Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
What does this paper work entail? Proving the diagnosis, treatment, result and fees were correct?
How does one catch people who do fraud?
When Obamacare went into effect, my doctor was required to put all my medicare records on a computer. That took some time. But now, others can read my record.
lol. I thought the same thing. If a psych doctor is still using a dictophone and transcribing it onto paper he's incompetent and Obama care had nothing to do with it. My SIL is a DO and her office does every thing electronically with 2 people.
None of the above. Job #1 is claim denial.
The longer the insurer can put off paying, the more profit they make. it's all about the time value of money
How do I know this?
This was my wife's job when she worked the the nation's largest health insurer.
It takes like 30 seconds for a clerical person to do it. Makes lots of work for everyone else, though.
It costs everyone but the insurance company money.
Tell me about it. A friend owns a small regional insurance company. When he dumped his wife and mother of his children, he kept the kids, bought her a $1.5 million house behind his so the kids could go back and forth. He gives her 50 grand a month. forever. Cheaper than splitting 50/50.
Years ago, the insurance companies made the claim forms so convoluted people who had a less than $250 claim would think it was too much trouble to fill out the form.
He also said something else I've been saying forever:
Powell later added that the “single biggest thing” that drives the “unsustainability” is health care delivery. “We spend 17% of GDP, everyone else spends 10%. ... It’s not that benefits themselves are too generous. We deliver them in inefficient ways.”
Quote:
Originally Posted by loves2read
But he didn’t say that the “inefficient ways” are responsible for lot of the wealth/momentum in the market and people’s pockets
That is not the case in systems run by countries
You don't understand.
The Hospital Model, which is what the US relies on, is the least efficient, least effective, most costly method of healthcare delivery.
Euro-States, with the exception of the UK, Sweden, Portugal and Spain, abandoned the Hospital Model decades ago in favor of the Clinic and Policlinic Model.
However, Sweden is in the process of privatization and abandoning the Hospital Model.
The former German Minister of Health has this to say on the matter:
Polyclinics—clusters of general practitioners who work together to form more specialized primary care centers—were used extensively and quite successfully in the former German Democratic Republic.
However, many politicians in West Germany initially disliked the idea of polyclinics because they associated them with communist ideology. It took a while for many people to understand that polyclinics offer significant advantages with regard to communication, coordination, and cooperation.
Source: How Germany is reining in health care costs: An interview with Franz Knieps pp 30-31.
Strikingly odd, isn't it?
The so-called "Communist" States, which were actually Socialist, utilized a corollary in Capitalist Property Theory: Diversification & Specialization.
The Western Euro-States adopted it later.
The Clinic and Policlinic Models are the most efficient, most effective, cheapest form of healthcare delivery.
So, why don't you have it in the US?
The American Hospital Association.
If you don't understand how the healthcare system in the US evolved, and you don't, then you can't possibly provide any solutions to the problems that plague your healthcare system.
You have two diametrically opposed groups: the American Hospital Association (AHA) and the American Medical Association (AMA).
The AMA used a sliding-scale fee system (up through the 1950s), and demanded total freedom for doctors, meaning doctors are to be self-employed. The sliding-scale fee was based on the patient's income and ability to pay. So, when making a house-call, like doctors did through the 1950s and even into the 1960s, a poor family of tenant farmers in Rockholds, Kentucky might pay $0.50 while a family that owns the furniture store in Williamsburg, Kentucky and was quite well-to-do might pay $1.00.
The AHA wanted flat fee billing for all patients, and total control of doctors, so that all doctors are controlled and employed by hospitals, and take orders from hospital administrators.
The AHA and AMA have been fighting over those issue for the last 100 years.
The ratio of hospital membership has changed little over that time. About 80% of hospitals are members of the AHA and 20% are members of the AMA.
In 1929, an AHA member-hospital, the hospital at Baylor University began an pilot program issuing health insurance to teachers in Dallas County, Texas (where Baylor is located).
It was $0.50/month for $22,600 worth of hospital care. That was the first health insurance plan in America. Over the next several years, both AHA and AMA member hospitals started issuing insurance.
The AMA member-hospitals provided care to anyone who purchased insurance through an AMA or AHA member-hospital anywhere in the US, but AHA member-hospitals only accepted patients who purchased their insurance directly from that hospital.
In 1933, to drive the AMA member-hospitals out of business, the AHA created the "In-Network/Out-of-Network" policy, where you could use your insurance issued by an AHA member-hospital at any AHA member-hospital, but not at AMA member-hospitals.
With the Depression worsening, States were looking hard at those hospital insurance plans, because they were looking for additional revenues.
The reason States regulate insurance, is because unscrupulous people sold worthless policies for life, home and business, and then spent the premiums on their lavish life-styles. Then, when the policy-holder filed a claim, the insurance company didn't have the money to pay-out on the policy.
So, policy-holders dutifully paid their premiums for years, then when they filed a claim, they got screwed.
States then required companies to register, obtain a license, pay an annual license fee, plus other fees, and more importantly, maintain adequate cash and non-cash assets to pay out benefits to policy-holders. Depending on the State, you had to maintain 20% to 35% of the total value of the policies issue in cold hard cash, and the remainder in assets that could be readily liquefied and converted into cash to pay policy holders.
There was no way the AHA could do that, so they started lobbying the State legislatures for "enabling laws."
The "enabling laws" enabled the hospitals to issue insurance policies without complying with State insurance regulations.
That was the 1st error your governments made.
