Text 10597, 78 rader
Skriven 2009-03-22 07:33:04 av Bob Ackley (1:300/3)
  Kommentar till text 10464 av Dave Drum (1:124/311)
Ärende: Learning Comprehension
==============================
Replying to a message of Dave Drum to Bob Ackley:

 BA>> In 2004 I spent 3 days in a civilian hospital's coronary care unit,
 BA>> and got an angioplasty and a stent.  The bill was just shy of $50K,
 BA>> of which my share was a whopping $33.00.  The insuror wrote a check
 BA>> for something under $10K and the hospital ate the other $40K.  I
 BA>> have a major problem with that sort of thing, but I don't happen to
 BA>> have an extra $40K lying around.

 DD> That's analagous to my U$38 for a stent. Medicare (and ALL private
 DD> insurance) has "negotiated" rates and discounts for what they will
 DD> pay for each procedure. The differences between what insurance pays
 DD> and that the medical service bills is written off on taxes as some
 DD> sort of loss. The total bill, however, is expected to be paid if ne
 DD> has NO health insurance.

That difference between what insurance and Medicare pay and the actual
bill is factored into general overhead and allocated to everybody else's bill -
just like retailers factor the cost of shoplifting and 'inventory shrinkage'
into the prices of the goods they sell.  Yes, *some* of it is written off
in taxes - but note that most hospitals are nonprofit corporations and don't
pay much in the way of income and property taxes anyway.

You are correct that Medicare (and the other big insurors) negotiate discounts;
although in the case of Medicare it's more of a take it or leave it sort of
negotiation.
Roughly sixty percent of the inpatients in any general hospital are Medicare
patients, and most hospital occupancy rates are around fifty percent or less
(I'd have to check the current statistics in the current AHA Guide, mine are
old);
if Medicare pulls its patients out the hospital's occupancy drops from 50% to
20%,
and if memory serves most hospitals are losing money if occupancy drops much
below 40% - there's a lot of fixed overhead that has to be paid for.

BTW, note that if a Medicare patient is seen in a non-Medicare authorized
hospital,
Medicare will pay that hospital the Medicare rates regardless of what's on the
bill or
the fact that they haven't negotiated anything with the provider.

Note also that increasing numbers of health care providers are turning away new
Medicare patients.  This is becoming a problem in rural areas, which have
generally
older populations and fewer physicians.  It will become a problem in the
cities.

Some years ago I read about a physician (in southern CA IIRC) who got so sick
and
tired of fighting with Medicare over billing that he quit billing Medicare
completely.
He still saw the patients, but he figured it was less hassle to treat them for
free
than it was to deal with Medicare so he threw the bills in the trash and wrote
them
off as charity care.  When they found out about it Medicare wanted to put him
in jail,
I don't think they were successful.  Medicare isn't about *treating* the
elderly, it's
about *controlling the treatment* of the elderly, that's why it is (or was)
illegal for
affluent Medicare-eligible elderly to privately contract with providers outside
of the
Medicare system - even though they can afford to pay the bills in cash.

 DD> Which is one of the major things wrong with our health care system.

IMO those discounts should not be allowed.  Of course, if the insurors had to
pay
the bills as presented, within 30 days of such presentation, the premium rates 
would go up.  Way up, I'd guess they'd at least double.  And note that if those
bills were paid in full they would, in fairly short order, get a lot smaller
because
all that cost shifting overhead would go away (and I doubt that the insurance
premiums would go down much if at all after that happened).

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