Health insurance premiums going up, thanks to new legislation

[Doc]

it IS making things better from a budgetary stand point. even if one accepts your nihilistic view of the budgeting process, the reform model is still better in a relative sense to what we had from a fiscal perspective.

Not it won't. Not even close. And it doesn't take a "nihilistic view" to realize that. Just a realistic one, that sees the budget trickery used to make this look far cheaper than it will end up costing (hopefully we never find out).

more emphasis on primary care benefits me but it also benefits society as a whole. the systems that produce the best results at the lowest cost worldwide are those that rely heavily on primary care. consider the example of the 20% copay for medicare advanced above. then consider the case of an elderly patient mulling knee replacement. if he's faced with $10k+ of the cost he's more likely to come to me first for joint injections and medical treatment than to jump into an expensive surgery frought with possible complications with marginally better outcomes. thats a win- win.

If it were as simple as everyone seeing his/her primary care doc at least every year and listening to his/her advice, it would be great. Unfortunately it's not nearly that simple. And no, this doesn't help in any regard since people still have no impetus to change their behavior.

[birdog1960]

 

 

If it were as simple as everyone seeing his/her primary care doc at least every year and listening to his/her advice, it would be great. Unfortunately it's not nearly that simple. And no, this doesn't help in any regard since people still have no impetus to change their behavior.

it's as simple as controlling utilization by refusing reimbursement. private insurers do it right now, all the time.

[Alaska Darin]

private insurers do it right now, all the time.

I thought private insurers were the devil.?

[Doc]

it's as simple as controlling utilization by refusing reimbursement. private insurers do it right now, all the time.

So it's bad when the private insurers do it, but okay when the government does it? And basically we'll have the government taking over the role of private insurers, with the attendant rampant government waste and inefficiency. Yes, that will surely improve things and bring down costs!

[erynthered]

So it's bad when the private insurers do it, but okay when the government does it? And basically we'll have the government taking over the role of private insurers, with the attendant rampant government waste and inefficiency. Yes, that will surely improve things and bring down costs!

 

 

He said he had a case study that proves his point. I'm still waiting for the link.

[Magox]

He said he had a case study that proves his point. I'm still waiting for the link.

I wouldn't count on it, he makes up ****. Just like the time when he told us the story about English Doctors pay... Yeah, that was a good story.

[birdog1960]

So it's bad when the private insurers do it, but okay when the government does it? And basically we'll have the government taking over the role of private insurers, with the attendant rampant government waste and inefficiency. Yes, that will surely improve things and bring down costs!

yes, exactly. lets break this down. premises: medicare at best will be solvent in its current iteration til 2029. medicare currently pays the vast majority of health care costs for the elderly and the disabled. if these individuals were forced to buy insurance on the open market, it would be unaffordanle to the vast majority of americans (any guess what the premium would be for a diabetic, cardiac patient age 80? anybody pondering early retirement ever price a policy for a healthy 50 yo?) if medicare were to be privatized, it would have to be hugely subsidized by the govt (eg medicare advantage program), medicare has a cost advantage over private insurance in regards to administrative costs.

 

ok? nothing controversial there..anyone take exception so far?

 

conclusions: govt must be involved in the funding of health insurance if the majority of elderly and disabled are to be covered. medicare needs to cost less to remain solvent. to cut costs substantively, medicare will need to reduce benefits. reducing benefit=rationing which=denying care for some currently covered items.

 

ok so far?

 

here's where i predict the argument starts. Who is in the best position to decide the parameters for rationing? i contend its the govt. the reasons are many and some have already been put forth earlier but the biggest would be: to take profit out of the decision making process, to allow the decisions to be made based on clinical data and societal preferences and to have universal policies follwed for and by all. in the case of medicare, this isn't the govt taking over the role of private insurers but continuing it's current role with stricter, necessary cost controls. once again, private insurance paid for directly by the elderly without govt subsidy (as a sole option) simply isn't an option if we are to cover any significant percentage of this high risk population.

 

the case study is 45 years of medicare. this was cited as evidence that administrative costs in medicare are less than private insurance. this is simply a fact based on data collected over that 45 year period.