But, the "enabling laws" did more than that, they allowed the hospitals to legally operate as monopolies and monopolistic cartels without fear of anti-trust legal action.
The AHA argued that the negative consequences of monopolies will be outweighed by the free medical care given to low-income patients.
So, how much free medical care have they provided?
No one knows.
The AHA wrote the laws in such a way as to avoid reporting mechanisms or objective measures.
The hospital monopolies are not required to publish reports, or make data available to the public, or the media, or any government agency, and there are no objective measures, like requiring a percentage of hospital revenues be spent on free medical care for low-income patients.
Crafty indeed.
By 1938, Wage Inflation starts creeping into the economy, and FDR will levy a Wage & Price Freeze.
That is the 2nd error your governments made.
Pay raises now have to be approved by the National Labor Board, who refuse to grant pay raises.
Exasperated, employers now start offering to pay for hospital insurance plans in lieu of pay raises. You chose the plan, your employer simply paid all or part of it in lieu of wages, but it was the first in a disastrous series of steps that gave your employer control over your health plan coverage.
The IRS is livid and furious, because they want to tax those benefits as wages, but in 1942, with the threat of mass strikes looming, the National Labor Board, now called the National War Labor Board, issues a ruling declaring health plan coverage to be a fringe benefit not subject to taxation.
That is the 3rd error your governments made.
In 1946, the AHA launches the Blue Cross, the very first insurance company, and the AMA follows suit with the Blue Shield a month later.
The AHA's Blue Cross continues with the "In-Network/Out-of-Network" policy it created.
The MAFIA controls the unions, and the MAFIA uses union pension plans to launder money. The MAFIA sees healthcare plans as just another vehicle to launder even more money, so the unions start pushing for control over employer health plan coverage.
That battle boils over into the 1949 In Re: Inland Steel Supreme Court decision which cements your employer's control over your health plan coverage.
That is the 4th error your governments made.
That opens the flood-gates and the real insurance companies jump on the band-wagon.
Within 2 short years, the AHA's Blue Cross has had its market share destroyed, falling from 78% of the market to just 56% of the market.
Why?
I already explained that.
The Blue Cross is not a true insurance company, because the AHA lobbied State legislatures to avoid being regulated.
The real insurance companies can do something Blue Cross cannot do: tie life insurance with catastrophic health coverage (which was the only coverage available).
You have two choices:
1) pay premiums for 10 years, then never pay another dime for the rest of your life, yet you and your spouse (and minor children) are covered until the day you die, and when you die, your named beneficiaries get whatever proceeds you haven't used for healthcare as cash.
or
2) pay premiums every month to Blue Cross until the day you die and never get a dime back.
So, which scheme allows you to profit?
Nobody wanted Blue Cross. The first scheme was a great way for low-income families to build wealth, and then pass that wealth onto their children and grandchildren.
Guess who screwed that up for everyone?
The AHA ran to Congress and lobbied for a change in the tax code to outlaw the practice, which happened in 1954 with the new 1954 IRS Tax Code.
That was the 5th error your governments made.
From that point on, various special interest groups start lobbying State legislatures to cover pet projects, constantly increasing the cost of health plan coverage without giving consumers a choice in their coverage.
Right now, special interest groups are lobbying State legislatures for autism coverage. Some State legislatures succumbed to the lobbyists, and if you live in those States, you pay more for health insurance than people in other States.
It's manifestly unfair to force people to pay for something they neither want nor can they use.
Older people are paying for pregnancy/maternity coverage, and birth control coverage they neither need nor want.
Other's are paying for doctor office visits they don't want or need. A relatively healthy person gets screwed paying extra for doctor office visits and then because they only go once or twice a year, they don't meet the deductible and have to pay even more.
That was the 6th error your governments made.
If you had a Free Market system, people could purchase catastrophic coverage only, and it would be affordable to more people. People who didn't want catastrophic coverage could purchase emergency room coverage in an amount of $50,000 or $100,000 or $250,000 or even $1 Million per year, if that's what they wanted, and it would affordable for everyone.
We don't force home-owners who don't live in earthquake or flood zones to purchase earthquake or flood insurance, but they are free to do so if they want. They'll pay more, but if that's what they want to do, then that's what they should do.
If health insurance were a la carte and people could pick and choose what they wanted, it would be affordable for everyone.
Anyway, now thanks to your governmnets and the AHA, you have an entire segment of the population who doesn't have health plan coverage, because they aren't working.
Well, the AHA has a solution for the problem they helped create, which is Medicare.
Yeah, the AHA wrote the legislation, then gave it to their lackeys in Congress to introduce, and who benefits? Oh, the Blue Cross, of course!
"Introduced by various House and Senate sponsors and subject to extensive hearings, the basic framework of part A began to reflect accommodations between the sponsors, the Administration and the American Hospital Association (AHA).
It ranged all the way from principles of institutional reimbursement, which has been pretty thoroughly already worked out in a general way for their own purposes between Blue Cross and the Hospital Association over a period of several years
The American Hospital Associationhas already nominated the Blue Cross organization for its membership, although some member hospitals will undoubtedly elect out of this arrangement. We have proceeded very far in the development of working arrangements with Blue Cross, although no formal approval as a fiscal intermediary has yet been given them."
Source: Report to Social Security Administration Staff on the Implementation of the Social Security Amendments of 1965, Robert M. Ball Commissioner, November 15, 1965
That was the 7th error your governments made.
