Making Baby Jesus Cry

[ltl/fb]

Originally posted by Replaced_Texan
Uh, that's why we have DRGs. They're never going to go away.

What's a DRG?

[Connect_the_Dots]

Originally posted by ltl/fb
What's a DRG?

It's a Dr of Groinocology. They have to approve medical treatment if you are shot in the nuts and don't have insurance.

[Replaced_Texan]

Originally posted by ltl/fb
What's a DRG?

Diagnostic related group. It's the way hospitals bill for services to provide disincentives to keep people there longer than necessary just for the sake of making a buck. Medicare started with this form of pps (prospective payment system) in 1982, and most everyone else jumped on the bandwagon shortly thereafter. The managed care experiment from the early/mid 1990s sort of sprung from the concept.

Basically, it means that you get admitted to the hospital with a particular diagnosis, and the insurance company and/or Medicare, pays the hospital bill based on the formula for that diagnosis. The laboratory services, radiology services, nursing services, equipment, etc are bundled into that payment, so there's not really an incentive to keep on ordering tests or keeping people in the hospital longer than they need to be. If the patient shows back up in the hospital a certain number of days after discharge, the payment is still under that first admission and the hospital has to eat the additional costs, so there's a nice incentive for not kicking people out too soon. Physicians have a similar sort of formula, though they're generally more on a per-visit or per diem sort of schedule. Upcoding can sometimes be a problem, as can unbundling of some services. Reimbursement specialists will never be out of work.

I could literally spend days talking about the various reimbursement rules. Don't make me.

[Hank Chinaski]

Originally posted by Sexual Harassment Panda
My buddy was fictional, meant to tweak Hank.

I thought maybe you were saying fringey was a guy.

[Spanky]

Originally posted by Connect_the_Dots
So in scenario 1) the hospital eats the costs and in scenario 2) the insurance company eats the costs. You claim that in scenario 2) we might save money? DOes it not occur to you that now that someone else is picking up the tab the hospitals may have an incentive to provide more services that are non-life threatening because someone else is paying? Don't you think judgment calls about what's necessary and what isn't will now be much more likely to be in favor of providing services than they would be if the hospital were picking up the tab?

But isn't that the problem that is inherent with any insurance including car insurance. And it will be up to the insurance companys to make sure the hospitals don't overspend. I think we will be a lot better off when insurance companys are trying to protect their pecuniary interest instead of a government buereacy trying to contol costs (which is how it is done now).

Originally posted by Connect_the_Dots
I pointed out (with your own examples) what would happen if government got involved. YOu don't think intruding in religion and childcare by government agents (your examples) are bad enough to warrant caution?

Again this is a side issue. But I consider not providing adequate healthcare to your children child abuse. So if you are beating up your kid, I think it prudent for the government to step in (I know, that you believe letting the government prevent child abuse could lead to a police state but that is a risk I am willing to take). Same goes if your kid gets sick and you don't get treatment. In my book that is abuse. If you call that freedeom of religion, what if my religion says that I need to torture my children. Freedom of religion stops where the exercise thereof inteferes with established law. And I anyway , I think child abuse is a good place to draw the line.

Originally posted by Connect_the_Dots
Well, I don't think it's a good policy. It's not realistic because it runs counter to human nature (like most utopian social schemes).

Right now the system runs counter to human nature. I am trying to make the system work a little more rationally. Why don't you explain to me how the current system is so intune with human nature that the current system maximises efficiency by using incentives properly.

Originally posted by Connect_the_Dots As I said, let people choose for themselves and live with the consequences.

Right now if you don't have health insurance, you get into an accident and end up bleading at the hospital I end up paying for it (see I said I instead of the government so I could make it clear that taxpayers end up paying the government tab in the end). So until people that can't pay are left bleading on the sidewalk people will not be living with the consequences of their own choices.

Originally posted by Connect_the_Dots What is it about choice and free will that you liberals find so offensive?

1) I am OK with your free will until you dump toxic wastes in my back yard. Then your free will becomes a problem
2) I am not forcing anyone to do anything. If you don't want to pay for health insurance then you don't get to use the public roads.
3) I may be forcing you to pay for indigents peoples health care by taxing you but that is already happening under the current system.