Edited September 28, 2010 by birdog1960

[Doc]

yes, exactly. lets break this down. premises: medicare at best will be solvent in its current iteration til 2029. medicare currently pays the vast majority of health care costs for the elderly and the disabled. if these individuals were forced to buy insurance on the open market, it would be unaffordanle to the vast majority of americans (any guess what the premium would be for a diabetic, cardiac patient age 80? anybody pondering early retirement ever price a policy for a healthy 50 yo?) if medicare were to be privatized, it would have to be hugely subsidized by the govt (eg medicare advantage program), medicare has a cost advantage over private insurance in regards to administrative costs.

 

ok? nothing controversial there..anyone take exception so far?

 

conclusions: govt must be involved in the funding of health insurance if the majority of elderly and disabled are to be covered. medicare needs to cost less to remain solvent. to cut costs substantively, medicare will need to reduce benefits. reducing benefit=rationing which=denying care for some currently covered items.

 

ok so far?

 

here's where i predict the argument starts. Who is in the best position to decide the parameters for rationing? i contend its the govt. the reasons are many and some have already been put forth earlier but the biggest would be: to take profit out of the decision making process, to allow the decisions to be made based on clinical data and societal preferences and to have universal policies follwed for and by all. in the case of medicare, this isn't the govt taking over the role of private insurers but continuing it's current role with stricter, necessary cost controls. once again, private insurance paid for directly by the elderly without govt subsidy (as a sole option) simply isn't an option if we are to cover any significant percentage of this high risk population.

 

the case study is 45 years of medicare. this was cited as evidence that administrative costs in medicare are less than private insurance. this is simply a fact based on data collected over that 45 year period.

No doubt the case study was done by the government. It defies all logic to claim that the government is more efficient than the private sector when it comes to controlling costs. And as complex as Medicare was before, things will be several-fold more complex if the government is becomes single-payer.

 

As for the government having to continue to be involved in Medicare, of course. But something will have to change in addition to denying service, like raising the age at which it starts to 70.

Edited September 28, 2010 by Doc

[birdog1960]

No doubt the case study was done by the government. It defies all logic to claim that the government is more efficient than the private sector when it comes to controlling costs. And as complex as Medicare was before, things will be several-fold more complex if the government is becomes single-payer.

 

As for the government having to continue to be involved in Medicare, of course. But something will have to change in addition to denying service, like raising the age at which it starts to 70.

or like spreading risk over a much larger segment of the population including young, healthy people. the problem with increasing the age requirement is that this worsens the unemployment picture by delaying retirement for many people (as does increasing the age for SS benefits).

 

btw, i never said cost cutting was limited to rationing, only that it will be required for substantial savings....and for the umpteenth time-administrative as well as total cost for govt administered medicare are less than privately administered insurance including medicare. in the case of medicare advantage programs, total cost to insure was up to 20% higher when administered through private insurers (even thought taxpayers pay the cost of both programs). please cite a reference that shows otherwise.

[KD in CA]

Maybe the govt should have camps where they send people who "don't take better care of themselves," .............

 

Oh yeah, did I mention that we are a free country?

 

Who sets the standard? Skinny guy? Fat guy? How about athletes? Maybe if you can't run a mile in under 9 minutes?

 

Can you see where this is going?

 

 

Which is why the gov't should just stay the f&^# out of it altogether and let people manage their own health, and make their own decisions about whether to purchase insurance for that (and any other) purpose.

 

p.s. Free country? :lol: That's a hoot.

[birdog1960]

Which is why the gov't should just stay the f&^# out of it altogether and let people manage their own health, and make their own decisions about whether to purchase insurance for that (and any other) purpose.

 

p.s. Free country? :lol: That's a hoot.

you should consider running for office on that position. it's a sure winner.

Edited September 28, 2010 by birdog1960

[OCinBuffalo]

or like spreading risk over a much larger segment of the population including young, healthy people. the problem with increasing the age requirement is that this worsens the unemployment picture by delaying retirement for many people (as does increasing the age for SS benefits).

 

btw, i never said cost cutting was limited to rationing, only that it will be required for substantial savings....and for the umpteenth time-administrative as well as total cost for govt administered medicare are less than privately administered insurance including medicare. in the case of medicare advantage programs, total cost to insure was up to 20% higher when administered through private insurers (even thought taxpayers pay the cost of both programs). please cite a reference that shows otherwise.

