Healthcare

[RedFromMI]

(Other stuff omitted...)

Don't believe for even one second haggling with the government over payments is even half as problematic as haggling with a for profit insurance company

This ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

[foreverlax]

https://www.msn.com/en-us/news/us/medic ... spartandhp This is one obstacle medicare for all has to overcome. How do you control costs without driving hospitals to suffer?.

What is being described in the article is happening now, and is not being caused by Medicare, its caused by the free market. Corporate profit needs to be wrung out of the system and its influence as companies try to maximize it. Rural healthcare is a disaster today because the markets are so small and not worth the effort in addressing them (from the corporate profit perspective). Hospitals use the inflated insurance payments (compared to Medicare) to makeup for the unreimbursed mandates that the republicans love (Reagan). The unreimbursed mandates have to go away -- you know like treating those without health insurance for free. The hospitals need to be paid for services rendered (via Medicare for All).

Rural hospitals will need to be subsidized inside the system, by the city mice. Just one more gift the city mice give to their country cousins. Damn socialism.

72, in the surgical center where my wife works many of the docs will not accept medicade patients. They can't make enough money off of the reimbursement rates and way too often they spend many hours haggling with the government to get paid. The 64 thousand dollar question still remains... how do you control costs? I don't see it as a rural/urban problem. These doctors want to make their money and they are hesitant to compromise on what they make. I don't know all of the nuts and bolts but the GI doctors my wife works with make in the ballpark of 2 grand for a 30 minute colonoscopy. The docs my wife works with can't schedule 16 procedures a day in the hospitals they practice from. That is why they do the majority of their cases off site. How does this change under single payer? No one knows. There is one thing I do know as in every medical profession... the best doctors will always charge top dollar.

Two years ago I had a detached retina in my right eye. I went to the very best retinal surgeon I could find. That is the point in time where you are not shopping for the cheapest, you want the best. When you are diagnosed with a detached retina... you have the surgery ASAP or you risk the vision in your eye. In my case I was a few days away from irreparable damage that would have taken the vision in my eye. There is a struggle between getting the best medical care and having to pay for it. How single payer answers how that is accomplished is unknown. I could not have accepted the next retinal surgeon that was available How does single payer deal with situations where the outcome is extremely critical to the patient? If single payers fails then the patient goes blind, doesn't have that polyp removed and winds up with colon cancer and the list goes on.

This is it...you broke the hammer here C&S.

That is the point in time where you are not shopping for the cheapest, you want the best.

IMO, this is exactly why market forces/competition have no bearing on purchase decisions, we demand the best, but want to pay the least. That is not how economics works.

If you have to ask the cost of a Ferrari, you can't afford it....unless you have some help from others, your are getting the Chevy.

The situations you describe are deeply concerning.

[OCanada]

Many advanced economies have solved the problem

The USA overpays for the quality of medical care it receives. Our outcomes fall relative to the rest of the advanced economies

[cradleandshoot]

https://www.msn.com/en-us/news/us/medic ... spartandhp This is one obstacle medicare for all has to overcome. How do you control costs without driving hospitals to suffer?.

What is being described in the article is happening now, and is not being caused by Medicare, its caused by the free market. Corporate profit needs to be wrung out of the system and its influence as companies try to maximize it. Rural healthcare is a disaster today because the markets are so small and not worth the effort in addressing them (from the corporate profit perspective). Hospitals use the inflated insurance payments (compared to Medicare) to makeup for the unreimbursed mandates that the republicans love (Reagan). The unreimbursed mandates have to go away -- you know like treating those without health insurance for free. The hospitals need to be paid for services rendered (via Medicare for All).

Rural hospitals will need to be subsidized inside the system, by the city mice. Just one more gift the city mice give to their country cousins. Damn socialism.

72, in the surgical center where my wife works many of the docs will not accept medicade patients. They can't make enough money off of the reimbursement rates and way too often they spend many hours haggling with the government to get paid. The 64 thousand dollar question still remains... how do you control costs? I don't see it as a rural/urban problem. These doctors want to make their money and they are hesitant to compromise on what they make. I don't know all of the nuts and bolts but the GI doctors my wife works with make in the ballpark of 2 grand for a 30 minute colonoscopy. The docs my wife works with can't schedule 16 procedures a day in the hospitals they practice from. That is why they do the majority of their cases off site. How does this change under single payer? No one knows. There is one thing I do know as in every medical profession... the best doctors will always charge top dollar.

Two years ago I had a detached retina in my right eye. I went to the very best retinal surgeon I could find. That is the point in time where you are not shopping for the cheapest, you want the best. When you are diagnosed with a detached retina... you have the surgery ASAP or you risk the vision in your eye. In my case I was a few days away from irreparable damage that would have taken the vision in my eye. There is a struggle between getting the best medical care and having to pay for it. How single payer answers how that is accomplished is unknown. I could not have accepted the next retinal surgeon that was available How does single payer deal with situations where the outcome is extremely critical to the patient? If single payers fails then the patient goes blind, doesn't have that polyp removed and winds up with colon cancer and the list goes on.

I suggest that the doctors your wife works with need to become more efficient. Lots of other doctors are doing fine with Medicare and even Medicaid reimbursements. Those doctors who don't want to deal with government reimbursement rates can always retire or start a boutique practice catering to folks with money and the ability to pay more. Sounds like what they have now. Don't believe for even one second haggling with the government over payments is even half as problematic as haggling with a for profit insurance company

72 I think I laughed your "they needto be more efficient"comment for 5 minutes. The 2 doctors my wife works with the most and she has known them both for 25 years can schedule up to 16 cases in one day. You think you can pull that off without being efficient? The second reason they don't take medicade folks is because despite detailed instructions on how to prep for a procedure many folks show up for their procedure with a colon full of poop... very very bad. Hard to find polyps when your navigating through a poop field with the scope. Third reason... a lot of these folks just don't show up for their appointments. Who pays the doctors for this waste of time? These doctors all have office staff that like to cash a paycheck every week.

I so wish you could debate this with my wife. You would have to do something you NEVER do. You would have to admit you were wrong. BTW... the one doctor my wife works with has his wife that runs his office and does all of the billing. When it comes to collecting money she is a force to be reckoned with. From the very beginning all patients are pre screened and the very first question asked is... how are you going to pay. Those pesky insurance folks have already told the doctor how much they will pay. You know why? because preventing colon cancer is a lot cheaper than trying to treat it. That is sort of like the same reason why those insurance companies pay you 100% to get your teeth cleaned every year and won't give you 2 cents for dental implants.

[foreverlax]

Docs are the worst at wasting patient and "other professionals" time, while demanding payment when their time is wasted.

[cradleandshoot]

Docs are the worst at wasting patient and "other professionals" time, while demanding payment when their time is wasted.

These doctors have no recourse to be reimbursed for their time and effort. When the patient shows up not prepared for the procedure or does not show up at all... who do theyprotest to... the medicade provider? Hence the reason these doctors refuse to treat these patients anymore. No problem though, their cases will probably referred to a brand spanking new GI Doc that is still trying to figure out what hole the scope goes in. What do you FLP folks call that... quality, affordable we are gonna kill you health care. We already have a small scale version of how single payer works over at the VA. That sure has worked out so very well for our veterans hasn't it?

[cradleandshoot]

Docs are the worst at wasting patient and "other professionals" time, while demanding payment when their time is wasted.

