Tuesday, May 01, 2007

Escape From National Health Care Hell

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This cartoon reminds of my friend in the United Kingdom, who was scheduled for a hip replacement, then had the operation repeatedly postponed over a several-year period to the point that when he finally got it, he was already permanently crippled and the operation was wasted.

A friend here in Gualala is a staunch supporter of government programs, particularly universal government health care, and he called me to task for saying that the government pays “pennies on the dollar” when billed for medical care provided. Ignoring his comments, I further stated that health insurance companies follow the government example, and also reimburse doctors and hospitals at very low rates. I said the reimbursement rate was roughly 25%, my friend said it was more like 75%.

Since Alice and I have government provided medical insurance, Tricare Prime, because of my status as retired military, when I got home from the meeting where we argued over reimbursement rates, I grabbed a recent pile of payment advisory notices from Tricare and added up what had been billed, and what Tricare paid.

The thirteen monthly statements were for the most part small amounts which have a relatively high reimbursement rate. Of the total billed of $5,770, the government paid $1,730, or 30%.

I was surprised the reimbursement rate was as high as 30%, because when I worked for Kaiser Permanente auditing large payments for member claims for services provided Kaiser members outside the Kaiser system, the overall reimbursement rate was closer to 20%.

In fact, the Kaiser rate was similar to the experience another friend told me of today. She had been billed $84,000 for a recent four-day hospitalization. She turned the claim over to her insurer, and Blue Cross paid $14,000 or 17%.

My debating buddy is a staunch Democrat, so I knew he favored government-funded universal health care as all good Democrats do.

Therefore, it was interesting to note as I Googled for Medicare/Medicaid reimbursement rates that there were several news articles featuring Democrat politicians complaining about low reimbursement rates.

Senator Patty Murray, D-Wash., not only complained that Washington was being penalized when compared to Florida reimbursement rates, she also noted that the government rates were so low that some doctors would not accept Medicare patients, and that others left the state.

Another complaint by Democrat politicians representing rural areas, such as one by Senator Feingold, D-Wis, was that the Medicare/Medicaid reimbursement rates there are much lower than for the same procedures in urban areas.

Senator Schumer, D-NY, complained that low Medicare reimbursement rates threatened to cause cancellation of ambulance services.

In Connecticut they complain that low Medicaid reimbursement rates force hospitals to shift costs to private individuals and insurance.

Psychiatrists complain that low Medicaid reimbursement rates for psychiatric services reduce Medicaid patients' access to psychiatrists and cause the low rate of acceptance of Medicaid patients by psychiatrists.

So far, it seems the only ones happy with the government reimbursement rates for medical services are people who think they are, or will be, much higher than they really are.

Maybe they think doctors are paid too much, and that doctors should be forced by the government to accept whatever the government thinks is fair.

There are nations that handle their national health plans along those lines, giving their doctors low pay and heavy workloads, with the result that many of their best and brightest, well educated, very experienced, and highly motivated, come to the United States to practice medicine. When they find that Kaiser Permanente will give them a good salary, great benefits including generous vacations, and a comfortable workweek and case load, they realize they have truly escaped National Health Care Hell.

It wasn’t long ago that we were tantalized by the prospect of “Hillarycare,” where doctors would have to take any and all patients, and it would be illegal to have a private practice.

Even a lot of Democrats saw how undemocratic such a health system would be, forcing doctors to be de facto government employees with no option of having a private medical practice.

For those Democrats who felt or still feel that such an arrangement was fair for doctors, who are already in short supply, why don’t you try it on lawyers first, of which we have an overabundance?

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