1. You cannot add a whole crapload of Demand to a model, while holding supply constant, and not expect to see the price go up.

 

2. Due to #1, in your model cost is almost irrelevant, because who cares what the exact cost is if the price is 2-3x more?

 

3. As a person who works with health care providers on at least a weekly basis, deep into the guts of their business processes, where especially doctors fear/refuse to tread...I can tell you that your "Insurance company administrative cost" argument is f'ing peanuts...when you compare it to how much money is wasted by the average provider.

 

4. To be clear: 80% of that waste is due to d-bags that neither provide care or receive it. The malpractice nonsense causes a ton of unnecessary cost. The government's amateur attempts at quality control, and cost control, end up costing the entire system 5-10x more than they are worth, and fail miserably at preventing fraud, which costs even more, and top of that adds even more useless government employees to the states' budget. Doctors are constantly being pushed by outsiders to over-prescribe drugs.

 

5. The average health care provider staff is beset by the terrible notion that "we take care of people, therefore, we don't have to manage ourselves or our employees". I have news for you: a lot of us have super special jobs that nobody else can do, that doesn't mean we don't have to be managers. Sloppy management runs wild top to bottom and across all sectors of health care, and there's really no excuse for it.

 

The insurance company "administrative cost" argument is nickels compared to #4-5's dollars, and even the wonk Democrats know it. The only people who won't admit it are the blowhard Democrats. And, to be fair, I bet there are some clueless Republicans that aren't even aware of any of this.

[birdog1960]

1. You cannot add a whole crapload of Demand to a model, while holding supply constant, and not expect to see the price go up.

 

2. Due to #1, in your model cost is almost irrelevant, because who cares what the exact cost is if the price is 2-3x more?

 

3. As a person who works with health care providers on at least a weekly basis, deep into the guts of their business processes, where especially doctors fear/refuse to tread...I can tell you that your "Insurance company administrative cost" argument is f'ing peanuts...when you compare it to how much money is wasted by the average provider.

 

4. To be clear: 80% of that waste is due to d-bags that neither provide care or receive it. The malpractice nonsense causes a ton of unnecessary cost. The government's amateur attempts at quality control, and cost control, end up costing the entire system 5-10x more than they are worth, and fail miserably at preventing fraud, which costs even more, and top of that adds even more useless government employees to the states' budget. Doctors are constantly being pushed by outsiders to over-prescribe drugs.

 

5. The average health care provider staff is beset by the terrible notion that "we take care of people, therefore, we don't have to manage ourselves or our employees". I have news for you: a lot of us have super special jobs that nobody else can do, that doesn't mean we don't have to be managers. Sloppy management runs wild top to bottom and across all sectors of health care, and there's really no excuse for it.

 

The insurance company "administrative cost" argument is nickels compared to #4-5's dollars, and even the wonk Democrats know it. The only people who won't admit it are the blowhard Democrats. And, to be fair, I bet there are some clueless Republicans that aren't even aware of any of this.

clearly there's waste...enormous waste and a fair amount of fraud. i had a rep from a scooter company come in with a patient to an appt after she saw him walking more slowly than everyone else in mcdonalds. dtc drug advertising should've been outlawed years ago (like it is everywhere else in the world). crooked durable medical equipment dealers are as common as garden slugs...and the list goes on. there exist multi specialty physician groups in the US that are very efficient (geisinger and mayo come immediately to mind) yet their costs are still higher than many groups in socialized national systems no argument here concerning waste and defensive medicine spawned from the threat of malpractice.

 

so...how do you propose fixing it? i propose best practice guidelines (ie protocols) set by a national board of experts (primarily clinicians but with the token ethicist and requisite bureaucrat thrown in) with safe harbors for malpractice buuilt in. fraud and abuse must be vigilantly and ruthlessly monitored and prosecuted. the private sector hasn't been wildly successful in these matters either in the health care arena. it's really only the govt that can adequately address the problems. if the govt lacks the will to do it, it won't change but if they aren't given the tools, we'll never know if they have the will. what's your proposed solution?

 

and you can add demand with constant supply and control cost if you are the sole payor and determiner of price.

