Posts Tagged ‘Health Care’

This week the DOJ (Dept of Justice) has come out and stated the health-care mandate (the one that states everyone must have insurance) is a tax. This appears to be their stance because that is the only way to apply any constitutionality to the mandate. Interestingly enough the President is stating it is not a tax in a recent New York Times article.

“For us to say that you’ve got to take a responsibility to get health insurance is absolutely not a tax increase,” the president said last September, in a spirited exchange with George Stephanopoulos on the ABC News program “This Week.”

The presidents response feeds into all the legislation being presented by this administration. They feel it is their right to mandate behavior and the long lived American right to make our own decisions is offensive to this progressive movement.

This same mentality is evident in the Cap and Trade legislation, the recently passed fiscal reform bill as well as the many spending bills that have hit congress in this administration and even the Bush administration.

writes a great article on the widening class system developing in America.

Never has there been so little diversity within America’s upper crust. Always, in America as elsewhere, some people have been wealthier and more powerful than others. But until our own time America’s upper crust was a mixture of people who had gained prominence in a variety of ways, who drew their money and status from different sources and were not predictably of one mind on any given matter. The Boston Brahmins, the New York financiers, the land barons of California, Texas, and Florida, the industrialists of Pittsburgh, the Southern aristocracy, and the hardscrabble politicians who made it big in Chicago or Memphis had little contact with one another. Few had much contact with government, and “bureaucrat” was a dirty word for all. So was “social engineering.” Nor had the schools and universities that formed yesterday’s upper crust imposed a single orthodoxy about the origins of man, about American history, and about how America should be governed. All that has changed.

While the American people truly embrace diversity those in power do their best to keep us fighting amongst each other so that they can solidify their kingship.


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Another post from my Vietnam Friend

NO, it is not a conspiracy.. Not a radically planed out thing or even for most a conscious thing.. It is just a natural happening thing.. even though it might be a spiritual thing depending how some think of the vibes of the universe..

We are broke, busted, outtta money and gottta cost cut.. Sorry, life happens.. There is a drain on society, on the money, on the benefits being paid.. Just cost cut and all will be better.. Sure some suffer, some are hurt, but that is what happens.. Many do not have health insurance while HUGE numbers get Medicare and Social Security… Nope, no need to target them, but why worry about protecting them much either… What value do they give to society? They might well be a drain keeping others from having many things because of the lack of money..

OK, it seems the Government money is going to Meda something and it is going to Social Security. They are people who do not work.. Gottta cut much of that out where possible while giving a lot of it to those of an age to work. Yep, why have the drain paying for the older group that is taking all the money.. OH yea, toss a few women in here also as some of the statistics seem to indicate they cost more medically than men to take care of..

OK, lets just cut back on procedures or tests allowed for certain age groups and classifications of people.. YEP, we gottta a plan.. OH sure some will expire.. That happens when you are outtta money and gottta make benefits for the productive class that has no health insurance..

OK, how do we get this to pass? YEP, the ole make them all think it is better for all .. that will work, we gottta a plan.. Lets call it health care reform.. WOW .. Lets take a vote on it TODAY.. Lets make sure it passes no matter what we have to do…

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Judge Andrew Napolitano calls on Americans to stand for freedom

“Ask your member of congress…where in the constitution is it authorized for the federal government to regulate health care? They will not be able to answer that question.”

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CNN money provides a cost breakdown from a practicing doctor:

….He spends about $60,000 a month on “fixed costs” to run his practice. “That’s more or less my breakeven point,” he said. “If I spend more, I’m in the red for the month.” Business costs include rent, payroll, utilities, medical and office supplies. Because he maintains electronic health records for his patients, Schreiber also pays for equipment maintenance and other management services associated with patient billing.

