Interesting article on Obama health care plan

Jolie, BSN · May 11, 2009

Currently, most hospitals care for a mix of patients. Some are self-pay, some privately insured with a variety of different plans, some are government paid, such as government employees and military who carry government-sponsored insurance, some are Medicaid (poor and/or disabled) and some are Medicare (elderly).

Let's say that 10 patients come into the same hospital for the same procedure (arthroscopic knee surgery). All 10 have different payment methods. All 10 will be billed different amounts, depending on the agreements they (and/or their insurers) have made with the institution. Let's also assume that each bill will be fully paid with no outstanding balance. The hospital will ultimately receive different amounts of payment for each patient, with some payment coming from the patients and some from the 3rd party payors.

Generally speaking, self-pay patients end up being billed the most for hospital services because they don't usually try to negotiate fees for service. Their payment may be made over a long period of time because few individuals have the means to pay a hospital bill in full upon receipt. Private insurance usually pays a reduced rate for services because they negotiate fees in advance. They typically pay their portion of the bill within a few months of service, with the covered person responsible for the balance. Government insurance for employees and military personnel typically pays less than private insurance, but pays reasonable promptly. Medicaid and Medicare are usually the lowest paying and may take quite a long time to pay a provider.

Because Medicare and Medicaid are lower paying and slower to pay bills, hospitals that receive a majority of their revenue from them may find themselves in financial trouble. They may need a better "mix" of private and publically insured patients in order to remain solvent, or may do away with certain services that are costly to provide such as OB, emergency, psych.

One concern that has been raised regarding government-paid healthcare is that hospitals may find it impossible to remain solvent if and when their only source of payment is the government. Without better and more prompt payment from private insurers and self-paying individuals, hospitals may have to close or eliminate services to remain afloat.

allnurses Guide · May 11, 2009

With my husband Medicare pays within a month.

My insurance company takes many months.

Magsulfate, BSN, RN · May 11, 2009

I read somewhere today that they were considering paying providers for the QUALITY of care they give.

Hm. I wonder how they would measure THAT!

I can only imagine.

Hushdawg · May 11, 2009

I've never understood why this is such a massive debate in the USA. Government controlled healthcare seems to work just fine in Canada, UK, Australia, New Zealand and most of the rest of the Industrialized world. Why is it that the USA is so far behind?

Oh, of course, because the politicians in control are paid big bucks by the healthcare conglomerates to maintain status quo.

Let's face it, healthcare in the USA is too much about business these days and not enough about providing care to the patients. You only find that on an individual basis at the levels of nurse and physician, anyone above that level is only looking at the bottom line.

SharonH, RN · May 11, 2009

I read somewhere today that they were considering paying providers for the QUALITY of care they give.
Hm. I wonder how they would measure THAT!
I can only imagine.

The doctors are rated based on patient satisfaction surveys and how well their patients stack up on HEDIS measures like BP and diabetes control just for an example. Pay for performance is not new.

Not_A_Hat_Person, RN · May 11, 2009

http://www.msnbc.msn.com/id/30672330/
as i was reading the article i came across the following line...
"and hospitals and doctors are concerned the government could dictate what they get paid to care for any patient, not only the elderly and the poor."

private insurers do this already.

classicdame, MSN, EdD · May 11, 2009

one of the reasons Americans are leery of universal healthcare is the fear of "big government". We like to have some independence and choice. Another is that in universal healthcare the providers (MDs, Nurses, everyone) are not paid as well as in USA. I have had the opportunity to visit many countries and have learned that nurses in USA do a lot of procedures and make decisions that only MDs are allowed to do elsewhere. In other words, there are fewer people to ACT and advocate for the patient. I do believe it is time to consider alternatives, however, to our current methods of reimbursement.

elkpark · May 11, 2009

Private insurers do this already.

Yes -- within the last week, I heard a physician (pro-single-payer) discussing this on "Morning Edition" on NPR, and his comment on this was (and I'm paraphrasing here), people are so concerned about the idea that a "faceless government bureaucrat" might be making the decisions about their healthcare -- well, how is that any worse than a faceless insurance company bureaucrat making the decisions, which is what we've got now? At least the "faceless government bureaucrat" would not be primarily motivated by generating profits for his employer, which is the primary motivation for the insurance company bureaucrat ...

SuesquatchRN, BSN, RN · May 11, 2009

The big fear, IMO, is of rationing, that certain people won't be able to have procedures done/care performed because of lack of funds.

Well, Medicare does a lot of stuff for the very old - hip replacements, knee replacements - while uninsured children go without minimal care until they reach school age and must be vaccinated to attend.

We need to rethink the entire US health care paradigm, inlcuding who gets what. Yes, I know, we all deserve everything, but we can't afford to continue spending the majority of our health care budget on the dying.

I work this crappy desk job as opposed to floor nursing because I need the benefits. How much better served would the worl be were I able to serve at the bedside per diem without worrying about benefits. And how much better could the little CAH serve were they not worried about supporting as many bean counters as clinicians.

Koyaanisqatsi-RN · May 11, 2009

The big fear, IMO, is of rationing, that certain people won't be able to have procedures done/care performed because of lack of funds.

This is a valid concern, but as has been pointed out, private insurers already heavily ration care, especially given that they are motivated by making a profit.

The whole fear of "socialized" medicine is one of the most irrational and ridiculous things I have ever seen as an American, and makes me truly ashamed of the fear-mongering that takes place in this country.

markuskristian · May 11, 2009

This is a valid concern, but as has been pointed out, private insurers already heavily ration care, especially given that they are motivated by making a profit.
The whole fear of "socialized" medicine is one of the most irrational and ridiculous things I have ever seen as an American, and makes me truly ashamed of the fear-mongering that takes place in this country.

The fear is over the potential waiting lists that may come from universal health care. It's a very real possibility as it has happened in Canada and Britain, however we can't be certain if it will in fact happen in America. We can only wait until it comes to fruition to find out. IMHO, with the general shortage of health care staff, it will happen.

The second fear may or may not happen. Will there be an option to purchase private insurance for private health care. If not, it seems unjust to limit one's ability to receive better and/or quicker health care when they have the willingness to pay for it. If it is allowed, those that will pay for private insurance will also be paying for the universal care, and no one likes paying twice for the same thing.

I resent your leftist coined term of "fear-mongering." It a legitimate fear. The true outcome of universal health care in America will just have to be seen firsthand. :twocents: