Personal Experience with Some of the Problems in Heath Care.

[Spartacus]

Re: Personal Experience with Some of the Problems in Heath Care.

a lot of administrative cost goes into "underwriting" [figuring out which people to avoid insuring] and "managing care" [figuring out ways to avoid paying for things]. medicare doesn't have either of those costs.

i hope people don't ignore that ny times article i posted, perhaps it was too long to post. message: give people free care for basic common chronic illnesses and you reduce overall cost.

it was a good article, but it describes a repetition-with-variation (a fugue or a canon?) of one problem the Gladwell article described - the US unions pursued medical care through individual companies for their membership only, the European unions pursued it through the political system, for everyone.

So I'm curious if the lobbyists of the companies you mention are lobbying in Washington for a national program.

[Jim Nickerson]

Re: Personal Experience with Some of the Problems in Heath Care.

a lot of administrative cost goes into "underwriting" [figuring out which people to avoid insuring] and "managing care" [figuring out ways to avoid paying for things]. medicare doesn't have either of those costs.

i hope people don't ignore that ny times article i posted, perhaps it was too long to post. message: give people free care for basic common chronic illnesses and you reduce overall cost.

jk, it was a good find, thanks for posting it. Except for the fact as you know, nothing is free. This might be a baby step towards what needs to happen. Recall Churchill's remark that I became aware of here, in effect, America will always do the right thing after making everything else fail. In a national health scheme drugs would be "free," but of course they wouldn't really be--they just would cost a helluva lot less for the system than they now cost for individuals. I think in following Churchill's observation we have just about proven him correct with how the current system has evolved. It cannot continue to be funded as it has been. So perhaps one step of others has been made to fail, it is just a question of how long it takes to get to the final step.

So I'm curious if the lobbyists of the companies you mention are lobbying in Washington for a national program.

Big drug makers like Pfizer and Merck, which could benefit politically and financially from the employer drug programs, are also supporting the effort.

Richard T. Clark, the chief executive of Merck, made the political connection in a recent trade journal article. “If we all don’t do a better job, the private employer-based market will continue to weaken and the country will move forward toward rationing of care and greater government control, with greater pressure for a single-payer model with price controls,” Mr. Clark wrote in the American Journal of Managed Care.

If I understand the NYT story, these guys are just looking after their own interests, Clark of Merck throws out the fear words: RATIONING, GOVERNMENT CONTROL, AND PRICE CONTROLS. If serious consideration for a national health scheme ever approaches reality, we will all become very tired of listening to those "fear words" as they will be on the lips of the "bought" politicians and anyone who presently reaps significant profits from the curent health care system. Count on it.

[Spartacus]

Re: Call it a dire case of more is less.

I don't know if this is the entire thing. Marketwatch has a habit of eating parts.

http://www.marketwatch.com/News/Stor...le&dist=google
http://www.cashdoctor.com/go?SERVICE..._ATM=EMERGENCY


By Kristen Gerencher
Last Updated: 2/17/2005 8:12:00 PM

SAN FRANCISCO (MarketWatch) -- Call it a dire case of more is less.

Alarm bells are sounding as to just how much health-care spending the economy can sustain when paired with declining insurance coverage and a weaker ability to ensure quality care.

By the end of this year, health-care spending is projected to have absorbed 25 percent of all economic growth in the last five years, according to a study from the Health Reform Program at Boston University's School of Public Health. Health-related expenditures will consume 15.5 percent of the total U.S. economy in 2005, up from 13.2 percent of the gross domestic product in 2000.

Yet the number of uninsured Americans rose to 45 million in 2003 from nearly 40 million in 2000.

Health-care spending dwarfs defense spending and is twice that of education. Each person in the United States spends on average twice the amount on health care compared with other industrialized countries, the report said.

"With each burst of rapid increases in health spending, it looks like more and more people are going to lose coverage, more and more caregivers are going to be destabilized," said Alan Sager, co-author of the report and a professor of health services at Boston University.

All providers, including hospitals, doctors and even drugmakers, are vulnerable, he said. "Nursing homes that depend on Medicaid run the risk of financial destabilization or payment inadequate to finance good quality care."