PS. Ty, Sidd, SS, etc... I am a liberal. Here is a liberal that supports CAFTA, the Iraq war, and voted for Bush. Don't say Bush doesn't have broad based support.

[sgtclub]

Originally posted by Connect_the_Dots
XXXXX

Where have you been?

[Spanky]

Originally posted by Replaced_Texan
No. They just have no idea what anything costs. No one really has a grasp on what healthcare actually costs. The guy bitching about the $8 aspirin doesn't realize that somehow or another, the cost of my legal services to healthcare providers is going to have to factor in there somewhere. Or that the hospitals have to pay Wonk's doctor to take call at inconvenient times. Wonk wouldn't have bitched about the bill as much if his insurance company had covered it.

Like I said people don't appreciate how much healthcare really costs. Good health care is really expensive. But if most people were like me and had lived in countrys with socialised healthcare they would realize our system is worth every penny.

Originally posted by Replaced_Texan And cost doesn't really come into the equation when making the decision as to whether going to Ben Taub (county owned teaching hospital) or St. Luke's (not-for-profit teaching hospital) or HCA (for-profit hospital). Most people just go to whereever their insurance will cover them or where their personal physician practices. Unless it's an emergency (trauma: btw, Ben Taub, especially gunshot wounds, or Hermann Memorial; heart attack: St. Luke's or Methodist; pregnancy: St. Luke's, Memorial, Women's or LBJ.)

I don't see the problem. As long as they have insurance what is the problem.

Originally posted by Replaced_Texan And most people choose their physicians based on bedside manner and who their friends like instead of competence, because they don't really have other ways to guage.*

How is this a criticism of my system. If you want to choose your own doctor then you have to pay more.

Originally posted by Replaced_Texan Define "poor." And you don't think that the 44 million people without health insurance haven't thought about the options? (Though thanks to your favorite political party the bankruptcy option isn't there any more.) $300 a month** is a lot of money for a lot of people. And that number just keeps on going up if they have pre-existing conditions, or kids, or spouses, or live in a place where there aren't that many providers.

I don't buy it. Like I said healthcare should be almost every families third biggest expense. After housing, and food. Middle tier Americans have the highest per capita income of middle tier (middle tier equals second and third quartile) people in almost every country in the world. In addition, middle class people in this country have a much cheaper cost of living than most other developed countrys (because of Walmart Costco etc Americans get to buy everything cheaper). They are also the least taxed of any developed country. These people are not on the brink of starvation. People just don't think healthcare should be such a huge burden. But they need to realize it is expensive and they need to prioritize for it. The mind set should be that it is a necessity and it is going to be one of your biggest expenditures.

Originally posted by Replaced_Texan
The managed care model would have worked if people had been stuck in the plans, because care would have been, er, managed by the pcps. We're too used, though, to having lots and lots and lots of choices, so the model was never going to work outside the Medicare context.

Exactly - so if people want to choose their own doctors they need to pay for it. Most insurance plans will cover you if you see their doctor but charge more if you don't. Free choice.

[Spanky]

Originally posted by Shape Shifter
Slippery slope is a logical fallacy. Doesn't mean it can't be used as persuasive rhetoric.

That should read. If you are talking to morons it can be used by people as a persuasive rehtorical technique. If you think it is actually a good argument to use with intelligent logical people you are not only a moron but you are wasting their time. Among certain people saying that Pat Robertson believes in something ads validity to that idea, that doesn't make it a good point of argument to use among educated people.

[Penske_Account]

Originally posted by Replaced_Texan
Diagnostic related group. It's the way hospitals bill for services to provide disincentives to keep people there longer than necessary just for the sake of making a buck. Medicare started with this form of pps (prospective payment system) in 1982, and most everyone else jumped on the bandwagon shortly thereafter. The managed care experiment from the early/mid 1990s sort of sprung from the concept.

