the 40 million uninsured is the Health care boogey man

[MikeWaters]

Originally Posted by Mormon Red Death

I cant speak for HUD but I notice FICA everytime it leaves my pay check. That is what pays for Medicaid.

Medicaid is funded its just poorly poorly ran. Filling out a medicaid application is difficult and it takes forever to be approved. Improve the access and people get the care they need

actually again, I don't think you see the big picture. In some states it has been purposefully made difficult to apply to these programs so that fewer people take advantage of them. "every hoop we put on this program means an attrition of x%." Also, by not advertising about them they get less people to sign up.

[Mormon Red Death]

Originally Posted by MikeWaters

I guess you don't fully understand how this works. Yes, ER docs usually get paid on a contractual basis, so it doesn't matter if they have insurance or not (generally speaking, because you can bet that if very few people in the ER have insurance the contracted amount will be less).

First of all I do fully understand how it works and I resent the implication that I am just someone throwing things out here. You seem to concur with my original point that the Hospital is taking the hit with the ER Docs...

Originally Posted by MikeWaters

But what happens when surgery is required. The on-call surgeon is called. Why is he on-call? Because he has privileges. Why does he have privileges? So he can do surgeries at that hospital. Does he get paid for doing surgery on the destitute? No.

There are two basic models for physician payment at hospitals. You can either be a paid employee of the hospital or you can have priviledges and have the hospital as your "work shop" and generally the hospital does its billing for them. For the 1st model the hospital takes the charity hit just like the ER Docs. For the second, it is true that the doctor will take the hit. The thing is its not that big of a hit for a doctor. One hour of work or a thousand dollars once a quarter is not going to kill them. The hospital pays for the nurses, bed, billing etc...

Originally Posted by MikeWaters

I can only think of one medical provider in town that works with the poor that isn't either govt. or contracted with the govt. But they are beneficiaries of a professional golf tournament, and they don't serve that many people and only do counseling.

If a hospital accepts medicaid and medicare they are contracted with the goverment as previously pointed out in this thread Methodist hospital provided 85 million in charity care last year.

[MikeWaters]

of the two basic models, which is more common, for surgeons?

(I don't know a single surgeon who is a paid employee for a hospital, if that helps you).

and I should add, it is usually a lot more than 1 surgery every quarter. Esp. for trauma surgeons and neurosurgeons.

[Mormon Red Death]

Originally Posted by MikeWaters

actually again, I don't think you see the big picture. In some states it has been purposefully made difficult to apply to these programs so that fewer people take advantage of them. "every hoop we put on this program means an attrition of x%." Also, by not advertising about them they get less people to sign up.

Actually again... I do see the big picture... the inefficiencies that medicaid has in its admin program are why they try and make it difficult. Make medicaid efficient you dont have that problem. This also raises the bigger picture.... if we know Medicare and Medicaid are run poorly what makes us think that a national health insurance wold be run well?

[Mormon Red Death]

Originally Posted by MikeWaters

of the two basic models, which is more common, for surgeons?

(I don't know a single surgeon who is a paid employee for a hospital, if that helps you).

In Michigan its about 50/50

[Mormon Red Death]

Originally Posted by MikeWaters

of the two basic models, which is more common, for surgeons?

(I don't know a single surgeon who is a paid employee for a hospital, if that helps you).

and I should add, it is usually a lot more than 1 surgery every quarter. Esp. for trauma surgeons and neurosurgeons.

Even if a surgeon was taking on an inordinate amount of uninsured he/she would not work at that hospital unless the hospital took on some of the pain.

[MikeWaters]

why do we think medicaid and medicare are run poorly? what is the overhead in the private sector (administrative costs) versus medicaid and medicare?

[Mormon Red Death]

Originally Posted by MikeWaters

why do we think medicaid and medicare are run poorly? what is the overhead in the private sector (administrative costs) versus medicaid and medicare?

Is the "we" directed towards me? Additionally, can you give a little more definition of what you are looking for in the admin costs?

[MikeWaters]

Originally Posted by Mormon Red Death

Even if a surgeon was taking on an inordinate amount of uninsured he/she would not work at that hospital unless the hospital took on some of the pain.

I know this has caused many doctors to leave hospitals (to get out of the business of taking care of trauma). I suspect this is the reason you have seen surgery centers spring up around the country. They offer no emergency care, so EMTALA does not apply.

There was a hospital in Dallas that was going to lose its status as a level 3 trauma center because of lack of neurosurgery coverage.

As far as psychiatry, at one of the larger hospitals they had a hard time getting psych coverage for the ER. So they had residents do it as well as physicians with priveleges. Finally so few psychiatrsts had priveleges, that they now have a social worker do the job along with the ER doc. No longer any psychiatrists that will see patients.

Why didn't psychiatrists want to do it? Because it was very infrequent they would hav a patient in the hospital, so privileges don't help that much. And probably 95% of the time, they would not be paid for seeing the ER patient.

At another large hospital in Dallas, it was whittled down to something like just 3 psychiatrists taking all the call. Those 3 finally decided to quit, then the hospital poneyed up significant dough to keep them going.

It's extraordinarly hard to get a psych consult in most hospitals. Because the referral incentive has broken down. It used to be you could pick up patients by doing consults. But now insurance drives where patients go, not relationships between doctors. So inevitably you go to the hospital, see the patient, and don't get paid, and don't get a patient, and it doesn't matter if you are friends with the referring doctor.

Probably every psych consult doc in the country is getting paid a salary.

Point is, that doctors are fleeing hospitals when they can, to get away from giving free care. And the free care that does occur, from the hospital's standpoint, is subsidized by the paying patients. And when the charity goes up, the price for paying patients will go up.

[MikeWaters]

Originally Posted by Mormon Red Death

Is the "we" directed towards me? Additionally, can you give a little more definition of what you are looking for in the admin costs?

The percent of money that does not go directly for medical services. I.e. the "overhead" to run the plan.