Changing the Healthcare Paradigm: A Physician And Patient Centered Approach
by Dr. Elaina GeorgeI have been reading various articles and listening to pundits for months talk about healthcare reform. They have discussed ad nauseam everything from complete government takeover with single payer on one hand to free markets on the other.
Next week, we will be witness to the President’s healthcare forum. This is what we know so far:
- Tort reform is pretty much off the table.
The trial lawyers lobby has seen to that.
- There seems to be no political will to apply anti-trust regulations
This will continue to benefit the health insurance industry since they will be able to continue to run fiefdoms in various markets guaranteeing their market share and profits.
- The public option is really NOT an option.
If it does get implemented it will be a glorified version of Medicare Advantage where the program is administered by the insurance companies. A particularly sweet win-win situation for them since it means we will have to pay them whether we want private insurance or not.
- More taxes
We will be paying money into a governmental black hole for the next 4 years in the hopes that we will get inexpensive, comprehensive health coverage in the end. I have just two words about that – Medicare and Social Security (enough said).
- If you don’t like your insurance too bad
People who don’t like their private insurance plan will not be able to access the exchange system.
We are at a crossroads.
As a practicing physician, I am really concerned about the state of our healthcare system if the Congressional reform bill gets passed. Even if it is an amalgam of both the House and Senate bill, there are so many negatives that the basic tenets that are good, like coverage for pre-existing conditions and not being dropped from an insurance plan, will not make any significant difference in our healthcare overall.
Some have said that the reform effort is a stepping stone to a single payer system and I agree that is possible. What physician would want to enter a system where their freedom to practice medicine is controlled by government task forces, and where the final medical decision is made by a government administrator who will be all about cost savings, and NOT what is best for the individual patient?
The healthcare system in Massachusetts is a look into the future. They have a high number of medical residents that leave the state when they graduate, practicing physicians are also leaving, because of the physician shortage people have to wait to be seen by a doctor, and healthcare costs have gone up significantly since they instituted universal coverage. The physicians who do remain in practice MUST accept all health insurance since getting and renewing their license is contingent upon them doing so. I believe that a government law mandating that all physicians must take health insurance in order to obtain and maintain their license to practice medicine would be the only way to capture enough physicians to help implement this system.
I have a problem with this as someone who was trained that medicine is an art as well as a science. I also have a problem as a professional with being told 1) who I can see; 2) what tools I can use to diagnose; 3) what therapeutic treatment options I can use, and 4) how much my time and expertise are worth. Wouldn’t anyone?
It’s time to change the paradigm. In my opinion neither the government nor the health insurance industry is the answer to the problems of healthcare costs. They are actually part of the problem. The government’s intrusion into healthcare via Medicare has set the reimbursements without regard to real world costs. Because they are so low and continue to get lower, it leads to cost shifting from those who cannot pay to those who can. This is compounded by the for profit private insurance industry that has injected a new layer of costs that are designed to make sure that they get paid no matter what. They have devised ever more novel ways to increase revenue by 1) increasing the premiums to patients; 2) increasing patient out of pocket expenses via deductibles and co-insurance; 3) decreasing reimbursement rates to physicians; and 4) adding other methods to reduce payments like multiple procedure discounts(e.g., if a procedure has two sides you get paid 50% or less for the second side), and global surgical days (i.e., a physician will see a patient postoperatively for up to 90 days with no charge and may not charge for supplies ,or anything related to the surgery).
Enough, we are on a path that is unsustainable. Yes, cost is one aspect, but so is the medical workforce. The system will NOT run without enough qualified doctors, nurses and other health professionals.
These are some of the things I would do:
1. Get rid of insurance companies anti-trust exemption to promote real competition
2. Tort reform that includes a mandatory payment of legal fees for the losing litigant.
This could even the playing field for lawyers who take cases based oncontingency and decrease the number of frivolous law suits which estimates place as high as 40%.
3. Change the way health insurance companies pay benefits.
Since health insurance is unlike any other type of insurance, mandate that a percentage of the yearly premium be used to provide patient care after this amount is met; the patient pays the percentage as set forth by the insurance company. For example, if a yearly premium is 23,000 then 30% needs to be available to be used for whatever medical treatment or therapy the patient needs (as determined by the patient NOT the insurance company). After the $6900 is met then the patient is responsible for the 30%-40% or whatever is mandated by the insurance company.