What's more, Medicare, the federal health program for elderly and disabled Americans, faces far greater long-term financial challenges than does Social Security, according to a new report from the Employee Benefit Research Institute (EBRI.)

Over the next 75 years, Medicare faces a shortfall, or unfunded liability, more than seven times greater than that of Social Security -- nearly $28 trillion compared with $3.7 trillion, the report said. Medicare spending is on pace to surpass Social Security in 2024.

"Medicare's financial problems are much more immediate -- and more difficult to solve -- than what the Social Security program will face in several decades," EBRI President Dallas Salisbury said in a statement.

Wide-ranging groundswell

Sager and EBRI aren't alone in calling for doctors, government, employers and insurers to enact reforms.

Last week, General Motors' Chief Executive Rick Wagoner urged renewed efforts to control spiraling health-care expenses. The automaker spent $5.2 billion in 2004 to cover 1.1 million U.S. employees, retirees and dependents.

"Failing to address the health-care crisis would be the worst kind of procrastination, the kind that places our children and grandchildren at risk and threatens the health and global competitiveness of our nation's economy," Wagoner said.

Former President Bill Clinton contrasted the quality care he received for his recent heart surgery with the more common experience of less fortunate Americans. He called for greater access to care at a forum in North Carolina earlier this month, according to the Associated Press.

"You can say you don't want to fool with this, but it's just going to get worse," the AP quoted Clinton as saying. "We are on course to have human misery that's unacceptable in a country as wealthy as ours."

To be sure, growth in premiums for employer-sponsored health plans took a bit of a breather last year, rising 11.2 percent compared with a 13.9 percent hike in 2003, according to the Kaiser Family Foundation. But the figure marked the fourth consecutive year of double-digit growth.

Increases that exceed inflation -- running at about 3 percent annually today -- by such a large measure are unsustainable unless the United States finds a way to contain health care's share of the economy, which it can do, Sager argued. "I'm worried, though, that health care has gotten used to more money for business as usual -- has almost gotten chemically addicted to more money for business as usual."

Fighting waste

As it is now, health care isn't equipped to withstand a drop in spending, which may happen if the economy were to slip into a serious recession, Sager said. Health spending rose by $120 billion between 2002 and 2003, but the number of uninsured people rose by 1.5 million in that time, he said.

Unlike past efforts to rein in spending, the key this time is to enlist doctors as a first step in fighting waste, which now accounts for about half of each health-care dollar spent, he said. Physician decisions account for 87 percent of personal health spending, the report said.

"We spend enough to take care of all Americans today, and we need to demand that health care gets reshaped in ways that encourage and persuade doctors to take charge of spending money more carefully in ways that weed out clinical waste," he said, noting that waste comes from unnecessary care, defensive medicine, excessive paperwork born of mistrust between insurers and doctors, as well as theft and fraud.

"We tolerate these kinds of waste in health care because we think health care has enough despite the waste to take care of us. That certainly isn't true today, if it ever was in the past."

Private-sector profits also play a role. Expenditures for insurance administration and profit rose 80 percent faster than spending on actual care in 2003, according to the report.

The Bush administration is focusing its health-care efforts on tax credits to allow individuals to purchase their own insurance, tax-advantaged health-savings accounts that are paired with high-deductible health plans and medical malpractice reform.

Some analysts have embraced the consumer-driven approach -- the idea that consumers will make better spending decisions if given more of the responsibility for the cost of their care -- as the next big thing to make a dent in spending.

But Sager said such initiatives amount to turning consumers into "kamikaze pilots" in a cost-control war, whose ability to shop around and make independent health-care decisions is inherently limited.

Taking on politics

Nearly $2 trillion will be spent on health care in the United States this year, but fixing the system and making it less fragile will require a series of political deals, Sager said.

While some states are experimenting with universal coverage policies, many others get "cold feet," said Alan Weil, executive director of the National Academy for State Health Policy.

"The solutions to these problems are complicated, they're expensive and the political will to actually solve them doesn't match the size of the concern that exists about them," he said.

