CBO and Trumpcare (Ryancare?)

[ednksu]

i get tired of people blaming insurance companies.  they're just pass throughs, the problem is the doctors.

Not sure if you're joking, but this is amazingly wrong.  Insurance companies are becoming very vertically integrated in the healthcare industry with processing and bureaucracy.  They are driving up costs and forcing providers and customers into their networks.

No, sys is right.

Think that all you want, but it doesn't make it right.  Who is setting reimbursement rates? Who is setting service rates? Who is setting processing rates?  Who is making lopsided contracts?  Who is making in network groups and out of network groups? 

This is the problem when people think that just because you make a lot of money means you must be damaging the industry.  What is a bigger issue, a doctor making enough to own a nice car or CVS buying Caremark and creating a vertically integrated structure where you can now go to a doctor, get your script filled, have all that processed to your insurance, at a company that is now related to insurance companies?  Better yet, they're doing all their paperwork on McKesson infrastructure (everything from POS terminals at the doctors office to billing suites) using pharmaceuticals provided by McKesson (who decides which generics they like at what price). 

So anyone who thinks insurance companies are a "pass through" for doctors is leaving out most of the cost associated with medicine.

[Rage Against the McKee]

i get tired of people blaming insurance companies.  they're just pass throughs, the problem is the doctors.

Not sure if you're joking, but this is amazingly wrong.  Insurance companies are becoming very vertically integrated in the healthcare industry with processing and bureaucracy.  They are driving up costs and forcing providers and customers into their networks.

No, sys is right.

Think that all you want, but it doesn't make it right.  Who is setting reimbursement rates? Who is setting service rates? Who is setting processing rates?  Who is making lopsided contracts?  Who is making in network groups and out of network groups? 

This is the problem when people think that just because you make a lot of money means you must be damaging the industry.  What is a bigger issue, a doctor making enough to own a nice car or CVS buying Caremark and creating a vertically integrated structure where you can now go to a doctor, get your script filled, have all that processed to your insurance, at a company that is now related to insurance companies?  Better yet, they're doing all their paperwork on McKesson infrastructure (everything from POS terminals at the doctors office to billing suites) using pharmaceuticals provided by McKesson (who decides which generics they like at what price). 

So anyone who thinks insurance companies are a "pass through" for doctors is leaving out most of the cost associated with medicine.

That vertical integration lowers costs, edn. "Doctors" is a very broad term, but at the end of the day, health care costs a lot because people charge a lot for it. The AMA (an association of doctors) actively works to restrict the number of doctors available to the public, which also helps to keep costs inflated.

[ednksu]

not sure what your experience is in the field, but there are a lot of fallacies you're conflating to make your point.  The AMA isn't really restricting to make sure there are fewer providers.  There is an epidemic of shortages in many areas.  There is a supply problem because of many other issues, one of the biggest problems is pay in rural areas and support and infrastructure in those areas. What is one of the biggest issues in many of those place, and something the advocated for, expanding medicaid so they can get money to subsidies the poor people already using services.  That leads to the other issue that the ACA tried to fix, the payment of medical care. Right now the costs are already socialized.  That is why we $20 aspirin. 
Simply looking at a doctor's pay check (which isn't broad at all, are you sure you don't mean "provider?") is a dumb way to look at the high price of medicine in this country.

[Emo EMAW]

Do insurers have a strong audit presence in hospitals?  The amount of waste that I've anecdotally become aware of makes me think there isn't.

Kinda, and they are there for pharmacies too, in a big way. 

I'm curious what you see as waste?

Unnecessary CYA tests for sure.

You may recall an example I gave where an admitted patient was fed food high in sugar, then had blood tested and found high glucose, and then treated with insulin.  Stupid from several angles and potentially fraud IMO.

[Emo EMAW]

The hospital was to bill an extra $1200/day to the insurer for this.

[Rage Against the McKee]

not sure what your experience is in the field, but there are a lot of fallacies you're conflating to make your point.  The AMA isn't really restricting to make sure there are fewer providers.  There is an epidemic of shortages in many areas.  There is a supply problem because of many other issues, one of the biggest problems is pay in rural areas and support and infrastructure in those areas. What is one of the biggest issues in many of those place, and something the advocated for, expanding medicaid so they can get money to subsidies the poor people already using services.  That leads to the other issue that the ACA tried to fix, the payment of medical care. Right now the costs are already socialized.  That is why we $20 aspirin. 
Simply looking at a doctor's pay check (which isn't broad at all, are you sure you don't mean "provider?") is a dumb way to look at the high price of medicine in this country.

We need more doctors. More supply will lower the amount an individual doctor can charge and also have an effect of pushing more doctors to rural areas where there is less competition.

[Woogy]

I'll keep saying it - If we're gonna keep shoveling more money into the demand side - more than any other place on earth - without making offsetting adjustments on the supply side - this thing will just keep getting more out of control.  About the only other option is force reductions in the actual demand.

