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Author Topic: Healthcare - Interesting Story
JoshuaD
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http://sacramento.cbslocal.com/2011/07/07/call-kurtis-i-dont-have-insurance-dont-take-me-to-the-hospital/

quote:
Some have been forced in this economy to drop their pricey medical insurance. A Loomis man without coverage says first responders forced him to the hospital after his motorcycle crash. Now he faces more than $40,000 in bills he doesn’t feel he should have to pay.

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Chael
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Well..

Judging by the last few lines of the article, this guy isn't an example of people who don't have medical insurance because they can't afford it, so that's a bit of a non sequitur on the part of the journalist. If he'd connected the dots to his point in more of an op ed sort of fashion ('this happened to this guy, it /could/ happen to others'), okay, but as it is, it's just misleading.

I've been considering the rest of it, and I'm interested in what you think of it, Joshua. On the one hand, I can see how it might be difficult for people who have made a profession out of saving lives to not give care in this situation, whether or not their licenses were on the line. The guy had head trauma; he may not have been coherent enough to think the situation through. On the other hand, people should have the right to say what they do and don't want done with their bodies.

Telling him to pay for services he didn't want is chutzpah, but I'm not sure it's the real issue--not when the state and the clinic have financial assistance programs, at any rate. Perhaps you think differently?

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threads
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There isn't an easy fix to this problem. Paramedics can't really ask patients for consent on treatment because an injured patient may not be in a suitable mental state to give consent. Given that the guy had a concussion and a broken eye, I think it's clear that the paramedics were correct in bringing him to the hospital. The real issue here is the absurd cost of medical bills. Doctors pay an enormous amount of money for insurance and that cost gets passed on to patients and insurance companies.
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Redskullvw
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in addition, people with insurance subsidize those who dont as well as the huge shortfalls between what treatment actually cost & what medicare/medicaid/state health plans does not pay.

If the guy had insurance through his motorcycle coverage, then hed be fine. Apparently he doesn't have a medical rider on his motorcycle policy. That likely saved him $100 over a year. He admits he didnt have medical insurance either because he doesn't like going to the doctor. We have no way of knowing what kind of Harley he was driving, or if it is his only vehicle. He may have a car. And He may have been simply out for a recreational bike ride. Judging from the frequency of motorcylce rides that Harley groups hold in Plumas County- two just this month- its plausible that this is a popular place to ride motorcycles recreationally.

So lets say he is a recreational rider. Whats the lowest cost for a decent Harley in California? Around $7,000. So assuming he is a recreataional driver, who has no medical rider on his motorcycle insurance, and is driving an older but mechanically sound Harley, he has choosen to spend $7,000 on a recreational vehicle instead of medical insurance. According to California Health Insurance, the average individual cost for insurance is $4,000 for an individual, $11,000 for a family of 4. Either way, if he is responsible to have health insurance for a family, he cant afford a motorcycle. If he is an individual, he couldn't afford the motorcycle he was riding.

He made a crap choice. They are called donorcycles for a reason. If you are that iresponsible about the potential risks involved in motorcycle operation, you really shouldn't be riding at all.

I have no sympathy for the guy. He made an insanely stupid choice, used his money for personal pleasure, & got F-d up without first being responsible enough to insure his dangerous activity. Would you drive a recreational car with no medical rider? Would you drive your car through rolling scenic roadways without medical insurance? Most people would be responsible and realize medical insurance comes first, then adequate motorcycle insurance, & finally after meeting those two responsible choices only then would you get a motorcycle and go riding.

Instead he hasn't paid any premiums, being irresponsible in the process. Now, after the medical services have likely saved his life due to the usual outcome of head trauma left untreated- ie death- he doesn't want to pay.

What a frigging moron.

He is in this case directly one of the causes why medical treatment is so expensive- unrecovered costs. He can't afford the $40,000 medical bill. Who pays for it? Those who buy health insurance. In this case a good start for the cost recovery would be a court ordered seizure of his motorcycle.