Public opinion seems to call for more attention to costs. A survey from the Harvard School of Public Health and the Kaiser Family Foundation released earlier this year found about 63 percent of Americans polled want the president and Congress to make lowering health-care costs a top priority, while 58 percent want a plan to make Medicare more financially sound for the future and 57 percent want the emphasis on increasing the number of Americans with health insurance.

Only 26 percent said the need to reduce jury awards in medical malpractice lawsuits should be a major issue on policymakers' priority lists.

[Spartacus]

Re: feels very strange

to have both sides of a debate thanking me

[Spartacus]

Re: One other thing you may find interesting

http://www.redflagsweekly.com/regush/2002_march25.html

Weed invented the POMR -

http://www.pkc.com/our_founder.aspx

[spunky]

Re: Personal Experience with Some of the Problems in Heath Care.

Two simple things can be done to dramatically reduce health care costs; that are easy and cheap but will take about 10 or so yrs to see the results


1) Severly reduce the malpractice suits( damages awarded ) and hold lawyers accountable for cases filed, by suspending their liscence for cases with little or no grounds.

a) I bet 25% of the CT scans and x-rays I see ordered from the ER/ICU are, cover our assess , so the physcians dont get sued . You can do the math on that one

More bonars are spent on grannies last year of life , than the previous 79 yrs, just keeping her alive:confused:


2) real health education in schools, real spiritual education, real gym classess.Real education that means quality of life counts, not quantity
of life. This means changing attitudes , beliefs, and expectations of health care. Science might keep granny alive for 1 more month, but what quality of life will she have ??

This includes american medical schools ,teaching the physcians, that they wont get their assess sued off if they make a mistake and that medicine is an art, not a science.





Americans have to get over this hot,fast, now idea of life, and health care.



I dont see it happening in a country that cant even clean up properly after a hurricane. Really folks, captialism builds the best car and televisions but is it really the best for health care ?????? I think not

[Spartacus]

diet and exercise are unproven for diabetes and heart disease

most laypeople think the safety and efficacy of various diets and of exercise for treating diabetes and heart disease and depression are a proven fact.

But the questions are still undecided. They really are. And no, the personal experience of one person does not count.

The authors of the original papers that suggested exercise is preventive for heart disease, the ones that studied London doubledecker conductors (active) versus drivers (inactive) admitted that their research was flawed and could not be used to conclude that exercise is protective.

Lots of exercise-based research has been re-evaluated, and the question is now up in the air.

As to diet, again, that's up in the air too.

Many tout vegetarianism, despite no peer reviewed, proof that in the long term vegetarians are healthier.

Some claim that if one can stay on Atkins, the complete opposite of vegetarianism, one's blood chemistry becomes the best possible for heart disease markers (especially triglycerides and C reactive protein) and diabetes is far easier to control because the body requires no insulin to process fat as a fuel. But again there are no long-term studies.

Many tout a low fat diet, whether vegetarian or not - The Harvard Nurse's study was touted in the media as showing high fat diets cause breast cancer. Yet the media failed to mention that the highest quintile of fat consumption had the lowest overall cancer rates.

And lots of scientists are coming out of the woodwork on the Cholesterol story, saying the science has been twisted to make a benign chemical into a bad guy.

Then there's the holistic medicine camp. I almost got into a fight with an holistic practitioner when I pointed him to an article that showed an Ayurvedic regimen cost more than the chemotherapy he was railing against, and the Ayurvedic regimen was unproven, and was supposed to be used by healthy people, daily.

[Jim Nickerson]

Re: Call it a dire case of more is less.

I don't know if this is the entire thing. Marketwatch has a habit of eating parts.

http://www.marketwatch.com/News/Stor...le&dist=google
http://www.cashdoctor.com/go?SERVICE..._ATM=EMERGENCY


By Kristen Gerencher
Last Updated: 2/17/2005 8:12:00 PM

SAN FRANCISCO (MarketWatch) -- Call it a dire case of more is less.

Yes, Spartacus, this is the article in it's all there.

Thank you for finding and posting it.

[grapejelly]

Re: Call it a dire case of more is less.

The argument in the New Yorker and other places is that medical care demand is inelastic and demand is the same regardless of who pays. And that is simply not true. It is not true of anything.

