No democrat should miss this once in several generations opportunity to finally realize health insurance reforms, and health care for all Americans - Senator Kennedy is watching you!

Nancy the Loon doesn't have the votes. Again.

You want to fix healthcare?  I can fix it in one sentence.  BEGIN THE "WALMARTIZATION" of health care.  

Think about this for a moment.  Imagine every doctor office is equivalent to a mom and pop corner store. Highly expensive and extremely inneficient.  Imagine a system where efficiency is the model and Doctors aren't paid for by billing codes for everything they to touch.  

Example... If I develop a practice with many many doctors and pay them in four ways.

1.  Health Outcomes
2.  Tenure
3.  Patient load
4.  Revenue sharing (from premiums within various groups) meaning it is beneficial to keep costs down.  

In no particular order of importance these four payment methods would totally change the game.    In my healthcare system no longer would a doctor feel like he needs to order MRI's or Bone Scans just for the heck of it.  

Think about the example of how it works today.  A person needs an MRI they go the doctor and he refers them to get an MRI by a Radiologist.  Remember, the MRI machine the Radiologist is using is probably anywhere from 1 to 3 million dollars.  The incentive the radiologist has is to bill the insured customer at a rate of about 5500.00 to over 10,000.00 dollars.  WOW.  

Now, here is the kicker, the insurance plan will only pay her a portion of the premium so the amount of money the doctor will actually get in revenues is between 3500 and about 5500 dollars.  The doctor of course is happy with this.  I mean you can bill 50,000 dollars if the insurance companies would pay you something close to it but they don't so the doctors bill what they want knowing they will get reimbursed only a set amount. i.e. bill 5500 to 10,000 and get only the actual 3500 to 5000 dollar payment from insurance companies (Medicare and VA included).

A truly disgusting practice Doctors implore is the fact while they bill an unreasonable price to insurance companies, [knowing they won't get paid anywhere near that level of reimbursement], they sure the heck bill people without insurance such prices and this really is unfair, unjust, and a reason why healthcare is putting people into bankruptcy.  

Now, just a thought but what if my system where in place.  The insurance companies would work as they do but they would work under the premise of different rules.  I.e. Say there is a pool of 20,000.00 people.  That's a large pool.  If you actually did the math you could create a system where as all the doctors with all the necessary specialties where in one building.

The Walmartization of healthcare is this.  Take the 20,000 people and make the healthcare they receive ultra efficient.  Pay doctors what is reasonable in a salary format.  I.e. give a radiologist a starting pay of $250,000.00.  Give a internist, which has much less overall schooling, a pay of $130,000.00. Let them work hard for bonuses, patient outcomes, and amount of patients they see.  So at the end of the year the Radiologist might make 300,000 to 350,000 and the internist might make 150,000 to 200,000.  Who in any medical system needs more than that? PLEASE tell me who needs more than that?  

See everyone, that is not system works and I will continue to use MRI as an example.  The reason why plan would save TRILLIONS of dollars is because like Wal-Mart everything is efficient.  I.e. what is the true cost of an MRI?  A doctor who is an established radiologist in the community will get paid 350,000 to well over a $1,000,000.00 a year.  Because think about the revenues brought in by getting 3500 an MRI scan.  

Using these numbers if a doctor took 20 (not unreasonable to think right?) patients for 260 viable business week working days at 3500 the revenues for that are 18.2 million dollars. THAT's INSANE RIGHT?  

Here's the thing, what is the true cost of an MRI?  The machine only costs a million dollars.  Say the doctor is leasing that machine for 50,000.00 dollars a month.  That is only $600,000.00 dollars a year.  Nothing compared to the 18.2 million in revenue it is generating.  

So again, what is the true cost of an MRI?  The fact is why can't the insurance companies use my system and just purchase the MRI and charge for it in a purely expense related way.  i.e. yes someone has to operate, fix, and maintain the machine.  Ok fine.  But isn't true profit from the actual person paying a premium.  Why the heck doesn't the insurance company just buy the MRI machine for my style of practice?  

To the benefit of the insurance company a doctor would do MRI's as needed.  The premiums paid incentivize to use the machine as much one wants.  There is no cost being charged to an insurance company.  

