IT'S TIME FOR UNIVERSAL HEALTH CARE

georgeob1 wrote:

All of which illustrates the enormous non-productive cost that is required to compensate for the adverse effects of disconnecting providers and consumers from the market and economic forces governing their transactions.

This clearly gives the lie to those who claim that government operated programs will be necessarily cheaper and more efficient.

Interesting take. Gotta wonder why U.S. bills for similar services are 10 - 200% higher in the U.S. than in Canada. Because the free market is so much more efficient?

cicerone imposter wrote:

icd-9 is the Classification of Diseases used to code and classify mortality data. What has this got to do with Cyclo's case?

There are two related classifications of diseases with similar titles, and a third classification on functioning and disability. The International Classification of Diseases (ICD) is the classification used to code and classify mortality data from death certificates. The International Classification of Diseases, Clinical Modification (ICD-9-CM) is used to code and classify morbidity data from the inpatient and outpatient records, physician offices, and most National Center for Health Statistics (NCHS) surveys.

Go ask your wife.

Ugh... because that's not ALL IDC-9 is. They are classifications for illness and diseases and conditions. They are used for BILLING. A hospital gets paid $xx for a specific ICD-9 code. Medicare and Medicaid reimburse a practice $xx for a given ICD-9. Bills are generated by taking the ICD-9 codes from a chart and summing them with the associated cost. LYNX and SNOMED are other coding types for this purpose, but they are older and are being used less often.

georgeob1 wrote:

You have several options. (1) You could elect to forego the surgery, and opt for another treatment the insurer will cover. (2) You could pay the $50,000.

You would be in precisely the same situation if we had a government managed "universal" system and the operation in question wasn't covered by that.

$50,000 is the price of 1 1/2 Honda Accords (including taxes); or an Infinity M; or one year's tuition at a major University. If my health was at stake I would value it over these alternatives.

Well, but that's b/c you have the money to do such things. Many people do not, or if they do, it drives their family way down, often into poverty.

What would be the effect of covering ALL procedures? Why would that be a bad thing?

Cycloptichorn wrote:

georgeob1 wrote:

You have several options. (1) You could elect to forego the surgery, and opt for another treatment the insurer will cover. (2) You could pay the $50,000.

You would be in precisely the same situation if we had a government managed "universal" system and the operation in question wasn't covered by that.

$50,000 is the price of 1 1/2 Honda Accords (including taxes); or an Infinity M; or one year's tuition at a major University. If my health was at stake I would value it over these alternatives.

Well, but that's b/c you have the money to do such things. Many people do not, or if they do, it drives their family way down, often into poverty.

What would be the effect of covering ALL procedures? Why would that be a bad thing?

We all must make choices about the relative importance of things. There are lots of Honda Accords out there.

Covering ALL procedures would require infinite money - a government blank check that charlatains and swindlers would very quickly learn to exploit, destroying the system for those who don't cheat. Alternatively we could have even more extensive systems for monitoring (and sometimes rejecting) claims such as those you described involving your father. Hard choices, either way.

It would also require that we very quickly gain absolute control of our borders (as for example does Canada) to avoid a flood of benefit seekers. Lots of potential for unanticipated side effects here.

Careful what you wish for. Human nature can be a bit perverse, and swindlers are usually quicker and more agile than bureaucrats.

Cycloptichorn wrote:

georgeob1 wrote:

You have several options. (1) You could elect to forego the surgery, and opt for another treatment the insurer will cover. (2) You could pay the $50,000.

You would be in precisely the same situation if we had a government managed "universal" system and the operation in question wasn't covered by that.

$50,000 is the price of 1 1/2 Honda Accords (including taxes); or an Infinity M; or one year's tuition at a major University. If my health was at stake I would value it over these alternatives.

Well, but that's b/c you have the money to do such things. Many people do not, or if they do, it drives their family way down, often into poverty.

What would be the effect of covering ALL procedures? Why would that be a bad thing?

We all must make choices about the relative importance of things. There are lots of Honda Accords out there.

Covering ALL procedures would require infinite money - a government blank check that charlatains and swindlers would very quickly learn to exploit, destroying the system for those who don't cheat. Alternatively we could have even more extensive systems for monitoring (and sometimes rejecting) claims such as those you described involving your father. Hard choices, either way.

It would also require that we very quickly gain absolute control of our borders (as for example does Canada) to avoid a flood of benefit seekers. Lots of potential for unanticipated side effects here.

