Text 281, 73 rader
Skriven 2009-10-01 06:24:30 av Bob Ackley (1:300/3)
    Kommentar till text 220 av mark lewis (1:3634/12.0)
Ärende: Universal health insurance
==================================
Replying to a message of mark lewis to Robert Bashe:

 BA>> Contrary to the leftist propaganda spewing from proponents of the US
 BA>> government's attempt to take over the industry, people in this
 BA>> country are *not* being denied necessary care.  They may not (and
 BA>> probably don't) have the money to pay for it, but the care is
 BA>> provided.

 RB>> Really? I have a different impression.

 ml> then your impression is quite incorrect... NO ONE is turned away from
 ml> *emergency care*... while they may have to sign papers stating that
 ml> they are the responsible paying party, they are not turned away...
 ml> personally speaking, i do not know what would happen if they did not
 ml> sign the "responsible party" papers but there are separate (TTBOMK)
 ml> papers to be signed to allow for treatment...

FYI the admitting process, emergency or not, includes signing a form contract
that basically says that the patient agrees to be responsible for the bill
regardless
of any insurance coverage.  25 years ago I did an internship in the admitting
office of Saint Mary's Hospital in Nebraska CIty, NE.  Note that a couple of
decades
ago congress passed a law making it illegal for providers to bill elderly
patients for
costs that Medicare refused to pay; now, of course, Medicare and the big
insurors
aren't quite that crass - they just require providers that want to be 'approved
Medicare providers' agree to accept what Medicare pays as payment in full.

Note that up until about 1970 most hospitals provided care for anybody that
needed it, emergency or not.  If they couldn't pay the cost of providing that
charity care was factored into overhead and added to other patients' bills.

The government changed all that with Medicare.  Medicare wouldn't pay their
share of charity care provided by the hospitals - and other big insurors
followed
suit.  While they no longer say that, Medicare and the big insurors have set
their
own prices for various services provided regardless of the institution
providing
them; that's what they pay, not the actual billed costs.  Oddly enough - but 
certainly not surprising - is that the approved reimbursement rates are nearly 
always less than the cost of providing the care.  Providers, of course,
suddenly
had to get very cost conscious WRT charity care, and started to avoid admitting
non-emergency patients that might have problems paying - and in some isolated
cases, emergency patients (which precipitated a number of states' laws that
make
refusal to admit and/or treat treatment to emergency patients a crime).

Medicare's dirty little secret is that many providers are quietly dropping out
of
the program by not accepting new Medicare patients.  Since the overall numbers
of primary care physicians is slowly declining and the numbers of primary
physicians
not accepting new Medicare patients is slowly increasing, there's going to be a
crisis, particularly in rural areas, WRT primary care for us old folks.

Note also that Medicare is (in)famous for slow pay (90 days or longer) and
writing
itself huge discounts on services provided.  In 2004 I was hospitalized for a
near
heart attack (99% blockage in one artery), and had an angioplasty and stent. 
The
hospital bill was $49,000 and change.  Tricare (which is Medicare for the
military)
paid $9,000 and change and effectively told the hospital to eat the other forty
grand,
which it did.

--- FleetStreet 1.19+
 * Origin: Bob's Boneyard, Emerson, Iowa (1:300/3)