The Moderate Voice - Latest Comments in US Health-care Reforms: Cut Expensive Procedures/Prescriptions

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

DLS — Mon, 29 Jun 2009 21:41:08 -0000

"doctors &#39get by&#39 on government negotiated rates"

Dialysis providers complain about losing money on Medicare reimbursement.

In the real world, physicians frequently decline to accept Medicare or Medicaid patients.

And it was a really poor move (could be ineptitude, or poor knowledge of public opinion, if they cared, which they may not have) for Team Obama to say that already-low Medicare reimbursements will be deliberately lowered as part of "paying" for the vast new ambitious health care proposal. (The providers and anyone to whom they can shift costs will be doing the paying in addition to taxpayers directly.)

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

DLS — Mon, 29 Jun 2009 21:37:53 -0000

"It would be like if all airline seats were sold at economy fare, it just won&#39t work."

Visit a few dialysis clinics sometime and ask them what they think of Medicare.

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

DLS — Mon, 29 Jun 2009 16:41:08 -0000

"doctors 'get by' on government negotiated rates"

Dialysis providers complain about losing money on Medicare reimbursement.

In the real world, physicians frequently decline to accept Medicare or Medicaid patients.

And it was a really poor move (could be ineptitude, or poor knowledge of public opinion, if they cared, which they may not have) for Team Obama to say that already-low Medicare reimbursements will be deliberately lowered as part of "paying" for the vast new ambitious health care proposal. (The providers and anyone to whom they can shift costs will be doing the paying in addition to taxpayers directly.)

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

DLS — Mon, 29 Jun 2009 16:37:53 -0000

"It would be like if all airline seats were sold at economy fare, it just won't work."

Visit a few dialysis clinics sometime and ask them what they think of Medicare.

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

GreenDreams — Mon, 29 Jun 2009 00:57:14 -0000

DaGoat, that&#39s your opinion. In the entire rest of the world, doctors "get by" on government negotiated rates. We suffer from the fully false assumptions that 1) we&#39re getting more for our high priced health care and 2) that providers need what they&#39re charging to "get by". Anyone have a hospital bill? Take ANY line item on that bill and check the price against full retail. See? Believe me, there&#39s 25% reduction possible in there without hurting them one bit. Besides, I know from my own physician that he makes just as much from Medicare patients, because for the private insurance folks, he needs 2 full time employees to deal with the hassles, the multiple claim forms, the pre-authorizations and all the other jive that easily eats up that 19%.

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

DaGoat — Sun, 28 Jun 2009 23:07:55 -0000

GD if physicians and hospitals had to get by on Medicare patients alone many of them wouldn&#39t stay in business. It would be like if all airline seats were sold at economy fare, it just won&#39t work.

I agree with your point that Medicare has a lower overhead than private insurers and potentially that could give some savings, but if you&#39re trying to say we can solve the health care problem by paying all physicians Medicare rates it will lead to a mass exodus from primary care.

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

GreenDreams — Sun, 28 Jun 2009 20:57:02 -0000

I know you don&#39t want to hear it, but the low hanging fruit in lowering health care cost is the insurance companies&#39 high costs and inability to negotiate better rates. As I&#39ve pointed out before, insurance companies admit they charge 12% more than Medicare, and Medicare pays doctors 19% less (hospitals 25% less), yet as many doctors and hospitals take Medicare patients as new private PPO patients. That&#39s a 31% reduction in cost for doctors, and 37% less for hospital care.

Does anyone have ANY suggestion that can yield that kind of saving??

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

GreenDreams — Sun, 28 Jun 2009 20:50:11 -0000

"Why is it that every article regarding health care costs fails to take on the lawyers who have driven up the costs of malpractice insurance to astronomical measures? Our litigious society is rampant and no one addresses the clowns that drive it."

How about the fact that IT ISN&#39T TRUE? Malpractice is only 2% of health care cost, and malpractice insurance has increased while actual malpractice awards have dropped. Some states though have done what you suggest, by capping damages for malpractice. Guess what? In the states that have done so, malpractice insurance rates went UP! Savings from this strategy? Less than ZERO. That&#39s right, negative improvement.

Next?

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

GreenDreams — Sun, 28 Jun 2009 19:57:14 -0000

DaGoat, that's your opinion. In the entire rest of the world, doctors "get by" on government negotiated rates. We suffer from the fully false assumptions that 1) we're getting more for our high priced health care and 2) that providers need what they're charging to "get by". Anyone have a hospital bill? Take ANY line item on that bill and check the price against full retail. See? Believe me, there's 25% reduction possible in there without hurting them one bit. Besides, I know from my own physician that he makes just as much from Medicare patients, because for the private insurance folks, he needs 2 full time employees to deal with the hassles, the multiple claim forms, the pre-authorizations and all the other jive that easily eats up that 19%.

