non-altruistic motive for altruism. It benefits us to help others, and vice versa. And the market is the perfect feedback tool to measure and keep us informed of who needs what where, and who can best provide it. But if there exists a way to reap massive profits without in fact providing a product that aids consumers, then capitalism--given it's very nature and directed end towards efficiency--will find it.

So what happens when people have no choice but to buy a product because it is necessary for them to have even the barest minimum of quality of life? When the terms of that product belong entirely to the provider, and the consumer is left with no bargaining chips, because of the desperate nature of their position? The terms "profit" and "a good product" are no longer synonymous, that's what. It is no longer about Adam Smith's overarching idea: that a free market simply adds economic motive to already good intentions. The dynamic changes because one party is suddenly without power, while the other half no longer has the altruistic check that capitalism is supposed to provide. The "father of capitalism" would be appalled, not delighted. Enter, unchecked greed.

When this happens, the "way" to profits, too efficiency, is often found by exploiting a weak minority of consumers for the apparent benefit of the majority, or to reframe the relationship so that consumers believe they are getting a good deal, even though they are not. Even this can eventually work out to be a good thing, as public perceptions and/or sympathy for that minority even out the market. Unfortunately, the alternative occurs more frequently: the basic inequalities remain in the face of greed, the absence of transparency, and the presence of a generally apathetic public.

Healthcare can currently claim all three of these ills- apathy in those who have it, greed in those who provide it, and the most muddled, PR-obsessed, image-centric non transparent operating methods of any industry in the country. The free market, just like government, doesn't work when it can only be viewed through an opaque lens. And yet even on top of this, healthcare is a unique beast for other reasons.

Unlike other many other goods, the demand for healthcare is both economically inelastic and tremendously demographically predictable. So, the "way" to efficiency is by rejecting those with pre-existing conditions, the elderly, denying procedures, etc. The people in charge are still working hard (good ol' capitalistic incentive!), but they now work hard to find the best way to increase their bottom line without worrying about you, because your opinion no longer holds any consequence for them. The easiest, best, most rewarding way to run healthcare for profit is to screw people. Period. And they know exactly how to do it, because the demographic data and quantifiable human vulnerabilities makes it clear as day.

Really, from the perspective of a sound business model, the ingenuity that capitalistic motivation has added to our healthcare system is amazing. But only one side benefits from it. The capitalistic contract that Smith valued so highly (and which the right wing loves to flaunt) has been turned on it's head.

There are certain goods- health care, education, roads, etc, that simply don't mix well with private industry. Their potential for profit is either too low to make the investment worth it (roads, etc), or the potential for corruption is too staggering for the capitalistic model to remain true to itself. There are extremes- college, private highways, etc, but these only serve a comparatively elite section of society. Healthcare is unique again in that when privatized, it is ripe for corruption AND comparatively selective service. The double whammy.

So, to my point- anyone who can't see how a traditional small business providing a good for which there is elastic demand (like cabinets), and a multi-billion industry controlling one of the basic necessities of life come down on opposite sides of the coin as described above, is fooling themselves. The principle is the very heart of the issue.

The public plan isn't the best option, but it's better than what we have. Ideally though, some bi partisan cooperation could take the engine of ingenuity that is capitalism, and place it back within the ethical confines that Smith originally envisioned.

aklim · #53 10-02-2009, 12:07 PM

Quote:

Originally Posted by Yeagersocs

or the potential for corruption is too staggering for the capitalistic model to remain true to itself.

So how will the govt cope with it? What has the govt done to assure you that corruption won't happen? Their excellent past? I don't say that they must be 100% efficient. However, they have shown their hand before when it comes to deceit as I have mentioned with but a few examples.

If an employee comes to me with their cash drawer short because they gave the wrong change, there is room for improvement to minimize occurences like that in the future. OTOH, would you be more accepting of a careless act by an employee or a deceitful act?

That said, which is easier for me to do? Discover the congressional BS that they come up with or have some one blow the whistle on a corrupt company? Further to that, which is easier? To deal with that company or the govt?

Why should I think that your word means a thing when you have shafted me in the past? They are constantly using cash accounting to do the budget. Do you use cash accounting too? Probably not. But it does make things look good though.

So what makes govt do it that well? Just because you see that on the surface they don't work for profit?

tankdriver · #54 10-02-2009, 01:39 PM

Quote:

Originally Posted by Yeagersocs

So what happens when people have no choice but to buy a product because it is necessary for them to have even the barest minimum of quality of life? When the terms of that product belong entirely to the provider, and the consumer is left with no bargaining chips, because of the desperate nature of their position?

While I disagree there is anything ethical about capitalism, I agree that the current system is hardly 'free'.

Healthcare access is necessary for the barest minimum of quality of life, as you put it. It also is something a moral society that believes in equality cannot deny to anyone.

There is no reason health, life, or death must be commodified. And that's what we've done.

aklim · #55 10-02-2009, 02:59 PM

Quote:

Originally Posted by tankdriver

While I disagree there is anything ethical about capitalism, I agree that the current system is hardly 'free'.

Healthcare access is necessary for the barest minimum of quality of life, as you put it. It also is something a moral society that believes in equality cannot deny to anyone.

There is no reason health, life, or death must be commodified. And that's what we've done.