The correct solution then, as now, was to remove health plan coverage from employers and give it back to the people through the States. If you had State-wide pools instead of myriad employer pools, then everyone would have access, and it would cost less.
You should be choosing your health plan coverage, not your employer. If your employer wants to pay all or part of it, that's fine and dandy, but you and only you should make that choice.
And, then, we have the PPACA.
That was the 8th error your governments made.
The correct solution is always the correct solution, and the correct solution still is removing health plan coverage from the realm of the employer, which the PPACA fails to do.
Worse than that, since the AHA also wrote Obamacare, it has Section 6001 and Section 6002, which are designed to keep doctors out of the loop and preclude the possibility of shifting from the grossly inefficient, ineffective, overly-expensive Hospital Model to the highly efficient, effective and less costly Clinic and Policlinic Models.
Now that you know how this nightmare came to be, and that your State and federal governments, along with the helping hand of the AHA, created this nightmare, you can find real effective solutions.
First things first, the federal governments needs to coerce the States into repealing all of the "enabling laws."
Why coerce?
The federal government does it all the time.
In the 1980s, the federal government withheld Medicaid funding to the States, unless the States enacted laws that provided religious exemptions for medical care.
What that means, is that if parents have a sick child, and they believe prayer or some snake-oil nonsense will cure the child, they don't have to take the child to a doctor, and if the child dies, then too bad, that's god's will, and you can't take criminal or civil action against the parents.
A lot of children have died or were permanently physically harmed because of it.
The federal government could withhold Medicaid funding until States repeal all the "enabling laws."
That will allow the States and the federal government to pursue anti-trust legal actions against the hospital monopolies and monopolistic cartels that illegally collude to illegally fix prices for medical care above market rates, forcing you to pay far more for medical care than you should, and since the cost of health plan coverage is based on the cost of medical care, you pay more for health insurance than you should.
It would also help to adopt the old FCC "radio rule." Used to be you could only own one radio station in the AM band and one in the FM band. Now, radio is mass corporatized and it sucks.
The AHA is moving to mass corporatize hospitals, with hospitals merging and buying up the few remaining independent hospitals.
If you let them do that, you'll be sorry.
Yes, there are 14 hospitals here locally, but in reality, there are only two, because all 14 are members of one monopolistic cartel or the other. They either fly the flag of Tri-Health or they're under the banner of the Mercy system.
That's like having 2 hospitals with 7 behemoth offices each, not 14 independent private hospitals.
Doing that will very rapidly move you from the Hospital Model to the Clinic/Policlinic Model.
How much would you rather pay for child-birth, $9,200 under the Hospital Model or $2,900 under the Clinic/Policlinic Model?
Would you rather pay $13,000 for open-heart surgery, or $29,000 to $42,000?
Those are actual figures, by the way.
When a group of doctors opened a cardio-pulmonary clinic under the Clinic Model, the AHA ran to Columbus and lobbied the State legislature to ban clinics.
One of the chief complaints in the article in the Cincinnati Enquirer was that "hospitals would lose their bread-and-butter" and that open-heart surgery was "one of the most profitable services" for some of the hospitals.
The ratio of administration/overhead for hospitals and clinics is about 6:1.
You pay far more in a hospital than a clinic, and you're largely paying for administration and overhead.
In addition to breaking up the hospital monopolies and monopolistic cartels that illegally collude to illegally fix prices, you need to yank healthcare from employers, and allow people greater control over what health insurance they want to purchase.
If you did that, your costs would drop 40%-50% almost over-night.
If people would learn to walk 40 minutes a day, and eat a salad once in a while, health care wouldn't be such a big issue in the country.
Obesity rate in the country is approaching 40%, people want to eat Cheetos everyday and wash it down with a Coke, and then want free health care on top of it subsidized by everyone else.
The poor people in this country are fat as heck. I agree the US Health Care system could use a revamp (especially in price transparency), but a lot of the problems are self inflicted.
I am not disagreeing with that as one factor in why people develop problems with their health’
But that is totally different from how dysfunctional our health care and insurance system is...
It is like blaming PGE whose deficient equipment and brush control were contributing cause of those bad fires in CA for climate change—
If people had decent health care where the emphasis was on PREVENTION vs treating long-term health problems then people might understand why eating Cheetos and drinking Coke are as dangerous long term as smoking or texting while driving...
And just to keep you honest
I see one “billionaire” sitting the the Oval (obese) Office who is fat as heck as well...
And what does he chow down on any time he gets the chance?
And how much exercise is he getting daily?
Such a good example for all the poor people who are following his lead...
The Hospital Model, which is what the US relies on, is the least efficient, least effective, most costly method of healthcare delivery.
Euro-States, with the exception of the UK, Sweden, Portugal and Spain, abandoned the Hospital Model decades ago in favor of the Clinic and Policlinic Model.
However, Sweden is in the process of privatization and abandoning the Hospital Model.
The former German Minister of Health has this to say on the matter:
Polyclinics—clusters of general practitioners who work together to form more specialized primary care centers—were used extensively and quite successfully in the former German Democratic Republic.
However, many politicians in West Germany initially disliked the idea of polyclinics because they associated them with communist ideology. It took a while for many people to understand that polyclinics offer significant advantages with regard to communication, coordination, and cooperation.
Source: How Germany is reining in health care costs: An interview with Franz Knieps pp 30-31.
Strikingly odd, isn't it?
The so-called "Communist" States, which were actually Socialist, utilized a corollary in Capitalist Property Theory: Diversification & Specialization.