Edited September 29, 2010 by birdog1960

[OCinBuffalo]

clearly there's waste...enormous waste and a fair amount of fraud. i had a rep from a scooter company come in with a patient to an appt after she saw him walking more slowly than everyone else in mcdonalds. dtc drug advertising should've been outlawed years ago (like it is everywhere else in the world). crooked durable medical equipment dealers are as common as garden slugs...and the list goes on. there exist multi specialty physician groups in the US that are very efficient (geisinger and mayo come immediately to mind) yet their costs are still higher than many groups in socialized national systems no argument here concerning waste and defensive medicine spawned from the threat of malpractice.

 

so...how do you propose fixing it? i propose best practice guidelines (ie protocols) set by a national board of experts (primarily clinicians but with the token ethicist and requisite bureaucrat thrown in) with safe harbors for malpractice buuilt in. fraud and abuse must be vigilantly and ruthlessly monitored and prosecuted. the private sector hasn't been wildly successful in these matters either in the health care arena. it's really only the govt that can adequately address the problems. if the govt lacks the will to do it, it won't change but if they aren't given the tools, we'll never know if they have the will. what's your proposed solution?

 

and you can add demand with constant supply and control cost if you are the sole payor and determiner of price.

Well, you asked for it...can't wait to hear the crying about the length of this post. These problems are large and complicated, therefore, defining the solution can't be done in 2 sentences. Only a simpleton looks for a simple story here. And hey, some people write entire books on this. I have kept it to a page.

 

Last thing first: NO, you can't. The market price is by definition what the market will pay. You can artificially set that price, but regardless of your scheming that market price will remain. For example, Canada may have set it's prices for health care...but that doesn't stop those Canadians that can from paying market price for QUALITY, or timely, health care here. The market price will always exist, regardless of all socialist machinations.

 

As far as your solutions, I don't see how they hurt, other than to say that giving care in Florida is by definition different than in Maine, and we have to make sure we remember that. You want the tools? We have them. And, the reason the "private sector" hasn't been good for health care is: the JV team has been working in your industry for a long time. I can prove this with voluminous technical detail if required.

 

As far as my "proposed" solution? There's nothing "proposed" about it. We do this, daily. It comes down to our simple insistence that we, all of us, tell each other the truth about what is happening in our health care organization, every day, all the time. IF we document every single detail of what we do, and how we correct what we do, in real time, then we take the "negligence" argument away, and kick the d-bag lawyers to the curb. The question is always how, and we have the how.

 

A few simple premises that our "thingy", because it's not a "solution" in the traditional sense, is based on(some of these are old standbys, some are not):

 

1. If you don't know what you, or your organization, are doing, in real time, there's no way you can do anything to fix it, in real time. Finding out tomorrow, that I was doing something dumb today doesn't help, and allows the d-bag surveyors, lawyers, etc., their opening.

 

2. You can't know the cost of doing business, if you don't know what your business activities actually cost you. Or, in this case, you can't talk about controlling the cost of care...if you don't know why and what costs you need to work on.

 

3. You can't know why and what costs you need to work on, if you don't know what each individual thing you do costs, both direct and indirect and including materials.

 

4. You can't stop fraud, if you can't monitor what each individual thing that was done costs, and determine if variance is due to fraud, or, that Mr. Jones simply crapped in the bathtub, which made the bath take twice as long as expected.

 

5. EMR, Integration, and basically everything you will hear at HIMMS does exactly 0 to measure and therefore control cost. Worse, it assumes "quality of care" is about patient outcomes. This is fundamentally flawed, and it's clear evidence of the amateurism of government employees/JV team private sector flailing about trying to do our job.

a. Care needs to be a verb, not a noun. Patients may determine what we do, but not HOW we do it, and HOW we do it = quality. This fundamental misunderstanding of how quality assurance works, and how to apply its concepts properly, is the root cause of all kinds of buffoonery.

b. If we are going to measure giving care, our focus must be on the care giver, not the outcome. You can't establish standards of performance...or performance indicators, based on patients. They are simply too varied. Instead we have to establish what a "good" task looks like and then measure how often we get it done properly and on time. Once we do that, we can figure out what wastes money, why, and attack it. This is not time motion, so don't even start. This is work sampling with some specific mods for health care, and some original thought as well. In essence, our "sample" never ends.

c. The reason teams practice, and don't simply play games, is because they seek to get better at the fundamentals and/or skills. If our health care organization only focuses on the scoreboard at the end of the game(the patient outcome), and not what we did well/poorly during it(the tasks we do individually and as a team), then we have no chance at getting better as a team.

