My Friend Needs HealthCare.

reply to post by TheRedneck

I realize there is no insurance company (to my knowledge) that specifies which tests are to be run under what conditions as a part of their insurance agreement. However, are you going to tell me that insurance rates will be unaffected by a claim? I think not.

Research DRGs.

They spell out quit clearly what test and what procedures will be paid for and for what condition.

It is all in a data base and if it doesn't match or someone makes a mistake with the code they will not pay.

continuation to post by TheRedneck

Step 3:

Assuming things don't work out as well as hoped, certain laws could be passed to counter present practices that are driving costs up:

• All health insurance companies could be forced to abide by medical decisions (yes, dj, I know your company does, but not all do all the time).
  
  
• Providers could be limited in their charges for simple things, such as aspirins, wheelchairs, etc. I am thinking a percentage-based restriction, where a provider could charge no more than, say, 3 times the lowest cost for an individual. So when you get that aspirin, which costs $1.00 for 100 at WalMart, you can be charged $0.03. No more. If nothing else,this will require providers to either cut their costs (buy aspirins at WalMart, since they are apparently cheaper there than at the supply house
  ), or at least line item list exactly what you are spending $20 for. It ain't aspirin, it never was aspirin, and it's time we were told the truth.
  
  
• A complete line-by-line bill could be required by any medical provider to make sure again that the payer knows what they are paying for.
  
  
• If malpractice insurance rates do not drop due to the NHRB, action to place the insurance companies under tighter scrutiny could be taken, up to and including financial regulations on pricing.
  
  
• Thanks to the information gleaned from the physician's billing clearinghouse and the new MHRB, public education campaigns could be undertaken to teach people about the health care system, and when to use it, and how to use it to their best advantage. We would now know where the problems lie and could better address education campaign dollars.

I know this is a bit rough, and could no doubt use some tweaking, but I believe the principles in it are sound. It also works well within our capitalist system while making sure that everyone has access to health care. It takes care of the problem with patient abuse by making them still ultimately responsible for the bill, it covers doctors when they comply with the restrictions, it weeds out those who should never have been doctors in the first place, and it reduces the tort payouts while making it easier to receive a fair settlement.

Thanks for reading. Thoughts?

TheRedneck

reply to post by SpiritoftheNightSky

Rather than research, I'll take your word for it.

I will also say that that practice should be illegal. If nothing else, it is false advertising. This is not insurance; it is nothing more than impersonating a physician.

TheRedneck

reply to post by radio_for_peace
When I was in nursing I watched a young man die of internal bleeding. They were waiting to transfer him to County.

It happens, yes it happens.

here in America, land of the free (cough cough) and home of the brave you are only as medically sound as your Bank Account or Insurance and pray your Insurance Company doesn't try to wiggle out of something you medically need.

Medical Care here in America is BIG BUSINESS and there are a lot of greedy fingers in this pie.



[edit on 7-9-2009 by ofhumandescent]

reply to post by TheRedneck


I like your ideas. It's nice to see somebody offering solutions instead of just spreading partisan misinfo and panic.

reply to post by Doc Velocity


OK, you WHOA, WHOA, WHOA! I said adequate healthcare, not no healthcare. BIG DIFFERENCE! And what choice??? Does your employer offer more than one option? Mine doesn't! Just one, and it sux! $10,000 max bene's a year! I guess I better not 'get the cancer'!!! And if I need a triple bypass, it's off to the bankruptcy courts I go... Companies without a union workforce choose 'health insurance companies' that cost the least, not ones that provide decent coverage.

And you still haven't addressed the fact that I'm paying for Universal Coverage for those residing in Afghanistan and Iraq! Why should I be paying for that and not expect it for my damn self????

