Text 13996, 118 rader
Skriven 2010-07-12 14:14:00 av Bob Klahn (1:124/311)
     Kommentar till en text av Bob Ackley
Ärende: Dependence
==================
 BK>>>>  Oh, and the govt runs the most successful part of our health
 BK>>>>  care system, medicare. At least before the right got their
 BK>>>>  claws into it.

 BA>>> Medicare FORCES providers to give care to the elderly for
 BA>>> whatever reimbursement

 BA>>> a horrible situation for the providers - which is why
 BA>>> increasing numbers of providers are
 BA>>> quietly dropping out of the Medicare system.

 BK>>  If providers are dropping out then Medicare is not forcing
 BK>>  anyone to provide care.

 BA> They do if the provider wants to remain in the Medicare
 BA> system. Remember that on any given day about sixty percent
 BA> of any hospital's inpatient population is Medicare patients
 BA> and are costing more than Medicare is paying (but costing
 BA> less than an empty bed).

 IOW, they chose to accept that payment.

 Back to the point. If everyone except those paying out of pocket
 get a discount, how do the hospitals make any money. Most people
 without coverage are poor. Working poor, but poor.

 BA> Last time I checked - and it was years ago - hospitals were
 BA> budgeting for about 40% occupancy (it used to be 80%, and
 BA> in the early 1980s there was a period where every hospital
 BA> in Omaha was packed to the rafters, every single hospital
 BA> bed in the city was occupied).

 Then it seems like time to shut down some hospitals.

 BA> Hospitals that expect 40%
 BA> occupancy can't operate for very long at 16% occupancy;

 True. And a reason to shut down some hospitals. And to support
 national health care.

 BA> years ago Grape Memoriah Hospital, a 50 bed facility
 BA> located on the north edge of Hamburg, in the southwest
 BA> corner of Iowa (population about 3K) got into severe
 BA> financial trouble.  For several weeks their inpatient
 BA> census there was *three*; 47 empty beds, there were more
 BA> people working the night shift than there were patients.

 Either the local population were unexpectedly healthy, or were
 not going to the hosptical when they needed to.

 BA> In the days when occupancy was much higher, low and partial
 BA> payments weren't as much of an issue as they are today (and
 BA> have been for several years); providers can no longer
 BA> *afford* to grant (or accept) such discounting.

 Then it is time to stop accepting it.

 BK>> All they do is set standards for what
 BK>>  they will pay, and the provider gets to say yes or no.

 BK>>  Which is exactly what my insurance company does. Everything you
 BK>>  listed. Only you can go outside the system, and the insurance
 BK>>  company would love it if you pay your own way. However, inside
 BK>>  the system the provider is not allowed to bill the patient for
 BK>>  the difference, just like Medicare.

 BA>>> For well over 25 years Medicare has been infamous for
 BA>>> paying late (if at all), disallowing
 BA>>> perfectly valid charges and writing itself huge discounts.

 BK>>  Exactly what my insurance company does. And 25 years goes right
 BK>>  back to Reagan.

 BA> Actually it goes back farther than that, I just became
 BA> aware of it in 1982 or 1983 as an undergraduate majoring in
 BA> Hospital Administration (and yes, I did graduate, Southern
 BA> Illinois University/Carbondale, in December of 1984).

  I know, you said it before. And it may go back a long ways, but
  ask yourself why it hasn't been fixed. You had mostly
  republican presidents in the last 30 years.

 BA>>> When providers billed the patients
 BA>>> for unpaid charges, Medicare got congress to make 'balance
 BA>>> billing' illegal (so those unpaid charges get factored into

 ...

 BK>>  As does my insurance company's discounts. And as does the unpaid
 BK>> from the uninsured.

 BA> I have a problem with discounting terms beyond than '10/10,
 BA> net 30.'  For those unaware, that means 'if you pay in ten
 BA> days you can take a 10% discount, otherwise full payment is
 BA> due in 30 days.'  That is pretty much a standard policy in
 BA> business.  Medicare is usually 120 days or more between
 BA> receipt of the bill and writing the check (so is Tricare,
 BA> BTW); OTOH, Physician's Mutual in Omaha usually pays within
 BA> a cuple of weeks, in full.

 So, why haven't the supposedly pro-business presidents fixed it?

 BK>>  IOW, just about everybody has an unpaid balance that gets
 BK>>  factored in. So the cost of medical care goes up for everybody
 BK>>  because nobody is paying the full cost.

 BA> See my above comment about discounting.

 It doesn't contradict what I said.



BOB KLAHN bob.klahn@sev.org   http://home.toltbbs.com/bobklahn

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