CaP'N GRuNGe Posted July 16, 2009 Share Posted July 16, 2009 Ursa you can argue anything, but that doesn't make it true. If they were paying a fare rate, doctors wouldn't be turning them away? To put it into some perspective, our CFO recently told us we make money on commercial insurance, we break even on medicare, and we lose money on medicaid. But Ursa does have a point. What is fair reimbursement? And who can honestly define that? Quote Link to comment Share on other sites More sharing options...
Perchoutofwater Posted July 16, 2009 Share Posted July 16, 2009 To put it into some perspective, our CFO recently told us we make money on commercial insurance, we break even on medicare, and we lose money on medicaid. But Ursa does have a point. What is fair reimbursement? And who can honestly define that? And to stay in business you have to over charge commercial insurance to make up for the medicaid losses. Fair reimbursement would where doctors aren't looking to turn away from medicare and medicaid. Quote Link to comment Share on other sites More sharing options...
CaP'N GRuNGe Posted July 16, 2009 Share Posted July 16, 2009 And to stay in business you have to over charge commercial insurance to make up for the medicaid losses. Fair reimbursement would where doctors aren't looking to turn away from medicare and medicaid. Again, you assume the problems are on the revenue side and not the expense side. Everything is negotiated on both sides. You can't say one is inherently unfair over the other. And this comes from someone who works in the industry who wants to selfishly see reimbursement rates go up to the benefits of my employer, its patients, and my own job security. But everybody has an agenda. There is no unbiased right or wrong here. Quote Link to comment Share on other sites More sharing options...
Perchoutofwater Posted July 16, 2009 Share Posted July 16, 2009 Again, you assume the problems are on the revenue side and not the expense side. Everything is negotiated on both sides. You can't say one is inherently unfair over the other. And this comes from someone who works in the industry who wants to selfishly see reimbursement rates go up to the benefits of my employer, its patients, and my own job security. But everybody has an agenda. There is no unbiased right or wrong here. You say you lose money on Medicaid and break even on Medicare. How does your company make money? Quote Link to comment Share on other sites More sharing options...
CaP'N GRuNGe Posted July 16, 2009 Share Posted July 16, 2009 You say you lose money on Medicaid and break even on Medicare. How does your company make money? In this economy? By cutting costs. I work for free now. Quote Link to comment Share on other sites More sharing options...
Clubfoothead Posted July 17, 2009 Share Posted July 17, 2009 Employees through lower wages so to cover the additional compensation they receive through insurance and retirement plans. Who did you think? So your contention is that our healthcare system in America is not an employer based system? Quote Link to comment Share on other sites More sharing options...
Perchoutofwater Posted July 17, 2009 Share Posted July 17, 2009 So your contention is that our healthcare system in America is not an employer based system? In probably the majority of cases employers are the conduit through which insurance is directed to individuals, but it is the individuals that are actually paying for it. Quote Link to comment Share on other sites More sharing options...
Perchoutofwater Posted July 17, 2009 Share Posted July 17, 2009 (edited) Centrist Dem leader blocking health care in committee. So basically everyone but the far out of touch left (atomic, bpw, club, and det) thinks this bill is trash. Edited July 17, 2009 by Perchoutofwater Quote Link to comment Share on other sites More sharing options...
Clubfoothead Posted July 17, 2009 Share Posted July 17, 2009 In probably the majority of cases employers are the conduit through which insurance is directed to individuals, but it is the individuals that are actually paying for it. I say you are wrong. Quote Link to comment Share on other sites More sharing options...
Perchoutofwater Posted July 17, 2009 Share Posted July 17, 2009 I say you are wrong. How so? Quote Link to comment Share on other sites More sharing options...
