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There was an interesting letter in the paper the other day from a doctor who said that he might not be able to AFFORD doing business if Medicare goes down.
Well, he might not be making six FIGURES anymore, but is that really "poverty"?
A) You don't know this doctors income so, you are only assuming "six figures"
B) While not personally reading the article, I can imagine this doctor was also referencing income to pay overhead - office, lights, STAFF, etc.
Hee Hee Hee. Yes, I have looked at all sorts of reports from CBO, NIH, etc and here is interesting stat:
80% of Medicare costs are consumed in the last 2 months of a person's life.
No one wants to talk about what that means. Discussing lengthening life expectancy is just not up for discussion. Neither are heroic means of trying to save a life or lengthening a life.
It is not as simple as life expectancy, nor as simple as how much profit BC/BS makes in a year - as they are in the business of making money - and if they have good actuarials - they will! One can only put together pools of privately insured patients and assume that, b/c of many factors, x amount will come down w/ cancer, x amount will have cardiac incidents, x amount will give birth w/ complications, etc.
I think insurance companies and pharmaceutical companies may be the Great Satan and Satan's lapdog, but I have never figured out wh/ is which, LOL!!! But the gov't sure is not the Savior either, as the reimbursement schedule affects everyone - from patients, to docs, to hospitals.
Do you think that those who can " charge what they feel their skill is worth" those who typically won't show much of thier income as taxable, should be paying a true percentage of income. If so, would that be enough for each American to pay say 12% of income as a tax / premium? I get the feeling several of you participating are paid to come up with better ideas for HC delivery daily. Thanks for giving us an insight as to the process.
Wordsmith, love your posts and know you are sincere in asking this, but such various scenarios are the purview of the various professional organizations and altho I have never seen a flat proposed rate such as you suggest, every facet of the industry has its own view of how to contain costs.
However, I will say this - federal regs are such that doctors cannot just charge"what they will" as the fees have to be "reasonable" and in line w/ Medicare reimbursement for each procedure. Insurance companies reimburse based on established parameters for reasonable charges, as well.
The point is - your gov't already does have the most influence over what docs charge. Did you know that?
Hospitals often serve populations w/ 40 -60% Medicare and Medicaid recipients and take a loss on every single patient they serve. Did you know that? (referred to as "shortfall.")
Charity care is a write off, wh/ a hospital has to absorb. How? They pass the costs along. I hear people say "Healthcare is a right," and then they complain that an aspirin cost them $5 and the hospital is ripping them off.
No - the hospital is trying to recoup costs for marked-off the books charity care. If they didn't do this, they could not stay in business. Now that is no mystery - there are all sorts of professional studies on this subject (in peer reviewed journals, gov't reports, etc).
What does this mean? For all of you who have posted how you "don't mind" paying more so EVERYONE can receive care - well - HELLO - you are paying more!!! But you are complaining about it!!! Your altruistic attitude stops when you look at your hospital bill and see that a pair of latex gloves were charged at a cost of $12. You feel ripped off! Yet, it was that charge that helped subsidize your neighbor who couldn't pay for his bill and so it was written off as charity care. Or it was your neighbor on Medicare whose bill was only partially reimbursed by the gov't, and so the hospital had to take a loss on it.
So you ARE paying for everyone else's care. Well, no you aren't really! Your insurance company is!!!!!
See what I mean . . . this is a very complicated issue!!!!
And since some of you have evidently not read my earlier posts - think about this one. You know how we always hear that the justification for such high drug costs in this country is - research and development costs? Well did you realize that the NIH subsidizes research on drugs, yet when the drug 's efficacy is proven, the drug company wh/ has been subsidized for those studies/trials gets the patient to it, NOT the federal gov't? Yet, YOU, the taxpayer, were footing the bill for the development of that drug.
Take stem cell research. Everyone is sooooo misguided about this issue. You want drug companies to do stem cell research? You think they cant b/c of some strange "ban" against it, right? The Prez says - NOPE - you can only do it if you use these certain DNA strands/embryos (whatever). So the public gets all up in arms about it. UH - NO - they can do all the research they want - as long as they pay for it. They just can't get GOVERNMENT FUNDING to do it except w/in the guidelines prescribed by federal regs.
