[TheLongshot]

Originally Posted by Xenophon

Interesting. I observe that a number of the largest medical insurance "companies" in the country are the various "Blues" (for example Blue Cross and Blue Shield of PA) -- which are non-profit organizations!

Not mine. Empire BCBS is for profit. The previous time I had BCBS it was Anthem, which is also for profit.

The economist I referred to earlier (whose name I still can't recall, darn it!) computed that the market equilibrium price for these various procedures would fall between the R&C price and the much lower amount Uncle Sam actually pays -- but a good deal closer to what Uncle Sam pays than to the R&C number.

Which tells me that there is something out of whack and it isn't just Uncle Sam that is to blame. Maybe if we do go to single source, maybe we can get to the equalibrium, if it is where the economist thinks it is.

Interesting. The providers I talk to here in Pittsburgh tell me that Medi* pays well below their actual costs. They also say that payments are slow-ish, ranging from a few days quicker than promised (I forget the official time-frame) to about 3 weeks late. By comparison, the better insurance companies pay R&C prices with prompt payment. The average ones pay R&C prices on a schedule that's modestly quicker than Medi*. The dregs of the insurance companies take up the vast bulk of the time and effort these providers spend dealing with insurance. The lousy insurers pull things like denying payment repeatedly until the provider bills the patient and the patient screams at the insurance company. Then the insurer sends the check to the wrong provider, thus delaying payment another 60 days! There are other paths, but this is a typically hideous example. The companies at the bottom appear to be really really sleazy!

It is hard to say. I know that with a past insurer that I had an outstanding balance with my dentist for a couple of months. I've also had errors where I've had to go back and talk with the doctor to clear up, and whatever they had to do wasn't exactly simple.

What I've been told, tho, is that the biggest issue isn't about when they get paid, but the different ways all these companies operate and not having any consistancy between the way they work. That's why a lot of doctors have decided not to deal with it anymore and have gone to managed care.

Finally, on the topic of gaming the system to make the most profit, my experience is that most people try to do the best they can within the rules of the game. When the game has rules that are arbitrary, baroque, and impenetrable, people appear to have no compunction about taking advantage of odd combinations of rules to get maximum benefit. And I am not sure that these individuals and companies are doing the wrong thing! (But the sleaze I described in the previous paragraph is clearly wrong...) Rather, I suspect that it's a symptom of a system that is at least partly broken and could use some fixing. Of course, I rather suspect that my idea of the right fixes diverges substantially from (say) Moejoe's -- and likely from most of our other European members as well.

Some do as you say, but I do think there are some that try to take advantage of the system, since the motivation in capitalism is to try to get as much profit as possible for your shareholders (for those companies that have shareholders, that is.) Certainly, doctors are mostly trying to get by and are the ones paying a lot for the byzantine system that we have now. While they certainly make money, it comes at a lot of pain that some just don't want to deal with. There are plenty of articles out there about the low job satisfaction of doctors.

Things do need to change in this country about health care and I think there is a lot to be learned from other countries about how they take care of the health of their people.