Tag Archives: Medicare

MEDICARE AND OUR OUTRAGEOUS MEDICAL CARE PRICING PROGRAM

This is a true story.  A family member had an accident in the home.  She took a nasty backward fall and her head slammed against a piece of sharp edged furniture.  The result was a bloody mess and a call to 911 for assistance.  Ambulance, police and fire department vehicles were promptly on the scene.  The patient was transported to the hospital about 4 miles distant.

Three stitches were required to close the wound.  Some tests were made to be sure there were no hidden injuries.  Twelve hours later the patient was released and walked out of the hospital.  It was as simple as that; there were no extenuating circumstances.  The medical care was good; the healing was complete.  That’s not the story.

When the bill came, it was $27,607.92.  That’s the story.  One item was $13,541.54.  It was called Trauma Response Level II.  That’s the price for the house call.  The other items were all various hospital charges.  One does not expect good medical care to be cheap but having to pay these prices is bizarre!  But wait.

There were two more items on the bill.  One item was Insurance Paid $1,610.51.  The other was Insurance Adjustment $25,947.41.  Translation – A) the prices were highly inflated, and B) nobody paid the artificially inflated prices.  Nobody was ever expected to.  The injured was a Medicare patient.  Medicare only pays a certain percentage of the “price” for each service, so the price is set high because the percentage paid is low.  There is something seriously wrong with a system that requires healthcare providers to bill at horrendous rates in order to receive modest remuneration for their services.  That’s the story.

Oh yes, there was one more item.  There was a box at the top of the bill that read Your Portion $50.00.  And so in round numbers, the patient paid $50, the healthcare providers got $1,600 but they had to bill for $27,000 to get it.

What about the uninsured, perhaps a mid-life family provider currently out of work, a foreign tourist or a member of the perpetually unemployed?  Is there a separate billing rate for them?  In some cases there is not.  Full rate billings happen every day.  In these cases it is up to the patient to negotiate a better rate.  It’s similar in the doctor’s office.  There is a list price, the price an insurance company pays and there is the price Medicare pays, all different prices for exactly the same service.  What you pay if you are uninsured may be different from all the other three and it will be the highest.  Health care in America is superb.  The financial administration of it stinks.

WHAT’L YA DO IF YA GET SICK IN 2025?

Richard Foster is the chief actuary for Medicare.  An actuary is someone who is a whiz bang with numbers and smarter than Einstein or even Paul Ryan.  Foster is the man behind the numbers of the recently released Medicare Trustee’s Annual Report.  At a conference hosted by the American Enterprise Institute, Mr. Foster explained that his calculations show Medicare (with Obamacare included) will run totally out of funds in 2024 as it is currently structured.

Foster’s actuarial machinations assume the federal government will cut payments to doctors by 30.9% in compliance with mandates already written into the law.  But they won’t do that.  Without that reduction in government expense the funds will be depleted even sooner.  The assumption is unrealistic, but as Foster explains, government actuaries are not given the latitude to do their math on the basis that the government will not enforce the law.

In the name of extending coverage to include everyone, the Democrats created a plan that in 10 years will cover no one.  Something will have to change.  That’s not an opinion; it’s arithmetic.

YOUR DOCTOR’S POSITION on OBAMACARE

What’s your doctor’s opinion of Obamacare?  Most doctors are tight-lipped with patients who ask where the doctor stands on Obamacare.  With political issues are as tense as they are today, any discussion has the potential of becoming a contentious one.  Doctors are there to heal, not to open wounds.  So we must look elsewhere for the answer to the question and we find your doctor’s opinion is decidedly negative.

The American Medical Association (AMA) was for more than 160 years the primary organization representing the interests of physicians in America.  It is the medical association most often quoted by the media.  The AMA supports Obamacare.  Doctors are leaving the AMA in droves.  Fully 47% cited their reason for discontinuing their membership was the association’s support for Obamacare.  After the exodus, only 17% of doctors practicing in America continue as members.  Now that’s a statement!

The Patient Protection and Affordable Care Act (aka Obamacare) does take a haircut out of reimbursements to physicians for services rendered to Medicare and Medicaid patients.  But to say that this is the only reason for their opposition to the Obama/Pelosi plan would be to indict the whole fraternity of physicians as unable to keep their priorities straight.  Such is simply not the case.

Sally Pipes, writing for Forbes:

More than three times as many doctors believe that the quality of American health care will “deteriorate” rather than “improve” under ObamaCare.  Nine of ten physicians think ObamaCare will have a negative impact on their profession.

Another gripe is that nothing in ObamaCare addresses the problem of defensive medicine that physicians feel forced to do as protection against frivolous lawsuits.  There is no tort reform in the new law.  Physicians are there to heal, not to practice law.  They do not like putting their patients through procedures for legal reasons, procedures they would not do for health reasons.

So now you know.  Unless your doctor is one of a small minority, he has a very negative view of Obamacare.  But he will be slow to tell you that.

MEDICARE MESSAGE FROM KATHLEEN SEBELIUS

Medicare and the New Health Law is the title of a glossy full color bulletin written by Kathleen Sebelius, Secretary of Health & Human Services. The leaflet is currently in the mail to a broad list of recipients across the nation. It is an expensive mailing, no doubt. It is little more than a propaganda piece that reads like an Obama speech with all of the same talking points.

Within the bulletin’s four pages Sebelius manages to cast aspersions on the insurance industry 5 times. For instance, in the opening paragraph we read:

It will also ensure accountability throughout the health care system so that you, your family, and your doctor – not insurance companies – have greater control over your care.  (emphasis is in the original).

The same arguments we heard from Obama when he was campaigning for passage of the bill are repeated in the bulletin: reduction of fraud, better quality care for more people at less cost, and new services to assure people “will no longer be forced into poverty”.

There is need for a letter to explain the provisions of the new law but this is not it.

Bob B

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