As I point out in the dental world, if I have a bad toothache, I can spend $200 for an extraction, $2000 for a root canal and crown, or $4000 for an extraction, implant and crown. Same problem, price points of $200 to $4000.

Everyone knows dentistry is discretionary. What they don't admit is that health itself is discretionary. People don't rationally "choose" poor health, but their behavior affects their health more than anything else does.

I pointed out how preventable degenerative diseases, obesity/hypertension/diabetes are one of the primary sources of health expenditures.

Orthopedic medicine is almost a scam, with most surguries showing no evidence for superior outcomes to other non-surgical treatments.

Even the evidence that medical treatment of things like breast cancer or prostate cancer helps lengthen life and improve the quality of life is sorely lacking and in fact rather doubtful.

Health care is LARGELY discretionary.

Also equally obvious is that demand for medical services will outstrip supply and this will lead to rationing. Because out-and-out rationing is politically impossible, the rationing takes the form of long waits for procedures, paperwork that delays procedures, etc. Bottom line, medical services are rationed through DELAY IN PROVIDING THEM.

Again, it is beyond me why a monopoly solution is the answer to health care. I mean, don't we have more imagination than that? I don't want to live like that. I would prefer to pay for healthcare, have competitive options, and subsidize people who can't afford healthcare...but I want to subsidize their healthcare so that it is not easy nor convenient for them to make poor life choices and then expend huge medical resources as a result of their choices. I want those people to have to pay as they go along so their poor lifestyle choices are not subsidized by me.

[jk]

Re: Personal Experience with Some of the Problems in Heath Care.

but I want to subsidize their healthcare so that it is not easy nor convenient for them to make poor life choices and then expend huge medical resources as a result of their choices. I want those people to have to pay as they go along so their poor lifestyle choices are not subsidized by me.

want to expand a bit on how you plan to do that? outlaw mcdonald's and nationalize dunkin' donuts? how about doing away with tv so people don't sit around so much?

you are asking for a huge cultural shift, along with an attendant revolution in our agricultural/food production-processing/restaurant sectors, and making that a PRECONDITION for the health care system changes you want.

i don't think we can afford to wait on health care reform, waiting for the general population to discover the wonders of vegetarianism and jogging.:rolleyes:

[grapejelly]

Re: Personal Experience with Some of the Problems in Heath Care.

want to expand a bit on how you plan to do that? outlaw mcdonald's and nationalize dunkin' donuts? how about doing away with tv so people don't sit around so much?

you are asking for a huge cultural shift, along with an attendant revolution in our agricultural/food production-processing/restaurant sectors, and making that a PRECONDITION for the health care system changes you want.

i don't think we can afford to wait on health care reform, waiting for the general population to discover the wonders of vegetarianism and jogging.:rolleyes:

I don't care if someone wants to eat fries and sodas every day. I just want them to pay if they do so. Why should I pay?

But you are right...we have to be practical.

BTW, I realize how the existing system we have in the US uses delays to ration healthcare. Poor people without insurance can get access only by waiting and filling out lots of forms and so forth.

I think if you made health savings accounts mandatory, and you provided one to people too poor to afford their own, perhaps you would give people ownership over their health and a stake in things...with the risk sharing pool we discussed. You'd have the advantages of a universal health care system similar to those of mandatory driving insurance.

If you handed someone who was poor, unemployed and diabetic a health savings account, would they have incentive to improve their health through non medical means? I don't know.

But I sense that a system that puts the consumer into the drivers' seat, like the consumer was before this collectivization really took hold, is the secret to controlling the costs and improving the quality of health care.

[Jim Nickerson]

Re: Personal Experience with Some of the Problems in Heath Care.

Two simple things can be done to dramatically reduce health care costs; that are easy and cheap but will take about 10 or so yrs to see the results


1) Severly reduce the malpractice suits( damages awarded ) and hold lawyers accountable for cases filed, by suspending their liscence for cases with little or no grounds.

a) I bet 25% of the CT scans and x-rays I see ordered from the ER/ICU are, cover our assess , so the physcians dont get sued . You can do the math on that one

More bonars are spent on grannies last year of life , than the previous 79 yrs, just keeping her alive:confused:


2) real health education in schools, real spiritual education, real gym classess.Real education that means quality of life counts, not quantity
of life. This means changing attitudes , beliefs, and expectations of health care. Science might keep granny alive for 1 more month, but what quality of life will she have ??

