Wednesday, September 02, 2009

Health care for Clunkers

I was at the gym this morning and saw a car dealer on Fox News talking with Megyn Kelly about the Cash for Clunkers program. He had sold 181 cars and been reimbursed for 6 of them thus far. Asked if he would use the program again, he said "yes, but I hope they'll pay next time. There was also too much bureaucracy."

Good luck with that and welcome to how the government takes its own sweet time getting money to providers of services. The auto dealers are just getting a little taste of what health care providers have been dealing with for years. Those of us who are health care providers are used to filling out forms over and over, stalling, lack of reimbursements and often, cuts in reimbursement without warning. I can't tell you how many times I have filled out forms, made phone calls and begged for payment for Medicare reimbursements. It's just not worth it.

Imagine what will happen if the government takes over all of health care. Cash for Clunkers, Health care for Clunkers, call it what you want, actual cash will be hard to come by and take outrageous amounts of time and energy to collect. Cash for Clunkers should serve as a warning sign to providers and patients alike that more government interference into health care will result in more bureaucracy and less time for providers to spend with patients. After all, filling out paperwork and begging for cash can be time consuming.

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48 Comments:

Blogger Cham said...

I wonder how much healthcare would cost if everyone had to pay cash out of pocket. There would be doctor's offices on every corner and minimal staff, just like in South and Central America. You could be seen on a walk-in basis, no appointment necessary.

Too much of dream I guess.

12:13 PM, September 02, 2009  
Blogger Helen said...

Cham,

I think health care would then be brought more in line with something reasonable. People could deal directly with the provider or his/her office and costs would be lower as the overhead would be less. It costs a lot to have staff who can file insurance, etc. I think that catastrophic medical insurance to pay for big ticket items like a hospital stay or MRI would make sense, with a high deductible. But when everyone wants every single thing paid for, costs get out of hand.

12:18 PM, September 02, 2009  
Blogger BarryD said...

The "successful" Cash for Clunkers program is a good example of why we need a very strong humanities canon in the modern university.

Should anyone who can't define "the broken window fallacy" or "Faustian bargain" be given a diploma, to say nothing of a job in DC?

1:36 PM, September 02, 2009  
Blogger BarryD said...

Hit "Publish" too soon.

Those who support Health Care for Clunkers (I like that) are similarly ignorant.

1:38 PM, September 02, 2009  
Blogger dr.alistair said...

in the cash-for-service model wouldn`t there be a motive for provider to make themselves available to the highest bidder?

in britain the harley street doctor does much better than his compatriot down on tottenham court road.

in our system here in canada you can breeze in to a walk-in to get a free check-up, but actual treatment will cost out of pocket.

and only horses get immediate mris.

guelph university just north of here has a veteranarian school complete with swimming baths for rehab.

again, if you are a horse.

and old friend of mine rocco trained trotters and he said if i was a horse he could take me to guelph and get world-class treatment that day.

2:05 PM, September 02, 2009  
Blogger Cham said...

If everyone had to pay for their own healthcare cigarettes wouldn't sell, alcohol would be nonexistent, fruits and vegetables would fly off the store shelves and there would be a stampede on the jogging trail.

2:30 PM, September 02, 2009  
Blogger Professor Hale said...

... and electricity could be made from unicorn farts. Where do you get such strange ideas? There are many place in the world where people pay for their own health care (even some people in America do that), and it has not shown any real diference in unhealthy lifestyle consumption among those who practice it.

2:59 PM, September 02, 2009  
Blogger Cham said...

When it comes to food intake, we are the most unhealthiest people by far.

3:08 PM, September 02, 2009  
Blogger Adrian said...

I'm fairly certain that electricity can, indeed, be made from unicorn farts. And, if you don't believe me, then by all means, prove me wrong!

3:13 PM, September 02, 2009  
Blogger Roman Wolf said...

Cham,

While I loved your first post(I've likewise flown the no insurance thought experiment myself and I like it), I think your second post is getting silly. Humanity loves vice for the simple fact that it's enjoyable. Even in a world where people have to pay for their healthcare, cigarettes would sell, alcohol would exist, fruits and veggies will still not be devoured, and people will still be lazy.