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AI Wessex
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So why are you opposed to the ACA?
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Pete at Home
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That was my impression at first, Red, but on closer look at the story, I'm not so sure:

quote:
Rushed to a hospital in Quincy against his will, doctors then loaded Terry into an air ambulance to Enloe Medical Center in Chico which was the closest trauma center. Terry learned he suffered a concussion and a broken bone around his eye. Against doctor’s orders, he walked out of the hospital and went home only to get slapped with bills totalling more than $40,000 for the care he says he never wanted.
Other than transport and x-rays, what treatment did he actually receive?

Due to the head injury, I don't have problem billing him for transport and initial treatment provided him against his will. But $40,000 under those circumstances sounds like a bill for treatment that wasn't provided. The man walked out. Transport and x-rays should not cost $40k. Even in California.

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threads
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Ambulance rides can run in the $1k range so I imagine that an air ambulance ride is absurdly expensive. $40k is still peculiarly high though.
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AI Wessex
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"Due to the head injury, I don't have problem billing him for transport and initial treatment provided him against his will. But $40,000 under those circumstances sounds like a bill for treatment that wasn't provided."

His billing may not have been different from anyone else, the difference being he didn't have insurance. This is the problem with runaway health care costs in the US, not government attempts to monitor and fix such problems.

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Chael
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The only reason I can think of for it to be that price, runaway health care costs or no, is the air ambulance.

My husband recently had surgery, stayed in the hospital overnight afterwards, etc. The bill was under $30,000. This guy only had diagnostics.

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Redskullvw
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Al

Well when the US government starts paying medicare/medicaid providers the actual cost for the treatments rendered...

And when people who choose not to have insurance, start paying their actual treatment costs...

and when state government health insurance programs start paying the actual treatment costs...

And when illegal aliens start paying the actual costs for their treatments....

It WILL NOt BE THE CASE ANY LONGER that people WITH insurance subsidize those who aren't paying their fair share.

Average insured person's copay cost rises 5% a year due solely to insurance companies attempting to recover unreimbersed costs. Average hospital bill? somewhere between 30%- 40% mark up to offset the unsubsidized cost of treatmenst. Its the whole illegal alien causes a massive accident on a roadway, where the injured party suffered a life changing catastrophic injury that cost in the miilions to treat, while the illegal who did it required over $600k in treatment costs. Real story, left vague due to HIPA rules.

Upshot, the guy left a regional hospital system 2 million in the hole just on the costs of treating the guy who caused the accident and his victim. This why your aspirin from the hospital dispensary costs $12.00 a piece.

Were the USA government to simply enforce its own borders and actually follow its own deportation laws, A VERY LARGE ammount of unreimbursed costs hospitals endure right now would evaporate. In my city, 100k people plus, total shortfall of unreimbursed costs due to treatment of illegals last year $30,000,000.00

That aint chump change.

The Obama laws will be removing my current health care provider in 2015.

The problem is the USA government choosing to monitor and fix a symptom. Instead of the cause.

And yes an obital bone/skull fracture is considered a trauma 1 priority- regardless of what any patient says. Pressuming stabil condition and flight worthiness, if you have such a condition, you will be expedited to a trauma 1 hospital by the most effiecent means possible in correlation to the objective severity of your injury. Being in a boondocks country hospital with such an injury is almost always mean a transfer to a regional health center, and will almost always be via helicopter or plane.

Sorry the guy is worthless and irresponsible. Although ethics and medical oaths prevent it, they paramedics should have accepted his wishes and left him to die.

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AI Wessex
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Right now, people with insurance DO subsidize those who don't have it. If everyone had health insurance and the cost of medical care was constrained to "actual costs" then the problem would go away.

"Sorry the guy is worthless and irresponsible."

And so is the system.

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Redskullvw
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To those not involved in it, yes I could see that conclusion being drawn.

Problem is even IF everyone had health insurance per Obama care, the problem wouldnt go away at all. Why? Uninsured illegals are literally bankrupting the medical system. If you believe that Obama care, by requiring everyone to have healthcare/ or pay an IRS penalty for not having healthcare is going to solve the problem- you are not only incorrect, but also largely ignorant as to the causality of the skyrocketing costs over the last 20 years.