You are making assumptions, and we all know what happens when you ass-u-me, now don't we. You should add 'apply ignorance' to your avatar!

reply to post by SpiritoftheNightSky


I've never heard of that company, but medical billing codes are used by all insurance and medical providers. Also, most insurance plans have limits and exclusions, which should be very clear what is outright excluded and what requires medical review for coverage. Diagnostic testing is usually covered, so long as it isn't experimental, but there are some tests that are very costly and should only be prescribed under certain clinical circumstances. Certain types of fertility and genetic testing are very expensive, and there are some providers would send every patient for that test simply to make huge money.

reply to post by 27jd

That's my point. The system is a bit out of whack, but it is far from broken. What's broken is our perception of reality.

People get sick. People die. Those are harsh realities. But today, in this society of "gimme it all and gimme it now", people can't seem to grasp this notion that not everything can be fixed in a 30-minute sitcom.

That's not incompassionate; it's realism. I do really feel sorry for those who are hurting, but I also know that life cannot always continue indefinitely, nor can it always be fun. Sometimes it hurts (believe me, I know pain very well). But we live in a nation that has over 3,000,000 citizens, all who live different lifestyles and who think differently.

Some people run to the ER every time they have a cold. I would use my last breath to fight to stay out of a hospital. Those are different needs, and although I suppose both are at the extreme ends of the spectrum, we have to either accept those individual desires or we turn our backs on that segment of our society.

People today tend to believe that everyone thinks the same as them and everyone must therefore want the same things they do. That's simply not true. Capitalism supplies those individual wants and needs, while Socialism does not. Socialism is a one-size-fits-all plan. You take what is offered, period.

If more people would just back up a moment and think about the other guy, I doubt we would have these intense partisan arguments. As the old saying goes, walk a mile in my shoes. Then you can tell me what I am doing wrong.

Sorry for the rant... it just popped out.

TheRedneck

Originally posted by Doc Velocity

Originally posted by mental modulator
Like I said the burden is on the rest of us who demand change,
however your attitude will get you no place at the table during the popular debate.

Last time I looked, the "popular debate" was chasing these battered and bruised healthcare reform supporters back to Washington, licking their wounds. Congressional approval ratings are at all-time lows, and the president himself has suffered a 20% drop in popular support since he got on the "healthcare reform" bandwagon.

You're in the minority on this one.

— Doc Velocity

Does not seem that way, there are still plenty of conservatives on this very thread
who want something to be done in some fashion.

Click here for more information.

Our US Congress has done nothing to fix the mess the health care system is today in the US. Now that Obama is on the war path the republicans are screaming fowl - lol.

Both the Democrats and Republicans of this country have screwed up everything they have ever touched and this will be no different. Anyone who reads the newspaper can figure that out.

Yes we need health care reform - all the issues that I have read on this thread proves that out without a doubt. Do we want the government running it? The same government that is exempting all government employees from taking the same plan - they don't have to make a choice. What kind of a message does that send to the American people?

We are being fleeced by our own government daily and it has to stop - according to the Obama health car plan there will be 45 new (yes 45) government departments to run this new plan - doesn't that scare anyone on this thread? I mean Holy crap.

There are many horror stories on here about the miss use of insurance and patients that could fill a library. So, we all know it is screwed up but we don't want the government screwing it up even more and also getting every bit of your information and history (and information that has nothing to do with health care) to put even a tighter grip on thier control.

If you can't see that is going down the socialism avenue you are blind commrad.

reply to post by mental modulator

Does not seem that way, there are still plenty of conservatives on this very thread
who want something to be done in some fashion.

'Something done in some fashion' leaves a lot of room for interpretation.

The bill now being bandied about is nothing more than forced insurance purchases. It changes nothing except the ability of the individuals to decide their needs for themselves. Do not make the mistake of thinking if I disagree with some components of the present system that I will therefore accept any change that comes down the pike.

I will only accept change that improves things (or at least doesn't make them worse) for all Americans.

TheRedneck

Originally posted by TheRedneck
reply to post by mental modulator

Does not seem that way, there are still plenty of conservatives on this very thread
who want something to be done in some fashion.

'Something done in some fashion' leaves a lot of room for interpretation.

The bill now being bandied about is nothing more than forced insurance purchases. It changes nothing except the ability of the individuals to decide their needs for themselves. Do not make the mistake of thinking if I disagree with some components of the present system that I will therefore accept any change that comes down the pike.