For the record the 2 docs my wife works with do not waste their patients time. If you have a 2:30 appointment you will be seen at 2:30. That is because they are sticklers for being efficient. That may be the reason they have so many people, including the vast majority of our local doctors that see them and recommend them to their patients. Just saying... some doctors actually do know how to practice medicine and respect their patients time. Imagine that...

[jhu72]

https://www.msn.com/en-us/news/us/medic ... spartandhp This is one obstacle medicare for all has to overcome. How do you control costs without driving hospitals to suffer?.

What is being described in the article is happening now, and is not being caused by Medicare, its caused by the free market. Corporate profit needs to be wrung out of the system and its influence as companies try to maximize it. Rural healthcare is a disaster today because the markets are so small and not worth the effort in addressing them (from the corporate profit perspective). Hospitals use the inflated insurance payments (compared to Medicare) to makeup for the unreimbursed mandates that the republicans love (Reagan). The unreimbursed mandates have to go away -- you know like treating those without health insurance for free. The hospitals need to be paid for services rendered (via Medicare for All).

Rural hospitals will need to be subsidized inside the system, by the city mice. Just one more gift the city mice give to their country cousins. Damn socialism.

72, in the surgical center where my wife works many of the docs will not accept medicade patients. They can't make enough money off of the reimbursement rates and way too often they spend many hours haggling with the government to get paid. The 64 thousand dollar question still remains... how do you control costs? I don't see it as a rural/urban problem. These doctors want to make their money and they are hesitant to compromise on what they make. I don't know all of the nuts and bolts but the GI doctors my wife works with make in the ballpark of 2 grand for a 30 minute colonoscopy. The docs my wife works with can't schedule 16 procedures a day in the hospitals they practice from. That is why they do the majority of their cases off site. How does this change under single payer? No one knows. There is one thing I do know as in every medical profession... the best doctors will always charge top dollar.

Two years ago I had a detached retina in my right eye. I went to the very best retinal surgeon I could find. That is the point in time where you are not shopping for the cheapest, you want the best. When you are diagnosed with a detached retina... you have the surgery ASAP or you risk the vision in your eye. In my case I was a few days away from irreparable damage that would have taken the vision in my eye. There is a struggle between getting the best medical care and having to pay for it. How single payer answers how that is accomplished is unknown. I could not have accepted the next retinal surgeon that was available How does single payer deal with situations where the outcome is extremely critical to the patient? If single payers fails then the patient goes blind, doesn't have that polyp removed and winds up with colon cancer and the list goes on.

I suggest that the doctors your wife works with need to become more efficient. Lots of other doctors are doing fine with Medicare and even Medicaid reimbursements. Those doctors who don't want to deal with government reimbursement rates can always retire or start a boutique practice catering to folks with money and the ability to pay more. Sounds like what they have now. Don't believe for even one second haggling with the government over payments is even half as problematic as haggling with a for profit insurance company

72 I think I laughed your "they needto be more efficient"comment for 5 minutes. The 2 doctors my wife works with the most and she has known them both for 25 years can schedule up to 16 cases in one day. You think you can pull that off without being efficient? The second reason they don't take medicade folks is because despite detailed instructions on how to prep for a procedure many folks show up for their procedure with a colon full of poop... very very bad. Hard to find polyps when your navigating through a poop field with the scope. Third reason... a lot of these folks just don't show up for their appointments. Who pays the doctors for this waste of time? These doctors all have office staff that like to cash a paycheck every week.

I so wish you could debate this with my wife. You would have to do something you NEVER do. You would have to admit you were wrong. BTW... the one doctor my wife works with has his wife that runs his office and does all of the billing. When it comes to collecting money she is a force to be reckoned with. From the very beginning all patients are pre screened and the very first question asked is... how are you going to pay. Those pesky insurance folks have already told the doctor how much they will pay. You know why? because preventing colon cancer is a lot cheaper than trying to treat it. That is sort of like the same reason why those insurance companies pay you 100% to get your teeth cleaned every year and won't give you 2 cents for dental implants.

I would disagree. Private practice doctors and their nurses and techs all think they got the answers for process efficiency. I am yet to meet one that doesn't feel this way and who's efficiency can't be improved pretty easily. Private practices, small ones all have their process arranged for their (the doctor's) convenience. Period. You can laugh all you want, but sight unseen, assuming this is a small practice as I believe you have indicated, I can guarantee there are major inefficiencies. The older the doctors running the place, the more inefficient it is and unprepared for the future. If this is not true these guys are truly exceptional and they are missing their calling. They should be efficiency expert consultants in their field rather than fishing around in poop.

I don't expect you or your wife to believe me. I got pretty much the reaction I expected. What is true is other doctors and medical facilities are doing just fine accepting Medicare patients and dollars for doing colonoscopies. Apparently others have figured something out that these doctors haven't or just don't want to (more likely). If you can do 16 procedures a day and get insurance companies to pay for it and you are making good money they should go for it. They are presumably happy, great. As long as the prices hold up which is far from guaranteed.

[jhu72]

Docs are the worst at wasting patient and "other professionals" time, while demanding payment when their time is wasted.

For the record the 2 docs my wife works with do not waste their patients time. If you have a 2:30 appointment you will be seen at 2:30. That is because they are sticklers for being efficient. That may be the reason they have so many people, including the vast majority of our local doctors that see them and recommend them to their patients. Just saying... some doctors actually do know how to practice medicine and respect their patients time. Imagine that...

Sounds to me like they have a boutique operational model, which is fine. I am less convinced of their efficiency than you are. The fact that they are never late for an appointment says they have significant slack in their schedule, which means they could handle more patients on most days.

[cradleandshoot]

https://www.msn.com/en-us/news/us/medic ... spartandhp This is one obstacle medicare for all has to overcome. How do you control costs without driving hospitals to suffer?.

What is being described in the article is happening now, and is not being caused by Medicare, its caused by the free market. Corporate profit needs to be wrung out of the system and its influence as companies try to maximize it. Rural healthcare is a disaster today because the markets are so small and not worth the effort in addressing them (from the corporate profit perspective). Hospitals use the inflated insurance payments (compared to Medicare) to makeup for the unreimbursed mandates that the republicans love (Reagan). The unreimbursed mandates have to go away -- you know like treating those without health insurance for free. The hospitals need to be paid for services rendered (via Medicare for All).

Rural hospitals will need to be subsidized inside the system, by the city mice. Just one more gift the city mice give to their country cousins. Damn socialism.

72, in the surgical center where my wife works many of the docs will not accept medicade patients. They can't make enough money off of the reimbursement rates and way too often they spend many hours haggling with the government to get paid. The 64 thousand dollar question still remains... how do you control costs? I don't see it as a rural/urban problem. These doctors want to make their money and they are hesitant to compromise on what they make. I don't know all of the nuts and bolts but the GI doctors my wife works with make in the ballpark of 2 grand for a 30 minute colonoscopy. The docs my wife works with can't schedule 16 procedures a day in the hospitals they practice from. That is why they do the majority of their cases off site. How does this change under single payer? No one knows. There is one thing I do know as in every medical profession... the best doctors will always charge top dollar.