- This would encourage the patient to seek medical care before a medical condition became more advanced. It would also encourage patients to shop for the most cost effective treatment. In short, market forces would be engaged in a positive way without limiting patient access.
- The patient would also be encouraged to purchase insurance because they would be getting real value. As it stands now, if a patient never sees a physician they merely pay money to the insurance company without any hope of getting it back. In addition, the increased deductibles and co-insurance have increased the out of pocket expenses and that has also limited patient access.
- Institute a rollover of the unused portion allowed for medical expenses. This would also benefit the patient because if they didn’t use it, the additional money would potentially add value to the insurance plan. It would encourage people to maintain coverage no matter their age or underlying health.
4. Encourage incentives for adopting a healthy lifestyle
In the form of premium reductions or possible tax credits
5. Allow patient to write off their medical expenses
from the first dollar instead of almost 7,000.
6. Allow physicians to write off bad debt
They would be encouraged to see more indigent people for free, and would also not need to go after and potentially ruin the credit of those patients who owe money. Currently, if a patient or insurance company does not pay, the physician is forced to write it off.
These are just some examples that I believe would put the power of individual health choices back where it belongs with the patient and the physician. People have good sense, and if given more control of their own healthcare costs along with clearly presented options that include cost transparency (from both health care providers and hospitals who will have to compete for a savvy patient consumer), they will choose what is best for them. When the inflated costs injected by the government and the insurance industry are stripped out, it would lead to a more affordable medical system that will work well for the foreseeable future.
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96 Comments
Amen Doc!
Next week will be a week of high drama and great political theatre. Regardless of the outcome, WE the People will be victimized once more.
A positive outlook to revamp the system from s doctor and not a politician. I like this.
Patient and doctor relation approach? Where is the government control that Progressives want in that type of relationship?
6. Allow physicians to write off bad debt
"They would be encouraged to see more indigent people for free, and would also not need to go after and potentially ruin the credit of those patients who owe money. Currently, if a patient or insurance company does not pay, the physician is forced to write it off."
What in the hell are you talking about?
"Currently, if a patient or insurance company does not pay, the physician is forced to write it off."?
And you want to change the rules to "6. Allow physicians to write off bad debt"?
God you people are stupid.
Excellent article!
Now if only someone in government would listen.
Dr. Geroge,
Can you please further describe #3 and #6. I'd like to better understand what you mean.
They can pass any of this crap they want. Its unconstitutional and I for one will become an outlaw before I will be forced in to anything that violates my rights.
Sorry Doc, that just makes too much sense to have a chance of flying in Barracks world.
Thank you Elaina for these excellent solutions. The problems with these solutions is that they are actual solutions to the actual problems at hand. And might actually work. The political problem is that they empower the individual patient, citiizen, Not to mention the physician, this does not fit the command and absolute control ideals of this administration and the DNC aparatchek elites. with regard to the disposable masses. The economic problem with these solutions is they do not ensure the status quo for the fat cat trial lawyers and insurance execs. Hows that hope and change workin for ya?? And besides, the real goal of the Obamacare plan is not to provide health care to anyone really, it is to provide deathcare to those commrades who are over the hill or not productive to the collective any longer. Unless they are of a certian demographic. but will be useful as glue and other rendered staples. Perhaps soylent green??
Make a BIG PUSH again THIS WEEK ….today…to contact your senator or representative on this issue. Pressure, pressure, pressure!
I think what the doc means is "6. Allow physicians to write off bad debt *as a tax deduction*", because today physicians have to *eat* bad debt (that is, absorb all of the lost revenue).
An average Emergency Department eats 30%-35% of its billing number in bad debt/non-paid invoices. The missus regularly sees patients (yes, EDs have "regulars", or "frequent fliers" in their lingo) with outstanding balances of $500,000 owed to the ED.
Yawn…Yeah, good luck with that whole paradigm changing thing. I won't be getting my hopes up until the Obama regime is over.
