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Medical Costs Bankrupt Patients; It's the Computer's Fault
nbauman writes "Don't get cancer until 2015. The Obama health reform is supposed to limit out-of-pocket costs to $12,700. But the Obama Administration has delayed its implementation until 2015. The insurance companies told them that their computers weren't able to add up all their customers' out-of-pocket costs to see whether they had reached the limit. For some common diseases, such as cancer or heart failure, treatment can cost over $100,000, and patients will be responsible for the balance. Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs? 'A senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: "We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person's out-of-pocket costs. They asked for more time to comply."'"
We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person's out-of-pocket costs.
So what's on the other side of this "balanced" solution?
This.
The mess is deep and wide, and likely still has some duct tape applied to cover up the Y2K transition. Many/most of these systems are ancient, and creaking under their own mass.
Suppose you were an idiot and suppose you were a member of Congress
By what legal authority did Obama delay this implementation?
Do you have ESP?
For who's benefit, though?
As far as I can tell, Republican partisans believe that everyone will hate Obamacare once it actually exists, which would mean that the Democrats are trying to avoid having it exist. The Democrats could have cut a deal with the insurance companies to prevent things from rolling out on schedule so they wouldn't have to deal with the negative campaign ads about their support of it.
On the other hand, Democratic partisans believe that everyone will love Obamacare once it actually exists, which would mean that the Republicans are trying to avoid having it exist. The Republicans could have cut a deal with the insurance companies to prevent things from rolling out on schedule so they wouldn't have to deal with the negative campaign ads about their opposition to it.
Or, alternately, gerrymandering has made it almost guaranteed that the House will be controlled by the GOP, and Obama is not up for reelection, so no matter what happens in November of next year nothing will get done. And don't think waiting 2016 will help, because the staunch Republican voters are slowly dying off making the president likely to be a Democrat, but still have a majority in enough congressional districts to keep the House Republican. So there's a good chance that absolutely nothing useful will come out of Washington D.C. for at least another decade.
I am officially gone from
Well damn, better go tell Microsoft to stop making Excel... *facedesk*
Go ahead and try to put health data into Excel without violating HIPPAA and going to jail. The same medical procedure can be billed at hundreds of different rates, depending on numerous criteria, many of which are covered by privacy laws, or are calculated by third party labs or testing facilities. If you really think this is easy, then you don't have a clue. There is a reason that we spend 2 trillion a year on health care, and if you compare America's longevity, infant mortality, etc. to other countries, it is pretty obvious that all that money isn't being spent on actual effective medicine. My family doctor's office has one doctor, two nurses, and four people in the billing department.
The last time I had to deal with the insurance programs they were nothing more than a web GUI hiding a dumb terminal interface. Most are still on mainframes.
"Think about how stupid the average person is. Now, realise that half of them are dumber than that." - George Carlin
Sadly, the reason we can't comprehend the problem is that nobody will make intelligent decisions. With "only" 300,000,000 records, and probably not more than 100 q/s (which should be restricted to UID, as privacy is important), the thing could run on any of a number of cheap and ubiquitous databases. Use off-the-shelf querying programs for reporting. Standards-based interfaces, and require other systems connect in standards-based ways. Instead, we have ancient systems built in the '70s and such on unusual languages with proprietary interfaces, and everything new needs to connect back with the old interface. When 30% of your systems are big-endian and 30% little endian, and 30% some bastardized undocumented middle endian (just making up a worst case, hopefully it's wrong), integration costs are large.
Burning the place to the ground and starting over would be cheaper. The problem is they never figure that out until after the first hundred billion dollars are spent. And the bigger problem is when they do burn it all down and start over, the never remember to lock the politicians in first.
Learn to love Alaska
Which is funny, because my health policy company (whatever BCBS in Florida is called this month - FloridaBlue I think?) sends me a statement every month of what was charged, what was paid, what I paid. And at the end of the year they send a nice summary for tax filing purposes. Heck, hte pharmacy the family uses - Publix - has a "year to date" on each receipt we get for prescriptions.... so, it obviously isn't impossible, or even too hard....