Two years ago I had a detached retina in my right eye. I went to the very best retinal surgeon I could find. That is the point in time where you are not shopping for the cheapest, you want the best. When you are diagnosed with a detached retina... you have the surgery ASAP or you risk the vision in your eye. In my case I was a few days away from irreparable damage that would have taken the vision in my eye. There is a struggle between getting the best medical care and having to pay for it. How single payer answers how that is accomplished is unknown. I could not have accepted the next retinal surgeon that was available How does single payer deal with situations where the outcome is extremely critical to the patient? If single payers fails then the patient goes blind, doesn't have that polyp removed and winds up with colon cancer and the list goes on.

I suggest that the doctors your wife works with need to become more efficient. Lots of other doctors are doing fine with Medicare and even Medicaid reimbursements. Those doctors who don't want to deal with government reimbursement rates can always retire or start a boutique practice catering to folks with money and the ability to pay more. Sounds like what they have now. Don't believe for even one second haggling with the government over payments is even half as problematic as haggling with a for profit insurance company

72 I think I laughed your "they needto be more efficient"comment for 5 minutes. The 2 doctors my wife works with the most and she has known them both for 25 years can schedule up to 16 cases in one day. You think you can pull that off without being efficient? The second reason they don't take medicade folks is because despite detailed instructions on how to prep for a procedure many folks show up for their procedure with a colon full of poop... very very bad. Hard to find polyps when your navigating through a poop field with the scope. Third reason... a lot of these folks just don't show up for their appointments. Who pays the doctors for this waste of time? These doctors all have office staff that like to cash a paycheck every week.

I so wish you could debate this with my wife. You would have to do something you NEVER do. You would have to admit you were wrong. BTW... the one doctor my wife works with has his wife that runs his office and does all of the billing. When it comes to collecting money she is a force to be reckoned with. From the very beginning all patients are pre screened and the very first question asked is... how are you going to pay. Those pesky insurance folks have already told the doctor how much they will pay. You know why? because preventing colon cancer is a lot cheaper than trying to treat it. That is sort of like the same reason why those insurance companies pay you 100% to get your teeth cleaned every year and won't give you 2 cents for dental implants.

I would disagree. Private practice doctors and their nurses and techs all think they got the answers for process efficiency. I am yet to meet one that doesn't feel this way and who's efficiency can't be improved pretty easily. Private practices, small ones all have their process arranged for their (the doctor's) convenience. Period. You can laugh all you want, but sight unseen, assuming this is a small practice as I believe you have indicated, I can guarantee there are major inefficiencies. The older the doctors running the place, the more inefficient it is and unprepared for the future. If this is not true these guys are truly exceptional and they are missing their calling. They should be efficiency expert consultants in their field rather than fishing around in poop.

I don't expect you or your wife to believe me. I got pretty much the reaction I expected. What is true is other doctors and medical facilities are doing just fine accepting Medicare patients and dollars for doing colonoscopies. Apparently others have figured something out that these doctors haven't or just don't want to (more likely). If you can do 16 procedures a day and get insurance companies to pay for it and you are making good money they should go for it. They are presumably happy, great. As long as the prices hold up which is far from guaranteed.

72, my wife works at a surgical center where the doctors that come to them already work out of local hospitals. In the case of my wifes doctors they work out of Highland hospital in Rochester. The reason they come to where my wife works is because Highland does not have the capability to perform 16 colonoscopies in a day, not even close. My wife is not required to provide any answers. She started her first case at 6:30 this morning. 16 cases for the day. Her job is to keep the doctors moving along. It would not be so much as she would not believe you, it is more about the fact that these specialized GI centers are designed to be as fast and efficient as possible. Do you get how frustrating it is when patient #11 didn't prep and has a colon full of poop. You don't understand the big picture they can only as efficient as the patients follow the directions of the doctors. If I show up for my procedure with a colon full of poop... that delay and waste of time comes out of my pocket. If you are a medicare patient who does not even show up or shows up with a colon full of poop... their irresponsibility does not cost them a dime. So explain to me how the efficiency factor comes in to play when you have to deal with this same issue over and over? That is the major reason why many of these doctors don't deal with medicare patients anymore. When I go in for my procedure... that will be this November, I already know what my insurer will pay. I will do the prep and I will show up with a colon that is as clean as a whistle. Not a single pea or speck of corn to be found.

[MDlaxfan76]

https://www.msn.com/en-us/news/us/medic ... spartandhp This is one obstacle medicare for all has to overcome. How do you control costs without driving hospitals to suffer?.

What is being described in the article is happening now, and is not being caused by Medicare, its caused by the free market. Corporate profit needs to be wrung out of the system and its influence as companies try to maximize it. Rural healthcare is a disaster today because the markets are so small and not worth the effort in addressing them (from the corporate profit perspective). Hospitals use the inflated insurance payments (compared to Medicare) to makeup for the unreimbursed mandates that the republicans love (Reagan). The unreimbursed mandates have to go away -- you know like treating those without health insurance for free. The hospitals need to be paid for services rendered (via Medicare for All).

Rural hospitals will need to be subsidized inside the system, by the city mice. Just one more gift the city mice give to their country cousins. Damn socialism.

72, in the surgical center where my wife works many of the docs will not accept medicade patients. They can't make enough money off of the reimbursement rates and way too often they spend many hours haggling with the government to get paid. The 64 thousand dollar question still remains... how do you control costs? I don't see it as a rural/urban problem. These doctors want to make their money and they are hesitant to compromise on what they make. I don't know all of the nuts and bolts but the GI doctors my wife works with make in the ballpark of 2 grand for a 30 minute colonoscopy. The docs my wife works with can't schedule 16 procedures a day in the hospitals they practice from. That is why they do the majority of their cases off site. How does this change under single payer? No one knows. There is one thing I do know as in every medical profession... the best doctors will always charge top dollar.

Two years ago I had a detached retina in my right eye. I went to the very best retinal surgeon I could find. That is the point in time where you are not shopping for the cheapest, you want the best. When you are diagnosed with a detached retina... you have the surgery ASAP or you risk the vision in your eye. In my case I was a few days away from irreparable damage that would have taken the vision in my eye. There is a struggle between getting the best medical care and having to pay for it. How single payer answers how that is accomplished is unknown. I could not have accepted the next retinal surgeon that was available How does single payer deal with situations where the outcome is extremely critical to the patient? If single payers fails then the patient goes blind, doesn't have that polyp removed and winds up with colon cancer and the list goes on.

I suggest that the doctors your wife works with need to become more efficient. Lots of other doctors are doing fine with Medicare and even Medicaid reimbursements. Those doctors who don't want to deal with government reimbursement rates can always retire or start a boutique practice catering to folks with money and the ability to pay more. Sounds like what they have now. Don't believe for even one second haggling with the government over payments is even half as problematic as haggling with a for profit insurance company

72 I think I laughed your "they needto be more efficient"comment for 5 minutes. The 2 doctors my wife works with the most and she has known them both for 25 years can schedule up to 16 cases in one day. You think you can pull that off without being efficient? The second reason they don't take medicade folks is because despite detailed instructions on how to prep for a procedure many folks show up for their procedure with a colon full of poop... very very bad. Hard to find polyps when your navigating through a poop field with the scope. Third reason... a lot of these folks just don't show up for their appointments. Who pays the doctors for this waste of time? These doctors all have office staff that like to cash a paycheck every week.