It's like your ice maker in the freezer. Yes, you can go to the store and buy a bag of ice for 2 or 3 dollars or you can pay pennies for it by using your own ice maker.  So what do you do?  You turn on the ice maker.  It’s literally that much common sense.  

Now, with my style of practice I am getting as many people as many choices of doctors they possibly can have.  They are a part of a practice that has every machine necessary for healthy outcomes that is used at will.  And if the doctor is seeing more patients with healthier outcomes they will be rewarded with higher bonuses.  Not millions of dollars but geez come on they will have adequate compensation.  

I have talked to doctors about this and they listen and smile and say "yea you're right."

I am a Medical student so for the information I provided it is accurate.  

CXM

She suggested there may be additional legislation needed to get the full reform she wants. "There's some things that we anticipate might be complementary to it, which might not fit into a reconciliation bill, but I feel pretty good about where we are."

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Brilliant! That means the Senate will have to re-vote on it. And not with reconciliation. Dems will need the whole 60 votes to pass it. And they don't have them!

LOLOLOL

I they are able to get this takeover through, say so long U$A.

Will Rahm be clothed for this meeting?

  Another box 'em in move...vote against PORK GOP.
That'll make great campaign material.

First... It took two MSNBC reporters to write this short article? That's just too funny!!! Now both top notch reporters seem to leave this out from Nancy's meeting with the National Association of Counties yesterday. Nancy Pelosi: “We have to pass the bill so that you can find out what is in it, away from the fog of the controversy.” Nancy actually wants to pass something so big without knowing what really is in it. Very Scary

Sorry Teddy, not gonna happen this time, the American people oppose this snake oil. Besides, what happened to "We're gonna focus on the economy", or "We hear the American people loud and clear" after the Brown win.

Pelosi didnt have the votes then, and since then shes lost votes, the math doesnt add up. Game over for Dems, they pushed their luck up to Brown win, and are just on a crash course to their faster demise in November, works for me, and the majority of Americans!!!

P.S. If you leftys love Canadian and European healthcare, move to those countries, dont destroy this one!!!

CXM -

Thanks for an illuminating post.  You've verified an aspect of the existing billing practices which I've long suspected.  Those without health insurance are in the same boat as people with bad credit - they pay through the nose because they have no representation and these are the people who can LEAST afford the higher fees.  We can do better, YES WE CAN!

That Northern Boundary Waters sound...the haunting, mournful, plaintive call of that dark bird at the edge of night...  The loon, you ask?  No, that hollow-eyed, darkest of freaks without a soul and without a conscience---Nancy Loon P.

pelosi is an idiot, just like HER president....

Come on Dems you have to make this happen if you don't get Healtcare done this year than you need to quit talking about it and move on. The American ppl have given you big majoities so just get it done and forget about the Republican they are useless and have nothing to offer the American people. All the do is stand in the way.

WE VOTE is absolutely clueless. Health care will get passed and it will get fixed.

Speaker Pelosi, wherever they said keep up with the Healthcare Reform, they are sad, because no more medical fraud, no more running test  for new patient even if the patiend doesnt need it, DOCTOR FOR MALPRACTE YO ARE DONE, NO MORE

Nancy! you don't have the votes, you never had the votes and you never will have the votes! forget about healthcare and get to work on jobs and the economy you freeky old coot!

Cxm...It is the misfortune of many companies to be run by an immediate bottom line. This is the work of accountants in the main, which has been generally a bad idea. To put this format into the health service would be a disaster, simply put everything would have to be cost effective. Peoples lives would be put at risk and treatment would boil down to the lowest common denominator. Please keep in mind under the present system over 40,000 people die because of no health insurance coverage every year and millions go bankrupt for the same reason. It is time to have health service that serves Americans, not the insurance giants. Robin

HET CXM,

AN INTERNIST COMPLETES 7 YEARS OF MEDSCHOOL AND RESIDIENCY. A RADIOLOGIST COMPLETES 9 YEARS OF MEDSCHOOL AND RESIDIENCY.  WHY SHOULD THE RADIOLOGIST GET TWICE THE SALARY OF THE PCP? DO THE MATH?

