Comments on: Health care reform, back of the napkin version http://www.kevinmd.com/blog/2009/08/health-care-reform-back-of-the-napkin-version.html Wed, 15 Feb 2012 00:27:00 +0000 hourly 1 By: gromithttp://www.kevinmd.com/blog/2009/08/health-care-reform-back-of-the-napkin-version.html#comment-110314 gromit Mon, 24 Aug 2009 18:24:44 +0000 http://www.kevinmd.com/blog/?p=39705#comment-110314 "Simplistic".... It's called "Back of the Napkin," isn't it?The general public's being overwhelmed with details, many of them intended to misdirect and kill the reform effort. A very basic discussion like this should be helpful to many.-g “Simplistic”…. It’s called “Back of the Napkin,” isn’t it?

The general public’s being overwhelmed with details, many of them intended to misdirect and kill the reform effort. A very basic discussion like this should be helpful to many.

-g

]]> By: Donald Green MDhttp://www.kevinmd.com/blog/2009/08/health-care-reform-back-of-the-napkin-version.html#comment-110303 Donald Green MD Mon, 24 Aug 2009 16:10:52 +0000 http://www.kevinmd.com/blog/?p=39705#comment-110303 Doc99: Without details it is hard to evaluate your colleague's unfortunate problems. Is this a general sense that Medicare is denying doctors a decent living? These problems seem very colloquial and specific to certain areas of the country but do require fixing, if true. It is not a problem in my state. However it pales in the face of the loss generated by private insurers. Why is that side of the ledger ignored. Yes they give you higher fees but lower volume per patient. They also tag on the expense when a patient can't afford their copay or don't pay you at the visit. This keeps any physician's billing department larger than it should be.Also those of you who think defensive medicine intervention by passing tort reform will help will be in for a rude awakening. The tort process costs represent about 1/2 to 1% of the health care bill. Well then, what about the extra testing needed to stave off being sued. Also an illusion. Most of this testing is done at hospitals that sit with fixed costs. So if they do 1000 tests or 2000 tests they have the capacity to handle it. To do basic care their personnel payroll remains about the same as when productivity is increased. If this revenue from testing was removed there would be a search to make up the shortfall since they would fall behind in paying for working staff. It is clear once a service is in place in a hospital there is an expandable range to finance it. Hospitals have made up their budgets to incorporate this expectation for business. They do not budget on what ifs, but from their past year. Recently such lack of income to our local hospital occurred because they had over-extended themselves on capital outlays. Their solution was to cut benefits(days off, pension plan) and cut back slightly on working hours. It was not good for morale and a terrible message to send to hard working people. Doc99: Without details it is hard to evaluate your colleague’s unfortunate problems. Is this a general sense that Medicare is denying doctors a decent living? These problems seem very colloquial and specific to certain areas of the country but do require fixing, if true. It is not a problem in my state. However it pales in the face of the loss generated by private insurers. Why is that side of the ledger ignored. Yes they give you higher fees but lower volume per patient. They also tag on the expense when a patient can’t afford their copay or don’t pay you at the visit. This keeps any physician’s billing department larger than it should be.

Also those of you who think defensive medicine intervention by passing tort reform will help will be in for a rude awakening. The tort process costs represent about 1/2 to 1% of the health care bill. Well then, what about the extra testing needed to stave off being sued. Also an illusion. Most of this testing is done at hospitals that sit with fixed costs. So if they do 1000 tests or 2000 tests they have the capacity to handle it. To do basic care their personnel payroll remains about the same as when productivity is increased. If this revenue from testing was removed there would be a search to make up the shortfall since they would fall behind in paying for working staff. It is clear once a service is in place in a hospital there is an expandable range to finance it. Hospitals have made up their budgets to incorporate this expectation for business. They do not budget on what ifs, but from their past year. Recently such lack of income to our local hospital occurred because they had over-extended themselves on capital outlays. Their solution was to cut benefits(days off, pension plan) and cut back slightly on working hours. It was not good for morale and a terrible message to send to hard working people.

]]> By: Shanhttp://www.kevinmd.com/blog/2009/08/health-care-reform-back-of-the-napkin-version.html#comment-110293 Shan Mon, 24 Aug 2009 14:59:29 +0000 http://www.kevinmd.com/blog/?p=39705#comment-110293 It seems like these guys are providing an opinion that shows Doctors only care about money (Prescribe new and expensive medications to keep money flowing in). It seems like these guys are providing an opinion that shows Doctors only care about money (Prescribe new and expensive medications to keep money flowing in).

