News Most US doctors now support a national health plan

[turbo]

Actually, the doctors in large practices are heavily insulated from day-to-day contact with insurance companies. Those roles are filled by coding specialists, accounting managers, practice managers, and IT specialists such as myself. Doctors know from their staff about the generalities surrounding delays and denials of payment, but they are not "in the trenches".

 

[mheslep]

Actually, the doctors in large practices are heavily insulated from day-to-day contact with insurance companies. Those roles are filled by coding specialists, accounting managers, practice managers, and IT specialists such as myself. Doctors know from their staff about the generalities surrounding delays and denials of payment, but they are not "in the trenches".

Yes, yes, I mean their offices, their agents if you will, and thus the docs are very cognizant of the costs and time involved.

 

[WheelsRCool]

This is the reason that Medicare and Medicaid are so horrendously expensive. They are publicly funded, but they are forced to obtain services from a private system that is terribly expensive, inefficient, and laden with administrative overhead. The insurance companies have bought Congress (both sides of the aisle) to prevent the establishment of a single-payer or public-option program.

Not saying you are wrong, but are you sure you don't have this backwards? From my understanding, it is Medicare and Medicaid that drive up the costs of healthcare in the private sector, because there is a price ceiling on how much the private sector can charge them.

They are publicly-funded, government-run health insurance companies, that themselves are very inefficient and expensive, but since the private sector cannot charge people on Medicare and Medicaid beyond a certain price, the private sector is thus forced to yank up prices elsewhere or flat-out ration to make up for the lost money.

 

[turbo]

Not saying you are wrong, but are you sure you don't have this backwards? From my understanding, it is Medicare and Medicaid that drive up the costs of healthcare in the private sector, because there is a price ceiling on how much the private sector can charge them.

They are publicly-funded, government-run health insurance companies, that themselves are very inefficient and expensive, but since the private sector cannot charge people on Medicare and Medicaid beyond a certain price, the private sector is thus forced to yank up prices elsewhere or flat-out ration to make up for the lost money.

The coding standards and rules enforced by Medicare and Medicaid are simple and relatively easy to understand and comply with. Thus, even if their reimbursal rates are somewhat lower than the ideal private insurer, the doctors can live with that because the administrative overhead that private payers impose on them to fight arbitrary denials and delays aren't present. If there was a single-payer insurer in this country with ONE set of rules and coding standards, doctors and hospitals could eliminate a vast amount of waste imposed by administrative overhead. Private insurers love to create mazes of rules and coding standards allowing them to (seemingly legally) delay or deny payments to providers. This behavior should be criminal. The insurance companies make fortunes on pools of unpaid claims, much like the banks used to do by dragging their feet while clearing checks. The unpaid balance is called the "float". The government forced the banks to clean up their acts, but allows the insurance companies to perpetrate much more egregious frauds on the public - for profit.

 

[Hurkyl]

The coding standards and rules enforced by Medicare and Medicaid are simple and relatively easy to understand and comply with...

Was there supposed to be a reply to WheelsRCool's objection in there? It looks to me as if you completely ignored him and went off on a canned spiel.

 

[turbo]

Was there supposed to be a reply to WheelsRCool's objection in there? It looks to me as if you completely ignored him and went off on a canned spiel.

The administrative overhead imposed on health-providers by the varied and ever-changing coding requirements of the private insurers is onerous and is making US health care far more expensive than it should be. In contrast, Medicare and Medicaid requirements are simple, monolithic, and easier to comply with, requiring doctors and hospitals to spend less money to secure timely payment. Doctors can submit a claim to a private insurance company only to have it denied because the doctor did not require some elaborate screening/diagnostics (which the insurance companies don't want to pay for anyway) in order to justify the medical necessity of a procedure of treatment, or because their staff did not justify the care based on some treatment code that the insurer did not previously demand.

Is that clear enough? What you call a "canned spiel" is a cogent response from a person who has spent years in the bowels of the health-care industry. Do you want a Master's thesis on the subject? I don't have that much time.

 

[WheelsRCool]

A problem though is I do not see single-payer as a magical solution to our healthcare problems either, especially when looking at ones in other countries.