Surprised? Drug companies licensed outside the USA can do all the testing they want - and they ARE! I don't know if the French gov't is subsidizing that research, for ex. - have never checked! But stem cell research goes on - as long as someone is willing to fund it (other than Uncle Sam).
Well, I have work to do to earn my keep . . . so hope you all have fun figuring out the h/c system in the meantime, LOL. Believe me, the more you know about it, the more you feel mystified as to what can be done to "change" the h/c system in this country. And the more you realize - all the babble doesn't mean a thing. The "regs" are there. Good luck getting any of that changed.
Hee Hee Hee. Yes, I have looked at all sorts of reports from CBO, NIH, etc and here is interesting stat:
80% of Medicare costs are consumed in the last 2 months of a person's life.
No one wants to talk about what that means. Discussing lengthening life expectancy is just not up for discussion. Neither are heroic means of trying to save a life or lengthening a life.
It is not as simple as life expectancy, nor as simple as how much profit BC/BS makes in a year - as they are in the business of making money - and if they have good actuarials - they will! One can only put together pools of privately insured patients and assume that, b/c of many factors, x amount will come down w/ cancer, x amount will have cardiac incidents, x amount will give birth w/ complications, etc.
I think insurance companies and pharmaceutical companies may be the Great Satan and Satan's lapdog, but I have never figured out wh/ is which, LOL!!! But the gov't sure is not the Savior either, as the reimbursement schedule affects everyone - from patients, to docs, to hospitals.
Simply put, it is a tangled can of worms.
Yes, it is. The statistic in bold simply means (to me) that people are sicker in the last 2 months of their lives than at any other time, on average, of course. Most of us would like to just "drop dead" w/o any medical intervention at some point, but it doesn't usually happen that way. Those stats are certainly true for both my father and father-in-law, maybe my mom, too. Certainly looks like my mother-in-law is going that way. The final illness is expensive, yes. BTW, both of my parents died in nursing homes, not in an ICU hooked up to machines, and FIL died in a hospice. Anyway you do it, it's expensive.
Wordsmith, love your posts and know you are sincere in asking this, but such various scenarios are the purview of the various professional organizations and altho I have never seen a flat proposed rate such as you suggest, every facet of the industry has its own view of how to contain costs.
Thanks.
However, I will say this - federal regs are such that doctors cannot just charge"what they will" as the fees have to be "reasonable" and in line w/ Medicare reimbursement for each procedure. Insurance companies reimburse based on established parameters for reasonable charges, as well.
But, that 's true for reimburesed procedures, however those that want and can pay can always get what they want.
The point is - your gov't already does have the most influence over what docs charge. Did you know that?
I thought I knew better......it effects treatment for those with limited means to pay. If I have a bill from the doc it will state my portion due because "over normal and reasonable" (sic) charges. Is the gov't attempting moral suasion?
Hospitals often serve populations w/ 40 -60% Medicare and Medicaid recipients and take a loss on every single patient they serve. Did you know that? (referred to as "shortfall.")
Can we help that by not dumping the indgent all in one ?
Charity care is a write off, wh/ a hospital has to absorb. How? They pass the costs along. I hear people say "Healthcare is a right," and then they complain that an aspirin cost them $5 and the hospital is ripping them off.
If this is true, and i am not trying to be argumenative, why isn't there a line item on the bill that reflects "unisured loss prevention" or clearly labled to that effect. I have seen the expense involved in documenting components that go into items sensitive to public saftey (areospace, aircraft) so some upcharge for items in a hosptital environment is to be expected. We should lose the subtrefuge.
No - the hospital is trying to recoup costs for marked-off the books charity care. If they didn't do this, they could not stay in business. Now that is no mystery - there are all sorts of professional studies on this subject (in peer reviewed journals, gov't reports, etc).
What does this mean? For all of you who have posted how you "don't mind" paying more so EVERYONE can receive care - well - HELLO - you are paying more!!! But you are complaining about it!!! Your altruistic attitude stops when you look at your hospital bill and see that a pair of latex gloves were charged at a cost of $12. You feel ripped off! Yet, it was that charge that helped subsidize your neighbor who couldn't pay for his bill and so it was written off as charity care. Or it was your neighbor on Medicare whose bill was only partially reimbursed by the gov't, and so the hospital had to take a loss on it.
