Maybe this is why a better term for what happens is a "medical payments" system, rather than a "health care" system.
I remember when my dad was still alive and employed, His "medical payments" system was set up such that when he submitted a claim to his employer's insurance company, the bill would be paid. Within a few weeks, he would receive a statement that showed the payment, with a little notation at the bottom: This bill exceeds the normal rate for this service in your area.
One time, he asked the insurance company how they determined the average cost for the service in his area. Their response: "We surveyed several doctors in your area that perform this service, and got an average." So he asked who those doctors were, so that he could get the services performed at average or below-average cost. Their response: "That's proprietary information."
So when the patient attempts to bring the costs of service downward, the payer won't help by telling who he could have perform the services for less!
That shows me that the insurance companies were in on the scam.
Human's seem to need limits. Things that work well at small scale, with intrinsic accountability associated with known relationships (the buyer of insurance knows the people providing the insurance) at large scale become nightmares due to the corruption & lack of accountability.
The same is true of organizations such as a Community Hospital, vs a large organization. I live in Canada, and Alberta Healthcare is a huge money pit, where some doctors are way over paid, while others such as your local Family Doctor are underpaid, despite being the backbone of the system. Inovations are resisted, because of turf wars, and what is good for the citizens of Alberta is completely lost. Polititians who are elected have no chance at reforming the system, as the people in the system know that they will be gone in a few years so just wait them out.
Well, I'll tell you what CHS. All you need to be is on the public dole and there is no cost of insurance to you (Medicaid), an illegal alien, "sanctuary state" like our good Governor Fatty here in Illinois has spent hundreds of millions on, and there is no bill presented to you, or just choose to ignore any billing from the scamming providers and have them declare that "charity care" was rendered, and that immediately saves them the like amount in payment of taxes.
So there you have it CHS, bitch about it all you want but here's the fact, the system is not broken, it's "fixed", yep, rigged to make sure the doctors are millionaires before age 50, "health care" facilities are for-profit centers REGARDLESS of their official status, and the middle class gets F***ed to pay the bill for everyone, through insurance premiums, co-pays, deductibles, and other means. Welcome to the 21st Century. Everything is on the shoulders of those who work, save, pay taxes, and support all of those who CHOOSE not to pay. I'll call it "socialism with a smile".
If you have actual experience within the system, you would see that its not usually the doctors/nurses who become millionaires. Its the admin staff and the owners of the various systems. All too many are owned by private equity groups of one type or another. Then there is the insane maze of insurance mafia and government regulations that have to be complied with. That is why so many doctors are burning out or setting up their own private cash only practices. That cuts out all of the insurance mafia and most of the government idiocy.
Given that there are literally trillions involved, you can bet that anyone who might actually have a chance at changing the self destructive national diet is likely to have a "tragic accident" or run into a "lone nut". From what I understand, Robert F. Kennedy Jr has a very professional protective detail. Lets hope its enough. He is really stepping on some powerful toes, and we have almost another 3 and a half years to go. Given that both his father and uncle were assassinated, he already knows how the game is played.
Indeed, and in a public forum, I defer giving you details on my more than 40 years experience within "the system". I'm not soft on the administrators and owners of the various systems. They are the ones who, along with the various perverted government run reimbursement schemes are the real culprits. That said, the DOs and MDs today expect to be millionaires before age 50, work within a "work-life balance" model, and would never dream of 80+ hour workweeks beyond their residency. Let's blame that big element on the educational system and society's "evolution" at large.
Sadly, I'd have to agree with you in regards to the last two generations. They are products of a corrupt and power mad system. The doctors I'm speaking of are in their 50's and 60's. Which does not bode well for what happens when they retire. Especially since most people can't be bothered to take even basic care of their health. As for the admin and owners, they are also symptoms of a badly corrupted and dysfunctional system. The entire rigged system is heading for a cliff at full speed. Many millions of people are unlikely to survive the coming collapse. But they have managed to kick the can down the road for decades. Lets see what they come up with this time.
My sister is a doctor in her 50s, struggling to remain a solo practitioner outside of a hospital system. The burden of recordkeeping, regulations, and bureaucracy is crushing. She often goes without pay because she is awaiting insurance reimbursement or navigating the labyrinth of insurance bureaucracy to fight denials. The whole system is geared to force doctors to be employees of a hospital system. Once there, they are treated better than nurses but not particularly well. Who wants 80+ hours of that hell?
Exactly. Which is why many are going into cash only private practice. Many of these people don't see this as only a job. Otherwise they would just retire or join one of the medical industrial complex(MIC) groups. The MIC's only focus is To Make The Numbers Go Up for their owners. Keeping the hysterical lemmings in the wall street casinos placated is their only focus.
