Thread: My Health Care plan

I was at a meeting for work all week and we were discussing healthcare and coverage and how it effected us as not only as consumers, but also as a company, and it got me thinking what I thought would be the best healthcare bill the government could pass. For those of you that don't know, I am currently in Medical Sales and my products are no longer covered by Medicare. Some private insurers still cover it, but, in general, when Medicare stops covering things, private insurance follows suit. What I sell ranges from $80 to $700 per product and most businesses that filed for insurance have gone out of business forcing patients to pay cash for it. This results in the following things: 1. the patient goes without treatment 2. the patient buys a low cost product that is generally also of low quality and sometime not even medically approved and does not get the proper treatment 3. the patient forks up the money. Most often it's #2.



I was thinking about the work that I've done with L codes and the work I've done in the past at the VA hospitals and how they make their decisions (disgusting in my opinion!), and these three factors let me to my decision.



Rather than making a code that reimburses a specific amount, make the code reimburse a % of the cost. For example, a back brace can reimburse up to $850 using the right code. So, a lot of the time, what a orthotist/Dr/etc. will do is order the least expensive brace to make the maximum amount of profit. So, a brace that is $400, which is clinically proven as the best brace will be overlooked in favor of the $150 copy-cat brace that has not been proven to be clinically effective. You get what you pay for right? Same with procedures. Some procedures do not reimburse as well as others but lead to the same result, so surgeons, given 3 options, will focus on the procedures with the most reimbursement causing a lot of low reimbursing simplistic low cost procedures to fall by the wayside only to be used by the uninsured. They will still charge the recommended reimbursement amount for those patients to maintain their profit.



The 2 things I would hope to accomplish. One, it would allow each patient to get the best product available over the provider getting the most profit. If a patient gets a $300 procedure, the provider would be reimbursed 33% more than $300. If the patient gets that procedure for $100, the provider would still only get 33$ of $100 rather than 33% of 100 + $200 for choosing the lowest cost option. Often that $100 choice is inferior so while it lowers the profits, it's still allowing the provider to cover labor/time while profiting. I liken it to how auto shops work. The shop is getting paid for product, labor, and then a small mark-up to profit. But rather than it be a flat fee mark-up, it would be a % of the products total cost and each mark-up would be different for each car depending on the cost.



Second, most reimbursements pay out 3:1. Anything that does not is generally not successful or they do what I described above to maximize profit. 3:1 in my opinion is too much. If we equalized all reimbursements based off the amount of the cost, overall healthcare costs would decrease. When all things are equalized, providers will be less likely to drop certain things because they are not profitable while cheating the system will decrease.



Of course, what else needs to be done is tort reform and companies that come in with low cost alternatives should have to prove their efficacy to keep the quality of healthcare high. What I don't want to see happen is providers over providing therefore over charging for fear of law suits or under providing to maximize profits. Btw, depending on the VA, the person making the decision is a desk employee, not the Dr. meaning, many times, they are getting low cost, low efficacy products. It makes them look good come budget time.



And in regards to reimbursement, I'm torn on legislating it be for most public and private healthcare because the libertarian part of me doesn't agree with limiting decision making on the private sector, but the other side of me knows that without it, what is currently happening will continue. The provider will pick and choose which insurances to take and many people will end up paying out of pocket.



Does this make sense? It makes sense in my head. I might not have explained it right.

[quote name='Morgan' date='23 January 2010 - 03:34 PM' timestamp='1264278846' post='104189']

My Healthcare plan.



All public healthcare is lumped into a single Medicare program with the following attributes.

A. Covers all Americans aged less than 18, and 65 and over.

B. Covers all Disabled Americans. This includes physically and mentally.

C. Covers Veterans. Congress must pass a bill for each specific conflict to include veterans of said conflict in the Medicare program.

D. Families with income below the poverty level will be allowed onto the public plan if they are not already provided with insurance.

[/quote]

I'm talking about how to lower costs.

This does nothing to lower costs. In fact it raises it which leads to lower quality healthcare. Veterans are already covered. And as I stated, it's a lot of times low quality shit because of budget. And, you didn't explain how to pay for items that Medicare is not covering because costs are so high.

[quote name='Vortex' date='23 January 2010 - 03:41 PM' timestamp='1264279298' post='104196']

Why are costs so high?



How much does it cost your company to produce that $850 back brace?



The concept of public option does address your concerns. The more people afforded the proper health care, the proper health care products, the more money that flows into the coffers of the providers thus resulting in higher profits and decreasing the costs to the citizens.

[/quote]

The thing is, the public option, assuming it follows the same route as Medicare does, is dropping things left and right. And private insurers follow Medicare's decision often times. Thus forcing the patient to pay out of pocket for what they need. And the patient will either choose the 3 options I mentioned. Did you know that Medicare only covers open wounds, but not once the wound is healed. But 96% of wounds will re-occur without post-healed wound treatment? If you can't pay for that, Medicare does cover your prosthetic leg and the surgery to remove your limb. Medicare does not cover many preventative care options. It still won't if it's expanded. Everyone is still paying out of pocket.



The low cost alternatives are generally low cost because they do not have to be backed by R&D. And unfortunately, what people are doing to decrease healthcare costs, is to use the low cost alternative. Would you want your Dr. to give you the low cost alternative?



As of Jan 1, 2010. Medicare stopped covering treatment for breast cancer survivors that suffer from this after surgery. Would you want to be this person?

http://www.klosetraining.com/dynamic...tment_3_BA.jpg

[quote name='Vortex' date='23 January 2010 - 03:41 PM' timestamp='1264279298' post='104196']

Why are costs so high?



How much does it cost your company to produce that $850 back brace?



The concept of public option does address your concerns. The more people afforded the proper health care, the proper health care products, the more money that flows into the coffers of the providers thus resulting in higher profits and decreasing the costs to the citizens. (Basic supply and demand.)

[/quote]

It's not $850. That's how much Medicare reimburses for it to the practicioner (or how much our tax dollars are paying out.) They make $850-cost of brace as profit.

[quote name='Vortex' date='23 January 2010 - 03:41 PM' timestamp='1264279298' post='104196']





The concept of public option does address your concerns. The more people afforded the proper health care, the proper health care products, the more money that flows into the coffers of the providers thus resulting in higher profits and decreasing the costs to the citizens. (Basic supply and demand.)

[/quote]



While generally I accept this statement as true Vortex, the problem is, these days we aren't dealing with our general supply and demand model. Our economy has changed and it is totally profit driven. Higher profits to day mean exactly that, higher profits. It does not necessarily mean lower retail costs. That to me is an angle that needs to be looked at. To assume that people will lower prices when their profits start to rise is an assumption that has failed us too long.

[quote name='metheron' date='23 January 2010 - 05:09 PM' timestamp='1264284599' post='104216']

While generally I accept this statement as true Vortex, the problem is, these days we aren't dealing with our general supply and demand model. Our economy has changed and it is totally profit driven. Higher profits to day mean exactly that, higher profits. It does not necessarily mean lower retail costs. That to me is an angle that needs to be looked at. To assume that people will lower prices when their profits start to rise is an assumption that has failed us too long.

[/quote]

It's like gas. They know they need it so why make it more affordable to the patient? They should profit because they do provide a service but they are currently profiting by cheating the patient. So much that the patient isn't getting proper treatment anymore. It should be 'you get what you pay for.' But it should allow people to afford the higher priced item. The current way doesn't allow for either.