Bicyclist Fatalities in AZ 2009

On 12/1/2010 8:17 AM, (PeteCresswell) wrote:
Per SMS:
Kaiser isn't perfect of course, you have to know your way around
the barriers they put up to ration care, but overall they do a good job.

I belonged to the Kaiser plan for a number of years during a
misspent youth in Hawaii.

Granted, that was 40+ years ago, but my experience with Kaiser
was bad enough that I would never participate in an HMO again as
long as I could avoid it.

Kaiser has totally changed in the past twenty years or so. I had them in
the 1980's and they were terrible. Of course part of the reason they've
improved is relative, the other HMOs have gotten much worse.

Per Simon Lewis:
And for each of these there are 1000x examples where people have their
systems running well. Cross referencing, at a press record retrieval,
readable, cross referenced, easy to print/email etc.

There will always be incompetents.

This guy's complaint seemed to center around the time needed to
marshall and review historical data.

With the PC, he needs to enter a patient identifier, wait for the
application to return that patient, and then drill down through
multiple windows. This takes time/concentration and only a
fraction of the results can be viewed at one time. It also takes
several minutes just to get the relevant data.

With paper, he tells an assistant to assemble the histories -
then he flips open each folder and spreads/eyeballs the paper in
a matter of seconds.


Having limited gray matter myself - and having to deal with
relatively large (at least to me...) amounts of information - I
suspect that one thing he could do to mitigate that problem would
be installing multiple large displays - as in three or four
1920x1200 native-rez displays.

He would still have the task of drilling down thorough multiple
windows - as opposed to having somebody at a much lower hourly
rate put together the paper - but I think it would help just by
showing more information all at once.

Beyond that, I can see somebody who knows the software writing
macros that accept a patient ID or something and do the drilling
down automagically.

The optimal solution would seem tb integrated applications that
serve the user better than they do now - incorporating a global
search as via macros above.

I guess this means that Steve Jobs' job is safe, but I cannot
imagine anything that could equal the ease and speed of the
physician's just spreading and eyeballing the paper - except for
having the aforementioned hourly employee print out the relevant
material and put it in a folder as before.

My experience is that, although many processes work better using
a PC, others work better using paper.
--
PeteCresswell

On Dec 1, 9:51*am, Phil W Lee wrote:

That you find this laudable says much about your tenuous grasp on
reality.

Perhaps you can point to where I have suggested any such thing.
Speaking of a tenuous grasp on reality ....

Apparently you have decided that you hate me. I have no problem
whatsoever with that. But I am curious how you justify your little
emotional and profane outbursts. Is it that you need to create enemies
so you have something to do.

DR

On Dec 1, 10:04*am, Phil W Lee wrote:

I'm not sure about your legal system there, but over here I'd pay him
the sum agreed on the estimate, and invite him to take me to court if
he thought he could increase it.


If he then tried, I'd produce the original estimate as proof of the
agreed price, and invite him to pay for my costs in defending the
claim, along with his own in bringing it.

You and many other do not seem to understand the difference between an
"estimate" and a contract price. If you have a contract fine. If you
only have an estimate don't assume that you will get anywhere with
that as "proof."

One billing system that is fairly workable is the one auto mechanics
use. They charge by the hour based upon "flat rate." The Flat Rate is
the time an industry standard says a typical reapir should take. A
skilled mechanic can usually work a bit faster and make more money to
benefit from his skill.
It's not perfect.
It doesn't account for a mechanic taking blatant shortcuts to do a
quick and shoddy job (customer loses). Nor does it take into account
things that may be unforeseen like broken or rusted parts that may add
significantly to the actual time required to perfrom the task
(mechanic loses). But at least it is not entirely open ended.
DR

"(PeteCresswell)" writes:

How long do you think a plumbing company would last if it
systematically charged five or ten times the normal rate to those too
poor to pay?

And you think that health care providers do this? Let me discuss the
reality of billing practices....

Try comparing the amounts that one's insurance actually pays for
a given service to the amounts that some poor schlemiel has to
pay if they don't have insurance.

