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lawrocket

What doe You Want to See in Health Care

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There are three competing interests in delivery of health care: (1) quality; (2) access; and (3) affordability.

You cannot have 100% of all three. If healthcare is cheap and available on demand then it will be low quality. If it is cheap and high quality it will be rationed. If it is high quality and available on demand it will be expensive.

Our system presently is quality healthcare available on demand. Ergo, expensive. Emergency rooms show what no-pay healthcare is about. You wait unless your problem is deemed serious by triage. If you are uninsured and destitute, that skin infection will not be seen for 30 hours. If you can pay you go to a doctor, pay the doctor, get good care and be in and out in 30 minites.

The reforms being pursued are aimed at lowering the price of healthcare. For price to come down, quality must suffer and/or access must be denied.

Vote for two. I just want to see what two things people think deserve the most weight.


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> For price to come down, quality must suffer and/or access must be
>denied.

Agreed. But that's per plan. You should be able to get a very cheap plan with lousy coverage and poor access, or a great plan with good access - if you're willing to pay.

The changes I'd like to see are:

1) A better way to cover the uninsured other than the current plan of "go to the ER and don't pay."

2) A way to get insurance even for people with pre-existing conditions

3) Tort reform that reduces legal/malpractice insurance for medical providers

4) Paperwork reduction, commonization of reporting codes and mandatory pricing transparency (i.e. you must, by law, be provided with an itemized bill for services upon request)

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> For price to come down, quality must suffer and/or access must be
>denied.

Agreed. But that's per plan. You should be able to get a very cheap plan with lousy coverage and poor access, or a great plan with good access - if you're willing to pay.

The changes I'd like to see are:

1) A better way to cover the uninsured other than the current plan of "go to the ER and don't pay."

2) A way to get insurance even for people with pre-existing conditions

3) Tort reform that reduces legal/malpractice insurance for medical providers

4) Paperwork reduction, commonization of reporting codes and mandatory pricing transparency (i.e. you must, by law, be provided with an itemized bill for services upon request)



All nice and very hard to disagree with.

One jumps out at me.

You really think a gov run option will support your "less paper work" option?

But for the itemized bill part of your post. I agree

The thing is, when you don't have to write the check many don't feel they need to ask. It is work to do that. So, if the feeling is it don't cost me nuttin, why ask.

Not direct at you FYI
"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

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>You really think a gov run option will support your "less paper
>work" option?

No, and I don't want government to run health care.

However, look at how air traffic control works. You can communicate very fast using standardized language that everyone agrees on. That standardization of communication is a good thing.

We have a government run set of standards (technical standard order) that all our gear is built to. The government isn't coming up with them, of course - that's done by Booth, Reid, Poynter et al. But they are approving them and maintaining them, and that helps manufacturers design gear that works with other gear without too many compatibility issues.

Likewise, I would like to see a more standardized set of diagnoses, treatments, bills, labwork reporting formats etc so that some of the confusion/time wasted filling out half a dozen different forms can be reduced.

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>You really think a gov run option will support your "less paper
>work" option?

No, and I don't want government to run health care.

However, look at how air traffic control works. You can communicate very fast using standardized language that everyone agrees on. That standardization of communication is a good thing.

We have a government run set of standards (technical standard order) that all our gear is built to. The government isn't coming up with them, of course - that's done by Booth, Reid, Poynter et al. But they are approving them and maintaining them, and that helps manufacturers design gear that works with other gear without too many compatibility issues.

Likewise, I would like to see a more standardized set of diagnoses, treatments, bills, labwork reporting formats etc so that some of the confusion/time wasted filling out half a dozen different forms can be reduced.



Yes, some of what you post is possible and it can be done quickly, but because diagnoses is so subjective (more of an art than a science at times) some will never be totally possible.

I also agree the current paper work is abusive at times. And generally speaking, the gov and the lawyers can shoulder the blame for this.

So, you list a good start to reform. A very good start. Both by sugestion and omission
"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

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You really think a gov run option will support your "less paper work" option?




Based on my EXPERIENCE, yes. Do you have any evidence to the contrary?



Yup - sure do. 20 years of contracting work for fed.gov.
Mike
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There are three competing interests in delivery of health care: (1) quality; (2) access; and (3) affordability.

You cannot have 100% of all three.



by using one plan. You, however, can have more than one plan (which often happens in the countries where universal healthcare coverage is available), and in this case you will have all three.
* Don't pray for me if you wanna help - just send me a check. *

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My experience with the government.. Filling out paper recording the time you spent filling out paperwork.
When shipping freight for the government. every item had to be signed off line for line to the manifest docs.. time to unload a trailer full of government freight: 4 times as long as any other, always...

