Sunday, June 14, 2009

Still brooding about health care

It's a good thing the S.O. isn't here. He might have had heart failure this morning. The idiots on C-SPAN and the morning news shows had me feeling so frustrated and pissed off that I resorted to doing actual housework in order to burn it off. You know I'm feeling frustrated when I'm on my hands and knees mopping the kitchen floor the old-fashioned way, with a scrub brush and a rag.

I think the one thing that had me wanting to reach right through the screen and strangle someone was the repetition of a flatout lie, over and over, that the problem with Medicare and Medicaid is the horrendous paperwork, just how incredibly inefficient the government is at processing claims. The Medicare program spends less than 5% of its budget on administrative costs, i.e., the paper shuffling, while the private insurance companies are spending well over 30% on administration.

Of course, there is one huge difference between Medicare and Aetna et al: the person running the Medicare program works for us. No multi-million dollar CEO salaries driving up administrative costs. Medicare is part of Health and Human Services. People may bitch about bloated government bureaucracies, but you can get an awful of lot of GS-5 clerks for the price of one private sector executive. Yes, the chief administrator for Medicare is making 6 figures, but not dramatically so. The senior executive service tops out at under $200,000 annually, although there would be locality pay adjustments on top of the base salary. Compare that with the over $15 million that the CEO for Travelers carried home in 2006.

Nonetheless, Medicare is derided for being expensive, cumbersome, and poorly managed. No wonder I felt like scrubbing floors -- the alternative was brain bleach, and that's hard to come by.

(The other thing that drives me right up a wall, of course, is hearing over and over that we don't want government bureaucrats making decisions about which medical procedures are necessary. Given that the first words out of my doctor's mouth every time he's contemplating ordering a lab test or prescribing a different drug are "I'm not sure your insurance covers this, let me check first," that argument doesn't have much traction with me.)


  1. I'm telling you that there is no solution to a health care fix. There is too much greed in it and too many bottom feeders in it.

    And too many fucking monkeys that don't want to die but are going to die anyway.

    I think that it's rather silly to expect the taxpayers to keep trying to keep us older fucks alive when we are assured of dying anyway.

    A good health care system in this country should be about the youth, not old fucks that are afraid to die.

    But being an omnipresent spirit the death of Billy is just the last interesting thing I will be doing here as Billy.

    And that's fine with me, I'm tired of this fucked up planet anyway.

  2. Hey, why should the presnut have better have better healt care than you? Is he really more special than you?

  3. Well, one of the things that's driving up costs is the fact too many people are either afraid of dying or believe the garbage they see on tv shows like ER. They insist on the heroic measures even though all they're doing is adding a few days or weeks, and usually with really poor quality of life for the short time they've got left.

    Going to a universal single payer system, Medicare for everyone, would eliminate the worst of the bottom feeders. I've no doubt there'd be corruption, fraud, and general chicanery, but it would still be a huge improvement over what this country has now.

  4. Actually, the "horrendous paperwork" and "incredibly inefficient" complaints are entirely separate from the "percent of budget spent on administrative costs" issue.

    My mom and uncle both dealt with Medicare and Medicaid billing. It *IS* an incredibly inefficient process that requires horrendous amounts of paperwork. They might be able to make it more efficient if they would spend more than 5% of their budget on administering the program.

    First, they are constantly "updating" their billing codes. And if you submit a bill with an old code, it gets rejected.

    They also constantly "update" their computer software. And once they update it, you have to also or you can't submit your bills.

    If a bill is late because of coding or software issues, they refuse to pay it. Ever.

    If a bill is timely but has one minor error anywhere in it, they can't just call you and ask for the right information and fill it in on the form you already submitted. Oh no, they simply reject the claim (after a couple of months of "processing"), and then you have to resubmit the paperwork in its entirety, with the one minor correction.

    And then if it's "late" due to the rejection and resubmission, they'll reject it again for that reason and then you have to go through an appeal process, submitting copies of the original claim and the corrected one, and wait months for them to process your appeal.

    Average time from claim submission to actual payment can be anywhere from months to years. If that isn't inefficient, I don't know what is.

    And their favorite way to "save money" is to lower the reimbursement rates for the providers. Which, practically speaking, means that if your normal billing rate as a doctor or psychiatrist or whatever is $100 per hour (which would be a pretty low normal billing rate for these professions), then the medicare "allowed reimbursement rate" is probably $85 per hour. Until they decide to save costs. Then they'll reduce it to $80 per hour. Or $75.

    So the fact that you have to spend at least one hour, or perhaps more, trying to get paid for each hour you spent actually providing services, combined with the fact that the billing rate is half to two thirds what you could charge a "private payor," essentially means you are working for 1/4 to 1/3 your normal billing rate when you treat Medicare patients.

    No wonder so many health care providers don't want to take Medicare.

    At least with the private insurance companies, doctors and hospitals can attempt to bargain, change the terms of the contract, influence the payment terms and procedures. No hope at all of that with Medicare. You take it or leave it.

    Many are choosing to leave it.

    Which means a huge portion of doctors and other care providers are unavailable to those on Medicare.

    Percent of budget doesn't impress me. I wish they'd spend more and improve their payment processing procedures - "shuffle the paper" faster and better.

    I agree that the private sector is out of whack with CEO salaries, but that is not just in the insurance industry - that is all over the board. But that is a completely separate issue from whether the company processes claims efficiently.

  5. Wow. I've never, ever heard a Medicare complaint before, at least not from the patient's side of the equation. I've heard clinicians bitch about unrealistically low compensation, and I've heard billing clerks bitch about codes, but every single old person I've ever known has loved their Medicare coverage (at least until they discovered it doesn't cover nursing homes). I do know people who are unhappy with the drug coverage (they're unlucky enough to have hit that infamous donut hole), but when it comes to doctors, procedures, etc., no problems. Wonder if it's regional? My anecdotal evidence is primarily upper Midwest.

  6. Well, this falls in the category of clinicians and billing clerks bitching about it, I suppose. These were not complaints from patients. But that doesn't, in my view, make the complaints about "inefficiency" any less valid.

    Another issue my uncle (an eye doctor) dealt with was being accused of fraud when he provided free services to a patient who did not have insurance and was ineligible for medicare.

    Apparently, he was "ripping off" the government by charging his "normal" [in actuality hugely reduced] fee for Medicare patients while giving away services for free to non-medicare patients, because he did not provide free services to Medicare patients too. Nevermind that he provided free services only for rare charity cases and that his normal fee for regular paying clients was twice or three times what Medicare paid (so that, in reality, *all* of his Medicare patients were receiving "reduced-fee" services). It was a huge legal battle with Medicare. Between that and the billing issues, he eventually quit taking Medicare patients at all.

    So, while the patients may be happy with the service from Medicare, the clinicians are not happy with the system at all.

    And if Medicare were the *only* game in town, what incentive would they have to improve their payment efficiency and/or pay fair rates to the clinicians?

    I agree we need Medicare. And we need to expand it so that those who are currently uninsured can be insured.

    I am just not as sure as you are that we should completely eliminate the private insurance system.

    I have had a variety of private insurance plans. Yes, they are expensive, but I've had good doctors and excellent care through my pregnancies. Granted, I've never dealt with a serious illness [knock on wood...], and I've never been on Medicare, so it's tough to compare. But I do think that the Medicare system is better for having to "compete" with the private insurers.

    Just my two cents.


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