For eight years I worked in supporting and designing healthcare software. First for a software company, then working directly for two hospitals supporting their medical and financial systems.
Below you will find a list I put together addressing the real costs of healthcare.
High Cost of durable medical equipment - No one ever seems to question that. Consider my wheelchair versus my 2007 Tundra.
Permobile
8 way adjustable seat
2 Car Batteries
6 actuators
Top speed 7mph
Range 9 miles
Weighs 250 lbs
Cost $30,000
Warranty 1 yr
Out of pocket $0.00
Tundra
6 way adjustable seat,
1 passenger seat,
Flip up rear bench that seats 4
1 Car Battery
5.7 liter 5.8
Top speed 100+ mph
Range 430 miles
Weighs over 1 ton
Cost $42,000
Warranty 3 yrs
Out of pocket $42,000
My guess is that the permobile is actually produced at a price of
$10-$12,000.
Brand or Generic - Do you question the drugs your doctor prescribes? Is there a cheaper alternative? Or do you happily accept his recommendation? Did you know Pharmaceutical Reps rewards Doctors for writing prescriptions? Their short skirts are easy on the eyes too.
Procedures - Do you question the procedures ordered by your doctor? Are they necessary? Did you know that unnecessary procedures are the biggest contributing factor in the high cost of healthcare? Why is it done? To prevent the possibility of malpractice suites.
Milking the system - Ever run out of a prescription that you have taken for years, call the doctor, and be told you must come in and be seen first? Why is that done? Because the doctors are trying to make up for lost fees from Medicare and Medicaid. Some doctors are even dropping that insurance coverage. Though doctors are not the only ones feeling the pinch from the Government cutting fees, the hospitals are feeling it too.
Union Contracts - Unions such as SEIU who work in hospitals who are vying for higher wages and healthcare coverage. Right or wrong, it is just one more stress.
Illegal Aliens - In every other country in the world, no money, no service, here it’s a different story. Border state hospitals are being crushed by the onslaught of illegals coming to the US for medical care, and blowing off paying. The Mexican Government even produces pamphlets directing pregnant mothers where to go to have their babies in the US and become citizens.
Working the system - Doctors and hospitals that ‘work’ the system, via adjusting codes to maximize payments by insurance. Not all do this, but a recent survey showed 1 in 3 providers didn’t see this as something they should not do.
Fraud - Then we have fraudulent claims to private insurers, Medicare, and Medicaid to the tune of 270 billion per year and the Gov’t isn’t doing anything. That 1 out of every 3 dollars paid by Medicare/Medicaid to the State of NY was Fraudulent.
Sure...let's do it, I have insurance! - Don’t like what you hear from your doctor? Many people will change doctors until they get the doc to do as they wish. Some legitimately, seeking second opinions, or having disagreements, then we have others who are just not satisfied. Either way, insurers bear the cost.
Billing - Many billing departments for physicians and hospitals are incorrectly staffed to efficiently handle timely accurate billing and payment collection.
Paperwork overload - Notice you always fill out the same paperwork for yearly visits to the doc? How about day surgery? Ever note the volumes of paperwork? Not only is this stuff produced, but much of it must be stored afterwards and space is not free.
Consider those who set up doctors appointments, yet fail to show. These costs can not be ignored, it’s a business.
Misuse of ER facilities - to treat people’s illnesses which is better handled by a doctor’s office. That’s like using a howitzer as a fly swatter. Even worse are the illegals who use the ER and never pay.
I've seen it all. I've been denied claims, battled insurance companies, and seen more inconsistancies than you can imagine. Why? Because I have had to use the system extensively due to having muscular dystrophy, being a cancer survivor, and receiving heart disease as a result of the cancer treatments.
But I do understand one very important thing and that is the drug industry and insurance industry is a business. And like any other, they have a right to make a profit.
Granted there is much to improve upon, they are not the vampires the Obama Administration and the Democrats would lead you to believe.
Consider the cost of developing a new drug.
The average time from taking the idea to FDA approval is 12 years.
Only 0-2 percent of these compounds make it to human testing.
And only about 20 percent of those tested are approved.
This equates to $359 million for a company to get one new drug on the market.
Then they only have 7 years to recoup the cost before the the generic competitors enter the market who sell a cut-price version without spending money on research.
So think twice before complaining about the high cost of drugs. Also realize the the US is the only real viable pharmeceutical market creating drugs because they are not forced to eat the costs.
Not one socialized or nationalized healthcare nation has drug development because the government regulations and price ceilings make it impossible.
Consider what will happen when HR 3200 passes.
How about insurance companies?
Insurance works because a pool of customers is created such that most will require little need for claims, allowing the funds to be shifted to those who do while still allowing the insurance companies the ability to make a profit.
Everyone understand that when you have an automobile wreck, that the insurance must determine whether the auto is totalled or worth repairing. Not all cars can be repaired. Still we don't drive like maniacs smashing up our cars because we have insurance. We also know that a car is a machine with parts that wear down and that we don't expect insurance companies to pay for dead batteries, tires etc. They would deny the claims.
So one should not be surprised that some claims are denied by health insurance companies for the same reasoning. There are areas for improvement, but Obama would have you believe that this evil empire should not be able to deny claims.
But when you have a claim denied, you can appeal it. And if you feel strongly about it, get a lawyer. The system isn't perfect, but nothing ever is.
I required a toilet lift to help me get to a stand, the insurance company denied the claim. Yet researching t, I discovered they based their aprovals/denials on what was established under the Medicare/Medicaid fee schedule which was determined by the government.
How interesting!
Further research showed that Medicare/Medicaid would pay for a Lazy-Boy recliner that would get me to a stand.
So in short, the government denied me for submitting a claim for a piece of durable equipment that was necessary to assist me with bodily functions, but if I wanted to relax in a lazyboy, they'd pay for it.
Isn't that just brilliant?
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