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Posts Tagged ‘healthcare’

Health Care: When facts don’t matter

22 Jun
I’ve found it difficult to engage in this conversation because most people, from any perspective, have built their argument on a foundation of ignorance. Having worked in medical management, I’ve got a perspective that most medical professionals and patients don’t have. I understand contracts between medical providers and insurance companies. I understand how Medicare and Medicaid work. I understand medical billing.  Having citizenship in two countries I also have a perspective that most people don’t share. Having had family members uninsured, on COBRA, personal insurance, group insurance, and government insurance, I have experience most people don’t.
Here’s some facts if you’d like to transition to a different foundation.
money and a stethescope
It’s a lie that only super wealthy can afford health care.
It’s simply not true. It may be that a doctor’s appointment cost someone $100. Now, we’re willing to pay that $100 to the cable company or the cell phone company. We’re willing to pay $100 to movie studios to watch and buy movies. Doctor’s visits are only for the elite in the same way that cell phones are for the elite: Not at all.
Here in Denver there’s a lot of offices geared specifically to those without a lot of money. The goal is to cut costs and ensure that everyone can get medical treatment. Offices that aren’t geared toward that provide discounts of cash patients, payment plans, and service those who are on Medicaid – tax-funded payment for medical services for the poor.
Cost of care in America
Those with insurance typically see the Explanation of Benefits (EOB) from their insurance company and are shocked at the original bill from the medical provider. A typical EOB reads something like:
Lab work. Billed: $3,000. Insurance discount: $2,994. Insurance paid: $6.
We walk away with the assumption that if we didn’t have insurance, we’d have to pay the list price of $3,000. It’s not true. Here’s a secret about how insurance payments work. Bureaucrats behind Medicare (tax-funded medical payments for the elderly and disabled) have a list of accepted medical procedures and how much the government will pay for those procedures. Each accepted procedure has an associated Current Procedural Terminology (CPT) code.  The base Medicare payment rates are so low, they don’t even cover the doctor’s expenses in seeing the patient. Medicaid (tax-funded medical payments for the poor) pay even less. Medical practices enter into contracts with insurance providers, that boil down to something like: “For covered procedures, we’ll pay you Medicare rates plus 15%.”
When the government or insurance payer receives a bill of CPT codes and associated charges, they validate whether the CPT codes are covered, and then pay the contracted rate or the billed rate: whichever is less. Because of this, it doesn’t matter whether they get billed $10 or $10,000 for a blood draw, they’ll only pay the contracted $9.54. The problem is if the billed amount is lower, say, $8, they’ll just pay that. So medical offices mark up the price of everything really high to prevent under-billing.
Cash-paying patients often can pay even less than insurance if they’re up-front. Insurance doesn’t need to be billed, the doctor doesn’t have to wait weeks or months for payment.
Sometimes our medical bills are still high. I recently heard someone angry that they paid over $100 and only saw the doctor for a few minutes. They whined. A lot. But  here’s what that $100 likely paid for:
  • receptionist (scheduling the appointment, placing reminder calls, etc.)
  • nurse and/or medical assistant (the person who checks your vitals before you see the doctor)
  • filing clerk (there’s a lot of laws about how medical records are handled, filing clerks track the files and have to go through training on how to handle records – that training is another expense paid for)
  • doctor (the doc only saw the patient for a few minutes, but spent time reviewing the patient’s history, writing up notes for the medical records, possibly writing referrals and prescriptions, etc.)
  • medical malpractice insurance
  • facility rent
  • medical equipment
  • lab work
  • the debt created by taking on Medicaid and Medicare patients
  • medical disposal costs (there’s special ways – that all cost money – to dispose of various things)
  • billing staff, especially if the patient didn’t say he was cash-only and pay up-front.
Cost of care in other countries
Meanwhile we have experiences or hear stories of cheap health care in other countries. A friend of mine recently went to a hospital in Asia and paid $5.  Reviewing the list above of what has to be paid for, did the hospital really provide all those services for $5? That would be less than 50 cents for each item on the list. $.50 for the receptionist, $.50 for the medical assistant. $.50 for the doctor. $.50 for lab work.
No. The doctors are not living off 50-cents per-patient. The medical bills are just being paid for by another source, and the patient has no idea what the actual cost-of-care was. In many countries, that payer is the government.
  • The government decides what treatment you can have.
  • The government decides when you can have the treatment.
  • The government simply raises taxes to pay for the treatment.

This then makes a legal requirement that someone else pay for your medical expenses. When it’s all paid for through tax revenue, the implication is that tax payers are required to give their hard-earned money to pay for your medical bills. If they don’t? They’ll take away the tax payer property, or take the money forcibly from their paycheck, and in some countries put the citizen in prison for not paying their taxes.

The demand that someone else be required to pay your medical bills or go to prison is immoral.

International Medical Tourism

But what about all those people going to other countries for health care? What about Americans going to Canada for prescription drugs?

