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Gayle in MD
03-19-2010, 12:56 PM
<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">The business model of American health insurers is basically: try to get healthy customers as clients, and then resist as long as possible when it comes to paying out claims.

That's actually not an indictment or a criticism.

It's just the way our system works, and it's screwed up.

Whatever you feel about Obamacare, you probably think our current system needs reform in some sense.

Below we present the posterboys of the problem. Top healthcare CEOs making millions, leading companies that deny you coverage.

Meet them here&gt;
</div></div>

http://www.businessinsider.com/here-are-..._medium=twitter (http://www.businessinsider.com/here-are-the-15-health-care-big-wigs-who-cant-sleep-because-of-health-care-reform-2010-3?utm_source=twitterfeed&utm_medium=twitter)

http://www.businessinsider.com/here-are-..._medium=twitter (http://www.businessinsider.com/here-are-the-15-health-care-big-wigs-who-cant-sleep-because-of-health-care-reform-2010-3?utm_source=twitterfeed&utm_medium=twitter)

LWW
03-19-2010, 12:58 PM
Would you like to discuss which major insurer turns down the most coverages?

Probably not?

LWW

sack316
03-19-2010, 02:17 PM
[quote=Gayle in MD] <div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">The business model of American health insurers is basically: try to get healthy customers as clients, and then resist as long as possible when it comes to paying out claims.
</div></div>

http://biggovernment.com/files/2009/10/AMAdenials.jpg

The biggest denier under the system? The gov't, at 6.85% denial of claims.

Sack

LWW
03-19-2010, 02:32 PM
OH DEAR!

Has the left been hoist by their own petard yet again?

LWW

pooltchr
03-19-2010, 02:55 PM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: sack316</div><div class="ubbcode-body">[quote=Gayle in MD] <div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">The business model of American health insurers is basically: try to get healthy customers as clients, and then resist as long as possible when it comes to paying out claims.
</div></div>

http://biggovernment.com/files/2009/10/AMAdenials.jpg

The biggest denier under the system? The gov't, at 6.85% denial of claims.

Sack </div></div>

The left is just going to deny this, just as they deny the fact that the majority of Americans do NOT want this HC bill to pass, or that Obama's "strongly disapprove" rating is right where GW was at the end of his second term.

They need to change their mascot from the donkey to the ostrich!

Steve

eg8r
03-19-2010, 03:16 PM
<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">15 Exects Get Paid Millions To Deny You Coverage </div></div>Why doesn't your subject line have anything to do with the text you quoted?

eg8r

eg8r
03-19-2010, 03:17 PM
Pretty interesting. Aetna is hot on their tails though. I guess that Exec will be gayles shoo-in in the next Presidential appointments. /forums/images/%%GRAEMLIN_URL%%/smile.gif

eg8r

Gayle in MD
03-20-2010, 12:46 AM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: sack316</div><div class="ubbcode-body">[quote=Gayle in MD] <div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">The business model of American health insurers is basically: try to get healthy customers as clients, and then resist as long as possible when it comes to paying out claims.
</div></div>

http://biggovernment.com/files/2009/10/AMAdenials.jpg

The biggest denier under the system? The gov't, at 6.85% denial of claims.

Sack </div></div>

These statistics are false. Operable words, "Reasons other than a claim edit."

What do you think a cliam edit is?

G.

Gayle in MD
03-20-2010, 12:49 AM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: eg8r</div><div class="ubbcode-body"><div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">15 Exects Get Paid Millions To Deny You Coverage </div></div>Why doesn't your subject line have anything to do with the text you quoted?

eg8r </div></div>

Why do you think it doesn't?

Qtec
03-20-2010, 01:59 AM
Sack's source is http://biggovernment.com/. Andrew Brietbart.

Q...[ right click on the chart, choose properties and you can see where it comes from.]

Gayle in MD
03-20-2010, 02:09 AM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Qtec</div><div class="ubbcode-body">Sack's source is http://biggovernment.com/. Andrew Brietbart.

Q...[ right click on the chart, choose properties and you can see where it comes from.] </div></div>

LOL, about as accurate as Rasmeusen...

/forums/images/%%GRAEMLIN_URL%%/crazy.gif

sack316
03-20-2010, 05:10 AM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Qtec</div><div class="ubbcode-body">Sack's source is http://biggovernment.com/. Andrew Brietbart.

Q...[ right click on the chart, choose properties and you can see where it comes from.] </div></div>

The image upload if from them... but the data findings are from NHXS, which I'm sure if you research will find as a more than acceptable source, as their purpose if to expose denial of claims and push for payment of legit claims. So please don't confuse the "image location" with the source of information.

Which, btw, the info is quite accurate. If not, please show my any legit source which shows any other payer being as big a denier of claims as the gov't.... ok... doesn't even have to be a legit source... any source will do.

Nope, ya can't, cuz the stats are facts, whether they are posted on Breitbart's site or any other... Medicare still denies a higher percentage of claims than any other entity that exists in this country.

Sack

sack316
03-20-2010, 05:25 AM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Gayle in MD</div><div class="ubbcode-body">

These statistics are false. Operable words, "Reasons other than a claim edit."

What do you think a cliam edit is?

G. </div></div>

What do you think a claim edit is? You do, I hope realize, that excluding claim edits actually benefits the gov't statistics moreso than the private statistics! please tell me you know that much (obviously you don't).