BarryD,

It is a sad day when our college graduates have never read Marlowe's or Goethe's Faust. But it's all too common. I can mention Faust(or pretty much anyone, Prospero, Sir Francis Drake, Leibniz, Saint Anselm of Canterbury, Doctor Samuel Johnson, ect.; basically any "second tier character" in either history or literature is ignored and any first tier character is really only known by name not what they've done or their ideas)...I can mention Faust and all I'll get is blank stares by at least half the students around me. It really is a sad day when some of the most important moral stories are not known by people and it shows.

So many(especially of my generation) are making a modern Faustian deal with a modern Mephistopheles(the government). Through this deal they'll loose their freedom for far less than what Mephisto offered Doctor Faustus. Mere crumbs from a corrupt aristocracy who steal from the people only to offer it back to them as if they where gifts. They, the corrupt aristocracy of our land, can only offer one gift, corruption, to the people they supposedly represent. I fear that my generation will take it, out of greed clothed in the language of altruism.

3:17 PM, September 02, 2009  
Blogger Cham said...

There is a correlation between the percentage of the populatio who smoke cigarettes and the cost of cigarettes. The more they cost the fewer people smoke. So if healthcare is going to hit more people hard in the pocketbook ultimately more people will get concerned about staying healthy.

3:25 PM, September 02, 2009  
Blogger J. Bowen said...

Why do you even continue to take Medicare?

3:37 PM, September 02, 2009  
Blogger Professor Hale said...

And yet those who can afford it least do it the most. You are confusing a general trend of diminished smoking in American society as being related to a general trend of politicians to increase taxes. The correlation is not causation as you imply.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5320a2.htm

3:37 PM, September 02, 2009  
Blogger Roman Wolf said...

First off, Professor Hale is correct. Correlation does not imply causation.

Second, Cham, in the scenario of no insurance whatsoever, I would argue that more people would actually smoke(if we could ignore the effect of the anti-smoking lobby/education, who I believe is the real reason for decreased smoking, that and increased wealth overall). This is not because there isn't an incentive to try to stay healthy(there is), it's because two assumptions of Neo-classical economic theory doesn't hold up in practice.

These are the principles of individual rationality and the idea of perfect information.

We all know that in the real world that individuals(much less the government or other large organizations) do not always act rationally(we tend to be short sighted). Hence, we typically don't think about how today's actions will influence us twenty years from now. Further, we lack perfect information on how smoking will affect our bodies. Simply put, Person A and B both smoke two packs a day. In 20 years, A develops cancer while B doesn't.

Lastly, the law of supply and demand wouldn't really hold up. Any market where the people are addicted to the product is going to be fairly inelastic. Meaning, to the addict, they don't care if it's $5 or $10 dollars a pack, he want's his fix. Granted, two things probably are contributing to lowering cigarette sales, one is less people than previously start smoking in the first place(education). Second, the amount of useful products to beat cigarette addiction have increased in recent years.

Finally, the stats could simply be wrong. For instance, black market cigarettes could be more common because of increased taxes. Or any number of other problems(both in data collections and in the actually analysis).

3:59 PM, September 02, 2009  
Blogger I R A Darth Aggie said...

If everyone had to pay for their own healthcare cigarettes wouldn't sell

I know a gentleman who's had a bout with cancer.

He still smokes. If actually having had cancer isn't adequate motivation to get him to quit, nothing will.

4:00 PM, September 02, 2009  
Blogger Thor's Dad said...

Back to the walk-in clinic - Does anyone know how well the Walmart Walk-in Clinics are working?

4:26 PM, September 02, 2009  
Blogger Tether said...

This comment has been removed by the author.

4:46 PM, September 02, 2009  
Blogger dr.alistair said...

as a person with some experience helping somkers to stop the habit, i can say that the government`s avctions to deter smooking have worked to substantially reduce the consumption of cigarettes.

the government has taxed them to $10 per pack and they have forced retailers to put all cigarettes behind a wall and made them all the same price.

this has deterred many younger people from buying or begining to buy cigarettes, and has helped regular consumers to cut back. the simple fact that the product was on display was a continued inducement for many.

why does the government want people to quit?

the increasing medical cost of treating sick smokers has overtaken the tax revenue amount from the sale of the cigarettes.

the next epidemic is obesity.

it will be interesting how the government copes with that little problem.

5:01 PM, September 02, 2009  
Blogger DADvocate said...

...in the cash-for-service model wouldn`t there be a motive for provider to make themselves available to the highest bidder?

