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Sunday, September 29 - 7:55amSanction this postReply
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My son woke up today with a case of Pink Eye. Nothing life threatening. Get some drops, goes away.

Wife takes him to doctors office. It's Sunday, so it is one of these clinics.

Doctor conducts all kinds of eye and other tests, then ... prescribes the drops. My wife is incredulous, and asks, "He really needs all these tests? It's pink eye."

So it's finally time to pay the bill. My wife lets them know we have high deductible catastrophic coverage only, and she will be paying directly, out of her checkbook.

There is a sudden wave of remorse, and the doctor amends the invoice to a 'level 1/general visit' ... which is what it always should have been to begin with. He just voids all the nonsense tests.

I guess that was him being a nice guy? I should just shut up and accept his huge sacrifice?

Because, when he thought he was a billing some nameless insurance corporation far over the horizon and outside of the room, my son was just a billable opportunity to pad an invoice with obviously un-needed tests, but when he had to look the person he was screwing over with all the uneccessary padding, suddenly they weren't necessary and he felt remorse.

This is exactly what has screwed up health care; the ability of providers to invoice third party payers directly.

Not the way health insurance used to be in the 60s(ie, before the crisis), for those who had it. Back then, a doctor would treat you, look you in the eye, and hand you a bill for service. If you had insurance, you took your bill home, sat at a desk, and filed a claim with -your insurer- for reimbursement. You paid the doctor directly. There was no 'Ring Around The Rosy' in the commerce of health care. Commerce between you and doctor. Commerce between you and your insurer. Period.

Same thing with my dentist; when I dropped my crappy dental coverage and self insured, suddenly he started charging me less. A lot less.

And now..,.Obamacare is going to institutionalize this nonsense.

I swear, its like living in a tribe of totally insane monkeys.

When a doctor asks if you have insurance, the sane answer would be 'None of your fucking business; what do I owe you?'

If everybody answered in that fashion, commerce would be restored in health care and costs would be under control.

It was MEDICARE/MEDIACAID that introduced this nonsense. As long as health care providers back offices had to accomodate direct third party payers, then private insurance providers might as well be included...not to mention, it was lucrative to bill third parties and not have to directly look patients in the eyes and get involved with filthy commerce.

The government, well meaning or not, created the crisis in health care costs. Without their fatfingering -- or at least, with more intelligent fatfingering(there is no reason MEDICARE/MEDICAID could not have operated without direct third party billing, in order to control costs for everyone in the market)-- there would be no health care costs crisis. They perverted the marketplace with this ring around the rosy nonsense.

Health care insurance under a reimbursement model keeps patients directly involved with monitoring costs. Few patients today getting care have any idea at all what they are being charged for their care.

Of course human beings like that arrangement; it is 'convenient' at the point of service. It is only the economic consequences -- the crisis in costs -- that human beings don't like.

The response in MEDICARE/MEDICAIDE? An attempt to dictate prices, which of course leads to displacement and out and out fraud. A total mess.

More insanity.

regards,
Fred




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Sunday, September 29 - 8:03amSanction this postReply
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The entire concept 'third party payer' is insane; what the fuck does that even mean?

What should it mean?

A buys services from B; C pays.

What lost episode from 'Star Trek' is that taken from??????

Seriously...where is the argument that this is a good idea?


Is it supposed to be, C pays for everybody, and so, has enormous leverage over B who must negotiate with C?


Seriously? How is that working out? C is far over the horizon when the commerce occurs. How in the world does C have any idea what and why B is providing to A, and if C is paying, why should A care at all to ask?


Seriously. Where do these theories come from? How are they ever permitted to blossom into the full light of day without just being laughed at? Who ARE these people????


regards,
Fred



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Sunday, September 29 - 8:09amSanction this postReply
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Why does a doctor ask if you have insurance?

To understand if you can pay your bill? Or to understand if you can be overbilled? I've provided specific anecdotal evidence that the answer is the latter.

"Can you afford this treatment? Yes or no?" That is commerce.

Not "Do you have insurance?"

regards,
Fred



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Sunday, September 29 - 9:40amSanction this postReply
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In hospitals, they take the patients hostage: "If you stop our expensive treatments Against Medical Advise (AMA), then we'll tell your insurance company that you did so AMA, and then the insurance will reject paying for the exorbitant bill that you've racked up so far, which we will make you pay for or destroy your credit rating."

For childbirth there is a ridiculous chain of negative consequences that frequently result in their demand for c-section, which all start from them giving a little drug to induce labor. C-section is a major surgery with a long recovery, vs my wife went home 3 hours post natural delivery and cleaned the kitchen. The hospital feeds the newborns formulas that lack essential fatty acids and antibodies vs mother's milk. Not breastfeeding and not being encouraged to breastfeed at the hospital has significant negative effects on brain development. With C-section recovery, breastfeeding is even less likely. But inducing labor and causing the need for C-section is more profitable.
(Edited by Dean Michael Gores on 9/30, 7:18am)




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Sunday, September 29 - 9:47amSanction this postReply
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Managerial economics courses discuss "moral hazards" and "perverse incentives" but somehow these terms get lost in the arguments about this type of funding for this economic sector.



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Sunday, September 29 - 11:51amSanction this postReply
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"I swear, its like living in a tribe of totally insane monkeys." -Fred

Funny you should say that...

Just read a few reviews for this book: "Starving the Monkeys: Fight Back Smarter" by Tom Baugh

He has an interesting recommended book list on his website: http://www.starvingthemonkeys.com/ReferencedBooks.html

I wish it included Mises' "Human Action".



Post 6

Sunday, September 29 - 12:31pmSanction this postReply
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Fred: Same thing with my dentist; when I dropped my crappy dental coverage and self insured, suddenly he started charging me less. A lot less.
I saw this at the dentist, and at the doctors (plural) endocrinologist and cardiologist.

In fact, one of them sends me to a clinic that takes off 20% for a cash payment.




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Sunday, September 29 - 3:26pmSanction this postReply
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This isnít to contradict anything that has been said here and is subject to rebuttal Ö just my impressions.

In 2005 I was diagnosed with congestive heart failure which necessitated a pacemaker/defibrillator and I also had a knee replacement, all in the same year. My HMO coverage was limited to $30K and I was getting billing statements over $60k. It was very complicated and I can only guess that I got off the hook because my HMO was taken over by another HMO and I think my case just got lost in the bookkeeping. Nevertheless, from what I can gather, it appears that HMOs negotiate with the hospitals and get a much lower rate (perhaps 50%) than individuals can. I think that the bills that I was receiving reflected the rate for individuals rather than the cut rate for the HMOs.

At the time, it was very stressful and added to the whole trauma. I think that I was very, very lucky to have gotten off scot free.

Sam




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Monday, September 30 - 7:15amSanction this postReply
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Sam:

That's a good example of insurance working as intended. It's more like how we'd wish insurance would always work for us; it's exactly what we have in mind when we purchase the insurance.

regards,
Fred




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