I will only accept change that improves things (or at least doesn't make them worse) for all Americans.

TheRedneck

Funny that is all you could get out of the monster, I have seen many changes in there
myself some great some horrible - My point is there are people who want something done, who are also conservative. However if it stench grows more like partisanship, with glee of POLITICAL victory then I will very much cease to care about other opinions
or conservative concerns and throw my support at a turd as opposed to nothing.

I am starting to feel like a the deep compromise JAM stated in his OP is only available in a fairy tale, I did not want my way of the high way, many of you do, maybe that is the only option left.

reply to post by Rellay

How convenient, stop trying to use pity for a supposed friend to push an agenda.Stop this redistribution of wealth bull, If you want something work for it. Stop trying to get us "greedy achievers" to hand to you what we earn.

All I ask from you is to put forth your opinion on how to solve this dilemma. I have yet to see a redistribution of wealth. Mainly all I have seen is proposals and ideas from all sides.

Sincerely waiting for yours.

reply to post by jam321


The problem is what the bill would say about the republican ideology. If they pass a public option, it will work. And when it works the republicans will be looked at as the party that tried to stop this for decades. And the republicans will be out of power for decades. What is happening is the proverbial rubber hitting the road. For years both sides have played their games and all ideologies where considered worth hearing, not anymore. Both the dems and the repubs and their people know it or at least feel it. Somebody this time has to lose and somebody has to win, pure and simple. What Obama should have done or can still do is make it simple and not complicated and to the point. Medicare for all who don't have insurance or aren't happy with the coverage of their insurance. And since the infrastructure is already in place all it would need is more funding. The republicans and their people would be confused as to how to attack this without destroying one another (the republican politicians want medicare gone but not their followers (its a secret)). The only way they could attack this plan is to say it would be to expensive to add more people. But that would put them in a position to start cutting from medicare and their people wouldn't like that.

The doctors will complain and in one tv ad against medical reform, they had doctors saying where would Obama's plan get the doctors for an increase in people in the public option. And they talk about death panels and rationing of health care, this doctor in a roundabout way just admitted to rationing. In essence he said those people without health care have to not have it in order for their to be enough doctors for everybody that does. But their would be alot of benefits to having a public option. For one their would be Tort reform on lawsuits and people who abuse the system. Also if they need more doctors the govt. could help that by saying they will pay for the education of people who go into medical school, etc. etc.. There is alot of ways to sweeten the deal for doctors if need be. We need some form of govt. run health care pure and simple. There was they quote from LBJ or one of the presidents where he said we can have "guns or butter not both" we have been having it good for so long trying to have both but what we did was to use our credit card on one and our bank account on the other. Now we are broke and need to prioritize what is best for the country.

Guns or Butter, Guns or Butter we can't have both anymore.

reply to post by mental modulator

No, that is not all I got out of your post, but it is the part I feel needed to be addressed. Too many people have this idea that if something is out of whack, then we must 'change' it at all costs. I do not echo that sentiment, and never have. If that attitude offends you, then sorry.

Too many time in my life I have seen pundits and politicians argue that because they were elected on a platform, that they are then able to say that everyone agrees with every plank in that platform. I simply will not allow any of this type of thinking to exist unchallenged.

I am not even suggesting that you have this attitude. I am simply making sure the record is straight about where I stand. I see much room for improvement in our present health care system, but that does not mean I agree with every notion of change.

I suggest you read the three posts I spent so much time typing out earlier. I have proposed ideas that I believe will work, but apparently you missed them. Please, can we hear your suggestions?

TheRedneck

reply to post by TheRedneck

I know this is a bit rough, and could no doubt use some tweaking, but I believe the principles in it are sound. It also works well within our capitalist system while making sure that everyone has access to health care.

That is the whole idea about offering solutions. They are supposed to be rough. Then somebody else makes a suggestion to further improve or tweak the first solution. Great job RED.