Don't blame me, I voted for Kodos
I hate to post AC, but I've modded this thread already.
As somebody who doesn't rate Obama too badly as presidents go, I still agree with you, that Constitutionally, he does not really have the power to delay any part of it. But who would challenge his actions in this case? The opposition party is full of people who are heavily beholden to the insurance companies and various medium sized business groups that tend to have just enough employees they aren't sure if the law will hurt them or not, and are working through the local chambers of commerce. The Republicans as a whole have their marching orders to try and delay implementation in every way possible. They will allow junior members who didn't personally get much support from the insurance lobbies to float some complaints about how the president is exceeding his powers, but, as a group, they really want him to do this and a lot of them are afraid they won't ever get elected dogcatcher again if they actively oppose it. The president's own party has plenty of people who owe big favors to the insurance companies and select sized business lobbies as well, and similarly want the law delayed, and they will be pressuring his own party to rally behind him.
The congress would have to grow a much bigger pair and challenge the lobbyists on their shit.
Are you a moron, or just ridiculously gullible? The text of the PPACA may only be a bit longer than a state's biennial budget, but it requires dozens or hundreds of executive offices to add tens of thousands more pages of regulations and other rule-making on top of the legislative part of the law. It's stupid political spin to ignore those when they control an awful lot of the law's substance -- don't fall for that type of dishonest stupidity, or whatever. On top of that, the bill was written essentially in "patch" form; it modified a lot of other laws scattered across the United States Code, and you need to consult the rest of those titles to understand what it really means. (This is part of why it's so hard to resist making "we have to pass the bill to find out what's in it" japes.)
As a side note, the Internal Revenue Code is also impossible to apply -- either in the abstract, or in a way that the IRS will accept -- without reference to more decisions and regulations that the IRS and its courts have promulgated over the decades. It contains too many ambiguities and external references, and some of the agency interpretations run counter to what a layperson might understand as the natural or most obvious meaning of the text.
In most polls on the subject, including some internal studies by the Republican Party, younger voters don't exactly like the Democrats, but think the more prominent Republicans are so insanely dangerous that they won't even consider them. I mean, running down the list of everyone who has made it onto the Republican presidential ticket in the last decade:
- George W Bush: Flat-out incompetent, with policies that: bankrupted the US treasury, gutted FEMA and then stood by while a major American city was destroyed, started 2 wars on false pretenses, willfully broke at least 5 of the 10 amendments in the Bill of Rights, ignored counterterrorism until it smacked him in the face with the biggest intelligence failure in US history, and caused the greatest economic mess since the Great Depression. The Republican Party has done its best to minimize his influence on the current campaigns.
- Dick Cheney: Admitted war criminal, and the architect of many of the bad policies of George W Bush.
- John McCain: In his first key decision as a would-be president, chose Sarah Palin. If he'd wanted a woman, he could have gotten someone at least competent like Christine Todd Whitman.
- Sarah Palin: She was stumped by the question "What magazines and newspapers do you read?" Enough said.
- Mitt Romney: Didn't know where Iran is, which I would think is kinda important if you're president. Announced that he didn't care about the fate of half of the citizens of the country.
- Paul Ryan: Produced budget after budget where the numbers, based on ludicrous assumptions (like 20% economic growth), fail to add up. And that's his area of expertise.
As for the last round of Republican primary candidates:
- Rick Perry and Newt Gingrich: Both at least appear to be racists, whether intentionally or not. That's a big deal to the growing percentage of young people who aren't white, and also to the significant percentage of white young people who oppose racism.
- Rick Santorum and Michelle Bachmann: Both have made it quite clear that their religious beliefs will trump scientific or statistical or factual evidence where the two conflict.
- Herman Cain: Had no actual factual understanding of any of the issues, as anyone who listened to an extended interview figured out pretty quickly.
- Ron Paul: Insightful about some stuff, also nuts about some other stuff. By all appearances, he believes the US government should not be in the business of issuing money.
So who is this Republican that is not going to be seen as incompetent, corrupt, or crazy?