The Western Euro-States adopted it later.
The Clinic and Policlinic Models are the most efficient, most effective, cheapest form of healthcare delivery.
So, why don't you have it in the US?
The American Hospital Association.
If you don't understand how the healthcare system in the US evolved, and you don't, then you can't possibly provide any solutions to the problems that plague your healthcare system.
You have two diametrically opposed groups: the American Hospital Association (AHA) and the American Medical Association (AMA).
The AMA used a sliding-scale fee system (up through the 1950s), and demanded total freedom for doctors, meaning doctors are to be self-employed. The sliding-scale fee was based on the patient's income and ability to pay. So, when making a house-call, like doctors did through the 1950s and even into the 1960s, a poor family of tenant farmers in Rockholds, Kentucky might pay $0.50 while a family that owns the furniture store in Williamsburg, Kentucky and was quite well-to-do might pay $1.00.
The AHA wanted flat fee billing for all patients, and total control of doctors, so that all doctors are controlled and employed by hospitals, and take orders from hospital administrators.
The AHA and AMA have been fighting over those issue for the last 100 years.
The ratio of hospital membership has changed little over that time. About 80% of hospitals are members of the AHA and 20% are members of the AMA.
In 1929, an AHA member-hospital, the hospital at Baylor University began an pilot program issuing health insurance to teachers in Dallas County, Texas (where Baylor is located).
It was $0.50/month for $22,600 worth of hospital care. That was the first health insurance plan in America. Over the next several years, both AHA and AMA member hospitals started issuing insurance.
The AMA member-hospitals provided care to anyone who purchased insurance through an AMA or AHA member-hospital anywhere in the US, but AHA member-hospitals only accepted patients who purchased their insurance directly from that hospital.
In 1933, to drive the AMA member-hospitals out of business, the AHA created the "In-Network/Out-of-Network" policy, where you could use your insurance issued by an AHA member-hospital at any AHA member-hospital, but not at AMA member-hospitals.
With the Depression worsening, States were looking hard at those hospital insurance plans, because they were looking for additional revenues.
The reason States regulate insurance, is because unscrupulous people sold worthless policies for life, home and business, and then spent the premiums on their lavish life-styles. Then, when the policy-holder filed a claim, the insurance company didn't have the money to pay-out on the policy.
So, policy-holders dutifully paid their premiums for years, then when they filed a claim, they got screwed.
States then required companies to register, obtain a license, pay an annual license fee, plus other fees, and more importantly, maintain adequate cash and non-cash assets to pay out benefits to policy-holders. Depending on the State, you had to maintain 20% to 35% of the total value of the policies issue in cold hard cash, and the remainder in assets that could be readily liquefied and converted into cash to pay policy holders.
There was no way the AHA could do that, so they started lobbying the State legislatures for "enabling laws."
The "enabling laws" enabled the hospitals to issue insurance policies without complying with State insurance regulations.
That was the 1st error your governments made.
But, the "enabling laws" did more than that, they allowed the hospitals to legally operate as monopolies and monopolistic cartels without fear of anti-trust legal action.
The AHA argued that the negative consequences of monopolies will be outweighed by the free medical care given to low-income patients.
So, how much free medical care have they provided?
No one knows.
The AHA wrote the laws in such a way as to avoid reporting mechanisms or objective measures.
The hospital monopolies are not required to publish reports, or make data available to the public, or the media, or any government agency, and there are no objective measures, like requiring a percentage of hospital revenues be spent on free medical care for low-income patients.
Crafty indeed.
By 1938, Wage Inflation starts creeping into the economy, and FDR will levy a Wage & Price Freeze.
That is the 2nd error your governments made.
Pay raises now have to be approved by the National Labor Board, who refuse to grant pay raises.
Exasperated, employers now start offering to pay for hospital insurance plans in lieu of pay raises. You chose the plan, your employer simply paid all or part of it in lieu of wages, but it was the first in a disastrous series of steps that gave your employer control over your health plan coverage.
The IRS is livid and furious, because they want to tax those benefits as wages, but in 1942, with the threat of mass strikes looming, the National Labor Board, now called the National War Labor Board, issues a ruling declaring health plan coverage to be a fringe benefit not subject to taxation.
That is the 3rd error your governments made.
In 1946, the AHA launches the Blue Cross, the very first insurance company, and the AMA follows suit with the Blue Shield a month later.
The AHA's Blue Cross continues with the "In-Network/Out-of-Network" policy it created.
The MAFIA controls the unions, and the MAFIA uses union pension plans to launder money. The MAFIA sees healthcare plans as just another vehicle to launder even more money, so the unions start pushing for control over employer health plan coverage.
That battle boils over into the 1949 In Re: Inland Steel Supreme Court decision which cements your employer's control over your health plan coverage.
That is the 4th error your governments made.
That opens the flood-gates and the real insurance companies jump on the band-wagon.
Within 2 short years, the AHA's Blue Cross has had its market share destroyed, falling from 78% of the market to just 56% of the market.
Why?
I already explained that.
The Blue Cross is not a true insurance company, because the AHA lobbied State legislatures to avoid being regulated.
The real insurance companies can do something Blue Cross cannot do: tie life insurance with catastrophic health coverage (which was the only coverage available).
You have two choices:
1) pay premiums for 10 years, then never pay another dime for the rest of your life, yet you and your spouse (and minor children) are covered until the day you die, and when you die, your named beneficiaries get whatever proceeds you haven't used for healthcare as cash.
or
2) pay premiums every month to Blue Cross until the day you die and never get a dime back.
