Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

[rjwjr]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

Does anyone know who wrote whatever is the current 1000-page law that is being considered?

Just a guess. ;) (Yes, that's Hillary hard at work on health care in between trips to China and elsewhere.)

[Jim Nickerson]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

I don't know of this article's credibility, but if it is credible, then it shows how nothing has changed with politics, not that I have expected it to do so.

My thrust is not anti-Obama, but rather that the politicians as a whole are doing nothing that is directed toward what could be a better life and future for this country. People should not be rendered destitute or even made poor with regard to seeking and receiving heatlhcare.

http://www.gregpalast.com/obama-on-d...ney/#more-2664

And what did Obama give up in return for $80 billion? Chief drug lobbyist Billy Tauzin crowed that Obama agreed to dump his campaign pledge to bargain down prices for Medicare purchases. Furthermore, Obama’s promise that we could buy cheap drugs from Canada simply went pffft!

What did that cost us? The New England Journal of Medicine notes that 13 European nations successfully regulate the price of drugs, reducing the average cost of name-brand prescription medicines by 35% to 55%. Obama gave that up for his 2%.

The Veterans Administration is able to push down the price it pays for patent medicine by 40% through bargaining power. George Bush stopped Medicare from bargaining for similar discounts, an insane ban that Obama said he’d overturn. But, once within Tauzin’s hypnotic gaze, Obama agreed to lock in Bush’s crazy and costly no-bargaining ban for the next decade.

[Jim Nickerson]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

A Century-Old Principle: Keep Corporate Money Out of Elections
Published: August 10, 2009 http://www.nytimes.com/2009/08/11/op...20cohen&st=cse

It is inconceivable that Congress would now try to lift the ban. Americans are far too angry at Wall Street and the obvious failure of government regulations. But the Supreme Court has decided to force the question: It took a case, Citizens United v. Federal Election Commission, in which the ban on corporate contributions was not a central issue; told the parties to prepare legal briefs on the ban’s constitutionality; and rushed to put oral arguments on the calendar in September before the new term even starts.

The court’s conservative majority has been aggressively championing the rights of corporations, but overturning the contributions ban would take it to a new level. Corporations have enormous treasuries, and there are a lot of things they want from government, many of which clash with the public interest.

If the ban is struck down, corporations may soon be writing large checks to the same elected officials whom they are asking to give them bailouts or to remove health-and-safety regulations from their factories or to insert customized loopholes into the tax code.

If the conservative justices strike down the ban, they would be doing many things they disavow. They would be substituting their own views for the will of the people, expressed through Congress. They would be reading rights into the Constitution that are not expressly there, since the Constitution never mentions corporations or their right to speak. And they would be overturning the court’s own precedents.

The only hope is that the court is listening to Americans. As it weighs the constitutional issues, it should be mindful that this is another historical moment in which the public is committed to strengthening the wall between government and big business, not tearing it down.

[dcarrigg]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

I'm not sure how contributions are defined here, but EJ just posted this web site:

http://maplight.org/map/us/bill/8471...committees/430

Note that there are several HR 3200 bills. I don't know enough about the legislative process to say why that is.

H.R.3200
Title: To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.
Sponsor: Rep Dingell, John D. [MI-15] (introduced 7/14/2009) Cosponsors (8)
Latest Major Action: 7/31/2009 House committee/subcommittee actions. Status: Ordered to be Reported (Amended) by the Yeas and Nays: 31 - 28.
COSPONSORS(8), ALPHABETICAL [followed by Cosponsors withdrawn]: (Sort: by date)

Rep Andrews, Robert E. [NJ-1] - 7/14/2009
Rep Kildee, Dale E. [MI-5] - 7/16/2009
Rep Maloney, Carolyn B. [NY-14] - 7/17/2009
Rep Miller, George [CA-7] - 7/14/2009
Rep Pallone, Frank, Jr. [NJ-6] - 7/14/2009
Rep Rangel, Charles B. [NY-15] - 7/14/2009
Rep Stark, Fortney Pete [CA-13] - 7/14/2009
Rep Waxman, Henry A. [CA-30] - 7/14/2009

[dcarrigg]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

One reason the US system is so expensive is the rot at the top (Scrushi types).

