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.
I'm kinda liking the idea of scores based on how likely all insurance companies (auto, medical, etc.) are to pay.
"The use-mention distinction" is not "enforced here."
In the United States, those in middle-to-low income groups often get very poor health insurance from their employer, or worse, depend on Medicare/aid grants from the government.
This means that only those with money have proper access to health care, treatment and diagnosis.
In Australia, private cover is only designed to be an add-on for existing government-provided cover via the Pharmaceutical benefits scheme and Medicare. Medicare levies are paid on an income-ramped scale, and you can be exempt in some cases from paying altogether.
In this way, those that can afford good health care (i.e high incomes) enable those who cannot (low incomes) with at least a baseline medical cover that is far more extensive than the government health grants in the US of A.
This introduction of a credit-rating style scheme only makes the problem worse. Someone may have been unemployed and become very ill, and ended up being unable to pay medical bills promptly/at all. They may later have become employed - perhaps even at a high income, but will therefore still be cursed with a poor medical credit rating and be turned away from healthcare.
No one should be denied medical treatment in this way, and the fact that this system is being developed suggests there is something wrong with excessively privatized health like in the United States.
Like I said before... baby boomer DINKs getting medicare before your parents. That's what this stuff is about, preparing for the coming wave of no longer able bodied and making sure that the number of those monopoly bucks the Fed prints are still what gets you into line.
-1 Uncomfortable Truth
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.
Receptionist: Do you have a Q4A5 planet insurance waiver?
Xev: No.
Receptionist: A D-class standard waiver?
Xev: Sorry.
Receptionist: Any waivers of any kind?
Xev: No.
Receptionist: Then cash will be fine.
Xev: Pardon?
Receptionist: Precious metals or bankable equivalents.
Xev: We have no precious metals or bankable anything.
Receptionist: Then your situation becomes a class 1313.
Xev: What's that?
Receptionist: Ignored.
Xev: You can't do that.
Receptionist: I'm afraid I have no choice. Policy is policy.
Kai: We will pay you later.
Receptionist: I'm sorry, MEDSAT does not accept credit.
Xev: This is an emergency!
Receptionist: I understand. Please inform the next person to appear on the screen.
Xev: Hey, lady, watch! Lexx, blow up that little red moon we just passed.
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.
Let's put up a web site where you can post the hospital's medical score.
We can see how many sponges got left in patients, etc. Just sounds fair to me.
-- Programming with boost is like building a house with lego. It's a cool but I wouldn't want to live in it
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.
Actually its people like you that drive health care costs up, since you have no insurance, get it a car wreck and spend a couple of days in the hospital. You don't have the means to cover your costs, so now its passed on the me the lowly responsible middle class citizen. Thanks.
I'm not not licking toads.
It turns out the triumph of the value of money over human life in the United States is now complete.
Medical One: "What's in your spleen?"
Table-ized A.I.
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.
Many hospitals will try to bill in triple if possible. My boss has been billed in triple several times, and each time he has called the hospital, asked them for prices on their procedures, and stated he would only pay the noted price. Even after that, the hospitals would submit the triple billing to his insurance company in hopes they would pay the difference. The problem with the hospital system in the US is the greed on many levels, whether it be from the malpractice lawyers right up to the doctors that will sometimes give unnecessary procedures in order to get more money. The US is one of the only, if not the only, countries in western civilized society that treats medical care like car repair. This sounds like a bit of a drum-circle bongo argument, but to treat health care like a commodity instead of a basic human right in the western civilized world is morally wrong.
The quality is mediocre, but what do you expect with socialized medicine.
Just so you know, I'm insured by the Ontario Health Insurance Plan. It's what we call a Crown Corporation - a company run for the benefit of the people of my province. It's formed by an act of the Provincial Parliament, and answers to the government, but is in all other aspects a real company - other than it's forbidden by law to make a profit. Yes, part of my Ontario Income Tax is used to fund the company, so I pay my premiums as a matter of course, rather than seperately. Last year I paid about $5500CDN in Ontario tax - total - and I make a pretty good salary. So, the risk you speak of is shared by all in Ontario through having a Crown Corporation. BTW - if it does make a profit, the money is put back into the public purse. People pay what they can afford, and other than having some fat-cat bureaucrats who make inflated salaries, it's cost effective for us - no one is trying to make money for shareholders, they try to give good care.
It's not perfect by any stretch, sure. We don't have enough doctors, but OHIP is trying to remedy that in a reasonable way. Yes, I've waited for hours in an emergency room, but that was after a rather nasty accident on the highway flooded the place with the severely injured and I just had a sore back. I went to a clinic the next day and received the care I needed - I just walked in, showed them my OHIP card and got medical care that fixed me up.