I stopped listening to what Barry says, I just watch what he does now. He will get what he wants, and will stop at nothing to get it…Period.
The good news is that the GOP can filibuster this. The bad news is that we've still got idots in DC who are still willing to pass this even though they will not get re-elected this Nov.
Sad, but probably true. There's really still no way to stop it other than public opinion…and we already know where this Administration stands on that!
The good news is nothing lasts forever. God said "…and it came to pass…", not "it came to stay"!
Polititians will not promote and support anything they will not benefit from, you can call, write, email, visit in person, but unless you have incentive they would not shoo a fly from you. The article has many good points which would not cost what they would save or promote, again these solutions would barely generate enough graft that would interest a city concilman. Vote them ALL out, and then you may see change you can believe. The days of make it cost more than worth to change works, but always at a cost that I never have.
Say it loud Brother. The Constitution is the law of the land, not the govt.
The only way to truly save the Health Care system is to get the government out of it.
Excellent article!
If only the administration would listen to this common sense we would be in a better place. However, to Pelosi, Reid and big O' this kind of approach has fallen on deaf ears. Typical Chicago style politics. According to pelosi, they're going to "parachute in". I'd like to see her on a parachute high over Afghanistan.
Give everyone coverage with a high deductible that will allow individuals to shop around for the minor health care that people need while at the same time having insurance companies pick up the costs after the deductible is reached. It might keep people out of emergency rooms and make them more responsible for their minor health problems.
Dr. George, Your article engages thoughtful solutions that a nation of patients, insurers, and health providers need to discuss and bring to the table a viable reform. Point #2, Tort reform, is clearly needed and long overdue.
Point # 3 is not as clear. Is this similar to HSA's? The word "mandate" is uncomfortable to me, especially if it is a federally regulated. I do like the idea some portion of benefits individualized, that a patient or the patient's guardian determine what health needs should be met per year in a way that motivates them to be cost effective with the option to rollover savings to future health needs.
Thank you Dr. George. Great Article.
Obama's lawyer brethren are partly responsible for the high costs of health care but thats OK with Obama, what a f-ing coward creep lying POS
Put another way:
Lots of insurance plans have high deductibles. Take the $2300 yearly plan mentioned above. Deductibles can be anywhere from $250 to over $3000. If I've got a $3000 deductible, then I've got to pay the $5300 before insurance will pay a dime. If I'm realtively healthy, there's no way I'll spend 3000 dollars on healthcare in a year, when the counter resets. I will have wasted every cent of the 2300 that insurance got, while they get to take it to the bank. If I get to apply 60% of that out of the box, I will get something of value for the money I've spent.
Since so many people have given up their right to think for themselves by becoming dependent on the govt., the pols now think that this is what everyone desires
The doctor means write it off taxes.
God you are stupid. It's obvious why you post anonymously.
When healthcare is addressed a piece at a time, legislation in 10 pages or less; AND TORT REFORM being the first piece of business; then there is nothing to talk about. We need more doctors and a hell of a lot less lawyers.
TORT REFORM……….NOW,……….there will be no change without it.
Titus and DarthRove,
The both of you are morons. Utter morons.
They've been writing off uncollectible accounts for decades.
God are you people stupid.
Excellent post Dave, thank you!
Well said, Doc! Well thought out and reflective of someone who has to make the system work on a daily basis. Unfortunately, politicians of both parties have no interest in really solving problems, or protecting patients. Instead, they love to distort reality, and spin their "kabuki theater" attempts to look like they're "protecting" us, in their neverending quest to buy votes and maintain their grasp on power.
In my younger years as a police officer, we did a two day course on "verbal judo", a method of convincing reasonable people to comply without going "handson".
After two days, the instructor informed us that we would never be dealing with reasonable people on the street. We should never assume that we are dealing with honest or reasonable people in politics. They don't exist in the modern age.
Stupid moroninc ahole anon just for being you. There are limits to what they can write off each year, and carrying over the excess amount for next year. Hmmm… Let's see… Left over debt plus new debt equals more debt being carried by the physicians. Moron leftist tool anon.
Really, anon?
Sure about that?
