A View From The Press Box

Absolutely the right way to go!

Make your deal with your family doctor while you're in good health, not when you're in dire need.

Make your deal with a health insurer, if you so desire, before you are in dire need.

Negotiate your deals from a position of strength--don't wait until you are desparate. Just like any other service. Be responsible for yourself--act like an adult.

The far left in America (referring to themselves always as the "we") always wants to treat other adults (the "them") like children, and so that's how "they" act--and it just backfires. Then they have to coerce doctors and hospitals to treat people whom they don't want to treat, because they aren't going to get paid for it.

Unintended consequences proliferate. More coercive mandates follow, like mandatory universal medical expense taxes. That's the road to serfdom.

My solution, Sam, is to remove the government from medicine. Free medical care is just too expensive.

Thirty years ago, when my parents became eligible for Medicare--essentially free medical care--they and the other people residing in a retirement community in Thousand Palms, Calif. (near Palm Springs) entertained their retirement years by going to a doctor two to three times a week. It was free, the doctors were nice, and they gave the old folks pills that made them feel good.

These people grew up in the Depression and would rather die than pay a doctor $50 for a visit, but when it's free they went as often as they could. The docs didn't complain because they made a fortune for doing very little.

FREE, as the government provides it is just too expensive and provides little or no good medical care. FREE as employer paid "insurance" is just too expensive.

Remember, TANSTAAFL, There Ain't No Such Thing As A Free Lunch.

SAM RESPONDS:
Barry, I would hardly describe Medicare as "free," since I have been "contributing" via payroll deduction my entire working life, with a good 15 years to go.....

That said, I agree that Medicare could be better managed to discourage such frequent, unnecessary use...Perhaps by upping the deductible for office visits.

Many are eager to dump on Medicare, but without it, elderly people would be dying in the street. Which private carrier would insure anyone over 50? And if so, at what price???

BARRY HAS THE LAST WORD:
Of course, it isn't free, Sam, but to the people who have it, especially if they take a supplemental HMO, it is free and they use it like it's free.

Before Medicare, old folks didn't die in the streets and they didn't spend millions on their medical service. If they had no insurance, charities took care of them.

I ask--as did President Madison, many years ago--where in the Constitution of the United States does the government get the power to take money from you and me to give charity to people they decide need it because they want to buy their votes with my money. It isn't there, Sam, and no one has dared to fight it.

I'm sure you have a good heart, but the path to Hell is paved with good intentions.

For example, college tuition increases more than 100% over inflation because money is available from the government. They give less education for more money.

Medical services would cost less if the docs didn't have to deal with the government, which is so inefficient it is easy to steal. Over $100 billion a year goes to fraud in health care.

How many old and poor could be taken care of if the fraud was stopped and taxpayers had their money to give charitable contributions to charitable institutions?

I run a very small business and manage to pay, at my advanced age, for insurance for my wife and myself. Those who won't or can't should not get it from my taxes, but from my voluntary charitable giving that I could do better if the government didn't take so much of my earnings to do stupid things like a Woodstock Museum in New York or contributions to people who preach hate of the U.S.

It is, to reiterate another of my posts, the availability of so much government money without controls that tempt crooked doctors.

I know a few doctors who have stopped taking insurance because of the things listed in this post. They are tired of the run-around and the late payments.

This is also going on with drug stores. We are losing the local stores with long-term pharmicists because--and I know this first hand--they cannot get reimbursed from a large national chain that controls the reimbursements from Medicare Part D.

I don't know if it's just in my area, but a lot of dentists already demand payment upfront. I certainly couldn't blame any doctor for doing the same.

I guess my question is (and I'm not arguing with you, just asking for information) how would universal healthcare address the mountain of paperwork and the low standard fees the doctors are protesting?

Would doctors be mandated to provide the services and accept the fees established by the government program?

Would doctors be allowed to opt out of the government program?

SAM RESPONDS:
Terrific questions, and I would welcome more reader feedback on this point.

I would imagine doctors would be allowed to opt out, which would mean top-flight practioners might still only serve the "rich"--those able to pay out of their own pocket.

Whether these folks would be entitled to any reimbursement, or whether such out-of-network doctors would be all privately paid, would have to be debated.

There might also be the opportunity to sell premium insurance plans to cover such contingencies--just thinking out loud here.

However, in return for getting a medical license, I could see requiring doctors to certainly start out accepting all government-payments for a period of time before being allowed to opt-out.

I am curious to hear more about this from other readers.

It seems that this industry is afflicted with the all too pervasive shoddy-service syndrome.

It used to be you paid a premium and you recieved equitable service with minimal aggravation. Today the attitude of insurers is grab the premium and we'll deal with the fallout later.

All the ad campaigns aren't going to be a substitute for quality service. It's time for the consumer to yell at the top of their collective lungs"we aren't gonna take it anymore"

It's about time you do get what you pay for.

In order to cut down on unnecessary visits and insurance battles, maybe it's time for health insurance to provide similar level of preventative care as dental insurance. Two fully (100%) covered routine checks per year. Dental insurance covers two visits per year with a lower-level (less-expensive) provider.