So, which scheme allows you to profit?
Nobody wanted Blue Cross. The first scheme was a great way for low-income families to build wealth, and then pass that wealth onto their children and grandchildren.
Guess who screwed that up for everyone?
The AHA ran to Congress and lobbied for a change in the tax code to outlaw the practice, which happened in 1954 with the new 1954 IRS Tax Code.
That was the 5th error your governments made.
From that point on, various special interest groups start lobbying State legislatures to cover pet projects, constantly increasing the cost of health plan coverage without giving consumers a choice in their coverage.
Right now, special interest groups are lobbying State legislatures for autism coverage. Some State legislatures succumbed to the lobbyists, and if you live in those States, you pay more for health insurance than people in other States.
It's manifestly unfair to force people to pay for something they neither want nor can they use.
Older people are paying for pregnancy/maternity coverage, and birth control coverage they neither need nor want.
Other's are paying for doctor office visits they don't want or need. A relatively healthy person gets screwed paying extra for doctor office visits and then because they only go once or twice a year, they don't meet the deductible and have to pay even more.
That was the 6th error your governments made.
If you had a Free Market system, people could purchase catastrophic coverage only, and it would be affordable to more people. People who didn't want catastrophic coverage could purchase emergency room coverage in an amount of $50,000 or $100,000 or $250,000 or even $1 Million per year, if that's what they wanted, and it would affordable for everyone.
We don't force home-owners who don't live in earthquake or flood zones to purchase earthquake or flood insurance, but they are free to do so if they want. They'll pay more, but if that's what they want to do, then that's what they should do.
If health insurance were a la carte and people could pick and choose what they wanted, it would be affordable for everyone.
Anyway, now thanks to your governmnets and the AHA, you have an entire segment of the population who doesn't have health plan coverage, because they aren't working.
Well, the AHA has a solution for the problem they helped create, which is Medicare.
Yeah, the AHA wrote the legislation, then gave it to their lackeys in Congress to introduce, and who benefits? Oh, the Blue Cross, of course!
"Introduced by various House and Senate sponsors and subject to extensive hearings, the basic framework of part A began to reflect accommodations between the sponsors, the Administration and the American Hospital Association (AHA).
It ranged all the way from principles of institutional reimbursement, which has been pretty thoroughly already worked out in a general way for their own purposes between Blue Cross and the Hospital Association over a period of several years
The American Hospital Associationhas already nominated the Blue Cross organization for its membership, although some member hospitals will undoubtedly elect out of this arrangement. We have proceeded very far in the development of working arrangements with Blue Cross, although no formal approval as a fiscal intermediary has yet been given them."
Source: Report to Social Security Administration Staff on the Implementation of the Social Security Amendments of 1965, Robert M. Ball Commissioner, November 15, 1965
That was the 7th error your governments made.
The correct solution then, as now, was to remove health plan coverage from employers and give it back to the people through the States. If you had State-wide pools instead of myriad employer pools, then everyone would have access, and it would cost less.
You should be choosing your health plan coverage, not your employer. If your employer wants to pay all or part of it, that's fine and dandy, but you and only you should make that choice.
And, then, we have the PPACA.
That was the 8th error your governments made.
The correct solution is always the correct solution, and the correct solution still is removing health plan coverage from the realm of the employer, which the PPACA fails to do.
Worse than that, since the AHA also wrote Obamacare, it has Section 6001 and Section 6002, which are designed to keep doctors out of the loop and preclude the possibility of shifting from the grossly inefficient, ineffective, overly-expensive Hospital Model to the highly efficient, effective and less costly Clinic and Policlinic Models.
Now that you know how this nightmare came to be, and that your State and federal governments, along with the helping hand of the AHA, created this nightmare, you can find real effective solutions.
First things first, the federal governments needs to coerce the States into repealing all of the "enabling laws."
Why coerce?
The federal government does it all the time.
In the 1980s, the federal government withheld Medicaid funding to the States, unless the States enacted laws that provided religious exemptions for medical care.
What that means, is that if parents have a sick child, and they believe prayer or some snake-oil nonsense will cure the child, they don't have to take the child to a doctor, and if the child dies, then too bad, that's god's will, and you can't take criminal or civil action against the parents.
A lot of children have died or were permanently physically harmed because of it.
The federal government could withhold Medicaid funding until States repeal all the "enabling laws."
That will allow the States and the federal government to pursue anti-trust legal actions against the hospital monopolies and monopolistic cartels that illegally collude to illegally fix prices for medical care above market rates, forcing you to pay far more for medical care than you should, and since the cost of health plan coverage is based on the cost of medical care, you pay more for health insurance than you should.
It would also help to adopt the old FCC "radio rule." Used to be you could only own one radio station in the AM band and one in the FM band. Now, radio is mass corporatized and it sucks.
The AHA is moving to mass corporatize hospitals, with hospitals merging and buying up the few remaining independent hospitals.
If you let them do that, you'll be sorry.
Yes, there are 14 hospitals here locally, but in reality, there are only two, because all 14 are members of one monopolistic cartel or the other. They either fly the flag of Tri-Health or they're under the banner of the Mercy system.
That's like having 2 hospitals with 7 behemoth offices each, not 14 independent private hospitals.
Doing that will very rapidly move you from the Hospital Model to the Clinic/Policlinic Model.