Private insurance companies versus government-run health insurance companies, both have bureaucrats, in private companies, corporate bureaucrats focus on squeezing out as much profit as possible, which can lead to denying care they otherwise could give, whereas in government-run companies, government bureaucrats focus on spending as much money as possible, which leads to inefficiency, too much bureaucracy, etc...plus as also is a concern, the control it gives to government.

 

[Hurkyl]

Is that clear enough? What you call a "canned spiel" is a cogent response from a person who has spent years in the bowels of the health-care industry.

I called it a "canned spiel" not because of whatever merits it may or may not have as an argument, but because you seem eager to make point X, despite the fact WheelsRCool was talking about the related, but different point Y.

Clear would be:
* "No, Y doesn't happen. (insert proof)", possibly followed with "X is what's happening. (insert proof)"
or
* "Yes, Y does happen. However, X is a much more significant factor. (insert proof)"
or
* "Yes, I think Y does happen", possibly followed with "X is happening too. (insert proof)"
or even
* "I have no idea about Y", possibly followed with "however, I know X is happening. (insert proof)"

 

[turbo]

To get the insurance-company supporters educated, please Google on "medical coding" and see what comes up. Instruction in how to properly code medical procedures in order to actually get paid by the insurance companies is a huge industry. Every year, new coding guides come out, and every year, doctors are denied payments as the insurance companies change their coding requirements.

My cousin is a coding specialist for a pediatric ophthalmologist. It is a one-doctor practice. The only reason that he can afford to pay his staff based on a primarily Medicaid clientel is that the coding requirements are simple and easy to comply with, and he gets paid promptly. She previously worked for the large multi-location ophthalmic practice that I worked for. Because of the simplified coding for public health-care payers, she is able to also act as his office manager. If he was reliant on private insurers, he would have to go back to a group practice with their high overhead in order to make a living.

 

[turbo]

I called it a "canned spiel" not because of whatever merits it may or may not have as an argument, but because you seem eager to make point X, despite the fact WheelsRCool was talking about the related, but different point Y.

Clear would be:
* "No, Y doesn't happen. (insert proof)", possibly followed with "X is what's happening. (insert proof)"
or
* "Yes, Y does happen. However, X is a much more significant factor. (insert proof)"
or
* "Yes, I think Y does happen", possibly followed with "X is happening too. (insert proof)"
or even
* "I have no idea about Y", possibly followed with "however, I know X is happening. (insert proof)"

It is easier and cheaper to gain timely payment from Medicare and Medicaid than from private insurers, because their standards and coding requirements are consistent. When you overlay a public-payer program on top of a private-payer system that is already expensive and overly complicated, you subject the public-payer system to much higher base costs than would be extant, absent the demands of the private insurers.

 

[bleedblue1234]

We simply cannot afford a public plan at this point, period- end of story...

 

[drankin]

We simply cannot afford a public plan at this point, period- end of story...

Pretty much the most practical statement in this whole thread. This isn't the time to spend money we don't have.

 

[mheslep]

We simply cannot afford a public plan at this point, period- end of story...

Pretty much the most practical statement in this whole thread. This isn't the time to spend money we don't have.

Yes, but as I posted https://www.physicsforums.com/showpost.php?p=2247474&postcount=72", I suggest we have had enough of the their-idea-is-broken, period, type responses. There are problems and what we need is more discussion of ideas that will work.

 

[bleedblue1234]

One thing I can tell you is no one in Washington or anywhere else, no select group of people (even the "experts") can pretend to know what is best for each individuals specific medical needs... thus a "national plan" would most likely envolve HUGE amounts of waste and mal-investment, and since the public plan has absolutely no need to have a balanced budget or stay solvent in any way, the public option can get as big as it wants...

Barrack Obama put out the old straw-man when he said something in effect to this, "well if public health care is so bad then why would you want to switch if it can't compete with private healthcare"... well it will compete just at a much greater cost and people also fail to realize these health care costs are coming from somewhere (whether it be taxes, inflation, whatever) SOMEONE somewhere is footing the bill for this public plan... and unfortunately it will most likely be the middle and lower classes... as it usually is...