The system used to be able to absorb the American citizens, & legal aliens who for whatever reason did not have health care. They still received treatment. What has literally caused the tidal wave of increasing costs is uncompensated medical expenses for illegal aliens.

I have 115,000 residents where I live who are documented with the census. Of those documented, a certain percentage are illegals. In addition to the documented 115k perople in my city according to the Census, there is an estimated 10,000 to 15,000 additional illegal aliens.

We have a regional healthcare system. This included a regional HMO & PPO program of insurance that is extremely high quality for relatively low rates. This also includes a state wide low income and childrens health insurance program. Somewhere around 20,000 residents in my city are illegal aliens.

They dont have healthcare insurance of any kind.

They never have accurate addresses, identification, credit cards, bank accounts, or legal property.

They get injured, they come straight to the emergency room. They always get full and complete treatment. Whether its because they have heartburn or they have suffered a catastrophic physical injury- they get treated.

If they die, the body often goes as unclaimed as the debts left. If the get better, they always skip payment and vanish from their obligations. Its called millions of dollars literally being given away in charity that isn't ever recovered, and paid for ultimately by people with private insurance.

For every legal census person in my city, the unfunded treatment costs for illegals is a $300 loss. That means, despite any indirect compensation from overcharging insured patients, or maximizing all medicare/medicaid charges to optimize as much of a payment as possible- the citizens of my city collectively have each been left holding a $300 bill from some illegal alien who will never pay that cost.

But wait it gets worse...

Most of the citizens in my city are on welfare and dont pay any taxes aside from sales tax. In addition they get "free healthcare" from the federal, state, & local authorities. The same authorities who decide to raise service fees and taxes associated with hospital usage. About 1/3 of Athenians are under the Federal poverty level. Around 50% are on welfare. So when it comes to who is paying for the costs of healthcare it sure isn't them. That means that the average taxpayer, who is not on welfare & is personally responsible for his own healthcare costs, has a hidden stress of being the only place in the city, by which the city hospital system can attempt to recover that $300 buck cost. But since only half the households here pay any taxes whatsoever, its really more like $600 for each person in each taxpayer household.

So if you scale that up a little say to a state or regional level- HEY YOU ARE TALKING REAL MONEY!.

And again what is the cause?

Tort law ? Nope it hurts some but not much in comparison.

Malpractice insurance? Nope it hurts but not even remotely on the same scale.

Uninsured citizens & legal aliens? Nope doesnt cause much stress and has always been comfortably absorbed by the system until the illegal influx collapsed it.

The real hole in the system dike is and has been illegals taking advantage of a system that teaches its practitioners to apply an ethical standard that calls for medical treatment regardless of ability to pay & a federal law that requires medical treatment while also seperating medical confidentiality from billing confidentiality. IE you can keep going to a hospital as long as you want and never pay a bill because your medical records and treatments are none of the buisness of the billing department's.

So even if every single person who was legaly living in my city had health insurance as mandated by Obama care, there would still be the unresolved issue that there are millions in unpaid for treatments every single year caused by a group of people who still wont be buying any kind of insurance, and still wont be paying for it after being treated.

Do you not know enough about the biggest cause of cost increases to realize that it has overwhelmed a system in less than 20 years? That it isnt the aging Boomers who are going to overwhelm us? Nor is it a shortage of doctors and nurses. It isn't even expensive class action torts nor skyrocketing malpractice insures. < bought any malpractice insurance lately? I have. And its going through the roof in the last 5 years>. It isn't even the lack of full payment by the federal government for medicare & medicaid patients. Its the illegals that pay little more than sales tax, exiting in a grey market all cash economy, that places a premium on anonymity & seceecy so as to protect the established illegals comunity from any legal oversight- including a hospital bill collector.

So you figure Athens Regional takes in around $70,000,000 a year in Medicare A payments. Then figure another $30,000,000 from privately insured people. And from that inflow, subtract the difference between actual cost vs paid costs for Medicare A & B, along with uninsured legal aliens, uninsured citizens, and uninsured illegal aliens.

Add all that up and the hole left over is $30,000,000 in this county alone.

Now imagine... we secure our borders- with land-mines if we have to. And we actually deport people illegally in the country regardless of why. And word gets out- hey America aint the land of a free ride anymore- including healthcare costs.

