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Health Care billing examples. The "public option" can’t work.

by Divorced one like Bush

For your consideration here are some real numbers from a Medicare Advantage policy via United Health Care

Cat Scan billed $1042.00
Not Covered $ 831.68
That means the contracted charge for this service with UHC is $210.32.
Copay $ 42.06
UHC payment $ 168.26

The “copay” is 20%.

Same plan has a “Deductible/Copay” individual combined limit of $3800.00/yr.

Ok, lets look at this. Eye Exam.
This is for my dad in the nursing home.
Service code 92004 $217.00. Medicare paid Zero.
Same code, 92004 via the doc my daughter saw was $160. This was discounted to $40.00and my share was zero.

Here is the issue, rational consumer and all that, how can we expect to get costs under control if the billed amounts and the paid/contracted amounts are so far apart? The consumer does not know the contracted rates, so the consumer can not purchase the insurance that pays the least. Thus, the consumer can not be “rational” when choosing health care. (Like we’re rational at anytime with this!) Basically, there is nothing in our current approach to the issue that economic theory would suggest is viable. Or maybe economic theory doesn’t apply?

At the same time, how do we know that these contracted prices are the correct price such that the market is “clearing” properly or in “equilibrium” of some sorts such that there is a reasonable profit for the providers and payers with reasonable cost for the consumer while producing the product of highest quality (as in it did not harm you and did actually help you)? These prices could be distressed prices in that the provider accepts them so that they can capture some of the patients planning to make up the difference in cash patients or other higher contracted fees. For the lawyers that read this blog, we are talking about “contracts of adhesion”. That is a contract signed where one party has most of the power. But then, what would you expect when you exempt a type of business from the anti-monopoly laws. In the past they were public utilities.

This leads to the question of just how can congress and Obama believe (and it is a belief because all examples of what is being proposed have failed in the past, MA being the most recent) their “public plan” is going to ultimately produce the savings that will allow coverage of 50 million more people, better product quality and happy, smiling Americans? After all, if the contracted rates are all over the map, then there will be massive cost shifting either by insured selection or subscriber (patient) deductible manipulation. And, there will still be a need for all the administration to “manage” the care which is in actuality a paper chase game.

We talk about pricing. Medicare wants to reduce the rates and that will just shift the burden onto the privates is the complaint. Well, I got news for all of you. The privates use the medicare fee schedules all the time and then start cutting from there. So, this is a bogus complaint by the privates/non-profits.

I assure you, though you may disagree, there is no way to fix health care via market theory when the approach is to believe that the market is with the middle man; the insurers. Private, public or non-profit, the problem with health care cost and all that leads to can not be found there because that is not the real market.

How much more and for how long do we continue to pay the privates more via Medicare Advantage before congress gets this message that the issue can not be fixed by focusing on a false market? From 2004.

Note this report on Nick Skala presentation of June 4, 2009 in front of the “Progressive Caucus”.

“Bill Gould emailed me after reading my testimony and materials I was going to present to tell me that they were not acceptable and that there could be no comparison between single payer and the public option with side by side comparison,” Skala told Single Payer Action. “Darcy Burner told me that they would construe talking about the public option — even comparing it to single payer — as an attack on the members of the Progressive Caucus.”

Darcy Burner; the candidate that Blue America backed. Head of the American Progressive Caucus Policy Foundation whose tag line is:

organization whose mission is to bring together the collective wisdom of progressives inside and outside of Congress to promote
* the health and economic well-being of us all.

Both are caucus’ that should be aware that the people want a medicare like program. The numbers are landslide size. The numbers should completely put to bed the meme of “not politically possible” if this nation actually worked it’s Constitution. And, if there is a caucus that should be working the Constitution as the normal course of it’s function, it should be a caucus that titles it’s self “Progressive”. Certainly a person who was a candidate for Blue America should get it!

Talking about a single payer system to the congress people who are part of a caucus FOUNDED by Senator Bernie Sanders, a “self described socialist” who is promoting single payer every chance he can, is to be construed as “an attack on the members”? ARE YOU FUCKING KIDDING ME! What! Prgressive suddenly do not like to learn about stuff…factually?

“During the presentation it was very nasty,” Skala said. “I got some very dirty looks from Darcy Burner. During the question period and once during the testimony, I was interrupted, told that the Progressive Caucus had taken a position on this issue and unless I had something positive to contribute, then there wasn’t really much point to answering my questions.

Here is Nick Skala’s actual presentation.

So, what does it say about a nation that states it is a democracy and yet the very organizations who should understand the implications of naming one self such, is unwilling to do the peoples bidding? This is not hard folks. A caucus’ job is not to do what is politically simple, it is to make the perceived politically impossible a social reality based on that caucus’ ideals. Well, if your ideals are “progressive”, if you are a part of a group founded by a socialist, and 65 to 70%of the people want something that by all Fox News reports is progressive and socialist then: How much easier can it get?

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