I think that kind of cash-pay practice works in some towns, but our hometown is very poor. When my mom passes away, my sister will likely move. Makes you wonder what will happen to other poo, small towns all across the US. They likely will not have very many doctors. We live in interesting times!
Hell no! But I’ll bet if you ask your sister, she’ll tell you that she doesn’t have much “work-life balance” because she doesn’t watch the clock. That’s my point, not the actual counting of hours, the attitude that has you providing care because it’s needed. As for remaining independent, the system is “fixed” in that respect too.
Tell her to join a local hospital group or private practice partnership, use her training to actually give care to patients (she went to school for a LONG TIME to be able to do this!) and have a decent wage. Just don't put up with the MBA's BS. MDs ARE in the driver's seat if they actually tell the MBA to F*** Off. It takes a spine, but it does work.
Our local hospital was owned by the county and the local towns. During the Covid lockdowns, the hospital was going broke, so it was sold to Providence Hospital Group. Care has gone to shit at the hospital. Everything is opaque. I couldn't see my X-rays or get my test results. I hate Providence Hospital Group.
I’m a DO physician and an OB/ Gyn in practice for 25 years . I am one of the last holdouts in my area to not be bought by a system . I didn’t get the covid shots , advise against a lot of the grifter nonsense and try to do more natural approaches . I try lots of natural / lifestyle things first , etc . I make now , what I made in 2000 thanks to the covid shutdown where I kept my clinic running 6 days a week as the hospitals shut them down except 2 1/2 days a week and forced patients to the ER for testing / admission / remdisivir etc .. I paid my employees like they always as had been paid even when the government tried to get employees to go on unemployment. The only reason mine didn’t do it is because I told them I wouldn’t have a job for them to come back to if they left because I would have to close . I should have I took a lein on my house to float us since we couldn’t do surgeries or any office visits other than sick visits. No mammograms / paps / “ wellness checks “ …. This was left to pile up in to a massive backlog that never got caught up . Last year , change healthcare owned by United, was hacked and shut down making it impossible to submit claims to insurance for over 10 weeks and then they denied claims after 120 days for the big payers , HMOS. United was 120 days . Then a billing person quit and we never got them submitted on time to get paid for some . I cashed out my 401 k to float us through that as my bills are the same. Most of the OB patients are Medicaid here and Molina is the worst . Whatever you see on your bill , discount that by 66 % and that’s what we get paid . For a new patient that I spend 30 min with we charge $145. United pays me $65 or less but it takes me 2 hours of billing time at $25 an hour to get that after it’s denied right off the bat . On the private insurance patients , they gave huge deductibles like 5-10 k . Our fee has to be filed first so we have to collect $1200 to cover the maternity care , calls , office ultrasounds , and my professional services anytime in clinic , triage visits , and the delivery 9 months later . Just to do the massive paperwork like PAs to get simple $4 meds covered requires a whole person all day , man the 5,000 calls where people can’t get in to their primary and want us to refill their 17 meds , the workins all day ( we do it all - laceration repair , pneumonia , direct admits to bypass the ER ..etc ) , nursing care , billing etc is a staff of 11 @ $18-$28 an hour so if I’m averaging $65 a visit and seeing 6 in an hour. Do the math. We aren’t millionaires . I honestly don’t know any . Not doctors anyway unless they do derm of pain management . I got $135 for a Medicaid hysterectomy on an over 400 lb patient and a check from Aetna for $.02 the other day. I’m framing that one . The reason I’m trying my hardest not to sell out is that I know they will cut my staff , quality will decline and they will extract whatever they can out of it for “ savings “ and then none of those services that no one wants to do anymore won’t get done. We have been unable to recruit to my hometown because of our gang violence , poor public schools , and our poor economy and limited workforce as we have the highest public housing in the state . It’s a real struggle and the massive influx of metabolically devastated patients makes it a total burnout .
What jumps out to me from the article and comments: private equity. Private... Hidden, secret, 'proprietary' as mentioned, all point to greed and corruption as you correctly write. If only my local community is involved, the system can work. But externalize the decision makers and shield them from any actual contract with patients and the system becomes brutal.
In my previous career, I worked as a nurse and at a large corporate owner of hospitals and clinics. I got sick of hearing the soft-handed, "polished penny loafer people" talk about how they were all about saving lives, all about the patients. These were paper pushers. Nobody cares about the patient, including the patient. It's all about $$$.
Maybe this is why a better term for what happens is a "medical payments" system, rather than a "health care" system.
