You're right. Something must be done. But all the options are going to be costly for the lower middle class on up. Remember, those that are totally busted or low income pay nada via Medicaid state programs. Medicare/Medicaid now pays for 45% of all health care costs in the country. The slack is now getting picked up indirectly and direcly by the caregivers and private insurers. I did an internship at a 600 bed teaching hospital....St. Elizabeth's, Dayton, OH......the St. Elsewhere of the region....we used to call the ER the "Knife and Gun Club". In business for more than 125 years, they closed their doors and shut down for good in '96 I think. And it's still happening as hospitals try to stay in the blue ink.

Medicare reimburses hospital for inpatient care via a system of payment under DRG (diagnostic related groups). They get paid a set amount per patient discharge based on DRG and weighted by case mix and region. If a hospital treats a patient for less than the reimbursed amount, it makes a profit....if it costs more to treat than the reimbursed amount...the hospital must absorb the loss as the patient cannot be billed for the excess under the Medicaid/Medicare system (I think this answers a question raised under a previous topic). Complicating matters even further, there are RBRVs (Resource Based Relative Value Scales) which affect how physicians are reimbursed. And while Medicare Part A deals with inpatients, hospitals moved certain procedures to an outpatient setting....which are reimburse through yet another set of criteria under APCs (ambulatory payment categories). APCs are based on a combination of CCPCS and ICD-9-CM coding systems for outpatient or ER visits and within which hospitals must justify the medical necessities for treatments and/or tests or absorb the cost.

Bottom line....it's a complicated administrative nightmare as it exists today and there isn't an easy way to fix it. Tearing the system down and starting anew is a thought.....perhaps a good thought....but we're all gonna pay one way or another. And, if the government gets more involved than it already vis is-a-vis Medicare/Medicaid......will we end up with a more simplified system? Think "tax code" dude....'nuff said.