Check this out… They are very determined to use reconciliation…and they are getting closer and closer…
http://openleft.com/diary/17450/whip-count-at-31-...
At least you acknowledge that the insurance industry will "continue to benefit" by not including anti-trust legislation. Next acknowledge that the entire thing is a gift to the insurance industry and big pharma, by forcing everyone to buy their faulty product, and this place might come to see the truth. Congress, whether it's Democrat or Republican, is owned by their corporate masters.
Sorry if I wasn't clear:
#3 I don't think people get their money's worth from the insurance companies. They pay most of the up front costs. On top of their premiums, patients can pay additional co-pays, deductibles (additional out of pocket expenses up to 10,000 dependiing on the policy) or co-insurance (a fixed percentage of the fee from 10-40%.) That adds up to the insurance company getting a free ride until the prescribed out of pocket expense is met. So if you never go to the doctor or go 2-3 times a year for routine problems (like the average patient) you basically gave your money to the insurance company to do what they want.
The insurance companies have too much power. They take your money then decide how you are allowed to spend it. It is an inherent conflict of interest and some can rightfully argue unethical. It is in their interest to deny expensive treatments and they have done it – e.g., Sicko where the patient with cancer was denied a bone marrow transplant, an excepted medical procedure, as experimental. It is hard to ignore the possibility that the denial was related to cost and not science. Bottom line – insurance companies should not have the power over life and death and also have fiduciary control. It is a bad combination.
My approach is more patient centered. If the patient has more control over their health dollars they will be more likely to make intelligent health choices that benefit them. Let's say a person has a $6,000 policy and they get 40% of it per year, the individual would have $2400 to spend on any medical treatment that they and their doctor determine is needed, Patient's would be more likely to a) go for routine/preventative treatment; b) be able to afford more expensive tests/procedures if needed because some of the out of pocket cost would be reduced; and c) the patient would become a savvy consumer looking for the best price because it is his/her money. The operative word is HIS/HER money. No governement handout, the individual has paid for the right to determine their health care. The insurance company's role is to negotiatte a discount with the physician or hospital and help cover large expenses. With this scenario the patient and their physician make the decisions NOT the insurance companies.
For those who don't use their alotted money, it would 'rollover' to the next year. so if the person didn't go to the doctor one year, he/she would have $4800 the next year to use and so on. It can only be used for medical care so if they never access it the insurance company keeps it. However, if they have been covered for several years and they have a catastrophic medical event there should be a significant amount of money that can be used to cover medical bills – a 'health savings account'.
Yes, I'm sure.
And if you use a cash basis of accounting you only are taxed on cash received. Less any expenses. Period. And if you don't use a cash basis of accounting you still get to write it off. Albeit a little bit later.
God you people are morons. You don't have to pay taxes on monies you never received.
"If you don’t like your insurance too bad
People who don’t like their private insurance plan will not be able to access the exchange system."
These two statements are in conflict…. all insurance has to be uniform to be on the exchange… so if there was an exchange and you DONT LIKE YOUR INSURANCE…. what good would the exchange do you? Question authority man.
Darn it, I forgot… all insurance HAS to be on the exchange… it sort of ties it togeather.
So, if there is an exchange, all insurance ends up the same under the obamacare plans. Which sucks for people who don't want HMO style cr*p care and want to pay more for another type of service. I actually like a catastrophic care plan that pays for whatever I and my doctor want after say a $2-$5k deductable… Up to a max limit (say $5 million)… I'd like this. I DONT WANT the government's idea of care and DONT want to be forced into it.
"Allow physicians to write off bad debt
They would be encouraged to see more indigent people for free, and would also not need to go after and potentially ruin the credit of those patients who owe money. "
We let hospitals do that and the opposite happens. They come up with those crazy bills that people without insurance can not pay… so they can get the silly huge write off.
An actual argument with less, albeit still too much, ad hominem! Better, but still room for improvement. Try to move away from "moron" to "I'm rubber, you're glue" or perhaps the time-tested "Neener neener neener!"
Anyway, the good doctor addresses this further down the comment chain, so further speculation on my part about what she meant is moot. She knows what she meant better than I do. So you may want to reply to Dr. George directly and give her the benefit of your rapier wit. I look forward to your next zinger with great eagerness.