I remember when my dad was still alive and employed, His "medical payments" system was set up such that when he submitted a claim to his employer's insurance company, the bill would be paid. Within a few weeks, he would receive a statement that showed the payment, with a little notation at the bottom: This bill exceeds the normal rate for this service in your area.
One time, he asked the insurance company how they determined the average cost for the service in his area. Their response: "We surveyed several doctors in your area that perform this service, and got an average." So he asked who those doctors were, so that he could get the services performed at average or below-average cost. Their response: "That's proprietary information."
So when the patient attempts to bring the costs of service downward, the payer won't help by telling who he could have perform the services for less!
That shows me that the insurance companies were in on the scam.
Human's seem to need limits. Things that work well at small scale, with intrinsic accountability associated with known relationships (the buyer of insurance knows the people providing the insurance) at large scale become nightmares due to the corruption & lack of accountability.
The same is true of organizations such as a Community Hospital, vs a large organization. I live in Canada, and Alberta Healthcare is a huge money pit, where some doctors are way over paid, while others such as your local Family Doctor are underpaid, despite being the backbone of the system. Inovations are resisted, because of turf wars, and what is good for the citizens of Alberta is completely lost. Polititians who are elected have no chance at reforming the system, as the people in the system know that they will be gone in a few years so just wait them out.
Well, I'll tell you what CHS. All you need to be is on the public dole and there is no cost of insurance to you (Medicaid), an illegal alien, "sanctuary state" like our good Governor Fatty here in Illinois has spent hundreds of millions on, and there is no bill presented to you, or just choose to ignore any billing from the scamming providers and have them declare that "charity care" was rendered, and that immediately saves them the like amount in payment of taxes.
So there you have it CHS, bitch about it all you want but here's the fact, the system is not broken, it's "fixed", yep, rigged to make sure the doctors are millionaires before age 50, "health care" facilities are for-profit centers REGARDLESS of their official status, and the middle class gets F***ed to pay the bill for everyone, through insurance premiums, co-pays, deductibles, and other means. Welcome to the 21st Century. Everything is on the shoulders of those who work, save, pay taxes, and support all of those who CHOOSE not to pay. I'll call it "socialism with a smile".
If you have actual experience within the system, you would see that its not usually the doctors/nurses who become millionaires. Its the admin staff and the owners of the various systems. All too many are owned by private equity groups of one type or another. Then there is the insane maze of insurance mafia and government regulations that have to be complied with. That is why so many doctors are burning out or setting up their own private cash only practices. That cuts out all of the insurance mafia and most of the government idiocy.
Given that there are literally trillions involved, you can bet that anyone who might actually have a chance at changing the self destructive national diet is likely to have a "tragic accident" or run into a "lone nut". From what I understand, Robert F. Kennedy Jr has a very professional protective detail. Lets hope its enough. He is really stepping on some powerful toes, and we have almost another 3 and a half years to go. Given that both his father and uncle were assassinated, he already knows how the game is played.
Indeed, and in a public forum, I defer giving you details on my more than 40 years experience within "the system". I'm not soft on the administrators and owners of the various systems. They are the ones who, along with the various perverted government run reimbursement schemes are the real culprits. That said, the DOs and MDs today expect to be millionaires before age 50, work within a "work-life balance" model, and would never dream of 80+ hour workweeks beyond their residency. Let's blame that big element on the educational system and society's "evolution" at large.
Sadly, I'd have to agree with you in regards to the last two generations. They are products of a corrupt and power mad system. The doctors I'm speaking of are in their 50's and 60's. Which does not bode well for what happens when they retire. Especially since most people can't be bothered to take even basic care of their health. As for the admin and owners, they are also symptoms of a badly corrupted and dysfunctional system. The entire rigged system is heading for a cliff at full speed. Many millions of people are unlikely to survive the coming collapse. But they have managed to kick the can down the road for decades. Lets see what they come up with this time.
My sister is a doctor in her 50s, struggling to remain a solo practitioner outside of a hospital system. The burden of recordkeeping, regulations, and bureaucracy is crushing. She often goes without pay because she is awaiting insurance reimbursement or navigating the labyrinth of insurance bureaucracy to fight denials. The whole system is geared to force doctors to be employees of a hospital system. Once there, they are treated better than nurses but not particularly well. Who wants 80+ hours of that hell?
Exactly. Which is why many are going into cash only private practice. Many of these people don't see this as only a job. Otherwise they would just retire or join one of the medical industrial complex(MIC) groups. The MIC's only focus is To Make The Numbers Go Up for their owners. Keeping the hysterical lemmings in the wall street casinos placated is their only focus.
