OT: Car insurance complaints

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On 8/15/2013 9:26 AM, Kurt Ullman wrote:

That question would make a good study for some sociologist. The armed forces (Navy, Marine Corps, Air Force, Coast Guard AND Army) are made up of a diverse bunch of people from all geographic areas of the country, with maximum formal educations varying from GRE to multiple doctorate degrees and everything in between. Obesity is highly prevalent among the spouses, especially the spouses of junior enlisted members. Many lower rate enlisted personnel qualify for food stamps and have difficulty affording healthy nutrition - even though they can shop at better prices at the military commissaries, or don't have the education or experience to understand what constitutes a healthy diet. Eligible patients vary in age from premature infants to the extreme geriatric.
The major difference in demographics that comes to my mind is a lower percentage of white people compared to the population at large, but I'm not sure that difference between populations is germane to the issue of generalizing management and economics data from the military health system to the US population at large.

I agree completely. The fact that almost all the metrics used to assess the system are strongly affected by multifactorial considerations makes the entire analysis exceedingly complex and difficult to get right.

No argument at all. As we both agree, essentially every consideration has multifactoral considerations. One sees similar problems in analysis when comparing patient outcome rates between community hospitals and tertiary care centers. The tertiary centers get the sickest patients so looking only a raw numbers is totally misleading.
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On 08-15-2013 09:26, Kurt Ullman wrote:

We are very concerned with patient satisfaction, BUT I am not aware of that having anything to do with Medicare. There are financial incentives to "Meaningful Use of the Electronic Health Record" but all of the goals are things that can actually be measured/counted.
And we have incentives based on treatment guidelines for various conditions.
And a new thing developing is payment for keeping the population healthy rather than payment for specific treatments.
But I am not aware of financial benefit from Medicare for warm fuzzies.
The reason we want the patient happy is so that they will come back instead of going to the for-profit down the street.
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Although Medicare has been publishing patient-satisfaction scores on its Hospital Compare website since 2008, it will begin using them to adjust payments, reports Kaiser Health News in conjunction with the Washington Post. Under CMS's "value-based purchasing" proposal, Medicare will withhold 1 percent of its payments to hospitals starting in October 2012, putting those funds into a pool to be distributed as bonuses to hospitals that score above average on several measures. Patient satisfaction scores would determine 30 percent of the bonuses, and clinical measures for basic quality care would decide the rest.
Read more: Patient satisfaction will impact Medicare reimbursement in October 2012 - FierceHealthcare http://www.fiercehealthcare.com/story/patient-opinions-will-impact-how-mu ch-hospitals-get-paid-medicare/2011-04-29#ixzz2c8Ht8sZ4 Subscribe at FierceHealthcare
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I just realized that I was talking doc and this is talking hospital. I have been spending too much time with hospital based docs recently who usually have a financial dog in the hunt that the outside practice doesn't and like to complain about how this is making their lives miserable...
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On 08-16-2013 08:00, Kurt Ullman wrote:

You're right--I forgot about that. On the other hand, you did say "is basing" rather than "will be basing"
I don't know whether our big-wigs saw this coming or not, but for many years, we have tied small but pleasant quarterly bonuses to patient satisfaction surveys. And we don't get them from CMS--we hire independent survey companies to call for us and total up the results.
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Wes Groleau

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I am writing a whole bunch of stuff on this now (it is has turned into sorta a cottage industry for me along with ICD-10 and PQRS) and sometimes forget that it isn't actually in place yet-grin).