[wetwillie]

not sure what your experience is in the field, but there are a lot of fallacies you're conflating to make your point.  The AMA isn't really restricting to make sure there are fewer providers.  There is an epidemic of shortages in many areas.  There is a supply problem because of many other issues, one of the biggest problems is pay in rural areas and support and infrastructure in those areas. What is one of the biggest issues in many of those place, and something the advocated for, expanding medicaid so they can get money to subsidies the poor people already using services.  That leads to the other issue that the ACA tried to fix, the payment of medical care. Right now the costs are already socialized.  That is why we $20 aspirin. 
Simply looking at a doctor's pay check (which isn't broad at all, are you sure you don't mean "provider?") is a dumb way to look at the high price of medicine in this country.

We need more doctors. More supply will lower the amount an individual doctor can charge and also have an effect of pushing more doctors to rural areas where there is less competition.

I don't understand why people deny the AMA isn't purposefully limiting the supply.  If I were them I would do it too if I could get away with it.  I know EDN won't engage in that discussion earnestly but hopefully someone ITT will argue as to why it's a good thing so we can at least have a debate.

[Woogy]

We need to be ramping the crap up to get out more NP's and PA's.  BSRN's also could have an expanded role.  The supply of medical professionals (MD's, DDS's, etc) is definitely constrained, partially in the name of prestige and the money involved.  It also does rightfully take an investment of time for education and training, but there are even perhaps different ways to do that and be more effective cost wise and time wise.

[SdK]

CRNAs are already squeezing out Anesthesiologists

[SdK]

And PAs still must has a Dr sign off. NP are autonomous.

[Woogy]

Which is where we need to rethink/think outside the box.  With modern communications, better EMR's do we need 8+year post secondary MD's as our baseline medical provider?  Morph PA's into a GP with 3 years school/1-2 years residency?  There's gotta be something happen/give on the supply side or we'll never come close to cracking this thing.

[wetwillie]

I'd really like to see the tech for self diagnostic or quantitative self take off.  Would allow for fewer qualified medical professionals to service more people at a lower cost.

[SdK]

PA is more than 3 years. 6 I believe.

[kim carnes]

There are already a bunch of shitty for profit med schools churning out terrible doctors.  I don't think we need anymore. 

[Emo EMAW]

PA is 2 years on top of the bachelors. 

[Fake Sugar Dick (WARNING, NOT THE REAL SUGAR DICK!)]

Have you guys been to a hospital lately? They assign you like 10 full time servants, 3 doctors, and 5 bitchy paperwork people.  Tylenol comes in individual packages instead of a 500 pill bottle, and they throw away stainless steel tools after a single use as if they were a plastic spoon from a box. It's the worst place in the world.

[Phil Titola]

So trumpcare dying in the house?  Shocking.

[SdK]

PA is 2 years on top of the bachelors.

So 6 years?

[SdK]

Have you guys been to a hospital lately? They assign you like 10 full time servants, 3 doctors, and 5 bitchy paperwork people.  Tylenol comes in individual packages instead of a 500 pill bottle, and they throw away stainless steel tools after a single use as if they were a plastic spoon from a box. It's the worst place in the world.

They do not thrown stainless steel away. There is a sterile processing department with am elevator direct from the or.

[Fake Sugar Dick (WARNING, NOT THE REAL SUGAR DICK!)]

Have you guys been to a hospital lately? They assign you like 10 full time servants, 3 doctors, and 5 bitchy paperwork people.  Tylenol comes in individual packages instead of a 500 pill bottle, and they throw away stainless steel tools after a single use as if they were a plastic spoon from a box. It's the worst place in the world.

They do not thrown stainless steel away. There is a sterile processing department with am elevator direct from the or.

That's true for surgucal tools, but things like scissors are absolutely trashed. And I don't need a $60k part time nurse to administer myself tylenol or get a drink of water. A candy-striper can handle that.

[SdK]

Well I hope they were putting them in sharps containers. I also have no idea where you get your wage estimates from. As i said previously, a full time nurse with 20 years experience is making 65k. Also you're not their only patient. Depending on the unit, a nurse can have 6 to 12 patients. The ICU being the main difference.

What are you in the hospital for that Tylenol and water are you're only needs?

[SdK]

Last I heard starting wage for an RN was $22 dollars an hour.

[Woogy]

Have you guys been to a hospital lately? They assign you like 10 full time servants, 3 doctors, and 5 bitchy paperwork people.  Tylenol comes in individual packages instead of a 500 pill bottle, and they throw away stainless steel tools after a single use as if they were a plastic spoon from a box. It's the worst place in the world.

They do not thrown stainless steel away. There is a sterile processing department with am elevator direct from the or.

That's true for surgucal tools, but things like scissors are absolutely trashed. And I don't need a $60k part time nurse to administer myself tylenol or get a drink of water. A candy-striper can handle that.

Infection Control.  The scissors - not the nurse or the candy striper.....

[ednksu]

Have you guys been to a hospital lately? They assign you like 10 full time servants, 3 doctors, and 5 bitchy paperwork people.  Tylenol comes in individual packages instead of a 500 pill bottle, and they throw away stainless steel tools after a single use as if they were a plastic spoon from a box. It's the worst place in the world.

They do not thrown stainless steel away. There is a sterile processing department with am elevator direct from the or.

That's true for surgucal tools, but things like scissors are absolutely trashed. And I don't need a $60k part time nurse to administer myself tylenol or get a drink of water. A candy-striper can handle that.

It's sad you're so ignorant you think that is all they do.