[wacor]

Originally Posted by Jmo

...doctors will always choose the number they are putting on your bill, and they never get to choose how much of that number they actually get to collect.

Well, duh. That is the same in the end as being told what you can bill.

[jmosmith]

Originally Posted by wacor

Well, duh. That is the same in the end as being told what you can bill.

It isn't the same, and you're ignoring the fact that they are participating in such discount pricing by their own choice. When dealing with uninsured patients that they "bill", they may not get paid in full, and they might, but the uncertainty remains.

And for Medicare, doctors cannot "bill" what they are "paid",... or that pay will decrease. The only way for them to get it to go up, is increase what they are paid, is to increase what they bill.

I know what you mean, but it is not the same; it's something of a "game", and doctors "play", by setting their own bill.

[Farmgirl22]

Originally Posted by jmosmith

I know what you mean, but it is not the same; it's something of a "game", and doctors "play", by setting their own bill.

You said yourself that Medicare pays for a service based on an average cost of that service over a 3-5(?) year period. If Medicare would start paying what everyone else does the "game" would become obsolete.

[jmosmith]

Originally Posted by Farmgirl22

You said yourself that Medicare pays for a service based on an average cost of that service over a 3-5(?) year period. If Medicare would start paying what everyone else does the "game" would become obsolete.

No, I said it was "based on" the average, not that they pay that amount.

They pay a fraction of that amount as the "base rate" for a given procedure; which is modified by another schedule. So if they did what you suggest, the average would get lower, and the base would decrease, again, and, again, and again,...

This "game" is so pervasive, there are actual classes for doctors and/or their staff on how to "code" their charts/claims to get the maximum reimbursements. There are consulting agencies that supply this service as well.

Feel free to look this stuff up yourself to verify.

[Farmgirl22]

Originally Posted by jmosmith

No, I said it was "based on" the average, not that they pay that amount.

They pay a fraction of that amount as the "base rate" for a given procedure; which is modified by another schedule. So if they did what you suggest, the average would get lower, and the base would decrease, again, and, again, and again,...

Why would they "base it on the average" if they didn't pay the amount that it's "based" on? That wouldn't make one iota of sense.

I wasn't talking about averages at all actually, I think that Medicare should be billed (and therefore PAY) exactly the same amount as any patient at that facility would for the exact same procedure. If I have to pay $13,000 to have an MRI at XYZ Hospital, Medicare should pay $13,000 to XYZ hospital for someone else to have an MRI. Instead of doing all those averages that they apparently don't even use anyway, they could spend that legwork on ensuring that they were billed properly at XYZ hospital.

[jmosmith]

Originally Posted by Farmgirl22

Why would they "base it on the average" if they didn't pay the amount that it's "based" on? That wouldn't make one iota of sense.

I wasn't talking about averages at all actually, I think that Medicare should be billed (and therefore PAY) exactly the same amount as any patient at that facility would for the exact same procedure. If I have to pay $13,000 to have an MRI at XYZ Hospital, Medicare should pay $13,000 to XYZ hospital for someone else to have an MRI. Instead of doing all those averages that they apparently don't even use anyway, they could spend that legwork on ensuring that they were billed properly at XYZ hospital.

Oh fer cryin out LOUD!!!... what is this? Remedial math class!!!

They make an average,... that is a "basis",... there is a fraction applied to that basis,... it produces an ANSWER!!!

How many times do you want me to explain that?

And Medicare IS billed the "same amount", as "any patient",... for EVERY "exact same procedure." And there is more "leg work" on the part of HMO's, and Suplemental Medicare insurance plans, and dr.s/hospitals, to maximize their reimbursements... they system is designed to minimize the leg-work done by Medicare, and put it off on to the other agencies.

...as for "paying what everyone else does", everyone else, is every other insurance company... playing the same game, or some other negotiated price which is less than the "billed amount". It's not just Medicare, it's the whole industry,...

[wacor]

James what you are describing is a big mess with a lot of gaming.

Sounds like a prescription for disaster when the scale is multiplied as it would be should there be a single payer national health care program run but a bureaucratically inept and incompetent system. AKA the federal govt.

