Obamacare wins? See you in 2014

Moderator: Super Moderators

Cherry Kelly
Pirate
Posts: 12851
Joined: 07-29-2000 02:00 AM
Contact:

Post by Cherry Kelly » 09-25-2014 09:20 AM

kbot - ya your rates are getting ludicrous -so maybe its all tied to the conversions from change-over from the coal to gas furnaces to produce the electricity?

Something strange there....

I guess a lot of hospital expenses/costs are not met, but charging $25 for two aspirins? That is what I questioned when I looked at a friend's hospital bill. Thing is the guy couldn't take aspirins yet there were two charges for those for the two days he was in the hospital. There was also a large charge for slippers, in spite of him taking his own and only wearing his own slippers. These are the kind of things people complain about.

BUT sadly these hospital closings we are seeing now have little or nothing to do with costs, but with the fact ACA has not approved them. THAT is sad.

User avatar
kbot
Pirate
Posts: 7004
Joined: 03-12-2008 05:44 AM

Post by kbot » 09-25-2014 11:59 AM

Yes, the charges don't make any sense.

Here's another reality, that I'm pretty sure I mentioned before, but, may help to explain why hospitals charge the way they do.....

A while back - well over ten years ago, many charges were bundled - a patient came in for something and all charges for everything was contained in a single charge. The government (Medicare - the one's who decide these things) decided a few years back to unbundle everything. So, hospitals responded and unbundled their charges and created separate charges for things.

Now, these charges have no basis in reality.

Some insurers will always 100% of the time, pay far less that what a hospital charges, some will pay in the middle and some more.

Well, we're back to bundling again because the government is just giving everyone all kinds of work to do and they decided to start bundling again.

But, we're back at the same issue again - what is paid, does not cover the costs of everything involved in the bundled payment.

Let me give you an example - say a patient comes-in for a CT-Guided biopsy of a lung. Sounds pretty straight forward - a patient comes-in and has a needle thrust into his or her lung while having the whole procedure guided by a series of CT scans.

ALL costs associated with that procedure should be covered by whatever the insurance company agrees to pay.

Except, they aren't.

Even before the patient comes-in, "someone" has to schedule the exam, "someone" has to start compiling a chart, which would include all pertinent studies - even if they aren't performed at the hospital where the procedure is being performed. "Someone" then needs to obtain those studies and hand-deliver them to the hospital. "Someone" then needs to import these studies into the PACS system, where a radiologist will review them and determine if the procedure can be performed. This is usually done with a nurse's involvement because the nurse will then call the patient, schedule a pre-procedure assessment, take a history, review lab tests, arrange to have additional lab tests if necessary - for example to check coagulation levels because we don't want someone having a lung biopsy to start bleeding uncontrollably........

This is all BEFORE the procedure, btw........

Then, the patient has the procedure, and now s/he needs to be recovered and monitored to sure that the lung hasn't collapsed. This, for a lung biopsy, it at least four hours.

So, for about 2 hours before the procedure, and four hours post procedure, we have an RNs time being used, that we cannot charged for because the charges are all "bundled".

We also have schedulers who arrange for the date and time, obtain prior authorizations, check medical necessity and ensure that preliminary documentation such as the order for the procedure and prior authorization are on file - we can't charge separately for these cases either, because they are not directly involved in patient care, but they and their families want to eat as well.....

The Housekeeping personnel who would clean-up the blood spatters and cart away the linens used would also want to get paid, but we can't charge for them either, nor for the coders who would submit claims to the insurers because they are also not directly involved in the procedure.

So, just in this short scenario (which is very common), we have four people that need to get paid - we also have the people, at Patient Registration, Security and so on, that also do not participate directly in the case, but still provide a service to the patient nonetheless, as do the nurses in Infection Control, Patient Transport and so forth.

The fact is, what is being paid for procedures by Medicare/ CMS (who in turn sets the tone for ALL insurers) does not, or barely, covers the actual costs involved in the procedure, including salaries and supplies and equipment utilization. You start factoring all these other people who cannot charge for their services, and this is where things turn ugly very fast. Because healthcare depends on all of these other people.

Take electronic medical records fro example. The IS/ IT people cannot "charge" for their services, but under Obamacare, EMR s are REQUIRED. And, while funding exists now, under Obamacare, eventually those sources of funding will evaporate. The system still needs people to support it.