We have $65+ trillion liabilities projecting into the future, and we simply CANNOT afford any form of nationalized health care... especially throughout the United States (great EU countries can do it but they are a fraction of the size and complexity of the US, and they have their own issues with it)...

But the current system is undoubtedly badly broken and we need to stop this nonsense, and I don't have an answer as to how, but a government option is surely the wrong way to go about it, as it will be even worse...

 

[mheslep]

One thing I can tell you is no one in Washington or anywhere else, no select group of people (even the "experts") can pretend to know what is best for each individuals specific medical needs... thus a "national plan" would most likely envolve HUGE amounts of waste and mal-investment, and since the public plan has absolutely no need to have a balanced budget or stay solvent in any way, the public option can get as big as it wants...

Barrack Obama put out the old straw-man when he said something in effect to this, "well if public health care is so bad then why would you want to switch if it can't compete with private healthcare"... well it will compete just at a much greater cost and people also fail to realize these health care costs are coming from somewhere (whether it be taxes, inflation, whatever) SOMEONE somewhere is footing the bill for this public plan... and unfortunately it will most likely be the middle and lower classes... as it usually is...

We have $65+ trillion liabilities projecting into the future, and we simply CANNOT afford any form of nationalized health care... especially throughout the United States (great EU countries can do it but they are a fraction of the size and complexity of the US, and they have their own issues with it)...

But the current system is undoubtedly badly broken and we need to stop this nonsense, and I don't have an answer as to how, but a government option is surely the wrong way to go about it, as it will be even worse...

More of the same. At the moment I don't care to here any more about Barack Obama, or what can not be done. Health care costs are increasing 7 to 9 percent a year. The pool of people without coverage is increasing as these costs increase. What do you propose be done about this unsustainable problem?

 

[Al68]

More of the same. At the moment I don't care to here any more about Barack Obama, or what can not be done. Health care costs are increasing 7 to 9 percent a year. The pool of people without coverage is increasing as these costs increase. What do you propose be done about this unsustainable problem?

First, do no harm. Doctors used to think if someone was sick, they had to do something. Not anymore. Now they consider doing nothing to be much better than doing something unless they have good reason to believe that the something will make the problem better. Hence, first, do no harm in the Hippocratic Oath.

Maybe we need such an oath in politics to replace the "well, we must do something" attitude that has done so much harm, just like it used to do to medical patients before the Hippocratic Oath.

 

[mheslep]

Which is not connected any way this case: the economic of heath care. Think your car if you must: its been wrecked[*]. Not totaled, it still runs, quite fast in fact but the tires are shot, it leaks oil all the time and the repair costs are killing you. You do not sit on the porch musing about 'do not harm'. The dam thing is going to leave you on the side of the road soon or worse.

The Mechanic:
http://www.hoover.org/publications/digest/3459466.html

*Wrecked by the government in WWII.

 

[Hurkyl]

"Do nothing" is a choice of a specific course of action to adopt, and as such it must be evaluated on the same level as the choice of any other specific course of action.

 

[turbo]

Which is not connected any way this case: the economic of heath care. Think your car if you must: its been wrecked[*]. Not totaled, it still runs, quite fast in fact but the tires are shot, it leaks oil all the time and the repair costs are killing you. You do not sit on the porch musing about 'do not harm'. The dam thing is going to leave you on the side of the road soon or worse.

The Mechanic:
http://www.hoover.org/publications/digest/3459466.html

*Wrecked by the government in WWII.

Thank you. Of every dollar spent for health care in the US, over 30 cents goes to pay for administrative costs. We cannot afford not to have public health care, or at least a public health care option against which private health care must compete.

This not a liberal vs conservative situation. It is an economic choice in which most real conservatives would select the most effective/least expensive option. Ironically, neo-cons rail against the more conservative option almost reflexively. The GOP hard-line is that if you cannot afford health care and preventive treatment, too bad. Not good, because poorer patients that cannot afford preventive health care present themselves to doctors too late to be good prospects for survival and drive up the cost of all our own coverages.

 

[Al68]

"Do nothing" is a choice of a specific course of action to adopt, and as such it must be evaluated on the same level as the choice of any other specific course of action.

