U.S. to Offer National Health Plan, "the robust public option that liberals wanted"

I was actually going to go up to bat for him a little. After reading LK's response and suddenly remembering the situation, I was ready to watch him be humbled and say "hey, talk to Lum, maybe get that whole D&D thing reversed so Brett doesn't troll up every thread you make, because sometimes you say some insightful shit that doesn't make me picture you sitting in an attic in 2 year-old boxers and ankle socks with empty cans of lemonade strewn about" but then I bit into one of those hard pieces of pepper that they put in the salami that came in this delicious fucking Wawa hoagie. Seriously, what the fuck is with that pepper? You think we could breed whatever animal makes salami into something that doesn't contain frivolous pepper seeds. I have no dental insurance, and that's BrettMCD's fault.

Well, this is the Santorum, where there's free reign to... hold on I gotta look this shit up because the word had something to do with internal organs... oh right, finely eviscerate dumbassitude.

Incidentally, as I think has been pointed out already, Medicare is not poorly run. Yes it has its share of obligatory red tape but provided it is followed properly, it's as good a managed care system as we've put together. Most of the particulars involve control of spending by limiting overlap or fraud (either deliberate or accidental) by health care providers. Its PAR price capping model (where a doctor may want to charge a certain fee for a service, but must cap it to the price Medicare sets for any Medicare patients the doctor sees, so there are no balance billings) has been copied by private coverage providers. It is built to integrate with and/or be supplemented by private and military coverages. It staff aren't paid bonuses based on how much money is saved by denying coverage to its members, unlike private companies.

It even uses just one form for all submissions. Just one form. That in itself is pretty impressive if you ask me. It is by no means perfect but it is actually much better than your average private company and far and away better than many government-run programs. Most of its problems are the problems medical care in the US has in general, most conspicuously the hyper-inflated cost/fees of medical care services which limits its ability to allow coverage for more and varied services for its patient base.

I'm almost 100% certain you've explained that exact same thing to Brett before.

edit: I'm serious, it's deja vu. We were both medical office managers who understood this shit and tried to explain the exact same thing. He doesn't care.

Also the payout rate to doctors for claims filed for Medicare is apparently vastly higher than private insurers, who are all "Ah, I see you are billing us for your standard $300; here is $50".

And the fraud rate is higher, but that doesnt matter, it is just the government being defrauded.

Citation needed.

So can anyone tell me how this is going to work? Is it really as great as people seem to think or is that just wishful thinking? And if it is that great, how can it get done without Congress (who I think it goes without saying will not be able to do this)? Or is it just posturing?

It happens to every insurance carrier. If you have statistics proving what you're claiming I'd love to see them. Anyway I don't know where the comment about nobody caring comes from. Plenty of people care, or they should.

Also this:

http://www.hhs.gov/news/press/2012pres/02/20120214a.html

Technically speaking in terms of recovered monies, more was recovered from the private sector. Plus, around 25% of that total were from scammers pretending to be Medicare providers, that isn't really in the same vein as doctors or patients trying to bilk the system.

I was on a government health care plan last year. I was satisfied with the experience I had, even though it required more paperwork than my private insurance company does (which is zero from me, usually). The toughest part was just finding places that would accept BOTH plans, since, by law, my private insurance has to apply benefits before the gov't plan will kick in. Every piece of documentation I ever had to do was either related to preventing fraud or determining if the care received was the result of a work-related injury (resulting in liability claims or whatever).

The only time I had an issue was when one of the anti-fraud systems (correctly) kicked in and didn't pay out on one of my claims. Apparently my private insurance had randomly decided that I suddenly had "employer-based health insurance" (it's not an insurance plan, nor was I legally considered employed) and wouldn't pay out until the gov't plan paid first. They forwarded the claim to the gov't, the gov't said "fuck no we're not doing this because it's the law." I cleared it up with a phone call to my private insurance company, they applied coverage, and then the gov't plan picked up what it was supposed to.

My coverage was not as comprehensive with the gov't plan (very little preventative care, no psych care, dental/orthodontic care limited to pain-relieving procedures only, pre-existing conditions not covered), but the co-pays were a LOT cheaper than my private insurance, so they usually picked up the difference ($100 ER visit co-pay turned into $5!).

Unfortunately, it's NOT insurance, so it wouldn't really work as a model system for a public option, but using it made me feel pretty confident about what a gov't-run system would be like.

As someone that's dealt with medical billing directly.. this is kind of a half truth. (Note: I am a big fan of a single payer govt healthcare option and am thrilled to see the OP's article, but partial information helps noone.)

Medicare pays comparable rates (if not a smidge better!) to doctors, but will deny claims made by a fair number of additional medical services: some blood tests, in-surgery nerve monitoring, some medical devices, etc. There are a number of sub-businesses that do work for doctors 'for free' on Medicare cases because the doctors will call them when they have non-Medicare cases that they can bill for. A member of my immediate family does this for a living.

Interesting. What you say sounds like it doesn't conflict with the information I have, which is mainly from general practice, family care, and pediatrics practices, primarily in the Northeast and California.

They say that their nominal rates that they officially charge to the uninsured and bill to private insurers are much higher than their expected values, and that private insurers pay out on 2/3 of claims, at 1/3 of the value, on a good week. Then comes the game of figuring out what's worth fighting and what's better to just ignore based on limited manhours and the cost of fighting it.

Medicare, on the other hand, requires (or so they say) a little bit more in the way of paperwork, but that paperwork is far less likely to get "lost" or be "missing information" when no such information is missing, and the rate of Medicare paying the claims they're supposed to be paying - and paying the amount they're supposed to pay - is far higher.

Obviously, things like in-surgery nerve monitoring and most medical devices are not something that those practices would be billing for, and I'm certainly interested in more details (if you're able to discuss them).

I suspect we move in different circles, as most of my experience relates to ORs and hospitals in the southwest (Vegas, north AZ, south Utah). And no, it doesn't sound like it's contradictory in nature, just that there's a little more to the story.

The specific numbers I've heard for hospitals around here are more generalized than Medicare vs private, unfortunately, but I've heard (reliable secondhand) that hospitals see 20-30 cents for every dollar billed, so taking into account uninsured and such that sounds like it works out comparably.

.. a lot of my experience involves specific types of surgery, and as I can count the number of doctors doing them within 3 hours on my hands, I'm hesitant to give out too much identifying info in a public space. I can PM if you'd like?

That's quite fair! :) If you wouldn't mind, I'd be delighted to know just for my personal edification; or if there has been anything published - news, papers, blograge from doctors, whatever - those would do too.

It's certainly not that I don't believe you! It's rather that I do, and love knowing more about things because dude, knowing more about things, what's not to love?

This is my experience. Medicare visits paid about $89, most private insurers paid above $72 for the same visits.

IIRC, Medicare pays better because it's essentially banned from bare knuckle negotiating. They have lowered from sticker price rates like everyone else, but they're not allowed to try and see how low they can get it. It's a lot of what the OMG taking 716B from medicare thing is about: they're fixing some overpayments in old negotiated rates. It's the sort of thing that would normally be a huge pro for the GOP (cutting government wasteful overspending), but since it's an election year and proposed by Dems it's killing grandma.

REPORTED

Aw, he deserves points for subtlety, right?