Just as regular dental cleanings and consultations help to avoid serious gum and teeth issues, if medical insurance provided 100% covered semi-annual routine check-ins with an RN or PA, many health issues may be addressed and headed off before becoming more serious (and, therefore, much more costly).

Going one step further, how about linking that routine check-up to your coverage? Make those visits mandatory in order for illnesses to be covered--similar to an auto warranty requiring regular maintenance in order for the warranty to remain in force.

Of course, neither of these would ever happen--but the only "fix" is to seriously think outside the box on this one.

Your premise takes me back to 1970, Sam, when that was how health insurance was paid. The insured patient would get the bill from the doctor, hospital, ambulance, pharmacist, etc. and submit all of the expenses to the insurer, which would subtract the deductible and 20% co-insurance penalties (subject to the maximum available payout) and cut a check directly to the insured patient (unless they signed a form allowing for payment to the medical provider).

The medical profession pushed for the current method of claim paying to guarantee collection of the insurance and to be able to negotiate the cost of services with the insurance companies.

If the system reverted back to 1970, the medical profession's income will drop precipitously (because ill and injured won't be able to afford COD for those expensive tests, non-emergency surgeries, etc). And about those emergencies...(don't have one!)

Nan has some great points! Prevention would minimize many of the costs we now see in corrective healthcare. Certainly something to explore...Are you listening Aetna, Blue Cross and others?

As of July 1, I understand the Medicare & TRICARE reimbursement for services will be decreased by 10.6 percent, unless some governmental intervention is made before that time.

Some doctors opted out of accepting that reimbursement for patients the last cut in reimbursement, and may opt to do so again. That will further impact the quality and ability of Medicare patients to obtain care in a timely manner as the number of doctors becomes more limited.

Many Advantage Plans now charge a monthly surcharge to see certain medical groups, ranging from $60 to $100 or more, simply because contracts cannot be gained without higher demand costs with the clinics and hospitals. If a subscriber wants to use those doctors and facilities, they pay the additional over and above the Part B Medicare premium of about $100 per month.

But, currently, that's their choice. If doctors start declining current fee structures again, what will happen to those with no additional-premium Medicare Advantage Plans next renewal? Will all plans see a surcharge?

Having worked with the medical community, and with a nurse spouse, we hear both sides of the story, and perhaps are able to ferret out what is truly the middle ground.

The doctors want a reasonable fee, given they frequently receive virtually nothing for their services, have to resort to collections, or have so much red tape and paperwork for reimbursement in governmental programs, that by the time they get anything, it's often less than the costs associated with going after the money.

The patient wants a decent policy that covers most, if not all illnesses and accidents, at a price they can afford. Problem is, most don't have any better clue of what they are getting in health insurance than they do a property policy. Especially those who must choose from the glut of Medicare options and providers of additional service policies.

Even I, with over 40 years in the business, took many hours to clearly lay out each potential policy for comparison for coverage, benefits and potential costs. How many seniors have the ability and background to be able to do that?

For most it's a point-and-pick proposition, I'm afraid! Plus, as some have pointed out above, the current system may encourage all too many visits in the name of "wellness" when several annual checks might just be the ticket to saving money and having a healthier population besides.

We found a doctor who is COD. She was an emergency room doctor before going private. Her prices are 40% below what other doctors charge because she does not have to have the staff needed to fill out all the forms and hound the insurers for payment.

This works great for us because we are self-employed and major medical is all we can afford.

Besides, she takes the time to get to know you. Just like a lot of the old-time agents did prior to the advent of computers and reduction of the commissions the agents were paid by the carriers.

Maybe there is a correlation there. "Easier" paperless files for the agents meant less commission and more time to generate new business and less time to get to know your clients.

For the doctors, it meant set fee schedules, lots more paperwork even with computers, and less time to get to know the patient.

Sam, your socialist-coercive-totalitarian mindset shines through your words again (and I quote):

"However, in return for getting a medical license, I could see requiring doctors to certainly start out accepting all government-payments for a period of time before being allowed to opt-out."

A medical license is not a favor handed out by government, "in return" for which a person should be subjected to indentured service. It is earned through arduous personal effort and great personal expense and sacrifice.

Government should act to prevent fraud (i.e., to bust people who represent themselves as qualified physicians when they aren't), and enforce contracts freely entered between physicians and their patients, but otherwise just butt out.

I'm a member of that previously referenced "far left."

Let me just say I am proud to be there on the "far left" if it means that I am not so short-sighted nor so narrow-minded as to think that I couldn't couldn't lose my job (with the reasonably-priced health insurance I depend upon), have a serious health issue that makes me undesirable in a small-group health policy, or puts the premium for an individual health policy out of reach.

Ever heard, or more importantly, do you know the meaning of the phrase, "There, but for the grace of God, go I"? It means that anything that happens to somebody else could happen to me, too. How would "I" wish to be treated?

Personally, I wish the government WOULD let the people such as Barry and Mikk "opt-out." Maybe for them, money will never be an issue. They'll be able to pay the premiums for any health coverage they want at any age, including all the co-payments, deductibles, coinsurance amounts, etc.