I do agree that cost cutting has to be done carefully, but is there any doubt that we need to pay less for health care?

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

$199537 — Sun, 28 Jun 2009 18:07:55 -0000

GD if physicians and hospitals had to get by on Medicare patients alone many of them wouldn't stay in business. It would be like if all airline seats were sold at economy fare, it just won't work.

I agree with your point that Medicare has a lower overhead than private insurers and potentially that could give some savings, but if you're trying to say we can solve the health care problem by paying all physicians Medicare rates it will lead to a mass exodus from primary care.

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

Rambie — Sun, 28 Jun 2009 17:54:19 -0000

tort reform is another hot button issue. On one side you have the kidney cancer patient who had the wrong kidney removed and now will suffer even more on the other you have the doctor/hospital that screwed up. The patient wants damages and the hospital doesn&#39t want to pay.

The problem with tort reform - the same the health reforms and every other big issue - is no one wants to meet in the middle. You have both sides pulling full force and not willing to look for any middle ground.

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

Dave_Schuler — Sun, 28 Jun 2009 16:38:51 -0000

The 46 million uninsured figure (from the Census Bureau) includes all in the United States without health insurance including non-citizens, both legal and illegal, those who elect not to have insurance although they can afford it, and those who qualify for some sort of insurance but have never applied for it.

In the interests of intellectual honesty I think we need to tailor our statistics to what we&#39re proposing. If we don&#39t plan to insure all comers including illegal immigrants, we should reduce our claims of the number of uninsured commensurately. If we do plan to insure all comers, I think we need to explain how we plan to finance it.

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

GreenDreams — Sun, 28 Jun 2009 15:57:02 -0000

I know you don't want to hear it, but the low hanging fruit in lowering health care cost is the insurance companies' high costs and inability to negotiate better rates. As I've pointed out before, insurance companies admit they charge 12% more than Medicare, and Medicare pays doctors 19% less (hospitals 25% less), yet as many doctors and hospitals take Medicare patients as new private PPO patients. That's a 31% reduction in cost for doctors, and 37% less for hospital care.

Does anyone have ANY suggestion that can yield that kind of saving??

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

GeorgeSorwell — Sun, 28 Jun 2009 15:55:40 -0000

DaGoat--

I appreciate your response.

I agree with one of your points:

The current reimbursement system also rewards doctors for doing a lot of procedures, reimbursing them at a much higher rate than cognitive services. If you pay doctors more for doing procedures than thinking about and talking with patients what do you think happens?

In fact, that is the main point of the New Yorker article from my first comment--that the financial incentives are out of whack.

As for malpractice insurance, I was responding to the previous commenter. Maybe you&#39re right, maybe I&#39m looking at it the wrong way. (I&#39m well aware that we live in a culture where someone recently sued a dry-cleaner for a million dollars over a pair of pants.) But the idea, put forth by that previous commenter, that this is a problem caused by lawyers, seems unsupported by actual data.

If you&#39re interested, here&#39s another New Yorker article by the same author called "The Malpractice Mess".

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

GreenDreams — Sun, 28 Jun 2009 15:50:11 -0000

How about the fact that IT ISN'T TRUE? Malpractice is only 2% of health care cost, and malpractice insurance has increased while actual malpractice awards have dropped. Some states though have done what you suggest, by capping damages for malpractice. Guess what? In the states that have done so, malpractice insurance rates went UP! Savings from this strategy? Less than ZERO. That's right, negative improvement.

Next?

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

DaGoat — Sun, 28 Jun 2009 15:11:10 -0000

GeorgeS you&#39re looking at the malpractice issue the wrong way. The current litigious climate encourages doctors to order a lot of tests and do a lot of procedures. This can&#39t be measured by looking at caps and malpractice insurance rates.

There is a saying among obstetricians - you can never be sued for deciding to do a C-section, only for deciding not to. The current malpractice climate encourages doing every possible test and intervention.

What&#39s more is the public likes having a lot of tests. Fixing this problem will take not only a change in malpractice laws but a change in public attitude. You don&#39t need an MRI for every back ache.

The current reimbursement system also rewards doctors for doing a lot of procedures, reimbursing them at a much higher rate than cognitive services. If you pay doctors more for doing procedures than thinking about and talking with patients what do you think happens?

This article really gets at the key to controlling health care, although as it implies it is a tough sell since Americans currently enjoy "all you can eat" medicine and resist any restrictions.

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

GeorgeSorwell — Sun, 28 Jun 2009 14:34:34 -0000

An article from the New York Times indicates that there is not much correlation between malpractice premiums and claims paid out by insurance companies:

But for all the worry over higher medical expenses, legal costs do not seem to be at the root of the recent increase in malpractice insurance premiums. Government and industry data show only a modest rise in malpractice claims over the last decade. And last year, the trend in payments for malpractice claims against doctors and other medical professionals turned sharply downward, falling 8.9 percent, to a nationwide total of $4.6 billion, according to data compiled by the Health and Human Services Department.