Fixed costs for a private practice also include malpractice insurance. He pays about $7,000 a year for himself and $2,000 each for his two nurse practitioners. Schreiber admits that his cost for malpractice insurance is relatively low, compared to specialists such as ob/gyns, who pay upward of $100,000 a year. (Rx for money woes: Doctors quit medicine) Finally, his fixed costs include benefits to cover his employees, including himself. Those costs go against the $800,000 or so in revenue, which includes about $100,000 in income, he said his practice collects in a given year….

This story also gives insight into the reason many doctors are in a hurry to diagnose and get on to the next patient.

Overall, Medicare pays between 63% and 72% of the costs for one of Schreiber’s patients — although the Center for Medicare and Medicaid Services applies different payment rates in different states. According to Schreiber, four billing codes make up the “bread and butter” of claims submitted to Medicare.

The first code represents a simple visit, which might include blood pressure and cholesterol checks. Schreiber gets about $44 from Medicare for the $70 fee he charges. The second and third codes correspond to a sick visit, when he spends 15 to 20 minutes evaluating a patient for symptoms such as coughing or shortness of breath. Schreiber charges $92 for a sick visit, of which Medicare pays about $58. The last billing code is a complex visit. “This is where a patient comes in with many problems like heart disease, hypertension, diabetes,” he said. Such a visit requires about 30 minutes of his time. Schreiber charges $120 for these visits, and Medicare pays $88 of that…..FULL STORY HERE

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I have spent the majority of my life immersed in American health care. I have worked on the profit and non-profit sides of the industry and have many friends working in hospitals etc. To top it off I also have a husband with a chronic and rare condition so I have experienced being the user of many specialties.

I have experienced health care with insurance and with out insurance, with major medical issues and with few/no medical issues, I have also experienced government health care (Medicaid/Medicare & VA).

In my experience there are a few clear cut cost drivers:

Over utilization – or in real words words, too many tests  – Your general practitioner just sent you for a MRI last week but the specialist orders another one. This generally occurs because the specialists does not know you had one last week, they want to use their own radiology department, or they are concerned they will be sued if they don’t order the test themselves. Not only is this expensive, but it can cause additional harm to the patient by over-exposure to radiation

“The latest and greatest equipment” – The doctor or hospital has to have the newest MRI even though they can send you down the street to have the same test with the same equipment. Too often “owning” equipment is a competition or marketing ploy. After all how many hospitals advertise their state of the art equipment. It sounds nice until you are in the hospital for a blood draw and it costs twice as much as the hospital down the road because someone has to pay for the multi-million dollar equipment that is only needed for 1% of the population.

Government regulations/paperwork – Astonishingly you don’t have time to read ERISA, HIPAA or other legislation, but you keep being notified of your rights and how your claim will be denied due to a provider not giving the proper information to the insurance company. Your insurance company just spent 40% of your premium on producing paperwork for the government.

Lack of consumer education – You don’t know you can ask for copies of your scans and take them with you from doctor to doctor. Hospitals and doctors don’t list their prices for services on their website and no one told you to price shop for medical services. Do you know what is in your medical record? Do you have a copy? Do you have a copy or your x-rays/scans?

Over prescribing/brand name drugs – You saw it on TV and you have to have that brand even though there is a comparable and cheaper option. You see a general practitioner and various specialists and none of these doctors are sharing medical records. The doctors are prescribing incompatible or similar medicines for different conditions.

Medical record systems – You see various doctors and they all have separate files and don’t share with each other thus creating duplications and extra work. Note: Many specialists send reports to the referring doctor but if you were not referred they don’t know to send a report. Specialists will often send a report to another physician if you request it.

And let’s not forget improper utilization — because of EMTALA, hospitals cannot turn anyone away from the Emergency Dept, and so uninsureds often go to the ER for non-emergent care, such as fevers or check-up of chronic conditions. An ER visit is always more expensive than a visit to a primary care provider, but the hospital and the doctors don’t get paid so they have to make up for it by increasing prices elsewhere.

Over the years We have partnered with our doctor to keep some of these costs under control.

