The US Healthcare Mass Debate

[Tero]

America for You

. For example, there are different codes for in-office earwax removal depending on the method used (irrigation or instruments), different codes for delivering different vaccinations and a code for each injection delivered in the hospital. Different insurers also use different coding systems.

Seemingly subtle choices about which code to use can have large financial consequences. If after reviewing a hospital chart of, say, a patient who has just had a problem with his heart, a hospital coder indicates the diagnosis code for “heart failure” (ICD-9-CM Code 428) instead of the one for “acute systolic heart failure” (Code 428.21), the difference could mean thousands of dollars. “In order to code for the more lucrative code, you have to know how it is defined and make sure the care described in the chart meets the criterion, the definition, for that higher number,” says one experienced coder in Florida, who helped with Wickizer’s case and declined to be identified.

. In a doctor’s office, a Level 3 visit (paid, say, at $175) might be legally transformed into a Level 4 (say, $225) by performing one extra maneuver, like weighing the patient or listening to the lungs, whether the patient’s illness required that or not.

For-profit colleges offered medical-coding degrees, and internships soon followed. Because alphanumeric coding languages are as distinct from one another as Chinese is from Russian, different degree tracks are necessary, along with distinct professional organizations that offer their own particular professional exams, certifications and licensing. Hospital systems and insurers — which have become huge, Hydra-like enterprises — now all employ roomfuls of coding-program graduates to perform these tasks. Membership in the American Academy of Professional Coders has risen to more than 170,000 today from roughly 70,000 in 2008.

[pErvinalia]

That sounds like satire. Is it real?

[Scot Dutchy]

Boy am I glad I live in a civilised country.

[Brian Peacock]

Medicaid has admin costs of c.2%. Health insurers have admin costs of c.12%.

[Tero]

Trump bill will be even more hated than Obamacare, so it will lead to the issue being the one that takes the House from GOP two years from now.
The House GOP Health Care Bill Is Very Much Alive
....bill that would violate a key promise from President Donald Trump, namely that insurers would have to offer plans to people with pre-existing conditions.
http://www.huffingtonpost.com/entry/hou ... a923b14b10

[Tero]

There is a reason that many conservatives want to do away with these provisions. Because they help people with substantial health care needs buy relatively affordable coverage, they drive up the price of insurance for people who are healthy. An insurance market that did not include cancer care — or even any cancer patients — would be one where premiums for the remaining customers were much lower. The result might be a market that is much more affordable for people with a clean bill of health. But it would become largely inaccessible to anyone who really needs help paying for medical care.

https://www.nytimes.com/2017/04/04/upsh ... .html?_r=0

[Tero]

Why an Open Market Won’t Repair American Health Care

https://mobile.nytimes.com/2017/04/04/b ... oogle.com/
Rosenthal thinks the health care market is different, and she sums up these differences as the “economic rules of the dysfunctional medical market.” There are 10 — some obvious (No. 9: “There’s money to be made in billing for anything and everything”); some humorous (No. 2: “A lifetime of treatment is preferable to a cure”) — but No. 10 is the big one: “Prices will rise to whatever the market will bear.” To Rosenthal, that’s the answer to Scalia’s question. The health care market doesn’t work like other markets because “what the market will bear” is vastly greater than what a well-functioning market should bear. As Rosenthal describes American health care, it’s not really a market; it’s more like a protection racket — tolerated only because so many different institutions are chipping in to cover the extortionary bill and because, ultimately, it’s our lives that are on the line.

Consider the epicenter of America’s cost crisis: the once humble hospital. Thanks in part to hit TV shows, we think of hospitals as public-spirited pillars of local communities. Yet while most are legally classified as nonprofits, they are also very big businesses, maximizing surpluses that can be plowed into rising salaries and relentless expansion even when they are not earning profits or remunerating shareholders. And they have grown much bigger and more businesslike over time.

[Brian Peacock]

There is a reason that many conservatives want to do away with these provisions. Because they help people with substantial health care needs buy relatively affordable coverage, they drive up the price of insurance for people who are healthy. An insurance market that did not include cancer care — or even any cancer patients — would be one where premiums for the remaining customers were much lower. The result might be a market that is much more affordable for people with a clean bill of health. But it would become largely inaccessible to anyone who really needs help paying for medical care.

https://www.nytimes.com/2017/04/04/upsh ... .html?_r=0

Trumpcare is going to create the perfect insurance environment, in which everyone will be comprehensively insured right up to the point when you want to make a claim.

[Tero]

Shameful help:
But America's conservative establishment, particularly in rural and poor states, has done a superb job of convincing the people who most need government's help that asking for it is shameful — it's socialism and it's evil — and that they should effectively vote against their own economic self-interest.

http://www.cbc.ca/beta/news/opinion/ame ... -1.4055389

[Tero]

Middle of the road Republicans want to keep most of Obamacare
http://www.businessinsider.com/gop-obam ... ent-2017-4

[Brian Peacock]

Freedom Caucus and chums looking to allow insurers to set their own prices for people with pre-existing conditions. The scam is that it will allow them to claim insures have to offer insurance to the sick, but the insurers will be free to prohibitively price the products. Yeah, STOP PRESS, health insurers are only interested in insuring healthy people.

[Tero]

Reuters

U.S. President Donald Trump told the Wall Street Journal on Wednesday that he might consider withholding billions of dollars of Obamacare payments to health insurers to force Democrats back to the negotiating table on healthcare.

Insurers and major medical groups have warned that not funding the payments, called cost sharing reduction subsidies, which help cover out-of-pocket medical expenses for low-income Americans, could wreak havoc in the individual insurance markets. Trump told the Wall Street Journal that by withholding the payments, Democrats will call him to negotiate.

(Reporting By Yasmeen Abutaleb; Editing by Chizu Nomiyama)

[Animavore]

Scumbag.

[JimC]

Reuters

U.S. President Donald Trump told the Wall Street Journal on Wednesday that he might consider withholding billions of dollars of Obamacare payments to health insurers to force Democrats back to the negotiating table on healthcare.

Insurers and major medical groups have warned that not funding the payments, called cost sharing reduction subsidies, which help cover out-of-pocket medical expenses for low-income Americans, could wreak havoc in the individual insurance markets. Trump told the Wall Street Journal that by withholding the payments, Democrats will call him to negotiate.

(Reporting By Yasmeen Abutaleb; Editing by Chizu Nomiyama)

No they wouldn't. They would love to see another Trump-caused chaotic mess, demonstrably hurting ordinary Americans...

[Tero]

GOP willing to dump money on insurance companies rather than give citizens dreaded subsidies:
https://www.usatoday.com/story/news/pol ... 100323512/

Alaska already does this.