Slashdot Mirror
The Doctor Will See Your Credit Score Now
mytrip writes to mention that the same people who invented credit scores are working to create a similar system for hospitals and other health care providers. "The project, dubbed "MedFICO" in some early press reports, will aid hospitals in assessing a patient's ability to pay their medical bills. But privacy advocates are worried that the notorious errors that have caused frequent criticism of the credit system will also cause trouble with any attempt to create a health-related risk score. They also fear that a low score might impact the quality of the health care that patients receive."
They also fear that a low score might impact the quality of the health care that patients receive.
Of course this will impact the quality of healthcare that people receive. Don't be absurd. Look, as someone who is involved in his family business (12 docs, 100 total employees), the ability of patients to pay is fundamental because healthcare is a business. Doctors graduate medical school with six figures in debt, buildings cost money, running a business with good people takes money to pay your employees with and more. It is hard enough as a small business in medicine, but competing with larger hospital groups who make access like this part of their business practice (like HMOs) are making it even harder because they shunt patients who are less able to pay to the local doctors or smaller clinics, and these are the businesses that suffer the burden of non-payment.
What is the solution? Trying to figure out who has what insurance (some insurance is better than other types) and who can afford to pay for more expensive procedures is just bad medicine and bad social responsibility. Socialized medicine is not it either, however, a return to fee for service medicine is a better option for all people involved. Scrap the HMOs (who are in business to make money, not provide health care), scrap the insurance companies (middle men extracting their pound of flesh) and return to a system where you pay for services rendered with insurance for catastrophic coverage. Granted, many specialized procedures will not be utilized as much but health care coverage for two healthy people is often in the $8k-$12k/year range as it is. And what is the average American getting for that expenditure? You are paying typically out of pocket expenses on top of that as well if you do take advantage of health care services and if you prove a bad insurance risk, you get dropped entirely. Look, insurance companies are not in business to help you stay healthy, or get well... They are publicly traded companies who's bottom line is profit and that profit comes at your expense. A classic parasitic business model that has been promulgated on the American public. However, this will have to change as it is dragging down US business, small and large, big time.
how about having a MDFICO (quality of provider)? hell! they wouldn't like that a bit, would they?
Because I know the types of posts that are coming.
There's no such thing as a free lunch.
We also need real accountability for credit reporting agencies. Simply requiring them to change incorrect information after the damage is already for done and requiring each of us to police the companies on our own dime - is crazy. They're immune for normal charges of libel, and should not be.
If you want to look up my licensing status and any restrictions, as well as board certification, go right ahead - http://www.docboard.org/docfinder.html. If you want to know if I'm a good match for you, you'll have to do the same thing as you would for your dentist, plumber, or lawyer - try me and see if it works out.
If you want to figure out how much I'm charging, good luck: each different plan with each distinct insurance company charges different prices for different procedures or visit types, which is often considered proprietary information so I'm not allowed to know or publicize what it is anyway, lest I collude with other physicians to get better a payment schedule.
And while some doctors may be competing for your business, as a primary care physician, I'm not - our practice (like many) limits new patients. I take Medicaid and uninsured patients along with commercial insurance, and my panel is overflowing. I'm happy to say I love my job, but the long hours, mountains of paperwork, and 13 year old car are typical of my colleagues - we're not exactly living high off the hog, or running our hands through a mountain of gold coins.
By law in the United States, no hospital with an emergency room can turn away anyone for needed care, but I can see why the folks doing elective surgeries might want to be sure you can pay your bill. This is America after all, and we are apparently a long way off from figuring out what virtually every other industrialized democracy has: private insurers are in it for the money, and are not necessarily aligned with your best interests.
By law in the United States, no hospital with an emergency room can turn away anyone for needed care,
Not quite. They can't turn you away for an emergency. They can turn you away for everything else if you can't pay.