To a point, but if you have plenty of providers, then there will be plenty of care. Take auto mechanics, except for collision repair, almost always cash-for-service. My only problem is deciding which one to use, not finding one who will fix my car. Sure a few specialize in exotic cars but not to the point where anyone can't find one easily.

My father was a clinical psychologist and professor. During an approximate ten year period during the 1980s and 1990s, he never billed Medicare/Medicaid but provided these patients service for free because the paper work was too much "trouble." This was an estimated $250,000 in services.

Maybe this is how the government intends to save money. Make it too difficult to get reimbursement.

(This pissed me off because being one of six kids, if my Dad didn't care about the money, he could have recruited one of us to help with the paperwork and then spread the money about to us kids and grandkids. Oh, well, too late now.)

5:13 PM, September 02, 2009  
Blogger fred said...

Let us use a very very simple examaple:

the health care and condition of any industrialized nation is best measured by the average longevity of a nation's citizens.

The United States ranks some 30 down from the longest lived people. 30th down!

Now: the average American pays TWICE as much for health care as citizens of ANY other nation.

don't like govt paperwork? don;'t accept clients unless they have care or cash where govt not involved. Simple as that.

6:39 PM, September 02, 2009  
Blogger Adrian said...

Good lord. Mortality is not the "best measure" or morbidity let alone the quality and availability of health care. I don't know why people keep repeating that retarded claim.

6:55 PM, September 02, 2009  
Blogger Tether said...

This comment has been removed by the author.

7:05 PM, September 02, 2009  
Blogger DADvocate said...

Screw you, Tether. You don't know crap about me. But, I'll be glad to kick your ass.

8:43 PM, September 02, 2009  
Blogger Tether said...

"But, I'll be glad to kick your ass."

----------

Well, get at the back of the line. Lots of others are in front of you.

But shouldn't you more wisely spend your time finding some sugar-momma to support you again?

8:51 PM, September 02, 2009  
Blogger Tether said...

This comment has been removed by the author.

8:53 PM, September 02, 2009  
Blogger DADvocate said...

I've supported myself my entire life since I was 19 and enjoy the freedom and independence. You're just a two-bit punk who gets his jollies by making anonymous insults and playing out your fantasies anonymously to sooth you ailing ego like every other impotent troll on the web. Try growing a pair and accept the fact that most of us have a better life than you.

9:31 PM, September 02, 2009  
Blogger David said...

"in the cash-for-service model wouldn`t there be a motive for provider to make themselves available to the highest bidder?"...that was the common view among car manufacturers, circa 1905..but Henry Ford found that there was plenty of money in selling cars to the not-so-wealthy. More recently, Wal-Mart has done well for itself focusing on serving those with modest incomes.

For healthcare providers, focusing only on those willing to pay top $$$ works only as long as the number of such providers is tightly controlled. Indeed, one of the things we *should* be talking about in the healthcare discussion is why there aren't more medical and nursing schools.

11:21 PM, September 02, 2009  
Blogger Dr.D said...

We have seen a number of nursing schools close that I know about. The student base wasn't there, and the costs were fixed or growing. That's at least part of why there are not more nursing schools.

On the main topic of Helen's post, the inability/unwillingness of the government to provide timely payment for services is just one of the thousands of reasons whey we do not want the Feds to run health care. Look around you. They have demonstrated that they cannot run the post office. The IRS cannot get the same decision from two different examiners. Social Security is failing. How about Fannie Mae and Freddie Mac? Those were great federal success stories!

Remember that for any situation ---
Government is never the answer. It is almost always the problem.

11:46 PM, September 02, 2009  
Blogger Dogwood said...

Back to the walk-in clinic - Does anyone know how well the Walmart Walk-in Clinics are working?

Our local WalMart clinic closed due to lack of business, but we really liked it. No appointments, no waiting, very affordable, usually $40 to $50).

It was great for the routine sinus infection, a kid's sore throat, etc., etc.

We have an urgent care clinic, but the office visit is $90 and we normally have to wait an hour or so. It works, but not nearly as convenient as the WalMart clinic.

1:34 AM, September 03, 2009  
Blogger Helen said...

J.Bowen,

I quit taking Medicare a year ago due to the paperwork etc. It was a good decision. However, many people are on it and do need providers willing to take it.

5:11 AM, September 03, 2009  
Blogger Pogo said...