I think that kind of cash-pay practice works in some towns, but our hometown is very poor. When my mom passes away, my sister will likely move. Makes you wonder what will happen to other poo, small towns all across the US. They likely will not have very many doctors. We live in interesting times!
The big hospital groups probably help sponsor all those doctor shows on TV that show hospitals in a good light.
Does anyone dream of an 80+-hour work week?
Hell no! But I’ll bet if you ask your sister, she’ll tell you that she doesn’t have much “work-life balance” because she doesn’t watch the clock. That’s my point, not the actual counting of hours, the attitude that has you providing care because it’s needed. As for remaining independent, the system is “fixed” in that respect too.
She doesn't make much money and works all the time. She wants out
Tell her to join a local hospital group or private practice partnership, use her training to actually give care to patients (she went to school for a LONG TIME to be able to do this!) and have a decent wage. Just don't put up with the MBA's BS. MDs ARE in the driver's seat if they actually tell the MBA to F*** Off. It takes a spine, but it does work.
Our local hospital was owned by the county and the local towns. During the Covid lockdowns, the hospital was going broke, so it was sold to Providence Hospital Group. Care has gone to shit at the hospital. Everything is opaque. I couldn't see my X-rays or get my test results. I hate Providence Hospital Group.
I’m a DO physician and an OB/ Gyn in practice for 25 years . I am one of the last holdouts in my area to not be bought by a system . I didn’t get the covid shots , advise against a lot of the grifter nonsense and try to do more natural approaches . I try lots of natural / lifestyle things first , etc . I make now , what I made in 2000 thanks to the covid shutdown where I kept my clinic running 6 days a week as the hospitals shut them down except 2 1/2 days a week and forced patients to the ER for testing / admission / remdisivir etc .. I paid my employees like they always as had been paid even when the government tried to get employees to go on unemployment. The only reason mine didn’t do it is because I told them I wouldn’t have a job for them to come back to if they left because I would have to close . I should have I took a lein on my house to float us since we couldn’t do surgeries or any office visits other than sick visits. No mammograms / paps / “ wellness checks “ …. This was left to pile up in to a massive backlog that never got caught up . Last year , change healthcare owned by United, was hacked and shut down making it impossible to submit claims to insurance for over 10 weeks and then they denied claims after 120 days for the big payers , HMOS. United was 120 days . Then a billing person quit and we never got them submitted on time to get paid for some . I cashed out my 401 k to float us through that as my bills are the same. Most of the OB patients are Medicaid here and Molina is the worst . Whatever you see on your bill , discount that by 66 % and that’s what we get paid . For a new patient that I spend 30 min with we charge $145. United pays me $65 or less but it takes me 2 hours of billing time at $25 an hour to get that after it’s denied right off the bat . On the private insurance patients , they gave huge deductibles like 5-10 k . Our fee has to be filed first so we have to collect $1200 to cover the maternity care , calls , office ultrasounds , and my professional services anytime in clinic , triage visits , and the delivery 9 months later . Just to do the massive paperwork like PAs to get simple $4 meds covered requires a whole person all day , man the 5,000 calls where people can’t get in to their primary and want us to refill their 17 meds , the workins all day ( we do it all - laceration repair , pneumonia , direct admits to bypass the ER ..etc ) , nursing care , billing etc is a staff of 11 @ $18-$28 an hour so if I’m averaging $65 a visit and seeing 6 in an hour. Do the math. We aren’t millionaires . I honestly don’t know any . Not doctors anyway unless they do derm of pain management . I got $135 for a Medicaid hysterectomy on an over 400 lb patient and a check from Aetna for $.02 the other day. I’m framing that one . The reason I’m trying my hardest not to sell out is that I know they will cut my staff , quality will decline and they will extract whatever they can out of it for “ savings “ and then none of those services that no one wants to do anymore won’t get done. We have been unable to recruit to my hometown because of our gang violence , poor public schools , and our poor economy and limited workforce as we have the highest public housing in the state . It’s a real struggle and the massive influx of metabolically devastated patients makes it a total burnout .
"Bankrupted by greed." I like that phrase. Reminds me of the Goose that laid the golden eggs.
What jumps out to me from the article and comments: private equity. Private... Hidden, secret, 'proprietary' as mentioned, all point to greed and corruption as you correctly write. If only my local community is involved, the system can work. But externalize the decision makers and shield them from any actual contract with patients and the system becomes brutal.
In my previous career, I worked as a nurse and at a large corporate owner of hospitals and clinics. I got sick of hearing the soft-handed, "polished penny loafer people" talk about how they were all about saving lives, all about the patients. These were paper pushers. Nobody cares about the patient, including the patient. It's all about $$$.
I am only able to see 2/10 comments. Are the others hidden for some reason?