[jmosmith]

Originally Posted by wacor

James what you are describing is a big mess with a lot of gaming.

You're catching on!...

Sounds like a prescription for disaster when the scale is multiplied as it would be should there be a single payer national health care program run but a bureaucratically inept and incompetent system. AKA the federal govt.

Oh, I dunno? The mechanism is already in place, the resourced available to support the complexities of the pricing model, but how well would the increased volume of claims, but the processing is done largely by computer.

I dunno.

[wacor]

Originally Posted by jmosmith

You're catching on!...

Oh, I dunno? The mechanism is already in place, the resourced available to support the complexities of the pricing model, but how well would the increased volume of claims, but the processing is done largely by computer.

I dunno.

The only thing that works with regard to SS and medicare is that people tend to get the care they need. But ignoring its finances and assuming we can sort it out once we move the rest of health care into this is a recipe for disaster. That is not speculation but common sense. Whatever it is done can not be modeled after SS and medicare.

[jmosmith]

Originally Posted by wacor

The only thing that works with regard to SS and medicare is that people tend to get the care they need. But ignoring its finances and assuming we can sort it out once we move the rest of health care into this is a recipe for disaster. That is not speculation but common sense. Whatever it is done can not be modeled after SS and medicare.

Well, from what I've seen, people do get the care they need with Medicare (I worked in suplemental Medicare HMO's).

As for SS being out of money,... that's because when they built up a surplus, Congress appropriated it, against the best advice. I'm sorry I don't have a link to the details, but they are easy to find quickly with a minute or two on google.

Otherwise, I don't know anything about "ignoring the finances",... and neither do you, since NOTHING has been proposed yet,... I agree that is something that has to be solved, of course.

The SS "model", is a transfer payments.

Medicare "model", is a risk-pool,... as are all health insurance companies. Another part of this model is to control costs through negotiated prices withing a "network" of participating providers ("par"),... I do not know how a similar "model" can be avoided in this case. I believe the Canadian and British systems are different, but I do not know how. I'd expect it to be a bit more like Kaiser Permanente, which keeps patients "in network"; so it doesn't have to pre-negotiate with itself.

In the end, this is why the gov't can't dictate prices,... becaue they can't dictate "costs",... not true costs.

I dunno what will work here, but that's why finding something that does work will be a massive achievment.

[wacor]

James,

SS is a ponzi scheme. It has been that way for years. As an example of how screwed up it was and continues to be I remember a story about 20 years ago dealing with people in their 70's who were getting benefits. Because of how SS was set up these people had already drained out all the money they had contributed within 5 years of getting benefits. They made adjustments but all the fiddling that was done over the years did was to stall the day of reckoning when the money could not be paid out.

Another problem is that originally the formula was about 16 people working for each person on SS. Now it is down to 3 and before long it will be two. Given SS was based on people living a lot less longer originally then the problem is not going away and it is not sustainable to have for every person on SS only 2 people paying into the system.

Something I was not aware of I found looking up some other info.

http://www.heritage.org/Research/Soc...ty/wm143.cfm#5

Workers have no legal right to Social Security benefits


According to the Supreme Court, workers actually neither own nor have a legal right to their Social Security benefits.In fact, the Court has even said that Congress can end Social Security benefits at any time. In 1960, the Supreme Court ruled in Flemming v. Nestor that Americans have no property right to their Social Security benefits. In his dissent, Justice Hugo Black observed that this decision "simply tell[s] the contributors to this insurance fund that despite their own and their employers' payments the Government, in paying the beneficiaries out of the fund, is merely giving them something for nothing, and can stop doing so when it pleases."

I think if the democrats get re elected in the same numbers that about this time 4 years from now you are going to see some serious talk about rolling our private 401k's into SS. That will be the only way to save SS and provide an infusion of cash to help provide instant funding for health insurance. It will be the final coup detat by the liberals under the guise of doing what is best for us. Cradle to grave baby.

[jmosmith]

Originally Posted by wacor

James,

SS is a ponzi scheme. It has been that way for years. ...

I'm beging to think that you've never met a right-wing sound-bite, that you DIDN'T like!!!...