If you would like, I can provide yet another lesson on here to explain obvious things that would take only a moment to look up. But maybe I'll switch it up, and allow you an opportunity to express your personal knowledge beyond a cut and paste, so you can tell me how excluding claim edits benefits "your side". I know you have a blog pulled up that told you the statistics are false... I also know that very same blog entry doesn't tell you "why". So please, tell me why....... and if you can't, then I will statistically show you why they are true.

But first, show me how it is wrong.

Oh, and I see you and Q dismissing the stats because the image location was from Breitbart's site (though that was not the source of the information). So if it is wrong, please do show me. Show my anything you can find on percentage of claim denials that say any other entity is higher than medicare. You can't. The statistics are real. But if my findings are wrong, I'll gladly admit it if anyone can show me.

Google awaits your search.

Sack

Qtec
03-20-2010, 05:28 AM
<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body"> The image upload if from them... but the data findings are from NHXS, which I'm sure if you research </div></div>

You do the research and get back to me <u>when you have a link.</u>

Are you saying BigGovernment is a reliable source?

A few headlines from this site.

<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">The Obamacare Deficit Fraud
</div></div>
<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">AmeriCorps: Obama’s Scandal-Plagued Indoctrination Machine
</div></div>
<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body"> Breaking: While An Anxious Nation Is Transfixed By The Healthcare Debate, The Obama Administration Restores ACORN Funding
</div></div>
<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">Don’t ‘Slaughter’ the Healthcare Bill—Kill it!
</div></div>

Sound 'fair and balanced' to you?
Impartial ?
Only reporting the facts?

Come on Sack, get real.

What you are doing now is trying to find facts to support your opinion instead of looking at the facts and forming one.




Q

sack316
03-20-2010, 05:29 AM
http://www.nhxs.com/docs/upload/2009_AMA_National_Health_Insurer_Report_Card_L.pdf

above for those didn't like the chart posted before because of the site it was hosted on. Same statistics... non-partisan site (which was the source of info originally anyway, if anyone cared to look into it at all). Enjoy debunking actual facts and statistics, I'd really love to see it.

Sack

sack316
03-20-2010, 05:34 AM
the post above this one has the link you request. I'm not finding opinions that support mine, I'm posting FACTS that show the truth.

If you can find some stats that show medicare is not the biggest denier of benefits, I will gladly give it a look over. But this far the best retort I've seen is that the IMAGE HOST was Breitbart's site. Which grated, Breitbart is an extemely biased site, and I should have known better, but it was the cleanest and best fitting chart to post as an image on the message board.

So please, look at the link in my last post, and find the same information on a more respectable site. The stats were valid all along, it was only the image host in how I posted it that was in question.

And again, I challenge anyone to disprove THE STATISTICS, from anywhere. No matter the source, you will find that Medicare is still the place that denies the greatest % of claims. Whine all you want, but those are facts.

Sack

Qtec
03-20-2010, 05:51 AM
Are you joking? If you expect me, or anyone here to go through that WHOLE friggin pdf you have lost it.

/forums/images/%%GRAEMLIN_URL%%/smile.gif

Actually, I have just skimmed through it and its Greek to me. /forums/images/%%GRAEMLIN_URL%%/tired.gif
Its a maze of graphs and charts and you - sorry - BigGovernment picked one that seems to back up your claim that Govt HC is more expensive than Private HC.......which is absurd. That can't be.

BTW,..............Statistics say your bathtub is more of a threat to you than Al Q.

Why no war on bathtubs?

Q

sack316
03-20-2010, 06:30 AM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Qtec</div><div class="ubbcode-body">Are you joking? If you expect me, or anyone here to go through that WHOLE friggin pdf you have lost it.
</div></div>

Hey, that's why i posted a clean chart, which happened to be found on the site you didn't like. You requested a source, I then provided it for you, and now you are too lazy to look through it. Which I anticipated originally, and was the whole reason for posting the simple numbers easily laid out in the first place.

But if you need me to hold you hand on how to read statistics, start on page 6 of the PDF, and go through page 8 (I hope 3 pages isn't too much). From the middle to the right end of the page you will find 2 companies listed on each page. Both companies per page have a 2008 and 2009 (incomplete) statistic. Those numbers (2008) are what you are looking at, because full figures have been reported. So right under "2008", you will see a number. This is the % of claims denied. Look over the mere 3 pages, and see who is the highest. To save you time, we have---- Aetna 6.80%, Anthem BCBS 4.62%, CIGNA 3.44%, Coventry 2.88%, UHC 2.68%, Medicare 6.85%. If you need instruction on what any other numbers read, please let me know and I will be happy to help.

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Qtec</div><div class="ubbcode-body">
Actually, I have just skimmed through it and its Greek to me. /forums/images/%%GRAEMLIN_URL%%/tired.gif </div></div>

Yeah, I understand. And I hope I am not coming off as a smartass here (though I realize I may be), but it is truly complicated... and I am simply trying to explain how the numbers work. I happen to be fortunate (or unfortunate enough) to study stats, graphs, numbers, etc. nearly every day... and happen to have a knack for "seeing it" when others may not.