How much would you rather pay for child-birth, $9,200 under the Hospital Model or $2,900 under the Clinic/Policlinic Model?
Would you rather pay $13,000 for open-heart surgery, or $29,000 to $42,000?
Those are actual figures, by the way.
When a group of doctors opened a cardio-pulmonary clinic under the Clinic Model, the AHA ran to Columbus and lobbied the State legislature to ban clinics.
One of the chief complaints in the article in the Cincinnati Enquirer was that "hospitals would lose their bread-and-butter" and that open-heart surgery was "one of the most profitable services" for some of the hospitals.
The ratio of administration/overhead for hospitals and clinics is about 6:1.
You pay far more in a hospital than a clinic, and you're largely paying for administration and overhead.
In addition to breaking up the hospital monopolies and monopolistic cartels that illegally collude to illegally fix prices, you need to yank healthcare from employers, and allow people greater control over what health insurance they want to purchase.
If you did that, your costs would drop 40%-50% almost over-night.
A very impassioned, detailed post
And like I said—
Money drives the train...
Just saw post on FB by Robert Reich about a defense company that is “voluntarily” returning almost half the profit it made from its deal w/the Defense Dept because it overinflated billing...
This is a large amount of money
And likely just the tip of the iceberg as to “overbilling” by defense contractors...
I used to see a lot of people sitting around at the start of projects. They would staff up for the projects and then most of the team would have nothing to do because they were waiting to be told what to do by the managers and the leads holding meetings with the client. Managers are also reluctant to get rid of contractors. If they can't do the work, they put them off in a corner office away from everyone else. I saw the same thing occur with unproductive people on three different projects.
He also said something else I've been saying forever:
Powell later added that the “single biggest thing” that drives the “unsustainability” is health care delivery. “We spend 17% of GDP, everyone else spends 10%. ... It’s not that benefits themselves are too generous. We deliver them in inefficient ways.”
Did he say anything about our Pentagon and LEO budget?
The Hospital Model, which is what the US relies on, is the least efficient, least effective, most costly method of healthcare delivery.
Euro-States, with the exception of the UK, Sweden, Portugal and Spain, abandoned the Hospital Model decades ago in favor of the Clinic and Policlinic Model.
However, Sweden is in the process of privatization and abandoning the Hospital Model.
The former German Minister of Health has this to say on the matter:
Polyclinics—clusters of general practitioners who work together to form more specialized primary care centers—were used extensively and quite successfully in the former German Democratic Republic.
However, many politicians in West Germany initially disliked the idea of polyclinics because they associated them with communist ideology. It took a while for many people to understand that polyclinics offer significant advantages with regard to communication, coordination, and cooperation.
Source: How Germany is reining in health care costs: An interview with Franz Knieps pp 30-31.
Strikingly odd, isn't it?
The so-called "Communist" States, which were actually Socialist, utilized a corollary in Capitalist Property Theory: Diversification & Specialization.
The Western Euro-States adopted it later.
The Clinic and Policlinic Models are the most efficient, most effective, cheapest form of healthcare delivery.
So, why don't you have it in the US?
The American Hospital Association.
If you don't understand how the healthcare system in the US evolved, and you don't, then you can't possibly provide any solutions to the problems that plague your healthcare system.
You have two diametrically opposed groups: the American Hospital Association (AHA) and the American Medical Association (AMA).
The AMA used a sliding-scale fee system (up through the 1950s), and demanded total freedom for doctors, meaning doctors are to be self-employed. The sliding-scale fee was based on the patient's income and ability to pay. So, when making a house-call, like doctors did through the 1950s and even into the 1960s, a poor family of tenant farmers in Rockholds, Kentucky might pay $0.50 while a family that owns the furniture store in Williamsburg, Kentucky and was quite well-to-do might pay $1.00.
The AHA wanted flat fee billing for all patients, and total control of doctors, so that all doctors are controlled and employed by hospitals, and take orders from hospital administrators.
The AHA and AMA have been fighting over those issue for the last 100 years.
The ratio of hospital membership has changed little over that time. About 80% of hospitals are members of the AHA and 20% are members of the AMA.
In 1929, an AHA member-hospital, the hospital at Baylor University began an pilot program issuing health insurance to teachers in Dallas County, Texas (where Baylor is located).
It was $0.50/month for $22,600 worth of hospital care. That was the first health insurance plan in America. Over the next several years, both AHA and AMA member hospitals started issuing insurance.
The AMA member-hospitals provided care to anyone who purchased insurance through an AMA or AHA member-hospital anywhere in the US, but AHA member-hospitals only accepted patients who purchased their insurance directly from that hospital.
In 1933, to drive the AMA member-hospitals out of business, the AHA created the "In-Network/Out-of-Network" policy, where you could use your insurance issued by an AHA member-hospital at any AHA member-hospital, but not at AMA member-hospitals.
With the Depression worsening, States were looking hard at those hospital insurance plans, because they were looking for additional revenues.
The reason States regulate insurance, is because unscrupulous people sold worthless policies for life, home and business, and then spent the premiums on their lavish life-styles. Then, when the policy-holder filed a claim, the insurance company didn't have the money to pay-out on the policy.
So, policy-holders dutifully paid their premiums for years, then when they filed a claim, they got screwed.
States then required companies to register, obtain a license, pay an annual license fee, plus other fees, and more importantly, maintain adequate cash and non-cash assets to pay out benefits to policy-holders. Depending on the State, you had to maintain 20% to 35% of the total value of the policies issue in cold hard cash, and the remainder in assets that could be readily liquefied and converted into cash to pay policy holders.