I used to live minutes away from the border of Canada. We took trips to Canada to buy certain things cheaper, and my relatives in Canada took trips to the US for certain things that were cheaper. Not only that, but it is normal behavior in Canada to go to the US if you need better or faster health care, and the Canadian healthcare system routinely sends patients to the US. American health care is part of the Canadian health care system, because America does certain things better/faster. It goes both ways.

Americans are traveling to India, Thailand, and other countries for significant medical treatments that are too costly in America. This is simple economics. Trousers in India may be significantly cheaper than in America. The cost of living is lower. They may have less government regulation to comply with. For various reasons, economies are different, and this has no necessary connection to the quality or accessibility of health care. Or pants.

These are the real problems with American health care

I do think America has the best health care – at least better than any other place I’ve had medical care, which is only about 5 countries on 3 continents. Here’s what the basic problems are that could be fixed very quickly:

  1. It’s easy to sue doctors. This means the cost of being a doctor goes up to may for malpractice insurance. This also means that doctors frequently do more tests and treatments than are necessary as an attempt to prevent a lawsuit claiming they didn’t do enough.
  2. It’s easy to collect big bills and then go bankrupt. It is the law that no hospital can turn a patient away. A Physician Assistant I know told me about working in a New York hospital where the same drunk homeless men would come into the E.R. complaining of chest pain every night. They were legally required to give a lot of costly treatment when the guys just wanted a warm place for the night. Others aren’t homeless, but purposely avoid paying for health care to later declare bankruptcy or otherwise avoid payment. This is equivalent of shoplifting, not paying for what you’re taking, and our legislators are the enablers. On the medical side, it’s costly to collect money that hasn’t been paid, and can take years.
  3. Insurance billing is screwed up. The insurance has a set dollar amount they’ll pay the doctor, but the doctor is still required to bill them with a dollar amount. The only reason why the doctor needs to bill a dollar amount is so the payer (government or insurance) can try to under-pay the doctor if the doctor pays less than the agreed payment amount. If this was not the arrangement, doctors and hospitals wouldn’t have to sky-rocket the list price of services, which is what causes people to stress about the cost of care.
  4. We need to take personal responsibility. I ought to be responsible for figuring out how my medical bills are paid. I ought not be responsible for figuring out how yours are paid. The majority of uninsured people already qualify for government insurance, but have never taken responsibility to sign up for it. We have a total aversion to personal responsibility and rejoice when we only have to pay $5 for a doctor’s visit. We’re simply rejoicing that we’re making a sucker of someone else who will be suck with the bill.
  5. Government regulation costs money. And everything medical is regulated. While payments to doctors aren’t increasing, regulations on medical practices increase ever year.

 

 
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Posted in Culture, Politics

 

Keep the Democrats in my uterus?

13 Apr
Protest Sign: Keep your Boehner out of my uterus!

Protest Sign: Keep your Boehner out of my uterus!

The signs are back. Boehner, speaker of the house, wanted to remove federal funding of abortion from the budget as one of the cuts. The thinking goes something like this:

If someone wants to stop spending tax-payer dollars on killing an unborn yet scientifically distinct human life, it’s an invasion of someone else’s rights. They should not only have the right to take this human life, but you should pay for it through your taxes.

Where was the outburst of anger when Obama, Pelosi, and Reid rammed through the Obama health care mandate? This gave more government control over every aspect of health, where was the liberal outcry that government should stay out of our bodies?

Evidently, these protesters want Barack Obama and Nancy Pelosi in their uterus and John Boehner out. They want legislation out of their uterus, but they want government-paid medical equipment in there scrubbing it. The signs seem like it’s a charge against big government intervention but the argument is the opposite. The sign would more accurately read: “Big government needs to be encouraging and funding abortion.” Statistically Planned Parenthood targets the poor, and a higher percentage of minorities are persuaded to abortion than whites. If the goal was to rid America of poor an brown folks, abortion would be the way to go. In fact, that’s why Planned Parenthood was started – to “to create a race of thoroughbreds” by rectifying “the unbalance between the birth rate of the ‘unfit’ and the ‘fit.’” Perhaps the sign should more accurately read:

Big government needs to be encouraging and funding abortion for the lower class and people with brown skin.

I’ve likely severely offended many readers, particularly if they found this article from a web search. Abortion is a highly charged issue for a few reasons:

  1. For lack of measurable results, the feminist movement pinned their success to the legalization and subsequently federal funding of abortion. The entire feminist push in our culture became focused not on celebrating and valuing what women do, but in promoting abortion because it was a situation unique to women (making it a woman’s issue) and along with more freely available contraceptives, claimed to free up women to have consequence-free sex just like men.
  2. Abortion is highly personal and highly emotional. Women who find themselves considering the option are in a huge crisis where the options seem like death of the child or suicide of self. If they keep the child their life feels like it will be destroyed, and they may not feel much more hope for the baby. With the political and cultural push for and funding of abortion, it’s not surprising that women make this choice. We’re paying their doctors to do it!