And granted, I have my beliefs and you have yours... and we can each take stats and find a way to make them fit. But I honestly do my best to take the numbers as they are, and show them for what they may be (such as in Gayle's thread on Hannity's charity, or even my own other thread where I told Steve my figures solely represented admin costs, and not costs as a whole). In this case, the honest to God (or honest to science, depending on one's beliefs) facts are that Medicare is the biggest denier of claims. That # is fact. It does not delve into why, or how, or anything else. But bottom line statistic (A and B, true and false, 1 and 0, or however one looks at it) is the same.

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Qtec</div><div class="ubbcode-body">Its a maze of graphs and charts and you - sorry - BigGovernment picked one that seems to back up your claim that Govt HC is more expensive than Private HC.......which is absurd. That can't be.</div></div>

True enough in the first part here. it was unfortunate that the cleanest chart happened to be on Breitbart's biased site (but as you yourself say, the true figures are complicated to look at on the PDF). So sorry for the image host. But WHERE that image was hosted, doesn't have any baring on the numbers. It was not a Breitbart study, not a big gov't.com manipulation that got the figures. Those are simply THE figures.

And no, it is not absurd to find numbers that show our gov't way of providing a service is more expensive. Have you seen our govt in action over the last 40+ years? Hell, just the other day I looked over maps of a landscaping job the stimulus is paying for. On 3 of every 4 streets, there was overlap of what the job was. In other words, due to crossroads and locations, in many instances we are being paid twice, three times, and some spots even 4 times for doing the same area.

That's not to say that private insurance or private industry does "good" or the "right thing"... I'm just saying the gov't doesn't necessarily do any better. And in some instances (such as the numbers provided earlier) does worse. But neither is "good".

We need complete overhaul, IMHO, from top to bottom. I fear currently that the only change is where payment comes from. But where payment comes from does nothing to change how payment is arrived at in the first place. My fear is what we will just be "spinning our wheels", so to speak.

Sack

sack316
03-20-2010, 06:32 AM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Qtec</div><div class="ubbcode-body">
BTW,..............Statistics say your bathtub is more of a threat to you than Al Q.

Why no war on bathtubs?

Q </div></div>

True enough, believe it or not. I face my bathtub, and it's possibly slippery surface once, sometimes twice a day. Odd as it may sound, this is good point.

Sack

Gayle in MD
03-20-2010, 06:55 AM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: sack316</div><div class="ubbcode-body"><div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Gayle in MD</div><div class="ubbcode-body">

These statistics are false. Operable words, "Reasons other than a claim edit."

What do you think a cliam edit is?

G. </div></div>

What do you think a claim edit is? You do, I hope realize, that excluding claim edits actually benefits the gov't statistics moreso than the private statistics! please tell me you know that much (obviously you don't).

If you would like, I can provide yet another lesson on here to explain obvious things that would take only a moment to look up. But maybe I'll switch it up, and allow you an opportunity to express your personal knowledge beyond a cut and paste, so you can tell me how excluding claim edits benefits "your side". I know you have a blog pulled up that told you the statistics are false... I also know that very same blog entry doesn't tell you "why". So please, tell me why....... and if you can't, then I will statistically show you why they are true.

But first, show me how it is wrong.

Oh, and I see you and Q dismissing the stats because the image location was from Breitbart's site (though that was not the source of the information). So if it is wrong, please do show me. Show my anything you can find on percentage of claim denials that say any other entity is higher than medicare. You can't. The statistics are real. But if my findings are wrong, I'll gladly admit it if anyone can show me.

Google awaits your search.

Sack </div></div>

Is Medicare dropping or are they unable to find doctors who will take them???????

Mayo Clinic in Arizona to Stop Treating Some Medicare Patients
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By David Olmos

Dec. 31 (Bloomberg) -- The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won’t affect other Mayo facilities in Arizona, Florida and Minnesota.

Obama in June cited the nonprofit Rochester, Minnesota-based Mayo Clinic and the Cleveland Clinic in Ohio for offering “the highest quality care at costs well below the national norm.” Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians, in a telephone interview yesterday.

“Many physicians have said, ‘I simply cannot afford to keep taking care of Medicare patients,’” said Heim, a family doctor who practices in Laurinburg, North Carolina. “If you truly know your business costs and you are losing money, it doesn’t make sense to do more of it.”

Medicare Loss

The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said.

Mayo’s hospital and four clinics in Arizona, including the Glendale facility, lost $120 million on Medicare patients last year, Yardley said. The program’s payments cover about 50 percent of the cost of treating elderly primary-care patients at the Glendale clinic, he said.

“We firmly believe that Medicare needs to be reformed,” Yardley said in a Dec. 23 e-mail. “It has been true for many years that Medicare payments no longer reflect the increasing cost of providing services for patients.”

Mayo will assess the financial effect of the decision in Glendale to drop Medicare patients “to see if it could have implications beyond Arizona,” he said.

Nationwide, doctors made about 20 percent less for treating Medicare patients than they did caring for privately insured patients in 2007, a payment gap that has remained stable during the last decade, according to a March report by the Medicare Payment Advisory Commission, a panel that advises Congress on Medicare issues. Congress last week postponed for two months a 21.5 percent cut in Medicare reimbursements for doctors.

National Participation

Medicare covered an estimated 45 million Americans at the end of 2008, according to the Centers for Medicare & Medicaid Services, the agency in charge of the programs. While 92 percent of U.S. family doctors participate in Medicare, only 73 percent of those are accepting new patients under the program, said Heim of the national physicians’ group, citing surveys by the Leawood, Kansas-based organization.