Fortunately, modern doctors reject that notion due to the Hippocratic Oath.

They consider "do nothing" the default correct action in the absence of good reason to "do something". Not to mention the obvious fact that a lack of action is not morally equivalent to action.

This results in a doctor being restricted to only those actions that he/she has good reason to think will help. My suggestion was that maybe we need to extend that oath to politicians.

 

[Al68]

Which is not connected any way this case: the economic of heath care. Think your car if you must: its been wrecked[*]. Not totaled, it still runs, quite fast in fact but the tires are shot, it leaks oil all the time and the repair costs are killing you. You do not sit on the porch musing about 'do not harm'. The dam thing is going to leave you on the side of the road soon or worse.

Well, then, I'll just try to fix it by taking the brake rotors off, then drive it. Since I skipped the "do no harm" musings.

 

[mheslep]

Thank you. Of every dollar spent for health care in the US, over 30 cents goes to pay for administrative costs. We cannot afford not to have public health care, or at least a public health care option against which private health care must compete.

This not a liberal vs conservative situation. It is an economic choice in which most real conservatives would select the most effective/least expensive option. Ironically, neo-cons rail against the more conservative option almost reflexively. The GOP hard-line is that if you cannot afford health care and preventive treatment, too bad. Not good, because poorer patients that cannot afford preventive health care present themselves to doctors too late to be good prospects for survival and drive up the cost of all our own coverages.

I do not support the public option Turbo, I oppose it. The only thing that drives productivity increases is competition, not having the government control everything. It happens that I don't care to hear any more 'everything is okay, do nothing' arguments either. See the Milton Friedman link above in this line.

Also: I believe the 'competition' between public care and private care argument is spurious, as were the President's comments on same. The public system can subsidize the price down below cost by running up the debt some more. It can, it will, and it has. See a near perfect analogy of Florida running off all the private home owners insurers with their (underfunded) state home insurance system. No Allstate, no Nationwide, no State Farm; they are gone in Florida, run off by the state.
http://online.wsj.com/article/SB124623134986666161.html

 

[Hurkyl]

Fortunately, modern doctors reject that notion due to the Hippocratic Oath.

I don't consider that fortunate. I'd rather when they do nothing, they do nothing because it's the best choice of action.

 

[Al68]

I don't consider that fortunate. I'd rather when they do nothing, they do nothing because it's the best choice of action.

It seems you miss the point of the Hippocratic Oath. The point isn't to not do what is best for the patient. The point is that in the absence of a good reason to do "something", doing nothing is the best choice.

Doing no harm is more important than doing "something".

 

[Al68]

Also: I believe the 'competition' between public care and private care argument is spurious, as were the President's comments on same. The public system can subsidize the price down below cost by running up the debt some more.

Advocates could of course create a non-taxpayer funded entity to compete similar to the USPS. They haven't and they won't. They know they could never compete.

They have always been perfectly free to compete with existing companies, even without any government support.

We are supposed to believe that in the current insurance market there is enough potential for improvement that investing in a new competitor would be a sure way to make enormous profits, yet nobody is interested? Is there a shortage of rich people who want to get richer?

 

[mheslep]

It seems you miss the point of the Hippocratic Oath. The point isn't to not do what is best for the patient. The point is that in the absence of a good reason to do "something", doing nothing is the best choice.

Doing no harm is more important than doing "something".

No, you miss the point. It is indeed to do what is best for the patient, but given imperfect knowledge and the human bodies ability to heal itself, then it may often be the wisest course for the physician to do nothing that has a possibility of doing harm.

All of which has at best an imperfect parallel to economics and the US health system; that mismatch is not improved by repeating 'Hippocratic Oath'.

 

[Al68]

No, you miss the point. It is indeed to do what is best for the patient, but given imperfect knowledge and the human bodies ability to heal itself, then it may often be the wisest course for the physician to do nothing that has a possibility of doing harm.

All of which has at best an imperfect parallel to economics and the US health system; that mismatch is not improved by repeating 'Hippocratic Oath'.

