(08-06-2014 11:41 AM)Hambone10 Wrote:  

(08-05-2014 05:02 PM)dawgitall Wrote:  Ok I've offered something what suggestions can you guys offer


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They've been offered numerous times... I'll spell it out for you.

Get rid of the hundreds/thousands of pages of 'stupid' stuff in the ACA. Keep those few pages that eliminate caps... and no PECs.... keep kids on your plan till 26 (actually, why even bother with any limit at all? why can't a family insure its members 'forever'? I'd want to look at the math to see if it matters.. because by eliminating the PECs, everyone is treated the same by the math... so what difference does it make?) Allow insurance policies to be sold across state lines.

That is LITERALLY all I'd keep from the ACA.

Increase financial transparency. Change the funding mechanism from a separate tax to a large increase in the medicare withholding and let poor people get their 'subsidy' through the traditional ways that the government transfers wealth

Change the individual mandate to cover preventative care and catastrophic care with a huge hole in the middle.... with the size of that hole determined by the costs. This coverage would be free for 'all CITIZENS' and covered by the medicare/medicaid taxes. Let insurers (including medicare and medicaid) offer supplemental policies to fill this gap. The holes encourage responsible behavior because doing stupid things like breaking your leg trying to jump a moving car for a youtube video should have a totally different consequence than having a congenital kidney disease. Eating and living well should come with benefits (you save money) and slothful acts should come with costs (you pay out of pocket). This would actually make healthy living (which is expensive) cheaper relative to 'fast food' living (which is cheap).

Fund significantly more FP residency programs and INCREASE (rather than decrease) the reimbursement for primary and preventative care.

What is significant about this is that it would be FAR less complicated than the ACA. Medicare reimbursement rates already exist and everyone else sets their rates off of these. All you have to do is go to the existing reimbursement rates, select the 'primary' codes and increase those numbers. There is no need for page after page of additional regulation... just change the price for a 473.9 (chronic sniffles) from $55 to $65... and decrease reimbursement (increase copay, even to 100%) for breaking your leg while bungee jumping. Same with collecting the money through taxes... you might change the rates, but you don't need to create any new legislation... You merely move the rate from 5% or whatever it is to 15% or whatever it takes. You may also move some exclusion points in existing tax law, but again, this isn't 'new' legislation or regulation... you are merely modifying existing regulation... changing numbers, not adding thousands of pages of regulation. There's also no need for the IRS to determine that you have care, because EVERY citizen has this coverage... you merely have the option to purchase MORE coverage or even forego the 'free' coverage and buy a whole different policy (much like the wealthy pay into social security, but don't get any benefits from it because they save and invest) Medicare already has a list of 'covered' codes... and the 'mandated coverage' would simply be this same list. We already fund residency slots and we already offer 'discounts/incentives' for public service to pay them off. We're just changing the existing legislation from saying we will fund 7,000 slots to saying we will fund 10,000 slots. A legislative increase of ONE NUMBER, not thousands of pages.

You guys have no idea how specific icd-10 codes are. Here is but a short list of examples:

E833.0 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING OCCUPANT OF SMALL BOAT UNPOWERED
E833.1 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING OCCUPANT OF SMALL BOAT POWERED
E833.2 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING OCCUPANT OF OTHER WATERCRAFT -- CREW
E833.3 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING OCCUPANT OF OTHER WATERCRAFT -- OTHER THAN CREW
E833.4 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING WATER SKIER
E833.5 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING SWIMMER
E833.6 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING DOCKERS STEVEDORES
E833.7 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT, OCCUPANT OF MILITARY WATERCRAFT, ANY TYPE
E833.8 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING OTHER SPECIFIED PERSON
E833.9 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING UNSPECIFIED PERSON

If you're following... E833 means FALL ON STAIRS OR LADDERS IN WATER TRANSPORT and then the number after the decimal (which can go to three decimal places) specifies it... meaning there can be 999 different modifiers for 'fall on stairs or ladders in water transport' and 999 different reimbursement rates.

All of this already exists. We merely have to go through the list and modify the rates (and copays) to promote good health and responsible acts. FTR... they already do this somewhat, so again, this isn't new legislation... merely perhaps a different focus by the medicare reimbursement comittee

This would be too simple.

It also wouldn't allow for those in Congress to "exempt" large donors and "friends" from all the various regulations....which we all know leads to more campaign "donations".

This whole boondoggle is just another way for those in government to "control the strings" in another industry because, well - we all know that controlling the strings means more money funneled to those in power.

(08-06-2014 12:42 PM)Crebman Wrote:  

(08-06-2014 11:41 AM)Hambone10 Wrote:  

(08-05-2014 05:02 PM)dawgitall Wrote:  Ok I've offered something what suggestions can you guys offer


Posted from my mobile device using the CSNbbs App

They've been offered numerous times... I'll spell it out for you.

Get rid of the hundreds/thousands of pages of 'stupid' stuff in the ACA. Keep those few pages that eliminate caps... and no PECs.... keep kids on your plan till 26 (actually, why even bother with any limit at all? why can't a family insure its members 'forever'? I'd want to look at the math to see if it matters.. because by eliminating the PECs, everyone is treated the same by the math... so what difference does it make?) Allow insurance policies to be sold across state lines.

That is LITERALLY all I'd keep from the ACA.

Increase financial transparency. Change the funding mechanism from a separate tax to a large increase in the medicare withholding and let poor people get their 'subsidy' through the traditional ways that the government transfers wealth

Change the individual mandate to cover preventative care and catastrophic care with a huge hole in the middle.... with the size of that hole determined by the costs. This coverage would be free for 'all CITIZENS' and covered by the medicare/medicaid taxes. Let insurers (including medicare and medicaid) offer supplemental policies to fill this gap. The holes encourage responsible behavior because doing stupid things like breaking your leg trying to jump a moving car for a youtube video should have a totally different consequence than having a congenital kidney disease. Eating and living well should come with benefits (you save money) and slothful acts should come with costs (you pay out of pocket). This would actually make healthy living (which is expensive) cheaper relative to 'fast food' living (which is cheap).

Fund significantly more FP residency programs and INCREASE (rather than decrease) the reimbursement for primary and preventative care.

What is significant about this is that it would be FAR less complicated than the ACA. Medicare reimbursement rates already exist and everyone else sets their rates off of these. All you have to do is go to the existing reimbursement rates, select the 'primary' codes and increase those numbers. There is no need for page after page of additional regulation... just change the price for a 473.9 (chronic sniffles) from $55 to $65... and decrease reimbursement (increase copay, even to 100%) for breaking your leg while bungee jumping. Same with collecting the money through taxes... you might change the rates, but you don't need to create any new legislation... You merely move the rate from 5% or whatever it is to 15% or whatever it takes. You may also move some exclusion points in existing tax law, but again, this isn't 'new' legislation or regulation... you are merely modifying existing regulation... changing numbers, not adding thousands of pages of regulation. There's also no need for the IRS to determine that you have care, because EVERY citizen has this coverage... you merely have the option to purchase MORE coverage or even forego the 'free' coverage and buy a whole different policy (much like the wealthy pay into social security, but don't get any benefits from it because they save and invest) Medicare already has a list of 'covered' codes... and the 'mandated coverage' would simply be this same list. We already fund residency slots and we already offer 'discounts/incentives' for public service to pay them off. We're just changing the existing legislation from saying we will fund 7,000 slots to saying we will fund 10,000 slots. A legislative increase of ONE NUMBER, not thousands of pages.

You guys have no idea how specific icd-10 codes are. Here is but a short list of examples:

E833.0 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING OCCUPANT OF SMALL BOAT UNPOWERED
E833.1 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING OCCUPANT OF SMALL BOAT POWERED
E833.2 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING OCCUPANT OF OTHER WATERCRAFT -- CREW
E833.3 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING OCCUPANT OF OTHER WATERCRAFT -- OTHER THAN CREW
E833.4 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING WATER SKIER
E833.5 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING SWIMMER
E833.6 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING DOCKERS STEVEDORES
E833.7 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT, OCCUPANT OF MILITARY WATERCRAFT, ANY TYPE
E833.8 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING OTHER SPECIFIED PERSON
E833.9 FALL ON STAIRS OR LADDERS IN WATER TRANSPORT INJURING UNSPECIFIED PERSON

If you're following... E833 means FALL ON STAIRS OR LADDERS IN WATER TRANSPORT and then the number after the decimal (which can go to three decimal places) specifies it... meaning there can be 999 different modifiers for 'fall on stairs or ladders in water transport' and 999 different reimbursement rates.

All of this already exists. We merely have to go through the list and modify the rates (and copays) to promote good health and responsible acts. FTR... they already do this somewhat, so again, this isn't new legislation... merely perhaps a different focus by the medicare reimbursement comittee

This would be too simple.

It also wouldn't allow for those in Congress to "exempt" large donors and "friends" from all the various regulations....which we all know leads to more campaign "donations".

This whole boondoggle is just another way for those in government to "control the strings" in another industry because, well - we all know that controlling the strings means more money funneled to those in power.

That's a non-starter


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(08-06-2014 12:42 PM)Crebman Wrote:  This whole boondoggle is just another way for those in government to "control the strings" in another industry because, well - we all know that controlling the strings means more money funneled to those in power.

Saw "Atlas Shrugged 3" as a guest of the Paul family in a private showing today (Ron has a cameo part). This message really comes through in the film. Talking over later over lunch, I realize that I probably have a different take from many in society because I've worked inside government and seen exactly how this is done, whereas lots of people who haven't probably still believe that government is our friend.

(08-06-2014 07:30 AM)blunderbuss Wrote:  

(08-06-2014 07:19 AM)vandiver49 Wrote:  

(08-05-2014 09:24 PM)dawgitall Wrote:  

(08-05-2014 08:32 PM)Brokeback Flamer Wrote:  I should have said expanded Medicaid patients. There is also discussion of policies offered by companies in the exchange reimbursing at a lower rate than policies offered outside the exchange

So who exactly is discussing this? They are the same policies regardless of whether you walk into the Farm Bureau office, search the blue cross website of browse the exchange. You just can't get a subsidy without going through the exchange. Rates are determined based on one pool, not separate exchange and off exchange pools. I don't see how there would be a distinction drawn between patients that get a subsidy or don't, or buy on or off exchange. The insurance company gets their premium regardless and the providers and the insurance companies negotiate rates. I'd appreciate any sources of these "discussions".

Because its ultimately about the reimbursements of the various insurance companies. Some are within the 90-100% reimbursement while the state insurance within the exchange are around 30-60%. Physicians have costs they need to cover and taking on patients that whose insurance doesn't cover that bottom line can financially cripple them. While is why some are choosing not to accept ACA plans, much like they did with Medicare. The ones that do accept these plans can only make up the difference by increasing the number of patients they see. Which I'm sure you can imagine reduces the quality of the give they give.

These concepts shouldn't be that hard to understand.

I'd like to separate conjecture from facts. Can anyone offer sources for private insurance reimbursements at lower rates for exchange policies?


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