RoR: Forum

I love #1. Number two, eh, not so much. While it's fine and good to offer charity if you're able, I would never make it a business "policy."

My own contribution would be to: specialize in a medical discipline and accept donations. Maybe allow for do-good types to organize fund raisers to pay for the charity cases. I'd also freely allow drug companies to conduct studies and drug trials for a fee on my patient list.

Post 1

Tuesday, September 15, 2009 - 4:20pm

I'd make it a policy to never inquire into the insurance status of my patients (private, Medicare, Medicaid...) Patients would recieve a bill for services, and be responsible for payment. They would carry their bills home, submit them for reimbursement to their insurance, Medicare, or Medicaid providers, their bank account, their friends, their church, charity, whatever, not my business. My hospitals back office would bill patients, period, and they would have the normal rules of commerce apply to their bills.

If patients requested 'direct billing,' my hospitals would charge an additional $10,000 per instance, purely to discourage this insanity.

Patients would be directly aware of and involved with the costs associated with their own care. and doctors would not directly deal with insurance companies, ever. The relationship between insurance companies and their insured would be between them, and they would be free to look at copies of our bills--provided by the insured.

Of course...the government programs would not permit this, even though this was the model prior to medicare/medicaid. (Insurance companies reimbursed, did not directly pay...)

It was not until the 60s, when the government introduced Meidcare/Medicaid, that health care providers back offices had to handle 'third party payer', and the entire marketplace became corrupted. But since their back office operations had to handle medicare/medicaid thrid party billing, privately insured patients were dragged along.

What seemed like a convenience was in fact a fatal perversion of the marketplace, the introduction of 'ring-around-the-rosy.'

Post 2

Tuesday, September 15, 2009 - 4:42pm

Fred,

That is a really good idea. I'm thinking the main problem is hospitals are required to accept particular forms of payment. I can't say I really like hospitals being required to be involved with insurance in any form. If they want to offer financing options or accept payment by insurance, its completely up to them.

It would also be nice if the hospital would provide a list of services it provides and prices. So then if the doctor recommends some kind of tests or operations, you can look up the prices and choose whether you would like to spend the money.

Some tests and operations are covered by an insurance company, while others are not. Since the person desiring the medical services generally doesn't know what tests and operations are equivocal, they would want the doctor's help to choose what service would be good for them given their insurance policy. So if a hospital would like to have customers who have a particular insurance policy, then they would probably perform this service.

I don't have medical insurance because I'm awesomely healthy.

Cheers,
Dean

Post 3

Tuesday, September 15, 2009 - 5:15pm

What Fred said. I changed my mind. lol

Post 4

Tuesday, September 15, 2009 - 6:23pm

I quite admit that when I was young, I did nt have insurance either, for the reason I was healthy, always had been, and [ silly or shortsighted or not] not thought it likely to be needing it for many many years - if ever!! But when had it offered as part of my working for Morrison's, took it - and was very glad I had, as THEN it was had a dislocation of right ankle, with all the needed medical and long-term post op care, not from the government but the insurance, so my base pay was covered even when wasn't able to work... is how life so often goes, in that when young, one does not [truly, we don't!] believe anything will happen to us to need such things - they're for 'old people'... then when get it old, hate that the premiums are high, etc. etc. etc.... so true, tho - if had been given this information on the nature and usefulness of health insurance, not as an 'ad' of insurance companies as so oft was, but as a 'disinterested' info, perhaps would had carried it earlier, and not depended on 'luck' to have gotten me thru this [as, for sure, if not had that as part of the job, would had been truly 'up the creek' in bills and job loss and loss of personal possessions and so much more]...