This includes american medical schools ,teaching the physcians, that they wont get their assess sued off if they make a mistake and that medicine is an art, not a science.

Americans have to get over this hot,fast, now idea of life, and health care.

I dont see it happening in a country that cant even clean up properly after a hurricane. Really folks, captialism builds the best car and televisions but is it really the best for health care ?????? I think not

Spunky, you offer some worthwhile thoughts about these problems.

There is a lot of CYA medicine practiced in my opinion induced by fear of being sued. Let's see now, how many lawyers are there associated with making the laws on the land on State and National levels? I am sure I will never live long enough to see lawyers allowing laws to be passed that would restrict their opportunities to "help people", but themselves mostly, and I expect plaintiff attorneys see that much differently than I.

The whole compensation system in rotten in my opinion. Take all those killed on 9/11. To my understanding, part of the claims amounts were based on what Joe Broker may have made in income over his lifetime had he not been killed. Joe Broker on the other hand through his own error could have stepped out in front of a taxi and ended up just as dead. Joe Broker had a responsibility to insure himself against such premature death in order to protect those things he needed to protect. The same for Joe Janitor.

There are wrongful deaths and wrongful injuries in medicine and elsewhere. If the system is interested in compensating such deaths and injuries (which I think it rightfully should), the country needs to determine a compensation schedule that is applicable to all people. I don't see a broker's life more valuable to him personally than I see a janitor's life being valuable to him. Whatever the schedule of compensation, more of it will benfit the family of the dead or injured if lawyers are removed from the equation. Panels of appropriately informed judges, not uninformed jurors, need to be the people rendering compensation decisions, now and when, if ever, compensation schedules should ever come into being.

[Jim Nickerson]

Re: Call it a dire case of more is less.

I would prefer to pay for healthcare, have competitive options, and subsidize people who can't afford healthcare...but I want to subsidize their healthcare so that it is not easy nor convenient for them to make poor life choices and then expend huge medical resources as a result of their choices. I want those people to have to pay as they go along so their poor lifestyle choices are not subsidized by me.

As a probably valid example of why all people should have ready access to health care, especially if one believes people should not make poor life choices and that poor choices are subsidized only to the smallest extent obtainable, read the following.

Some time along the way of seeing patients to extract teeth that could not be restored or that the patient could not or would not afford to restore, it seemed clear to me that people who for whatever reasons had been able to go a dentist and get fillings for decay seemed less often to see me for an extraction(s) because of advanced periodontal (gum) disease--loss of bone to hold the tooth in a jaw. Not uncommonly would I see patients with teeth totally free of decay, but because of never having the pain of tooth decay never had occasion to go to the dentist for fillings--it is not hard for me to grasp the concept of not going to a doctor when nothing hurts especially if one is not flush with money.

The conclusion I reached is that when people had been associated with dental care they were less likely to suffer the ravages of extensive periodontal disease leading to tooth loss. Even if your parents didn't take you to the dentist as a child for whatever reasons, but somewhere along the way pain made you go to what happened to be a good dentist, then such a patient may have walked out of the office with a bit of education about caring for his/her teeth and further may have become someone who took care of the teeth daily and periodically by having the teeth cleaned. The lack of that knowledge, education having been imparted probably accounted for for those poor people, who were lucky enough never to have painful tooth decay that would have led, if care were sought, to some education about the value of good oral hygiene, not infrequently ended up losing teeth that were near 100% sound in themselves but had not enough bone to allow retention of such teeth.

People except for lack of finances or insurance coverage could benefit in a preventative way from having exposure to good doctors (doctor means teacher) if the system just allowed them ready access. If the only medical care one ever seeks is from an emergency room, there likely will be little discussion regarding measures that could lead to improved health.

My contention is that the easier it is for the population to be exposed to heath care the more likely is knowledge from such exposure to impact their lives in a preventative manner. There will always be those who when led to the water don't drink, but many will and thus will benefit.

[Spartacus]

Are you really just coming to this now?

I've always been skeptical of all types of medicine- faith or technological or holistic.