See response below.
And good move by you move to quit defending the indefensible.
I don't think you morons even know what a write off is.
I challenge any of you birdbrains to explain it.
You're speaking Greek to them, Doctor. They don't understand when you say "insurance companies have too much power" because that doesn't fit in with what they are told on Fox News and Rush Limbaugh. If you're not blaming Obama, Democrats and liberals then they're not interested. I appreciate your input on this. We need more rational independent people and less partisan hacks.
Thank you for your question. I did reply, but it ended up way down the line on the comments section. just scroll down.
All the best!
LOL. I just pictured that. Thanks!
Thank you for your response. I explain #3 in more detail further down in the comment section. In short it would be for all intents and purposes an HSA. However, everyone who carries insurance would get it, not just those who work for employers.
I agree, I don't think anything should be mandated. Let me amend that. If an insurance company came up with this way of paying benefits I think they would get a lot of business.
Changing the Healthcare Paradigm: A Physician And Patient Centered Approach by Dr. Elaina George—I'm with you, as I'm sure most of America, but I don't think that it matters anymore? To quote Cowboy logic above "WE the People will be victimized once more." Our only chance as surviving as a free society is electing only people that PROMISE to REPEAL all of the Executive Orders this tyrant is making and is planning to make in the near future! Also, if anybody "lies" about it after getting elected(I'm sure that there will be some you do), we throw them out too! WE ALL MUST FOLLOW OUR CONSTITUTION TO SURVIVE! Yes, we're all with you Dr. Elaina George! You are 100% American!
Doctor as an alternative could you support a system that had no insurance regulations at all. Insurance would be optional. Market forces would create winners and losers. second for our entitlement programs rather then contracting services out as they do here in Mi to the blues, why not set an individual budget. Spend it all on qualified services and government takes over, don't spend it and get half of it back in the form of CASH. This would create a savings incentive in an otherwise third party wasteland.
I absolutely agree with you.
On a cash basis accounting system you get taxed on what you earn. So if you bill $100 and get $60 you only get taxed on $60. That is basic accounting, but that is is not the point of the argument. It is the fact that $40 (which is part of the value for the service) vanishes because of an artificially set fee schedule that does not take into account the actual costs of doing business or the skills necessary to perform the job. Just because insurance says the price is x doesn't mean that it actually is. Because there is a short fall that has to be made up then it leads to aggressive collection etc..
My article is a list of things I would LIKE to see. If the the $40 or at least a portion of it could be deducted it would help. In reality, it would improve cash flow and make running a medical practice more viable.
I am not an accountant, i just call it as I see it ,and I want to see our system work better. I assume you do too. However, you seem to want to focus on the small stuff. Let it go, you will be a happier person.
If you don't agree with my opinion then so be it, but instead of name calling why don't you tell us how YOU would go about fixing healthcare?
Thank you!!!!
But whenever I research their profits / expenses / whatever it seems the vast majority of money still goes back out in claims. So… medical care is just expensive for those who come down with serious health problems.
I'm a contractor, I get it. But I'm adding that hospitals have a loophole that allows them to 'write off' bad debt at a different rate (as more of a tax credit… but I don't know if it is based on a percentage of a dollar or 1 to 1; I'd have to look it up). The author probably wants a similar deal for doctors. As I said, I don't think that is a great idea as we've seen it encourages hospitals to make up phony large bills for people without insurance in order to get their tax break.
I'd actually go the other way as part of healthcare reform… and take this back from hospitals…
"The author probably wants a similar deal for doctors."
You obviously don't understand what a write off is but nice try. You're more brave than the other cowards here.
The doctors can do it today. Use a cash basis of accounting. Done.
And you're claim that hospitals are allowed "to 'write off' bad debt at a different rate (as more of a tax credit" is stupid. If anything hospitals, since they would use accrual accounting, would not be allowed to write off uncollectable accounts as quickly.
And of course, Dr, Elaina was quite clear that she thought DOCTORS should be able to write off uncollectable accounts, "6. Allow physicians to write off bad debt"
Again, doctors are free to do so today. God you people are stupid.