Can you imagine such a situation?

Now having imagined that, what would its impact be on healthcare - especially at a Trauma II level regional where I live in terms of health insurance and medical treatment costs? Suddenly a $30,000,000 drain from illegals would be gone.

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PSRT
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quote:
Uninsured illegals are literally bankrupting the medical system.
THis is false
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Pete at Home
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Red, I don't see how Obamacare will aggravate the problem, which already existed prior to Obamacare.

Seems to me that the solution is to pay for health care through a consumption tax, which affects foreign companies that export to the US, as well as forcing undocumented persons who consume, to pay into the system.

While the consumption of many undocumented persons is fairly minimal, I have observed a substantial number who drive luxury cars and trucks, have top of the line cell phones, etc. So tax them. While you're at it, slap a tax on wiring money overseas from the USA, particularly to countries that send a x% or more of our illegal immigrants.

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AI Wessex
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"So even if every single person who was legaly living in my city had health insurance as mandated by Obama care, there would still be the unresolved issue that there are millions in unpaid for treatments every single year caused by a group of people who still wont be buying any kind of insurance, and still wont be paying for it after being treated."

So, if you insure the 44 million uninsured legal residents and accurately measure the number of uninsured unauthorized residents (approx 7 million) and compensate for their lower usage of the health care system per capita, then you would find that uninsured unauthorized residents probably only represent 1-2% of total health care costs in the country. Not a deal breaker.

But even if every one of the approximately 13 million unauthorized residents uses as much health care as everyone else and all are uninsured, they still only represent about 3% of the population. Since they won't sign up for organ transplants or expensive end of life services like you're describing (since they tend go to the emergency room for care), they would actually incur far less medical costs than insured patients on a per capita basis.

No matter how you cut it, unauthorized residents aren't the problem. You're using scare tactics.

[ July 17, 2011, 09:35 PM: Message edited by: AI Wessex ]

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Redskullvw
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PSRT

sorry aint buying that bucket of fish.

Al

lol

Wow you are amazingly dogmatic.

Even if you and PSRT want to maintain that among the non elderly seekers of medical treatment the unrecovered cost is 1-2%. Thats great. Thats like saying the accident rate among drivers age 0-14 is less than 1% of the damage costs to the transportation network. You shave off kids and elderly ...

yeah anyway.

BTW Pete

consumption tax would simply drive mature grey/black market economies underground even further. Meaning an even lower sales tax/consumption tax return than exists now. And in terms of Free trade, I dont think we could institutte such a tax and still be in compliance with our treaty comitments.

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AI Wessex
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"Even if you and PSRT want to maintain that among the non elderly seekers of medical treatment the unrecovered cost is 1-2%. Thats great. Thats like saying the accident rate among drivers age 0-14 is less than 1% of the damage costs to the transportation network. You shave off kids and elderly ..."

It was you who made the grand claim:
quote:
Uninsured illegals are literally bankrupting the medical system.
Clearly that's not the case. Or if you still think it is, explain how that 3% of the population are doing that, but 14% (legal uninsured's) are not.
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PSRT
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quote:
sorry aint buying that bucket of fish.
But no substantive rebuttal to the fact that, statistically, your claim that it is illegal aliens bankrupting the system is ridiculously misleading.
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G2
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quote:
Originally posted by PSRT:
quote:
Uninsured illegals are literally bankrupting the medical system.
THis is false
Your claim of false is false:
quote:
... the Federation for American Immigration Reform (FAIR) estimated that, as of 2004, more than 3.5 million immigrants were covered by Medicaid. FAIR likewise reports that “in some hospitals, as much as two-thirds of total operating costs are for uncompensated care for illegal aliens.”