So you ARE paying for everyone else's care. Well, no you aren't really! Your insurance company is!!!!!
See what I mean . . . this is a very complicated issue!!!!
And since some of you have evidently not read my earlier posts - think about this one. You know how we always hear that the justification for such high drug costs in this country is - research and development costs? Well did you realize that the NIH subsidizes research on drugs, yet when the drug 's efficacy is proven, the drug company wh/ has been subsidized for those studies/trials gets the patient to it, NOT the federal gov't? Yet, YOU, the taxpayer, were footing the bill for the development of that drug.
I posted this before.
Take stem cell research. Everyone is sooooo misguided about this issue. You want drug companies to do stem cell research? You think they cant b/c of some strange "ban" against it, right? The Prez says - NOPE - you can only do it if you use these certain DNA strands/embryos (whatever). So the public gets all up in arms about it. UH - NO - they can do all the research they want - as long as they pay for it. They just can't get GOVERNMENT FUNDING to do it except w/in the guidelines prescribed by federal regs.
Surprised? Drug companies licensed outside the USA can do all the testing they want - and they ARE! I don't know if the French gov't is subsidizing that research, for ex. - have never checked! But stem cell research goes on - as long as someone is willing to fund it (other than Uncle Sam).
There are hedge funds sucking mony from (some of the same medical types) with money to invest in research to find the "holy grail" patent. I bet the research personel don't see a pitance vs the banker.
Well, I have work to do to earn my keep . . . so hope you all have fun figuring out the h/c system in the meantime, LOL. Believe me, the more you know about it, the more you feel mystified as to what can be done to "change" the h/c system in this country. And the more you realize - all the babble doesn't mean a thing. The "regs" are there. Good luck getting any of that changed.
Don't stress, we should be done by evening. ( bad multiple quote, sorry)
Yes, it is. The statistic in bold simply means (to me) that people are sicker in the last 2 months of their lives than at any other time, on average, of course. Most of us would like to just "drop dead" w/o any medical intervention at some point, but it doesn't usually happen that way. Those stats are certainly true for both my father and father-in-law, maybe my mom, too. Certainly looks like my mother-in-law is going that way. The final illness is expensive, yes. BTW, both of my parents died in nursing homes, not in an ICU hooked up to machines, and FIL died in a hospice. Anyway you do it, it's expensive.
And please know - I am not meaning to sound insensitive, b/c like your family, mine has experienced very similar situations . . . and I expect someday I will be one of those hooked up somewhere, either in hospice or nursing home. So I hope I did not sound strident.
My point is - what happens when healthcare is rationed, and coverage is limited as to what will be approved as to "end of life" procedures? And what happens to the hospitals and nursing homes who are having to pay the shortfall on those patients who are using up that level of service the last few months of their lives? It is a sticky wicket subject! We expect our hospitals to be there to take care of us . . . but someone has to absorb cost for that care. And it is your hospital which does that.
Don't stress, we should be done by evening. ( bad multiple quote, sorry)
Okay. Will try to answer what I can re: your posts. Taking a coffee break.
Federal regs are such that doctors cannot just charge"what they will" as the fees have to be "reasonable" and in line w/ Medicare reimbursement for each procedure. Insurance companies reimburse based on established parameters for reasonable charges, as well.
But, that 's true for reimburesed procedures, however those that want and can pay can always get what they want.
True. That is why I keep saying on this (and other threads) that healthcare is totally available in this country - as long as you can cough up the cash or credit cards. And even insurance cannot protect you from those costs.
For example: there is a scan being done all over the country - to measure calcium deposits - cardiac. It is not reimbursed by any healthcare insurance (that I am aware of - this could have changed) and Medicare has discussed reimbursing for it (don't think they have ruled on that yet). Nevertheless, let it suffice to say - for the majority of people - this would be an out of pocket expense. Yet, it may be a valuable diagnostic tool (I think it is). It may eventually be covered by both Medicare and private insurance. So this is perfect example of a diagnostic tool that is available to you - if you have the $$ to pay for it.
********
The point is - your gov't already does have the most influence over what docs charge. Did you know that?