I was reading this guy and his fellow travelers in the 80s - I may have learned what "iatrogenic" means from him.

http://www.amazon.com/Confessions-Me.../dp/0809241315

(not that he was any great shakes either - from the works I read, he was 100% against immunization which I 60% believe in. )

[Jim Nickerson]

Re: Personal Experience with Some of the Problems in Heath Care.

Story continued from post #20.

It was after the neurologist’s notes that I had requested he send reached me that I went back and looked more closely at his office’s charge slip for the day wife had had the muscle and nerve stimulation tests run.

Besides the total amount of the charges of those studies, which really knocked my socks off, but against which I had no standard of judging them to be usual, excessive or even low, there was a charge for a level 2 evaluation and management for $83 which was by far the lowest charge for any specific service “rendered” during that visit.

In looking at the neurologists notes for that visit, there was no documentation that he had actually physically re-examined wife nor even questioned her regarding any changes in symptoms since initially seeing her only seven days previously. A level 2 evaluation and management service transmitted to an insurance company is conveying to the company that the provider did the following:

Established Outpatient: CPT Code 99212

1. Key Components (2 of 3 meet or exceed requirements)
   1. E/M Problem Focused History
   2. E/M Problem Focused Exam
   3. E/M Straightforward Medical Decision
   1. E/M Self Limited or Minor Problem
   2. Physician Time: 10 minutes

http://www.fpnotebook.com/MAN9.htm

Besides performing at least 2 of 1,2, 3 above, a provider should as a matter of fact document in his records the results of having done them—otherwise why do them? And certainly, why charge for them if they weren’t done?

I asked my wife simply to recall for me all that she recollected as having transpired during the visit for the testing—and this was days after the visit, not weeks or months later. She recounted being taken to a treatment room where she was greeted by a man who was Pakistani who set her up on a table and then began stimulation of her left arm in various places with some probes, none of which involved insertion of needles into her flesh. When he was done, the neurologist came in and performed some more studies that did involve his sticking needles into various sites in her left arm and hand. I was not there but I presume all of the probes and needles were connected to meters that made records of whatever the stimulations evoked. When the neurologist was done, he told her to set up return visit for a week to discuss the results of the studies. It would be that visit at which I went with her and have written about above.

After wife recounted the visit as she recalled, I asked her did the neurologist question you about any changes you’d experienced over the week from your first visit to that day and did he examine you in any of the ways he did on the first visit? I used his notes from first visit to recall for her what he had done then in the way of examination especially with regard to her left arm. She said, no, he didn’t do any of that stuff. He just came in sat down and started sticking the needles in my left arm and hand. One reason I married this wife is that she is mostly honest. Of course, I loved and love her too. Through out all of this she has been more on the side of the neurologists (one of whom I am yet to discuss) than against them in any way.

Make no mistake that I am writing, complaining, bitching about a charge of $83, not the $1440 in charges for 5 different muscle or nerve stimulation studies. Why?

In a word, the answer is “dishonesty.” On the other hand it could have been a mistake; however, coupled with the experience in post #20, which was a blatant act of dishonesty the moment the box for a level 4 E&M was ticked and fraud from the minute the claim for that visit was transmitted to the insurance company even after being marked down one level of CPT coding, I have no reason to believe the level 2 charge for $83 was not an intentional act of dishonesty.

Where in our society would we most likely expect dishonesty in someone charging us for some type of service? The first place that pops into my mind is that it is more likely to be encountered in a auto repair or maintenance facility—either something being charged for that isn’t done or overcharged for something that is done. The last place I personally would have expected to encounter blatant dishonesty is in a medical doctor’s office. But then the last place I would have expected widespread pedophilia to exist would have been among Catholic priests.

Why not among medical doctors? Perhaps because I am naïve, but more so because since childhood I was taught or accepted as a fact that the practice of medicine by physicians is an honorable and humane profession. It should be. We should not expect that anyone in a very well paid profession should have any inclination to need to be dishonest in rendering and charging for their services. Am I too naïve? Maybe.

I can rationalize thievery not to be immoral if one has to steal food in order to survive, or if one, as an example, has to “steal” by going into a health care provider for needed care knowing on the front end that one intends to “stiff” the provider for any charges made.