So, it is more probably why we see the proverbial $25.00 aspirin -because hospitals are trying any way they can to find sources of income in order to keep the people that patients expect to be there, employed.
What the hell are we fighting for? Ah, just surrender and it won't hurt at all. You just got time to say your prayers. Yeah, while you're waiting for the hammer to fall. (Brian May of Queen)

User avatar
Riddick
Pirate
Posts: 12364
Joined: 11-01-2002 03:00 AM
Location: SE WI
Contact:

Post by Riddick » 09-25-2014 01:04 PM

kbot wrote: This price increase stems from the conversion of coal-fired plants to natural gas - which, we were told, is cheaper, because the US is the world's #1 producer of natural gas. So, why the rise in electricity rates? Makes you wonder, huh?
IS it any wonder? Hey, just wait 'til we feel the full force of O's carbon-curbing initiatives - Power to the people? Yeah, right! With price rises assured all around, the bill to keep America going will be anything but absurdly cheap.

Still, think of the cost of NOT fighting climate disruption-! In that way, rather than an expense, it's a long-term 'investment' isn't it? So quit bitching all the sooner and get over it folks. Saving the planet is cheap at any price.

Cherry Kelly
Pirate
Posts: 12851
Joined: 07-29-2000 02:00 AM
Contact:

Post by Cherry Kelly » 09-25-2014 04:48 PM

kbot - am well aware of everyone getting paid appropriately and while mentioning all the "extras" in a bundled package - its like trying to explain a mfg company where still the CEO gets the biggest share of the monies.

The thing is when it was unbundled - and a patient gets charged for things not done as in case mentioned, that is where the problem comes in.

As for Medicare - it doesn't cover only certain things and does not truly cover two very important things to seniors - eye and dental. Oh it might cover some - like exams, but that's about it. NOW considering that if a senior can't see well - they are apt to suffer more problems - like missing a step on a stairway that could lead to broken legs, arms, etc. Or if a senior can't eat properly that can lead to several other problems in not getting enough or proper nutrients, thus making them more susceptible to diseases. Sadly drs and hospitals now are not accepting a lot of medicare patients or should we say new ones. Along comes ACA (ObamaCare) and things are getting worse all the way around.

Cherry Kelly
Pirate
Posts: 12851
Joined: 07-29-2000 02:00 AM
Contact:

Post by Cherry Kelly » 09-25-2014 04:57 PM

Riddick - you mean Obama's fakery about climate change ... and carbon emissions? The man needs to be sent back to grade school. Climate conditions follow cycles as anyone who honestly studies it can verify.

The only problem with the verification is that as scientists have improved upon accuracy of heat, cold, etc. the older numbers don't fit with newer numbers in all cases.

Take for example from my own experiences. Snow - May 7, 1957 did not show up again for almost 20 yrs (in that area) - was actually in 1976, but the next one was 1997 and actually was May 9th.

Or take drought conditions that show up every so many years and sometimes far worse and longer due to absence of rain or snow in the mountain areas (IE water shortages). Or the opposite where more floods and rains than "usual" in certain areas.

Then along comes those like GORE or like Obama and the CARBON stuff. Plants need carbon to grow - they take in the CO2, keep the C and release O2... hmm but oh no we have higher carbon emissions?? Do we really - show that please in the atmosphere. oh can't ---

User avatar
kbot
Pirate
Posts: 7004
Joined: 03-12-2008 05:44 AM

Post by kbot » 09-26-2014 05:26 AM

Cherry Kelly wrote: kbot - am well aware of everyone getting paid appropriately and while mentioning all the "extras" in a bundled package - its like trying to explain a mfg company where still the CEO gets the biggest share of the monies.

The thing is when it was unbundled - and a patient gets charged for things not done as in case mentioned, that is where the problem comes in.

As for Medicare - it doesn't cover only certain things and does not truly cover two very important things to seniors - eye and dental. Oh it might cover some - like exams, but that's about it. NOW considering that if a senior can't see well - they are apt to suffer more problems - like missing a step on a stairway that could lead to broken legs, arms, etc. Or if a senior can't eat properly that can lead to several other problems in not getting enough or proper nutrients, thus making them more susceptible to diseases. Sadly drs and hospitals now are not accepting a lot of medicare patients or should we say new ones. Along comes ACA (ObamaCare) and things are getting worse all the way around.