I thought I knew better......it effects treatment for those with limited means to pay. If I have a bill from the doc it will state my portion due because "over normal and reasonable" (sic) charges. Is the gov't attempting moral suasion?
This has to do w/ your insurance and what has been negotiated b/n the doc (or the hospital) and your insurance company. If you do not have healthcare insurance, you have every right to attempt to negotiate those charges yourself. I would suggest always doing that, in fact. When I get a statement showing that my insurance has paid according to "reasonable" charges, I will still attempt to negotiate w/ the physician to lower his fees to be more in line w/ those "reasonable" charges. Doesn't always work for me, but I would say I have been successful about 66% of the times I have done this. 2 outta 3 ain't bad.
********
Hospitals often serve populations w/ 40 -60% Medicare and Medicaid recipients and take a loss on every single patient they serve. Did you know that? (referred to as "shortfall.")
Can we help that by not dumping the indgent all in one ?
Not sure if I processed the meaning of your question correctly, so forgive me if this is not what you were asking.
What I understand you to mean is - are we dumping the indigent care on particular hospitals? In some cases, I would say this may be accurate, but overall, the demographics in any given hospital, especially rural hospitals, simply add up to those percentages. That is why so many hospitals are struggling.
And just think - that tells you how many people in any given community are already on "universal healthcare" wh/ is subsidized by your tax dollars. We are not accounting for charity care w/ those stats - only those who are actually receiving subsidized care through either Medicare or Medicaid.
***********
Charity care is a write off, wh/ a hospital has to absorb. How? They pass the costs along. I hear people say "Healthcare is a right," and then they complain that an aspirin cost them $5 and the hospital is ripping them off.
If this is true, and i am not trying to be argumenative, why isn't there a line item on the bill that reflects "unisured loss prevention" or clearly labled to that effect. I have seen the expense involved in documenting components that go into items sensitive to public saftey (areospace, aircraft) so some upcharge for items in a hosptital environment is to be expected. We should lose the subtrefuge.
This is very complicated subject. Hospitals are under federal regs to comply w/ providing x amount of charity care. They cannot simply add a % onto bills that covers "loss." it is called cost-shifting and all the prices charged for items are consistent on everyone's bill. The higher your bill, the more the % would be for "uninsured loss" as you put it. Won't work. Can't just tag on fees that are not justified as an actual expense. Strictly regulated.
**************
I noticed I misspelled patent as "patient" and appreciate that you read over that and still got what I was trying to say - sorry.
Yes, patents are a big issue, especially since our tax dollars foot the research (in soooo many cases) that allowed that drug to come to the market in the first place.
The stock market counts on pharma costs be astronomical. That keeps the shareholders happy and your pharma costs high. And the ads. I saw a figure last year on how much pharma companies are spending on ads . . . dern - wish I had that at my fingertips. It was enuff to measure up to the GDP of a small country, LOL. SHOCKING. So you know - if shareholders are getting dividends . . . and the expenses include astronomical costs for ads . . . you, the consumer, are footing the bill that leads to all those profits. That is why I suspect pharma companies are the Great Satan of healthcare costs . . . but never have been able to pinpoint it . . . so hard to get the data I would need to assimilate all that (and for what - not working on my doctorate so what good would it do to waste the time - Wall Street Journal should pay someone on their staff to figure it out, LOL)
All i know is . . . if it costs $.12 to manufacture a pill . . . it shouldn't cost the consumer $3 to buy that pill.
Now, back to work . . . hope that answered your questions in even a small way.
I've done tax returns for doctors. I have seen how much they make.
What is your conclusion?
Do you think it is accurate to say that docs (and we are talking specialists here - family practitioners make the lowest $$$) have the most earning power in this country, of any other professional group, other than CEOs of major corporations?
I realize there are exceptions (such as some major players in finance and law firms and business owners) . . . but as a professional group . . . isn't it fair to say a doc can command one of the highest salaries in this country?
I've done tax returns for doctors. I have seen how much they make.
Really? You know how much every doctor makes? How so?
Or, are you assuming you know?
And, I doubt any doctor making lots of money would go to a non cpa for their returns - going to a big box store tax preparer is not exactly the best way to go -
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( bad multiple quote, sorry)