I cannot under any circumstance rationalize dishonesty as being acceptable amongst doctors of any ilk in seeking remuneration for providing health care services. Doctors can certainly be wrong in their opinions. Doctors can and do make mistakes. Doctors can fail to keep abreast of current advances in their field. They can do a lot of things that detract from the quality of care they otherwise might be capable of delivering, but there is no justification in the US for a doctor being dishonest in charging for service, or for ordering unnecessary tests done by themselves as a method of making more money—this last requires expertise greater than I have in order to present arguments that such was done in my wife’s having undergone the testing she did, but amongst honest peers of the neurologist, there might be arguments.

Having in effect practiced what would pass for the practice of medicine, but under a dental license for 20 years, and from near daily contact with physicians I can state it was not uncommon to encounter them bitching about the disallowances by various insurance companies by way of reduction of their charges for various services. Similar bitching among dental colleagues was less common as dentistry does not rely as heavily as does medicine for insurance reimbursement—if it did, I am sure the bitching would be equal. Since I quit practicing I have had little contact with health care providers, but with a couple of guys in my specialty, I have learned when I have an opportunity to speak with them, it is an unwanted tirade that will evolve if I broach the subject of insurance reimbursement, so I never any longer broach the subject. Incidentally, it seem they both are making far better than average incomes—and I trust and hope honestly.

From the practitioners’ points of view, it might be productive to attempt to look at what my wife was charged in her journey to see if her progressively worsening disability in her dominant left hand could be remedially treated.

Total charges by physicians, which were constituted by two neurologists, an internist, a physiatrist (physical medicine), a hand surgeon, and perhaps four or five radiologists, and an anesthesiologist, and one hospital’s outpatient operating room, were $16,569. Of that, the insurance company disallowed $9,644.79. The insurance company and we paid $6924.21. We paid $2500 out of pocket because of wife’s deductible as part of the $6924. That amounts to a 58% reduction from the amounts the providers felt they should be reimbursed. Parenthetically, I could also argue that were a system in place where treatment was dictated by computer algorithms (see reference by Spartacus post #35 ) several thousands of dollars of these charges probably would never have been generated as part the costs of her seeking and finally receiving what fortunately turned out to be effective remedial care, but I won’t present those arguments.

What is a provider to do if one is “forced” to sign contracts with insurance companies knowing that doing so will result in lesser remuneration than if one just went it alone and only saw patients who would pay for services without “interference” from insurance companies? Excluding those specialties that practice cosmetic treatments, I think most others might never achieve the financial well being they may feel they deserve.

How easy would it be for a provider to think, “My time, knowledge, length of training, diligence, good looks and personality fully justify more money that these goddammed insurance companies pay me?” To counter the “loss” of insurance companies’ disallowances, the first tenable thing to do is to keep raising one’s fees at every opportunity. With ever-higher fees at least one can make more money from those capable of paying outright because for whatever reasons they don’t have insurance, and eventually the insurance companies are likely to up the nominal amount they pay providers or allow providers to collect from patients. Another is to work more days and longer, but that is dependent upon the supply of patients seeking one’s services, thus it might not produce any greater income. Another would be to accept life as it is and reduce one’s expectation of what is desired in the way some standard of living.

If none of those answers seem to solve the problem then how about just upping the charge a level (or two) for those services one provides or charging for something that one does not do. The patient certainly won’t catch on, and the odds that the insurance company will may be small. (This is pure negative speculation on my part, but it has to be possible for any given provider that another has told him, “I have up-coded for years and never been caught,” or “I up-coded and was caught and warned, after a while I left that company and still do the same: up-code the other companies.”) So a provider feeling he is being under-paid or under-allowed because of his contractual agreements with insurance companies could sacrifice honesty by the rationalized justification of being more appropriately reimbursed as would result by some up-coding for services or for charging for services that aren’t rendered. Who’s to catch him? Dumb patients or insurance companies, were they to catch him, that mete out warnings?

I’ll leave it there for the moment. I fear “turning off” readers by making this too long—I might have already succeeded, if so I’m sorry. I still think there is some insight to be gained for laypersons from all this.