Baldies' Blog began originally in the UK by a 26 year old journalist with a blood cancer on a mission to inform the world about bone marrow donation.

He has since died, and I took on the cause of making cancer care more transparent for everybody.

Cancer is a disease that will touch everybody through diagnosis or affiliation: 1 in 2 men will be diagnosed and 1 in 3 woman will hear those words, "You Have Cancer."

I invite you to read how I feel along my journey and
how I am continuing to live a full life alongside my Hodgkin's lymphoma, with me controlling my cancer, not my cancer controlling me.

I hope that "Baldies' Blog" will prepare you to handle whatever life sends you, but especially if it's the message, "You Have Cancer."

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Friday, January 23, 2009

Health care Merry-go-round

I have wondered about something for a while now. Let me know if you understand this or have the solution.
Most hospitals are Not-for-profit businesses that are reimbursed by medicare/medicaid but also by insurance companies (such as Blue Cross/ Blue Shield, Cigna, etc.).
Insurance companies are FOR PROFIT businesses!
How can a not-for-profit business pay for the profits of big insurance companies?
To me, this sounds like business 101 for health care chaos.
There is a deep discrepancy here that just doesn’t make common sense.
Also, there seems to be some price fixing going on.
Okay, maybe not “price fixing,” maybe this is the wrong word.
Let me give you an analogy about how medicare/medicaid works.
A visiting nurse association goes to a patient’s home administers the necessary care and orders, let’s say they debreed a wound and place a new sterile dressing.
The cost for the materials used and the RN’s time equals $52 (This is just a number).
However, when billing calls for reimbursement, medicare says sorry, according to our standards, we only pay $38. This is the amount we will send you.
There is no option for negotiation just “sorry, this is what we’re paying.”
VNS now has to eat $14. They’re told just to write it off a tax time (so really, the tax payers are all ready paying the discrepancy).
How would this go over if this was a conversation between a contractor and a client? Say the contractor calls a client and says, “I fixed your ceiling. The charge will be $3000 dollars. This was the bid price, and because your special, I’m just charging you at cost and for my labor.”
THEN the client says, “Oh, sorry. I got another bid from another contractor that said they could do it for $2500. So I’m only going to pay you $2500. You can just write the other $500 off as a bad debt loss.”
WHAT?! No dice. Not in the business world. Why would this ever be okay in the health care world.
I’ve got one better. This is an example from change.gov. A man on medicare went to the clinic to get a flu shot. They charged the man $25. The man then went home and submitted the cost to medicare. When he was reimbursed, he received $27.50.
He made a profit on his flu shot!
When he brought this to medicare’s attention (this is clearly a man with principles), they said that was the going rate national for flu shots so that was what he is being reimbursed.
No wonder health care is a big old mess.
To compensate for insurance companies refusal to pay even the MINIMUM for patient care, health care agencies RAISE THEIR PRICES in hopes they will at least break even.
Then, in response to the health care agencies response, the insurance will raise their reimbursement costs a little bit, but it cuts into their profit margins, so they pass the increase along to their customers in the form of HIGHER PREMIUMS.
Then, eventually, this whole cycle will start all over again and health care costs will just rise and rise and rise due to the internal business struggle, like a health care merry-go-round.
Except, no ones having any fun here.
Oh no. You know my feelings about people profiting off suffering, specifically mine. So here goes the rant.
People’s health should not turn a profit!! No one should profit off suffering.
Americans have a clearly stated constitutional right to life. Our current process and system has made health care unaffordable, and therefore unattainable, for many Americans.
I’m not just talking about the poor here. I’m talking about me, a woman with the means to build a home at twenty, who had a combined income with my spouse of six figures at twenty-three. If a woman like me cannot afford to both simultaneously receive treatment, pay my mortgage and eat, there is a huge, country wide, problem.

1 comment:

Katie said...

I work in the billing department of an ambulance company. I can say without hesitation that there is not a SINGLE BILL sent to Medicare by us that is covered in full. We have this process of redetermination, where we fight with Medicare to convince them that these are "medically necessary" costs....I would think that needing an AMBULANCE ride qualifies as a medical emergency, but I guess I don't know all that much....I'd say we spend anywhere from 3-5 hours per week on these alone. And we're a non-profit company. So we have to spend OUR time and money figuring out how to get money on behalf of people who have precious little money from a bureaucracy that, despite the official public relations stance, DOES have plenty of profits......we may be a capitalist society, but we're also a democracy, and healthcare shamelessly disregards the RIGHT to life every day.