Single payer healthcare - Page 2

I'm illustrating that in a consumer level fee for services exchange healthcare is the only industry that I know of that is expected to wait for payment on services rendered. For a corporation this may be a good business plan. For the average doctors office employing less than 10 people this isn't the best way to run your business.

Especially when the price you need to function is reduced by the insurance company.

Do you honestly think that the healthcare industry is the only industry that has to wait for payment on services rendered? Please. You may want to visit your own industry to take care of those delusions.

In the normal world, people don't accept contracts with a negative margin. Seems to me that it's your own fault for accepting a contract that pays you less than what it costs.

Since this is a movie site, although a political forum on said movie site, I'll assume you understand the quote I am going to use here:

Mechanic? Fuck you. Pay me.

Clothes? Fuck you. Pay me.

Groceries? Fuck you. Pay me.

Restaurant? Fuck you. Pay me.

New Car? Fuck you. Pay me.

Attorney? Fuck you. Pay me.

Any consumer goods? Fuck you. Pay me.

Totally ignoring my comment about accepting contracts at a negative margin. Hmm, why do that? Greed. You want the money, and you know you can pass the costs onto other people. Thiefs, all.

It's painfully obvious we aren't going to see eye to eye on this issue. You can go back to stealing from people, and I'll go back to not using your services. I can't wait for the government to dismantle and get the healthcare system working correctly.

I don't think he is factoring in the insurance co-pay with his cost, especially in terms of his specified industry, have you seen Chricropractic co-pays?

So $50 co-pay + $38 insurance payment = $88 for the $50 procedure means $38 profit.

edit -- it's also important to point out, co-pays are instant payment.

Do you think every business runs on having payment in full upfront? You're sadly mistaken.

How many businesses that accept payment plans or POs do so without a credit or reference check during account setup?

As a primary healthcare provider that option isn't available to us.

Also, until the insurance company pays, the amount of time sending material (xrays, charts, etc.) or talking on the phone to reps is unbounded.

Again, for the accountants (HBarr), what do you think is the percentage of revenue we write off in bad debts each year, i.e., uncollectible fees?

And yet statistically, which is what counts, Canada's and the US's systems perform equally well. Except when you factor in your uninsured. Then ours is better.

I can tell you that in this province at least, availability problems are a result of Conservative policy, not the nature of single-payer health insurance in general. The more positions you abolish, the harder the lucky survivors have to work in order to provide the same level of care; if you don't maintain the facilities you have and provide more as the population grows, of course waiting times will increase.

I could tell personal anecdotes, both good and bad, but suffice it to say that despite a long list of complaints, I wouldn't trade my insurance for American health insurance in a second. In the past five years I've spent about 15 days in the hospital for separate reasons that would have left something like 40 million Americans utterly bankrupt and possibly destitute had it happened to one of them.

I got a bill for my premiums every three months. Any ambulance rides I happen to need, I'm billed for sometime later. A new development, I had to pay a small fee for my semi-private room because isolation was not strictly required. The most inconvenient was the ambulance fee, around $250. And that's pretty much the extent of my personal dealings with my health insurer, other than getting them to spell my name properly when they issue my next insurance card.

I hear Americans have a few more hoops to jump through. No surprise, since I also hear American insurers have staff on hand specifically to attempt to weasel out of claims.

It runs on fear. Hence the horror stories about waiting times and the like. And when it comes to health care, it's running on capitalism very well. I don't know about you, but I think results are more important than ideology.

Guess not. Oh well. Somebody else's problem, I suppose.

I didn't answer your contract comment because it was already covered. You just don't like the answer. Insurance companies are a huge and powerful entity, they have bargaining power that creates these lower fee schedules. The way that is made up is that cash prices go up to compensate. Creating buffet style insurance policies would lower risk for insurers, thereby opening up the ability to raise fees in some instance and thereby lowering cash prices to stay competitive.

I am factoring in copays. You are mistaken how insurance pays in the case you have listed above. If a patient has a $50 copay and I only do $38 worth of services I can only legally collect $38 from the patient. In this instance the insurance company would not pay me anything at all. The patient would be responsible for the entirety of the bill. Yes, I am getting paid up front but I am still $12 short of what it costs to run my office. The problem is, with contracted rates I cannot charge the patient above the $38 allowable you mention.

The fact that we are treated as specialists and do incur those higher copays is a big problem to my industry. Precisely because of falling contracted allowables the chiropractic industry has had to expand into rehabilitation post passive treatment phases in order to make up lost revenue. This in turn has caused our national organizing bodies to butt heads with the physical therapist lobby because we are Portal of Entry(POE) providers and are taking money out of their pockets because we have easier access to patients. Hence the rising prevalence of the Doctor of Physical Therapy degree being created in medical schools and conferred upon graduates. This allows them POE status and they can bypass the need for a referral from an MD.

Here's a huge kicker for you to ponder as well. A 15 minute therapeutic ultrasound treatment performed in my office is paid by most insurance carriers at approximately $12. That exact same treatment performed and billed from a physical therapy office will usually be paid by the same insurance carriers at around $60. Why is my profession getting kicked in the balls for the exact same work?

http://www.youtube.com/watch?v=0DacChr5MRo

Why we have HMO's

Good question; however, I'd wager you can't answer that question either. How much of your revenue is actually written off and how much of it is sold to collection agencies? When you're selling the accounts, they aren't exactly being written off, are they?

Never mind the fact that if the health care system actually billed somewhat reasonable, you might be able to actually collect and set-up payment plans. When you start at a number that is borderline fradulent, it makes people not want to even deal.

True; however, I've never heard of a mechanic charging $6,000.00 an hour for work. Naturally, they have an easier time of charging.


Doesn't apply. Goods not services.


Doesn't apply. Goods not services.

Doesn't apply. Goods not services.

Doesn't apply. Goods not services; however, dealers aren't paid in full.

Don't have any experience with them (yet, hopefully never). Not sure whether you would need to pay in full or whether they accept installment plans.


True. Healthcare isn't a good though. It's a service. Different ballgame here.

You don't have to accept their contracts. You accept them because you want the money, and you'll try to make the difference on innocent people. Thief.

You're insane. Do you realize how many phone calls I get every week and the first question out of a potential patients mouth is, "Do you accept my insurance?" If the answer is no all you get is a click as the phone hangs up.

I personally do not believe insurance should cover simple office visits. Insurance should be a catastrophe only business. Your visit to the doctor to tell you that you have the flu and write you a scrip for that? Shouldn't be covered. Lots of things should not be covered in my opinion.

Ok. So you want business. You want to accept the contract, full knowing that it isn't going to cover your costs. Who is the insane one here? Obviously it's you, for accepting a contract that pays you less than what it costs. Instead, you pass YOUR losses onto other customers.

These are not individual contracts, they are standardized across geographical regions. The insurance companies drive fees down and that drives other fees up. You are being purposefully obtuse.

You are trying to justify stealing from your customers. The insurance company doesn't hold a gun to your head to accept their contracts. Your greed for the revenue (never mind the cost) has you accepting those terms. Then you pass on YOUR losses (because you wanted their business no matter the cost) on to people who can't afford it. Evil, evil, evil.

Long and short of it is this, in normal business practices you don't pass on margin losses onto other customers. You find ways to lower your costs or you just flat out don't accept contracts for less than your costs.

I feel as though I must be misunderstanding the position you're taking. Are you arguing health care providers should only help those who have insurance or can afford procedures?

I'm arguing that health care providers are stealing from people who can't afford insurance by charging them more to compensate for their losses incurred by accepting current insurance contracts. Rather than passing their losses onto people who can't afford it (and who shouldn't be paying it) health care providers need to find ways to lower their costs (like any other business) or negotiate better contracts.

You and I are (and for the most part, have always been) in complete agreement. If I could just get you steered in the right direction with guns. ;-)

Actually the dental association and college keeps on top of this and many other financial statistics -- it helps when they draft the fee guide if they know if there's at least a correlation between, say, prices and delinquent accounts. For my province, the average for a clinic is less than half of one percent.

For us, we've only had very few cases referred to collection agencies since there's a minimum charge per case and most large amounts are insurance problems.

Of course this brings in a whole host of issues, beginning with whether patients are qualified (even if informed) to judge what a reasonable cost is.

Agreed. I beleive there needs to be some sort of universal coverage, but I am not enthusiastic about the Government taking over the whole industry.

That's generally the case here in Ontario as well (thanks, Mike Harris!) which is a constant source of irritation for me whenever Americans start talking oh-so-knowledgeably about the Canadian health care system. I seriously believe the Conservatives are out to fuck up Canada's health care so they can steer things towards the massively profitable American system. And I don't think I'm alone in my paranoia, which is why mentioning health care is political cyanide for the Conservos. The side benefit is that American conservatives get to point at the damage caused by their ideological brethren and use it as an example of how all us northern radical hippie lesbian communists can't run a good health care system.

I know the Conservatives want to implement private health care, because they float it here every few years. And I'm not entirely opposed to what they propose, but for the following: spending at least 50% of their working hours in the non-private hospitals would NOT become a requirement for practicing surgery in Alberta; the province would still pay for the day-surgery (the most these hospitals would be allowed to perform) of people jumping the line. Patients would just have to pay the difference between the cost to the province of removing a ganglia and the private hospital's fee. Bugger that. Like the man said, you're in or you're out.

But if I had the opportunity to trade all our problems for American insurance, with the prior condition conditions and the paper and the being cut off mid-treatment when you're no longer profitable and so on, I'd say no. What an awful thing to have hanging over my head. It would be like a fire department that will only spend 20 minutes putting out my burning home.