Clubfoothead Posted July 17, 2009 Share Posted July 17, 2009 How so? Something like 60-70% of Americans get their healthcare coverage from their employers. Another 20ish get it from the government. Then there are at least 48,000,000 winging it uninsured. What does that tell you about the affordability coverage for individuals and individual families? Do you consider the health insurance you offer your employees a break-even proposition because of the amount of their wage you depress to offset your costs? My boss pays for me as an individual then I pay the $10,500 a year in premiums plus the $5,000.00 deductible. He also pay BCBS for the right to be our insurance company plus the cost of the HR girl. That's the way its been at every office I've worked at, an expense for the employer. If providing heath coverage is so cheap, why are companies slashing benefits, even pre-fall of 2008? I think businesses should worry about being businesses not promoting the general welfare. That's the federal government's job. Quote Link to comment Share on other sites More sharing options...
bpwallace49 Posted July 17, 2009 Share Posted July 17, 2009 (edited) So basically everyone but the far out of touch left (atomic, bpw, club, and det) thinks this bill is trash. Methinks you need to read other posts. I bolded the part that is relevant for you . . . Does anyone REALLY think there isnt any problems with the system??? I think there are MAJOR gaps in the current bill, and it doesnt address many of these issues. But to blithely ignore the situation or merely snipe at differences in the bill instead of ACTUALLY generating somthing that might HELP the situation is just as bad. Please return to your previously scheduled tirade . . . Edited July 17, 2009 by bpwallace49 Quote Link to comment Share on other sites More sharing options...
Perchoutofwater Posted July 17, 2009 Share Posted July 17, 2009 Club, Insurance is part of the compensation package. I figure out how much I can afford in total compensation for a given employee. Health care is part of it, as is 401K compensation, vehicle (or vehicle allowance), vacation etc... If medical insurance premiums go up faster than inflation there are a few things that are likely the happen. The easiest is opt for lesser coverage, either higher deductibles ore less favorable splits. Another option is keeping the health care but not giving a cost of living raise. Another thing that can be done is reducing or eliminating bonuses. Regardless it is part of employee compensation which is a finite pool. If we weren't providing health insurance we would be providing higher salaries or better benefits in other areas. Quote Link to comment Share on other sites More sharing options...
Ursa Majoris Posted July 17, 2009 Share Posted July 17, 2009 Ursa you can argue anything, but that doesn't make it true. If they were paying a fare rate, doctors wouldn't be turning them away? So, if you have three project owners willing to pay more than the real rate, two owners willing to pay the real rate and capacity to do only three projects, which two owners will you turn away? Quote Link to comment Share on other sites More sharing options...
Perchoutofwater Posted July 17, 2009 Share Posted July 17, 2009 So, if you have three project owners willing to pay more than the real rate, two owners willing to pay the real rate and capacity to do only three projects, which two owners will you turn away? If there is so much demand then we need to provide people with the incentive to get into the field to increase supply. If you artificially decrease the fair market value then you decrease the incentive people have to enter the field and start a vicious cycle of incentive which decreases supply which in turn increases demand. That is exactly what has been happening, and why health care is so expensive. The real rate is what the market will bear without artificial influence. So in your quote above you really have 3 willing to pay the real rate, and two that are unwilling to pay the real rate. Should I be forced to build something below market value? Quote Link to comment Share on other sites More sharing options...
Ursa Majoris Posted July 17, 2009 Share Posted July 17, 2009 If there is so much demand then we need to provide people with the incentive to get into the field to increase supply. If you artificially decrease the fair market value then you decrease the incentive people have to enter the field and start a vicious cycle of incentive which decreases supply which in turn increases demand. That is exactly what has been happening, and why health care is so expensive. The real rate is what the market will bear without artificial influence. So in your quote above you really have 3 willing to pay the real rate, and two that are unwilling to pay the real rate. Should I be forced to build something below market value? Not at all. The real cost is known to you - materials, labor and all the rest that go into a project. You then add a markup, as you should. I contend that hospitals and doctors add massive markups because they have grossly expensive premises and bloated administrations, both of which you've mentioned yourself. They also have a ludicrously high technology turnover. Their "market rate" is artificially inflated. Quote Link to comment Share on other sites More sharing options...
