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How the U.S. Government Rations Health Care
Wall Street Journal ^ | October 2, 2009 | Scott Gottlieb

Posted on 10/02/2009 5:39:08 PM PDT by hocndoc

. . . Formal patient and provider appeals to Medicare took an average of 21 months, according to a report issued in 2003 by the Government Accountability Office (using 2001 data), with delays in "administrative processing" due to "inefficiencies and incompatibility" of data systems eating up 70% of the time spent processing appeals. There's nothing inherently wrong with a program like Medicare seeking value for taxpayers. But it shouldn't make up the rules as it goes. When private plans ration care, patients can appeal directly to an insurer's medical staff. Only a small fraction of Medicare's denied claims—about 5%—are ever formally appealed because its process is so impenetrable. People can also switch insurers, and in many cases patients chose a policy because it matched their preferences in the first place. These options don't exist in a government health program. —Dr. Gottlieb is a resident fellow at the American Enterprise Institute and a former senior official at the Centers for Medicare and Medicaid Services. He is partner to a firm that invests in health-care companies, and he advises health plans.

(Excerpt) Read more at online.wsj.com ...


TOPICS: Business/Economy; Constitution/Conservatism; Government; News/Current Events
KEYWORDS: government; healthcare; socialism
I would much rather dispute a refusal with another doctor who is the medical director of the insurance company than try to fight Medicare.

Medicare reps get to view and copy anything in the office. They can write their own subpoenas. They can fine and have me "excluded" or even charge me with crimes that can result in jail time.

1 posted on 10/02/2009 5:39:08 PM PDT by hocndoc
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To: hocndoc; neverdem; Bigun; socialismisinsidious

ping


2 posted on 10/02/2009 5:43:05 PM PDT by hocndoc (http://www.LifeEthics.org (I've got a mustard seed and I'm not afraid to use it.))
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To: hocndoc

My daughter is a trama certified registered nurse who currently will not take a job in the health care industry because of the outright waste, fraud, and abuse permeating the system. We have talked about this for countless hours and have concluded that either the government completely fails to understand the marketplace it has involved itself in or is willfully trying to destroy that marketplace.


3 posted on 10/02/2009 6:46:00 PM PDT by Bigun ("It is difficult to free fools from the chains they revere." Voltaire)
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To: hocndoc

Thanks!


4 posted on 10/02/2009 7:24:49 PM PDT by socialismisinsidious ( The socialist income tax system turns US citizens into beggars or quitters!)
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To: hocndoc

Short. SHORT

4th place and that doesn’t even enter the Win, Lose, Draw category


5 posted on 10/02/2009 8:18:21 PM PDT by Dov in Houston (The word Amnesty invokes a passion in me. Illegal immigrants are criminals. Supporters Aid & Abet)
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To: hocndoc

thanks, bfl


6 posted on 10/02/2009 8:43:35 PM PDT by neverdem (Xin loi minh oi)
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To: Dov in Houston

I don’t get your post, at all.


7 posted on 10/02/2009 9:26:12 PM PDT by hocndoc (http://www.LifeEthics.org (I've got a mustard seed and I'm not afraid to use it.))
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To: Bigun

No one can keep up with the rules and regulations, even the CMMS. The advice of the regulators is more likely to result in a fine than not, according to the Center, itself!

I for one, have just given up and work for other people. I’ve gotten to the point where I don’t even question the arbitrary rules, anymore.

Between the stories of restricted defibrillators and asthma medications, there’s these statistics:

“” From 1999 to 2007, Medicare denied access in a third of the treatments it evaluated through its coverage process, taking an average of eight months to complete its reviews. When coverage was granted, in 85% of cases the treatments were restricted, usually to patients with more advanced illnesses.

“”Medicare is lately increasing its use of the national coverage process and is becoming more tightfisted. Since 2008, according to my review of Medicare data, it conditioned access in 29% of its reviews and denied new or expanded coverage in fully 53% of cases.””


8 posted on 10/02/2009 9:32:16 PM PDT by hocndoc (http://www.LifeEthics.org (I've got a mustard seed and I'm not afraid to use it.))
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