Impeding changes to our Health Care system

[Spexxvet]

Originally Posted by TheMercenary

I am thinking that you would have a hard time proving that. My for profit insurance company pays 100% for a complete eye exam each year for each person in my family.
...

How much does your insurance company pay the doctor, though? That's the question. I'll bet it's not doctor's the "regular retail" rate, nor is it as much as Medicare pays.

Originally Posted by TheMercenary

Once we can establish what the cost of a general eye exam is, which may or may not include refactory testing, which changes the cost, then we can determine what percent Medicare pays. I have the CPT codes and Medicare rates for NJ. So do you have an EOB with the phyicians charged fee on it?

92014. Medicare allowable is $111.83, of which they pay 80%, or $89.46. Medicare never pays for a refraction. Are you sure this is your business?

[TheMercenary]

Originally Posted by Spexxvet

How much does your insurance company pay the doctor, though? That's the question. I'll bet it's not doctor's the "regular retail" rate, nor is it as much as Medicare pays.

You do understand that most private insurance pays much more than Medicare rates don't you? Private insurance has contractual relationships with each provider or group or hospital.

92014. Medicare allowable is $111.83, of which they pay 80%, or $89.46.

Each state is different for reimbursement amounts.

[Spexxvet]

Originally Posted by TheMercenary

You do understand that most private insurance pays much more than Medicare rates don't you?

I don't know anything of the sort. I know that Medicare pays the highest for an annual eye exam. I also know that most for-profit insurance companies use Medicare guidelines for their cataract surgery reimbursement. Where do you get your information that for-profit insurance pays the provider more than Medicare?

Originally Posted by TheMercenary

...Each state is different for reimbursement amounts.

Yes, that's why I bagan with:

Originally Posted by Spexxvet

In New Jersey, Medicare pays 80% of $110ish ($88ish) for a complete eye exam by an ophthalmologist. Most for-profit insurance companies pay $40 - $50 for the same service. And here's the kicker: some patients pay a $40 copay, and their insurance company contributes zilch, nada, nil, zip, zero. But we're all better off with health insurance companies running things...

[TheMercenary]

Originally Posted by Spexxvet

I don't know anything of the sort. I know that Medicare pays the highest for an annual eye exam. I also know that most for-profit insurance companies use Medicare guidelines for their cataract surgery reimbursement. Where do you get your information that for-profit insurance pays the provider more than Medicare?

I get my information not from cataract surgery but from other procedures, GYN surgery specifically, but I was thinking of reimbursement in the larger sense. For example in bariatric surgery Medicare pays 28% less than private insurance. http://www.springerlink.com/content/m52w62k100j21n71/
. For choclear implants Medicare paid 57%, and Medicaid 46% of what private insurance paid for the surgeon. For the hospital Medicare paid 80% of what private insurance pays for outpatient services and less for inpatient services. http://www.rand.org/pubs/research_br...-1/index1.html . For anesthesia services the difference is huge. For GYN procedure is in our outpatient surgery center the differences are huge. Bottom line is that Medicare pays significantly less than what private insurance pay for reimbursement. Cataract surgery may be the exception, not the rule when it comes to differences between private insurance reimbursement and Medicare.

[DanaC]

Obamy? I really dislike that. It has connotations I find rather distasteful.

[TheMercenary]

Originally Posted by DanaC

Obamy? I really dislike that. It has connotations I find rather distasteful.

I agree, I find him quite distasteful as well. Him and all the other politicos in D.C.

Edit: Until they change the way they do business inside the Beltway the Government will continue to be completely inept at their attempt to change the way healthcare is delivered in the US. So far all proposals pretty much are doomed to failure. Sure they may appease those people "without" or with the expectation that the government will be their new mommy, providing them with all their wants, but so far most people don't buy that notion.

[classicman]

just send him a txt instead :p

[DanaC]

Maybe she is happy that the government is making some kind of an attempt to resolve a pretty fucked up situation, whereas the Bush administration wasn't?

[morethanpretty]

Originally Posted by DanaC

Maybe she is happy that the government is making some kind of an attempt to resolve a pretty fucked up situation, whereas the Bush administration wasn't?

Yup yup. I never said that the gov't was all evil under Bush, or that I hated everything Bush did (just most of it: No Child Left Behind, banning embryonic stem cell research, "protection of marriage" wire-tapping citizens, allowing "enhanced interrigation techniques," tax cuts for the rich...)
So yeah, I am much happier that we have more liberal gov't, now if only they prove they have integrity and backbone...

[gadfly]

To me - the Healthcare debate/situation is very similar to when Clinton introduced it in 93. Conservatives run their propaganda to create fear and confusion. Clinton wasn't focused enough on this issue to make it happen.

What is diseartening is that Obama has waffled on the public option. The progressives came out and said no to Obama on this-- which was the appropriate response. True reform cannot happen without a gov't run system.

The conservatives for over 40+ years have had a bull's eye on rolling back the New Deal at all costs. They have chaged the tax system - so the rich get richer. Remeber privatize Social Security? They have continually deregulated since the the time of Regan. Why do you think the middle class was fooled into believing that they could afford a 350,000 home when they make 50000 a year. DEREGULATION. or maybe they believed in "Living the American Dream"- I guess.
Rich get richer again.

Is civic virtue dead or has it been dead? (To the citizens that say - why should I care about people having no health insurance?)



For those who say the government can't run anything right --I have a few friends that are veterans that go to the VA hospital for treatment and they have very minimal complaints (no one is ever happy about any system are they?). Sign a form - no money exchanged - need meds? get them in 2 days in the mail--easy. That is true "socialized" medicine in the USA. Maybe that is not efficient enough for most people?


If this does not go through will it be another in a long list of citizen complaints that assert that corporations run the USA not a government for the people by the people-----(that would be on both sides of the aisle).

Is this our last chance for "universal" healthcare?

BTW - whatever happened to reforming Caimpaign finance? Could this be needed before we have true Health Care reform? In our current system are our representatives truly held accountable to the people?

Respond to any - all - or none.

[TheMercenary]

Originally Posted by gadfly

For those who say the government can't run anything right --I have a few friends that are veterans that go to the VA hospital for treatment and they have very minimal complaints (no one is ever happy about any system are they?). Sign a form - no money exchanged - need meds? get them in 2 days in the mail--easy. That is true "socialized" medicine in the USA. Maybe that is not efficient enough for most people?

You left out the part where those people who get VA benifits actually had to give up something to get them, you that little government service thing. They didn't get them for nothing like the current plan central to the current debate. Like I said before, if they want a public plan make sure that everyone pays the same percent of income to make it happen. No one gets a pass, no matter how little or much you make, the same percent. There are lots of other problems with it but I will spare you and not repeat them all again.

[gadfly]

Mercenary - When you said that everyone pays the same percent into the system - I had a flashback to Steve Forbes ---Flat Tax campaign.

[TheMercenary]

Originally Posted by gadfly

Mercenary - When you said that everyone pays the same percent into the system - I had a flashback to Steve Forbes ---Flat Tax campaign.

Awesome!

[gadfly]

Clinton wasn't focused enough is what I meant.

[Griff]

Originally Posted by gadfly

Clinton wasn't focused enough is what I meant.

You can edit your post inside a certain time frame. Etiquette says to make a note of it in the reason box. Welcome aboard. g