Sadly, since many people are unable to pay for their emergency care, the hospital ends up eating the bill. Some hospitals decide to close their emergency rooms as a result.
from putting every aspect of our lives to an index. We won't be able to get good service at a restaurant because our ACTT (Average Cost to Tip) Index is too low and the waitress is busy working the patrons with above average scores. Frugal shoppers will be stuck in long lines in the grocery store because the index that keeps track of how many high markup, name brand products we buy won't qualify us for the express lanes for prefered customers. Our MedFICO score will be shot because the new wave of Medical History Theft screwed us up before privacy and consumer laws could catch up to the problems and we'll have to goto Mexico for our routine exams.
Unfortunately the people making these indexes never have to tell single mothers with starving children that they can't use their services. They give that job to the other single mothers with starving children that they've hired minimum wage to work the reception desk. If they did, they might realize that people are actually more than the sum of their indexes.
Once again, American libertarian Slashdotters come out in droves to let us know that socialized medicine couldn't possibly work. I guess this is plausible enough, as long as you're suffering from some sort of epistemological disorder that prevents you from perceiving the universe outside the borders of the United States. Because in every other Western industrialized nation, some sort of socialized medicine has been the reality for decades, and, not coincidentally, they all provide a better standard of care to their citizens for less money than we do here in the USA. (Yes, even with the waiting lists.)
Argue, if you want, that health care shouldn't be universal on some sort of social Darwinist grounds ("The sick should die, because they are weak!"), but please stop trying to suggest that there's something inherently unworkable about government-provided health care. It's sort of like arguing that the Earth is flat or that water runs uphill: it's clearly contradicted by fact.
Anyone who understands free market capitalism should understand why it doesn't work for healthcare. The rational, informed, value-seeking man does not exist in the healthcare world. Real healthcare patients are seeking the best treatment that they can afford, not the cheapest healthcare that will probably get the job done. That's the kind of market where prices go up instead of down because the only downward price pressure is whether or not a provider can find enough people that can pay at the prices they offer.
Matters of life and death are not ruled by bargain-seeking behavior, and thus the entire driving forces of supply and demand are thrown completely out of whack. Anyone who's spent any time studying economics should recognize that the fundamental assumption of modern economic theory doesn't apply here.
If it's for-profit but free, you're not the customer -- you're the product (e.g., the Slashdot Beta's "audience").
In 2004, I was diagnosed with Acute Lymphatic Leukemia. At the time, I was working for a rather well known technology company that had a great benefits package, great insurance, and treated me well -- I was placed on Short Term Disability, then Long term Disability, and Aetna/BCBS paid for most of my Rx and Dr's Trips. 18 months later, in 2005, my cancer was in remission, but, my doctor didn't want me back on the road because of my immune system being in the state that it is.
I've changed employers, since then, because I grew tired of being stuck on LTD, and was 'acquired' by another company last year. Same insurance (Aetna became BCBS), similar benefits.
I go to the Pharmacy to grab my Monthly Maintenance Medication this month, only to find out that my employer removed that coverage from the benefits package. Now, I'm paying $750/month for medicine to keep me alive. No Biggie -- I go in for my monthly labwork, only to discover that my blood draws and hematologic shit isn't covered anymore. Well, now I'm kinda getting worried, because It's going to cost me another 1200 to get my lab work done. (We're at $1950/month just to keep me alive, right now, where it used to be $100 -- $80 for my meds, and $20 for the labwork).
Add on top the trips to the Dentist (I've spent over $6K with my Dentist in the past 2 years recovering from the hell that chemotherapy and Barium treatment does to your teeth), and I'm looking to probably spend $24,000 this _year_ on medical bills alone. While Flex plans help, it's really not that much.
This begs the question -- If I had chosen a different career path, and if I was working as a busboy at a restaurant, would I still be alive today?
I'm not saying that Social Medical coverage is the answer. I'm not saying that I know the answer, but, think about things like this:
My brother has a daughter that has Cystic Fibrosis. My brother barely scrapes by on minimum wage. He literally has $250K worth of medical bills from his daughter alone. He can't afford a house, I bought him the car that he drives, and every penny of his money (and every ounce of his love) goes to making sure that his daughter is alive, safe, and cared for.