Greater access to primary care is a goal of the broad overhaul supported by Obama that would provide health insurance to about 31 million more Americans. More family doctors are needed to help reduce medical costs by encouraging prevention and early treatment, Obama said in a June 15 speech to the American Medical Association meeting in Chicago.

Reid Cherlin, a White House spokesman for health care, declined comment on Mayo’s decision to drop Medicare primary care patients at its Glendale clinic.

Medicare Costs

Mayo’s Medicare losses in Arizona may be worse than typical for doctors across the U.S., Heim said. Physician costs vary depending on business expenses such as office rent and payroll. “It is very common that we hear that Medicare is below costs or barely covering costs,” Heim said.

Mayo will continue to accept Medicare as payment for laboratory services and specialist care such as cardiology and neurology, Yardley said.

Robert Berenson, a fellow at the Urban Institute’s Health Policy Center in Washington, D.C., said physicians’ claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients’ primary care.

“Some primary care doctors don’t have to see Medicare patients because there is an unlimited demand for their services,” Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, “then Medicare does indeed look like a poor payer,” he said.

Annual Costs

A Medicare patient who chooses to stay at Mayo’s Glendale clinic will pay about $1,500 a year for an annual physical and three other doctor visits, according to an October letter from the facility. Each patient also will be assessed a $250 annual administrative fee, according to the letter. Medicare patients at the Glendale clinic won’t be allowed to switch to a primary care doctor at another Mayo facility.

A few hundred of the clinic’s Medicare patients have decided to pay cash to continue seeing their primary care doctors, Yardley said. Mayo is helping other patients find new physicians who will accept Medicare.

“We’ve had many patients call us and express their unhappiness,” he said. “It’s not been a pleasant experience.”

Mayo’s decision may herald similar moves by other Phoenix- area doctors who cite inadequate Medicare fees as a reason to curtail treatment of the elderly, said John Rivers, chief executive of the Phoenix-based Arizona Hospital and Healthcare Association.

“We’ve got doctors who are saying we are not going to deal with Medicare patients in the hospital” because they consider the fees too low, Rivers said. “Or they are saying we are not going to take new ones in our practice.”

To contact the reporter on this story: David Olmos in San Francisco at dolmos@bloomberg.net

Last Updated: December 31, 2009 00:01 EST


First of all, you don't have to be condescending about it. These figures do not match what I've seen elsewhere...

Let's look for a moment at the big picture of what health care costs are doing to our economy.

<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">

http://www.businessinsider.com/havent-go...e-system-2010-3 (http://www.businessinsider.com/havent-gotten-a-raise-in-forever-blame-our-broken-healthcare-system-2010-3)




[quote]Posted on July 17, 2007
Health insurance for the 21st Century
PRINT PAGE
EN ESPAÑOL

Upgrading To National Health Insurance (Medicare 2.0)
The Case For Eliminating Private Health Insurance
by Leonard Rodberg & Don McCanne
CommonDreams.org
July 13, 2007

Private health insurance was an idea that worked during part of the last century; it will not succeed through the 21st Century. With jobs increasingly service-based and short-term, the large employment-based risk pools that made this insurance system possible no longer exist. Medical care has become more effective and more essential to the ordinary person, but also more costly and capital-intensive. The multiple private insurance carriers that emerged during the last century can no longer provide a sound basis for financing our modern health care system.

Alone among the nations of the world, the U.S. has relied upon private insurance to cover the majority of its population. In the mid-20th Century, when medical care accounted for barely 1% of our gross national product, medical technology was limited, and jobs lasted for a lifetime, health care could be financed through such employment-based, premium-financed health insurance. But the time for private insurance has passed.

Health care has now become a major part of our national expenditures. The premium for an individual now averages more than $4,000 per year, while a good family policy averages more than $10,000 per year, comparable to the minimum wage and nearly one-fourth of the median family income. As a consequence, though the US spends far more on health care than any other nation, we leave millions of our people without any coverage at all. And those who do have coverage increasingly find that their plans are inadequate, exposing them to financial hardship and even bankruptcy when illness strikes.

If we believe that everyone should have health care coverage, and that financial barriers should not prevent us from accessing health care when we need it, then it has become clear that the private health insurance system cannot meet our needs. Health care has simply become too expensive to be financed through private insurance premiums.

Supporters of insurance companies claim that they create efficiency through competition. However, the truth is that insurance industry is increasingly concentrated, with three national firms, United Health, Wellpoint, and Aetna, dominating the industry. And the high and rising cost of health care shows that whatever competition there was in the past has not worked to hold down costs.

Supporters of private insurance also claim that it expands consumer choice. However, the choice of plans that these companies offer is not what consumers want; it is the choice of their physician and hospital, exactly the choice that private insurance plans, in the guise of managed care, increasingly deny us.

What has been the response of the health insurance industry to this situation? To protect their markets and try to make premiums affordable, they have reduced the protection afforded by insurance by shifting more of the cost to patients, especially through high-deductible plans. They have also targeted their marketing more narrowly to the healthy portion of the population, so as to avoid covering individuals with known needs for health care. Yet premiums continue to rise each year, increasing by nearly 70% above inflation in just the last six years.

