Gear Grinding 8: I Got A Lot Of Problems With You People!

[SJHovey]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

THis has been happening for yrs where I am. Pay before you do anything. Can't tell you the number of times I ordered tests that I got a call saying they couldn't do them because the pt couldn't pay.
Take a hammer to the insurance industry. They are the ones that set the 'standards'. When I first started practice we would do things like waive fees or take things in barter (no, I am not in rural America- suburbs). We had a guy who would bring us bags of veggies from his gardens. Then the insurance co/medicare said we needed to prove need (pages of proof) or we were committing fraud by charging them $- if it wasn't worth anything for the guy with the veggies then we were overcharging for services. I could go on but in interest of sanity I won't. Not practicing anymore has recovered my sanity.


Not recent law changes. This has been standard where I am from way before the ACA came into being. Got worse when people had the insurance with huge deductibles and the Cruz bill passed a while ago that decreased the stabilizing payments/rules. It will be insane now they have stopped the requirement for having insurance. If you think this is bad you ain't seen nothin' yet. The population is aging, they are finding more ways to treat things (all new things cost more- not generic), population is less healthy- poor diet, less exercise, and the current political climate doesn't have the balls to deal with the insurance companies. Without the payin from low utilizers that leaves a higher percentage of those who need $$ care. Duck and cover.
Add- the gubmint is screwing the funding sources for a lot of the social net which will affect most rural clinics, hospitals, Primary care providers are leaving in droves (one study said 63% were very burnt out). The ERs are no longer staffed or set up to deal with all the pts that will present in extremis from lack of care for preventable things. They have figured out to defer testing that isn't absolutely necessary, telling pts to come back the next day for tests- which they then can't get because they can't pay. Eventually the pt ends up in the ICU, CCU or surgical costing the hospitals (and by default us) mucho buckos because no way is a person going to be able to cover the hundreds of thou they will rack up in care costs. (yeah, I guess the above aobut me stopping to save my sanity was BS

... and Darwin will not only make those bad brown people suffer but also a good part of the 'Repeal!!!!!' population. Red states have the worst stats for almost all medical measures- morbidity, mortality, general health... Just. plain. bad.

Exactly. I don't blame the health care industry. That industry may have certain issues that have helped contribute to this mess, but the primary problem is this. We have created a public belief or perception that receipt of healthcare is a right, but we refuse to go away from the business model of delivering healthcare. It's no different than if we suddenly decided that clothing is a right. I'm sure if you stopped off at Macy's on your way to the hospital and told them you absolutely needed some new clothes, Macy's is going to expect to be paid.

 

[St. Clown]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

Broke my wrist on Dec. 29th. Scheduled Surgery for Monday. Was told today that I need to be paid in full to have the surgery

When the **** did that become a thing?

I had that same situation for my shoulder surgery back in 2013, and I have pretty good insurance.

 

[The Sicatoka]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

Broke my wrist on Dec. 29th. Scheduled Surgery for Monday. Was told today that I need to be paid in full to have the surgery

When the **** did that become a thing?

I'd tell them they're just another contractor doing a job for you: half up front, half upon satisfactory completion of work.

 

[leswp1]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

Exactly. I don't blame the health care industry. That industry may have certain issues that have helped contribute to this mess, but the primary problem is this. We have created a public belief or perception that receipt of healthcare is a right, but we refuse to go away from the business model of delivering healthcare. It's no different than if we suddenly decided that clothing is a right. I'm sure if you stopped off at Macy's on your way to the hospital and told them you absolutely needed some new clothes, Macy's is going to expect to be paid.

Personally I believe it is a right but it is also financially smart to provide it. The current model costs us, as a country, ridiculous amounts of $$. If we had a cohesive system and provided care instead of the current system which is based on profit so rations care to those who have $$ or some of those who don't (and before people go off, it is a fallacy that people need to be poor to get care- they don't get it either, and no, the immigrants are not bankrupting the system except maybe in Calif). By excluding large chunks of the populace we spend huge amounts to fix things that are preventable or could have been fixed for way less earlier in the disease/event. THis costs the person, the family who needs to financially adjust, the place the person works to adjust, the hospital that eats what isn't paid. The insurance companies are killing us. They are not built on providing optimal care or keeping one healthy. They are built to minimize benefits and maximize profits. When you get ill your premium is not going to cover the expense.

Look at other countries- they have huge initiatives for prevention. We can't do that. THe companies that base profit on unhealthy things are very powerful. Look at Michelle Obama. All she tried to do was say be healthy- eat right and exercise. People did assassinated her on all levels. Whining about personal rights, stoked by companies who feed them sh1t about the right to eat or smoke or whatever that will end up in personal harm. With freedom comes responsibility. We have lost the responsibility part. Responsibility for ourselves and for our fellow citizens. We want the right to do things with impunity (including flying without insurance coverage) and then expect someone to pick up the pieces when we crash. I always wonder what would happen to all those healthy white young males who go off about not being required to have insurance if we were to put a tag on them that said don't treat. There are a few on here who go off about if people are properly prepared it won't be an issue. Huh. One little accident and you are screwed, your family is screwed and so is the taxpayer //end of rant.