Many other cost drivers and other health care information can be found at Campaign for an American Solution

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I for one was thrilled to hear Paul Ryan dissect the actual costs of ObamaCare during the “Health Care Summit”. After all everyone is always throwing around numbers but do any of us ever know if the numbers represent reality? After all ‘junk in = junk out’.

The Wall Street Journal details the true costs.

‘Every argument has been made. Everything that there is to say about health care has been said, and just about everybody has said it,” President Obama declared yesterday as he urged Democrats to steamroll his plan through Congress. What hasn’t been heard, however, is even a shred of White House honesty about the true costs of ObamaCare, or its fiscal consequences….

Nearby, we reprint Wisconsin Republican Paul Ryan’s remarks at the health summit last week, which methodically dismantle the falsehoods—there is no other way of putting it—that Mr. Obama has used to sell “reform” and repeated again yesterday. No one in the political class has even tried to refute Mr. Ryan’s arguments, though he made them directly to the President and his allies, no doubt because they are irrefutable. If Democrats are willing to ignore overwhelming public opposition to ObamaCare and pass it anyway, then what’s a trifling dispute over a couple of trillion dollars?….

Mr. Obama’s fiscal assertions are possible only because of the fraudulent accounting and budget gimmicks that Democrats spent months calibrating….

The real cost over a decade is about $2.3 trillion on paper, Mr. Ryan estimates, and even that is a lowball estimate considering how many people will flood to “free” health care and how many businesses will be induced to drop coverage. Mr. Obama claimed yesterday that the plan will cost “about $100 billion per year,” but in fact the costs ramp up each year the program exists. The far more likely deficits are $460 billion over the first 10 years, and $1.4 trillion over the next 10….

Yesterday Mr. Obama again invoked the “nonpartisan, independent” authority of CBO, which misses the reality that if you feed the agency phony premises, you are going to get phony results at the other end….FULL STORY HERE

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Copied from Sean’s Medical Blog

My name is Sean Cowlishaw and I have a rare condition (fibrous dysplasia of the skull). In short my skull has never quit growing and bone is surrounding my optic nerves, has filled my sinus cavities, and is putting pressure on my brain. My condition is extremely rare in that the bone growth did not end in puberty and the bone continues to grow to this day (I am in my thirties).

About three years ago I finally found a doctor that not only helped me find answers but that works closely with me and my family to assure us a high quality of life. I have also been blessed in that I have had good insurance (for the past five years) and a wife that understands the health care system. My wife and I have worked closely with our doctor to keep costs down for both us and the insurance company and to maintain a high quality of care (see my blog entry about cost containment).

As the Health Care Reform debate heated up in 2009 my quality of life was significantly lowered. The first blow was that my costs for specialists were raised due to the media and Congressional blitz about high quality insurance plans. At first this was not a huge issue for me as I have seen ever specialist possible and there is nothing they can do for my condition. The specialists had sent me back to my general practitioner for pain management and for almost a year my quality of life was the best it had been for a long time. I had one doctor managing my care and he took all aspects of my quality of life into consideration as well as doctoring my full person not just my fibrous dysplasia.

In February of 2010 the second and worst blow fell. I was called into my general practitioner’s office and told he was no longer allowed to practice pain management. The clinic management has determined that because of the DEA practices of treating pain management doctors as drug dealers it was too big of a risk for their doctors to prescribe pain medicines. The clinic was only able to give us the names of two practices that are still willing to prescribe pain meds. One option will cost us and our insurance three time as much as our general practitioner. The other option costs over $1000 more a visit and is not covered by insurance. We have our first visit with the new doctor on Tuesday and will update this blog continuously.

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Earlier this year (2009) the Commonwealth Fund Commission issued multiple reports asserting a government-run health care plan could cut insurance premiums approximately 20%. It asserts that private insurance spends 40% of claims costs on administrative expenses. The Sherlock Company was commissioned to do a study of private insurance costs in 2009 (the study most frequently quoted in the debate today dates from 1988).