The so-called “universal health care” proposals being put forward by mainstream politicians would simply expand the current system without addressing any of its problems. They would simply mandate that either our employers provide us with coverage or we, as individuals, purchase our own coverage in the private insurance market. These plans cannot work in the face of the high cost of premium-based coverage for even the average person. (Some proposals would offer the option of buying a competing public plan, under the theory that the public program would be more efficient and effective. The flaw here is that the public plan would attract those who are unable to afford private coverage or who are paying high premiums or have no insurance because of pre-existing conditions. Placing these high-cost individuals in a separate government pool would make it unaffordable for most other people. This “death spiral” would cause the public plan to fail.)

The main impetus for renewed interest in health care reform has been the rapid rise in costs over the last few years. Yet, while most of these proposals give lip service to the need to control costs, none actually addresses the problem in a serious way. (The introduction of health information technology and “disease management”, which some of them urge, are mere placebos; they may make politicians feel better, but studies have shown they will do little to reduce costs and may actually increase them.)

Everyone acknowledges that coverage for low-income individuals must be subsidized. But what about the average-income individual and family? If they must now be subsidized as well, we might as well throw in the towel and recognize that a more efficient, more equitable financing system has to be adopted if it has any chance of providing coverage while being affordable to the society. An individual mandate to purchase private insurance cannot provide good coverage while remaining affordable, while employer-provided coverage also can no longer be sustained as the premium costs to the employer become increasingly unaffordable.

The private insurance industry spends about 20 percent of its revenue on administration, marketing, and profits. Further, this industry imposes on physicians and hospitals an administrative burden in billing and insurance-related functions that consumes another 12 percent of insurance premiums. Thus, about one-third of private insurance premiums are absorbed in administrative services that could be drastically reduced if we were to finance health care through a single non-profit or public fund. Indeed, studies have shown that replacing the multiplicity of public and private payers with a single national health insurance program would eliminate $350 billion in wasteful expenditures, enough to pay for the care that the uninsured and the underinsured are not currently receiving.

Such a single payer plan would make possible a set of mechanisms, including public budgeting and investment planning, that would allow us to address the real sources of cost increases and allow us to rationalize our health care investments. The drivers of high cost such as administrative waste, deterioration of our primary care infrastructure, excessive prices, and use of non-beneficial or detrimental high-tech services and products could all be addressed within such a rationalized system.

In sum, we will not be able to control health care costs until we reform our method of financing health care. We simply have to give up the fantasy that the private insurance industry can provide us with comprehensive coverage when this requires premiums that average-income individuals cannot afford. Instead, the U.S. already has a successful program that covers more than forty million people, gives free choice of doctors and hospitals, and has only three percent administrative expense. It is Medicare, and an expanded and improved Medicare for All (Medicare 2.0) program would cover everyone comprehensively within our current expenditures and eliminate the need for private insurance. This is the direction we must go.

Leonard Rodberg is Research Director of the New York Metro Chapter, and Don McCanne, Senior Policy Fellow, of Physicians for a National Health Program. http://www.pnhp.org