 

Frederica Mathewes-Green wrote an article about pregnancy centers a few years ago. Most disturbing to me are the statistics that it’s overwhelmingly those with wealth that want funding for Planned Parenthood to be used for providing abortions for poorer Americans. The rich are paying for abortion to be promoted for the poor who don’t want it. Here’s an exerpt:

Those who provide alternatives to abortion believe that pregnancy is just one facet of the woman’s larger and more complex life. They believe she is not best served by treating her as merely a polluted uterus in need of a good scrubbing. Her life is tangled with the life of her child growing within, woven with the lives of the child’s father, with her own parents, friends and co-workers in a tapestry of lives. To remove the child is to cut a hole in the tapestry, by literally cutting into human flesh, tearing the child apart and tearing the mother’s heart. Unplanned pregnancy is not one problem, but a host of problems, great and small; pregnancy care providers try to solve them, one at a time.

Problem pregnancy is associated frequently with poverty, and Planned Parenthood selects the poorer neighborhoods; it is popularly believed that abortion is the best solution for the poor. At any rate, this belief is popular with those who are not poor. Polls regularly show that those with higher income levels are the most likely to endorse public funding of abortion, a gift that the recipients are not eager to accept. David Gergen, in an editorial written before he joined the Clinton administration, pointed out that a 1992 Reader’s Digest poll discovered “poorer Americans are the most opposed to federal funding [for abortion]. Among those earning less than $15,000 per year, opposition ran 63 to 32 percent against funding, while those making over $60,000 favored it by 57 to 41 percent.” Gergen asks, “Is Clinton listening to the people he wants to help?”

When people offer to help you by giving you money to eliminate your children, there’s an implied message that’s hard to miss. A friend who worked in an abortion referral center stocked a flier which explained how we could reduce our tax burden by helping poor women have abortions; one day a Hispanic client came in, slapped the flier on the counter, and hissed, “This is what you really think of us.” Margaret Sanger, the founder of Planned Parenthood, was an enthusiastic eugenicist who wanted “to create a race of thoroughbreds” by rectifying “the unbalance between the birth rate of the ‘unfit’ and the ‘fit.’” Planned Parenthood still has great admiration for Sanger, and president Faye Wattleton said a few years ago that the organization is “just following in the footsteps” of its founder.

Two brands of compassion, each offering what they think is best, but one gets the lion’s share of funding. While pregnancy care centers are a woman-to-woman operation, with funds raised in batches through bake sales and small grants, abortion is more lavishly supported from above. Planned Parenthood Federation of America is the recipient of impressive grants from a long list of foundations and corporations, from Helena Rubenstein to the Pew Charitable Trusts to the New York Times Company. In a typical year, $125 million was received via Government grants and contracts. Planned Parenthood has fought for federal funding of abortion, and with the expanded provisions of the Hyde Amendment will now be able to charge more abortions to the public purse. Some states, as well, use taxpayer funds to underwrite abortions: in Maryland the bill totals $3 million per year. There is plenty of money from above to eliminate the children of the poor, and little need for bake-sale fundraising from below. The director of Planned Parenthood in Maryland is a well-mannered, sober Bostonian in a dark suit; it is hard to imagine him raising funds by poking his head in an office door, like Gloria’s volunteers, and asking how many want a pastrami sub.

 
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Posted in Culture, Politics, Reason

 

Dr. Roger Starner Jones Muses On Crisis Culture : Fact.

17 Sep

emergency room doctor roger starner jonesWhen my cousin, a medical professional, shared this on Facebook, I assumed it was just an email forward telling a fictional story. It’s not.

Dr. Roger Starner Jones is an ER Doctor who works at UMMC and is currently selling this condo, featuring a central vacuum. Real guy. What he wrote below was published August 29th, 2009 and is currently making rounds on Facebook in a slightly modified version addressed to the President.

If he is correct, then the health care overhaul just made worse the problem that has caused the mess we’re currently in with health care. What do you think?

Dear Sirs:

During my last night’s shift in the ER, I had the pleasure of evaluating a patient with a shiny new gold tooth, multiple elaborate tattoos, a very expensive brand of tennis shoes and a new cellular telephone equipped with her favorite R&B; tune for a ring tone.

Glancing over the chart, one could not help noticing her payer status: Medicaid.

She smokes more than one costly pack of cigarettes every day and, somehow, still has money to buy beer. And our President expects me to pay for this woman’s health care?

Our nation’s health care crisis is not a shortage of quality hospitals, doctors or nurses. It is a crisis of culture – a culture in which it is perfectly acceptable to spend money on vices while refusing to take care of one’s self or, heaven forbid, purchase health insurance.

A culture that thinks I can do whatever I want to because someone else will always take care of me.

Life is really not that hard. Most of us reap what we sow.

Starner Jones, MD
Jackson, MS

As a side note, I’m not the only one trying to find the source of this letter. The news paper that published this doesn’t have it archived on their website, but people are looking. 5 of the top 10 searches today are trying to find this story:

Clarion Ledger searches

 
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Posted in Culture, Politics