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Name:
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wix
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Subject:
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Understanding the past..
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Date:
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8/3/2009 10:52:09 PM
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Having spent the past 30 odd years in and around the health care industry, I can share a few observations that may explain how we got in this mess. From Medicare's inception the government paid hospitals on a cost plus basis. If a bottle of IV fluid cost the hospital $1.00, the Fed's would pay $1.08, 8% as the + factor. Medicaid was non-existant and insurance companies paid billed charges or close to it. Hospitals soon learned that cost plus was pretty good as long as they could keep ratcheting up the costs; the + factor, while low, wasn't too bad. Insurance companies and personal pay made up the difference.
Then in the 80's Congress gets really smart and changes the reimbursement system. Now Hospitals would be paid under the DRG Program. Diagnosis Related Groupings were the magical way the Feds could get ahead of the industry by paying a set amount for a patient's hospital stay based on the diagnosis of the patient. If the patient was admitted for a stroke the hospital knew up front they would receive, say $10,000 from Medicare, regardless of how long they had to warehouse the patient. For the hospital to make money they had to get that patient out of the hospital ASAP. So they ship the patient off to Health South for re-hab. Notice HS was born about this time. Now the Feds have to pay the hospital, plus they have to pay Health South, plus home health care, ++++. A whole new facet of the industry is born out of the wonderful DRG program. Ain't they smart.
Outpatient Surgery Centers are born about this time to move procedures out of the hospitals, so that reimbursement is greater. Now the surgical patient gets sent home sick, to save money.
Next the experiment in socialized medicine called HMOs is born. This experiment lasts about 10 years and is largely rejected by Americans, or is hated by those still inflicted with HMOs. As more and more procedures are moved out of the now poor hospitals, physicians gain more and more power (and money) by having control over the patient. The physicians also own surgery centers, imaging centers, re-habs, etc. Since they control the patient they also control what happens to the patient, where he has MRIs, what lab tests are necessary, where surgery is conducted, etc. Get the picture; it ain't pretty. Yes, there are "safe harbor laws" that are supposed to prevent the above, but these laws are useless.
The above is a very simplistic explanation with many steps left off for brevity, but it'll give an idea of the problem.
What to do to correct the mess? I'm not nearly smart enough to make a suggestion, but o-BAMA is not even addressing the problem. All he is advocating is giving a bunch of his sorry, lazy, worthless followers free insurance so they will vote Democrat every time. Yes, the system needs fixing, but not his way.
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