I don't know what point you think I missed, since my post was consistent with this one. The main point is that there is no automatic advantage to "doing something" over "doing nothing". And too many politicians seem to think that doing "something" is always better than doing nothing. And usually, the "something" is worse than doing nothing. That's the parallel.

I never said the parallel was perfect. But your post expands it. In economics also, we have imperfect knowledge and its ability to heal itself.

 

[Hurkyl]

The main point is that there is no automatic advantage to "doing something" over "doing nothing".

And the converse is true as well. I see quite a lot of people in these kinds of discussions who want to exempt the choice to do nothing from requiring justification, almost to the point of being offended at the suggestion that one should consider the merits (or lack thereof) of such a choice.

Such people, when faced with no good option, they will often advocate doing nothing -- even if it happens to be the worst option of all -- because they focus on what's bad about the various ways of doing something, but never weigh that against what might be bad about doing nothing.

 

[Al68]

And the converse is true as well. I see quite a lot of people in these kinds of discussions who want to exempt the choice to do nothing from requiring justification, almost to the point of being offended at the suggestion that one should consider the merits (or lack thereof) of such a choice.

Such people, when faced with no good option, they will often advocate doing nothing -- even if it happens to be the worst option of all -- because they focus on what's bad about the various ways of doing something, but never weigh that against what might be bad about doing nothing.

Inaction isn't equivalent to action. And as a matter of fact, I don't need to justify doing "nothing".

As an obvious example, a crime require a specific action. The cliche defense "I didn't do anything" is a valid defense to an accusation of wrongdoing.

Actions can be crimes. Defining the lack of an action as a crime is the definition of slavery.

There is a famous example in philosophy classes about a railcar with a lever that if pushed would switch tracks and kill someone, but if not pushed would kill 10 people that are on the current track. The moral dilemma is that moving the lever is murder, while doing nothing "fails to save" 10 people.

While people may disagree about whether or not to pull the lever, choosing to "do nothing" is not murder.

 

[Hurkyl]

Inaction isn't equivalent to action.

This is a semantic game, nothing more.

As an obvious example, a crime require a specific action. The cliche defense "I didn't do anything" is a valid defense to an accusation of wrongdoing.

Except, of course, when it isn't. It didn't take much searching to find examples like this.

Another example, although I'm not a lawyer and cannot be sure, is that if you notice that you received property mistakenly (e.g. the cashier at the grocery store gave you too much change) and decide to keep it (an inaction), then you have committed theft.

This isn't made up off the top of my head -- I spent a few minutes actually looking at legalese. Unfortunately, I wasn't able to find anything crystal clear[/size]

Actions can be crimes. Defining the lack of an action as a crime is the definition of slavery.

When did we start talking about crime anyways? I don't see how this is relevant, since we're talking about people whose job it is to make these decisions.

There is a famous example in philosophy classes about a railcar with a lever that if pushed would switch tracks and kill someone, but if not pushed would kill 10 people that are on the current track. The moral dilemma is that moving the lever is murder, while doing nothing "fails to save" 10 people.

It wouldn't be a famous example if it was settled that easily. e.g. an alternative interpretation is that it demonstrates how vigorously people will try to search for any technicality to try and absolve themselves from making a difficult decision.

 

[Al68]

Except, of course, when it isn't. It didn't take much searching to find examples like this.

I notice in this example inaction isn't equivalent to action. Failure to rescue isn't the same as murder.

The bottom line is that most moral codes don't consider inaction to be the same as action. And most laws. That doesn't mean inaction is never wrong of course.

And semantically, if they were the same, there would be no such word as inaction.

 

[mheslep]

..

I never said the parallel was perfect. But your post expands it. In economics also, we have imperfect knowledge and its ability to heal itself.

Alright I'll torture the analogy one more time in hopes of bringing the discussion back on topic (US health care). The body (the economics of the health system) has not been left alone. The patient is on the table, and somebody (the government) stuck a knife in long, long ago. A reasonable course might be to stop any further meddling and have the government pull its knife out: eliminate limitations on state only insurance, eliminate employer based health care that's rigged by the federal tax code and kills competition, cap run away malpractice law suits and consequent defensive medicine costs enabled by tort law. But to just walk away from the table and do noting is not in any sense a reasonable option.

