You cannot apply basic economic theory and free market principles to health care. Health care is fundamentally different and should be considered a public good.
First, health care is completely self-regulated and controlled. A person does not have free choice when choosing a provider. Due to an unholy alliance of provider networks, insurance underwriters, pharmaceutical conglomerates and private for profit hospital corporations such as HCA.
By negotiating with providers and developing one-size-fits-all prescription formularies and treatment protocols, we remove the ability for the consumer to make independent informed decisions about the value of various treatment options.
We rely upon one the ratings of physicians who have a self-interest in controlling access and information to accurate information through their reliance upon Certification and Licensing Boards. By limiting access into the profession, health care costs are inflated and it is near impossible for the consumer to determine the fair value of a health care service.
Second, the consumer is far removed from the negotiating process, so we do not have a good sense of the fair, free market value of one particular service in comparison to another. All you need to do is look at any EOB (explanation of benefits) report for your last trip to the hospital.
Billing codes are used and assigned through various service departments and the insurance carrier then decides which services are covered and at what rate. They use the terms like "Reasonable and Customary Rates" and then choose to pay 80% of that. So by definition, that 20% must be built in to the billing rates to adjust for the actual (and expected) rate of reimbursement.
Such complicated billing procedures and methods are so complicated and technical that the end recipient of services (the consumer) really has no idea if an X-ray costs $90 or $73. Add into that a separate fee for the radiologist, and sometimes a charge just to use the facility, and even smart people find it difficult to understand.
The bills are then processed by an insurance adjuster who must determine primary and secondary (supplemental) plans and determine who is responsible for what, the end cost and intricate design is truly "priceless."
A false sense of security is unfair and unjust. I would rather have nothing than false expectations and disappointment.Writing Through Dark
Without regulation, intervention and enforcement, many people will continue to believe they are prepared and protected from that ultimate for "just in case" scenario that results in major, catastrophic medical loss.
Yeah, right. The administrative cost alone on the part of the "Responsible Party" is probably more costly than the initial service they received at whatever hospital for whatever condition.
The bottom line is this, we can pass laws, we can file injunctive, pass symbolic legislation, and spew feel good if oration about public programs that fall short if their promise to assist those in crisis. However, unless we demand accountability from state and federal agencies (1) demanding a timely response; (2) create and external entity to do an independent audit to ensure compliance, (3) enforce those laws through whatever means necessary; we have no recourse.
As more and more people continue to lose their benefits, and their unemployment benefits run out... the state will continue to be overburdened, and people in crisis can only go so long without before it is too late. Social Security and DHS MUST be held accountable, and we must pressure our legislators to create a separate entity to conduct external reviews IMMEDIATELY.
I would write more, but I have some forms that MUST be filed out and faxed immediately to appeal the termination of my benefits. Since the Dept of Human Services only have 20 days to appeal, they should be required to respond in a timely fashion.
It is on us to see that this happens. Regardless of whether we chose a public or private option, without regulation, accountability and strict enforcement... we have no recourse. Please fix it. I can't do this alone!
First, health care is completely self-regulated and controlled. A person does not have free choice when choosing a provider. Due to an unholy alliance of provider networks, insurance underwriters, pharmaceutical conglomerates and private for profit hospital corporations such as HCA.
By negotiating with providers and developing one-size-fits-all prescription formularies and treatment protocols, we remove the ability for the consumer to make independent informed decisions about the value of various treatment options.
We rely upon one the ratings of physicians who have a self-interest in controlling access and information to accurate information through their reliance upon Certification and Licensing Boards. By limiting access into the profession, health care costs are inflated and it is near impossible for the consumer to determine the fair value of a health care service.
Second, the consumer is far removed from the negotiating process, so we do not have a good sense of the fair, free market value of one particular service in comparison to another. All you need to do is look at any EOB (explanation of benefits) report for your last trip to the hospital.
Billing codes are used and assigned through various service departments and the insurance carrier then decides which services are covered and at what rate. They use the terms like "Reasonable and Customary Rates" and then choose to pay 80% of that. So by definition, that 20% must be built in to the billing rates to adjust for the actual (and expected) rate of reimbursement.
Such complicated billing procedures and methods are so complicated and technical that the end recipient of services (the consumer) really has no idea if an X-ray costs $90 or $73. Add into that a separate fee for the radiologist, and sometimes a charge just to use the facility, and even smart people find it difficult to understand.
The bills are then processed by an insurance adjuster who must determine primary and secondary (supplemental) plans and determine who is responsible for what, the end cost and intricate design is truly "priceless."
A false sense of security is unfair and unjust. I would rather have nothing than false expectations and disappointment.Writing Through Dark
Without regulation, intervention and enforcement, many people will continue to believe they are prepared and protected from that ultimate for "just in case" scenario that results in major, catastrophic medical loss.
Yeah, right. The administrative cost alone on the part of the "Responsible Party" is probably more costly than the initial service they received at whatever hospital for whatever condition.
The bottom line is this, we can pass laws, we can file injunctive, pass symbolic legislation, and spew feel good if oration about public programs that fall short if their promise to assist those in crisis. However, unless we demand accountability from state and federal agencies (1) demanding a timely response; (2) create and external entity to do an independent audit to ensure compliance, (3) enforce those laws through whatever means necessary; we have no recourse.
As more and more people continue to lose their benefits, and their unemployment benefits run out... the state will continue to be overburdened, and people in crisis can only go so long without before it is too late. Social Security and DHS MUST be held accountable, and we must pressure our legislators to create a separate entity to conduct external reviews IMMEDIATELY.