<snip>

Statistics submitted by WakeMed Faculty Physicians, an OB/GYN practice in Wake Forest, indicate that 40 percent of the babies it delivered were born to illegal immigrants. Each birth cost between $6,800 and $18,000. In most cases, the tab was picked up by taxpayers through Emergency Medicaid. Indeed, a recent study (March 2007) in the Journal of the American Medical Association found that between 2001 and 2004 total spending on Emergency Medicaid services for illegal immigrants in North Carolina increased by 28 percent. In 2004, 82 percent of this spending was for childbirth and complications related to pregnancy. Spending for elderly illegal immigrants also increased rapidly. Overall, state Medicaid spending for illegals more than doubled between 2000 and 2005, going from $25.8 million to $52.8 million.

and

quote:
Beleaguered Bay State and U.S. taxpayers coughed up a staggering $35.7 million this year [2010] in free emergency health care for more than 52,000 illegal aliens in Massachusetts...

<snip>

The report states that nearly 70% of the people who are enrolled in the MassHealth Limited plan are in fact illegal aliens...


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Pyrtolin
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G2, can you explain how costs for unauthorized immigrants being covered by Emergency Medicaid or other state medical programs somehow transforms into uncompensated costs that the hospital has to recoup on its own?

No one has contested the claim that medical care is given to unauthorized immigrants or that there is a cost to it- the specific claim was that the majority have no coverage and the hospital has to pass those costs on.

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LetterRip
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I'll look into the numbers folks are tossing around later.

Almost all of that is indeed air ambulance but ridiculously high even for those.

http://www.msnbc.msn.com/id/34419018/ns/health-health_care/t/air-ambulances-leave-some-sky-high-bills/

http://www.ehow.com/about_4674530_much-does-air-ambulance-cost.html

I don't see why he had to have an air ambulance specifically, with the amount charged it sounds like this hospital likes to treat it as a profit center. If I were the courts - I'd reduce his fee to 1500$ or so which would cover the care provided and reasonable transport fees.

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Redskullvw
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Pyr

In its most simple form..

Illegal alien enters the healthcare system. The illegal gets treatment. The illegal then is protected by HIPA confidentiality that allows for the treatment to be a medical record availible to the patient & his Doctors, Specialists & Nurses. Its not open for the billing and management side of the medical billing process. WHile he may be very truthful as to his name, residence, & employment status to his medical provider- he can utterly lie to the billing department of the hospital, emergency room, doc in a box.

In the case of private hospitals- they either eat the whole treatment cost or may be able to defray a percentage of the cost thanks to some state and federal programs that attempt to compensate the losses either through tax credit or actual cash transfer. This still leaves the majority of the bill unpaid. In Georgia, the state and federal programs & tax credits cover about 25% of the cost of treatment.

In the case of large regional hospitals and trauma centers, they routinely get fed the majority of the patients without any form of insurance/ability to pay as well as the most serious medical cases. meaning they have both the largest number of patients who will not pay for their treatment as well as the largest number of patients who require the most expensive types of treatments only found at regional Hospitals and trauma centers. In the case of my hometown regional hospital in addition to the state and federal programs that attempt to abate unrecovered costs, the City provides another $11,000,000 a year to cover unabated costs.

PSRT's link point blank admits it cannot determine the actual un abated helthcare costs due to illegals. In fact it has a hard time even quantifying illegals consistently.Using percapital comparatives as a basis of saying it isnt a problem masks the reality that unabated healthcare costs - not per capital percential based expendatures is the issue. Of course illegals will use less helthcare dollars compared to legal citizens because they have a reason to avoid any interaction with a system that they percieve as being able to initiate INS involvement. What the report utterly skips is the fact that in terms of unabated costs illegals will be both under reported and cannot be assessed in how the report is formed. The reality hidden in the report is both the estimated numbers of illegals who are not considered in the report nor the fact that the increase in numbers of unisured aliens likely is sourced specifically from data of aliens that had insurance but now no longer do. IE the small increase in alien unisurance rates is based on legal aliens losing insurance coverage. It is not accoubnting for the increase in illegal population nor whether they have lost insurance- especially considering most illegals have no health insurance ie 51% , illegally have Medicaid insurance 10% or illegally have employer provided healthcare insurance at 33%.

So if you arent counting the full estimated pool of illegals, cross contaminating them with data about legal aliens, and ignore the fact that of the illegals 95% of their status of having insurance is either non existent or fraudulently acheived- you can then make the claim illegals aren't a significant health care cost.