I am officially gone from
It's totally obvious that you have not read the law. I have. You have no clue where it's strong or weak. Instead of learning for yourself, you get your opinions from your favorite vending machine. You said Obamacare, "requires dozens or hundreds of executive offices to add tens of thousands more pages of regulations and other rule-making on top of the legislative part of the law."
Bullshit. Try reading this tiny Voter ID law passed yesterday in my state (which, yes, I've read). It's 35,000 words, or about 1/12th the size of Obamacare. The NC voter ID law commands tons of county and municipal governments to take various actions to comply with the new law. Obamacare is light in comparison. Our state agencies will be much more laden with additional red tape due to the voter ID law compared to Obamacare. Why don't you try and point out some concrete examples of why I'm wrong? Or... are you just a stupid bag of hot air?
Celebrate failure, and then learn from it - Nolan Bushnell
Obamacare is really an attempt to create the sort of socialism that Americans can stomach. I got a good buddy with some serious health problems who relies on gov't health care (got several actually, because if you have a health problem it isn't long until you die or need help from the gov't unless you're an Heir/heiress).
Anyway, I started asking him what he was gonna do. How would he use private insurance. Wouldn't they insurer just keep raising his rates. He said that would be wrong, and so somebody should do something 'bout that. I asked who, and how and he said there should be a law that the insurance companies could only charge so much.
Basically he, like most Americans, deep down want single payer health care. But we're been taught from cradle to grave that socialism is bad. We're indoctrinated. It's called cognitive dissonance. He knows he needs socialism to live. He knows he needs help, and he knows it's his right (as a human) to live. Not just to have some blind dumb chance at good luck, but to actually have a life. But he's been taught, over and over, lied to and lied to. So he breaks down.
Obama recognized that there's lots of people like that. So he's giving them what they need (socialized health care) but doing it in the only way he can. He's letting the devil have it's due, and he's going to give billions and billions to parasitic insurance companies who's only purpose is to make us feel better about getting something that's a basic human right.
Hi! I make Firefox Plug-ins. Check 'em out @ https://addons.mozilla.org/en-US/firefox/addon/youtube-mp3-podcaster/
Actual payouts due to litigation is around 0.5% of medical spending. The money wasted by Doctors on malpractice insurance is far more, but you'd have to ask them why they agree to pay so much more than the expected cost of settling. I suppose it's a risk management issue - you're extremely unlikely to have a $10M settlement, but if you did you'd be happy to have paid $100K/year for insurance, even though if you averaged the settlements it'd be $5K/year/doctor. That kind of thinking is probably how the insurance companies are making so much money. :-)
Enable 3D printed prosthetics!
As a Canadian I have yet to see the very interference of the government into my health. I have never had any government official stop me getting an x-ray, stomp on my doctor when he ordered an ECG, or any of the other numerous tests and prescriptions he has ordered for me.
It's true that there are flaws, but when my wife was diagnoses with a life threatening cancer, no time wastes in diagnostics and in the two surgeries that followed. Better still, I was unemployed by the second surgery and we didn't have to bankrupt ourselves to save her life.
The world's burning. Moped Jesus spotted on I50. Details at 11.
Having had a couple serious problems after moving to a universal health care country from the US, and being familiar with my father's case, where he gave away his family farm to me when he thought he was going to die because he was so far in the hole in health costs, bankruptcy couldn't help him (he had the family farm rented out for living money, about 1/2 poverty level, and there was no form of bankruptcy that would have protected that land while addressing the health debt greater than the value of the farm), I'd take universal health care every time. The time from injury to surgery for my ACL torn in the US was smaller in the US than it would have been under universal care, but it wouldn't have been done in an outpatient clinic with me forcably removed from the property to make room for the next while I was vomiting and non-ambulatory from complications, escorted to the curb to make way for the conveyor belt of the outpatient OR. I could have paid more to get it done in the hospital. Had I know the level of care at the outpatient clinic, I'd have insisted on the hospital. Sure, when you spend millions on every cancer, even when there is only a 1% chance of saving the life of a 60 year old smoker, when the universal care country says "you got plenty old and are still smoking, so we deny your care to use those resources on others who didn't knowingly cause their own problem and have better quality of life after treatment, if successful", it's going to affect the statistics. And every universal health care place I've looked at allows private insurance that will treat you like an insured American in the same situation. The reason why the universal care places still score lower with that is few have insurance. Universal care works great enough of the time, people don't see the need.