</div></div>

http://www.pnhp.org/news/2007/july/_health_insurance_fo.php


<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body"> PNHP Research: The Case for a National Health Program
Over the past two decades, PNHP research has “framed” the debate and focused it on the need for fundamental health care reform. Some of these findings have become so well known that new members of PNHP (and most members of Congress) may not know that we are the source:
1. Administrative costs consume 31 percent of US health spending, most of it unnecessary.
(Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8) Sept. 21, 2003)
2. Medical bills contribute to half of all personal bankruptcies. Three-fourths of those bankrupted had health insurance at the time they got sick or injured.
1. “Illness and Injury as Contributors to Bankruptcy,” Himmelstein et al, Health Affairs Web Exclusive, February 2, 2005.
2. “Medical Bankruptcy in the United States, 2007: Results of a National Study,” Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009), Am J Med, 122, 741-746.
3. “Medical Bankruptcy Fact Sheet,” Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009).
4. “Medical Bankruptcy Q&A,” Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009).
3. Taxes already pay for more than 60 percent of US health spending
Americans pay the highest health care taxes in the world. We pay for national health insurance, but don’t get it.
(Woolhandler, et al. “Paying for National Health Insurance — And Not Getting It,” Health Affairs 21(4); July / Aug. 2002)
4. Despite spending far less per capita for health care, Canadians are healthier and have better measures of access to health care than Americans.
(Lasser et al. “Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey,” American Journal of Public Health; July 2006, Vol 96, No. 7)
5. Business pays less than 20 percent of our nation’s health bill. It is a misnomer that our health system is “privately financed” (60 percent is paid by taxes and the remaining 20 percent is out-of-pocket payments).
(Carrasquillo et al. “A Reappraisal of Private Employers’ Role in Providing Health Insurance,” NEJM 340:109-114; January 14, 1999)
6. For-profit, investor-owned hospitals (Cite 1, Cite2, Cite 3, & Cite 4), HMOs5 and nursing homes (Cite 6 & Cite 7) have higher costs and score lower on most measures of quality than their non-profit counterparts.
1. Editorial by David Himmelstein, MD and Steffie Woolhandler, MD in the Canadian Medical Association Journal
2. Devereaux, PJ “Payments at For-Profit and Non-Profit Hospitals,” Can. Med. Assoc. J., Jun 2004; 170
3. Devereaux, PJ “Mortality Rates of For-Profit and Non-Profit Hospitals,” Can. Med. Assoc. J, May 2002; 166
4. Himmelstein, et al “Costs of Care and Admin. At For-Profit and Other Hospitals in the U.S.” NEJM 336, 1997
5. Himmelstein, et al “Quality of Care at Investor-Owned vs. Not-for-Profit HMOs” JAMA 282(2); July 14, 1999
6. Harrington et al, “Himmelstein, et al “Quality of Care at Investor-Owned vs. Not-for-Profit HMOs” JAMA 282(2); July 14, 1999,” American Journal of Public Health; Vol 91, No. 9, September 2001
7. Comondore, et al “Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis,” BMJ 2009;339:b2732-b2732
7. Immigrants1 and emergency department visits2 by the uninsured are not the cause of high and rising health care costs.
1. Mohanty et al. “Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis,” American Journal of Public Health; Vol 95, No. 8, August 2005
2. Tyrance et al. “US Emergency Department Costs: No Emergency,” American Journal of Public Health; Vol 86, No. 11, November 1996
8. 45,000 annual deaths are associated with lack of health insurance1. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002. The uninsured do not receive all the medical care they need — one-third of uninsured adults have chronic illness and don’t receive needed care2. Those most in need of preventive services are least likely to receive them.
1. Wilper, et al “Health Insurance and Mortality in U.S. Adults,” American Journal of Public Health; Vol. 99, Issue 12, Dec 2009
2. Wilper, et al “A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults” Ann Intern Med, Aug 2008; 149: 170 - 176.
9. The US could save enough on administrative costs1 (more than $350 billion annually) with a single-payer system2 to cover all of the uninsured.
1. Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8) Sept 21, 2003
2. “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance,” JAMA 290(6): Aug 30, 2003
10. Competition among investor-owned, for-profit entities has raised costs, reduced quality in the US
(Himelstein and Woolhandler; BMJ 2007;335:1126-1129 (1 December), doi:10.1136/bmj.39400.549502.94)
11. The Canadian single payer healthcare system produces better health outcomes (Cite 1, Cite 2) with substantially lower administrative costs (Cite 3, Cite 4) than the United States.
1. Guyatt GH, et al. “A systematic review of studies comparing health outcomes in Canada and the United States.” Open Medicine (2007); 1(1): E27-35.
2. Lasser KE, Himmelstein DU, Woolhandler S. “Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey.” American Journal of Public Health (July 2006); 96(7): 1300-1307.
3. Himmelstein DU, Lewontin JP, Woolhandler S. “Who administers? Who cares? Medical administrative and clinical employment in the United States and Canada.” American Journal of Public Health. (1 Feb. 2006); 86(2):172-178.
4. Woolhandler S, Campbell T, Himmelstein DU. “Cost of Health Care Administration in the United States and Canada.” New England Journal of Medicine. (21 August 2003); 349(8).
12. Computerized medical records (Cite 1, Cite 2) and chronic disease management2 do not save money. The only way to slash administrative overhead3 and improve quality (Cite 4, Cite 5) is with a single payer system.
1. Woolhandler, et al. “Hope And Hype: Predicting The Impact Of Electronic Medical Records,” Health Affairs, September/October 2005; 24(5): 1121-1123.
2. Himmelstein, et al “Hospital computing and the costs and quality of care: a national study,” Am J Med, Vol 123, Issue 1, Pages 40-46, Jan 2010
3. Geyman, J “Disease Management: Panacea, Another False Hope, or Something in Between?,” Ann Fam Med 2007;5:257-260. DOI: 10.1370/afm.649.
4. Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8) Sept. 21, 2003
5. Schiff, et al “A Better Quality Alternative” JAMA, 272(10); Sept. 12 1994
6. Schiff, et al “You Can’t Leap a Chasm in Two Jumps,” Public Health Reports 116, Sept / Oct 2001
13. Alternative proposals for “universal coverage” do not work. State health reforms over the past two decades have failed to reduce the number of uninsured1.
1. Woolhandler, et al “State Health Reform Flatlines,” International Journal of Health Services, Volume 38, Number 3, Pages 585-592, 2008
</div></div>

http://www.pnhp.org/resources/pnhp-research-the-case-for-a-national-health-program


Why we need single payer:
http://www.pnhp.org/facts/single-payer-faq#publicl_financed

Any way you slice it, Sack, our medical and insurance industries have to be reformed, and the only way to do that is through the Government.' The costs are simply unsustainable, higher than anywhere else, and our wellness statistics are way down when compared to other industrial nations.

You can single out a statistic, but that does not tell the story behind the statistic. Are some people being dropped because they were not eligible? We do know that medicare fraud is a problem, which is why part of the new reforms will include better oversight, and technological advances which will eliminate much of the paper work currently necessary, and costly.

The time will come when doctors will not take medicare patients. It's already happening. The system is broken, and it's only logical that if profits are the driving force, costs will contiue to go up, and more and more people will not be able to afford insurance.

I think it's rather pointless to cherry pick, and nit pick, when the overall truth is that the system if broken, and it will not be fixed unless the government steps in.

G.

G.

sack316
03-20-2010, 07:26 AM
actually, in many ways, I agree. It's the system that is broken. Changing who pays for it, doesn't change the system, it just passes the buck on down the line.