 

[mheslep]

A history of meddling with the US health system:
(Not Krugman, but a comment)
http://krugman.blogs.nytimes.com/20...ot-a-bowl-of-cherries/?apage=7#comment-192283

...the US has not used the standard competitive market model for the last say, 70 years... To understand how we got in this situation we need to understand inflation and the history of the US medical insurance industry.

There are several factors related to the inflation of medical coverage in the United States. One is the amount of doctors available. The American Medical Association beginning in 1910, decided everyone would benefit from fewer, more highly trained doctors, and that medical schools should raise standards, tuition and improve facilities, the number of medical schools then dropped from 131 to 81, and of course the fee doctors charged went up.

Soon after it was the American Hospital Association that expanded prepaid hospital service plans that had just been developed to the community level, a precursor to Blue Cross Blue Shield (set up in the 1930s) this eliminated the need for hospitals to offer competitive prices against each other, as they all began to pull money out of the same pool. Prices again went up.

The real spike in health care inflation happened as a result of what happened in 1940-1960 [*], when we went from under 20mil people insured to 140mil, or aprox. 75% of the country. After which, health care costs went up approximately 6.5% per year until 1970 and continued at a rate of 4% since, until it spiked at 90% in 2004 and then dropped to where we are now, at 85% covered. Despite advancements in technology that have made the same level of health care cheaper, and other methods such as outpatient care, the price of medical coverage is through the roof, but then again so are doctor’s salaries, hospital profits, and the markup on pharmaceuticals...

*due to WWII wage and price and controls and the subsequent special off-the-books tax status of health benefits.

 

[bleedblue1234]

The main issue here is government interference distorting what the market can bear and what the market should bear. The argument currently is that everything costs too much so why don't we subsidize it through the government rather than letting market forces drive the cost of ridiculously expensive drugs down to the point where the average American making a moderate income can afford to purchase them (not just drugs, health care in general).

Also people need to realize that health "insurance" is just that ... insurance against damages. I don't buy house insurance so that if my light bulb burns out I call State Farm to the rescue, on the contrary, I fix it myself. Much the same in health care, people use "health insurance" as if it should cover every facet of medical expenses, rather than covering the 'big issues' (cancer, heart attacks, etc.)

Another factor that pushes health care costs high is just the fact that Americans taken as a whole are pretty unhealthy. We do not eat many good fats (fish, etc.) and we instead consume fats and oils like nobody's business. We choose to forgo prevention and instead look to quick fixes or just 'doing nothing' (and this is especially prevalent in the minority communities.)

Another issue health care costs a considerable amount is government interference in the system through medicare, medicaid, managed care... etc... education and health care costs seem to be going through the roof, and that is what happens when government steps in in unforeseen ways and tries to subsidize or somehow fund health care...

Insurance companies also have a stranglehold on much of government through lobbyist organizations and the like, and they push through drugs through the market so they can make as much profit as possible... and the issue also seems to be like of generic alternatives (some medicines cost a fortune while you can buy generics of other at Walmart for $3-4 per month) and issues with over medicating are also an issue.

So it basically comes down to government interference and societal values concerning what 'health care' really means and what health insurance should provide us... but a government plan is not the answer... considering we have extremely large liabilities moving forward and a lack of any meaningful case where a country on a scale of the United States has had success with a single-payer system.

And the Liberals and a lot of Americans continue to push for a "competing" health plan... well there is no sensible way for a government funded agency to 'compete' with private insurance companies due to the fact A) the government has (virtually) unlimited pocketbooks and can run deficits year after year (amtrak etc.) B) Employers will happily dump coverage for the employees if a public option is available due to the fact that it is cheaper (thus making it the only option) and C) the government program is bound to include all sorts of bureaucracy and waste that this country simply CANNOT afford... we just simply CANNOT afford a new system right now, the best course of action would be to 'reinvent' the old one...

 

[mheslep]

Harvard economist G. Mankiw on http://gregmankiw.blogspot.com/2009/07/costs-versus-efficiency.html"

The bottom line: Low administrative costs are not to be confused with high administrative efficiency. In other words, administrators are not necessarily a deadweight loss to the system.