 

[leswp1]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

ANd the grammar horse is neighing like mad from those run on sentences

 

[SJHovey]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

Yeah, we can debate whether it's a "right" or not. I understand the thinking behind making it a right. However, I think there are complications where we expand rights from intangible concepts (like the right to free speech or from unreasonable search and seizure) into the right to have an actual product. While it sounds good in practice that we all have that product as a matter of simple humanity, we do then get to the problem of who is going to provide that product without cost the the recipient. As soon as you make the recipient pay for some or all of the product, it really isn't a "right" anymore.

But my point was that if you want to make it a right, fine. Just don't try to do it using the current business model of delivering healthcare like it is fuel oil or something.

 

[SJHovey]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

To further expand upon my last point, the closest we have to medical care (the product) as a right is free legal counsel to those accused of a crime. We don't make legal services free to everyone. We just make it free if charged with a crime, and only then if you meet certain indigency standards. Personally, I'm not certain that system is working that great right now. Funding gets stifled because it only affects a limited portion of the population, and not a very popular segment at that.

It seems to me you either just have to say that it's going to be free to everyone, then figure out how it's going to be paid (and what we're going to do with the multi-billion dollar medical business/insurance infrastructure already in place), or you're going to have to come up with another solution that has not been thought of yet.

 

[dxmnkd316]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

I think the idea is that making it a right necessarily changes the business model.

 

[FreshFish]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

To further expand upon my last point, the closest we have to medical care (the product) as a right is free legal counsel to those accused of a crime.

However, there is no clearcut right to competent legal counsel.

The problem with a "right" to healthcare on the demand side is how do you manage the supply side? Are you going to force doctors to treat people without getting paid for it? If not, where does the money come from? and if there isn't enough money to go around, who decides what patients must be denied which treatments?

Economics 101: wants always exceed available resources; therefore "rationing" is always in play, every time, everywhere, for everyone, always. You can ration by price, you can ration by waiting lists, you can ration by a set of arbitrary standards (i.e., politicians and other rich people always get better care than anyone else), but there must be and always will be rationing in some form or another.

 

[FreshFish]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

Perhaps a more trivial gear grinder.....

Many food products now have self-seal strips built in (e.g., shredded cheese, croutons, bagged lettuce, etc.) With some of these packages, the self-seal strip holds together more strongly than the glue that holds the strips to the packaging material. I've inadvertently ripped the strips from the package when trying to separate the strips from each other.

Of course, then I place the torn package in a storage bag with self-seal strips. They never seem to have that problem.

 

[FreshFish]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

I think the idea is that making it a right necessarily changes the business model.

Would it even be a "business" or would it be a giant public charity?

 

[St. Clown]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

Would it even be a "business" or would it be a giant public charity?

Charities have business models. Every organization needs revenue and operating models. Call them what you will, they're ostensibly the same.

 

[unofan]

However, there is no clearcut right to competent legal counsel.

You have a specific right to effective counsel (hence the post-conviction relief claim of "ineffective assistance of counsel"). And all licensed attorneys have an ethical duty of competence.

So basically, yeah there is a clear cut right to competent counsel.

 

[leswp1]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

However, there is no clearcut right to competent legal counsel.

The problem with a "right" to healthcare on the demand side is how do you manage the supply side? Are you going to force doctors to treat people without getting paid for it? If not, where does the money come from? and if there isn't enough money to go around, who decides what patients must be denied which treatments?

Economics 101: wants always exceed available resources; therefore "rationing" is always in play, every time, everywhere, for everyone, always. You can ration by price, you can ration by waiting lists, you can ration by a set of arbitrary standards (i.e., politicians and other rich people always get better care than anyone else), but there must be and always will be rationing in some form or another.

News flash- this already happens all the time. If you refuse treatment in an ER it is negligence. This is why ERs are inundated with people who have no insurance getting care they should be getting in non urgent settings.. Instead of it happening in the places where it is cheaper- Primary Care offices- it happens in the most expensive places- the ER. When I first started practicing in 1988 the system was mostly self pay or BCBS 80/20 with a smattering of other insurances. Then the HMOs came in. THey started trying to charge really high copays for ER visits and trying to make people get prior authorization for ER visits/ambulance rides etc. It was challenged in court and came down that if the patient felt like it was an emergency then it had to be OK because the pt didn't have medical knowledge to know it wasn't an emergency.

If a person goes to the ER they at least need to be triaged and evaluated before they are sent home. If they need something done emergently then they get it. Ex- you go into the ER for abdominal pain. You have a fever. They must evaluate you- bloodwork, various imaging, treatment if the problem is acute. All this is done either without knowing the pt can pay or knowing they can't. If the person can't pay everyone loses- the hospital and the staff that provided care- no one gets reimbursed. In the end the cost is passed on to everyone who can pay.

