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More On The Sicko Issue

Update: Hipparchia at Over the Cliff, Onto the Rocks has more information comparing the administrative costs of the US and Canadian systems

Sue Sturgis at Facing South looks at Sicko South and reports on coverage in the southern states. I note that 24% of Texans and 20% of Floridians have no health insurance. Both states have large military presences and Florida is known for it’s Medicare-covered retirees, but they are the worst states in the South for insurance coverage.

Flying into a rage, which is difficult for a penguin, BadTux makes it quite obvious that he doesn’t like the current health care system or the the companies involved in health [or music]. Deservedly strong language for the greedy bastards [not that I have anything against non-greedy bastards] who think the world owes them a profit and jobs.

I’m going to add my bit by telling you something you probably don’t know.

You are going to hear a lot about health care as Sicko starts a conversation, so I thought I would mention some things that most people don’t know, but I have encountered over the years.

A single payer system is going to put people out of work, the same way closing an auto factory or outsourcing puts people out of work. In fact many of those put out of work are not going to be Americans because of outsourcing.

Every medical procedure has a code, or multiple codes, and those codes are different for each insurance company. To get paid by the insurer the health professional has to file a claim using the forms and codes of that particular insurance company. If a patient is on Medicare and has “gap” insurance, two forms will have to be filled out using two different sets of codes.

There is an entire industry, medical billing, that has sprung up to take care of this paperwork, and specialized software [the reason I was involved] to allow a clerk to enter the patient information and have the proper forms produced. If you don’t use the software, you need a supply of forms for each insurance company, and a listing of each company’s codes.

Some companies group procedures under a single code, while others require you to enter multiple codes to describe the same actions. The software knows this, and takes care of it. A billing clerk would have to read the procedures for each of the companies to figure out what that company wants.

Single payer, means a single form, with a single set of codes. It might make it possible for doctors to once again have the old style office with a nurse/receptionist. These days, doctors are forming group practices to share the cost of billing, and the billing may come from a company in an different state.

Paperwork is a major cost of the American health care system that would be radically cut by a single payer system, and would have no impact at all on the quality of care. This is something that the insurance companies could have done decades ago, but chose not to, and just made it worse. Confusing billing procedures delays payouts, and that is one of the reasons they do it, no matter what they tell you.

Oh, the codes are proprietary information, so you have to pay the companies to get a copy.


1 hipparchia { 07.02.07 at 9:28 pm }

what i just discovered last night: google “denial management”

2 andante { 07.02.07 at 9:58 pm }

Single payer would mean a certain loss of jobs, though as you point out – not necessarily in this country. I’d be curious to know just how much billing is done offshore.

The true pity is that the greedy bastard CEO’s of the insurance extortionists won’t be the ones at the unemployment office.

I know I’ve mentioned it before, but our local hospital’s billing “office” is not one office. It’s a four-story building with Lord-knows-how-many little worker bees in cubicles. At least half of them would make wonderful nursing assistants, and the other half could hunt down fraud and save my taxpayer dollars.

Except the lady I talked to in the financial office today; she can kiss my grits.

3 Steve Bates { 07.02.07 at 10:32 pm }

“denial management” … damn. I should have known it was so systematic, but I didn’t. I can’t help being reminded of the company that teaches corp’s how to succeed at H-1B abuse. Who are we as a nation, that we have whole industries dedicated to helping corporations in their efforts to screw individuals through every imaginable bureaucratic system.

andante, beware; they’ll find a way to serve those grits to someone else for breakfast…

4 Steve Bates { 07.02.07 at 10:38 pm }

I forgot what I really intended to post. Bryan, I read Sturgis’s post today, and noted the numbers confirming what I already knew about Texas… but for Texas, we have the highest percentage uninsured, not just in the South, but in the nation. And don’t ask me about insurance coverage for children. Gov. Goodhair hates children, whatever he may tell you.

And good luck with those @#$%^ codes. I’ve dealt with various flavors of ICD-whatever codes on government-sponsored research projects, but at least one could buy a book in a medical bookstore to look those up. (By now they’re surely online; this was in the old days.) Heaven preserve me from dealing with insurance codes… as IT person or as patient.

5 hipparchia { 07.02.07 at 10:41 pm }

yep, steve, that youtube video about “how to [not] search for american employees” was running through my head as i scrolled down through the list of denial management firms and products.

6 Bryan { 07.02.07 at 10:59 pm }

Hipparchia, I just updated to include your post on the US-Canadian comparison.

