|For What It’s Worth….|
Here are some compromise solutions that Congress is ignoring. Obviously, congressional Republicans are resisting any solution that the administration might claim credit for during the next election cycle. Regardless, here are some ideas that we can push for.
Medicare and Medicaid are major issues but they are dependent upon a clear and rational health care program. A careful examination of our health care options is clearly in order.
Here are a few bed-rock facts that must be included in any health care discussion.
Some care providers refuse to provide non-insured persons the same lower rate than they would accept from and insured person. Personal example: I needed a crown and my dentist quoted $600 since I had insurance. The uninsured rate was $800. A friend did not have dental insurance and also need a crown. I asked my dentist if he would accept $600 CASH from my friend. No paperwork. No waiting for the insurance to pay the bill. Same day payment. The answer was, No!
If you have or know someone who has been hospitalized for some serious need you undoubtedly have noticed how many "extra" specialists seem to descend for an extra opinion. Have you noticed how many different persons are needed to read an x-ray? These are just examples how doctors and hospitals unnecessarily pad up their billing.
There all too many examples where doctors have had billing "quotas" at their hospitals. Some doctors will order MRI's where an x-ray is more than sufficient "just to see what's happening." These examples don't even include blatant abuses like ordering a PAP smear for a terminal 83 year old cancer patient!
Skyrocketing lawsuits have led to excessive testing resulting in defensive medicine. There are many areas that are losing physicians because of overly liberal malpractice laws and thus malpractice insurance rates are soaring. With decreasing compensation from programs like Medicare and Medicaid physicians are dropping out from accepting those patients or moving their practice to safer regions. Additionally, high risk patients are often referred out to an emergency room to avoid possible liability issues.
Physicians are packing their schedules to maximize their revenues. A non-emergency appointment may take 2 to 3 weeks, even months. If a patient needs an earlier appointment they are often referred to the "Emergency Room." These doctors are using the ER as an extension of their office and not allowing room on their schedules for unexpected patient needs.
Meanwhile hospitals report overloads that keep them from attending patients or waiting times for non-emergency patients that extends to many hours. This ER overload is further aggravated by patients who have no primary physician and simply use the ER for many of their needs and/or communities that close local clinics to "save money" and thus force more patients to the nearest ER.
Summary: Many persons do not have access to health insurance and cannot carry the burden the inflated charges for uninsured medical care. Care givers often inflate their charges for uninsured. Liability issues significantly increase fees and/or cause professionals to drop classes of patients. Politics twist the facts and pander special interests.
Suggestions to Improve Health Care:
1. Require all health insurance providers seeking to solicit government employees to provide the same group plan to individuals and small businesses within their service area. The overall demographics for the hundreds of thousands of government employees would be about the same as the nation. The national group plan would be with the same benefits and the same premiums with a minimal adjustment for individual billing.
As it stands now, to receive the same insurance as the government or large corporations, small businesses face premiums about 27% higher and individuals face about 47 % higher premiums. This is not suggesting "individual" plans where rates can be changed for individuals! This is a National Group Plan! This would allow small businesses to offer insurance on a par with large corporations!
2. The government may chose to provide basic health care coverage via an established carrier to the indigent and unemployed. Since the premiums are set they will know precisely what impact this coverage will be on the budget. This would eliminate playing games with budget numbers!
3. Allow no exclusions of coverage if the insured has had continuing insurance during the past 12 months. Coverage would be portable if an employee or individual changes employer or moves to another city serviced by the different provider. If an insurer withdraws from a service area all insured may apply to another insurer without prejudice. (This is pretty much a reaffirmation of existing rules.)
4. Prohibit declining coverage or restricting coverage due to prior conditions where those conditions are not relevant. Examples are declining insurance because the applicant had acne in their teens or declining insurance because the applicant runs a flower shop or interior decorating business (life style stereotype).
5. Require hospitals with emergency rooms to maintain a public clinic on that site with the same hours. The cost center rates would be far less for a clinic than an ER. Staff could be shifted between the clinic and ER as patient load changes.
6. In an effort to prevent doctors from using the ER as an office extension, hospitals and/or the insurance companies would charge the patient only the rate as an appropriate doctor's visit. However, if it can be shown that the patent's primary care physician's office habitually refers patients to emergency rooms by failing to allow reasonable open appointments times for unscheduled needs, then charge back to the patients doctor's office any cost center difference. Conscientious doctors usually make advanced arrangements if they will be gone for a period of time. This most often occurs for expecting mothers but should be a "standard of care."
7. Increase the penalty for fraud and abuse to include hefty fines, criminal prosecution and even removing their license to practice for repeat offenders. Congress has known about this problem for decades but has failed any serious attempt to attack it.
8. Oppose any attempt to create a "voucher" program! Health care and insurance is a complicated arena. A "voucher" program would leave individuals without any knowledgeable watchdog to prevent abuses and overcharges.
9. Do not reduce payments to physicians! Guaranteed, if payments are cut more physicians will refuse to participate in Medicare and Medicaid. The costs of care will be shoved off on the elderly!
10. Finally, keep the government, and their administrators, out of managing our health care! If one doesn't like the treatment at one insurer, one is free to change insurance. Anyhow, the government has a totally crummy record managing major programs.!
We recently received an e-mail outlining the numerous failures of the Federal Government to manage major programs. Click Here to read.
Beneath all the political verbiage there are significant, ignored facts and considerations that we need to be aware of. And, this is what Fogcutters is all about.
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Searching for solutions avoided by politicians and activists!
Millions of individuals have paid into this fund over the years. As currently established, Part A (hospital coverage) is pre-paid by retirees. Part B and Part D and Medigap are additional insurances that retirees can purchase through the government and/or private insurance. Most political leadership acknowledge that this fund is significantly under funded. The political rancor is over increasing the premiums or reducing benefits.
Medicaid: Now this program is a real mess and a discussion here would be complicated and beyond the scope of this page.
Fraud & Abuses are costing the programs Billions of dollars. Congress promises to crack down on fraud -that is part of their cost estimates for the current "Obama Care." See: Examiner.com for a recap.
P.S. So why hasn't Congress already cracked down on fraud? Remember "Past is Prologue."