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Healthcare Bill Passes - What happens next?

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02-03-2011 , 06:13 PM

#4926

csull23

journeyman

Join Date: Mar 2010 Posts: 374

Quote:

Originally Posted by Money2Burn

I have no idea what is involved as far as processing patients is concerned. If there is very little that goes into the actual processing of claims versus the regular processing that is required for annual maintenance of patient accounts then the answer would be no. But for either of us to say definitively one way or the other is nothing more than ignorant speculation.

Agreed.

02-03-2011 , 06:14 PM

#4927

Money2Burn

Carpal \'Tunnel

Join Date: Jan 2006 Posts: 12,628

I will say that the one area that could make an even greater difference between the two would how rampant fraud is and/or how much of an effort Medicare/ provate providers make to prevent it. On the surface it would seem that private companies have more incentive than Medicare to ferret out and squelch fraud, but again, I have no idea. Perhaps DE could enlighten us on this.

02-03-2011 , 06:15 PM

#4928

pokerbobo

Carpal \'Tunnel

Join Date: Mar 2007 Posts: 14,432

Quote:

Originally Posted by csull23

That's all true, but wouldn't you think if you had healthier patients, you would be able to cut back on administrative costs? I agree that comparing Medicare numbers with private insurance numbers might be misleading, but I would also think Medicare admin. costs would be much greater than most private insurers b/c of their sick pt. population, making the ratios comparable.

I guess I'd personally rather look at private insurance companies on their own and say they should spend a larger fraction of their money on patients and less on advertising and other expenses.

In general, it costs about the same to process a $150 claim for a sore throat as it does to process a $15,000 surgery..... private business actually has incentive to lower admin costs, the way the govt budgets, if you don't spend your yearly budget dollars, the budget may not get that funding next year, there is no incentive to lower costs, in fact, just the opposite.

02-03-2011 , 06:16 PM

#4929

iron81

Carpal \'Tunnel

Join Date: Sep 2005 Posts: 17,730

Let's say that that 10% fraud rate and the 10% administrative expenses rate for Medicare are correct. That's still less than the 30% administrative expenses rate for private insurers assuming there zero fraud for private insurers.

02-03-2011 , 06:20 PM

#4930

biggbob

centurion

Join Date: Dec 2010 Posts: 129

Quote:

Originally Posted by csull23

Most insurance companies currently have a "medical losses" ratio of about 70%. That means 30% goes to administrative costs and profit, and 70% goes to back to us as "medical losses" (i.e. to pay for our health care). I don't know about you, but making a 30% profit off of sick people seems like a lot. I'm also fairly sure that insurance companies have increased profits yearly over the past decade or so.

Insurance companies would like you to think they will go out of business if Obamacare is implemented, but I'm positive they will be more than fine. They might be required to limit their profits to something like 15%, but I'd say that's more than fair.

insurance companies dont make 30% or anywhere near that..........lol.

harry reid just said 80% is ok with obamacare. where do you come up with 30% profit margin?

02-03-2011 , 06:22 PM

#4931

csull23

journeyman

Join Date: Mar 2010 Posts: 374

Quote:

Originally Posted by biggbob

insurance companies dont make 30% or anywhere near that..........lol.

harry reid just said 80% is ok with obamacare. where do you come up with 30% profit margin?

Quote:

Originally Posted by csull23

It would be if I said that number was just profit. I said that it was for administrative costs and profit. That also includes marketing and other overhead.

What I'm saying is, only 70% of our money is actually used for care. That number varies, but I think 70-80% is about the middle. I know for a fact Wellpoint insurance has a medical loss ratio of 82.4%, and UnitedHealth is 83.7%. In California, Great HealthCare's is 69.4%.

Pay attention please.

02-03-2011 , 06:23 PM

#4932

suzzer99

Save the Cheerleader, Save the World

Join Date: Nov 2005 Posts: 100,711

Dude don't even try, he's not.

02-03-2011 , 06:23 PM

#4933

Inso0

Carpal \'Tunnel

Join Date: Nov 2006 Posts: 9,058

Quote:

Originally Posted by iron81

C'mon, do you REALLY think that the government has more efficient administration than private companies?

Really?

Edit: Unless by "efficient" you mean just rubber stamping $200,000 payouts for spinal care given to Donald Duck in a clinic whose address comes up in the middle of a corn field on GPS. Then yes, they're very efficient when processing "claims."

02-03-2011 , 06:24 PM

#4934

pokerbobo

Carpal \'Tunnel

Join Date: Mar 2007 Posts: 14,432

Quote:

Originally Posted by iron81

Yeah, the govt doesn't need to hire an army of lawyers and employees to make sure they are in complience with the thousands of pages of laws and regulations in order to avoid fines.

If my number of 25% admin is correct, and you add in the 10% fraud, then you are over the 30% that private companies are at.

Throw in the fact that private companies pay taxes into the system, and that medicare and medicaid are adding to the national debt.... the choice is clear that private companies are far better for the country.

02-03-2011 , 06:25 PM

#4935

csull23

journeyman

Join Date: Mar 2010 Posts: 374

Didn't realize who I was responding to until it was too late. I'd take it back if I could...

02-03-2011 , 06:27 PM

#4936

iron81

Carpal \'Tunnel

Join Date: Sep 2005 Posts: 17,730

Quote:

Originally Posted by Inso0

Yes. Sometimes, government > market. Your ridiculous hypothetical would be included in the 10% fraud argument.