Andante, one of my Mother’s best doctors is having to consider joining a group practice to deal with billing because it is currently being done by his wife, and she has threatened divorce [and taking his boat in the divorce] if he doesn’t do something. He admits his wife spends more time billing, then he spends on medicine, and they can’t find a competent clerk who doesn’t get hired away as soon as they are trained.

Steve, it amounts to a huge cross-referenced database combined with a series of forms templates. The program is expensive enough, but you have to subscribe for the updates. I fixed a couple of things for them, but refused a job on ethical grounds. I didn’t like the people or their business practices, and didn’t want to get involved. After I said no I tracked down a couple of the guys who had quit and found out they ripped off their programmers, as well as their clients.

When a small company sells a piece of software that none of the managers understands, I get a feeling that they ripped off the original programmer and cheated him/her of their copyrights.

7 hipparchia { 07.02.07 at 11:47 pm }

he could stand losing his wife, but not the boat?

thanks for the link.

8 Bryan { 07.03.07 at 12:07 am }

Actually the boat thing is pretty funny. He hated the boat about a month after he bought it, but won’t admit it because he spent so much on it and it has never been what he thought it should be. He should have bought a smaller boat because the one he has still isn’t big enough for the Bay when it’s choppy, and it’s too big for the area where he wanted to fish [the engine cooling system sucks up sand].

His wife has to be the last person on the planet not to know that he hates the boat. He spends a lot of time on it, mostly taking it in for repairs. My Mother likes going to him because the office is like a sit com. She rags on the doctor about how ratty his office looks, and he says his wife decorated it. Except my Mother knows that the stuff in the office are things the wife didn’t want after she bought them at garage sales.

The nurse knows the truth about everything but swears you silence, because she enjoys the “show”.

The possibility of a divorce is from zero to minus 1000, but the problem is real.

9 hipparchia { 07.03.07 at 12:39 am }

what a wonderful story!

probably, joining a group practice would mean having to “clean up his act” somewhat, which would be a real shame, especially when sacrificed on the altar of more profits for insurance executives. i’ve had some really good doctors who were lousy at making human connections, and i worship the ground they walk on just because they’ve taken such good care of me, but that’s not necessarily an ideal way to take care of sick people.

he’d better not be uprooting the turtle grass with that sucky engine.

10 Bryan { 07.03.07 at 10:52 am }

Group practices normally mean that the doctors are taking orders from a manager, and shift from being small business owners to an employee. I’m not sure that they make any more money, they are simply losing less to the overhead. He certainly will have to conform to the standards of the practice on matters of decor.

Turtle grass? There’s no turtle grass in bayous, which is where he’s sucking up the sand and trying to fish. If there were more boat launches, he could get away with a jon boat.

11 hipparchia { 07.03.07 at 11:30 am }

it didn’t even occur to me to think of bayous. i wonder how many other unrecognized, knee-jerk prejudices i’ve got running around in my brain besides if it hasn’t got salt in it, it’s not water.

12 Bryan { 07.03.07 at 2:20 pm }

Most people think of the Gulf, when thinking of water, which requires a really big vessel. You need a 30-footer to deal with the bays comfortably, but we used to go all over in a 14-foot with a ten-horse that my Dad built.

I have a friend who has built several 40 to 50 foot wooden shrimpers with a farm tractor diesel supplying the power. That is a good boat for the Gulf.

During hurricanes we get a lot of people moving their larger boats into the bayous, and then demonstrating that they don’t know how to anchor a boat. We lose a lot of docks to those idiots. My Dad would pull the engine and sink the 14-footer for hurricanes.

13 hipparchia { 07.03.07 at 4:19 pm }

i’ve never actually believed that you can successfully anchor a boat for a hurricane. i’ve always thought that if your boat survived, it meant that either mother nature or lady luck took pity on you. but then, i’ve never owned a boat, so what do i know? my strategy is to surround myself with selfless, gregarious boat-owning friends. that way, they invite out on their boats, and i get all the fun of boating without any of the headaches of boatkeeping.

14 Bryan { 07.03.07 at 8:23 pm }

The key to anchoring a boat for a storm is anticipating the direction of the wind and the water. In a small bayou it tends to be obvious, as the water is going to be flowing in and out of the mouth, so you bottom anchor fore and aft parallel to the shores with enough slack for the storm surge. You also run storm anchors fore and aft to stay in the flow.

15 hipparchia { 07.04.07 at 11:58 am }

“enough slack for the storm surge” strikes me as the sticking point. ivan proved fairly conclusively that we don’t know as much about predicting the magnitude of storm surge as much as we thought we did.