But to add - even with insurance, if had to do it via reimbursement method, that would have sucked me dry too - there is good valid reason for having it paid by insurance, with the paper copies given to me as well - or via perhaps a 'medical card' that I apply after being billed, so know what all is involved moneywise... few would be able to function with reimbursement - is the cash flow problem...
(Edited by robert malcom on 9/15, 6:31pm)

Post 5

Tuesday, September 15, 2009 - 8:11pm

Robert:

Yeah, insurance is a "cash flow controller" and by its nature is there to diminish the impact of large fiscal setbacks (loss of life, disability, etc.)

---

To all:

Thanks for the input. The only point I really wish to underscore is that entrepreneurialism applied to the health care system results in creative, value-added solutions that meet the needs of both businessperson and customer (oh, whoops I meant patient ;)

Post 6

Tuesday, September 15, 2009 - 8:44pm

1. A health savings account started at birth, linked to a co-op format organization where its used for traditional banking loans. Transferable to other healthcare systems.

2. Aggressive use of low and mid level practioners to cut costs.

3. Aggressive triage of drug seekers and frequent flyers.

4. Mandatory up front fees for non-insured patients indexed to the price of cable television.

5. Lobby for drastically increased power to all levels of healthcare professional. You shouldn't need a doctor to prescribe extremely common prescriptions or to treat common complaints. You wouldn't believe how many things can be treated via protocol.

6. Lottery system feeding profits into a benevolence fund. Fund used to defray cost of charity cases which would be aggressively screened.

Post 7

Wednesday, September 16, 2009 - 5:09am

Fred Bartlett wrote:

I'd make it a policy to never inquire into the insurance status of my patients (private, Medicare, Medicaid...) Patients would recieve a bill for services, and be responsible for payment. They would carry their bills home, submit them for reimbursement to their insurance, Medicare, or Medicaid providers, their bank account, their friends, their church, charity, whatever, not my business.

It's fun to fantasize, but I bet this fantasy hospital would be a financial flop. Hospitals inquire about insurance because they expect to get paid. You might require patients to pay in advance, which would severely limit the number of patients. You might provide the service and then rely on the patients or their assignees to pay you later. Good luck trying to collect! You will need a costly financing and collections operation to support the hospital.

(Edited by Merlin Jetton on 9/16, 5:53am)

Post 8

Wednesday, September 16, 2009 - 7:22am

Merlin:

The difficulty you are describing is called 'commerce.'

You mean, such a practice would bankrupt any nation that attempted it?

I think your comment is dead on illustrative. If I was a short sighted hospital administrator, I would look for the easiest way to verify that my clients could actually pay for their bills.

And, what easier way than proof of insurance?

And, if I was already forced to bill third parties, because of the imposition of Medicare/Medicaid, then I would leverage that requirement by offering direct billing as a convenient service to my clients.

And, for a few decades, so would my competitors, until we had all totally corrupted the marketplace with third party payer ring-around-the-rosy, and brought ruin down on what was once a vital and thriving segment of our economies.

At that point, I would, sadly, recognize that what looked good based on my short-term analysis was fatal in the long term.

Why should hospitals and health care providers be removed from the same discipline/risk of 'commerce' that governs what is left of the balance of the free market? It is exactly that risk/discipline that controls costs.

I'm a self employed "S" Corp contractor, been paying for my own health insurance for over 25 years. I used to include 'dental' coverage, but it was notoriously not a good deal; I think the coverage cost me $600/yr...but it also had a $1000/yr cap on payout. So, I decided to remove the dental coverage and 'self-insure.' I thought, "Hell, if the insurance company can make money insuring my dental coverage, then so can I."

Suddenly, when I went to my dentist and told him I was 'self-insured'... the same cleanings and services suddenly got cheaper. Everytime he performs a service, he actually has to look me in the eye and say, 'that will be $75.' The days of anonymously billing my dental insurance policy are over...and I'm not only saving money, I'm...saving money.

My dentist might have even liked the old arrangement better. But, I'm still on the hook for my dental bills, and he still accepts my commerce.

And, costs are controlled.