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The VA is, and pretty much always has been, an interesting study in contrasts. Indiana is fairly typical in that the Indy VA is a sterling place, staffed by docs who are all faculty at the Indiana University Med Center, the nursing staff is first-rate largely because of the draw of working at a teaching hospital with Fed Fringe Benefits. Down I-69, the Ft. Wayne VA is in need of paint, a larger percentage of the docs tend to be from foreign medical schools, and the labs and other tools not so great (and getting worse since they are currently in their we are thinking about closing it down phase for this decade).
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On Thu, 15 Aug 2013 00:57:25 -0400, Wes Groleau

A bud of my brother heard about caffeine jacking up pressure, and when he got drafted during Viet Nam, he drank a couple quarts of real strong coffee just before his induction physical exam. Didn't work. He passed with flying colors. Got sent to Viet Nam for a tour of duty. Was in some bad spots, saw most of his squad mates die, but never got a scratch himself. Back in the states after his tour, he peeled potatoes for the remaining 5 months of his active duty commitment. To keep from going crazy doing that, he'd repeat to himself over and over, "I'm the luckiest man in the world."
The day he was discharged from the Army, they gave him his discharge physical exam. The medic taking his blood pressure seem confused, and did it 3 times. Told him to see a civilian doc when he got home. Said, "I got no idea how in hell they let you in the Army with such low blood pressure."
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That's a story worthy of "The Gift of the Magi" by O. Henry. That's the one about a poor woman who wants to buy her husband a Christmas gift but only had two dollars. She decides that she will have her long hair cut off and sells it to buy her husband a golden watch chain. He turns out to have sold his watch in order to buy her hair brushes.
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Bobby G.



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I can assure you that in the private sector this happens all the time. My MD graduated med school in 1980 and that's where the bulk of his ideas about treatment are stuck. )-: Despite the requirements for continuing their medical training, doctors tend to treat based on what they learned in med school. Worse than that, all the specialists they are likely to refer you to are from the same age cohort.
When my friend had serious prostate trouble he did a lot of research after getting a referral to a 65 year old urologist whom he thought was too "old school." (No hate mail from seniors, please!) He discovered that there's a lot in the way of new technology and found a much younger MD who was working with the latest high-powered green lasers instead of surgical techniques from 20 years ago. The results were outstanding.
In those cases, as you apparently did, you have to "urge them along" into the 21st century. I always did my own research making sure to cite *reputable* sources when discussing treatment options. It's very tricky because it's easy to offend doctors. They are innudated with dummies bringing in printouts from "Yahoo Answers" who take the word of some whacko as gospel. I always make sure to innundate him with NIH, Medline, JAMA and other "reputable" sources.
(-;
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On 08-15-2013 16:18, Robert Green wrote:

And a good doctor may have so many patients (BECAUSE he's good) that he doesn't have time to do any research. So his only knowledge of new advancements are the reprints cherry-picked by drug salesmen.
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whacko

and

Don't get me started on "detail men" for pharma companies. When they walk into the waiting room and then right into see the doctor I always say, loudly, "Hey, did you make an appointment?" (-: I've gotten some great free stuff that way.
My MD said he depends on the reps for free samples he can give to his poorer patients, but it's never a generic sample, always something high priced. Those reps seem so much like heroin pushers at times. The huge fines assessed for pharma companies pushing "off label" prescribing shows how successful detail men are at persuading MDs to use the products they are pushing. The placebo effect guarantees that at least some of that "off-label" treatment will be effective. (-:
I found that for GP's in particular, if you present them with high-quality research about your own particular problem it does help them "keep up" and they appreciate it. It's just crazy what a GP is expected to know, especially in relation to what they are paid (not much compared to specialists).
The good doctors I know that have too many patients are starting to use nurse practitioners for the easier stuff and I have no problem with that as long as I get to see the doctor whenever I really feel the need to.
I tried to find a new GP for my neighbor, whose own doctor retired and just closed down the practice - no one wanted to buy it. All I could find were foreign born and trained GPs which presented a bit of a problem for her because she's a xenophobe.
We're definitely approaching a very serious crisis in US health care.
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I'm finding that harder and harder to believe, overall. With the great emphasis throughout medicine on clinical guidelines, you have the feds and/or the clinical societies doing most of the work. Heck guideline.gov even has a way to compare competing guidelines to let you pick one from column A and one from column B if you want to.
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wrote in message