You also forgot about ambulance trips - Medicare doesn't cover them - and if you are basically an invalid, and live in a city with tenements and climb the stairs and don't drive - usually, an ambulance ride is your only recourse. MC won't w pay - and the ambulance companies charge (around here at least) $350.00 - each way.
What the hell are we fighting for? Ah, just surrender and it won't hurt at all. You just got time to say your prayers. Yeah, while you're waiting for the hammer to fall. (Brian May of Queen)

User avatar
kbot
Pirate
Posts: 7004
Joined: 03-12-2008 05:44 AM

Post by kbot » 09-26-2014 05:29 AM

Riddick wrote: IS it any wonder? Hey, just wait 'til we feel the full force of O's carbon-curbing initiatives - Power to the people? Yeah, right! With price rises assured all around, the bill to keep America going will be anything but absurdly cheap.

Still, think of the cost of NOT fighting climate disruption-! In that way, rather than an expense, it's a long-term 'investment' isn't it? So quit bitching all the sooner and get over it folks. Saving the planet is cheap at any price.
What's been happening around here is that utility companies are buying power plants, and then announcing that they will be closing them.

Make absolutely no sense...... until you research and find out that the companies that are buying-up and closing these plants are based in Texas, and they will be supply the energy -from Texas, at a huge premium. I thought that we had people in government who's job it was to prevent this sorta thing.......
What the hell are we fighting for? Ah, just surrender and it won't hurt at all. You just got time to say your prayers. Yeah, while you're waiting for the hammer to fall. (Brian May of Queen)

User avatar
Riddick
Pirate
Posts: 12364
Joined: 11-01-2002 03:00 AM
Location: SE WI
Contact:

Post by Riddick » 09-26-2014 02:17 PM

kbot wrote: I thought that we had people in government who's job it was to prevent this sorta thing.......
Oh sure we do! Trouble is, they get their "pay" whether they actually do their job or not.

Hey, if it's a Texan plant scheme OR a climate scare scam, sheeple need fleecing one way or another now don't they?... All said and done, government is a racket.
Last edited by Riddick on 09-26-2014 02:33 PM, edited 1 time in total.

User avatar
Riddick
Pirate
Posts: 12364
Joined: 11-01-2002 03:00 AM
Location: SE WI
Contact:

So, How's That ObamaCare Policy Working Out For Ya?

Post by Riddick » 10-28-2014 05:03 PM

Front Page Item 9.28.14 USA Today Dead Tree Edition -

THE DOCTOR WON'T SEE YOU NOW
Some Physicians Wary Of Taking Insurance Exchange Patients

User avatar
kbot
Pirate
Posts: 7004
Joined: 03-12-2008 05:44 AM

Post by kbot » 10-28-2014 05:57 PM

This is nothing new and doctors warned that this was going to happen - the reimbursements don't cover the costs, pure and simple.

I challenge ANYONE to say that they can successfully stay in business over the long term where this is the case.

Of course, when you have a plan such as this developed by career politicians and academics, this is what you get.

Doctors cannot be forced to accept various insurance plans - the government apparently didn't think that through......

Congratulations!!!!!
What the hell are we fighting for? Ah, just surrender and it won't hurt at all. You just got time to say your prayers. Yeah, while you're waiting for the hammer to fall. (Brian May of Queen)

User avatar
Riddick
Pirate
Posts: 12364
Joined: 11-01-2002 03:00 AM
Location: SE WI
Contact:

Post by Riddick » 10-28-2014 11:26 PM

kbot wrote: This is nothing new and doctors warned that this was going to happen - the reimbursements don't cover the costs, pure and simple.

I challenge ANYONE to say that they can successfully stay in business over the long term where this is the case.

Of course, when you have a plan such as this developed by career politicians and academics, this is what you get.

Doctors cannot be forced to accept various insurance plans - the government apparently didn't think that through......

Congratulations!!!!!
Insofar in general, thinking isn't necessarily government's strong suit, even so it could be they WERE well aware of the long term ramifications of the reimbursement policy relative to their long term plan -

Catastrophic system failure? Hey, no worries folks, nothing an upgrade to SINGLE PAYER won't cure... Indeed, congratulations are in order: ObamaCare not working as advertised isn't a bug, it's a feature!

User avatar
kbot
Pirate
Posts: 7004
Joined: 03-12-2008 05:44 AM

Post by kbot » 10-29-2014 06:29 AM

Personally, I think you're correct in that there are elements within government that would like nothing better than to see certain sectors in society fail. That's not to say that "everyone" in government is evil - that's a ludicrous conclusion. But I truly believe that there are factions - on both sides, that, for whatever reason, want to see a systemic breakdown in our society.