I would write more, but I have some forms that MUST be filed out and faxed immediately to appeal the termination of my benefits. Since the Dept of Human Services only have 20 days to appeal, they should be required to respond in a timely fashion.
It is on us to see that this happens. Regardless of whether we chose a public or private option, without regulation, accountability and strict enforcement... we have no recourse. Please fix it. I can't do this alone!
CLICK HERE TO CALL CONGRESS: YOU'RE CALL WILL AUTOMATICALLY BE RECORDED AND COUNTED
SO STFU ALREADY YOU STUPID, SELF-SERVING, POLITICAL WANNA-BE, SELL-OUT! OF ALL THE THINGS IN MY ARSENAL: THAT LETTER YOU SENT FROM YOUR BOSSES E-MAIL? NO WONDER THE DEMS RE GOING TO SHIT IN TENNESSEE-- AND YOU PRETEND TO SPEAK FOR ALL OF THEM!) I ALMOST GET GIDDY THINKING OF THE DVD THT WAS MADE ABOUT COMMUNITY APATHY... WHICH IN LL PROBILITY, WILL, IN FACT GO "VIRAL"
BECAUSE THERE AINT NOTHING LIKE YOUR OWN WORDS TO DIGG A GRAVE!
TRANSPARENCY? YES. PRICELESS!
Elyssa Durant, Ed.M.
Nashville, Tennessee
MODIFIED 366 DAYS LTER.... [EDD/eds 11.07.09]
I have a serious problem with the most recent health reform effort. Asking or expecting the health industry to reduce costs through self-regulation without accountability is simply ridiculous.
Health care is already completely self-regulated and controlled. A person does not have free choice when choosing a provider. Due to an unholy alliance of provider networks, insurance underwriters, pharmaceutical conglomerates and private for profit hospital corporations such as HCA.
By negotiating with providers and developing one-size-fits-all prescription formularies and treatment protocols, we remove the ability for the consumer to make independent informed decisions about the value of various treatment options.
We rely upon one the ratings of physicians who have self-interest in controlling access and information to accurate information through their reliance upon Certification and Licensing Boards. By limiting access into the profession, health care costs are inflated and it is near impossible for the consumer to determine the fair value of a health care service.
Second, the consumer is far removed from the negotiating process, so we do not have a good sense of the fair, free market value of one particular service in comparison to another. All you need to do is look at any EOB (explanation of benefits) report for your last trip to the hospital.
Billing codes are used and assigned through various service departments and the insurance carrier then decides which services are covered and at what rate. They use the terms like “Reasonable and Customary Rates” and then choose to pay 80% of that. Therefore, by definition, that 20% must be built in to the billing rates to adjust for the actual (and expected) rate of reimbursement.
Such complicated billing procedures and methods are so complicated and technical that the end recipient of services (the consumer) really has no idea if an X-ray costs $90 or $73. Add into that a separate fee for the radiologist, and sometimes a charge just to use the facility, and even smart people find it difficult to understand.
The bills are then processed by an insurance adjuster who must determine primary and secondary (supplemental) plans and determine who is responsible for what, the end cost and intricate design is truly “priceless.”
Good luck to those people who actually purchased supplemental plans they saw advertised on TV, you have been duped. Giving people (especially the poor, the elderly, and other high risk populations) a false sense of security is unfair and unjust.
Without regulation, intervention and enforcement, many people will continue to believe they are prepared and protected from that ultimate catastrophic medical loss.
The administrative cost alone on the part of the “Responsible Party” is probably more costly than the initial service they received at whatever hospital for whatever condition.
You cannot apply basic economic theory and free market principles to health care. Health care is fundamentally different and until I am convinced that the poor pathetic people of this nation are competent enough to understand the complexities innvolved in the healthcare industry, I say we all need to stfu. As a "certified health insurance information broker" [a bullshit title, but it does give the right to comment, and my that gives me the right to say "I don't know," then surely America can admit, just a little, that you really don't know nearly as much as FaceBook status would have us believe.
Yes I am angry as hell, but after seeing the ignorant, vile, completely innapropriate, irrelevant, and in... in... in... OMG! You've finally done it... I am speechless. WOW!
discussion that hurts every single one of us, I hope you think twice before you ask me to log my calls. Trust me, I have. Every single one!
That's all. I have nothing more to say. I watch you make asses out of yourselves fighting over values, religion, ethics... Anyone who knows anything about healthcare can see through your ridiculous facade. Because values, SES, education, elitism, LIBERALS, CONSERVATIVES, oh and lets forget the evil "SOCIALISTS" "atheists" whore mongering welfare recipients like myself (who are going going to hell anyway!)
RICH, POOR, STUPID, SMART, IDGAF anymore... none of these things will lay the groundwork for sound policy and effective reform. America has shown the world our true colors, and the rest of the world is laughing as we fall like dominoes into the depths of the depression.
When you start a real converation, let me know. But until then... I can't participate in this massive effort to completely self destruct.
On the brightside, for dear friends like @Potus, @badjerry @dwbjr69 @donnette @amazingflora @rocketman528 @almostvisible @PortCityPisces @badwebsites @elvisofdallas dont worry, I got this one.... As usual I will continue to take names, laugh out loud, scream and shout for justice, but for those who know me best, my silence speaks so much louder than my words.
So when I find the words, maybe I'll rejoin the conversation. Until I am convinced that people are informed and prepared for the mess you are creating, I want no part of of it. Healthcare is public good. Without it, we have nothing.
Elyssa Durant, Ed.M.
Nashville, Tennessee
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Elyssa D. Durant, Ed.M.