Richard Scrushi - for those who are not familiar.

Thanks for bringing this up -

[BK]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

The Government officials always come up with a reason to intervene.

Look at the Minimum Wage - forced through in decades ago to prevent Textile Jobs from leaving the Northeast for the South.
Decades later we are stuck with a Federal Minimum Wage Standard and the how many Textilte Manufacturers are in the Northeast?????

There is always a Good Reason for the Politicians to help out the Private Citizen and t he control is rarely returned to the Citizens -

[Jim Nickerson]

HASSLE OF PRIVATE INSURANCE--micro-micro-microcosm



What I hope is that anyone interested in this bullshit can discern the details from the copy of a BC/BS EOB (explanation of benefits) for a chest x-ray (not apparent from the EOB) wife had. The EOB is for one of two charges submitted by the physician's office. On the other EOB the charge was $53 and was designated on the EOB as "X-ray Services" just as in the first box on the form above where the "X-Ray Services" shows the charge as $34.00 followed by the code (1).

Code (1) provides the reason for denial which, if the person paying the premiums is to attempt to understand the denial's basis, would require perusing the Health Care Plan contract. Though it is not apparent to anyone reading this, the reason for the x-ray charges being denied is that BC/BS is telling wife that the x-ray(s) of her chest were considered as a "rountine" chest x-ray. You know like you go to the doctor every year or two and have a rountine examination, lab work, chest x-ray, ECG, etc. Now how BC/BS would arrive at that assessment of these studies being "rountine" probably would depend upon the diagnostic code submitted by the physician's office. However, because that information--diagnostic code(s)--is not included on the EOB, the patient cannot determine, if he/she is even interested in trying, on what basis the denial rests. Perhaps (and this is my cynical speculation) BC/BC denies ALL chest x-rays done within a doctor's office as opposed to the same action of those done in an emergency room. Doing so could save a lot of money unless every such denied claim involved the policy holder going to the trouble to question the denial.

Neither we nor you can determine anything specific about the "X-Ray Services" that were performed. There are probably nine different CPT (treatment codes) that pertain to chest x-rays. Because BC/BS does not write the exact treatment code on the EOB, the patient cannot assure (assuming a certain level of intelligence and curiosity on the part of the patient) that what was submitted to BC/BS was in fact what was done in the doctor's office. The doctor could do one thing, say a single posterior-anterior chest x-ray, but submit the treatment code as that for doing the A-P x-ray as well as a lateral view, and odds are likely gigantically in favor of the doctor that the insurance company would never know that the procedure was overcoded--so insurance company gets "frauded." The simplest check on such that even begins to exist is for the patient to be able to determine for what the charge submitted to the insurance company was. Impossible to do with BC/BS of Texas which is also I believe the largest insurance provider in Texas and the State's contractor. A failure of an insurance company to put the treatment code on the EOB favors fraud on the part of doctors, and does nothing to insure the correct assessment of the claim.

You note I have written there were two EOB's. Both denoted services as "X-Ray Serices." Patient does not know if there were two charges for services one of which was not performed, or just why the fuck are there two charges? The answer here is one was for the physical act of taking the x-rays, film, processing, owning the equipment, and the second is for the doctor apparently having reviewed the x-ray and dictated his/her interpretation of the x-ray(s).

Assuming wife and husband work daytime jobs, pursuing answers to these issues becomes more difficult. Wife so far between BC/BS, doctor's office that did the chest x-rays, and doctor's office that made the recommendation that wife should have chest x-rayed (looking for a zebra having to do with a skin complaint) so far has entailed nine phone calls by her back and forth, and at least three phone calls by employees of the doctors' offices, and it remains to be seen whether or not the disallowance for wife's non-rountine chest x-rays will be reversed.