Perchoutofwater Posted July 17, 2009 Share Posted July 17, 2009 Not at all. The real cost is known to you - materials, labor and all the rest that go into a project. You then add a markup, as you should. I contend that hospitals and doctors add massive markups because they have grossly expensive premises and bloated administrations, both of which you've mentioned yourself. They also have a ludicrously high technology turnover. Their "market rate" is artificially inflated. So you are saying my mark up (or fee) should always be the same regardless of market conditions? If I had to do work at the mark up (fees) I'm currently using on new work in this market, I'd quickly go out of business. I agree that many of the facilities we've recently built have been lavish, but we have a choice on which facilities we use. We can choose insurance that has certain facilities in network, or we can also choose to pay the out of network fees. I'll agree the market rate is artificially inflated, but the main reason is because the government is artificially tampering with the incentive to enter the market as a competitor (doctor or facility) by coercing those already in the market to take less than fair market. I'll also note that the most lavish facilities we've built recently haven't been for-profit facilities but non-profits who need to spend money. Same thing with schools, we offer all kinds of value engineering, and rather than reducing the cost of the building, they spend it on fluff, because they passed a bond for $X so they have to spend $X. Quote Link to comment Share on other sites More sharing options...
Azazello1313 Posted July 17, 2009 Share Posted July 17, 2009 CBO chief: Dem plan would weaken economy, provide no cost savings seems like this is very relevant, but no one responds Quote Link to comment Share on other sites More sharing options...
millerx Posted July 17, 2009 Share Posted July 17, 2009 I haven't read through this whole thread, but has anyone brought up how a sizeable portion of the problem with runaway doctors' fees is due to how litigious our country is?... and how it's the dam lawyers faults for causing 7-8 figure settlements for stupid sh!t? Not to mention the idiots on the juries that go ahead and award them these damages? Doctors are human and they will make mistakes, but to have lawyers bankrupt them for an accident (believe it or not 99.9% don't WANT to hurt their patients) is f'n ridiculous! All I'm saying is that doctors have to cover their arses with insane amounts of coverage that, as with anything else, IS GONNA be passed on to the consumer. You wanna lower the cost of going to the doctor, quit using get-rich-quick lawsuits and if your on a jury, be f'n reasonable!! People get pissed about golden parachutes for execs that get millions for nothing, but for some reason we don't seem to bother trying to control (sorry use the political term "regulate") these freakin' jagoffs! I have no idea if this even fits in the discussion at this point, so please continue as you were... Quote Link to comment Share on other sites More sharing options...
Ursa Majoris Posted July 17, 2009 Share Posted July 17, 2009 I haven't read through this whole thread, but has anyone brought up how a sizeable portion of the problem with runaway doctors' fees is due to how litigious our country is?... and how it's the dam lawyers faults for causing 7-8 figure settlements for stupid sh!t? Not to mention the idiots on the juries that go ahead and award them these damages? Doctors are human and they will make mistakes, but to have lawyers bankrupt them for an accident (believe it or not 99.9% don't WANT to hurt their patients) is f'n ridiculous! All I'm saying is that doctors have to cover their arses with insane amounts of coverage that, as with anything else, IS GONNA be passed on to the consumer. You wanna lower the cost of going to the doctor, quit using get-rich-quick lawsuits and if your on a jury, be f'n reasonable!! People get pissed about golden parachutes for execs that get millions for nothing, but for some reason we don't seem to bother trying to control (sorry use the political term "regulate") these freakin' jagoffs! I have no idea if this even fits in the discussion at this point, so please continue as you were... [perch]read my posts[/perch] Quote Link to comment Share on other sites More sharing options...