There was no way the AHA could do that, so they started lobbying the State legislatures for "enabling laws."
The "enabling laws" enabled the hospitals to issue insurance policies without complying with State insurance regulations.
That was the 1st error your governments made.
But, the "enabling laws" did more than that, they allowed the hospitals to legally operate as monopolies and monopolistic cartels without fear of anti-trust legal action.
The AHA argued that the negative consequences of monopolies will be outweighed by the free medical care given to low-income patients.
So, how much free medical care have they provided?
No one knows.
The AHA wrote the laws in such a way as to avoid reporting mechanisms or objective measures.
The hospital monopolies are not required to publish reports, or make data available to the public, or the media, or any government agency, and there are no objective measures, like requiring a percentage of hospital revenues be spent on free medical care for low-income patients.
Crafty indeed.
By 1938, Wage Inflation starts creeping into the economy, and FDR will levy a Wage & Price Freeze.
That is the 2nd error your governments made.
Pay raises now have to be approved by the National Labor Board, who refuse to grant pay raises.
Exasperated, employers now start offering to pay for hospital insurance plans in lieu of pay raises. You chose the plan, your employer simply paid all or part of it in lieu of wages, but it was the first in a disastrous series of steps that gave your employer control over your health plan coverage.
The IRS is livid and furious, because they want to tax those benefits as wages, but in 1942, with the threat of mass strikes looming, the National Labor Board, now called the National War Labor Board, issues a ruling declaring health plan coverage to be a fringe benefit not subject to taxation.
That is the 3rd error your governments made.
In 1946, the AHA launches the Blue Cross, the very first insurance company, and the AMA follows suit with the Blue Shield a month later.
The AHA's Blue Cross continues with the "In-Network/Out-of-Network" policy it created.
The MAFIA controls the unions, and the MAFIA uses union pension plans to launder money. The MAFIA sees healthcare plans as just another vehicle to launder even more money, so the unions start pushing for control over employer health plan coverage.
That battle boils over into the 1949 In Re: Inland Steel Supreme Court decision which cements your employer's control over your health plan coverage.
That is the 4th error your governments made.
That opens the flood-gates and the real insurance companies jump on the band-wagon.
Within 2 short years, the AHA's Blue Cross has had its market share destroyed, falling from 78% of the market to just 56% of the market.
Why?
I already explained that.
The Blue Cross is not a true insurance company, because the AHA lobbied State legislatures to avoid being regulated.
The real insurance companies can do something Blue Cross cannot do: tie life insurance with catastrophic health coverage (which was the only coverage available).
You have two choices:
1) pay premiums for 10 years, then never pay another dime for the rest of your life, yet you and your spouse (and minor children) are covered until the day you die, and when you die, your named beneficiaries get whatever proceeds you haven't used for healthcare as cash.
or
2) pay premiums every month to Blue Cross until the day you die and never get a dime back.
So, which scheme allows you to profit?
Nobody wanted Blue Cross. The first scheme was a great way for low-income families to build wealth, and then pass that wealth onto their children and grandchildren.
Guess who screwed that up for everyone?
The AHA ran to Congress and lobbied for a change in the tax code to outlaw the practice, which happened in 1954 with the new 1954 IRS Tax Code.
That was the 5th error your governments made.
From that point on, various special interest groups start lobbying State legislatures to cover pet projects, constantly increasing the cost of health plan coverage without giving consumers a choice in their coverage.
Right now, special interest groups are lobbying State legislatures for autism coverage. Some State legislatures succumbed to the lobbyists, and if you live in those States, you pay more for health insurance than people in other States.
It's manifestly unfair to force people to pay for something they neither want nor can they use.
Older people are paying for pregnancy/maternity coverage, and birth control coverage they neither need nor want.
Other's are paying for doctor office visits they don't want or need. A relatively healthy person gets screwed paying extra for doctor office visits and then because they only go once or twice a year, they don't meet the deductible and have to pay even more.
That was the 6th error your governments made.
If you had a Free Market system, people could purchase catastrophic coverage only, and it would be affordable to more people. People who didn't want catastrophic coverage could purchase emergency room coverage in an amount of $50,000 or $100,000 or $250,000 or even $1 Million per year, if that's what they wanted, and it would affordable for everyone.
We don't force home-owners who don't live in earthquake or flood zones to purchase earthquake or flood insurance, but they are free to do so if they want. They'll pay more, but if that's what they want to do, then that's what they should do.
If health insurance were a la carte and people could pick and choose what they wanted, it would be affordable for everyone.
Anyway, now thanks to your governmnets and the AHA, you have an entire segment of the population who doesn't have health plan coverage, because they aren't working.
Well, the AHA has a solution for the problem they helped create, which is Medicare.
Yeah, the AHA wrote the legislation, then gave it to their lackeys in Congress to introduce, and who benefits? Oh, the Blue Cross, of course!
"Introduced by various House and Senate sponsors and subject to extensive hearings, the basic framework of part A began to reflect accommodations between the sponsors, the Administration and the American Hospital Association (AHA).
It ranged all the way from principles of institutional reimbursement, which has been pretty thoroughly already worked out in a general way for their own purposes between Blue Cross and the Hospital Association over a period of several years
The American Hospital Associationhas already nominated the Blue Cross organization for its membership, although some member hospitals will undoubtedly elect out of this arrangement. We have proceeded very far in the development of working arrangements with Blue Cross, although no formal approval as a fiscal intermediary has yet been given them."