I so wish you could debate this with my wife. You would have to do something you NEVER do. You would have to admit you were wrong. BTW... the one doctor my wife works with has his wife that runs his office and does all of the billing. When it comes to collecting money she is a force to be reckoned with. From the very beginning all patients are pre screened and the very first question asked is... how are you going to pay. Those pesky insurance folks have already told the doctor how much they will pay. You know why? because preventing colon cancer is a lot cheaper than trying to treat it. That is sort of like the same reason why those insurance companies pay you 100% to get your teeth cleaned every year and won't give you 2 cents for dental implants.

I would disagree. Private practice doctors and their nurses and techs all think they got the answers for process efficiency. I am yet to meet one that doesn't feel this way and who's efficiency can't be improved pretty easily. Private practices, small ones all have their process arranged for their (the doctor's) convenience. Period. You can laugh all you want, but sight unseen, assuming this is a small practice as I believe you have indicated, I can guarantee there are major inefficiencies. The older the doctors running the place, the more inefficient it is and unprepared for the future. If this is not true these guys are truly exceptional and they are missing their calling. They should be efficiency expert consultants in their field rather than fishing around in poop.

I don't expect you or your wife to believe me. I got pretty much the reaction I expected. What is true is other doctors and medical facilities are doing just fine accepting Medicare patients and dollars for doing colonoscopies. Apparently others have figured something out that these doctors haven't or just don't want to (more likely). If you can do 16 procedures a day and get insurance companies to pay for it and you are making good money they should go for it. They are presumably happy, great. As long as the prices hold up which is far from guaranteed.

72, my wife works at a surgical center where the doctors that come to them already work out of local hospitals. In the case of my wifes doctors they work out of Highland hospital in Rochester. The reason they come to where my wife works is because Highland does not have the capability to perform 16 colonoscopies in a day, not even close. My wife is not required to provide any answers. She started her first case at 6:30 this morning. 16 cases for the day. Her job is to keep the doctors moving along. It would not be so much as she would not believe you, it is more about the fact that these specialized GI centers are designed to be as fast and efficient as possible. Do you get how frustrating it is when patient #11 didn't prep and has a colon full of poop. You don't understand the big picture they can only as efficient as the patients follow the directions of the doctors. If I show up for my procedure with a colon full of poop... that delay and waste of time comes out of my pocket. If you are a medicare patient who does not even show up or shows up with a colon full of poop... their irresponsibility does not cost them a dime. So explain to me how the efficiency factor comes in to play when you have to deal with this same issue over and over? That is the major reason why many of these doctors don't deal with medicare patients anymore. When I go in for my procedure... that will be this November, I already know what my insurer will pay. I will do the prep and I will show up with a colon that is as clean as a whistle. Not a single pea or speck of corn to be found.

Have to admit that I'm a bit confused by all this poop discussion. I'm not yet eligible for Medicare but I sure as tooting will be on Medicare as soon as I am. Am I going to have more poop or not show up because I'm now paying with Medicare?

I don't get it.

[cradleandshoot]

Docs are the worst at wasting patient and "other professionals" time, while demanding payment when their time is wasted.

For the record the 2 docs my wife works with do not waste their patients time. If you have a 2:30 appointment you will be seen at 2:30. That is because they are sticklers for being efficient. That may be the reason they have so many people, including the vast majority of our local doctors that see them and recommend them to their patients. Just saying... some doctors actually do know how to practice medicine and respect their patients time. Imagine that...

Sounds to me like they have a boutique operational model, which is fine. I am less convinced of their efficiency than you are. The fact that they are never late for an appointment says they have significant slack in their schedule, which means they could handle more patients on most days.

Far from boutique my friend. In many respects my wifes facility is the last refuge for patients other facilities won't accept. Slack in the schedule??? my wife started her first procedure at 6:30 this morning. 16 cases at an average of 30 minutes per procedure not include pre am for the patients and pacu . Do the math skippy and tell me where the slacking off comes into play. When their day was done this doctor also had to process all of the results from the specimens he took to send them off to the labs for testing to find out if they were cancerous or not and take care of all the required paperwork. For a really smart guy you really seem clueless how these nuts and bolts work. The other day one of my wifes patients was over 400 pounds. It takes a special lift to get the patient on the stretcher and into the procedure room. She recently had a patient who had severe mental issues who could not understand what was happening to him.

My wife did not get home until almost 6 pm tonight and cried most of the way home at the frustration of working so long on her feet. She is almost one year out from a total knee replacement. She is the only RN in the room so she is responsible for her patient and making sure the tech in the room and the doctor are all up to speed. Are you aware of the procedure for making certain a scope has been sterilized?. That includes being efficient at the same time. That is the reason these doctors book procedures where my wife works. Because these nurses are best damn GI nurses in the city of Rochester. I will cut you some slack here 72. I realize that there are things that even you don't understand.

[cradleandshoot]

https://www.msn.com/en-us/news/us/medic ... spartandhp This is one obstacle medicare for all has to overcome. How do you control costs without driving hospitals to suffer?.

What is being described in the article is happening now, and is not being caused by Medicare, its caused by the free market. Corporate profit needs to be wrung out of the system and its influence as companies try to maximize it. Rural healthcare is a disaster today because the markets are so small and not worth the effort in addressing them (from the corporate profit perspective). Hospitals use the inflated insurance payments (compared to Medicare) to makeup for the unreimbursed mandates that the republicans love (Reagan). The unreimbursed mandates have to go away -- you know like treating those without health insurance for free. The hospitals need to be paid for services rendered (via Medicare for All).

Rural hospitals will need to be subsidized inside the system, by the city mice. Just one more gift the city mice give to their country cousins. Damn socialism.

72, in the surgical center where my wife works many of the docs will not accept medicade patients. They can't make enough money off of the reimbursement rates and way too often they spend many hours haggling with the government to get paid. The 64 thousand dollar question still remains... how do you control costs? I don't see it as a rural/urban problem. These doctors want to make their money and they are hesitant to compromise on what they make. I don't know all of the nuts and bolts but the GI doctors my wife works with make in the ballpark of 2 grand for a 30 minute colonoscopy. The docs my wife works with can't schedule 16 procedures a day in the hospitals they practice from. That is why they do the majority of their cases off site. How does this change under single payer? No one knows. There is one thing I do know as in every medical profession... the best doctors will always charge top dollar.

Two years ago I had a detached retina in my right eye. I went to the very best retinal surgeon I could find. That is the point in time where you are not shopping for the cheapest, you want the best. When you are diagnosed with a detached retina... you have the surgery ASAP or you risk the vision in your eye. In my case I was a few days away from irreparable damage that would have taken the vision in my eye. There is a struggle between getting the best medical care and having to pay for it. How single payer answers how that is accomplished is unknown. I could not have accepted the next retinal surgeon that was available How does single payer deal with situations where the outcome is extremely critical to the patient? If single payers fails then the patient goes blind, doesn't have that polyp removed and winds up with colon cancer and the list goes on.

I suggest that the doctors your wife works with need to become more efficient. Lots of other doctors are doing fine with Medicare and even Medicaid reimbursements. Those doctors who don't want to deal with government reimbursement rates can always retire or start a boutique practice catering to folks with money and the ability to pay more. Sounds like what they have now. Don't believe for even one second haggling with the government over payments is even half as problematic as haggling with a for profit insurance company

72 I think I laughed your "they needto be more efficient"comment for 5 minutes. The 2 doctors my wife works with the most and she has known them both for 25 years can schedule up to 16 cases in one day. You think you can pull that off without being efficient? The second reason they don't take medicade folks is because despite detailed instructions on how to prep for a procedure many folks show up for their procedure with a colon full of poop... very very bad. Hard to find polyps when your navigating through a poop field with the scope. Third reason... a lot of these folks just don't show up for their appointments. Who pays the doctors for this waste of time? These doctors all have office staff that like to cash a paycheck every week.

