From: usenet@only.tnx   
      
   On Fri, 22 Jan 2021 16:45:04 -0800 (PST), Bob  wrote:   
   >On Wednesday, January 20, 2021 at 3:12:36 PM UTC-5, Questor wrote:   
   >> After nurses, doctors and other groups of medical professionals, by far the   
   two   
   >> largest departments in the system -- dozens of employees -- were the ones   
   >> dedicated to the recording, coding, transmission, accounting, and billing   
   for   
   >> every action taken on behalf of a patient. It's a very complicated and   
   >> byzantine system, and it exists in large part only to determine who pays how   
   >> much for what. Apart from keeping a record of treatments administered, it   
   does   
   >> not contribute to patient care.   
   >   
   >> Why does the U.S. spend one-sixth of its GDP -- two to three times that of   
   other   
   >> industrialized nations -- and still has worse health outcomes and doesn't   
   even   
   >> have universal coverage for all its citizens? In an over-simplified   
   nutshell,   
   >> it is because in America we spend our money on health *insurance*, not   
   health   
   >> *care*.   
   >   
   >> Insurance companies generally do not provide patient care. They do not see   
   >> patients, conduct tests, or perform operations. They are middle-men,   
   inserted   
   >> into the health system between the payers (employers, government,   
   individuals)   
   >> and the care providers (medical professionals). Absent strong government   
   >> regulation in the U.S., they have continued to siphon off more and more of   
   the   
   >> dollars meant for health care and used it to support their own bureaucratic   
   >> structure.   
   >>   
   >> I'm not wedded to single-payer as a solution, since there are examples of   
   >> industrialized countries where their multiple-payer system is effective. (It   
   >> still requires strong government regulation.) But single-payer does seem   
   like   
   >> the obvious system to simplify health insurance. The problem, and the   
   >> resistance, comes from the thousands of clerical workers, medical analysts,   
   etc.   
   >> who work at insurance companies and the hospitals. Most of them would no   
   longer   
   >> be needed.   
   >   
   >What makes you think they wouldn't?  No matter who does the paying, there'd   
   be a   
   >need to control costs by paying for certain cases and not others.  That's   
   going   
   >to require the same people to look at each service and each potential service   
   >and decide whether it is/was  needed badly enough, as against whatever policy   
   is   
   >adopted.  Nobody's ever going to pay unquestioningly for everything, and   
   people   
   >are going to push up against the limits of whatever policy is adopted.  It can   
   >never be reduced to a simple no-judgment formula, because medicine always   
   >involves judgment.  Nor can you let the person getting paid have the last say   
   as   
   >to that judgment.   
      
   The process I sketched out takes place after treatment, so nothing you wrote   
   applies.  There's no effort to cut costs at that point, except to the extent   
   that avoiding paying for a treatment if another entity can be found responsible   
   can be said to be cutting costs.  There may be some effort on the part of   
   health   
   insurance companies to reduce the cost of treatments, but it doesn't happen in   
   coding and billing.   
      
   With universal coverage, everyone who walks in the door gets whatever treatment   
   needed that is offered without having to consider their insurance situation.   
   A few years ago I read an anecdote by a tourist from the USA who developed an   
   ear infection while visiting Great Britain.  They went to a doctor, were   
   diagnosed, and treated.  They then spent over forty-five minutes on the phone   
   back to their insurer in the States, trying to determine if they were covered,   
   and never even received a definitive answer.  Of course they were not charged,   
   although they did have to pay for the ear drops -- a few pounds, or about ten   
   U.S. dollars.  One can find similar stories from other countries with universal   
   health care.   
      
   There's a big duplication of effort now as both the hospital and the various   
   paying entities are all doing their own coding of treatments, both as a check   
   on   
   the others and to conform to their own internal requirements.  And it's more   
   complex to keep track of the billing if several different payers are involved   
   in   
   a patient's account.  Much of the system exists to satisfy its own needs.  To   
   repeat myself, it doesn't contribute to patient care.  With single payer, most   
   of these analysts, coders, and clerks et. al. simply aren't necessary.   
      
   (There was one computer in the hospital system that didn't get upgraded -- and   
   it was in the accounting department.  I was told never to touch this machine.   
   Apparently they had some very long-term accounts, and the software that   
   managed them wouldn't even run under later versions of MS-DOS, let alone   
   Windows.  I don't think they even upgraded it from MS-DOS 3.3.  They may have   
   been overly cautious, but they weren't taking any chances on screwing it up.)   
      
   There are several structural problems with the health care/insurance industry   
   in the U.S., and the relatively free reign the insurance companies have to   
   insert themselves into the system is just one of them.   
      
   --   
   Then I leave my rented room and I walk, through the fading light down streets   
   that talk   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)