St. Barry's Prayer

Obama, make me an instrument of your single payer system, 
Where there are elderly, let me sow hospice;
where there is injury, hospice;
where there is cancer, hospice;
where there is heart failure, hospice;
where there is blindness, hospice;
where there is a hip fracture, hospice.

O Great Leader, grant that I may not so much seek to be consoled as to die quickly and get out of the way;
to be healed as to decline treatment; 
to be cured as to die.

For it is in taxation that we receive care, until age 65; 
it is in rationing that we are released from this earth; 
and it is in dying that we are making room for the productive.


Amen.

9:53 AM, September 03, 2009  
Blogger Roux said...

Walmart...

10:01 AM, September 03, 2009  
Blogger kf said...

When I saw the headline I thought this article was going to be about how under Obamacare (or PelosiCare), old people would get a carbon-silica gel IV and be forced to walk on a treadmill until their heart gave out, to be replaced with younger, more environmentally conscious Japanese people. ;-)

10:17 AM, September 03, 2009  
Blogger Alexander D. Mitchell IV said...

KF had my sentiments precisely; I thought someone was proposing that we pay $4500 to trade in the unhealthiest individuals! Oh, well, we'd add the poison and they'd stop working, but could we still harvest other surviving parts? Or do we assume that nobody can reuse the various internal parts from a "clunker" of a human?

10:27 AM, September 03, 2009  
Blogger JAL said...

I am a provider with a very small practice. I have had Medicaid patients. For a mental health professional in my state, after an initial number of visits (different for children and adults)the labyrinth I would have to go through to get approval for reimbursement for treatment is remarkable. And those bureaucrats seem committed not to make the process accessible for little guy. (I finally gave up when the person responsible NEVER returned the phone call asking for paperwork. Maybe they checked my party affiliation?)

Meanwhile, last year Medicare cancelled my mother's participation in her Advantage plan. (A nice supplement plan which would, incidently, disappear with the Obamacare plan.) Did not tell her. And then when I tracked down the error denied that it was a Medicare computer glitch. If she didn't have someone watching out for her she would have been up the creek until someone there noticed that 200,000 names disappeared from their base. Maybe.

That being said I have also had dealings with the Social Security Administration.

(Some things are necessary evils.)

I have in my files numerous letters cancelling previous letters. Letters making pronouncements with no reason. Letters giving money followed by letters taking the same money away. Letters looking for money from an error on their part 4 years previous.

I have a letter with a completely incomprehensible sentence in it.

Every time I see that people want the federal government to get more involved in health care (decision making / guiding) I get the willies. (You want the IRS sending your info around the fed gov't? Got it! Check this box right here.)

There is no cure for the willies except to stay away from the government helping you decide how much money they are going to give you after they take it from you.

10:45 AM, September 03, 2009  
Blogger Number Six said...

Pogo,

That prayer is beautiful. Can I copy it and share it around?

10:49 AM, September 03, 2009  
Blogger Pogo said...

Please do.

11:05 AM, September 03, 2009  
Blogger Larry said...

A few years ago, I was referred to a surgeon to lance an abscess. They had an interesting policy there: $400 if you want them to collect from insurance, or $300 if you pay cash (they really didn't care if you were paying out of pocket, or claimed the money yourself).

I think that it's true that a substantial part of the cost charged to patients is bad debts that the providers simply can't collect for one reason or another. A return to cash-for-service for services under $1000 would save a lot of money, at least from those who pay their bills.

11:21 AM, September 03, 2009  
Blogger kf said...

@Larry,

The $100 is probably a combination of administrative costs, having to wait 90-180 days for payment, and (probably pretty limited) allowance for bad debt.

11:33 AM, September 03, 2009  
Blogger Wayne said...

Dogwood - $40-$50 at Wal-Mart? Holy mackerel! No wonder they had no business. I just paid $40 for my son's visit to our GP, and I currently have no insurance.

On the other hand, the $120 for prescription eye drops hurt, because I've had a bad month in general.

12:06 PM, September 03, 2009  
Blogger Paul Taylor said...

Brings to mind this parody entitled "Democrats Push Greenbacks for Geezers Program" http://optoons.blogspot.com/2009/08/democrats-push-greenbacks-for-geezers.html

12:22 PM, September 03, 2009  
Blogger Pluto's Dad said...

This comment has been removed by the author.

12:23 PM, September 03, 2009  
Blogger Pluto's Dad said...

