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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: Lane3 who wrote (3778)	1/11/2008 4:01:05 PM
From: TimF	Read Replies (1) \| Respond to of 42652

France may be more like us than like the British system. They seem to be closer to us, than Canada, definitely closer than the UK. It was a bit of a surprise to see French people in any numbers railing against socialist solutions. "...British-style national health service, which the French dismiss as "socialized medicine..."

To: Lane3 who wrote (3778)	1/11/2008 11:24:24 PM
From: Peter Dierks	Respond to of 42652

Sécurité Sociale has created a standardized and speedy system for physician billing and patient reimbursement... "Our Medicare has done that, as well." The standardized part is true. The doctors I know say the speedy part is not so true. Medicare is known for having unforgiving systems that often do not yield prompt payment. Apparently if a claim is not submitted correctly the first time (correctly according to arcane rules) it is permanently denied, so one of the big cost savings is from not paying what is owed. Also most doctors find the reimbursement amounts have not increased in decades and that they are grossly insufficient for all but the most industrially efficient providers. This has the effect of forcing small practices to chose to lose money on providing care or decline to accept the business. I have been told repeatedly what happens is that if Medicare patients have an established relationship their doctor continues to provide care at a loss. Doctors only permit a small percentage of their business to be Medicare patients. Patients who need to find a new doctor find it difficult to find one that is accepting new Medicare patients. Those that do are generally new to their practices. Do we want to increase the scope of this problem?

To: Lane3 who wrote (3778)	1/12/2008 2:51:47 AM
From: Constant Reader	Read Replies (1) \| Respond to of 42652

I recently ran across a statistic that the average French physician earns $60,000 per year. (I do know that is true in Spain, which is why so many Spanish doctors are practicing in the UK). If the number is reasonably accurate, it probably does not bode well for adopting that system here. As the article you quoted earlier says, liability claims (more specifically, fear of liability claims) are not the problem there as they are here. I think we're bordering on the realm of fantasy to expect genuine tort reform from the 535 members of Congress, the vast majority of whom were once practicing attorneys. WRT: Medicare. Peter's comments to the contrary, I've reviewed a few hundred Medicare claims and EOB's, and a minor fraction had problems due to misunderstanding billing requirements. With the advent of completely computerized programs for both the provider and Medicare, those problems are largely a thing of the past. What is not a thing of the past, however, is Congress's failure to set payment rates in a timely fashion. They wait until the very last minute every year. This causes some confusion and consternation, because, for certain procedures, even a billing error of $1 over the allowed amount can result in an accusation of Medicare fraud. As well, faced with mounting expenses as a whole, the government has been cutting fees year after year, back to 1980's rates, for some providers. This is particularly true in the mental health field and it is next to impossible for a Medicare recipient to find an established psychiatrist willing to take them on as a patient. (This relates to the triage aspect of the Canadian healthcare plan you mention later - we're doing it now, it just isn't as obvious.) At the same time, all of those claims also went through the largest private health insurer in the United States. Their processing error rate exceeds 20%, their harassment of physicians for failing to dot an I or cross a T apparently knows no bounds, they defrauded the government itself for over 5 years before being caught, and they have resorted to novel interpretations of their contracts in order to avoid paying per the contract. Three years ago, they resolved that issue by never getting around to sending out hard copies of the contracts. It appears that they have now outsourced their customer service operations to Bangalore which leads to entertaining mutually unintelligible conversations with "Skip" or "Molly." If one gives the company the benefit of the doubt, they are merely incompetent. As they are making money year after year, and just about the only genuinely big name left in the business, somehow I doubt that. Their Explanations of Benefits do have their lighter moments, however: I treasure the one saying the $500 emergency benefit did not apply as having a heart attack was no excuse for not calling them at their 800 number while riding in the ambulance on the way to the hospital and obtain prior authorization. The recent non-payment of a physician's bill because he was "Out of Network" was good for a chuckle: the plan in question is one of the very few good old fashioned "fee-for-service" plans in the country There is no such thing as a network in that plan. Of course, no one at the customer service office in Hyderabad actually has a copy of the plan so explaining this to them is a waste of time. Don't pretend to have a solution, because I doubt there is one, but Medicare is a model of efficiency compared to the largest provider of private health insurance in America. They cover about the same number of Americans.