Nothing In Life is Free

How is it an issue of equality? Unless you commit a crime, you have the right to life, liberty and the PURSUIT of happiness. Nobody is stopping you from buying what you can afford.

No reason you are willing to accept, maybe.

DieselAddict · #56 10-02-2009, 03:21 PM

Quote:

Originally Posted by aklim

Simply put, it shows a pattern of deceit and not just incompetence. IF you gave someone 2 $50s instead of 2 $5, it is a mistake. If you gave someone the change less $5 which you pocketed, it is theft. The govt has shown it excels at the latter. Why do you trust them with even more opportunity for theft if not so you can have your butt wiped by someone else besides yourself and be tucked into bed with a bedtime story? Instead of dismissing it as simply "anti-govt", why don't you look at it, see if there is truth and then tell me why you think we should trust them again other than you want your butt wiped by someone else and to be tucked into bed.

My point is that at 3%, I'd have to hire some moron to be writing checks and pay them min wage to do it. Little else if I want the lights, building and what not to be there in the morning.

Edit: Just a thought. Based on what your 2nd paragraph says, how does that 3% even factor into anything then? For the sake of argument, lets say that the 3% is accurate. (I'd have to be on some GHB to believe that). Aren't we comparing 2 totally different sets of clients? How would that even suggest that the govt can duplicate that effort with full blown insurance?

Let me turn that around and ask you this. Do you trust your private insurance company to do what's right with your dollars based on their past and current performance? To me govt is far from perfect, but they are no doubt the lesser of the two evils. Again the 3% overhead is not denied even by the anti-Medicare websites you've shown me. It's true. And why do you think seniors are the ones most apathetic or opposed to health care reform? Because they already have the best health care among all of us.

tankdriver · #57 10-02-2009, 03:47 PM

Quote:

Originally Posted by aklim

Nothing In Life is Free

least of all a market in which the consumers are held hostage.

Quote:

How is it an issue of equality? Unless you commit a crime, you have the right to life, liberty and the PURSUIT of happiness. Nobody is stopping you from buying what you can afford.

It's an issue of equality because people without the money to pay are denied life. Which is the first of your 3 rights.

DieselAddict · #58 10-02-2009, 04:09 PM

Quote:

Originally Posted by tankdriver

least of all a market in which the consumers are held hostage.

It's an issue of equality because people without the money to pay are denied life. Which is the first of your 3 rights.

People without money do fine. It's those who don't have coverage but make too much money to qualify for Medicaid who are in real trouble. Last Friday on PBS they featured a story of a working middle-class couple with an asthmatic child that was dumped by their insurance company for having a pre-existing condition. It wasn't an issue with money. They wanted to buy private coverage but no insurance company would take their money. Their only option was to quit their jobs and work part time so they could qualify for Medicaid which doesn't discriminate based on pre-existing conditions, only on income. How stupid is that. Our health care system not only drives people into bankruptcy but sometimes also drives them out of work.

aklim · #59 10-02-2009, 04:16 PM

Quote:

Originally Posted by DieselAddict

Let me turn that around and ask you this. Do you trust your private insurance company to do what's right with your dollars based on their past and current performance? To me govt is far from perfect, but they are no doubt the lesser of the two evils.

Again the 3% overhead is not denied even by the anti-Medicare websites you've shown me. It's true.

And why do you think seniors are the ones most apathetic or opposed to health care reform? Because they already have the best health care among all of us.

Trust is EARNED, not given. So, not without a good dose of GHB. Nice thing about private insurance is that the govt, like the traffic cops are always waiting to earn a few bucks by levying fines for misdeeds. IOW, there is one more layer of control. One of the reasons I moved to USA is that it was easier for me to change the environment than to change the govt. I would assume the same is true here too. A few years back, I got pissed by my HMO. I went to another one. How do I change my govt as easily?

As has been suggested, the 3% number is true in that context. HOWEVER, the insurance companies are not judged in that same context. But I ask you, what do YOU think when you look at their history of inefficiency and deceit? Do you believe it in the sense that it is a valid comparison? They don't pay taxes like insurance companies do, they don't advertise or compete and they certainly don't seem as aggressive as insurance companies are for fraud investigation. The only way I see this working out is if they are simply writing checks with far less checks and balances. I don't think you understand that what you are saying is that this lazy clown is suddenly the model of efficiency for this one thing. I will concede that if all you want is a company to write the checks and collect the money, they are the best. As an insurance company where they have to be viable on their own (at least till Bush and Obama), I don't think so.

Old people tend to be afraid of change. Can you blame them seeing that the govt has been deceitful or at the very least, less than totally forthcoming? The wife works with medicare people that don't even know what it is. She usually has to send them to a special counselor that understands it well enough to explain it all to them. I remember people thinking it was a attempt by Bush to take over Medicare when he came out with that Prescription drug thing. From the standpoint that we pay for our healthcare and they don't, you are right. The DO have more bang for their nothing or little current contribution.

aklim · #60 10-02-2009, 04:23 PM

Quote:

Originally Posted by tankdriver

It's an issue of equality because people without the money to pay are denied life. Which is the first of your 3 rights.

I suppose then MB needs to give me their V12 Biturbo car since without it, I would be denied happiness? You are not denied life any more than the grocery store that won't give me food for nothing is denying me life. What you are saying is that me shooting you in the head is akin to me letting nature take it's course and you not live for another 20 years.