"If the the $40 or at least a portion of it could be deducted it would help."
It is deductible. Right now. Today. That is my point.
"why don't you tell us how YOU would go about fixing healthcare?"
Short answer is Medicare for all.
There are 29 other modern countries that provide the same level of care for 1/2 to 1/3 of the cost of ours. Most, yet not all, use some sort of a single payer.
You are a hard one to figure, Doctor Elaina.
As far as I can tell you are trying to protect the very people that are making your practice difficult, insurance providers.
How do you like dealing with the insurance paperwork? Is that making you a lot of money?
Our system sucks. And we are the only one that does it this way. And we pay 2 to 3 times what the rest of the modern world pays, for the same level of care.
I want to get off point a little, and ask this question. Why do you have an ad for Bennet on this site? We here in Colorado are trying to get rid of him. He doesn't represent our interests. I've emailed him several times and always get the same Obama like answer.
It says right in his ad that he's a progressive!!!
He supports the ridiculous healthcare bill that the dems are trying to ram down our throats!!!
"The insurance companies have too much power. They take your money then decide how you are allowed to spend it."
Exactly. And their fiduciary duty to their shareholders is to maximize profits. Thus today's problems.
I don't like government running things any more than anyone else. However, at least with the government we can vote them out. With health insures we have no say. We are powerless.
And you don't hear many seniors bitching about Medicare, now do you?
Stupid moron anon. How about time for services performed and products used? It's not only about payments received. Tool!
And office/staff expenses for unpaid services. Moron! Next time you try to show you're snot a moron, don't.
You have missed the point entirely. Health Insurance *is* indeed like any other type of insurance. Stop the third party payer system and many of the cost issues go away. Have patients pay directly for services and healthy lifestyles become more attractive.
Wow….It's almost like you physicians are REALLY smart people who REALLY care about your patients and want to relieve pain and sufferning. Nice article, doc.
Heard this on Hugh Hewitt's show today that the Dem's are really going to stick it to the GOP next week. They are going to try at all costs. Start calling your representatives now.
I can picture a woman exposed in the exam room and an IRS agent in there to make sure there are no frivilous services hidden in the charges.
Not only that. But if were advising highly qualified health professionals with fat 401s who are eligible to retire I would say GET OUT.
What is the reward of facing the future? If your 401 isn't protected from the future abyss then you will get crucified again. If you are in 'stable principal' you may think all is well until we get indications that the Fed secretly want to confiscate your 401 in exchange for an annuity paying 2-3%. YES. Since the Scott Brown election the rhetoric has toned down. But not their intentions.
So any plans to pass your nest egg on to your children is now not so cut and dry. Well paid highly qualified health professionals have been busting tail for many many years and to repay them we are going to tax the living hell out of them, threaten their retirement accounts and take over control of their decision making process. Pure Genius.
Who in the hell wants THAT RISK? GET OUT. Yes I know it's not in your heart to turn your back. But if you don't make an exit strategy SOMEONE WILL MAKE IT FOR YOU. And my guess is that you will not like the 'forced option.' If you think this is just hot air then may I suggest digging a little deeper.
Believe me. They don't want you to know. The soft handed offer to roll into annuities is a hard handed fantasy to confiscate sorely needed capital for their pathetic agenda that is BROKE and BROKEN.
You've been forewarned.
WELL SAID DOC!
Hmm, well I have a different perspective. As a pharma researcher I have seen my industry contract nationwide as well as face public villification. And right up in front were the physicians – just as loud and self-righteous as can be. Because, ya know, when it was pharma providing the vast amount of medical benefit to patients for about 10% of the total health care bill – that was price gouging on an egregious scale. And the fact that pharma detailed and incented physician to prescribe their drugs – brought to you courtesy of the federal government's "learned intermediary" restriction – that placed docs as hapless victims, lured into financial depravity by the industry rather than their own greed. So now the government turns on the docs. And I have no sympathy – if a free market is bad, then its bad for everyone.
Only 30% of doctors currently take Medicare in NY and the national avererage is only moderately higher. I can't find an internist to refer patients to because they are not accepting new medicare patients.