Now, separately... if I obtained 'dental insurance', and carried my now smaller bill home, and filed for reimbursement from my insurer, then... what business is that of my dentist? His commerce with me is not my commerce with my insurer.

The marketplace is directly perverted by introducing third-party-payer ring around the rosy.

But, you are right: if my 1000 hospitals are the only hospitals who operate in this fashion-- ie, the way hospitals used to operate before the impressed overburden of Medicare/Medicaid third party payer(and, the pertinent lesson in that is, 'before the current crisis in the marketplace') -- then my 1000 hospitals would likely suffer first... before the entire system collapsed under the present market corruption.

So, if we are talking about a scenario in a life boat circling the drain, I agree with your analysis; don't be the last one down the drain.

regards,
Fred

(Edited by Fred Bartlett on 9/16, 7:34am)

Post 9

Wednesday, September 16, 2009 - 7:48am

Medicare/Medicaid is a separate debate -- whether one agrees with Hayek's safety-net or not is another issue.

The issue is, Medicare/Medicade, as part of that safety net, could have been and should have been implemented as a reimbursement insurance program, not direct third party payer. And, private insurance should have remained a reimbursement model.

Patients would have direct knowledge of and interest in the costs associated with their treatment if these were reimbursement programs. The government would not be in the ludicrous position of contemplating building an even larger bureaucracy to 'oversee costs' because each and every patient would instead be pouring over his own bill and handling his own reimbursement/payment for his own services -- even if paid for via public safety net/welfare. We would all now be actively pouring over our own bills.

"You want to bill me how much for a damn aspirin? I don't think so..."

"You walked into my room while I was recovering, we chatted about the Red Sox, and you want to bill me $2,500? For doing what?"

When humans look other humans in the eye and bill them for services, they don't wane insane. When instead they fire up ever more convenient technology in their high school girls on roller skates back offices... laser printers...fax machines...modems....internet connections...to anonymously bill remote third party payers for what they may when they may, then the market is severely corrupted.

Of course 'third party payer' is a 'profitable' gig, but ... the party is over. Time for a new drug of choice...

Post 10

Wednesday, September 16, 2009 - 8:27am

All third-party payer arrangements aren't alike. Medicare, Medicaid, and employer- paid health insurance strongly insulate the first party from the cost of medical care. Somebody else is paying the bill and there is hardly any incentive for the patient to keep the cost down. An individual buying health insurance and bearing the full cost also involves a third party, the insurer. However, there is a stronger link between the amount the individual, or first party, pays -- the premium -- and the associated cost of medical care.

Post 11

Wednesday, September 16, 2009 - 11:42am

Merlin:

I'd buy most of that, they are different. But under a reimbursement model, both would become aware of the actual costs associated with their treatment. Not only that, but both would benefit from a marketplace in which the supplier of the service is looking someone in the eye and billing that human being for service.

In fact, all participants in the same marketplace -- the self insured, the privately insured, and the publicly insured -- all mutually benefit from the same discipline in the marketplace, no matter what their personal incentives are.

That is at least part of what is wrong with the current marketplace -- all of the participants, including the self insured and the privately insured and the publicly insured -- are being hammered by the current market perversion.

regards,
Fred

Post 12

Wednesday, September 16, 2009 - 12:08pm

Fred, I'm not sure what you mean by "reimbursement model". It seems you mean the insurer only pays the insured, who is responsible for paying the health care provider. Even if this were not the case -- the insurer pays the health care provider -- the insurer can still inform the patient of the cost. This happened the only time I was a hospital patient.

That is at least part of what is wrong with the current marketplace -- all of the participants, including the self insured and the privately insured and the publicly insured -- are being hammered by the current market perversion.

I strongly agree. Medicare, Medicaid, and employer-paid insurance largely insulate patients from the cost of medical care.

(Edited by Merlin Jetton on 9/16, 12:26pm)

Post 13

Thursday, September 17, 2009 - 6:48am