 

6. If we don't start getting sound raw data collected in health care...all the rest of the IT heavy artillery that has been/can be brought to bear is irrelevant. Example: Using business intelligence design patterns to predict falls in long term care is stupid if you can't accurately determine how many baths, who gives them/assist/independent etc., and when residents get them. Obama etc. keep talking about electronic medical records and integration. Both are 100% dependent on the quality of the raw data collected. It doesn't matter how many Billions of dollars are spent on what comes after bad raw data collection, it will fail.

 

7. Care providers don't work at desks. They work on the floor/unit/room/bed whatever. Therefore, giving care providers desktop oriented solutions is patently retarded. Worse, taking existing desktop solutions and attempting to bastardize them into mobile ones is even more retarded. Putting things on the wall simply means standing in line, and most care providers don't have that kind of time. Given this, and the amount of paper that is still in use in 2000 f'ing 10, it's not a shocker that most raw data is inaccurate, incomplete, or non-existent altogether.

 

8. Care providers need a vehicle they can use and put away, in less than 6 seconds. I have seen desktop computers attached to walls, collecting dust, and, laptop computers pushed around on carts, getting in the way....because people want to push their tired old crap on doctors/nurses/therapists/etc, and these providers end up rejecting these systems, hence the dust.

 

9. Things change, period. If solutions are designed around the Microsoft model, which is about 90% of health care software right now, then, when things change, you wait. Things change in health care at a much more rapid pace than in many other industries. So, you are likely to be waiting longer and for more things. And there's no guarantee that the change you get is the change you need. It may work for others, but usually nobody gets 100% of what they want. Unlike tired old Microsoft, etc., we don't make our clients wait for the next version to come out. We have innovated, and can roll immediate changes, not patches, broad or specific, for the whole group or a single user, because, changing literally everything, without performance hits, is inherent to the design.

 

10. People want to control the software they use. Literally everybody at least hates some part of the next version of Windows, but what the hell can they do about it? Due to our ability to change, or not change, ever, you get to decide on every detail of how your extension of our "thingy" works...if you want to. Or, you can just go with whatever somebody else built. It makes no difference to us, because this is also inherent to the design. In all cases, our integrations to other systems, health care or otherwise, are still uniform, even if your extension is completely different than the next guy's. Nice trick, huh? This is how we get $8/hr CNAs, housekeepers, etc. to buy in....and for that matter, $2000/hr docs as well.

 

These are some of the the primary premises of what we do, there are many more, but you aren't paying me, so you don't get them. I don't allow us to stray from any of them.

 

Right now, the ONLY way a health care provider can qualify as an "accountable care"(hysterical, because that was literally our old codename for this) provider under the new "meaningful use" standards that are coming is to implement something like our "thingy". We are it right now, unless there are other start-ups I don't know about...and that makes me smile

[Magox]

Maybe Mcdonalds won't be serving up aNot So Happy Meal.

 

McDonald's Corp. has warned federal regulators that it could drop its health insurance plan for nearly 30,000 hourly restaurant workers unless regulators waive a new requirement of the U.S. health overhaul.

 

The move is one of the clearest indications that new rules may disrupt workers' health plans as the law ripples through the real world.

 

Corporations have already written down Billions of dollars in losses, small businesses and corporations are burdened with the $600 Tax deal, premiums have increased partially because of the health insurance law, health insurance companies are dropping coverage for single kid policies in certain states and now we are beginning to see corporations considering dropping health insurance for employees. We said this would happen during the debate, we said that companies that offer health insurance to low level employees will have to be dropped because it doesn't make economic sense for them to keep it.

 

All these things have happened AND it's only been 6 months since the health insurance law has been enacted.

 

The fact that this bill doesn't even come close to addressing costs is truly embarrassing...