IMO, the biggest problem I see in Washington is a take it or leave it mentality when solutions are offered..

reply to post by JaxonRoberts


So what you want is not healthcare reform, you want insurance reform, because you don't believe your employer is providing "adequate" coverage. You have a choice. You can go outside your employer for your insurance needs if you think you need more, nobody is stopping you. There are a wide range of private healthcare insurance plans available. Pick the one that suits you and pay for it.

But that's not what you want. You want free healthcare, you don't want to work for it, and that is what this whole controversy is about. It's about the greedy, not the needy, wanting better coverage than is already available to them.

If you "get the cancer," healthcare reform is not going to save your ass. If you "get the cancer," walk your ass down to the charity hospital and get treated. Sign up for Medicaid if you're so damned indigent, nobody is stopping you, and you can't be refused. We already have government healthcare for people such as yourself.

But nobody owes you better healthcare — not me, not the government, nobody but yourself.

— Doc Velocity

Originally posted by TheRedneck
reply to post by 27jd

That's my point. The system is a bit out of whack, but it is far from broken. What's broken is our perception of reality.

People get sick. People die. Those are harsh realities. But today, in this society of "gimme it all and gimme it now", people can't seem to grasp this notion that not everything can be fixed in a 30-minute sitcom.

That's not incompassionate; it's realism. I do really feel sorry for those who are hurting, but I also know that life cannot always continue indefinitely, nor can it always be fun. Sometimes it hurts (believe me, I know pain very well). But we live in a nation that has over 3,000,000 citizens, all who live different lifestyles and who think differently.

Some people run to the ER every time they have a cold. I would use my last breath to fight to stay out of a hospital. Those are different needs, and although I suppose both are at the extreme ends of the spectrum, we have to either accept those individual desires or we turn our backs on that segment of our society.

People today tend to believe that everyone thinks the same as them and everyone must therefore want the same things they do. That's simply not true. Capitalism supplies those individual wants and needs, while Socialism does not. Socialism is a one-size-fits-all plan. You take what is offered, period.

If more people would just back up a moment and think about the other guy, I doubt we would have these intense partisan arguments. As the old saying goes, walk a mile in my shoes. Then you can tell me what I am doing wrong.

Sorry for the rant... it just popped out.

TheRedneck

Well I would argue the system is a bit more than out of whack. We are trying to keep our foothold on a dominant economic position in the world and we cannot figure out a basic part of societal infrastructure. We are the last developed nation that still has this problem and I would argue that 47,000,000 people SOL is a sizable problem. The economy and the sector are strained with the costs associated with treating these people and their diminished capacity at times.

Only compounded with the rising costs
that can be expected to hit 100% every ten years at this present pace. Within that ten years it should be only a lean to suggest that the majority of all business's supplying insurance will drop their contributions. Which would promptly swell the ranks well over 50% of the US population. It would have the same effect as RAISING TAXES on business, in that it would create a net loss domino effect, less people covered, higher the cost, higher the cost the less people covered. I think to sit back and let the house burn hoping that the garden hoes will suffice is lunacy.

This system is horrible skewed, free market idealism would suggest that if net profit
has gone up 100% cost should come down by competitive expansion. Yet the opposite has happened, profit is up as much as cost all one has to do is some simple math to see where these numbers are headed.

It is not this way with the AIRLINE industry people, HEAVILY REGULATED, very stringent consumer protection, yet somehow I can fly from LA to NOLA for $99.00. With all the regulation and rising fuel prices I have a better deal than I would have gotten ten years ago. Now in this sector many companies teeter on the edge, yet they preserver, still COMPETE and ADAPT to the market and the FAA guidelines alike.

It is not broken for me either, however I have seen it wipe people clean

I will expand later...

reply to post by Doc Velocity


No, I want affordable health care, and I make too much money for medicaid but not enough to afford outside insurance. And what exactly do you think the whole health care debate is about? INSURANCE COMPANIES!

You seem to keep ducking my point about Iraq and Afghanistan and how we are paying for their health care. I'm going to guess it's because you can't counter it...