I have choice in health care providers, do need to pay some out of pocket expenses (i.e. prescriptions, crutches etc.), and get excellent care when I really need it. I haven't looked for the numbers, but I'm pretty sure our outcomes are very close to yours. There are horror stories of course, but there are also just as many examples of people getting stellar care.
It works pretty damned well, we get very good care and I don't need to worry that I'll be bankrupted by getting sick and having someone trying to profit from my misfortune. I'll take a little less quality for half the price, thankyouverymuch.
Soko
"Depression is merely anger without enthusiasm." - Anonymous
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 live in Uruguay, and like the previous Romanian poster, we have a socialized medicine here (a bit mixed, not fully socialized).
,and somehow seem to have better access to healthcare than most of you? (with all the caveats).
It seems to work a bit better than what you're describing (and way better than the Romanian system), but it has some severe downsides.
I get deducted 4,5 % of my salary each month (6% if you have children), and that pays for the monthly fee at the "mutual" (our form of medical care based on the ), which gives me basic health coverage.
By "basie", I mean "call us if you're dying or in severe risk, otherwise don't bother", the hospital seems to have been teleported to Iraq (they started some structural work and didn't have the money to finish it, so the entrance is covered in rubble and you have to enter through a small passageway on the side of the hospital), if you want to be seen by a specialist you have to book it anywhere from a month to three months in advance, unless the doctors (general practitioners?) determine you're likely to die or a severe threat to health from it. Oh, and you pay an extra fee for everything, too.
Medicine is included, but you never get "brand" name stuff, everything is generics, sometimes of dubious quality (I definitely notice a decreased effect from some of the stuff I've taken, in particular I used to suffer from asthma and the generics are nowhere as effective at stopping an attack).
Some medical procedures that seem to be common in the US are not included, dental care besides some tooth extraction is not included (everyone has lousy teeth compared to the US), and god forbid if you have to go to the "emergency" room, it takes something from 1 to 3 hours to be seen by the overworked staff, unless you actually look like you'll die on the spot. Most people (myself included) buy additional emergency services (not included in the social healthcare) which actually come in case of a non life-threatening emergency, and which you can see for all kinds of usual health-related stuff that would take all day in the mutual system (this or that hurts, my son has a fever, etc..).
And even then, only those who work, or whose relatives work, have access to the "mutual system".. the rest goes to the "public" hospitals, which are directly state managed (the "mutual system" seems to be private, non-profit based, see http://en.wikipedia.org/wiki/Mutualism_(economic_theory) ), and those are even worse, even though they do provide basic healthcare.
The upside is, my hospital (with the entrance covered in rubble and all), has access to MRI, CRT and most modern equipment, and instead of being billed into oblivion, if I ever require the use of such services (if the doctors determine that - that is, very less frequently than in the US), I get to use them for a relatively small fee (most expensive procedures are about U$ 50 to U$ 100 fee).
I really can't understand how you can say with a straight face that medical care for someone in the US can be U$ 12.000 per year, even taking into account the huge difference in salaries between here and the US. For comparison, I earn about U$ 6.000 per year after taxes
I don't know how socialized medicine would work in the US, but you already have my anecdotal evidence and the Romanian's, so you can see which you would prefer.
There are three kinds of lies: lies, damned lies, and statistics.
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!
The claim is not that socialized medicine works well, the claim is that it works better than the US system. For evidence, even Canada would do, but also the UK, The Netherlands, Germany, Denmark, Sweden, Finland, Iceland, France, Spain, Portugal, Italy, Greece, Australia, New Zealand, and frankly, every developed country that isn't the US. There might be waiting lists, but hardly not for life-threatening situations, there are no large groups of people running around uninsured, no people trying to cling to a job while dying because of insurance considerations, and bankruptcy due to health-care bills is unheard of. And it's cheaper.
The government, nominally, does whatever it does in the "best interest" of all citizens. At least, it says so, and there is, at least, some truth in that. Also, people who get involved in government do so for reasons other than to enrich themselves as much as possible; there are, in government, other currencies of power besides money. Corporations haven't even got a withered little figleaf of concern for anything other than profit. In other words, the government, if it thinks there are enough votes in it, might screw you. A corporation, if it thinks there is any money in it, will screw you.
I worked for a year and a half in France. Doctors made house calls for children because 1) they didn't want to spread infections and 2) they didn't need an army of clerks to fight with insurance companies. When I did go to the doctor's office, I just signed in on a sheet of paper. The doctor came out, looked to see if anyone was in need of urgent attention and called the next name on the list. But of course, this cannot possibly be a workable system because it is socialized medicine.
Think global, act loco