halbert said...
I was fortunate when my 35 yr+ career ended 2 years ago (at 58) that I was eligible for retiree medical insurance to keep me going until Medicare kicks in.
That being said--and this is difficult to do without getting political--part of the answer does lie with us, the voting citizens. In a way, we have to decide what we are willing to do without personally in order to improve the system for everyone.
It was summed up nicely in a article I remember reading in the early 90's, where the writer (I don't remember who), pointed out that we want 3 things from the system--unfortunately we can only get 2 out of 3. Any 2 are possible, but the third will not fit. The 3 things are:
1. The latest and greatest technologies and advancements (in our case, think Proton beam RT)
2. Low cost to whomever is picking up the tab (government/insurer/us as individuals)
3. Easy access/short waits/no waits/available everywhere
Finding the balance point is the answer. And, in the US, we have the added insanity of how the market and economics actually work. From a pure economic standpoint, how can any entity stay in business for long when they write off anywhere from 30%-75% of their total billings? Or are the list prices simply numbers that have no reflection on any real cost to the provider?
Good points!
However, I would answer to "how can any entity stay in business for long when they write off anywhere from 30%-75% of their total billings?": In part, because the billing is so preposterous to start with that some providers are able to make a fine living even after the staggering reduction in payments. Don't you ever wonder how our RP docs are getting by - maybe even living real high on the hog - when most of their patients are on Medicare? I speak from personal experience on this.
For example, my last few years before retiring from anesthesia(CRNA) were spent driving over to the MS delta a couple of days a week, where I worked with a dental surgeon who also drove up from Jackson, MS. I would put these kids to sleep, then he would yank all their rotting teeth and replace with implants, they called it "getting a rack". These patients- sometimes an entire family would get this done including the adults, but mostly kids - were 100% medicaid. No exceptions. Now if you or I went to our private dentist and had this done- all our teeth pulled and replaced- at the surgery center or hospital, under general anesthesia, I can't even imagine the billing. Probably 20K-35K, and most likey insurance would not pay to replace our teeth that we had allowed to rot out.
But this dentist was happy to make a living driving around to rural MS hospitals and doing it for the pittance MC would pay him. So what kind of living was that? ( and of course I made a good living off of what the hospital paid me to come give anesthesia, and the hospital made money also). Well, he told me that the gov paid him an all inclusive fee of $400 per patient, no billing hassles involved, guaranteed payment. Would you do this for a living?
He would arrive at about
0730 as I was getting the 1st child to sleep. He would take an average of 10-30 minutes to get the job done per patient, and do 10-12 cases by noon-1330. Then go back home. Then repeat the next day at different hospitals across the state. Then be off- no call at night or weekends, a real stress point for most medical types.
So, $400 per patient X 12 patients(sometimes 15+!) = guaranteed $4800 per day. Then off about
noon until the next morning(but plus commute time). Times even 4 days a week = $19,200 per week, times say 48 weeks a year(with 4 weeks vacation) = $921,600 per year. Less if he only gets 2 or 3 days a week, but still, would you work to noon 4 days a week for that measly Medicaid pay of $19,200 per week? $400 is a huge reduction from what he would charge me in his office, but still very lucrative compared to what the average Joe can earn at a job, and plenty are still happy to do it, so far.