Then let's see what happens if their circumstances change.

"LEFTY" SAM RESPONDS:
Amen, Gail!

Good God, somebody call the hyperbole-police on this guy, Mikk.

Socialist-totalitarian? Really? You need a reality check as well as a history lesson, friend.

Sam is a big boy and can take care of himself. I'll let him respond with information detailing how much government assistance doctors receive in the form of subsidized loans during their education if he wishes to defend his position.

It's because I have family that actually escaped the nightmarish Russian empire that I take such offense at your attempts to set a land-speed record in vindicating Godwins law by declaring the editor of an insurance trade publication a Stalinist because his viewpoint differs, really only slightly from your own if you actually look at it objectively.

As for the first post, where Mikk claims that the far left is pushing universal health care--last I checked it was a cornerstone of the Democratic party's election campaign.

Democrats lost the last two presedential elections by very slim margins (in fact, won the popular vote in 2000, if you'll recall that little fact). And they are probably going to win this election if the Vegas odds of 13/10 on McCain are correct.

(Admittedly some of those odds are pretty suspect. 100-1 on the Green party? Those bookies are real champions of risk management!)

That makes 50% of the electorate far left lunatics, I suppose.

Where is the middle to you? How many autographed photos with Rush Limbaugh does it take to be considered far-right?

It just never ceases to amaze me that everyone who is not a right-wing, Bible-thumping, deer-hunting, Kenny-Chesney-loving, these-colors-don't-run-bumper-sticker-owning, young-Earth-creationist, anti-abortion, anti-gay (excuse me, pro-family), gigantic-truck-driving, cowboy-hat-AND-boots-wearing, Republican is a far left wack job to people like you.

Believing that health care is a human rights issue instead of a chance to scream FREE MARKET at the top of your lungs does not make one Che Guevara. You do a disservice to yourself and everyone with more than a high school education by pretending otherwise.

As for the actual meat on the bone in your posts, ideas borrowed no doubt from some management book that heavily references Sun Tzu and Machiavelli: my family doctor doesn't treat cancer, major fractures, appendicitis, heart failure, etc.

Should I make a deal with every specialist in my county in case of emergency? What kind of deal? How can I trust they will honor it? Are you sure they won't laugh me out of their office?

What is my position of strength, exactly, having not been diagnosed with major illness? Does it make me an adult to pretend the problem of soaring medical costs can be solved by masterful negotiation?

Why don't we make every public service a for profit enterprise? Fire trucks, police, the military? Certainly I could save money on taxes by negotiating a deal up front with my Fire Department, right?

You might want to listen to the following video that explains why we can't afford medical services:

http://www.youtube.com/watch?v=bLJxmJZXgNI&eurl=http://insureblog.blogspot.com/

Gail's basic point seems to be that if someone needs something they can't pay for, someone else must be forced to pay for it for them.

OF COURSE I'd like to have someone else pay for my needs and wants! If that's my "human right," (are there any other kinds of rights?), then why should I bother to work and save for my old age and manage my affairs and live prudently and buy insurance and all the rest of that boring stuff? Let's party!

But when everybody does that, nobody will have the means to pay for anybody's misfortunes, including their own.

In the end, everybody dies. The only question is at whose expense do you get to postpone your end, for how long, and what do you do in the meantime.

I don't think I have, or should have, a right to force you to act, or to force my hand into your pocket, to postpone my death; I only have a right to what's in my own pocket. I can spend what's in my pocket selfishly; or I can spend it charitably--it's my right to choose.

But if you vote to give the federal government the right to force its hand into my pocket to pay to enable you to live longer, you have voted to rob me. I resist.

I don't have time to respond to Anonymous right now...

SAM RESPONDS:
Mikk, you seem to believe that the only people without health insurance are those who refuse to pay for it, as opposed to those who cannot afford it even if they want it.

While there are people out there who recklessly go bare, they are in the minority, by far.

Barry Zalma's reference to this video is exactly what I have pointed to as a huge problem here in California as well.

Illegals who are sick, injured, even those injured as a result of criminal activities, receive care at our expense for whatever time is required, and the other countries laugh at our attempts to either repatriate the people or collect expenses.

In fact, the Mexican Consulate in Southern California has been known to use forged law enforcement and other credentials to get illegal aliens who have been injured while commiting crimes, such as drug smuggling, out of hospitals, and return them to Mexico to avoid prosecution; but won't do that with others whom we simply pay the health care bill for ad nauseum.

And, the government does nothing to stop the flow across the border.

Thanks, Barry. Great video!

As an agent who sells a lot of health insurance, I would be willing to let doctors work on a C.O.D. basis for six months. It wouldn't take them long to beg for insurance to return.

Patients would see how expensive health care is. Doctors blame health insurers for the high cost of insurance. But insurance would not be so expensive if doctors, hospitals and drug companies would reduce their fees.

A national study last year showed the average health insurer makes a 3% profit, and takes another 13 cents of every dollar of health insurance premium for administrative costs. This is reasonable.

The rest of every dollar paid (by far the largest) for health insurance goes to pay health care costs--doctors, hospitals and drug companies.