I so wish you could debate this with my wife. You would have to do something you NEVER do. You would have to admit you were wrong. BTW... the one doctor my wife works with has his wife that runs his office and does all of the billing. When it comes to collecting money she is a force to be reckoned with. From the very beginning all patients are pre screened and the very first question asked is... how are you going to pay. Those pesky insurance folks have already told the doctor how much they will pay. You know why? because preventing colon cancer is a lot cheaper than trying to treat it. That is sort of like the same reason why those insurance companies pay you 100% to get your teeth cleaned every year and won't give you 2 cents for dental implants.

I would disagree. Private practice doctors and their nurses and techs all think they got the answers for process efficiency. I am yet to meet one that doesn't feel this way and who's efficiency can't be improved pretty easily. Private practices, small ones all have their process arranged for their (the doctor's) convenience. Period. You can laugh all you want, but sight unseen, assuming this is a small practice as I believe you have indicated, I can guarantee there are major inefficiencies. The older the doctors running the place, the more inefficient it is and unprepared for the future. If this is not true these guys are truly exceptional and they are missing their calling. They should be efficiency expert consultants in their field rather than fishing around in poop.

I don't expect you or your wife to believe me. I got pretty much the reaction I expected. What is true is other doctors and medical facilities are doing just fine accepting Medicare patients and dollars for doing colonoscopies. Apparently others have figured something out that these doctors haven't or just don't want to (more likely). If you can do 16 procedures a day and get insurance companies to pay for it and you are making good money they should go for it. They are presumably happy, great. As long as the prices hold up which is far from guaranteed.

72, my wife works at a surgical center where the doctors that come to them already work out of local hospitals. In the case of my wifes doctors they work out of Highland hospital in Rochester. The reason they come to where my wife works is because Highland does not have the capability to perform 16 colonoscopies in a day, not even close. My wife is not required to provide any answers. She started her first case at 6:30 this morning. 16 cases for the day. Her job is to keep the doctors moving along. It would not be so much as she would not believe you, it is more about the fact that these specialized GI centers are designed to be as fast and efficient as possible. Do you get how frustrating it is when patient #11 didn't prep and has a colon full of poop. You don't understand the big picture they can only as efficient as the patients follow the directions of the doctors. If I show up for my procedure with a colon full of poop... that delay and waste of time comes out of my pocket. If you are a medicare patient who does not even show up or shows up with a colon full of poop... their irresponsibility does not cost them a dime. So explain to me how the efficiency factor comes in to play when you have to deal with this same issue over and over? That is the major reason why many of these doctors don't deal with medicare patients anymore. When I go in for my procedure... that will be this November, I already know what my insurer will pay. I will do the prep and I will show up with a colon that is as clean as a whistle. Not a single pea or speck of corn to be found.

Have to admit that I'm a bit confused by all this poop discussion. I'm not yet eligible for Medicare but I sure as tooting will be on Medicare as soon as I am. Am I going to have more poop or not show up because I'm now paying with Medicare?

I don't get it.

I needed a good laugh MD. I am sure you know this but the "prep" part of a colonoscopy is to remove all of the fecal matter from your intestines. You can't put thescope up there and look for polyps if you are trying to maneuver through poop. A GI doc goes crazy when this happens because they have to stop the procedure and inform the patient why. My wife could add in stories about peas and corn and getting sprayed with colon juice( always wear that face shield) I hope you are not eating dinner.

[MDlaxfan76]

https://www.msn.com/en-us/news/us/medic ... spartandhp This is one obstacle medicare for all has to overcome. How do you control costs without driving hospitals to suffer?.

What is being described in the article is happening now, and is not being caused by Medicare, its caused by the free market. Corporate profit needs to be wrung out of the system and its influence as companies try to maximize it. Rural healthcare is a disaster today because the markets are so small and not worth the effort in addressing them (from the corporate profit perspective). Hospitals use the inflated insurance payments (compared to Medicare) to makeup for the unreimbursed mandates that the republicans love (Reagan). The unreimbursed mandates have to go away -- you know like treating those without health insurance for free. The hospitals need to be paid for services rendered (via Medicare for All).

Rural hospitals will need to be subsidized inside the system, by the city mice. Just one more gift the city mice give to their country cousins. Damn socialism.

72, in the surgical center where my wife works many of the docs will not accept medicade patients. They can't make enough money off of the reimbursement rates and way too often they spend many hours haggling with the government to get paid. The 64 thousand dollar question still remains... how do you control costs? I don't see it as a rural/urban problem. These doctors want to make their money and they are hesitant to compromise on what they make. I don't know all of the nuts and bolts but the GI doctors my wife works with make in the ballpark of 2 grand for a 30 minute colonoscopy. The docs my wife works with can't schedule 16 procedures a day in the hospitals they practice from. That is why they do the majority of their cases off site. How does this change under single payer? No one knows. There is one thing I do know as in every medical profession... the best doctors will always charge top dollar.

Two years ago I had a detached retina in my right eye. I went to the very best retinal surgeon I could find. That is the point in time where you are not shopping for the cheapest, you want the best. When you are diagnosed with a detached retina... you have the surgery ASAP or you risk the vision in your eye. In my case I was a few days away from irreparable damage that would have taken the vision in my eye. There is a struggle between getting the best medical care and having to pay for it. How single payer answers how that is accomplished is unknown. I could not have accepted the next retinal surgeon that was available How does single payer deal with situations where the outcome is extremely critical to the patient? If single payers fails then the patient goes blind, doesn't have that polyp removed and winds up with colon cancer and the list goes on.

I suggest that the doctors your wife works with need to become more efficient. Lots of other doctors are doing fine with Medicare and even Medicaid reimbursements. Those doctors who don't want to deal with government reimbursement rates can always retire or start a boutique practice catering to folks with money and the ability to pay more. Sounds like what they have now. Don't believe for even one second haggling with the government over payments is even half as problematic as haggling with a for profit insurance company

72 I think I laughed your "they needto be more efficient"comment for 5 minutes. The 2 doctors my wife works with the most and she has known them both for 25 years can schedule up to 16 cases in one day. You think you can pull that off without being efficient? The second reason they don't take medicade folks is because despite detailed instructions on how to prep for a procedure many folks show up for their procedure with a colon full of poop... very very bad. Hard to find polyps when your navigating through a poop field with the scope. Third reason... a lot of these folks just don't show up for their appointments. Who pays the doctors for this waste of time? These doctors all have office staff that like to cash a paycheck every week.

I so wish you could debate this with my wife. You would have to do something you NEVER do. You would have to admit you were wrong. BTW... the one doctor my wife works with has his wife that runs his office and does all of the billing. When it comes to collecting money she is a force to be reckoned with. From the very beginning all patients are pre screened and the very first question asked is... how are you going to pay. Those pesky insurance folks have already told the doctor how much they will pay. You know why? because preventing colon cancer is a lot cheaper than trying to treat it. That is sort of like the same reason why those insurance companies pay you 100% to get your teeth cleaned every year and won't give you 2 cents for dental implants.