Don't run out of altitude and experience at the same time...

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Yup - sure do. 20 years of contracting work for fed.gov.



Did you also contract to large companies in private industry, so you have a valid comparison base? I assume it's obvious that Joe the Neighbor paying cash for your 4-hour service is not a valid comparison point.

I deal with large companies, and it indeed requires a lot of paperwork. In fact even my wife, who is employed by such a company, spends approx. 20 hours a week just doing the paperwork.
* Don't pray for me if you wanna help - just send me a check. *

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Try a little harder to stop a little healthcare fraud?

Govt: Medicare paid $47 billion in suspect claims
By HOPE YEN, Associated Press Writer Hope Yen, Associated Press Writer – 1 hr 34 mins ago
WASHINGTON – The government paid more than $47 billion in questionable Medicare claims including medical treatment showing little relation to a patient's condition, wasting taxpayer dollars at a rate nearly three times the previous year.

Excerpts of a new federal report, obtained by The Associated Press, show a dramatic increase in improper payments in the $440 billion Medicare program that has been cited by government auditors as a high risk for fraud and waste for 20 years.

It's not clear whether Medicare fraud is actually worsening. Much of the increase in the last year is attributed to a change in the Health and Human Services Department's methodology that imposes stricter documentation requirements and includes more improper payments — part of a data-collection effort being ordered government-wide by President Barack Obama this coming week to promote "honest budgeting" and accurate statistics.

Still, the fiscal 2009 financial report — covering the first few months of the Obama administration — highlights the challenges ahead for a government that is seeking in part to pay for its proposed health care overhaul by cracking down on Medicare fraud. While noting that several new anti-fraud efforts were beginning, the government report makes clear that "aggressive actions" to date aimed at reducing improper payments had yielded little improvement.

In recent years, the suspect claims have included Medicare prescriptions from doctors who were dead, and requests for payment for medical supplies such as blood glucose strips for sexual impotence and diabetic shoes for leg amputees. Patients, many of them new citizens who barely speak English, are sometimes recruited by brokers who go door-to-door offering hundreds of dollars for use of their Medicare numbers.

Obama is expected to announce new initiatives this coning week to help crack down on Medicare fraud, including a government-wide Web site aimed at providing a fuller account of health care spending and improper payments made by various agencies. The Centers for Medicare and Medicaid Services also will launch a Web interactive next month that will allow users to track Medicare payment information by categories such as state, diagnosis and hospital.

According to the report, the Bush administration from 2005-2008 reported improper payments of roughly 4 percent in the fee for service program, or about $17 billion total in 2008. Government officials at the time, however, typically did not consider a Medicare payment improper if the medical documentation was incomplete or a doctor's signature was illegible. Since these were flaws that ordinarily bar payment, that methodology drew complaints from government auditors that the figures were understated.

For fiscal year 2009, the Obama administration began counting those claims as improper, but was unable to complete an official tally based on the new methodology. As a result, it officially reported improper payments for its fee for service program at 7.8 percent, representing a partial tally under the new formula. But it considers the unofficial tally of 12.4 percent to be more representative.

Beginning next year, the 12.4 percent figure — or a total of $47 billion in improper payments when counting both Medicare fee for service and managed care — will be used as the baseline estimate. The federal report sets a target of reducing improper payments in the fee for service program to 9.5 percent by next year, which would represent a savings of roughly $9.7 billion.

The findings come as the Obama administration is making Medicare anti-fraud efforts an important priority. In recent months, HHS has said it was multiplying by 10 the number of agents and prosecutors targeting fraud in Miami, Los Angeles and other strategic cities where tens of billions of dollars are believed to be lost each year. The new partnership seeks to have better sharing of real-time intelligence data on health care fraud patterns.

Officials say they also want to increase training and outreach among Medicare providers to reduce documentation errors, while proposed health overhaul legislation would increase background checks on Medicare claimants and impose stiffer penalties for false claims.

Other findings:

_In the Medicaid program for the poor, roughly $18.1 billion, or 9.6 percent of claims, are believed to be improper payments.

_Using a baseline of 12.4 percent in improper payments in the Medicare fee for service program, HHS is setting targets of reducing fraud and waste to 9.5 percent, 8.5 percent, and 8.0 percent, respectively, for fiscal years 2010 through 2012.

Records released in the past week showed that CMS for three years ignored internal watchdog warnings about swindlers stealing millions of dollars by scamming several Medicare programs. The agency received roughly 30 warnings from inspectors but didn't respond to half of them, even after repeated letters.

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