For me, it's a 20%+ diff just for an office visit to a GP.

For a visit back on 8/25, the GP wanted $90. Insurance paid
$71.28... ((90-71)/90) * 100 = 20%+

For a certain recent test, the medical corp performing it
tendered $4,810.00.

Insurance company paid them a grand total of $280.18 - completely
satisfying their claim - as opposed to abovementioned poor
schlemiel, who would be on the hook for $4,180.

((4,180-280)/280)*100 = 1,390%+. If my 2nd-grade arithmetic is
correct (not a "given", by any means....) that's a beeeeeeg
percent....

Sure, two profit-making enterprises have a perfect right to
negotiate terms between themselves - but the bottom line is...

Normally they wouldn't, federal antitrust laws would prevent firms with
near monopoly power from colluding in this way. But insurance companies
are exempt from antitrust actions. And, recently, hospital group
purchasing organizations have been made exempt as well. According to
the Kaiser Health News one hospital supplier kicked back 94% of its
sales to a GPO. Because of this sort of crookedness the hospital markup
on that $200 bandage may not even be excessive.

See

http://www.kaiserhealthnews.org/Stor...-Business.aspx

http://www.washingtonmonthly.com/fea...007.blake.html

I don't know whether the free market would provide acceptable health
care in the US, but I'm quite sure it hasn't been tried in a good long
time.

"(PeteCresswell)" writes:

Per Radey Shouman:
I wasn't really thinking of an operation, though, but of the cases I've
seen of a person convalescing in hospital. Some doctor walks in, has a
brief conversation or just a look at the sleeping patient, and boom,
that's a billable event. No consent or knowledge needed from the
patient. For those with insurance this is an occasion for head shaking
and wonderment, for those without it can lead to bankruptcy.

A long time ago, I had some sort of allergic reaction upon
returning from a ride.

Fingers swelled up like sausages, eyes swollen shut, face
unrecognizable. I was afraid the swelling would progress to my
trachea, so I got somebody to take me to the local ER.

Looking over the resulting feeding-frenzy of bills, I was struck
by four things:

1) There was significant padding. Things like $12.00 for hand
lotion that was in a little tray (along with other pad items)
under the patient's bed - but which were never accessed, just
moved, unopened and untouched, to under the next patient's
bed.

2) The three doctors who actually treated me all submitted bills
that I had to pay in full - not covered by the insurance.

3) A fourth doctor "under whose care" I was admitted, got his
bill paid, but I never saw the guy until I was in the
wheelchair being wheeled down to the lobby for release.

His contribution: "Mr Cresswell?" "Yeah..." "How are
you feeling." "Like I've been run over by a truck."
(end of conversation).

"Are you going to bill me for this conversation?"

"That will be $300, any other questions?"


4) When I tried to document this nonsense to my insurance
carrier, nobody wanted to hear it... *nobody*....

I call that endemic corruption.

"(PeteCresswell)" writes:

How long do you think a plumbing company would last if it
systematically charged five or ten times the normal rate to those too
poor to pay?

And you think that health care providers do this? Let me discuss the
reality of billing practices....

Try comparing the amounts that one's insurance actually pays for
a given service to the amounts that some poor schlemiel has to
pay if they don't have insurance.

That's not even the worst of it. The poor shlemiel that consults a
doctor without benefit of insurance has established a pre-existing
condition, so even if he manages to buy insurance later he will have to
pay cash rates to treat whatever condition might have been discovered.

This might make sense in the context of actual insurance, but medical
insurance in the US is more about price fixing, so it feels more like a
protection racket. This is a real disincentive to seeking early medical
care.

Obamacare is supposed to fix this, eventually, but I'm not holding my
breath.