"in the cash-for-service model wouldn`t there be a motive for provider to make themselves available to the highest bidder?"

There'd also be a motive for more people to become doctors. Witness the areas of health care where insurance doens't pay: Lasik, much plastic surgery, anything considered "optional". In all of those areas we see prices continuing to go down, and service getting better. When people have to spend their own money they are pickier, and providers are forced to care more about the consumers.

It's not that its "fee for service", since all services are, and other industries don't get the complaints. It's that the customer is not the one paying, and the provider will get paid the same no matter what they do, that removes the incentive to do the best job.

Secondly, remember all doctors had sliding scales in the past to help others. It was insurance companies that put an end to that practice for many doctors, because they'd only pay the lowest price. Remove "pay for all" insurance and Doctors could charge more to more well-off customers.

Finally, we'd have to break the power of the AMA which stops new medical schools from getting accredited, caps the number of internships the government sponsors, and basically is like any other union: they care about protecting doctors more about what's good for patients, which I suppose is ok, but perhaps the AMA mission should be better defined, and a splinter group created to represent patients.

12:25 PM, September 03, 2009  
Blogger dr.alistair said...

thanks pluto. i was hoping someone would see the disincentive for doctors under a restrictivre payment system.

why would anyone aware enough of thier abilities as a student, choose to go into a field where their prospects are limited?

canadian doctors are limited by how much they can earn, and suprisingly to some, doctors started disappearing.

the probelm is that too many voters resent the idea and practice of being able to choose your vocation to the point of being able to become a doctor or other high paying jobs, and so when someone comes along with the means to shackle those percieved as earnig too much, they jump at the chance.

that`s what my dad used to call cutting your nose off to spite your face.....

1:36 PM, September 03, 2009  
Blogger Professor Hale said...

I cancelled my dental insurance plan. It was just not a good bargain. Out of pocket was cheaper. We told out dentist and his office staff we were doing this. We paid cash up front. They billed the insurance company anyway. They claim it was because they never got a form from the insurance company cancelling coverage. Morons.

2:56 PM, September 03, 2009  
Blogger Trudy W Schuett said...

Ten years ago, when my dad was in a board & care home (like a nursing home without the medical staff) we kept getting a notification from Medicare every month about a $700 bill they were paying for some sort of specialized bed we'd never seen & my dad didn't use.

I tried to correct it, but Medicare refused to speak to me, would only speak to my dad, who was unfortunately unable to do so.

So they kept on paying that odd bill when they didn't have to until my dad's death a couple of years later.

Never figured out who was billing, even.

4:01 AM, September 04, 2009  
Blogger dr.alistair said...

the dentist isn`t a moron, he`s a thief.

if you or i tried to take something that wasn`t ours, we`d be a criminal.

same with the home.

thieves.

5:16 AM, September 04, 2009  
Blogger Cham said...

I have a story from a few years ago that will give you the willies over what really goes on in the medical business.

I changed my phone number of my home phone 3 years ago. The phone company gave me the old number of a woman who must have really enjoyed going to the doctor. My guess is that she had some really great insurance plan.

The woman had failed to notify her army of doctors and dentists of her change in phone number. About 6PM every day while I was busy relaxing from a busy day at work the phone would start ringing. A multitude of doctor's representatives would call asking for this woman. I'd tell them that this was no longer her phone number. I can only assume these solicitation calls were outsourced to a 3rd party because the callers wouldn't stop calling.

The callers wanted this lady to make follow-up appointments with her army of doctors. She had a plethora of afflictions, or maybe she just liked to go to the doctor, so there were many doctor's offices calling. I quit answering the phone. Then the callers would leave messages on my machine discussing this woman's personal medical history. (Isn't there a law about that?) They had no qualms leaving some very scary message saying that if she didn't show up for her follow-up appointments she could put her life at risks. The hardball solicitation calls were worse than those of a home-security system salesperson.

Finally I got so fed up, and since I only used the phone for outgoing calls, I left a screaming message on the machine that anyone who left a message for the previous phone number holder on my personal machine wouldn't be hunted down and beheaded.

A few days after I did that the previous number owner called me and begged me to take the message off the machine. I refused, my number my message. I told her that if she didn't want her doctor's representative to be insulted and frightened to make an effort to change her number with the offices, I wasn't her answering service.

Within days the calls stopped.

8:41 AM, September 04, 2009  

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