I need help thinking this through...

[JustThinking...]

While the country is discussing the complicated issues involved in our current profiteering-based healthcare system vs. healthcare as a basic right, we're overlooking the fact that medical care is usually an immediate concern and that we should probably be installing some kind of stop-gap measure to improve our nation's overall health until the situation irons itself out, with or without the formal blessing of the governmental machine (or politicians, or special interest groups, or whichever party or subgroup that involves themselves in the issue).

This is a very broad outline of what I'm thinking and please let me know if I'm missing some serious flaw or if I'm just being a naive idealist (fair warning: I have no idea how the insurance industry works and financial paperwork is no different than ancient alchemist runes to me);

A non-profit corporation with the sole purpose of providing healthcare insurance on a national scale. Funded by tax deductible donations, legitimate grants, in-kind donations from willing care providers, and any other fund-raising schemes that are legal and moral.

It is not uncommon for non-profits to work with huge and complex budgets and history shows that some of our greatest social advances have been made on a national scale by large and complex organizations such as the ACLU, GLADD, even the ASPCA (does the term NGO fit here?). There are a number of very prestigious non-profit hospitals and clinics who are already carrying their side of the burden.

As with any non-profit, staff would be paid market wages BUT we would be taking the very large profit margin out of the equation and quite possibly find other ways to reduce costs.

I know, I see all the very valid arguments right off the bat and the loudest one in my own brain is that IF anything like that actually gets off the ground it will serve to undermine the fight for ANY type of National system not to mention be literally provoking the wrath of the existing, powerful, and ruthless healthcare profiteers.

But hey, we seem to be stuck in an endless loop in our quest to simply take care of ourselves as a nation while we suffer and die and I thought I would throw this out there.

I thought maybe it's an idea worth discussing or perhaps it's just so blatantly impossible that I should just go back to my morning coffee and watch the world go 'round.

[lark]

1. It's a good idea, but very difficult to implement.

We have a medical charity group that operates in NE FL (maybe elsewhere too, don't know) called St. Judes. They are a charity that helps people get medical care as one of their missions. They would contact our office and want to arrange services for a patient. All the services related to a specific thing were to be included in the price, no patient billing. I can't tell you how many times I got calls from St. Jude or Managed Care because one of our clinics/hospitals/Imaging centers was billing a St. Judes contract patient. Clinics are not used to coordinating care and suck at it. We (Patient Services) always had spreadsheets and work queues going to track , maintain the accounts, stop the billing to the patient, bill St. Judes, ensure proper resolution. I worked for a large healthcare organization, part of Univ. of FL, and we took this seriously and still had constant issues with groups like anesthesia, radiology & labs not being included in quotes, but providing services. Medical care is so fragmented with so many providers giving services and wanting compensation, it would be almost impossible to provide accurate quotes for a whole host of procedures. My area had to take over giving quotes because the clinics were so bad at it and we coordinated with the hospital where our physicians worked and things improved substantially, but that was just for advance scheduled services and didn't include any patients from ER. Most hospitals and physician billing groups don't have a dedicated team of people to provide quotes including all services for one thing, for two - medical isn't a totally exact science. Physicians think one thing is the issue, open you up and there's something else going on as well - what do they do? In most places, their ethics say they have to fix the unexpected problem they found. Then they bill for what was really done vs. what they thought they'd be doing and the cost is different. Unless there is only one group doing joint healthcare billing for everything, i don't see how this can work effectively and I worked in the industry for 20 years dealing with these issues.

[JustThinking...]

2. wow.

Thanks for all that first hand experience info.

I had always just assumed that because healthcare is currently profit-driven, the complications in administration were just another deliberate way to promote "upselling", like when you simply want to purchase a specific channel on cable it becomes a rat's nest of various 'packages' all at different costs and always seem to lead to buyer's remorse somehow when they could just simply write a line of code so you get that channel and charge you a price for it.

It still amazes me that the healthcare industry has such a hard time at costing and billing logistics. We've had accountants in our midsts for quite a few hundred years now and you would think this type of thing could be dealt with so much more efficiently.

I guess that's why I suspect it's all part of some kind of profit-squeezing charade.

[lark]

4. It is in a way.

It's the way the industry is structured here - every dr. gets a piece of the pie. Lab physicians want to be paid for their work and so does every single type of dr. That is exactly the problem, they don't want to work together on pricing and there's a bunch of them and even when they do cooperate for "package pricing", it takes years to negotiate the deal and by that time the industry is changing again. Package pricing is the future of the industry, with or without the needed consolidation into single payer. Single payer would make this so much more accurate and patient friendly, it's truly the only way we can have transparency.

Yes there are some dr. that try to "juice" things, but they are not the majority of the doctors I saw - we had over 400 physicians working in 27 locations and 4 hospitals. Our group would catch this and we'd have to tell the doctors that it's against the rules to do both surgeries in the same session or let them know about whatever the conflict was and we often could "convince" them to change the orders. Luckily we had a great CEO who was an ethics stickler and she supported us often when we & the physician disagreed. I left the co. within a year of her retirement because things started changing for the worse.