So, we have on the Far Left, those that want to impose the socialist "state" system with its cradle to grave metrics, and on the Far Right, we have those who want to impose its corporate structure.

That both find common ground in areas such as technology and the erosion of privacy/ monitoring/ tracking/ data mining, etc to keep tabs on people scares the heck out of me - witness how quickly the administration was able to produce damning e-mails for Army generals that it didn't want to lead in Afghanistan........ Spread that mindset to the public - and as we've been warned, government does spy on its citizens. To what purpose?

And, now we have the IRS - the enforcement arm of Obamacare:

IRS Seizing Bank Accounts of Innocent Americans

The Internal Revenue Service has been seizing money from the bank accounts of individuals and businesses with no proof of any crimes nor any charges filed.

Now, the IRS claims that it will stop — but will it?

Using a law, the Civil Asset Forfeiture Reform Act of 2000, that allows the feds to seize money from suspected gangsters, drug dealers and terrorists, the IRS has put innocent people into bankruptcy and massive debt and taken the money a military father saved from his paychecks to put his kids through college, solely by tracking the amounts that people put into their bank accounts.

When no criminal activity is charged, The New York Times reports, the IRS often negotiates to return only part of the seized money, leaving impoverished citizens with little option but to either accept the IRS' offer or continue a lengthy and very expensive legal battle to try to get their legitimately earned money back.

The problem has been growing. The Institute for Justice estimates that from just 114 seizures in 2005, the IRS made 639 seizures in 2012, and in only 20 percent of the cases were any criminal charges ever pursued.


Under the Bank Secrecy Act, banks report transactions larger than $10,000 to federal authorities, but also report a pattern of regular, smaller deposits which appear designed to get around the act. This alone can be enough to trigger a seizure, the Times reports, and banks filed over 700,000 "suspicious" reports last year.

One involved a 27-year-old Long Island candy and cigarette distribution company, Bi-County Distributors, which made daily cash deposits, usually under $10,000. When the IRS seized $447,000 from the company, it refused to return it, despite the fact that there was no crime to prosecute, and instead offered a partial settlement.

The company is now $300,000 in debt and attorney Joseph Potashnik told the Times, "I don’t think they’re (the IRS) really interested in anything. They just want the money."

Army Sgt. Jeff Cortazzo was saving up for his daughters' college education when the IRS seized $66,000 of his money – it cost him $21,000 to get the remainder back.

Richard Weber, the chief of Criminal Investigation at the IRS, said in a written statement in response to the Times story, "After a thorough review of our structuring cases over the last year… IRS-CI will no longer pursue the seizure and forfeiture of funds associated solely with 'legal source' structuring cases unless there are exceptional circumstances justifying the seizure and forfeiture and the case has been approved at the director of field operations (D.F.O.) level."


http://www.newsmax.com/Newsfront/crime- ... id/603098/
What the hell are we fighting for? Ah, just surrender and it won't hurt at all. You just got time to say your prayers. Yeah, while you're waiting for the hammer to fall. (Brian May of Queen)

Cherry Kelly
Pirate
Posts: 12851
Joined: 07-29-2000 02:00 AM
Contact:

Post by Cherry Kelly » 10-29-2014 10:00 AM

Rather disgusting that the IRS can just take $$ without a full court order -- but just take it and then the person has to take the IRS to court... and of course the attorneys wind up with more of the monies that belonged to individuals or companies.

---

User avatar
kbot
Pirate
Posts: 7004
Joined: 03-12-2008 05:44 AM

Post by kbot » 10-29-2014 10:39 AM

It's a racket.....
What the hell are we fighting for? Ah, just surrender and it won't hurt at all. You just got time to say your prayers. Yeah, while you're waiting for the hammer to fall. (Brian May of Queen)

User avatar
Riddick
Pirate
Posts: 12364
Joined: 11-01-2002 03:00 AM
Location: SE WI
Contact:

Post by Riddick » 10-29-2014 01:07 PM

kbot wrote: It's a racket.....
Government, the Mob: Talk about organizations with the same Modus Operandi...

Health care? Hey, it's where the money is - Like asking "Why do you rob banks?"

Post Reply

Return to “Politics and Government 2014 - Present”