[birdog1960]

Well, you asked for it...can't wait to hear the crying about the length of this post. These problems are large and complicated, therefore, defining the solution can't be done in 2 sentences. Only a simpleton looks for a simple story here. And hey, some people write entire books on this. I have kept it to a page.

 

Last thing first: NO, you can't. The market price is by definition what the market will pay. You can artificially set that price, but regardless of your scheming that market price will remain. For example, Canada may have set it's prices for health care...but that doesn't stop those Canadians that can from paying market price for QUALITY, or timely, health care here. The market price will always exist, regardless of all socialist machinations.

 

As far as your solutions, I don't see how they hurt, other than to say that giving care in Florida is by definition different than in Maine, and we have to make sure we remember that. You want the tools? We have them. And, the reason the "private sector" hasn't been good for health care is: the JV team has been working in your industry for a long time. I can prove this with voluminous technical detail if required.

 

As far as my "proposed" solution? There's nothing "proposed" about it. We do this, daily. It comes down to our simple insistence that we, all of us, tell each other the truth about what is happening in our health care organization, every day, all the time. IF we document every single detail of what we do, and how we correct what we do, in real time, then we take the "negligence" argument away, and kick the d-bag lawyers to the curb. The question is always how, and we have the how.

 

A few simple premises that our "thingy", because it's not a "solution" in the traditional sense, is based on(some of these are old standbys, some are not):

 

1. If you don't know what you, or your organization, are doing, in real time, there's no way you can do anything to fix it, in real time. Finding out tomorrow, that I was doing something dumb today doesn't help, and allows the d-bag surveyors, lawyers, etc., their opening.

 

2. You can't know the cost of doing business, if you don't know what your business activities actually cost you. Or, in this case, you can't talk about controlling the cost of care...if you don't know why and what costs you need to work on.

 

3. You can't know why and what costs you need to work on, if you don't know what each individual thing you do costs, both direct and indirect and including materials.

 

4. You can't stop fraud, if you can't monitor what each individual thing that was done costs, and determine if variance is due to fraud, or, that Mr. Jones simply crapped in the bathtub, which made the bath take twice as long as expected.

 

5. EMR, Integration, and basically everything you will hear at HIMMS does exactly 0 to measure and therefore control cost. Worse, it assumes "quality of care" is about patient outcomes. This is fundamentally flawed, and it's clear evidence of the amateurism of government employees/JV team private sector flailing about trying to do our job.

a. Care needs to be a verb, not a noun. Patients may determine what we do, but not HOW we do it, and HOW we do it = quality. This fundamental misunderstanding of how quality assurance works, and how to apply its concepts properly, is the root cause of all kinds of buffoonery.

b. If we are going to measure giving care, our focus must be on the care giver, not the outcome. You can't establish standards of performance...or performance indicators, based on patients. They are simply too varied. Instead we have to establish what a "good" task looks like and then measure how often we get it done properly and on time. Once we do that, we can figure out what wastes money, why, and attack it. This is not time motion, so don't even start. This is work sampling with some specific mods for health care, and some original thought as well. In essence, our "sample" never ends.

c. The reason teams practice, and don't simply play games, is because they seek to get better at the fundamentals and/or skills. If our health care organization only focuses on the scoreboard at the end of the game(the patient outcome), and not what we did well/poorly during it(the tasks we do individually and as a team), then we have no chance at getting better as a team.

 

6. If we don't start getting sound raw data collected in health care...all the rest of the IT heavy artillery that has been/can be brought to bear is irrelevant. Example: Using business intelligence design patterns to predict falls in long term care is stupid if you can't accurately determine how many baths, who gives them/assist/independent etc., and when residents get them. Obama etc. keep talking about electronic medical records and integration. Both are 100% dependent on the quality of the raw data collected. It doesn't matter how many Billions of dollars are spent on what comes after bad raw data collection, it will fail.

 

7. Care providers don't work at desks. They work on the floor/unit/room/bed whatever. Therefore, giving care providers desktop oriented solutions is patently retarded. Worse, taking existing desktop solutions and attempting to bastardize them into mobile ones is even more retarded. Putting things on the wall simply means standing in line, and most care providers don't have that kind of time. Given this, and the amount of paper that is still in use in 2000 f'ing 10, it's not a shocker that most raw data is inaccurate, incomplete, or non-existent altogether.