It's called managing your own health care -- good idea and nicely done.
Tomsic
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Thanks. It's important to evaluate options - and to sniff them out when they're not presented to you so you can ask intelligent questions like: "What is the success rate for this sort of surgery and what it the worst I can expect from a bad outcome?"
Now I'll play the devil's advocate and talk about my poor neighbor who is elderly and totally afraid of the web. I do what I can for her but I also realize a lot of what I am saying is just gobbledy-gook and doesn't make much sense to her. It's not easy to be a intelligent consumer of medical services without having a medical degree and even doctors run into problems when evaluating their own treatment options.
If I had to state the most important rule I've learned it's "Don't get admitted to a hospital without someone who cares about you knowing you're there and even better, staying with you to answer questions and run interference. DAMHIKT!
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Bobby G.


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Part of the problem is that so many people believe that we have the best healthcare system in the world but some troubling statistics put those beliefs in doubt. The problem is that there are so many possible ways to measure health care outcomes that comparisons across different cultures becomes very dicey indeed.
American cancer patients outlive those in most other countries, but some say it is a horribly prolonged death, adding a few months to a person's life that are of very low quality but costing more than the insured ever paid in premiums. Sadly, a huge amount of Medicare money goes towards just those sorts of situations. People in near vegetative states suffering through major operations as their bodies fail. Medicare dollars to treat terminal elderly patients might be better used to provide health care for young who might benefit from those dollars for a much longer time than a senior with dementia.
One good thing about the ACA is that is has finally brought a lot of issues to the table that weren't really being openly discussed before.

What would you recommend to fix those problems?

A lasting legacy of WWII and a reminder of how long the effects of a war can linger:
http://www.frbsf.org/economic-research/publications/economic-letter/1998/april/health-insurance-and-the-us-labor-market/
<<Although the earliest employer-sponsored health plans date to the 1920s, two public policies from the 1940s and 1950s firmly established the link between health insurance and the workplace. First, during World War II Congress responded to excess demand for labor by enacting limits on the extent to which employers could increase wages. Since these limits did not apply to fringe benefits, many employers began offering health insurance to attract and retain workers. Second, in 1954 the IRS created a permanent incentive for employers to substitute in-kind benefits for cash wages by declaring that fringe benefits are not taxable.>>
http://www.nap.edu/openbook.php?record_id 44&pageI
History is a record of ''effects" the vast majority of which nobody intended to produce. Joseph Schumpeter, 1938
<<The current U.S. system of voluntary employment-based health benefits is not the consequence of an overarching and deliberate plan or policy. Rather, it reflects a gradual accumulation of factors: innovations in health care finance and organization, conflicting political and social principles, coincidences of timing, market dynamics, programs stimulated by the findings of health services research, and spillover effects of tax and other policies aimed at different targets. The path taken by the United States has diverged from that of other developed nations, particularly since the end of World War II.>>
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Actually shows how the effects of governmental expediency can linger. This was a classic government pretending that something isn't what it really is (or was) to avoid a political problem.

I have long trumpeted for a Truth in Bill Naming Act (for example every law having to do with campaign money reform should be called "The Incumbent Full Employment Act" unless it gives the challengers more money to overcome the perks associated with incumbency). And most should include ... "as well as other things we know about and did not tell you and other things that we didn't begin to contemplate but screwed things up royally.." Act.