Yes, I understand that Doctors work very hard to get where they are. I have two engineering degrees, and I am still paying those off at this point in time. I also understand the costs of finding and keeping good talent and staff. At what point do we say, "Your daughter can't live because you can't pay," or, "you can't live because you can't pay?"
I honestly don't think that anyone has a good answer for any of this.
I have never understood this phrase "socialized" medicine you Americans use for a tax payer funded health care system. In the US the police forces, fire services etc are funded by tax payers but you do not describe them as "socialized" police forces etc. Public schools are funded by tax payers, do you have a "socialized" education system? Here in the UK we have had tax payer funded National Health Service for over 50 years. The NHS is just considered a public service like refuse collection, fire and police service, state education etc and from my perspective it is bizarre to talk about healthcare like it is a commodity.
"The vast majority of us who want a free market for health insurance do so because we know that in the long run, everyone including the poor will be much better off. Free markets a) promote innovation and better health care and b) drive costs down.
Do you also stand by this argument regarding fire services and police forces protecting your house and neighbourhood? Do you prefer private fire protection to publicly taxed fire departments, and private law enforcement over public police? Just curious as perplexed as it seems to me as an outsider that "socialized" fire and police protection seem acceptable but "socialized medicine" appear to be less acceptable in the USA. Wondering where the difference between these services is seen by the American public?
There's a fairly large set of holes defined by the "underinsured" and the "uninformed".
The uninformed are those who qualify for Medicaid, but are unaware of how to apply for it, or unwilling to do so because of legal dubious status (arrest warrant, dubious immigration status, etc.). Their unwillingness may not be rational, but it's real and contributes to a LOT of people sitting around with treatable conditions, waiting until those conditions get untreatable, or just really expensive to treat.
The underinsured are those whose insurance doesn't cover what they have, or covers only a small fraction of it, or would have covered it if conditions were slightly different. They're the ones with passable or decent jobs with insurance companies that have horrible payment schedules and are slow to pay, on top of it. If their insurance is relatively new and they had ANY gap in prior coverage, there's a strong chance that it will be defined as "pre-existing condition" and they'll be completely denied.
This twist happened to a friend of mine about ten years ago; he had recently got a new job, and soon after he started was complaining of stomach pains. His employer told him that since he had been employed more than a month, his insurance had kicked in and he should get checked out. It was diagnosed as "diverticulitis", and he was given some medications and food recommendations. Fast forward two more weeks and the pain has increased and turned out to be full-blown pancreatitis. Huge chunks of his pancreas were removed, making him a diabetic. His insurance pointed back to the earlier misdiagnosis of diverticulitis, indicated that the pancreatitis was pre-existing even the start of his coverage, and denied his bill: his $120,000 bill. 25 years old, new job, 120,000 in debt. He died a year later in a diabetic coma due to poor glucose control, completely unable to pay for any medical care. He was working on bankruptcy proceedings, but this was back when it was "easier" to get a medical bankruptcy; current bankruptcy laws in the US are dramatically different - against him.
Sorry, nope. As an ER doctor, I can tell you there are many things you will never get that way. Need a pap smear? Nope, we don't do them in the ER? Need surgery and chemotherapy for your advanced cervical cancer? Again, sorry - we don't do that in the ER. Maybe when you come in bleeding out from your vagina, we'll admit you, but you won't be getting definitive care. Need surgery for your broken arm? Nope - that's not an emergency, so the only care you will get in the ER is stabilization. No orthopedist has to admit you under EMTALA to do it either, since the standard of care is splint and then follow-up for outpatient surgery. Of course when you try to make that appointment, they will tell you $20,000 up front or no follow-up appointment.
And don't play that 'I grew up on welfare' card. So did I dipshit - when it was a more decent system in the 70's and 80's. We've been going downhill since then with regard to public assistance - including health care assistance. Thank you republican controlled congress and private health insurance industry!