Thanks to Madov, this kind of thing is all over the news these days, more of the sensationalizing in "media",...

SS is NOT a Ponzi Scheme, for many reasons, the first being that it is not a fraud scheme, the second that it is not an investment plan (there is no promis of asset growth), third, it is structured and is what economists call and "overlaping-generations model" for wealth transfer, which is something that is sustainable; a Ponzi scheme has none of these properties.

That's not to say SS doesn't face some seriously bad progress reports at the moment, it does. But that doesn't make it a Ponzi Scheme, it just needs fixing,... (and the money Congress "borrowed" from it back).

Ponzi scheme is unsustainable because the number of potential investors is eventually exhausted. That's when the last people to participate are out of luck...

LINK <---- I found this article a bit "Pollyanna", but this was among his most salient points.

But there is one enormous difference between Social Security and a Ponzi scheme: Technological change. Over the past century, new technologies have enabled the output of the country to grow much faster than its population. To be more precise, the U.S. population has more than tripled since the early 1900s, while the U.S. economic output has gone up by more than 20 times

Businessweek <--- yes, yes, I know the article you linked from the Heritage Foundation criticized this very thing, but it did so in the light of problems with SS, NOT in addressing the question of is it or is it not a Ponzi Scheme (a long read, but good link, even with some arguable points presented)

There are similarities, but they are deceptive. The fact that payors into the system are very different from those withdrawing from it, is the key factor to sustainability of the system,... so long as factors remain stable (which they have not), but this, and the fact that it is not a fraudulent "investment", mean it is absolutely NOT a Ponzi Scheme, despite superficial similarities.

I think if the democrats get re elected in the same numbers that about this time 4 years from now you are going to see some serious talk about rolling our private 401k's into SS.

Argument to the Future <--- fallacy (the sky isn't falling, it's GOING TO!!!)

That will be the only way to save SS and provide an infusion of cash to help provide instant funding for health insurance.

Cherry Picking <--- fallacy (that is NOT the "only way"... as the article you liked to illustrated; so I KNOW you know the truth of this)

It will be the final coup detat by the liberals under the guise of doing what is best for us. Cradle to grave baby.

<--- And that's just plain fear-mungering,... based on fallacious arguments (as usual)

The first step in getting better is to admit you have a problem!!! You have got to stop smoking that stuff!!!



Now arguments/debate asside, IMHO... SS is in a jam, but I doubt it will be "allowed to fail", I think it will be an 11th hour fix, and that it will hurt a lot, and that whom ever is in office at the time will be forced to do it and Congress to support this, it will be the ONE issue that the LARGEST voting block of Americans will have in common; so if it is not saved from the cliff's edge, then ALL of Washington will likely be voted out of office!!! And the replacements will all win on the promise to "fix it". This is what I expect, but can't really argue.

Thanks,
J.

[jmosmith]

Originally Posted by TooBad

One can only debate one that makes sense. Your circular reasoning does nothing to add to the debate, it is just confusing to try and follow that lack of logic.

Since all these words are hurting your head, maybe you could see if the "Telle-Tubbies" or "Baby Einstein" is on Nick-at-Night?... Or maybe finger-paint!!! (the yellow is lemon-flavor; go ahead; try it!)

[wacor]

Yes James you are correct it is not a ponzi scheme. In a ponzi scheme there are willing investors that are duped. In this case we are forced to hand over the money.

Laugh all you like at the comment about the 401k investments being rolled into SS. But there already has been testimony on the Hill to that effect. Is the sky falling? Well it just might be. Sometimes ideas are put into effect. Can you imagine 30 years ago if somebody told you one day you would not be able to smoke a cigarette in their own business? Anytime these idiots speak about something there is always the chance it will gain traction. And that 401k money is one way to infuse money and make SS solvent again. Although knowing how the govt works that will not last.

[Knotbored]

Perhaps it should be looked at in mirror image. A while back someone made a calculation of how wealth would have grown if all the social security funds for an individual had been invested in the stock market instead of dumping into government and it seems each retiree would be a zillionair. Recent stock market crash perhaps alters the calculations, but then perhaps the crash would not occur if that huge investment was in place to bolster the prices.