One thing about unifying and simplifying the US healthcare into a single provider system (which unfornately is not going to happen) would be it would put a lot of people out of work in the private health insurance industry. But what the fuck, those people are largely an impediment to efficient and cost effective delivery of health care to all the legal citizens of the US, and acting as impediments is how they manage to survive in the workforce.

I want to make another point about inefficiency in the current system, that pays the providers (doctors primarily), as I see it, doubly considering what the patient gets as benefit. Say wife had gone to a radiology clinic for her chest x-rays (shopping might have resulted in doing that). X-rays taken--charges generated, radiologist interprets--charges generated, faxes or mails report to doctor who ordered the study who reads the report and discusses it with the patient--charges again generated in all likelihood based on time spent with patient discussing findings. So in some real sense as I see it there are two charges to the patient (or patient and insurance company) for getting the information and possible benefit of x-ray findings to the patient. Anyone thinking my thought on this is invalid is encourage to show me that I am wrong.

One final point. As I grew up after age 5 or so, I never went to the doctor except in late teens and early twenties to get a couple of head lacerations sewn up. For two such lac's I saw two different doctors--they were both doctors and they were both equal in my and my families perceptions.

Whatever they were, odds are they were not actually equal. I think most people, the majority, look upon doctors as being equal if they practice in the same field. If you think you are smarter than average and say you know that all doctors are not equal in education, diligence in performance and keeping abreast of unending changes in whatever are the specialties, then I say you still have a problem with ever determing just how good any one doctor actually is. If my thoughts on this are correct what you get and are charged and hopefully from the doctor's perspective gets collected may not be well justified. You almost cannot know how good some service is unless you get multiple opinions--which for average people only comes about when what was tried by the last doctor fails and new options are sought elsewhere.

Did the doctor (internist) in whose office wife's chest x-rays were taken do as good a job in interpreting her films as would a radiologist? Impossible to answer, if not impossible, then highly impractical to answer.

[Jim Nickerson]

Re: Investor's Business Daily fucks up.

In perhaps the most amusing effort to discredit US President Barack Obama's plan for nationalized health care - if not the most ridiculous - US financial newspaper Investor's Business Daily has said that if Stephen Hawking were British, he would be dead.

"People such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless."

"I wouldn’t be here today if it were not for the NHS," Hawking told The Guardian. "I have received a large amount of high-quality treatment without which I would not have survived."

The best you can say about Investor's Business Daily is that unlike US radio talk host Rush Limbaugh, it has not compared Obama's health care logo to a swastika.

http://www.theregister.co.uk/2009/08...ish_and_alive/

Great entertainment, truly.

[Jim Nickerson]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

By ATUL GAWANDE, DONALD BERWICK, ELLIOTT FISHER and MARK McCLELLAN
Published: August 12, 2009

10 Steps to Better Health Care http://www.nytimes.com/2009/08/13/op...13gawande.html

So we invited physicians, hospital executives and local leaders from 10 of these regions to a meeting in Washington so they could explain how they do what they do. They came from towns big and small, urban and rural, North and South, East and West. Here’s the list: Asheville, N.C.; Cedar Rapids, Iowa; Everett, Wash.; La Crosse, Wis.; Portland, Me.; Richmond, Va.; Sacramento; Sayre, Pa.; Temple, Tex.; and Tallahassee, Fla., which, despite not ranking above the 50th percentile in terms of quality, has made such great recent strides in both costs and quality that we thought it had something to teach us.

If the rest of America could achieve the performances of regions like these, our health care cost crisis would be over. Their quality scores are well above average. Yet they spend more than $1,500 (16 percent) less per Medicare patient than the national average and have a slower real annual growth rate (3 percent versus 3.5 percent nationwide).

The way things strike me as currently going with the healthcare debate, it seems that the country (politicians and oligarchal interests) is about to shoot the citizens in the foot, i.e. fail to produce anything toward remedy.

Good article, worth reading unless you think the status quo is some sort of nirvana.

[flintlock]

Re: Investor's Business Daily fucks up.

http://www.theregister.co.uk/2009/08...ish_and_alive/

Great entertainment, truly.

