OT - Expert Opinions Sought

 Circa Memorial day I took sick - food poisoning or a virus - so sick that
SWMBO called 911 and the paramed's carried me off to the ER.  The ER folks
poured liquids into my veins and ran tests with no conclusive results.  By
Mourning, and two liters of liquid later, I was well enough that they tossed
me out with instructions to see my doctor.

Last week I got a statement from my medical insurer. The ER billed them
$3700, not including the ambulance. The insurance co "negotiated" that down
to $1406!  I later saw on TV that Medicare normally pays only a fraction of
what insurance companies pay.

So why the discrepancy?  If the hospital can afford to treat me for $1400,
and presumably make a profit, why are they billing me for $3700.  And if
they can treat medicare patients for even less ....       ??

I'm sure somebody here on reeky has all the answers :)

 

I expect it's sort of like commodities: they charge what the buyer is
willing to pay or that they can get away with. The insurance
companies have enough clout to negotiate a nice reduction in the
price that the ER would have tried to charge you.

Medical costs are certaily outrageous. When I got sick last fall and
SWMBO called 911, the amublance ride/EMT charges were $4500, for
services rendered and a 10 mile ride to teh hospital. The ER/one
night in ICU came in at $27,000. Fortunately, I have the advantage of
working for a company with excellent health benefits, so I only paid
$50 for the ambulance and nothing for the ER/ICU.

-Keith

 On 7/16/2011 3:55 PM, Vito wrote:

It's not that the hospital is overcharging you, but rather that Medicare
only pays a fraction of the normal rate which forces them to make up the
difference elsewhere.

Basically, the government gets to say, "Fuck you, Doc, we're only paying
$xxx" and the only options are either for them to accept it and say
"Thank you sir, may I have another" or stop accepting ALL Medicare
patients.  If you take even one, you're bound to their payment.

What this boils down to is that the privately insured and uninsured
subsidize Medicare because otherwise they wouldn't have enough to keep
the lights on.

But wait, it gets better!  The Messiah's health care plan, destined to
save us all, cut an additional $818B over 10 years from Medicare..
Because, as we all know, you can just ignore the fact that costs rise
and continue to pay less and less for the same services over the years.
  Compound this with a 21% across-the-board fee reduction hanging over
physicians' heads and the divide becomes even more pronounced.

The above is why increasing numbers of doctors are either getting out of
the field or refusing to accept Medicare at all.  It has also given rise
to the "boutique" physician where you pay them a set amount per month
directly, receiving MUCH more intensive attention and care as a result.

Short version:  The Feds screw hospitals and doctors by paying well
under market value for goods and services via Medicare, forcing the
providers to make up the difference elsewhere to remain solvent..
"Elsewhere" being private insurance and individuals.

 On 7/16/2011 4:23 PM, Polarhound wrote:

Here is some more from you, from the 2011 Annual Report of the Medicare
Board of Trustees:

https://www.cms.gov/ReportsTrustFunds/downloads/tr2011.pdf

"Under current law, the SGR system requires a reduction in January 2012
of almost 30 percent in the physician fee schedule, which, on average,
currently sets fees that are significantly below those for private
health insurance. If the rate of growth of private payments were not
affected by continued implementation of the SGR, Medicare physician
payments would be less than 40 percent of the corresponding private
health insurance prices within 20 years and, by the end of the 75-year
period, would be only about 25 percent of private insurance levels. If
such payment differentials were allowed to occur, Medicare beneficiaries
would almost certainly face increasingly severe problems with access to
physician services.

For these reasons, it is important to note that the actual future costs
for Medicare are likely to exceed those shown by the current-law
projections in this report. The potential magnitude of the
understatement can be illustrated by use of an alternative projection.
Specifically, if Medicare payments to physicians were updated by the
Medicare Economic Index, rather than decreasing over 29 percent in 2012
as required under current law, and if the productivity adjustments to
price updates for other Medicare services were gradually phased out
starting in 2020, then the projected total cost of Medicare in 2080
would be 10.4 percent of GDP (versus 6.2 percent under current law), and
HI trust fund exhaustion would still occur in 2024, but the HI actuarial
deficit would be 2.15 percent of taxable payroll (versus 0.79 percent).
These levels still represent a very significant improvement compared to
the estimates prior to the Affordable Care Act, but they clearly
illustrate that the relatively favorable projection results shown under
current law rely partially on the scheduled reductions in physician
payments and heavily on the permanent annual reductions in Medicare
price updates for most non-physician services."

 
So, what's your beef?  Doctors are willing to work for that price.
Insurance companies negotiate the same way.  It sounds to me that you
are pissed off because you are too simple minded to get with the
messiah's program and become part of the collective bargaining
process.

At the turn of the last century, engineers out earned medical doctors
by a substantial amount.  Good political lobbying over the ages has
reversed that and now we have a country full of over-paid service
providers and a dearth of wealth creators.

Don't get your panties all in knots because service providers have to
take pay cuts as they serve a progressively poorer clientele can't
afford their services as they have no means of creating wealth.  If
the feds couldn't borrow the money cheaply from the Asians to treat
all our elderly, our medical professionals would earn considerably
less...

And don't get too teary eyed over the compensation of the medicos.
Even with all the negotiating, the rate of inflation and inflated
salaries in those fields still far outweighs that of the average sick
dood.  Those doctors don't have any other way of supporting the
Porsche and country mansion lifestyles.  Relax, they ain't going
anywhere.