This thing between the repub. and demo's is just a race to see which party will get the credit for health care and they don't care who pays for so long as it's not them. They want a feather in their hat for the next Presidental election. I think we should put them on a slow boat to china and let them help destroy this country. The boys scouts have better leadership the United States does

We need health reform and not just to cover the 30 million people that need it now, but to cover the millions of people that will need it soon.  The fact is, the recession is still bad.  Those people that have run out of cobra benefits are going to need choices very soon.  

More importantly, also because of the recession, younger people are not finding work.  Why is this important?  Well, in order to make insurance work, you need young, healthy workers putting more money into the system than they're taking out to cover the older, sicker workers that are taking out more money than they're putting in.  Since this isn't really happening they way it's supposed to, the whole health insurance concept isn't working-- which is a big part of the huge increases we've been seeing (i may be liberal, but i can also understand that it isn't ALL greed).  

What people need to understand (republicans especially) is that the current health insurance really only works with a healthy, reasonably well-off pool.  This pools is shrinking fairly rapidly.  What covers 90% today may cover 88% next year and 85% the year after that.  If the economy doesn't recover soon, we're looking at even fewer people being covered.  Considering the health problems that will be facing the boomer generations shortly, i have doubts that there could be a recovery big enough to make our current profit driven system work.

Love her or not, Nancy is a very strong woman who gets things DONE!

Brilliant! That means the Senate will have to re-vote on it. And not with reconciliation. Dems will need the whole 60 votes to pass it. And they don't have them!

Beth - she said "supplemental" legislation.  That means pass what they have and then amend it later.

They will shove it down our throats.  Just wait until November, Nancy and company!  You are in big trouble.  The giant is no longer sleeping.

Any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods. Definition, sounds alot like Barack Obama. Sorry but the man is a socialist.

kEEP UP THE GOOD WORK,SPEAKER PELOSI. SHE IS INTELLEGENT, UNLIKE SOME STUPID WOMEN ON THE REPUB WING NUT SIDE.

I for one am sick of compromise, our health care is too important for compromise. This bill doesnt address the rising costs of health care and leaves some 15 million plus American without any health care at all. The attitude of something is better than nothing is a bogus argument made by the spineless incompetent elected majority which cant seem to get out of their own way to get things done. Its time to stand up to the special interests and the obstructionist minority and do whats right for American and its people. Compromise is a poor excuse for health care and unless they can provide affordable comprehensive care for ALL Americans then they have failed and will pay the piper come the 2010 and 2012 elections.

Re:  WALMARTIZATION.  If you pay doctors based on health outcomes, you chill doctors' desire to treat critical or long-shot patients.  And you are comparing apples to elephants because the whole point of health care reform done right is that neither health care providers nor health insurers should be making a profit.  That is the point of having the government do it - instead of insurers spending 20%+ of all dollars received on overhead and administrative costs, you have 2-3% (ala Medicare) going to such costs, and nothing going to profits.  It is ironic that you use WalMart as an example because WalMart has more uninsured full-time workers than any other company in America.

CXM is correct -- and it already exists (basically) in a clinic model called Solantic.  Check it out and tell me how close it comes in your mind.  Write me back at Colin@LFRUSA.com.

Hi Subversives, Now that Greece belongs to Germany , soon your socialist America will belong to China.  We need more of your outdated socialism. Carry on subversives.

CXM,

You are still a student and have no real understanding of how a business/practice works. You are making several invalid assumptions. First off, you assume that you can keep your MRI machine at 100% capacity, this is grossly inaccurate.

Second, you assume you will get anything resembling a 3500 reimbursement. I just looked up the codes in PA and no MRI from *any* insurance carrier will reimbursement $3500 for an MRI, period. Most are generally floating around 1000-1200.

So, lets realistically say your MRI machine generates 2-3mm in revenue, set that expense operational expenses and the fact that this is effectively all you will be doing and you have a radiologist making 400-500k a year.

So, lets take a look at that, then ask who would become a doctor to make 150-300k a year? A person who can be a physician has many other career options. None of the others require 4 years of undergrad, 4 years of med, 3-5 of residency, and a fellowship in some cases. S, you have 7+ years of additional education, which is very expensive, to make marginally more than a pharmacist? What about the lost earnings over those 7 years? Have they showed you how to do present value of capital calculations?

This is why your entire analogy is wrong. If you want to work for 100k a year, go ahead, its your life.

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