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Thursday, January 05, 2012


Dick Williams

I do think there are some doctors who are not wealthy - at least early in their practice of if they choose to live in rural or small town areas or inner cities and have a big percentage of patients who are on those discounted pay skeds whether by Medicare, Blue Cross or other private insurers.

Look at the staff in a doctor's office you're not paying just the doctor but everybody else in that office, and the office rent, utilities, malpractice and other professional insurance. Lots come out of the $125 office call fee you're charged which is then discounted before being paid by Medicare or insurance. Yeah it is a road to great wealth for many but I'd see how there can be doctors who are strapped. Many come out of med school with over 100K in student loans so a hefty payback is due on those. I wouldn't want the 24 on-call life they lead and I'd not do well with the responsibility of getting it "right" nearly every time. They don't always get it right of course but we have high expectations that they will. And we're quite willing to sue them for ten million bucks when we feel they've made a major mistake.


The right uses the Canadian and UK health systems as scare tactic - often mentioning long wait for surgery.

this is an article from a Canadian paper - no relation to US politics - and it does confirm in the city of Hamilton, Ontario that there is a long wait for procedures we'd consider essential and in need of being done ASAP. If you have cancer and need an MRI you don't expect a four month wait list here in the US - you want it this week or next and surgery right away. And hip replacement (up to 375 day wait) seems far down the line for someone in pain or unable to walk needing that procedure.

Where the "right" gets it wrong is equating our Medicare or the new "Obamacare" with a government health system - there is no Medicare hospital - no Medicare clinics - all regular facilities with reimbursement by Medicare or private insurance. The VA system is a true "government run health system" here in the US but that service is limited to a small segment of the population. We're not even close to a government run system.

From what i see Medicare drives a hard bargain with providers and in order to participate they do have to discount their charges significantly so in this country Medicare has the clout to keep medical costs in check. Another way of putting it -- those without Medicare or any insurance pay full fare since the insured patients are getting a bargain. Put another way still - providers have to inflate their list price (which few pay) so they can discount for Medicare - sort of a shell game.

We do most of our "doctoring" at the Univ of Kansas Medical Center and the spread between what's billed and what's actually paid is very wide. Here's a recent bill for "Tissue exam by pathologist". KU billed it at $382. Medicare paid $24.89 and Blue Cross will pay an additional $10.50 for total of $35.41 on a $382 bill. Will that KU pathologist go broke? No, but he or she got about 9% of the amount billed for that tissue prep, analysis and report.

Do you ever go online to check your Medicare billing? I see a note that we can - I haven's done it but will. We get the paper statements from CMS but will check out MyMedicare.gov and take a look.

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