02-03-2011 , 06:29 PM

#4937

suzzer99

Save the Cheerleader, Save the World

Join Date: Nov 2005 Posts: 100,711

Quote:

Originally Posted by Inso0

C'mon, do you REALLY think that the government has more efficient administration than private companies?

Really?

A big chunk of the administrative costs that private insurance companies currently incur involves screening applications for pre-existing conditions, underwriting individuals based on any number of factors, working over claims as rescission candidates, then the legal fees defending those decisions. The same companies have something like 10% admin costs for their corporate policies where they don't have to worry about these things vs. 20-30% for their private policies.

02-03-2011 , 06:30 PM

#4938

dinopoker

Carpal \'Tunnel

Join Date: Mar 2006 Posts: 9,437

Quote:

Originally Posted by csull23

Actually I'm pretty sure that did happen in Canada.

Show me a Canadian who would rather have the US system than the one they have there and I'll buy you a motorcycle with gold handlebars.

02-03-2011 , 06:30 PM

#4939

Borodog

Enemy of the State

Join Date: Jan 2004 Posts: 25,491

Quote:

Originally Posted by pokerbobo

Yeah, the govt doesn't need to hire an army of lawyers and employees to make sure they are in complience with the thousands of pages of laws and regulations in order to avoid fines.

This. The "medicaid/medicare is so much more efficient than private insurers" crowd just do not get this. Medicaid/medicare manufacture the regulatory burdens for the private insurers (at the behest of those same insurers, of course, because it elliminates competition and they just pass the cost through), but the cost of compliance that is created is not carried on their books. ZOMG MEDICARE HAS 2% OVERHEAD!!!!!1111

02-03-2011 , 06:31 PM

#4940

Borodog

Enemy of the State

Join Date: Jan 2004 Posts: 25,491

Quote:

Originally Posted by dinopoker

Show me a Canadian who would rather have the US system than the one they have there and I'll buy you a motorcycle with gold handlebars.

Paging Zygote. PM me where I can pick up my motorcycle.

02-03-2011 , 06:33 PM

#4941

csull23

journeyman

Join Date: Mar 2010 Posts: 374

Quote:

Originally Posted by pokerbobo

How is it possible that you know those numbers? I bet the government doesn't even know how much it spends on admin costs, and somehow you say 25%.

Also, if you get insurance through your work, there is a tax subsidy on it. You also get to pay for your health insurance through pre-tax dollars. That's why private insurance not obtained through employment is so expensive. Should we count that against private health insurance?

02-03-2011 , 06:35 PM

#4942

jogsxyz

Carpal \'Tunnel

Join Date: Mar 2005 Posts: 6,362

Quote:

Originally Posted by Borodog

This. The "medicaid/medicare is so much more efficient than private insurers" crowd just do not get this. Medicaid/medicare manufacture the regulatory burdens for the private insurers (at the behest of those same insurers, of course, because it elliminates competition and they just pass the cost through), but the cost of compliance that is created is not carried on their books. ZOMG MEDICARE HAS 2% OVERHEAD!!!!!1111

Why do you all lump medicaid and medicare together? Isn't medicaid just a free lunch? There are healthy individuals like myself paying into medicare and receiving no services.

02-03-2011 , 06:37 PM

#4943

Inso0

Carpal \'Tunnel

Join Date: Nov 2006 Posts: 9,058

Quote:

Originally Posted by suzzer99

Eliminating pre-screening or underwriting practices isn't going to magically save that money.

The only reason those processes exist is because the insurance company thinks it will cost MORE to not have them.

So I guess you're okay with the administration:payout ratio being improved, even if it means the price goes up?

That sounds..... silly.

02-03-2011 , 06:38 PM

#4944

Inso0

Carpal \'Tunnel

Join Date: Nov 2006 Posts: 9,058

Quote:

Originally Posted by dinopoker

Show me a Canadian who would rather have the US system than the one they have there and I'll buy you a motorcycle with gold handlebars.

All the ones who actually get sick.

OH SNAP!

02-03-2011 , 06:38 PM

#4945

iron81

Carpal \'Tunnel

Join Date: Sep 2005 Posts: 17,730

Quote:

Originally Posted by jogsxyz

Why do you all lump medicaid and medicare together?

Because to Borodog, all elements of the government besides the Federal Reserve are equally evil.

Quote:

Originally Posted by Inso0

All the ones who actually get sick.

OH SNAP!

Premiums are only one element of the cost. Sick patients in Canada pay much less for quality care as well.

02-03-2011 , 06:42 PM

#4946

pokerbobo

Carpal \'Tunnel

Join Date: Mar 2007 Posts: 14,432

Quote:

Originally Posted by Borodog

Paging Zygote. PM me where I can pick up my motorcycle.

You can pick it up in the same place where govt is more efficient than the private sector......

Spoiler:

02-03-2011 , 06:42 PM

#4947

csull23

journeyman

Join Date: Mar 2010 Posts: 374

Quote:

Originally Posted by dinopoker

Show me a Canadian who would rather have the US system than the one they have there and I'll buy you a motorcycle with gold handlebars.

http://www.medicalprogresstoday.com/...ve.php?id=1720

Article written in Wall Street Journal 2007

Quote:

Lindsay McCreith, would have had to wait for four months just to get an MRI, and then months more to see a neurologist for his malignant brain tumor. Instead, frustrated and ill, the retired auto-body shop owner traveled to Buffalo, N.Y., for a lifesaving surgery.

When do I get my motorcycle?