I would disagree. Private practice doctors and their nurses and techs all think they got the answers for process efficiency. I am yet to meet one that doesn't feel this way and who's efficiency can't be improved pretty easily. Private practices, small ones all have their process arranged for their (the doctor's) convenience. Period. You can laugh all you want, but sight unseen, assuming this is a small practice as I believe you have indicated, I can guarantee there are major inefficiencies. The older the doctors running the place, the more inefficient it is and unprepared for the future. If this is not true these guys are truly exceptional and they are missing their calling. They should be efficiency expert consultants in their field rather than fishing around in poop.

I don't expect you or your wife to believe me. I got pretty much the reaction I expected. What is true is other doctors and medical facilities are doing just fine accepting Medicare patients and dollars for doing colonoscopies. Apparently others have figured something out that these doctors haven't or just don't want to (more likely). If you can do 16 procedures a day and get insurance companies to pay for it and you are making good money they should go for it. They are presumably happy, great. As long as the prices hold up which is far from guaranteed.

72, my wife works at a surgical center where the doctors that come to them already work out of local hospitals. In the case of my wifes doctors they work out of Highland hospital in Rochester. The reason they come to where my wife works is because Highland does not have the capability to perform 16 colonoscopies in a day, not even close. My wife is not required to provide any answers. She started her first case at 6:30 this morning. 16 cases for the day. Her job is to keep the doctors moving along. It would not be so much as she would not believe you, it is more about the fact that these specialized GI centers are designed to be as fast and efficient as possible. Do you get how frustrating it is when patient #11 didn't prep and has a colon full of poop. You don't understand the big picture they can only as efficient as the patients follow the directions of the doctors. If I show up for my procedure with a colon full of poop... that delay and waste of time comes out of my pocket. If you are a medicare patient who does not even show up or shows up with a colon full of poop... their irresponsibility does not cost them a dime. So explain to me how the efficiency factor comes in to play when you have to deal with this same issue over and over? That is the major reason why many of these doctors don't deal with medicare patients anymore. When I go in for my procedure... that will be this November, I already know what my insurer will pay. I will do the prep and I will show up with a colon that is as clean as a whistle. Not a single pea or speck of corn to be found.

Have to admit that I'm a bit confused by all this poop discussion. I'm not yet eligible for Medicare but I sure as tooting will be on Medicare as soon as I am. Am I going to have more poop or not show up because I'm now paying with Medicare?

I don't get it.

I needed a good laugh MD. I am sure you know this but the "prep" part of a colonoscopy is to remove all of the fecal matter from your intestines. You can't put thescope up there and look for polyps if you are trying to maneuver through poop. A GI doc goes crazy when this happens because they have to stop the procedure and inform the patient why. My wife could add in stories about peas and corn and getting sprayed with colon juice( always wear that face shield) I hope you are not eating dinner.

https://www.msn.com/en-us/news/us/medic ... spartandhp This is one obstacle medicare for all has to overcome. How do you control costs without driving hospitals to suffer?.

What is being described in the article is happening now, and is not being caused by Medicare, its caused by the free market. Corporate profit needs to be wrung out of the system and its influence as companies try to maximize it. Rural healthcare is a disaster today because the markets are so small and not worth the effort in addressing them (from the corporate profit perspective). Hospitals use the inflated insurance payments (compared to Medicare) to makeup for the unreimbursed mandates that the republicans love (Reagan). The unreimbursed mandates have to go away -- you know like treating those without health insurance for free. The hospitals need to be paid for services rendered (via Medicare for All).

Rural hospitals will need to be subsidized inside the system, by the city mice. Just one more gift the city mice give to their country cousins. Damn socialism.

72, in the surgical center where my wife works many of the docs will not accept medicade patients. They can't make enough money off of the reimbursement rates and way too often they spend many hours haggling with the government to get paid. The 64 thousand dollar question still remains... how do you control costs? I don't see it as a rural/urban problem. These doctors want to make their money and they are hesitant to compromise on what they make. I don't know all of the nuts and bolts but the GI doctors my wife works with make in the ballpark of 2 grand for a 30 minute colonoscopy. The docs my wife works with can't schedule 16 procedures a day in the hospitals they practice from. That is why they do the majority of their cases off site. How does this change under single payer? No one knows. There is one thing I do know as in every medical profession... the best doctors will always charge top dollar.

Two years ago I had a detached retina in my right eye. I went to the very best retinal surgeon I could find. That is the point in time where you are not shopping for the cheapest, you want the best. When you are diagnosed with a detached retina... you have the surgery ASAP or you risk the vision in your eye. In my case I was a few days away from irreparable damage that would have taken the vision in my eye. There is a struggle between getting the best medical care and having to pay for it. How single payer answers how that is accomplished is unknown. I could not have accepted the next retinal surgeon that was available How does single payer deal with situations where the outcome is extremely critical to the patient? If single payers fails then the patient goes blind, doesn't have that polyp removed and winds up with colon cancer and the list goes on.

I suggest that the doctors your wife works with need to become more efficient. Lots of other doctors are doing fine with Medicare and even Medicaid reimbursements. Those doctors who don't want to deal with government reimbursement rates can always retire or start a boutique practice catering to folks with money and the ability to pay more. Sounds like what they have now. Don't believe for even one second haggling with the government over payments is even half as problematic as haggling with a for profit insurance company

72 I think I laughed your "they needto be more efficient"comment for 5 minutes. The 2 doctors my wife works with the most and she has known them both for 25 years can schedule up to 16 cases in one day. You think you can pull that off without being efficient? The second reason they don't take medicade folks is because despite detailed instructions on how to prep for a procedure many folks show up for their procedure with a colon full of poop... very very bad. Hard to find polyps when your navigating through a poop field with the scope. Third reason... a lot of these folks just don't show up for their appointments. Who pays the doctors for this waste of time? These doctors all have office staff that like to cash a paycheck every week.

I so wish you could debate this with my wife. You would have to do something you NEVER do. You would have to admit you were wrong. BTW... the one doctor my wife works with has his wife that runs his office and does all of the billing. When it comes to collecting money she is a force to be reckoned with. From the very beginning all patients are pre screened and the very first question asked is... how are you going to pay. Those pesky insurance folks have already told the doctor how much they will pay. You know why? because preventing colon cancer is a lot cheaper than trying to treat it. That is sort of like the same reason why those insurance companies pay you 100% to get your teeth cleaned every year and won't give you 2 cents for dental implants.

I would disagree. Private practice doctors and their nurses and techs all think they got the answers for process efficiency. I am yet to meet one that doesn't feel this way and who's efficiency can't be improved pretty easily. Private practices, small ones all have their process arranged for their (the doctor's) convenience. Period. You can laugh all you want, but sight unseen, assuming this is a small practice as I believe you have indicated, I can guarantee there are major inefficiencies. The older the doctors running the place, the more inefficient it is and unprepared for the future. If this is not true these guys are truly exceptional and they are missing their calling. They should be efficiency expert consultants in their field rather than fishing around in poop.