]]> By: Doc99http://www.kevinmd.com/blog/2009/08/health-care-reform-back-of-the-napkin-version.html#comment-110290 Doc99 Mon, 24 Aug 2009 14:44:32 +0000 http://www.kevinmd.com/blog/?p=39705#comment-110290 @Dr. Green ... CMS via NGS took months last year to pay claims, forcing at least one primary in our area to take out a second mortgage to make payroll, pay malpractice, etc. Also, Medicare is about to go belly-up. So yes, I'd agree, Medicare has its problems. @Dr. Green … CMS via NGS took months last year to pay claims, forcing at least one primary in our area to take out a second mortgage to make payroll, pay malpractice, etc. Also, Medicare is about to go belly-up. So yes, I’d agree, Medicare has its problems.

]]> By: MatthewBowdishhttp://www.kevinmd.com/blog/2009/08/health-care-reform-back-of-the-napkin-version.html#comment-110289 MatthewBowdish Mon, 24 Aug 2009 14:40:17 +0000 http://www.kevinmd.com/blog/?p=39705#comment-110289 Simplistic and not entirely accurate. For example, health care is hardly a free-market with government mandates, bans on interstate competition, etc, all of which increase costs. Also as a provider, I hardly prescribe novel treatments "to keep the money flowing in." Sounds like Obama saying doctors perform unnecessary procedures (tonsillectomies, palliative hip replacements, amputations) just to make money. Furthermore, this cartoon doesn't address the potential role of the patient being incentivized to take more responsibility in his/her own health choices. And to say the GOP doesn't want change, and then identify Sen Coburn's bill, is inconsistent, not to mention untrue given many different amendments offered by republicans that have been voted down. I could go on and on about the mischaracterizations of the left-leaning proposals too, but others have addressed that. It's one thing to simplify the debate...However, oversimplification can lead to misinformation. Simplistic and not entirely accurate. For example, health care is hardly a free-market with government mandates, bans on interstate competition, etc, all of which increase costs. Also as a provider, I hardly prescribe novel treatments “to keep the money flowing in.” Sounds like Obama saying doctors perform unnecessary procedures (tonsillectomies, palliative hip replacements, amputations) just to make money. Furthermore, this cartoon doesn’t address the potential role of the patient being incentivized to take more responsibility in his/her own health choices. And to say the GOP doesn’t want change, and then identify Sen Coburn’s bill, is inconsistent, not to mention untrue given many different amendments offered by republicans that have been voted down. I could go on and on about the mischaracterizations of the left-leaning proposals too, but others have addressed that. It’s one thing to simplify the debate…However, oversimplification can lead to misinformation.

]]> By: Michael Kirsch, M.D.http://www.kevinmd.com/blog/2009/08/health-care-reform-back-of-the-napkin-version.html#comment-110284 Michael Kirsch, M.D. Mon, 24 Aug 2009 13:14:09 +0000 http://www.kevinmd.com/blog/?p=39705#comment-110284 Great presentation! Great presentation!

]]> By: stargirl65http://www.kevinmd.com/blog/2009/08/health-care-reform-back-of-the-napkin-version.html#comment-110283 stargirl65 Mon, 24 Aug 2009 13:10:01 +0000 http://www.kevinmd.com/blog/?p=39705#comment-110283 The only mistake was saying a government run system is socialist as that implies all the doctors are paid by the government and the hospitals owned by the government. Otherwise very nice. The only mistake was saying a government run system is socialist as that implies all the doctors are paid by the government and the hospitals owned by the government. Otherwise very nice.

]]> By: Donald Green MDhttp://www.kevinmd.com/blog/2009/08/health-care-reform-back-of-the-napkin-version.html#comment-110280 Donald Green MD Mon, 24 Aug 2009 12:43:51 +0000 http://www.kevinmd.com/blog/?p=39705#comment-110280 Excellent overview of the problem. Thanks for posting. I hope is not too late for people to realize that HR676 is the only solution to deal with the present health insurance mess. When Medicare was enacted it took one year to sign up 90% of seniors. There was no disruption and its history has been one of relative success. Its excesses and shortcomings have needed attention along the way, but so far have not presented any reason to throw out the baby with the dishwater. Excellent overview of the problem. Thanks for posting. I hope is not too late for people to realize that HR676 is the only solution to deal with the present health insurance mess. When Medicare was enacted it took one year to sign up 90% of seniors. There was no disruption and its history has been one of relative success. Its excesses and shortcomings have needed attention along the way, but so far have not presented any reason to throw out the baby with the dishwater.

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