(10-07-2014 03:12 PM)BobL Wrote: People like me?? WTF
Yes, people like you who think that a promise to pay is the same as cash.
Quote:Call it what you like the fact remains without insurance you will not get an appt. so therefore the folk who own these dr practices now also own the hospitals and are essentially saying we will treat you but only where it is 10x the cost.
This is even MORE factually inaccurate. You ignore the cost of insurance when you compare prices for insured vs uninsured. Yes, your insurer pays far less for your care than you would, because your insurer can't declare bankruptcy to avoid paying your claims (there is a fund to pay them if they do). In fact, doctors that are part of HMOs essentially schedule you far enough in advance so as to avoid many appointments... you often get well or lose the symptoms before you can see them... because they get paid the same whether or not they see you or you show... as long as they see #X patients per period. You're not even describing a current business model.
No, doctors didn't have to take you... and they still don't. Yes, you have more options as a result, but only by taking that appointment time away from someone else. There isn't a glut of physicians out there with empty waiting rooms. Instead of having to go to the hospital sponsored clinic, you can now go elsewhere. Good for you, bad for the hospital because THAT care covered much of their overhead.
Quote:The Bismark model requires everyone have insurance...that is point one in my book and always has been. You want a true open and free market in "health care" then everyone needs insurance.
Nobody said it wasn't. Health Insurance is worthless without providers to deliver the care.
Quote:My point about the hospitals in my area has nothing to do with Obamacare, I used it as an example of over saturation due to excessive competition among the health care corporations in my area that will result in even more costs passed along to us in the end. These healthcare corporations are trying to win "customers" by being more convenient, closer to home, and opening urgent cares everywhere. I maintain there are not enough "customers" in my area to sustain this thereby increasing costs. I also stated this has been going on long before ACA.
In what business world does excessive competition lead to higher costs?
The urgent care centers opened because they get ER-like reimbursement (higher than your PCP) for providing PCP-like care. Unlike the ER, they don't have to treat you. MOst of that extra expense comes from people who CHOOSE to see that facility because they can charge you the $50-100 ER copay rather than the $15-$35 PCP copay for the same care.... but they get the same amount from the insurer as the PCP, which is less than the ER. It lowers, not raises overall costs... and the more there are, they more they have to compete on 'copay'. They may see somewhat higher acuity patients so a study might show they get paid slightly more for their 'average' patient than a PCP, but if the PCP saw that same acuity, the reimbursement would be the same... and less than the ER.
Quote:Ya you work in health care...I look at it from my point of view as the "customer".
I have 2 college age children that I support on my own. I look at it as a consumer as well.
Quote:FWIW My sister inlaw lived in Germany for 3 years, her hospital stay when her daughter was born(1994) was 2 weeks, that a normal pregnancy, no complications for baby or mom. The Bismark system was developed and still used in Germany. I'd be happy for it here, but then that would be another government mandate....everyone must be covered!
My son's fiance is a German national and her parents are EXTREMELY liberal. (her mother won't travel, even for their wedding if she can't make it some sort of 'humanitarian' trip). We've had this discussion numerous times.
The biggest difference by far is that virtually nobody in the country is more than a few hours from a major city so they can consolidate many services in those cities and share overhead. We aren't set up that way and it is difficult to imagine a way we could be. Even the VA (which best I can tell was essentially modeled after this or is at least as close as we have come) outsources their care to HMOs in rural areas of this country.