Learn to love Alaska
It's not such a great idea to remove personal accountability. When nobody cares about being healthy because "someone else" will pay the bill, then nobody will be healthy, and the amount of money required to pay the bill every year will exceed all of our production (although we already do not produce enough to pay our bills).
This has been disproven by 40 years of research, starting with the Rand Health Insurance Experiment http://en.wikipedia.org/wiki/RAND_Health_Insurance_Experiment and confirmed with studies by insurance companies and big corporations that self-insure their employees. The reason people believe it, when the data contradicts it, is that they're following an irrational free-market ideology. The rich conservatives figure that they can easily afford copayments themselves, and they can save money by not having to pay for the poor. It's a way of making the poor pay more for worse health care. Copayments result in worse health outcomes, and higher health costs. Companies have tried copayments and gone back when it wound up costing more. In health care, the free market fails, and we know the reasons why. If a doctor tells you to go to the hospital immediately because you could die, you can't start researching it on the Internet and comparing prices. If you want to discourage people from spending money on needless health care, you should put pressure on the doctors, who actually make the big purchasing decisions. That's what they do in countries like Canada and England, that spend half as much as we do. This is part of the Republican war on science. They try a free-market solution, it doesn't work, and instead of accepting failure, they ignore the facts and make excuses.
The Rand study was a controlled study that randomly divided people into different groups, with different levels of copay among them. That's the strongest evidence you can get.
The goal of the Rand study was to find out whether people who must pay copayments would be more likely to use appropriate treatments, and less likely to use inappropriate treatments.
-- The people with copayments were less likely to use inappropriate treatments, but they were also less likely to use appropriate treatments -- like drugs to control blood pressure, asthma, diabetes, etc. As a result, they wound up in the hospital more.
-- With copayments, people with asthma would save $100 by not taking their asthma controller medication, have an asthma crisis, go to the emergency room, and run up a $1,000 hospital bill that they couldn't afford to pay anyway.
The Rand study didn't have the statistical power to tell whether people with higher copayments were more likely to die, but they did find that the secondary outcomes like high blood pressure and high blood sugar were worse.
Studies of copayments have been done ever since, by insurance companies and big employers that were looking for ways to save money. They consistently found that copayments cost them more money in the long run.
-- Copayments raised costs. http://www.nejm.org/doi/full/10.1056/NEJMsa0904533 Increased Ambulatory Care Copayments and Hospitalizations among the Elderly. People made worse health care decisions.
-- When Medicare managed care companies imposed a small copayment for mammograms -- in over-65yo women, one group in which mammograms are cost-effective -- the rate of mammograms went down significantly. http://www.nejm.org/doi/full/10.1056/NEJMsa070929 Effect of Cost Sharing on Screening Mammography in Medicare Health Plans
-- IBM tried a copayment scheme with their employees. It wound up costing them more money, so they dropped it.
The reason it doesn't work is that the free market doesn't work in health care. The Nobel prize-winning economist Kenneth Arrow explained why in an article seve
Obamacare is a compromise forced by unions and large corporations that want to maintain their tax deductible "cushy" medical plans whilst the rest of the populous get forced into a command-economy style health care industry.
If Obamacare was actually single payer, or socialist, the cushy medical plans couldn't really exist (because the infrastructure that would have supported them meaning the insurance companies and the pay-for-service medical providers would have evaporated) and there would have been no support for it. Regardless if the that is what Obama wanted, his support base wanted to be able to keep their plans, so this is what came out of the backroom deal.
If you want some evidence of this, I suggest you start with the sad fact that congress needed to hastily pass a law to allow their staffers to get a federal subsidy to help pay for getting their insurance through Obamacare since they feared "brain-drain" of people fleeing public service to get better health coverage from the private sector. No, the people in charge of Obamacare don't want the same coverage for everyone, they just want to change the way healthcare is funded for the masses, not the elite.