I don't expect you or your wife to believe me. I got pretty much the reaction I expected. What is true is other doctors and medical facilities are doing just fine accepting Medicare patients and dollars for doing colonoscopies. Apparently others have figured something out that these doctors haven't or just don't want to (more likely). If you can do 16 procedures a day and get insurance companies to pay for it and you are making good money they should go for it. They are presumably happy, great. As long as the prices hold up which is far from guaranteed.

72, my wife works at a surgical center where the doctors that come to them already work out of local hospitals. In the case of my wifes doctors they work out of Highland hospital in Rochester. The reason they come to where my wife works is because Highland does not have the capability to perform 16 colonoscopies in a day, not even close. My wife is not required to provide any answers. She started her first case at 6:30 this morning. 16 cases for the day. Her job is to keep the doctors moving along. It would not be so much as she would not believe you, it is more about the fact that these specialized GI centers are designed to be as fast and efficient as possible. Do you get how frustrating it is when patient #11 didn't prep and has a colon full of poop. You don't understand the big picture they can only as efficient as the patients follow the directions of the doctors. If I show up for my procedure with a colon full of poop... that delay and waste of time comes out of my pocket. If you are a medicare patient who does not even show up or shows up with a colon full of poop... their irresponsibility does not cost them a dime. So explain to me how the efficiency factor comes in to play when you have to deal with this same issue over and over? That is the major reason why many of these doctors don't deal with medicare patients anymore. When I go in for my procedure... that will be this November, I already know what my insurer will pay. I will do the prep and I will show up with a colon that is as clean as a whistle. Not a single pea or speck of corn to be found.

Have to admit that I'm a bit confused by all this poop discussion. I'm not yet eligible for Medicare but I sure as tooting will be on Medicare as soon as I am. Am I going to have more poop or not show up because I'm now paying with Medicare?

I don't get it.

I needed a good laugh MD. I am sure you know this but the "prep" part of a colonoscopy is to remove all of the fecal matter from your intestines. You can't put thescope up there and look for polyps if you are trying to maneuver through poop. A GI doc goes crazy when this happens because they have to stop the procedure and inform the patient why. My wife could add in stories about peas and corn and getting sprayed with colon juice( always wear that face shield) I hope you are not eating dinner.

Yes, it's definitely one of those "you have to either laugh or cry" sorts of situations...laughing better.

But it's also no fun to be the recipient.

I highly recommend the Cologuard test to see if you really need to do a colonoscopy. It has almost as high a probability of catching the colorectal cancer as a colonoscopy but a lot less rigamarole. On the other hand, don't panic if it comes back positive as there's a decent risk of false positives. But get your butt in for the colonoscopy to be sure one way or another, and to have whatever is necessary to remove, done.

My only confusion was why it would be expected that I'd do a better job of being prepared, be on time, etc if I was on Medicare in a couple of years than I would now. Is dementia kicking in?

[jhu72]

Docs are the worst at wasting patient and "other professionals" time, while demanding payment when their time is wasted.

For the record the 2 docs my wife works with do not waste their patients time. If you have a 2:30 appointment you will be seen at 2:30. That is because they are sticklers for being efficient. That may be the reason they have so many people, including the vast majority of our local doctors that see them and recommend them to their patients. Just saying... some doctors actually do know how to practice medicine and respect their patients time. Imagine that...

Sounds to me like they have a boutique operational model, which is fine. I am less convinced of their efficiency than you are. The fact that they are never late for an appointment says they have significant slack in their schedule, which means they could handle more patients on most days.

Far from boutique my friend. In many respects my wifes facility is the last refuge for patients other facilities won't accept. Slack in the schedule??? my wife started her first procedure at 6:30 this morning. 16 cases at an average of 30 minutes per procedure not include pre am for the patients and pacu . Do the math skippy and tell me where the slacking off comes into play. When their day was done this doctor also had to process all of the results from the specimens he took to send them off to the labs for testing to find out if they were cancerous or not and take care of all the required paperwork. For a really smart guy you really seem clueless how these nuts and bolts work. The other day one of my wifes patients was over 400 pounds. It takes a special lift to get the patient on the stretcher and into the procedure room. She recently had a patient who had severe mental issues who could not understand what was happening to him.

My wife did not get home until almost 6 pm tonight and cried most of the way home at the frustration of working so long on her feet. She is almost one year out from a total knee replacement. She is the only RN in the room so she is responsible for her patient and making sure the tech in the room and the doctor are all up to speed. Are you aware of the procedure for making certain a scope has been sterilized?. That includes being efficient at the same time. That is the reason these doctors book procedures where my wife works. Because these nurses are best damn GI nurses in the city of Rochester. I will cut you some slack here 72. I realize that there are things that even you don't understand.

I understand you wife works hard. Who doesn't? You made the statement that the doctors are always on time for their appointments -- "they never make patients wait". Explain how they do this if they are each doing 16 colonoscopies a day?? Are the doctors working 6 to 6? What time does the first procedure begin, and the last procedure end. When do they report out the results of the procedure, how do they do this? No procedure always ends on time. Some run long, some run short, and there is no predicting which will run short or long (generally). So if the doctors are stacking them up every 30 minutes (which is very normal for colonoscopies - nothing special here) how long are the doctors actually involved in the imaging suite? What I am getting at is if the "patients never have to wait for the doctor", then the doctors are leaving themselves a cushion between procedures so that they can guarantee that timeliness! Basically you are telling me their work day looks like your average colonoscopy shop but I know damn well in the average practice the doctors are frequently late for their procedures. Being behind schedule is a fact of life in most medical practices. You can't have it both ways. Working like a madmen but always on time is not believable. Your wife working 6 to 6 everyday (a 12 hour day) means the doctors are likely not working 8.5 hour days and they are not likely to be religiously scheduling every 30 minutes. Just basic arithmetic.

Lets not conflate hardwork and long hours with efficiency. Long hours and "hardwork" frequently are indicative of something less then maximum efficiency.

[Brooklyn]

ACA ~ so much better than Republican death panels.

[foreverlax]

Trump's top ten actions to improve our healthcare, per Breitbart

Here are the top ten.

1. Lower premiums. After the Obama administration oversaw massive double- and triple-digit annual increases in the price of Obamacare, the Trump administration has succeeded in stabilizing prices, which have decreased for many plans — contrary to what many experts predicted. Obamacare is still too expensive, and its deductibles far too high, but Trump fulfilled his campaign promise in 2016 to stop the massive premium increases under the policy.

There were _not_ such massive increases, and what Trump has done to sabotage the system has actually kept the Obamacare record of lowering the rate of increase from keeping things in check as well (see acasignups.net under their rate hikes section for the last couple of years showing what the results would have been without Trump/Republican interference with the ACA.

2. Short-term plans. Obamacare eliminated many cheap, bare-bones, short-term health insurance plans favored by younger people, forcing them to pay huge premiums for coverage they did not need. Some of these plans are 80% cheaper than the cheapest Obamacare plan. President Trump signed an executive order, and promulgated new rules, that expand the length of these plans from three to 12 months, and allow them to be renewed for up to three years.

They were eliminated because they were not full insurance. You need to get healthy (often young) people into the system to reduce costs - that is the whole purpose of insurance. By allowing fake insurance to be purchased (sometimes not covering hospitalization, for example) you increase the risk that one of those younger customers ends up in medical bankruptcy because they were not covered. The plans are cheaper because they are not full health insurance. One of the biggest mistakes Obama made in his "you can keep your insurance if you like it" statement was that if you had dump insurance you could not actually keep it.