That's a funny story. What an idiot that author must feel like. We are seeing how good the insurance industry's campaign of misinformation has worked. People just assume every bad story about NHS is true. I don't doubt there are some horror stories, but I can tell you of some horror stories that happened to me personally right here in the good ole USA.

[Ghent12]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

The Government officials always come up with a reason to intervene.

Look at the Minimum Wage - forced through in decades ago to prevent Textile Jobs from leaving the Northeast for the South.
Decades later we are stuck with a Federal Minimum Wage Standard and the how many Textilte Manufacturers are in the Northeast?????

There is always a Good Reason for the Politicians to help out the Private Citizen and t he control is rarely returned to the Citizens -

I wasn't aware of the origin of minimum wage, just the effects of it. I guess that eventually all forms of government control change and morph, take on a life of their own, and the unintended consequences be damned.

Kind of like how, regardless of IBD's reporting of it, the section it references on H.R. 3200 will ultimately make private insurance illegal. I would liken it to Indian casinos, actually. Only where private insurance is grandfathered in, or in small law vacuums, will there be any semblance of our current private insurance.

Of course, the death of private insurance isn't itself a bad thing, as it long ago shed any semblance to what insurance is, and instead became a pooled cost ticket to the doctor. The cost of health care is already mostly socialized; changing the ownership of it will simply enrich different people at the expense of other people. The causality of the enormous cost will still be there, unaffected; yet the causality will remain strangely absent in the same industry for things that will remain uncovered by "insurance" like nose jobs, breast implants, etc. I wonder why.:rolleyes:

[charliebrown]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

i can relate to your x-ray story. I have had similar problems with a very expensive CT scan. With the new hippa b.s., EOB's come with virtually no information. Your bill comes with no information. Spend a few days in the hospital and you get many bills (hospital, anethesia, doctor, lab, imaging etc.) for $$$ with now way to reconcile them against your eob.

Now one fundamental problem that your question misses is why does something like an x-ray have to go through insurance at all? a routine x-ray ought to be cheap. i know many times they are not. that is one of the points of this whole debate. my son had a 7 lead ekg run at a walk in clinic. it was needed for pre-op certification. bill to insurance $500.00. was reduced to 250 by insurance, then I paid 20% out of pocket. The test should have cost $50.00 in the first place. The person running the test was not a doctor, the device was no more than a glorified p.c. the whole procedure took 5 minutes. the majority of that was attaching the leads to my son. wth?? that is why so many of us have insurance, is that even cookie cutter simple things cost way too much.

[Jim Nickerson]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

i can relate to your x-ray story. I have had similar problems with a very expensive CT scan. With the new hippa b.s., EOB's come with virtually no information. Your bill comes with no information. Spend a few days in the hospital and you get many bills (hospital, anethesia, doctor, lab, imaging etc.) for $$$ with now way to reconcile them against your eob.

Now one fundamental problem that your question misses is why does something like an x-ray have to go through insurance at all? a routine x-ray ought to be cheap. i know many times they are not. that is one of the points of this whole debate. my son had a 7 lead ekg run at a walk in clinic. it was needed for pre-op certification. bill to insurance $500.00. was reduced to 250 by insurance, then I paid 20% out of pocket. The test should have cost $50.00 in the first place. The person running the test was not a doctor, the device was no more than a glorified p.c. the whole procedure took 5 minutes. the majority of that was attaching the leads to my son. wth?? that is why so many of us have insurance, is that even cookie cutter simple things cost way too much.

Regarding the HIPPA shit, a while ago I asked BC/BS regarding wife's plan why are there not CPT codes on EOB's? Answer was something to do with privacy bullshit.

I won't go to the trouble to copy and paste one of my Medicare EOB's, but it is a fact that it shows a CPT (treatment code) for every charge.

EDIT: And in my generally cynical assessment of things, someone in financially benefitting (perhaps ripping off is better) from a patient's inability to determine exactly for what charges are on any type of a hospital bill or EOB.