Basically, it means that you get admitted to the hospital with a particular diagnosis, and the insurance company and/or Medicare, pays the hospital bill based on the formula for that diagnosis. The laboratory services, radiology services, nursing services, equipment, etc are bundled into that payment, so there's not really an incentive to keep on ordering tests or keeping people in the hospital longer than they need to be. If the patient shows back up in the hospital a certain number of days after discharge, the payment is still under that first admission and the hospital has to eat the additional costs, so there's a nice incentive for not kicking people out too soon. Physicians have a similar sort of formula, though they're generally more on a per-visit or per diem sort of schedule. Upcoding can sometimes be a problem, as can unbundling of some services. Reimbursement specialists will never be out of work.

I could literally spend days talking about the various reimbursement rules. Don't make me.

Please do, i need some clarification on a couple of items for when I pretend I am a HC regulatory atty.

[Hank Chinaski]

Originally posted by Penske_Account
Please do, i need some clarification on a couple of items for when I pretend I am a Health Care regulatory atty.

2. Please do, i need some clarification on a couple of items for when I pretend I am an atty

[Penske_Account]

Originally posted by sgtclub
I haven't been following this story closely, but . . .:

• In response to questions regarding the Cindy Sheehan/Crawford Texas issue: Sheehan Family Statement:
  
  The Sheehan Family lost our beloved Casey in the Iraq War and we have been silently, respectfully grieving. We do not agree with the political motivations and publicity tactics of Cindy Sheehan. She now appears to be promoting her own personal agenda and notoriety at the the expense of her son's good name and reputation. The rest of the Sheehan Family supports the troops, our country, and our President, silently, with prayer and respect.
  
  Sincerely,

Cindy Sheehan is a shreiking stooge for Soros and the Moveon.org crowd. They couldn't win at the ballot box so they use their money to harass the duly elected leader of the Free World.

Where you do think she gets the money to be a professional protester. Disgusting.

I imagine her son probably wanted to enlist in the foreign legion at age 10.

[Penske_Account]

Originally posted by Secret_Agent_Man
Holy Smoke. I'd pay to watch Cheney vs. Hillary Clinton

The real race to watch is Hillary v Pirro for the NY Senate seat:

Pirro Leads Clinton in Online Poll

Westchester County District Attorney Jeanine Pirro was leading Senator Hillary Clinton in an online poll Thursday night conducted by the most listened to radio station in New York, 1010 WINS.

The WINS poll continues a trend that began this week after Pirro announced she intended to challenge Mrs. Clinton, with Mrs. Clinton's support plummeting almost 14 points since April.

For NYers who want good representation this race boils down to one question:

"Senator, if the voters of NY send you back to the Senate, will you pledge to serve a full term?"



Yikes, talk about Beauty and the beast. Woof. Woof on the right hand side there.

More to follow.....................

[Not Bob]

Originally posted by Penske_Account
The real race to watch is Hillary v Pirro for the NY Senate seat:

Pirro Leads Clinton in Online Poll

And Landon led Roosevelt in the Literary Digest poll, too.

So, a district attorney whose husband is a convicted tax cheat, and who is such a skilled campaigner that she stopped her kick-off speech for half a minute in the middle to look for a missing page, is going to knock off the Empress? I think not.

edited to add that I wouldn't cry if Hillary lost to a a pro-choice, war-waffling Rockefeller Republican like Pirro, who does have nice gams.

[Penske_Account]

Originally posted by Not Bob
And Landon led Roosevelt in the Literary Digest poll, too.

So, a district attorney whose husband is a tax cheat,

Tax cheat does not trump impeached liar and rapist. Maybe District Attorney Pirro can ask Mrs. Clinton what she knew when. Interesting that one has spent a career seeking justice for abused women and the other has aided and abetted an ongoing conspiracy to abuse women.

By the way, I am still waiting for an answer:

"Senator, if the voters of NY send you back to the Senate, will you pledge to serve a full term?"

[Not Bob]

Originally posted by Penske_Account
By the way, I am still waiting for an answer:

"Senator, if the voters of NY send you back to the Senate, will you pledge to serve a full term?"

I dunno. What did Dubya say when he ran for re-election for governor in 1998?