3. End to individual mandate. President Trump’s tax cut, signed into law in 2017, eliminated the requirement to purchase insurance — the most constitutionally objectionable part of Obamacare. That change saved individuals and families hundreds of dollars per year in IRS fines. And contrary to the predictions of critics, it did not result in the collapse of the system as a whole, as premiums dropped and more insurance providers participated in the system.

Definitely one of the more disliked features of not just ACA but the predecessor Romneycare in MA. But it drives people to buy insurance, and that keeps everyone's cost down. Also tends to keep hospitals open since they know that the patients have insurance coverage...

4. Group health plans across state lines. President Trump took a crucial step toward fulfilling the Republican promise of allowing people to buy insurance across state lines by signing an executive order in October 2017 that opened the door to employers in the same industry to pool their employees into common Associated Health Plans (AHPs) in different states. The result would be cheaper and better coverage for workers within those industries.

The issue is that some states have better standards, so their coverage tends to cost more. So you substitute a race to the bottom... .. as well as make mergers and acquisitions more likely so that you drive up prices

5. Choice for veterans. President Trump signed the VA MISSION Act in 2018, which passed with bipartisan support and expanded options for veterans to obtain health care in the private sector. Trump has also prioritized addressing backlogs within the Veterans Affairs system. His commitment to veterans and first responders is such that even left-wing comedian Jon Stewart acknowledged Trump was doing a good job for 9/11 responders.

Rather than invest in and fix the VA.

6. “Right to try.” In May 2018, President Trump signed the “Right to Try” Act, which allows patients in desperate need to try new, experimental drugs that had not yet been approved by regulators. The law allowed patients to approach manufacturers directly, and limited their liability in the event the drugs did not work as hoped. In addition, the administration focusing on streamlining new drug approvals at the Food and Drug Administration (FDA).

Actually good in theory, a bust in practice. Does not seem to be working.

7. Drug price information. President Trump has presided over the largest decline in drug prices in 46 years, and is proposing measures to lower them even further. In his 2019 State of the Union address, for example, he proposed “requir[ing] drug companies, insurance companies, and hospitals to disclose real prices to foster competition and bring costs way down.” He also proposed eliminating kickbacks to the middlemen in the prescription drug industry.

Based on a lie. Average drug prices have continued to increase. .. as well as laughable, you just have to sign a piece of paper to make kickbacks go away. Notice the most obvious improvement does not appear on turd for brains' list -- removing the restriction that government can't negotiate bulk pricing -- dead give away they don't care about costs

8. Opioids and fentanyl. The Obama administration failed to deal with the opioid epidemic, even declining to declare a national emergency to stop the proliferation of deadly fentanyl. In contrast, President Trump has made the fight against opioids and fentanyl a priority. His effort to build a barrier along the U.S.-Mexico border, and his administration’s tougher border enforcement, have also aimed to improve public health by stopping the drug flow.

One of the Obama administrations biggest failures, yes. Trump has not done much of anything about it, as border security along the US-Mexico border has little to do with the fentanyl crisis. That is mostly shipped through mail/UPS/etc. If it comes from Mexico, it most likely comes through ports of entry, for which there has been little action of the Trump administration.

9. Better administration. Trump told reporters in the Oval Office Wednesday that his administration is doing a better job of administering Obamacare than the Obama administration itself. One way it is doing so is through allowing the states greater flexibility in addressing their insurance markets ” rather than subscribing to the previous administration’s prescriptive one-size-fits-all approach,” wrote Medicare and Medicaid administrator Seema Verna.

10. Support for repeal. President Trump’s enduring commitment to repealing Obamacare and replacing it with a policy that actually works is crucial. The alternative is letting the government take over health care entirely, which Democrats are embracing in the “Medicare for All” policy — which would ban private insurance and limit access to experimental drugs, among other fatal flaws. If not for Trump, Republicans would have given up long ago.

Outside of Trump and apparently Mick Mulvaney there is little demand for repeal. Most of the public is wary of attempts to mess with what they have, and that includes repeal of the ACA.

"5. Choice for veterans. President Trump signed the VA MISSION Act in 2018, which passed with bipartisan support and expanded options for veterans to obtain health care in the private sector. Trump has also prioritized addressing backlogs within the Veterans Affairs system. His commitment to veterans and first responders is such that even left-wing comedian Jon Stewart acknowledged Trump was doing a good job for 9/11 responders."

The 911 VCF back in the news with - Jon Stewart eviscerated these clowns. Good time for Trump to make something happen....something we can all agree on. Victims of 911 should not have to worry about losing their homes so they can get the health care they require and deserve.

Why do I sense Mitch holds the reins on this...

[foreverlax]

Maybe there is hope -

Get Rid of Surprise Medical Bills
Congress can fight the scourge of out-of-network doctors at in-network hospitals.

Scott Kohan woke up in an Austin, Texas, emergency room after an attack that broke his jaw. The hospital was within his insurance network. But the oral surgeon who set his jaw wasn’t. Mr. Kohan’s insurer refused to pay the surgeon’s $8,000 bill.

He’s not alone. An estimated 51% of ambulance rides, 22% of emergency-department trips, and 9% of elective cases, in which patients have time for due diligence, lead to surprise bills. These typically come from providers who refuse to join insurance networks so they can charge astronomical fees.

Even patients who make all the right choices can’t prevent surprise bills. Patients at in-network hospitals don’t get to choose their anesthesiologists, for instance. It’s hard for the market to discipline this behavior when patients can’t avoid it. And because doctors and hospitals can implicitly threaten exorbitant surprise bills, they’re able to extract higher rates from insurers, meaning higher premiums for everyone.

Congress should ban these predatory practices, but it should avoid the temptation of price controls. The Lower Health Care Costs Act, introduced last month by Sens. Lamar Alexander and Patty Murray aims to eliminate most surprise out-of-network medical billing. It’s the most consequential bipartisan health-care reform of the ObamaCare era.

The bill offers three ways for Congress to address this problem. One would have policy makers regulate prices directly, while a second would establish an arbitration system to resolve disputes between health-care providers and insurers. Arbitration seems like a “light touch” solution, but it simply punts the problem to arbiters who will determine rates for each service. It’s rate setting by fiat, only more expensive and opaque.

The last option, the “in-network guarantee,” is a better solution. Hospitals would ensure that all providers treating insured patients are also considered in-network. Some already do this. Doctors at these facilities would have two options: come to an agreement with the insurer (as most already do) or receive payment directly from the hospital. This would eliminate the inflated surprise bills, reduce premiums and federal spending, and leave it to doctors, hospitals and insurers to work out market prices.

Surprise medical billing ought to be addressed, but the solution isn’t to rely on an omnipotent arbitrator. The ideal solution is to require hospitals, doctors, and insurers to clean up their own mess wherever possible.

https://www.wsj.com/articles/get-rid-of ... 1560294309

[Brooklyn]

A truly great American proposed using WMD as a means of solving the health care problem in 1945:


https://www.trumanlibrary.org/anniversa ... rogram.htm


No, it's not quite what you may think.


As Harry S Truman once said "if you want to live like a Republican, vote Democrat". If only people had had the sense to heed his wisdom, life in the USA would have been a lot better and healthier.

[holmes435]

Worth watching the entire thing. Any guesses as to who has put up the most resistance to getting 9/11 first responders the health care they need?