The full report can be found at http://tinyurl.com/kjo9hq

Top health insurance lobbyist fires back at the White House

I. Executive Summary
Health plan administrative expenses often are cited as consuming a significant share of health insurance premiums. Proponents of a public health insurance plan often state that Medicare is more efficient than private insurance companies. However, these statements are based on outdated data and misconceptions about private administrative expenses, especially in the small group and individual markets.

Recent reports claim that health plan administrative expenses in the individual and small employer markets can exceed 30%. However, these estimates are based on data from Hay-Huggins that is more than 20 years old (1988) — a time when most claims were paper-based and many electronic processes were in their infancy — and based on estimated, rather than actual, administrative costs for companies that no longer provide health insurance.
An independent analysis by Sherlock Company of health plan administrative costs finds that prior estimates do not reflect the actual administrative costs for Blue Cross and Blue Shield Plans and other major health plans. Based on our review of actual health plan administrative expenses, we find that:

• Private health plan administrative expenses are grossly overstated in previous reports.
Based on combined data from 36 health plans participating in our performance benchmarking studies in 2008 (2007 data) and other data, administrative expenses for all commercial products represented 9.18% of premiums. Administrative costs are 11.12% of premiums for the small group market and 16.35% of the individual market, amounts that are nearly one-half and in some cases nearly one-third of other estimates.

• Traditional Medicare performs only a fraction of the administrative functions of private health plans because it retains its original fee-for-service design and is, therefore, not comparable.
Private plans use their administrative costs to promote care coordination and wellness, reduce unnecessary utilization and aggressively combat fraud and abuse. No precise, generally accepted measure of Medicare administrative expenses exists that is comparable to private plans. Moreover, Medicare does not need to market its coverage, develop provider networks, negotiate provider rates or maintain capital. If the government were to create a public health option to compete with private plans in a health insurance exchange, it would have to take on many additional functions that are not part of Medicare’s administrative costs today, resulting in increased administrative costs.

• Private plans perform those administrative functions that Medicare performs at lower costs.
In comparing only those administrative functions that Medicare performs, private administrative costs are actually lower — $12.51 per member per month, compared to a $13.19 per member per month in traditional Medicare. Many of Medicare’s administrative functions are, in fact, performed by private administrative contractors.

• Comparing administrative expenses between Medicare beneficiaries and people under age 65 should consider the unique health care needs of seniors.
Medicare beneficiaries have higher costs per claim compared to private plan enrollees. This means that the service requirements are less per dollar of health benefit, and administrative expenses are less for Medicare simply by virtue of the higher cost per claim.

• Comparing administrative costs as a percentage of claims overstates the difference
between plans for small groups or individuals and large groups.
Instead of calculating administrative expenses as a percentage of premiums, which is the most conventional metric used for comparing administrative costs, Hay-Huggins and subsequent reports have expressed the values as a percentage of claims, which is very misleading. Because health insurance premiums pay for both health claim costs and administrative expenses, the Hay-Huggins approach, repeated by Lewin, of dividing administrative expenses by claims costs unrealistically magnifies the differences between administrative expense ratios.

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Rep. Paul Ryan

He started off good but now in 2014 not so great

 Paul Ryan on Glenn Beck about Progressivism 

Paul’s roadmap for America

Great summary of Rep. Ryan’s career & health care work.

“To be clear: it is not sufficient for those of us in the opposition to await a reversal of political fortune months or years from now before we advance action on health care reform. Costs will continue their ascent as the debt burden squeezes life out of our economy. We are unapologetic advocates for the repeal of this costly misstep. But Republicans must also make the case for a reform agenda to take its place, and get to work on that effort now.”…FULL OP-ED HERE

Today (March 15, 2010) Rep. Ryan did a wonderful job of defending the true will of the majority of the American People.


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