 

8. Care providers need a vehicle they can use and put away, in less than 6 seconds. I have seen desktop computers attached to walls, collecting dust, and, laptop computers pushed around on carts, getting in the way....because people want to push their tired old crap on doctors/nurses/therapists/etc, and these providers end up rejecting these systems, hence the dust.

 

9. Things change, period. If solutions are designed around the Microsoft model, which is about 90% of health care software right now, then, when things change, you wait. Things change in health care at a much more rapid pace than in many other industries. So, you are likely to be waiting longer and for more things. And there's no guarantee that the change you get is the change you need. It may work for others, but usually nobody gets 100% of what they want. Unlike tired old Microsoft, etc., we don't make our clients wait for the next version to come out. We have innovated, and can roll immediate changes, not patches, broad or specific, for the whole group or a single user, because, changing literally everything, without performance hits, is inherent to the design.

 

10. People want to control the software they use. Literally everybody at least hates some part of the next version of Windows, but what the hell can they do about it? Due to our ability to change, or not change, ever, you get to decide on every detail of how your extension of our "thingy" works...if you want to. Or, you can just go with whatever somebody else built. It makes no difference to us, because this is also inherent to the design. In all cases, our integrations to other systems, health care or otherwise, are still uniform, even if your extension is completely different than the next guy's. Nice trick, huh? This is how we get $8/hr CNAs, housekeepers, etc. to buy in....and for that matter, $2000/hr docs as well.

 

These are some of the the primary premises of what we do, there are many more, but you aren't paying me, so you don't get them. I don't allow us to stray from any of them.

 

Right now, the ONLY way a health care provider can qualify as an "accountable care"(hysterical, because that was literally our old codename for this) provider under the new "meaningful use" standards that are coming is to implement something like our "thingy". We are it right now, unless there are other start-ups I don't know about...and that makes me smile

i'm somewhat familiar with the issues that you address. we've had an EMR since about 1999. it's constantly upgraded yet i find it very user unfriendly and actually adds significant time to my work day rather than saving time. i hear this complaint from most of my colleagues. most systems also end up producing "cookie cutter" notes in which 2/3 of the note is filler or regurgitation of previously documented data. when will we have an accurate voice recognition system with the ability to meaningfully parse notes? this seems to be the holy grail of emr.

 

i agree that whole books have been written on the subject. if you read Daschle's book then you can see that i fundamentally agree with his approach. this however involves wholesale change to the current system rather than incremental efficiency changes (which i agree, need incorporation).

 

in regards to cost versus price, health care has not had an open market for decades. private insurers take their lead from medicare in valuing services in almost every instance. it is difficult and sometimes illegal for me to "collude" with my colleagues to negotiate prices. an example in the us that refutes your point is drug costs. most drugs can be bought in other countries for much less but americans are legally forbidden to buy them from these places.

 

in short, exclusive of the problems you put forth (which are real and important), the primary cause of the high cost of health care in the us is greed. take the profit making possibilities out and much of this (fraud and abuse, malpractice threats, defensive medicine etc) goes away.

[IDBillzFan]

The fact that this bill doesn't even come close to addressing costs is truly embarrassing...

Yes, but 30 million previously uninsured people have coverage now, even though they don't, and that is all that's important. Plus...y'know...the status quo was unacceptable, so we had to do something, even if the something was worse than the status quo, at least something was done, and now the Dems have this big effin' deal they can promote during the mid-term campaigns about to start. Just wait until you hear all the Dems promote how proud they are of this legislation.

[Joe Miner]

Yes, but 30 million previously uninsured people have coverage now, even though they don't, and that is all that's important. Plus...y'know...the status quo was unacceptable, so we had to do something, even if the something was worse than the status quo, at least something was done, and now the Dems have this big effin' deal they can promote during the mid-term campaigns about to start. Just wait until you hear all the Dems promote how proud they are of this legislation.

 

You write this with mocking sarcasm.

 

What's incredibly sad are the left-wing pundits bashing the democrats for not proudly standing up for these very same accomplishments.

 

60+% of the country doesn't/didn't want it to pass. It's so bad none of the people that passed it are talking about it, but these bozos in front of various TV cameras feel that it's really the linchpin for the success of the democratic party in a month.