Tiered coverage often doesn't work with single payer very well, because of economies of scale limit the availability of competition for supplemental insurance resulting in a very have and have-not price points. As an example of this, you can start by looking into the fact that in the US medicare supplemental insurance needs to be subsidized by the government to keep providers in the market. If that seems like an inherently unfair use of government resources to give health benefits to some people over other people, well, you are probably looking at a preview of Obamacare in a few years if they want to keep private insurers in the market as costs rise, but premiums are capped due to political pressure.
On the other hand, if you are a cynic, you probably think that this design was an intentional long-term policy to drive out all insurers so that the system has to convert to single payer. If you want to see some evidence of this, look at what Obamacare is doing to Medicare Advantage programs (alternate Medicare-like insurance provided by private insurers).
Having worked on these kind of systems I'm sure the code is a dogs breakfast, but changing financial rules isn't something unexpected, it's practically an everyday occurrence in a large corporation operating across multiple jurisdictions. Two years to debug and fix y2k was reasonable considering most legacy code did not envision operating beyond 1999, and the herculean task of regression testing required for some systems, even though most systems only had a few lines of code changed. Two years to add a fairly straight forward line item to an account sounds like 'top floor' politics to me.
And did you exchange a walk on part in the war for a lead role in a cage? - Pink Floyd.
Because the customer's first requirement will be that the new system comes up with the "same numbers as the old system" (even if they are wrong).
That is the truth there. At one point in college I worked at a place where they had a legacy accounting system that ran on ancient mainframe that it was becoming incredibly expensive to keep running. They were unable to get it to function properly on any other hardware. So they finally gave up and reimplemented the system on what was then the latest and greatest hardware using modern programing techniques and languages. The software in question implemented an incredibly complicated set of rules to various transactions. They spent a fortune having people go through the old code, as well as the original source documents, to map what all these rules were. Just one problem, in some cases the new system would sometimes come out a few cents to a couple of bucks off from the old system. This on transactions frequently in the multiple, or even hundreds, of millions of dollars. The end result of that was that for the entire time I worked there they had to enter everything into both systems. Last time I talked to anybody from there they were still doing that. All the while the organization has spent a fortune trying to find out why the numbers are different. That is despite the fact that as far as they can tell everything is implemented exactly right in the new system. So there is every possibility that it is the old system that is wrong. Management just can't accept that and take the leap of faith to declare the new system right and move on.
back in 1995 I was working for a larGe TElco when my director called me into her office and instructed me to go down to Hartsfield (ATL airport) & pay the walk-up fare to get on the next flight to Raleigh b/c they couldn't process commissions & the SE sales reps were revolting ("you ain't kiddin' - they stink on ice" - sorry, couldn't resist). I immediately knew what problem was (well, 99+%) but felt conflicted so called (then) girlfriend (now wife) and said: "${DIRECTOR} just told me to get on next flight to Raleigh to fix commission processing but I'm 90% sure someone just didn't check ASCII->EBCIDIC when they uploaded the file" (which was prepared in 1-2-3) "I could probably walk them through it over phone in 5 min but it's effectively a free vacation day & I can probably get upgraded" (since I was medallion at time). she told me I should do the right thing & unfortunately I was born with the ethics gene (I probably be worth a lot more w/o it) & just called the desktop support guy in Raleigh who confirmed/fixed in 30 sec.
I just always thought that was funny - they were dead seriously telling me to pay probably $1K & waste a whole day to check an "x" in a dialog (& sadly I was too honest to take them up on it).
Most of those people are idiots looking for a reason to hate Medicare/Medicaid/Any-Service-That-Doesn't-Help-Them.
The truth is that the abusers are a tiny minority, and the amount of money they scam from the system is utterly dwarfed by the amount of money scammed from the government/other-citizens by our national heroes in the finance industry. Suggest policing healthcare programs and you're a responsible citizen fighting corruption. Suggest policing the Fed or investment companies and you're a filthy hippie who hates freedom.