Perchoutofwater Posted July 17, 2009 Share Posted July 17, 2009 I haven't read through this whole thread, but has anyone brought up how a sizeable portion of the problem with runaway doctors' fees is due to how litigious our country is?... and how it's the dam lawyers faults for causing 7-8 figure settlements for stupid sh!t? Not to mention the idiots on the juries that go ahead and award them these damages? Doctors are human and they will make mistakes, but to have lawyers bankrupt them for an accident (believe it or not 99.9% don't WANT to hurt their patients) is f'n ridiculous! All I'm saying is that doctors have to cover their arses with insane amounts of coverage that, as with anything else, IS GONNA be passed on to the consumer. You wanna lower the cost of going to the doctor, quit using get-rich-quick lawsuits and if your on a jury, be f'n reasonable!! People get pissed about golden parachutes for execs that get millions for nothing, but for some reason we don't seem to bother trying to control (sorry use the political term "regulate") these freakin' jagoffs! I have no idea if this even fits in the discussion at this point, so please continue as you were... It has been estimated that litigation and fear of litigation make up as much as 10% of health care cost today. Part of it is the outrageous cost of malpractice insurance. Part of it is the amount of "defensive medicine" being practiced, some of which is admittedly a profit center particular for many of the larger private networks, though it is questionable how profitable they would be if defensive medicine wasn't being practiced. The fear of litigation has also caused some doctors to stop practicing certain types of medicine all together. How many OB/GYN's have dropped their OB practice, as a result of the cost of malpractice insurance and the cost of not being paid fair market value for their services when delivering children to illegals and the destitute. In most cases the risk out weighs the reward. Of course as more and more OB, quit delivering babies, demand for the doctors remaining will go up, which will make it that much more expensive for those of us that actually pay our own way whether it be in cash or through insurance premiums. You also have to look at the quality of care you get now as well as a result of a lack of OB's. My last child was delivered by a nurse, the OB didn't come in until the cord was cut and the baby was cleaned up and breast feeding. Some sort of tort reform regarding medical care would definitely help both in reducing the cost of care as well as increasing the quality of care. Still it isn't a silver bullet. It is just one of the many pieces that drive up the cost of medical care. Quote Link to comment Share on other sites More sharing options...
AtomicCEO Posted July 17, 2009 Share Posted July 17, 2009 It has been estimated that litigation and fear of litigation make up as much as 10% of health care cost today. It has been estimated that that estimate is high. Quote Link to comment Share on other sites More sharing options...
Ursa Majoris Posted July 17, 2009 Share Posted July 17, 2009 It has been estimated that that estimate is high. Given a health care cost of $2 trillion per annum, 10% would have to be $200 billion. I find it difficult to believe. The Trojan Horse in this 10% argument is the "defensive medicine" piece, which is entirely in the eye of the beholder. it suits the anti-lawsuit folks to use 10% - the reality is probably closer to 1% or 2%. Quote Link to comment Share on other sites More sharing options...
AtomicCEO Posted July 17, 2009 Share Posted July 17, 2009 Given a health care cost of $2 trillion per annum, 10% would have to be $200 billion. I find it difficult to believe. The Trojan Horse in this 10% argument is the "defensive medicine" piece, which is entirely in the eye of the beholder. it suits the anti-lawsuit folks to use 10% - the reality is probably closer to 1% or 2%. If I threw out a fake figure that supported perch's argument, I bet he'd quote it. If I posted it, I bet it would actually crash the server my blog was on because of so many hits from right-wingers desperate to make the counter-intuitive argument that changes to healthcare are bad. Quote Link to comment Share on other sites More sharing options...
bpwallace49 Posted July 17, 2009 Share Posted July 17, 2009 Or you can believe that the only reason that health care costs continue to outpace wages and inflation every single year is due to poor people and illegal aliens. So if we got rid of all the poor people and let them die in the streets a la "gangs of new york" style and built a big fence around the US, everything would be swell . . . . right Perch??? Quote Link to comment Share on other sites More sharing options...
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