Now looking at figures, and comparing apples to apples as I have in a few threads here... the gov't is not a model of efficiency on the matter as claimed. Note: that is NOT saying that private companies ARE a model of efficiency, they obviously are not. But as is... "medicare for all" would serve for no greater long term good. Even as your own info shows, the selection of where to get care from would be severely limited due to underfunded payments (you are correct, it IS already happening now).

I wish I knew what the solution was, but honestly I don't. And from what I do know of what is out there being proposed now, the reality is that it won't do much to fix it. Maybe you can show me otherwise, and I hope you can.

As far as "singling out a statistic"... I didn't single it out. Washington did, using it as a selling point. How often have we heard "3% overhead"? I simply showed, by the numbers, how that figure (while true) is misleading in terms of how they represent its meaning.

Sack

sack316
03-20-2010, 07:27 AM
Oh, and FWIW, I think we do agree that there is a need for gov't to step in. it's to what extent and how that the line begins to blur.

Sack

Gayle in MD
03-20-2010, 07:41 AM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: sack316</div><div class="ubbcode-body">Oh, and FWIW, I think we do agree that there is a need for gov't to step in. it's to what extent and how that the line begins to blur.

Sack </div></div>

Well, the medical field seems to think that single payer is the answer.

I agree.

If Republicans would stop yapping about big government, we'd have had single payer, IMO.

Also, we do not know the reasons behind your statistic. What we do know, is that costs are rising incredibly, our economy is being negatively affected. Our jobs are being outsourced to a large degree because of medical insurance costs. And the CEO's that are running insurance, and many hospitals, AND doctors, are making a killing.

How can a fifteen minute visit with ANY doctor be worth $700.00?

How can we go forward without changing the system? We can't. It's that simple.

I believe that this president is level headed, intelligent, and compassionate. I think we will end up with single payer, and the Medical field, the top clinics i this country, all say that that is the answer.

I don't like things about the current bill, either. But, I do believe they will be improved upon. Republicans will never do anything about it, so this may be our last chance to improve the system we are stuck with right now.

G.

LWW
03-20-2010, 09:26 AM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Qtec</div><div class="ubbcode-body">BTW,..............Statistics say your bathtub is more of a threat to you than Al Q.

Why no war on bathtubs?

Q </div></div>

Because that's an absolutely ridiculous and implausible analogy.

Now, the truth is that my bath tub poses zero risk to me. I know of no case in recorded history where a bath tub of it's own volition did harm to anybody in any way shape or form.

What poses a risk is the bath tub owner being careless and slipping or falling asleep or using electrical items where they call fall in or some other level of human stupidity.

Al Qaeda is a completely different issue. Can you show a single point of carelessness from the victims that would have made them the cause of their own demise.

LWW

Qtec
03-21-2010, 04:35 AM
<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body"> Cigna Gives $110.9 Million Compensation Package To Ex-CEO

The insurance giant Cigna last year gave compensation packages worth more than $120 million to two executives who left the company, according to a filing with the SEC on Friday.

The vast majority of that total went to former chairman and CEO H. Edward Hanway who left his post <u>with a retirement package </u>worth $110.9 million -- which included $18.8 million in executive compensation for 2009, <u>as well as a healthy pension </u>plan, deferred compensation and stock options. </div></div>

link (http://www.huffingtonpost.com/2010/03/20/cigna-gives-1109-million_n_506974.html)

Q

Stretch
03-21-2010, 05:23 AM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Qtec</div><div class="ubbcode-body"> <div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body"> Cigna Gives $110.9 Million Compensation Package To Ex-CEO

The insurance giant Cigna last year gave compensation packages worth more than $120 million to two executives who left the company, according to a filing with the SEC on Friday.

The vast majority of that total went to former chairman and CEO H. Edward Hanway who left his post <u>with a retirement package </u>worth $110.9 million -- which included $18.8 million in executive compensation for 2009, <u>as well as a healthy pension </u>plan, deferred compensation and stock options. </div></div>

link (http://www.huffingtonpost.com/2010/03/20/cigna-gives-1109-million_n_506974.html)

Q </div></div>


That's a lot of money for saying no! I heard that most insurers automaticaly refuse coverage simply because they reolized that at least 10% of the applicants don't have the heart or resourses to fight for what is thier due. St.

pooltchr
03-21-2010, 05:24 AM
The insurance industry as a whole typically operates on a 2 to 4 percent profit margin. I'm sure you can find many industries that are much higher than that.

Steve

Qtec
03-21-2010, 05:50 AM
I had another look at it and yes, it does say that Medicare is denys the most requests but it also tells you why.


For instance, the #1 cause for denial in Medicare was,

<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). </div></div>

To me this just means the request form wasn't filled in properly. There is no reason to expect that next time the same request will not be approved with the proper paperwork because clearly they said they have not yet 'adjudicated' . ie decided yes or no.

The figures don't show what most here think it shows, namely that Medicare is worse than private insurance. The facts are that Medicare spends the the highest % of the money they receive on treating people.

<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">There was a time, in the early 1990s, when health insurance companies devoted more than 95
cents out of every premium dollar to paying doctors and hospitals for taking care of their members. No more. Since President Bill Clinton's health reform plan died 15 years ago, the health insurance industry has come to be dominated by a handful of insurance companies that answer to Wall Street investors, and they have changed that basic math. <span style='font-size: 17pt'>Today, insurers only pay about 81 </span>cents of each premium dollar on actual medical care. The rest is consumed by rising profits, grotesque executive salaries, huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most.