Frank Krygowski wrote:
On Nov 30, 10:27 pm, Tºm Shermªn™ °_° ""twshermanREMOVE\"@THI
$southslope.net" wrote:
On 11/30/2010 8:00 PM, Tim McNamara wrote:

With a few exceptions, health care providers want to help their patients
and make a living. I need to make enough money to pay my bills and to
set aside something for retirement, like everybody else. I make about
the median income for Americans (a bit less because I elect to work less
than full time).
Is having a large house with a pool in a fancy gated community, a
condominium at a ski resort, a fancy cabin by a lake, a country club
membership, multiple luxury or sports cars, an expensive Swiss watch,
multiple tailored suits, eating most meals at restaurants, etc just
"making a living"? Is a discretionary income of more than $100,000 per
year just "making a living"?

FWIW, there are doctors and there are doctors. Over the years, as
family physicians we've had all kinds.

One who was a "prominent," luxury-car driving, status-seeking Dr. Snob
who misdiagnosed several conditions for us, and could have killed my
little daughter had the pharmacist not caught his mistake. We weren't
with him long.

One was a very competent DO who volunteered to take care of the local
sports teams for free. Got dropped from my HMO plan because he cost
them too much money - perhaps when he saved me from appendicitis?

One was a nice guy, quite competent, with one of the most low-rent,
unimpressive offices I've ever seen. Matched only by that of the
saintly doctor who cared for my mother in her final years. Both
appeared, from dress, car choice and office decor, to be making
$30,000 per year.

Our current doctor was a physics pupil of my brother. I know he
treats the indigent for free, lives in a modest home where he cares
for his own father (who was the pharmacist who caught Dr. Snob's
mistake) and said any changes in his income resulting from _real_
health care overhaul wouldn't affect his living style at all, although
it might reduce the considerable amount he gives to charity.

" $30,000 per year."

or $100,000 before taxes and medical liability insurance

--
Andrew Muzi
www.yellowjersey.org/
Open every day since 1 April, 1971

On Nov 30, 7:00*pm, Tim McNamara wrote:

Did you have to pay premiums to a plumbing insurance
company for several years in order to get a reasonable rate?

Another goofy question. *But it does demonstrate my point nicely, which
is that somehow we expect health care to operate as a different sort of
economy than other business sectors.

Tha's not a goofy question at all. It goes to the heart
of one of the suckier aspects of health care in the USA.

And it doesn't illustrate anything about wanting health care
to be different. If anything, it's about asking why it is an
exception. Pharmacies charge more money for the same
prescription from an uninsured customer than they do from
someone with insurance. Same product, and in the case
of the uninsured guy the transaction is simpler (cash and
carry). This is not like most other businesses.

The people who pumped my septic tank were more
professional and ethical than many of the businesses
I've dealt with for medical needs.

Tom Ace

DirtRoadie wrote:
On Nov 30, 9:03 pm, Tºm Shermªn™ °_° ""twshermanREMOVE\"@THI
$southslope.net" wrote:
On 11/30/2010 10:01 PM, T m Sherm n _ wrote:



On 11/30/2010 8:40 AM, SMS aka Steven M. Scharf wrote:
On 11/30/2010 6:02 AM, DirtRoadie wrote:
On Nov 30, 6:13 am, T m Sherm n _ _ _
wrote:
It's a wonder my pal Frank Krygowski uses his realname on his posts,
when he falsifies quotes.
But you stand by his every word. Birds of a feather.
At least Frank doesn't wake up every morning and forge a new e-mail
address in order to get around everyone's filters.
Adding extraneous characters is not forging an email address. Forging an
email address would be using someone else's email address. Nym-shifting
is not forgery.
Furthermore, if Scarf kill-files people, he should keep it to himself.
If you kill-file someone, pretend that they do not exist, instead of
cowardly commenting and sniping second hand. Hell, even Ed Dolan knows
as much.
I should add that my correct, working email address is in the header of
every post I make.

Please post your home town.
There is nothing remotely distinctive about the name Tom Sherman. You
might just as well be "John Smith." And you know how despicable you
find anonymity to be. Set an example.
DR

Tom posts his coordinates regularly:
http://www.hell2u.com/

--
Andrew Muzi
www.yellowjersey.org/
Open every day since 1 April, 1971