To top off the obnoxious restrictions that Medicare places on providers, on January 1st they stopped allowing consultation fees, and on March 1st there will be an accross the board 20% fee cut (unless congress does something to fix it). For specialists that amounts to a 40-50% reduction in reimbursements from last year. Good luck finding a physician to take care of you now and pray that you find one if they enact Medicare for all aka single payer.
I would prefer to see doctors and patients getting together to decide on discount services. Insurance should be used for catastrophic conditions.
Yeah, I actually do
Thanks!
6 The way IRS works, taxes are paid on what you actually make not what is billed. When a doctor bills a fee, say $100 and insurance pays $60 the $40 disappears. Because the doctor can't claim it as a loss of income, that loss cannot be deducted at the end of the year. Essentially, the reduction of fee through discounts doesn't exist as far as the IRS is concerned. The same thing goes for patient's who owe money. If the physician/hospital doesn't get the money from the patient or collections they must write it off. This is a major reason why medical bill collectors are so relentless. By allowing the physician/hospital to deduct the "bad debt"/outstanding balances it would take a big burden off of everyone since there would be less of an appetite to use aggressive measures to go after patients. The major loser in this scenario would be the collection agencies.
Amen.
I could see a system with no insurance regulations if we had real choice among the insurance companies. In addition, it wouldn't work if you don't get rid of their anti-trust exemption. Monopoly and no regulation generally don't mix.
When you say an individual budget what do you mean? I would rather see doctors and patients work together to agree on a discounted fee. Insurance would then only be needed for catastrophic conditions – no government involvement.
I don't know where you went to school doctor but you are a certifiable idiot.
You said "The way IRS works, taxes are paid on what you actually make not what is billed"
"By allowing the physician/hospital to deduct the "bad debt"/outstanding balances it would take a big burden off of everyone since there would be less of an appetite to use aggressive measures to go after patients."
You just said you are taxed on what you are paid. How in the hell do you write off what you never were paid for. In other words it was never written on.
God you people are stupid.
Thanks gapatriot for the heads up. I will be calling my congressman.
Check out the Blog I wrote on this very subject a while back:
http://drelainageorge.com/?s=and+the+winner+is
The problem with the hospitals is there is absolutely no cost transparency. They bundle all sorts of charges into Misc. That needs to stop. They also charge by the pill, the kleenex and anything else they can get away with. This really jacks up the price. The surgical charges are even more insane. For example if I do a sinus surgery on average I am paid anywhere from $400-1,100 depending on the complexity of the case. A patient showed me his insurance statement and the hopital was paid 30,000. (for a 90 minute case and the patient went home that same afternoon). I was amazed.
One way to contain hospital costs would be to pay them a flat global hospital fee based on the procedure. I work at a surgery center that offers that package to self pay patients and it works pretty well. It can stop the nickel and diming that can occur.
ObamaCare has absolutely NOTHING to do with health care reform.
It is all about power and control. Power for the political elites and more control over our lives.
We spend way too much money on medical research. All that research money expense is tacked on to the price of drugs, and the cost of drugs are picked up by either the Government or Private Insurance.
[...] Changing The Healthcare Paradigm: A Physician And Patient Centered Approach [...]
"Short answer is Medicare for all. "
Medicare is going broke with the existing beneficiaries.
God you are stupid.
I agree with your comments, Dr. George. I also would recommend that insurers be required to meet a "sunshine law" that reveals ALL their data about their actuarial choices, and makes it a simple, open book, just like an annual report for a stockholder. Without transparency, the battle is lost.
I also believe that insurance companies will not be competitive in the US until their rates are simple, posted publicly, and all policies are written in plain English. I just today downloaded California's analysis of "Medicare Supplement Plans…" it's 490 pages long. So tell me. Why is that? And please don't say, because of the complexity of Medical Care. That is baloney. These things are long and confusing because the govt and insurers want them that way. Also, I know many excellent physicians. However, on the physician front, a BY NAME AND ADDRESS rating system that shows what patients think of their docs would be much better than "peer review" in a hospital or clinic setting. Saying that "Patients don't understand" is ridiculous. Of course they understand. They, after all, have the best information possible–personal experience of care or noncare.