So now looking at the report as DOA in terms of statistical validity, you can then return back to the root cause of why healthcare treatment costs, insurance costs and non-abated treatment costs have been skyrocketing. All other things remaining relatively stable.. ie tort costs, supply costs, training costs, legal compliance costs, physical plant operations, administration & staffing costs, even uninsured citizen costs, the only wild card would be the costs associated with illegals.

This cost is the one cost that has no abatement. The reality is the costs are attributed directly to the treatment costs being seen in states where the illegal immigrants are seeking emergent care or chronic care. Compare percapital illegals or estimated illegal totals by state to those state's level of increased medical costs per capita. The correlation is past strong .

If you choose not to agree with those statistics then you'll have to decide for yourself if $30,000,000 unabated due to illegals is a myth unreplicated by the other regional hospitals in gerogia. The last time this made national news and got to ornery, the hospital in question was Gwinnett medical Center in Georgia that had a whopping 30 mill illegal alien treatment cost. And that was at least 4 years ago. Meanwhile our number of illegals has gone up an estimated 28,000 peoplein Georgia.

Anyway...

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Pyrtolin
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Red- I wasn't challenging your response; I do agree that treating those without any coverage is an issue that adds some degree of cost, and that unauthorized immigrants makes up a notable, if not significant portion of that, depending on the region. I was challenging G2's rebuttal that focused almost entirely on the portion of such immigrants that are covered, which was useless in the context of your position, as those are not costs that the hospital has to pick up.

I think spending resources on border security is tilting at windmills and would cost vastly more than it could ever hope to save, as people desperate to survive will find a way through no matter what. I'd rather see our immigration policy stripped of caps and quotas such that the only unauthorized immigrants are those that are criminally or medically dangerous are unauthorized to begin with, and the minimum wage and other economic support programs replaces with a basic income grant for all citizens unconditionally and available to authorized immigrants with certain household size/active worker ratio requirements so that it's difficult, if not impossible for undocumented workers to actually compete on labor costs.

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JWatts
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quote:
Originally posted by Pyrtolin:
G2, can you explain how costs for unauthorized immigrants being covered by Emergency Medicaid or other state medical programs somehow transforms into uncompensated costs that the hospital has to recoup on its own?

No one has contested the claim that medical care is given to unauthorized immigrants or that there is a cost to it- the specific claim was that the majority have no coverage and the hospital has to pass those costs on.

Generally Medicaid payments are on average below actual costs. So all Medicaid treatment is going to cost a hospital on average more than it receives in reimbursement. Clearly illegal immigrants utilizing Medicaid is going to exacerbate the bottom line.

This example just covers children's hospital in Ohio, but it provides a relevant and large case in point.
quote:
The cost to children’s hospitals of providing care to Ohio’s Medicaid-reliant children was $1.06059 billion in 2009, but the current funding mechanisms reimburse children’s hospitals only $835.75 million for this care (approximately 21 percent below cost).
Link

I'm sure plenty of other cases can be found, whereby Medicaid payments aren't sufficient to cover costs and the resulting gap is covered by payments from private insurers.

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LetterRip
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JWatts,

we really need a cost breakdown to see what it 'really costs'. If I claim to normally bill 1,000$ an hour, and you are only willing to pay 200$ an hour I can claim I lost 800$ an hour working for you. So unless you see an actual cost breakdown take such numbers with enormous grains of salt.

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G2
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quote:
Originally posted by Pyrtolin:
G2, can you explain how costs for unauthorized immigrants being covered by Emergency Medicaid or other state medical programs somehow transforms into uncompensated costs that the hospital has to recoup on its own?


Just as I was thinking about this I see J covered it nicely .... Medicare and Medicaid do not reimburse 100% of the costs leaving hospitals and other healthcare providers in the lurch.
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AI Wessex
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According to JWatts linked article, the Ohio hospitals recouped the "shortfall" with public funding, which is on the chopping block in Congress. Also, following up on LR's point, isn't this the sort of opportunity Cons and Liberals have all been looking for to isolate the actual costs of health care and bring the fees in line with those actual costs?