Careful what you wish for. Human nature can be a bit perverse, and swindlers are usually quicker and more agile than bureaucrats.

USAFHokie80 wrote:

Ugh... because that's not ALL IDC-9 is. They are classifications for illness and diseases and conditions. They are used for BILLING. A hospital gets paid $xx for a specific ICD-9 code. Medicare and Medicaid reimburse a practice $xx for a given ICD-9. Bills are generated by taking the ICD-9 codes from a chart and summing them with the associated cost. LYNX and SNOMED are other coding types for this purpose, but they are older and are being used less often.

If you had provided the correct information, my questions would not have occured. Half ass answers is what gets most people in trouble.

ICD-9-CM Coding System

The International Classification of Diseases is a system developed collaboratively between the World Health Organization (WHO) and ten international centers, including one in the US. The purpose is promote international comparability of in the collection, classification, processing and presentation of health statistics.
In the US, the system takes on another purpose as the HIPAA-mandated coding system used in medical billing. ICD-9 Clinical Modification (CM) is the system currently used in the US for medical billing purposes. It is more finely grained than ICD-9 alone, including 5-digit codes where ICD-9 does not. The ICD-9 system is updated an annual basis. New codes go into effect on October 1 of each year.
ICD-9-CM contains three "volumes" of information. Volume 1 contains the diagnosis codes that every provider needs for billing. Volume 2 is an alphabetical index of Volume 1. Since computerized searches do the same thing as a printed index, this volume is not useful a data file. Outpatient diagnostic or treatment centers, like physician offices, need only Volume 1. Volume 3 contains procedure codes, which are used for billing inpatient hospital stays in the DRG system.
ICD-10-CM is not expected to become a HIPAA mandated coding system until 2009. However, the draft system is available in educational volumes and as draft ICD-10-CM and draft ICD-10-PCS data files.
Licensing

So, we're willing to put up with a bad situation that doesn't work, in order to avoid potential fraud by an army of illegal aliens?

I'm not sure I agree with the logic of this plan.

Cycloptichorn

Cycloptichorn wrote:

So, we're willing to put up with a bad situation that doesn't work, in order to avoid potential fraud by an army of illegal aliens?

I'm not sure I agree with the logic of this plan.

Cycloptichorn

I think you know that you are grossly oversimplifying the issue and distorting the point. If you didn't like the bureaucratic controls that limited your father's coverage, do you really believe that aspect of the situation would be improved by and of the "universal" systems being put forward?

Please explain the "logic" of how you would pay for services with no limits.

Hokie, Do you even understand the concept of insurance? I doubt it, but I thought I'd ask.

So let's see... insurance premiums run... say.... 5K a year. And you have your little copays and stuff when you go to the dr. But you can get $500 in medication for $50. Or you can go to the hospital in need of a cardiac cath that costs well in excess of $25K... and you pay maybe $2000 of that... but that's not enough... You want the insurance company to pay for EVERYTHING, which amounts to many, many times what they get in... Gee, I wonder why it doesn't work like that.

USAFHokie80 wrote:

So let's see... insurance premiums run... say.... 5K a year. And you have your little copays and stuff when you go to the dr. But you can get $500 in medication for $50. Or you can go to the hospital in need of a cardiac cath that costs well in excess of $25K... and you pay maybe $2000 of that... but that's not enough... You want the insurance company to pay for EVERYTHING, which amounts to many, many times what they get in... Gee, I wonder why it doesn't work like that.

When you write shite like this example, it makes me wonder if you know what you're talking about.

Since when does medicare and medicaid pay for food?

Miller wrote:

And as far as the nonsense posted in this forum on "formularies", anyone with medical experience knows, that hospitals have formulary committees that meet on a regular basis and have the right and obligation to change formularies at any time, without consultation with an insurance company.

It's hardly nonsense. The hospital can do whatever they want. But the insurance company will only pay for what is approved on THEIR formulary, regardless of what the hospital wants to administer.

It's hardly nonsense.

USAFHokie80 wrote:

Miller wrote:

And as far as the nonsense posted in this forum on "formularies", anyone with medical experience knows, that hospitals have formulary committees that meet on a regular basis and have the right and obligation to change formularies at any time, without consultation with an insurance company.

It's hardly nonsense. The hospital can do whatever they want. But the insurance company will only pay for what is approved on THEIR formulary, regardless of what the hospital wants to administer.

And the patient, privy to practically none of this information, is just expected to grin and bear it?

Jeez, you don't see a problem with this scenario?

Cycloptichorn