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RAND -Health Reform Options to Reduce # of Uninsured

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posted on Aug, 25 2009 @ 02:00 PM
reply to post by mental modulator

I mean, I am a good guy here, I do my part, contribute to the world and yet I am lumped in with Stalin and Hitler for even providing vital facts for all to consider...

We both know it shouldn't be that way. We all can learn from each other and IMO, you have a lot to offer to this issue. What you are describing is exactly what is happening. People are getting scammed.

Does any of the below match with what you described in your earlier post?

Medical billing game is somewhat of a game. Most anesthesia groups bill $80 a unit. Some bill $100. For all that it matters, they could bill $10,000 a unit. What matters is what they collect.
If an anesthesiologist accepts Medicare assignment, they will get about $17 a unit from Medicare. Insurance companies seem to reimburse at some magical percentage of what is billed. That is why groups keep upping the billed amount. Insurance companies gradually figure this out and lower the percentage of the billed amount that they reimburse. Sounds like a great system doesn't it?

Now, I am not sweating the AMA for trying to make a buck. The coding system is very complex and has been developed over about 20 years. They have put a great deal of work into it. The do make money on it, about $80 million a year. Every office has to buy a CPT book or program to do their billing. The AMA makes a royalty off each sale or user. I'm a firm believer in a capitalist system. Unfortunately, what they have is a state sponsored monopoly.

Some good places to look for reimbursement data are the pharmaceutical and medical equipment companies. They all want docs to use their products. If docs can't make money using their product, then what's the point. Therefore, many companies actually educate their reps and/or have a reimbursement consultant who will aid the physician/group in how to maximize their billing using their device/drug.

Boston Scientific makes drug eluting stents. They cost alot of money and the company makes alot of money when they are used. As you can see, they also let the cardiologist know how much cake they will make when they deploy the stent. You can almost hear the purr of that V8 in your new Ferrari you like red or silver?....I prefer the red, but I don't deploy stents.

posted on Aug, 25 2009 @ 02:37 PM
It's all so convoluted and intertwined "legally." If this reform happens the fall of dominoes will expose the illegalities many don't want exposed. As long as they are getting their piece of the pie they don't care who it hurts.

We need real change -not to be made trite with the phrase. The dominoes need to fall and LOUDLY for real progress to be made in reform.


[edit on 25-8-2009 by anyone]

posted on Aug, 25 2009 @ 02:49 PM
reply to post by anyone

We need real change

I agree. Therefore I hereby ask Congress for transparency and to provide the individuals, entities, or organizations that have written up the healthcare bills that are currently being proposed by Congress.

I just have a weird feeling that the insurance companies and big pharma have all angles covered. They are going to make their money one way or the other.

Here is one of the reason I am so skeptical.

As his committee has taken center stage in the battle over health-care reform, Chairman Baucus (D-Mont.) has emerged as a leading recipient of Senate campaign contributions from the hospitals, insurers and other medical interest groups hoping to shape the legislation to their advantage. Health-related companies and their employees gave Baucus's political committees nearly $1.5 million in 2007 and 2008, when he began holding hearings and making preparations for this year's reform debate.

To avoid any appearance of favoritism, his aides say, Baucus quietly began refusing contributions from health-care political action committees after June 1. But the policy does not apply to lobbyists or corporate executives, who continued to make donations, disclosure records show.

posted on Aug, 25 2009 @ 03:30 PM
reply to post by jam321

That is ugly. Lobbyists make me sick. It is suppose to not matter but how can you separate from it. It is where the $ comes from.

It's hard to differentiate from all the crap. Almost all of them accept these "donations." -not saying that makes it right. We vote these people in to do right for us. It's is so hard to tell who has been bought, but the idea behind the proposal seems to be working for the good.


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