Last, considering that the Medicaid patients obviously are in ever growing need of health care attention in Ohio and presumably elsewhere, what do you propose to do to address that problem? Would you increase funding for Medicaid?

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JWatts
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quote:
Originally posted by LetterRip:
JWatts,

we really need a cost breakdown to see what it 'really costs'. If I claim to normally bill 1,000$ an hour, and you are only willing to pay 200$ an hour I can claim I lost 800$ an hour working for you. So unless you see an actual cost breakdown take such numbers with enormous grains of salt.

The Ohio Children Hospitals state that they spent more money that it cost them. Unless you can point to a credible source that says they are lying, I'm going to treat them as credible. I am not going to assume they are misrepresenting the cost without any evidence that they did so. If the story were exceptional it would require exceptional evidence, but nearly every story I read on Medicaid reimbursements says the rates don't cover the expenses.

quote:
Originally posted by AI Wessex:
Last, considering that the Medicaid patients obviously are in ever growing need of health care attention in Ohio and presumably elsewhere, what do you propose to do to address that problem? Would you increase funding for Medicaid?

Oddly enough the current Obamacare Law assumes a cuts to reimbursement rates for Medicaid/Medicare.

[ July 18, 2011, 04:42 PM: Message edited by: JWatts ]

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AI Wessex
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I asked what would you do?
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Wayward Son
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quote:
Oddly enough the current Obamacare Law assumes a cuts to reimbursement rates for Medicaid/Medicare.
No, apparently no cuts. Simply a reduction in the increase in rates (which may or may not be sustainable).
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JWatts
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quote:
Originally posted by Wayward Son:
quote:
Oddly enough the current Obamacare Law assumes a cuts to reimbursement rates for Medicaid/Medicare.
No, apparently no cuts. Simply a reduction in the increase in rates (which may or may not be sustainable).
Really? LOL, Because every liberal referred to Paul Ryan's plan as massive cut's to Medicare, but it was just as you have described, a reduction in the increase in rates.

Furthermore, did you actually read the PolitFact article?

From the PoltiFact article:

Lois Kolkhorst says $500 billion in Medicare cuts are coming

quote:
quoting Richard S. Foster, Medicare's chief actuary, outlining intended cuts in payments to medical providers and hospitals as well as reductions in payments for Medicare Advantage, an optional program where the federal government pays private insurance companies a set rate to treat Medicare recipients.
Those are real cuts.

quote:
The 2010 health care law will phase out extra payments for Medicare Advantage programs to bring their costs in line with traditional Medicare. The law also calls for slowing increases in payment rates to hospitals and other service providers each year. Also, the law directs a new national board to identify $15.5 billion in savings, though the board — the Independent Payment Advisory Board — is prohibited from proposing anything that would ration care or reduce or modify benefits.
Yeah, and what is the point in the advisory board in identifying $15.5 billion in savings if they aren't going to actually be cut out. That's BS pedantry there.

quote:
Foster’s memo says the Medicare savings are to be achieved largely through reduced payments to medical providers including hospitals, tied to raised productivity expectations.
And that's more cuts. Politfact disputes the claim that there are $500 Billion in Medicare cuts. It doesn't dispute the fact that there are billions of dollars in cuts.
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LetterRip
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JWatts,

I've provided evidence here that medicare and medicaid patients are profitable based on cost breakdowns. (The doctor provided the specific volume of patients he needed to treat for it to be profitable - and above a certain threshold they were significantly profitable).

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Wayward Son
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quote:
Because every liberal referred to Paul Ryan's plan as massive cut's to Medicare, but it was just as you have described, a reduction in the increase in rates.
True.

quote:


quote:
quoting Richard S. Foster, Medicare's chief actuary, outlining intended cuts in payments to medical providers and hospitals as well as reductions in payments for Medicare Advantage, an optional program where the federal government pays private insurance companies a set rate to treat Medicare recipients.