I believe that each person needs to expect to pay something for HIS OWN CARE. No more "negotiated benefits" by employers. All that money should go on the paycheck, and used by the patient to pay for his own insurance.
I pay my own, since I'm a businessman, and that makes me much more careful in what I buy.
Finally, I think all insurers ought to have to consider their entire spectrum of insured clients as "their pool;" no more group insurance, with insurance purchased more cheaply for sick people who happen to be govt employees, or the like. When Wal-mart puts a product on the shelf, it charges a sick person the same for it as a well person. I know people will attack me for the analogy, but the reality is that if insurers can afford to insure sick people in a group for the same money as well people, then they can afford to do so for individuals.
Of all these, a "sunshine law (make them show what they really make)" and a "plain English" law would do the most good.
The other suggestions you've made are good. These need to be included as well, at least some of them.
Finally someone who knows what they are talking about!!!!! The cost are too high Medicare & Medicaid as well private insureres have not paid cost since 1980. Hospital rates have been cut every year since 1981 since the inception of the DRG system by Medicare. They do not pay cost so why did Obama & the Democrats in congress talk about healthcare cost are too high, its because this has to do with controlling more of the U.S. economy.
Dr George I appologize for the lack of clarity. The current entitlement sytems eliminate the end user from consequences for over using benefits. If my children are sick I send them to bed give them clear fluids and monitor them. If they worsen or to not improve, I then make a decision about medical intervention. The budget I was postulating was a replacement of the entitlement. A set dollar amount available for medical treatment. Unused dollars in that budget would be split between user and in this case government. Major medical expenses would of course empty the account in which case government picks up nessacery expenses.
Only your mom cares about what you think LOL. And only because, until your 16, she's required by law. It's pretty cute that because you know what a write off is (most taxpayers know what a write off is, you think socialism is the answer. LOLOL!!! Were you recently running Greece?
Oh, by the way, we have more illegal aliens than some single payer countries have in taxpaying citizens. Figure that one out, genius. You are truly laughable.
Two days ago there was a news headline asking, "Are the Feds Denying Your Pain Meds?" How timely!!!!
Last week I had to have my pain med refilled. It is Oxycodone/apap, 10/650, 120 tablets/month. Because I don't want to become an addict, I only take the pills when the tears run from the pain, and a prescription lasts me about 2 1/2 months.
The prescription co-pay jumped from $7.00 to $40.00 since filled in December. I called Humana and asked why. I was told that my prescription was "non-preferred." Which means THEY would prefer I not use that drug…..(and it was a GENERIC!!).
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They suggested I use a med of THEIR choice which would be $8.00. I said I would have to discuss it with my pharmacist. He told me the one they suggested wasn't nearly as effective, and I would have to take more, meaning my prescription would have to be filled more often.
Now get this. Percocet 10/650 (brand name) is oxycodone/pap 10/650. Endocet 10/650 (generic) IS oxycodone/apap!!!!
The label on my Feb prescription stated: "oxycod/apap 10/650, sub for" Percocet 10-650"
The label on my Dec prescription stated: "endocet 10-650, sub for Percocet 10-650"
The insurance company told me they would NOT pay for OXYCODONE/APAP except as a Tier 2 drug with a higher co-pay,` but would pay for endocet as a Tier 1 drug with the $8 co-pay. When I told them that endocet IS oxycodone/apap, they told me I was wrong. I asked to speak to someone responsible for making these decisions, I was transferred to another imbecile who again told me that I was incorrect. When I asked further questions, I was told this was a joint decision between the government and the insurance company.
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I paid into SS and medicare while working. Today I am still paying over $1500 a year for medical care (not counting all the co-pays)! It's too bad the government removed trillions from the SS lockbox and now want to penalize us for it. Washington is so full of hypocrits and idiots it is unreal. And people want these idiots making all the decisions about our health-care?
Is the government on the way to denying seniors their meds? You d– betcha they are!
I just hope they really will consider this. Getting yourself in the heath care industry is worth it if this will pursue.
Mariz from College Network
Awesome website…
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