It is not critical to mankind, but I wonder if others here receive EOB from commercial insurance companies that have a CPT code by whatever else it shows for services rendered.

Not important to me what kind of insurance anyone has, but as mentioned somewhere else for many people who have insurance today through their employment, the protection from the insurance only lasts as long as one's employment (plus 18 months of Cobra if affordable), so to me there is some fantasy with the notion that everyone with insurance at the moment does not potentially face not having insurance in the future. Unless one is quite wealthy (whatever that is) the issue of being able to obtain affordable healthcare applies to us all, and the current system does not achieve such a status.

[flintlock]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

EDIT: And in my generally cynical assessment of things, someone in financially benefitting (perhaps ripping off is better) from a patient's inability to determine exactly for what charges are on any type of a hospital bill or EOB.

Of course they are ripping off people with all this smoke and mirrors. After 20 years in business, I can assure you, its always easier to present a bill AFTER the fact than have to compete by giving a clear up front estimate of fees. I told my wife that a lot of these doctors wouldn't have the balls to tell you to your face what they are going to charge you for some of these minor procedures. Instead they plead ignorance or pass you off to an underling, who then says, "we can't tell you what the cost is until we submit it to your insurance company". I recently canceled a procedure because the surgeons office literally would not tell me what it was going to cost. I started a month in advance and after being put off for 3 weeks, I canceled rather than go ahead and put myself at their mercy. I asked for a ball park, " $100? $5000?" Not a peep. They want a blank check is what they want. This goes for hospitals too. Then they find a way to max out what the insurance will pay and that miraculously is exactly what the bill turns out to be. :rolleyes:

The insurance statements are unreadable and they know it. I'd love to see my customer's reaction if I submitted a bill for " $2500 code 14". Then make them stay on hold for an hour just to find out . What we have now is not "Free enterprise". What other free market business could exist with that kind of service?

[Jim Nickerson]

Re: Investor's Business Daily finds an "uh-oh" moment in the House's health-care-for-all bill

Of course they are ripping off people with all this smoke and mirrors. After 20 years in business, I can assure you, its always easier to present a bill AFTER the fact than have to compete by giving a clear up front estimate of fees. I told my wife that a lot of these doctors wouldn't have the balls to tell you to your face what they are going to charge you for some of these minor procedures. Instead they plead ignorance or pass you off to an underling, who then says, "we can't tell you what the cost is until we submit it to your insurance company". I recently canceled a procedure because the surgeons office literally would not tell me what it was going to cost. I started a month in advance and after being put off for 3 weeks, I canceled rather than go ahead and put myself at their mercy. I asked for a ball park, " $100? $5000?" Not a peep. They want a blank check is what they want. This goes for hospitals too. Then they find a way to max out what the insurance will pay and that miraculously is exactly what the bill turns out to be. :rolleyes:

The insurance statements are unreadable and they know it. I'd love to see my customer's reaction if I submitted a bill for " $2500 code 14". Then make them stay on hold for an hour just to find out . What we have now is not "Free enterprise". What other free market business could exist with that kind of service?

All good points, flintlock. When I practiced, I did not always ask patients if they would mind bringing me a copy of their hospital bills, but for periods I did ask that they do so. I believe I did that because I was interested in what I was doing was costing someone. It's hard to recall any details from over 20 years ago, but I think correctly almost always if not always when I went over bills I could check 10 or more charges from the OR for trays, supplies that were not used and probably a few lesser items for things patients had not received due to any orders I had written. It was always to me unfuckingbelieveable.

I used to buy burrs (drill bits to cut bone) or blades and take them to the hospital for my cases because they were perfectly autoclaveable and reuseable, and not to do so resulted in the patient (insurance company) getting charged 4-5 times at least what I might pay for them.

I applaud your action to have cancelled your surgery because no one would tell you what cost it might approximate. One can sure as shit not apply any notion of capitalism to receiving healthcare on a competitive pricing basis if one cannot get an honest quote.

The entire system should be nationalized yesterday.