Those are real cuts.
True, but you neglected to quote the next paragraph:

quote:
It was hoped that competition between private insurers for Medicare Advantage programs would drive down costs and make the system more efficient, ultimately saving the federal government money. But it has not worked out that way. A June 2009 analysis from the Medicare Payment Advisory Commission said the Advantage programs cost taxpayers an average of 14 percent more than traditional Medicare.
I don't think cutting a special program that costs 14 percent more than the regular program is the kind of "real cuts" you were referring to, is it? Or are you defending the costly program?

quote:
Yeah, and what is the point in the advisory board in identifying $15.5 billion in savings if they aren't going to actually be cut out. That's BS pedantry there.
Except that, in the last line of your quote, it states that "the board ... is prohibited from proposing anything that would ration care or reduce or modify benefits."

So the "cuts" you are criticizing here are ones that have nothing to do with care or benefits. Are you saying that you are against such cuts?

These cuts, if advanced by a Republicans, would be called "cutting the fat" of the programs. But because they are completely Democratics in origin (since Republicans have completely disavowed themselves of it), they are suddenly "substantial cuts."

The bottom line, though, is that the "Obamacare" cuts are designed to reduce the costs without affecting care or benefits. Whether they will be successful remains to be seen. But it does not call for nilly-willy reductions in benefit payments that hopefully would not result in decrease in care and benefits or an increase in payments by the recipients, as in Ryan's plan.

So while "Obamacare" reduces increases in reimbursement rates as you say, they are targetted decreases, which (hopefully) will keep the current level of care. The type of "cuts" that no one would critize, except for political purposes. [Wink]

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JWatts
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quote:
Originally posted by Wayward Son:
quote:
Oddly enough the current Obamacare Law assumes a cuts to reimbursement rates for Medicaid/Medicare.
No, apparently no cuts. Simply a reduction in the increase in rates (which may or may not be sustainable).
So first you say that there are No Cuts.


quote:
Originally posted by Wayward Son:
I don't think cutting a special program that costs 14 percent more than the regular program is the kind of "real cuts" you were referring to, is it? Or are you defending the costly program?

And then you seem to say, well yes this is a cut, but it's a good cut.

quote:
Originally posted by Wayward Son:
So the "cuts" you are criticizing here are ones that have nothing to do with care or benefits. Are you saying that you are against such cuts?

And then you try to turn it around and say how can I be against good cuts?

quote:
Originally posted by Wayward Son:
So while "Obamacare" reduces increases in reimbursement rates as you say, they are targetted decreases, which (hopefully) will keep the current level of care. The type of "cuts" that no one would critize, except for political purposes. [Wink]

I believe the correct response would have been, yes I was wrong, there are cuts.


Unless of course you are just trying to score political points. [Wink]

[ July 18, 2011, 06:11 PM: Message edited by: JWatts ]

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JWatts
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quote:
Originally posted by LetterRip:
JWatts,

I've provided evidence here that medicare and medicaid patients are profitable based on cost breakdowns. (The doctor provided the specific volume of patients he needed to treat for it to be profitable - and above a certain threshold they were significantly profitable).

Yes, you've provided evidence that it's possible to occasionally do such. That doesn't mean that the system is profitable on average.

There is plenty of evidence to indicate that it's not and that it's being shored up by:
a) Charging private insurers higher rates
b) Supplemental Federal funding
c) Supplemental State funding
d) Supplemental Local funding

There is plenty of evidence to indicate the current rate is below breakeven level without these various additional expenditures.

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AI Wessex
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JWatts, I missed where you spelled out what you think should be done...
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LetterRip
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JWatts,

I"ve seen plenty of claims, not any evidence. Evidence would be cost breakdowns or other information that is subject to analysis. Since most nations can operate federal health insurance programs for much less than what we pay for medicare and medicaid without numbers the claims are suspect.

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Wayward Son
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quote:
I believe the correct response would have been, yes I was wrong, there are cuts.
Perhaps you are right. If savings--decreases in spending without decreases in service--are "cuts," then you are absolutely right, there are cuts. I stand corrected. [Embarrassed]

My confusion occurred because, when I think of "cuts," I automatically assume they simply decrease spending, without regard as to how the money is saved, much like Ryan's plan. But apparently cuts can also apply to increasing the efficiency of a program.

That would explain why conservatives see no difference between Ryan's plan and Obama's. [Wink] [Smile]

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