the health care dilemma from a provider perspective

[lawnchairboy]

Those of you who desire intelligent, motivated and caring individuals holding a scalpel over you or a friend or loved one either electively or in an emergency during surgery, please take the time to watch this, let me know what you think.

 

the "reform" will not be without personnel implications.

 

I am not a physician.

 

I think it is worthwhile to see from one physicians perspective, I sincerely hope it will not degenerate

 

 

 

http://vimeo.com/11378278

 

[Quinn]

Nicely said and thoughtfully reasoned. I'm not sure I agree, however, with his views about the absurd hours that interns work. Don't really want someone making decisions and caring for me that has been on duty for 48 hours. The lawyer bashing I agree with.

 

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[John Ranalletta]

While I share his concerns; and, very likely, some of his political views, I'm convinced the situation in which we find ourselves today is as much the fault of the physician community as not.

 

In no other market I can imagine does a supplier of goods or services abdicate pricing power or availability (metering) of their services or goods to a 3rd party payor as physicians. Physicians, including specialists, have done so, gladly or not. They have not stood up for themselves or their patients. They handed over control of the feed bag to the insurance companies and the government; and, now, when the pour spout is being restricted, they complain.

 

Are their complaints valid? Yes; but too little, too late. If every physician serving medicare patients pledged to take no more, Washington would listen. But that threat would have to be coupled with a proactive solution to fees; and, the physician community, as a whole, is like teachers as a whole, unwilling to take the first step; be proactive; present non-traditional solutions, etc.

 

Secondly, physicians have painted themselves into a corner where they are paid for what they do rather than what they know. They let insurance companies sucker them into paying by the stitch, degree of fracture, number of chemo treatments, hours in surgery, etc.

[lawnchairboy]

There was an obvious contradiction with the whole resident work hour discussion and John, agree with you to the extent that the AMA and insurers have been around making their market for a while. I find the whole idea that we can truly reform our system without any tort reform laughable.

[Dave McReynolds]

I find the whole idea that we can truly reform our system without any tort reform laughable.

 

This was the part about his comments that made me think the most. My assumption had been that tort reform would pretty much take care of itself once the government started paying the bills. Once the government starts paying the bills, directly or indirectly, my thought was that they wouldn't want to pay anymore than they had to for medical malpractice costs, and since the government has the power to limit medical malpractice recoveries, they would act to do that. However, his point that the government is made up mostly of lawyers, and that lawyers always have and will probably continue to look after their own interests first has merit.

 

As to some of his other points, when medical schools stop having waiting lists of students eager to get in, I'll start worrying about doctor shortages.

 

Having had direct and personal experience with two doctors who recently completed residencies, his comments about the necessity of residents working 80+ hours a week to learn everything they need to know is patently absurd. All this amounted to was enforced servitude.

 

If we truly had a single-payer system, administrative tasks should be significantly reduced. I'm not so sure that he might not be right about increasing administrative burdens under the new "compromise" legislation.

 

As to whether doctors in the future will be as highly skilled and capable as those in the past, I'm not so sure about that either. One would think that if pay and working hours were reduced, an occupation would attract less motivated people. He could be right about that. On the other hand, I can think of many occupations, like scientists and classical musicians, where the pay is low and yet they still attract qualified and motivated people. I've always thought of medicine as being more of a calling, like science and music, rather than a business, like selling real estate, and maybe it's time medicine returned more toward those roots.

[John Ranalletta]

In no other market I can imagine does a supplier of goods or services abdicate pricing power or availability (metering) of their services or goods to a 3rd party payor as physicians. Physicians, including specialists, have done so, gladly or not. They have not stood up for themselves or their patients. They handed over control of the feed bag to the insurance companies and the government; and, now, when the pour spout is being restricted, they complain.

 

More proof that physicians are tools of insurance companies. Most suppliers would stop providing services when payments stop.

 

Report says Blue Cross worst in insurance claim accuracy One in five medical claims is processed inaccurately by commercial health insurers—and a unit of Indianapolis-based WellPoint Inc. does even worse—often leaving physicians shortchanged, according to the nation's largest doctor's group. Article here.

[Richard_D]

My friend just crashed his dirtbike on a motocross track. 66 years old. He had internal bleeding. The hospital stay was about 4 days . It took almost 3 hours of surgery. The bill was $64,000. Can this be justified ? Not in my eyes .

[Joe Frickin' Friday]

My friend just crashed his dirtbike on a motocross track. 66 years old. He had internal bleeding. The hospital stay was about 4 days . It took almost 3 hours of surgery. The bill was $64,000. Can this be justified ? Not in my eyes .

 

How much should it cost?

[John Ranalletta]

My friend just crashed his dirtbike on a motocross track. 66 years old. He had internal bleeding. The hospital stay was about 4 days . It took almost 3 hours of surgery. The bill was $64,000. Can this be justified ? Not in my eyes .

 

How much should it cost?

Less. As the fellow is 66, this is a Medicare case. Let us know how the claim is adjudicated. Let's assume the providers are willing to accept whatever Medicare pays and can't charge more, that's what it's worth.