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I was not pleased with the GWB "remove protection from the power of government act" one, and it's follow up bill, two.
. Christopher A. Young Learn about Jesus www.lds.org .
On 8/17/2013 9:16 AM, Kurt Ullman wrote:

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On Wednesday, August 14, 2013 5:24:10 AM UTC-7, Peter wrote:












Amen to that. When I was living in Europe, a member of my family was treat ed, long-term, for a very serious condition, without a penny of cost, even though neither of us was a national of that country.
Allow me to reiterate that physicians in many developed countries -- I only know specifically about European countries, so am extrapolationg -- comple te their medical studies at government expense. No sky-high tuition bills from for-profit universities. No crushing debt load for the first 15-20 y ears of practice. No wild divergence in physician-hospital fees between pr actitioners and institutions. No drive to specialize in big money practice s like plastic surgery. In return,physician obliged to devote 'n' years to (more or less) government assigned practice, meaning often working in unde r-served communities.
Sounds like a win-win to me. In those countries, health care is not consid ered an "industry" --I wince every time I hear that term --but a public goo d.
Those governments must have figured out that $1 spent on preventive health care and affordable care for existing conditions saves $100's of dollars do wn the line in social costs that we pay out of our other tax pocket.
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It's interesting that despite models that show that health care delivery can be substantially improved, we're stuck with a pretty miserable system that makes it impossible to apply standard "free market" competition rules.
http://www.scribd.com/doc/148822563/Brill-Senate-Finance-Committee-Testimony
Shows that it's almost impossible to shop for medical care based on price because it's almost impossible to ascertain the costs for expensive procedures beforehand.
<<In a functioning marketplace prices are based on something that is explainable - whether it's the cost of producing the product, the laws of supply and demand, or the quality of the product. In this marketplace, no one can explain a hospital's charge of $77 for a box of gauze pads, or $18 for a diabetes test strip that can be bought on Amazon for about 50 cents.
No one can explain a supposedly non-profit hospital's $13,702 charge to an underinsured small business owner -- whose family income is about $40,000 -- so that he could get his first dose of a cancer drug that cost the hospital $3,500 and cost the drug company, whose gross profit margins are 90%, a few hundred dollars to make.
That school bus driver (charged $9,400 for an ER visit) didn't wake up one morning and say to herself, "I wonder what they have on sale over at the emergency room today? Maybe I'll go have a look." Instead, when she involuntarily became that hospital's customer, she not only had no price information, she also had no choice. She paid for whatever procedures, lab tests, CT scans and anything else she was told she needed, whether she needed it or not, at whatever price she later found the unintelligible chargemaster had spit out on her bill.>>
My neighbor was recently diagnosed with breast cancer and discovered her employer-supplied policy was a joke. It was written to "appear" to cover a large percent of the cost of treatment - in fact it was an amazing con job - but it covered close to nothing. Trying to find out beforehand what cash treatment would cost from various different providers was absolutely impossible. I know, I tried to help her and no one would point to a list of standard or even potential charges. How can a "free market" work if you can't comparison shop, can't determine costs before treatment and are so sick or hurt you have to take whatever you get - or die? The ACA and Medicare will help set things straight - eventually - by setting up reimbursement rates that can serve as a baseline for comparison.
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It's all part of the growing "bash the Federal government" movement which I find pretty despicable.

I strongly agree with your disagreement. (-: The institution of a single payer healthcare system where everyone gets basic care and those who want can buy supplemental insurance would gore a LOT of very wealthy oxen. Those special interests turned what could have been a very simple universal health care system into the bureaucratic nightmare of the ACA. The VA can negotiate for lower drug prices because it buys so many of them but Congress denied that bargaining power for the ACA. Instead, Americans are ending up subsidizing lower drug costs for *Europe* which I find disgusting and close to insanity. We already provide them an enormous amount of free military protection. Must we pay for their drugs, too?
http://www.forbes.com/sites/paulroderickgregory/2012/07/01/obama-care-will-end-drug-advances-and-europes-free-ride-unless-china-steps-in/
<<Pharmaceutical companies finance new product development by devoting a higher percentage of their revenues than any other major industry (an astronomical 20 percent) to R&D. It is the American consumer who pays these costs by buying the new drugs at prices that cover these R&D expenses. Free-riding Canadian, German, French and Dutch consumers buy at much lower prices and avoid contributing to the costs of product development. China, Russia, India and most of the developing world ignore intellectual property rights and knock off the drugs for sale in domestic markets with no compensation to the developer>>
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