From the conclusion:

And some researchers are skeptical that caps ultimately reduce costs for doctors. Mr. Weiss of Weiss Ratings and researchers at Dartmouth College, who separately studied data on premiums and payouts for medical mistakes in the 1990&#39s and early 2000&#39s, said they were unable to find a meaningful link between claims payments by insurers and the prices they charged doctors.

"We didn&#39t see it," said Amitabh Chandra, an assistant professor of economics at Dartmouth. "Surprisingly, there appears to be a fairly weak relationship."

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

carlh — Sun, 28 Jun 2009 13:44:27 -0000

Why is it that every article regarding health care costs fails to take on the lawyers who have driven up the costs of malpractice insurance to astronomical measures? Our litigious society is rampant and no one addresses the clowns that drive it.

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

GeorgeSorwell — Sun, 28 Jun 2009 13:11:56 -0000

Here&#39s an interesting article from the New Yorker about the misplaced financial incentives that can lead doctors to order unnecessary tests.

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

Rambie — Sun, 28 Jun 2009 12:54:19 -0000

The problem with tort reform - the same the health reforms and every other big issue - is no one wants to meet in the middle. You have both sides pulling full force and not willing to look for any middle ground.

I agree with DaGoat, the doctors and hospitals LOVE to play with their new toys a little too much.

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

Dave_Schuler — Sun, 28 Jun 2009 11:38:51 -0000

In the interests of intellectual honesty I think we need to tailor our statistics to what we're proposing. If we don't plan to insure all comers including illegal immigrants, we should reduce our claims of the number of uninsured commensurately. If we do plan to insure all comers, I think we need to explain how we plan to finance it.

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

GeorgeSorwell — Sun, 28 Jun 2009 10:55:40 -0000

DaGoat--

I appreciate your response.

I agree with one of your points:

The current reimbursement system also rewards doctors for doing a lot of procedures, reimbursing them at a much higher rate than cognitive services. If you pay doctors more for doing procedures than thinking about and talking with patients what do you think happens?

In fact, that is the main point of the New Yorker article from my first comment--that the financial incentives are out of whack.

As for malpractice insurance, I was responding to the previous commenter. Maybe you're right, maybe I'm looking at it the wrong way. (I'm well aware that we live in a culture where someone recently sued a dry-cleaner for a million dollars over a pair of pants.) But the idea, put forth by that previous commenter, that this is a problem caused by lawyers, seems unsupported by actual data.

If you're interested, here's another New Yorker article by the same author called "The Malpractice Mess".

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

$199537 — Sun, 28 Jun 2009 10:11:10 -0000

GeorgeS you're looking at the malpractice issue the wrong way. The current litigious climate encourages doctors to order a lot of tests and do a lot of procedures. This can't be measured by looking at caps and malpractice insurance rates.

There is a saying among obstetricians - you can never be sued for deciding to do a C-section, only for deciding not to. The current malpractice climate encourages doing every possible test and intervention.

What's more is the public likes having a lot of tests. Fixing this problem will take not only a change in malpractice laws but a change in public attitude. You don't need an MRI for every back ache.

The current reimbursement system also rewards doctors for doing a lot of procedures, reimbursing them at a much higher rate than cognitive services. If you pay doctors more for doing procedures than thinking about and talking with patients what do you think happens?

This article really gets at the key to controlling health care, although as it implies it is a tough sell since Americans currently enjoy "all you can eat" medicine and resist any restrictions.

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

GeorgeSorwell — Sun, 28 Jun 2009 09:34:34 -0000

An article from the New York Times indicates that there is not much correlation between malpractice premiums and claims paid out by insurance companies:

But for all the worry over higher medical expenses, legal costs do not seem to be at the root of the recent increase in malpractice insurance premiums. Government and industry data show only a modest rise in malpractice claims over the last decade. And last year, the trend in payments for malpractice claims against doctors and other medical professionals turned sharply downward, falling 8.9 percent, to a nationwide total of $4.6 billion, according to data compiled by the Health and Human Services Department.

From the conclusion:

And some researchers are skeptical that caps ultimately reduce costs for doctors. Mr. Weiss of Weiss Ratings and researchers at Dartmouth College, who separately studied data on premiums and payouts for medical mistakes in the 1990's and early 2000's, said they were unable to find a meaningful link between claims payments by insurers and the prices they charged doctors.

"We didn't see it," said Amitabh Chandra, an assistant professor of economics at Dartmouth. "Surprisingly, there appears to be a fairly weak relationship."

Re: US Health-care Reforms: Cut Expensive Procedures/Prescriptions

carlh — Sun, 28 Jun 2009 08:44:27 -0000