[Lawman]

My friend just crashed his dirtbike on a motocross track. 66 years old. He had internal bleeding. The hospital stay was about 4 days . It took almost 3 hours of surgery. The bill was $64,000. Can this be justified ? Not in my eyes .

 

How much should it cost?

Less

 

Almost daily, where I live, someone in my county is flown by a helicopter fully staffed and medically equipped to a major trauma facility in a neighboring state..Very few of these people have insurance. Until we stop trying to provide the best health care money can buy to everyone regardless of their ability to pay we are not going to solve the health care crisis.

 

[Lets_Play_Two]

My friend just crashed his dirtbike on a motocross track. 66 years old. He had internal bleeding. The hospital stay was about 4 days . It took almost 3 hours of surgery. The bill was $64,000. Can this be justified ? Not in my eyes .

 

I suggest we exclude coverage for injuries to 66 year olds riding dirt bikes. Why should all the rest of us pay for such frivolity?

[Woodie]

I dare you to post that on Adv!

 

LOL!

 

[motoguy128]

My friend just crashed his dirtbike on a motocross track. 66 years old. He had internal bleeding. The hospital stay was about 4 days . It took almost 3 hours of surgery. The bill was $64,000. Can this be justified ? Not in my eyes .

 

How much should it cost?

 

I added some figures together, and came up with around $22,000 if it was like repairing industrial equipment based on time and materials. Toss in another $3000 for the inital ER work on arrival.

 

I believe the next $20k is for malpractice insurance and administrative costs related to litigation. The next $25k or so is to help pay for uninsured patients.

 

I'm not saying that's justified, but it can be explained. If you want ot reduce healthcare costs, you have to either refuse treatment to people that can't pay, an/or eliminate litigation.

[motoguy128]

My friend just crashed his dirtbike on a motocross track. 66 years old. He had internal bleeding. The hospital stay was about 4 days . It took almost 3 hours of surgery. The bill was $64,000. Can this be justified ? Not in my eyes .

 

I suggest we exclude coverage for injuries to 66 year olds riding dirt bikes. Why should all the rest of us pay for such frivolity?

 

Nah... I'd rather just exclude smokers and really fat people instead. Maybe throw in alcoholics and drug addicts while your at it.

[CarrotNC]

I added some figures together, and came up with around $22,000 if it was like repairing industrial equipment based on time and materials. Toss in another $3000 for the inital ER work on arrival.

 

I believe the next $20k is for malpractice insurance and administrative costs related to litigation. The next $25k or so is to help pay for uninsured patients.

 

I'm not saying that's justified, but it can be explained. If you want ot reduce healthcare costs, you have to either refuse treatment to people that can't pay, an/or eliminate litigation.

 

Boy howdy, but I sure would like to see a straightforward bill like that:

Your Emergeny Room Assessment and Stabilization = $ 3,000.00

Your Operation and recovery care = $22,000.00

Your share of Malpractice Insurance = $20,000.00

Your share of Other People's Care = $25,000.00

Thank you for choosing our hospital.

[John Ranalletta]

As long as health care providers let themselves be held hostage by 3rd party payors, it shall ever be the same (even under a single payor system where conditions will worsen).

 

Imagine running a business where:

• you only know your costs but cannot predict your revenue or margins
  
• customers will come
• they will demand the very best your industry has to offer
• you don't know how much or even if you'll be paid for the services you render
• you've given away your right to collect
• your industry is politically unpopular
• the only way to justify your charges is to build more buildings and buy more expensive technology

[Ken H.]

The bill was $64,000.

How much should it cost?

Nothing.

 

At least not in the sense of direct cost to the person for a specific event.

 

[Ken H.]

If you want ot reduce healthcare costs, you have to either refuse treatment to people that can't pay, an/or eliminate litigation.

If you want reduced healthcare cost (and have better quality of healthcare BTW) you have to eliminate the for-profit aspect of the USA’s current system.

 

And tort litigation cost are estimated to be about 1/10th of 1 percent of the total cost of healthcare in the USA. So that particular soapbox is definitely in the same category as looking for change in pay phones.

 

[Quinn]

Nothing.

 

At least not in the sense of direct cost to the person for a specific event.

 

 

So, what you're saying is that it should be prepaid from a portion of his insurance premiums. The rest going for administrative costs.

 

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[John Ranalletta]

Cool. If we can just get young men and women to enter lives of servitude with little pay to reward them for many years of study and labor, it'll work like a charm.

 

Oh, I forgot that in your nirvana, there'd be no tuition for medical schools; and, the government would pay young people to go to school. Which means, of course, schools would have to be free of charge and educators, too, would have to live lives of servitude and would be educated at no cost to anyone...the money would just be there.

 

What a system. I'm surprised it hasn't been tried before.

[Paul Mihalka]

"And tort litigation cost are estimated to be about 1/10th of 1 percent of the total cost of healthcare in the USA"

 

I don't think that would include the extreme insurance cost to doctors because of the litigation exposure.

[Lawman]

Ken,

Heck, if it will work for health care it will work for everything else...Why stop there..Let's take all the profit out of everything.. Look at how much our expenses would go down if we didn't have to fill the pockets of all those greedy capitalists..