Source: Report to Social Security Administration Staff on the Implementation of the Social Security Amendments of 1965, Robert M. Ball Commissioner, November 15, 1965
That was the 7th error your governments made.
The correct solution then, as now, was to remove health plan coverage from employers and give it back to the people through the States. If you had State-wide pools instead of myriad employer pools, then everyone would have access, and it would cost less.
You should be choosing your health plan coverage, not your employer. If your employer wants to pay all or part of it, that's fine and dandy, but you and only you should make that choice.
And, then, we have the PPACA.
That was the 8th error your governments made.
The correct solution is always the correct solution, and the correct solution still is removing health plan coverage from the realm of the employer, which the PPACA fails to do.
Worse than that, since the AHA also wrote Obamacare, it has Section 6001 and Section 6002, which are designed to keep doctors out of the loop and preclude the possibility of shifting from the grossly inefficient, ineffective, overly-expensive Hospital Model to the highly efficient, effective and less costly Clinic and Policlinic Models.
Now that you know how this nightmare came to be, and that your State and federal governments, along with the helping hand of the AHA, created this nightmare, you can find real effective solutions.
First things first, the federal governments needs to coerce the States into repealing all of the "enabling laws."
Why coerce?
The federal government does it all the time.
In the 1980s, the federal government withheld Medicaid funding to the States, unless the States enacted laws that provided religious exemptions for medical care.
What that means, is that if parents have a sick child, and they believe prayer or some snake-oil nonsense will cure the child, they don't have to take the child to a doctor, and if the child dies, then too bad, that's god's will, and you can't take criminal or civil action against the parents.
A lot of children have died or were permanently physically harmed because of it.
The federal government could withhold Medicaid funding until States repeal all the "enabling laws."
That will allow the States and the federal government to pursue anti-trust legal actions against the hospital monopolies and monopolistic cartels that illegally collude to illegally fix prices for medical care above market rates, forcing you to pay far more for medical care than you should, and since the cost of health plan coverage is based on the cost of medical care, you pay more for health insurance than you should.
It would also help to adopt the old FCC "radio rule." Used to be you could only own one radio station in the AM band and one in the FM band. Now, radio is mass corporatized and it sucks.
The AHA is moving to mass corporatize hospitals, with hospitals merging and buying up the few remaining independent hospitals.
If you let them do that, you'll be sorry.
Yes, there are 14 hospitals here locally, but in reality, there are only two, because all 14 are members of one monopolistic cartel or the other. They either fly the flag of Tri-Health or they're under the banner of the Mercy system.
That's like having 2 hospitals with 7 behemoth offices each, not 14 independent private hospitals.
Doing that will very rapidly move you from the Hospital Model to the Clinic/Policlinic Model.
How much would you rather pay for child-birth, $9,200 under the Hospital Model or $2,900 under the Clinic/Policlinic Model?
Would you rather pay $13,000 for open-heart surgery, or $29,000 to $42,000?
Those are actual figures, by the way.
When a group of doctors opened a cardio-pulmonary clinic under the Clinic Model, the AHA ran to Columbus and lobbied the State legislature to ban clinics.
One of the chief complaints in the article in the Cincinnati Enquirer was that "hospitals would lose their bread-and-butter" and that open-heart surgery was "one of the most profitable services" for some of the hospitals.
The ratio of administration/overhead for hospitals and clinics is about 6:1.
You pay far more in a hospital than a clinic, and you're largely paying for administration and overhead.
In addition to breaking up the hospital monopolies and monopolistic cartels that illegally collude to illegally fix prices, you need to yank healthcare from employers, and allow people greater control over what health insurance they want to purchase.
If you did that, your costs would drop 40%-50% almost over-night.
Thank you, Captain Obvious. This country has been on an unsustainable economic path for decades. It's just that in the past 15 to 20 years it has reached, in my opinion, the point of no return. Meaning, it doesn't matter much who's in the Oval Office and who's in Congress. We are headed for destruction.
As someone who majored in Finance and currently works in the field, I'm not too worried about this "looming crisis"...yet. The US Dollar is still the reserve currency of the World Bank and other powerful countries still hold tons of US-backed public debt, meaning that the US would take the world's financial system down with it should it ever fall. Also, the mineral rights that the US could sell would bring in TRILLIONS of dollars in new revenues, quickly eradicating the debt that we owe. Finally, developing nations would also falter due to a lack of continued US aid.
With that said, however, we really should start to address our level of national debt. The Reagan-era tax cuts ended up hurting this nation in a manner more severe than some will admit to. Taxes need to be raised across the board, with a heftier tax imposed on households making more than $250,000/year. Healthcare needs to be nationalized, and military spending could easily be cut. What we DO need to spend money on is infrastructure. The US needs new water/sewer lines, power distribution systems, rail lines, airports, bridges, and other items. This time around, we need to invest in city centers and metropolitan areas instead of subsidizing the existence of the suburbs. I'd love to see investments made in public transportation, especially subway systems in cities that have population densities exceeding 10,000 people per square mile (ex. NYC, Chicago, Philadelphia, San Francisco, etc.). High-speed rail should also be built out in a select few megaregions and urban agglomerations. Finally, I'd love to see a SIGNIFICANT hike in the national gas tax so that motorists end up paying for the true costs of their infrastructure.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