I would rather have rationing with things like wait lists for nonurgent things than have to take care of patients who can't afford their medications or can't be seen because they can't pay for a visit.

Would it even be a "business" or would it be a giant public charity?

Considering the amount of $ we would save if people had access to prevention I would say it would be charity to ourselves.

 

[The Rube]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

And here's where I'm ignorant. I don't see doctors unless I have to. If urgent care is open, I go see them. The last two times I was in ER, it was 2, 3am. Not really a choice at that point. Either drove myself or had a driver, no ambulance. Have good insurance; not the super best, but good. Basically, I go to what is minimal and what is open at the time. Is that the best option for that decision given my choices?

 

[FreshFish]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

And here's where I'm ignorant. I don't see doctors unless I have to. If urgent care is open, I go see them. The last two times I was in ER, it was 2, 3am. Not really a choice at that point. Either drove myself or had a driver, no ambulance. Have good insurance; not the super best, but good. Basically, I go to what is minimal and what is open at the time. Is that the best option for that decision given my choices?

In some urban areas, they have 24-hour urgent care centers as an alternative to hospital ER.

 

[jen]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

This is a HUGE gear grinder. We used to get health insurance discounts with biometric screening - if you met certain numbers, you got the discount (not perfect - but, whatever).

Now they've instituted a new program. You have to register online, and then track your activities/moods/every ****ing thing, and put it all on some website, every single day. When you do this, you are rewarded with points that convert to discounts on your health insurance. You can take challenges with your team! Share your activities! It's fun!

The brochure they mailed our suggests that we "take time for ourselves" to do this. I don't have time for this **** when I'm at work because I'm BUSY DOING MY JOB AND SUPPORTING OUR CLIENTS, so now I have to spend extra time on social media, in my free time, for this? Are you ****ing kidding? How is that healthy? If I "take time for myself", it's not in front of a phone or a computer, after I sit in front of a computer for 10 hours a day.

Are you really at a gym if you don't take a selfie? Did you really work out if you don't post about it on social media? If it's not on your Fitbit, did you really do it? This is the worst idea they've had in a long time and it was obviously designed by someone who spends every ****ing waking hour on social media.

 

[FlagDUDE08]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

This is a HUGE gear grinder. We used to get health insurance discounts with biometric screening - if you met certain numbers, you got the discount (not perfect - but, whatever).

Now they've instituted a new program. You have to register online, and then track your activities/moods/every ****ing thing, and put it all on some website, every single day. When you do this, you are rewarded with points that convert to discounts on your health insurance. You can take challenges with your team! Share your activities! It's fun!

The brochure they mailed our suggests that we "take time for ourselves" to do this. I don't have time for this **** when I'm at work because I'm BUSY DOING MY JOB AND SUPPORTING OUR CLIENTS, so now I have to spend extra time on social media, in my free time, for this? Are you ****ing kidding? How is that healthy? If I "take time for myself", it's not in front of a phone or a computer, after I sit in front of a computer for 10 hours a day.

Are you really at a gym if you don't take a selfie? Did you really work out if you don't post about it on social media? If it's not on your Fitbit, did you really do it? This is the worst idea they've had in a long time and it was obviously designed by someone who spends every ****ing waking hour on social media.

As the old saying goes, "pics or it didn't happen."

 

[The Sicatoka]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

You have to register online, and then track your activities/moods/every ****ing thing, and put it all on some website, every single day.

Cool.
Do that.
It'll take me under a week to find patterns.
Got any nice stuff at your place I can "pick up" when you're required to inform me you're not home but instead at the gym?


And that's why "status updates" on social media are completely stupid. "I'm having blueberry pancakes at IHOP!" ... yeah, and someone is now sure you're not home so they're going in to take whatever they want.

I guess "status updates" are my gear grinder. They are stupid, just stupid. My neighbors are of the generation that does them. I've told them they need to let me follow them so I know when they're out of town and to be suspicious of that strange car in the neighborhood.

 

[dxmnkd316]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

This is a HUGE gear grinder. We used to get health insurance discounts with biometric screening - if you met certain numbers, you got the discount (not perfect - but, whatever).

Now they've instituted a new program. You have to register online, and then track your activities/moods/every ****ing thing, and put it all on some website, every single day. When you do this, you are rewarded with points that convert to discounts on your health insurance. You can take challenges with your team! Share your activities! It's fun!

The brochure they mailed our suggests that we "take time for ourselves" to do this. I don't have time for this **** when I'm at work because I'm BUSY DOING MY JOB AND SUPPORTING OUR CLIENTS, so now I have to spend extra time on social media, in my free time, for this? Are you ****ing kidding? How is that healthy? If I "take time for myself", it's not in front of a phone or a computer, after I sit in front of a computer for 10 hours a day.

Are you really at a gym if you don't take a selfie? Did you really work out if you don't post about it on social media? If it's not on your Fitbit, did you really do it? This is the worst idea they've had in a long time and it was obviously designed by someone who spends every ****ing waking hour on social media.

This is a lot of companies’ plans now.