This equation is known as the medical loss ratio (MLR), an aptly named figure that is widely seen by investors as the most important gauge of an insurance company's current and future profitability.

When Wall Street isn't calling the shots, the outcome is decidedly better for health care consumers. Government-operated plans, such as Medicare, and some organizations that provide coordinated care, consistently maintain higher medical loss ratios. <span style='font-size: 17pt'>Kaiser had a 90.6 percent MLR in 2007. Between 1993 and 2007, Medicare's MLR hasn't dropped below 97 percent.</span> </div></div> Wendell Potter....and he should know. (http://www.huffingtonpost.com/wendell-potter/the-insurance-industrys-l_b_382001.html)

Q

Qtec
03-21-2010, 05:54 AM
I would say its a lot more than 10%. Its hard enough to fight these big Co's when you are fit and healthy and have resources. Imagine if you are Joe six-pack, bedridden and seriously ill.

Q

Qtec
03-21-2010, 06:02 AM
Not surprised if they only make 2% profit when they give the CEO a $110 million golden handshake.

<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">In addition to Hanway, former Cigna Executive Vice President and CFO Michael Bell received a $10.9 million executive compensation package in 2009. Bell left the company abruptly that year -- no reason was given for his departure. </div></div>

Who is this guy?

<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">Bell Resigns From Cigna Cfo Post
Hagan Taking Over
May 27, 2009|By DIANE LEVICK, dlevick@courant.com

CIGNA Corp. chief financial officer Michael W. Bell resigned Tuesday, and Annmarie Hagan was appointed to succeed him.

No reason was given for Bell's departure, but a federal filing by the company said "there was no disagreement or dispute with the company surrounding Mr. Bell's resignation." A CIGNA spokeswoman had no further information.

Bell, 45, worked for Philadelphia-based CIGNA for 25 years, and had been chief financial officer since 2002. </div></div>

He quit after only working 5 months of the year and they paid him $11 million.

Q

sack316
03-21-2010, 06:40 AM
Interesting stuff. Did you happen to look into the reasons for denial in private insurance companies, namely what % of their denials were for that same reason "Claim/service lacks information which is needed for adjudication"? I do not know the answer for this one right now, was just curious if you had any kind of comparison to see who may stack up better/worse in that area.

Also, I would think an organization the size of Medicare would have smoother procedures with its providers that would allow for a smaller number of such claims denied.

Sack

Qtec
03-21-2010, 07:03 AM
<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">Did you happen to look into the reasons for denial in private insurance companies, </div></div>

Do you really have to ask?

Of course I did.

Q

sack316
03-21-2010, 07:04 AM
And?

pooltchr
03-21-2010, 11:21 AM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Qtec</div><div class="ubbcode-body"> <div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">Did you happen to look into the reasons for denial in private insurance companies, </div></div>

Do you really have to ask?

Of course I did.

Q </div></div>

Was there a reason you didn't feel the need to share that part of your research?

Steve

Qtec
03-21-2010, 10:06 PM
<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body"> Did you happen to look into the reasons for denial in private insurance companies, </div></div>


<span style='font-size: 20pt'>DID YOU?</span>

Eh.....no.

<span style='font-size: 20pt'>You </span>posted that chart and you never <span style='font-size: 20pt'>really</span> read it.

Q

Qtec
03-21-2010, 10:09 PM
Did YOU read it?

Why you are commenting on something you obviously know nothing about escapes me.

It doesn't matter what RW TP it is or how ridiculous it is, you can always be relied upon to believe and repeat it.

Q

Qtec
03-21-2010, 10:13 PM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: sack316</div><div class="ubbcode-body">And? </div></div>

Its not for me to disprove your claims, its up to you to prove them.

Q................All republicans are perverts.............prove me wrong.

sack316
03-21-2010, 10:19 PM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Qtec</div><div class="ubbcode-body"> <div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body"> Did you happen to look into the reasons for denial in private insurance companies, </div></div>


<span style='font-size: 20pt'>DID YOU?</span>

Eh.....no.

<span style='font-size: 20pt'>You </span>posted that chart and you never <span style='font-size: 20pt'>really</span> read it.

Q </div></div>

Ummm, I did read it. IIRC you were the one who decided it was too long (24 pp) and complicated to read:

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Qtec</div><div class="ubbcode-body">Are you joking? If you expect me, or anyone here to go through that WHOLE friggin pdf you have lost it.

/forums/images/%%GRAEMLIN_URL%%/smile.gif

Actually, I have just skimmed through it and its Greek to me. /forums/images/%%GRAEMLIN_URL%%/tired.gif </div></div>

Or is your lack of response to the question because your reasoning, when applied across the board, still ends in the same net result?

Not that it matters now, it is done.

Sack

eg8r
03-22-2010, 11:58 AM
Because nothing in your text says anything to the effect that the execs are being paid to deny coverage.

eg8r

Gayle in MD
03-22-2010, 01:36 PM
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: eg8r</div><div class="ubbcode-body">Because nothing in your text says anything to the effect that the execs are being paid to deny coverage.

eg8r </div></div>

Like I said, you never know what you're talking about... /forums/images/%%GRAEMLIN_URL%%/crazy.gif