[JustThinking...]

6. so yes, single payer, once it's ironed out would solve all those problems

Except where the overall budget money comes from.

And that overall budget money would be far less than it is now witout all those problems AND all the profit floating on top. Not to mention a lack of capitalist incentive to INCREASE billing at any chance.

I believe other National Universal care programs do just that by the providers being salaried employees therefore doing away with all the crazy billing concerns but I might be wrong about that.

[lark]

9. Exactly, they do this because it's the only way this actually works out for th patient.

I will be so happy when we have this here.

[TreasonousBastard]

10. Sounds like an infinitely more complicated version of any...

repair in modern society-- your plumber finds a new leak, your mechanic finds a cracked head, your contractor's subcontractor fails to do a job...

It seems like a large part of the problem is that medicine is still billed like piecework. If you bring your boat in for repair, every part and action is billed-- not only are you billed by the hour for sanding the hull, but also for each sheet of sandpaper. Sound familiar?

We have this curious arrangement of public and private hospitals, with some of the private ones being for-profit. I'm not sure of the difference between non-profit and for-profit, except non-profits have some more rules and don't pay taxes.

Duplication of effort is endemic-- "making the rounds" is team sport, with your doctor followed by a half dozen others who say nothing but sign charts and submit bills.

When my mother had a severe heart problem, it couldn't be handled by the hospital her doctor was admitted to, so they sent her to the large regional hospital where she did receive excellent care. But, since her doctor and hospital were not to be trusted, she had a complete workup done by the big guys and spent over 10 grand doing it. They found a few things and scheduled more tests, until they reluctantly talked to her doctor and found they existed for years and were being watched.

But enough of that-- we now have a system where the federal government administers Medicare, Medicaid, VA, Indian Health Service, Public Health Hospitals, and who knows how many others.Then we get down to state, county and municipal services and plans, and even further down to private services and plans.

I haven't seen how MOFA or any other "plans" can organize this mess. Seems no one remembers how difficult it was to get Obamacare through, and how it was, and still is being, eviscerated.

[brush]

3. We really need to research how other countries fund their universal care.

Those on Medicare paid for it during their working career so how could Medicare for all work without working out the funding for millions who have not paid into it?

Other countries have figured it out. We have some serious, complex research to do. Many tout their employer provided care but is that really a bargain with the payroll deductions, co-pays, 3k-5k deductibles when you try to use it?

And then there are the generous union-negotiated plans that beneficiaries don't want to give up, even for a Medicare-type plan. And we also have to add in that Medicare only pays 80% of the cost. You have to have a supplemental plan that you pay for for the other 20%. Hello! Who has 20k if you hospital bill is 100k?

So there's a lot to work on. It can be done. A new Dem president has to immediately appoint a research group to come up with a workable plan as O did with the ACA. It should not include Christie Wittman.

[JustThinking...]

5. yeah, and we need to look at how...

...other "departments" are paid for too because really, universal medical care is no different in how it should be paid for than any other citizen benefit or national program like the military, or the costs of running government buildings, infrastructure, heck even the postal service.

Do we have a special funding plan for the Secret Service or the supreme courthouse's electric bill or do we just.. pay it.

How about the IRS, is that just paid for out of the National budget that it is responsible for compiling or is there some kind funding scheme I'm unaware of?

I know the president has to pay for his family's regular meals in the whitehouse but how is the cost of his limosine covered?

I'm sure each program expenditure system is different depending on.. something or other, but let's look at all these things for some existing model we could adapt for a medical care program.

Maybe we should start think about breaking it up into different areas of concern? For instance children in the public school system have their portion sent to a healthcare fund from the budget of the school system, employed adults have their portion sent to the fund as a part of their wages, unemployed adults who are not on public assistance (spouse of a worker or wealthy) can choose to pay it out pocket or go without, some kind of crazy arrangement like that.

Or we can be honest with ourselves and stop pretending money is a thing of value and admit it's just a worthless IOU system and just write government checks for it like all those topsecret black ops accounts.

And on another, completely different thought, do we have any idea at all how much the collected taxes, government bond sales, weapons sales, etc., you know, our income, even is? I've never heard a number that reflects the total of how much we actually have to work with for these kinds of things. I know we have a National 'budget' but that refers to how much we spend, not how much we actually GET.

The most important part is that we remove our medical care from the profiteering sector for the obvious reasons that 1. Without billions of profit going into a few shareholder's hands we would immediately save those billions and 2. Profiteers have a legal obligation to benefit their shareholders first and foremost and any medical care program must by definition benefit the patient firstand foremost.

[brush]

7. Really good points. It is complex and much is involved but it can be done.

It takes will and only a Dem president will have the will to tackle such a huge task. I hope we get there.

[JustThinking...]

8. me too.

If we can't find the will to take care ourselves medically as a nation, well, I think that could be called National Suicide.