Katz: Here's an ugly secret that not too many people know. Insurance companies pay a FRACTION of what "Joe off the street" pays for every medical procedure. They negotiate with the hospitals and clinics to get the best rate possible which is an enormous discount from the "list price". Medicare, as far as I know, sets their price largely based on what those negotiated rates are.

For a continuing problem I had, each ER visit would "cost" $2500 or more (typically 2-4 attack per year). My insurance company paid nowhere near that. When the same thing hit me in Montreal while on vacation, I saw the FULL 'retail' bill was $550. (I paid $50 and my insurance paid the rest)

I learned about these 'negotiated rates' while working at Boston's Beth Israel Hospital. Just to give you an idea of what was going on - in the mid 1990s, as everyone is complaining about rising insurance rates, most insurance companies were lowering what they paid the hospital for inpatient admissions. We HAD been getting $1600/day and the next year many companies came in at $1200/day (looked suspiciously like collusion).

Yes - they paid by the day NO MATTER WHAT PROCEDURES YOU HAD DONE OE HOW MANY!!!

So the insurance companies were hiking their rates while paying us less. Guess where the extra money went. (Hint: The people who own the insurance company)

Where do I start...? :posting: I have worked in the healthcare field for 36 years, been an x-ray, CT, and MRI technologist, director of an outpatient imaging center, and currently manage 40 employees in the departments of CT, MRI, Ultrasound, Nuclear Medicine and PET/CT. For the last 10 years I have overseen budgets in the millions and ensured patient satisfaction in numerous settings.
Having said that, I feel I have laid some ground work to be able to speak with a smidgen of authority and experience on certain matters...First of all I think that you have it backwards about who sets the price. Medicare sets the price that they are going to pay, no questions asked. We take a beating on the reimbursement that they give. If we only got what CMS (Medicare) deems proper, we would never be able to afford the purchase let along maintenance of the cutting edge technology that we use to SAVE lives.
It is set up that we should charge for what we use even tho CMS is not going to reimburse. Every several years, CMS will take these charges into account and MAYBE change their minds and pay us a little more. So Medicare sets the bar and we cannot negotiate that reimbursement. On the other hand, hospitals and insurance companies negotiate in and attempt to keep cost down by "bulk purchasing". The average CMS reimbursement for an MRI without IV contrast is about $250. The charge is about $2500 and the average payment made by insurance companies is $1600.
The average MRI scanner costs approx 2million dollars and maintnance fee is about $15,000-20,000/month. The average MRI tech (highly skilled, intelligent person-it's not just a video game we are playing) makes about $28/hr with approx $7/hr for benefits. A scan without contrast takes 45minutes so the facility can do about 20 exams/day...are you getting the drift? Insurance companies are the big bad horrible greedy companies that are still helping us out to be able to afford to help the American population prolong their happy lives.
Montreal? Dare we ever compare what goes on in the USA with what goes on in Canada in the healthcare arena?!?! I live in the Detroit/Toledo area, and as of 10 years ago there are more MRI scanners in my town than in the whole of Canada. We could and still can get a person in TODAY for the same exam that would have a waiting time of 6months to one year in Canada! I know, because we serve the overflow of Canadians that can afford to come here to have life savings measures done in a timely manner. You might have to just trust me on these facts...again, I refer to my experience, but you be the judge.
PAY BY THE DAY NO MATTER WHAT IS DONE...Yes this is another CMS mandated reimbursement protocol. It is called a DRG=Diagnosis related group. That means that is Mr. Jones comes into the hospital to have his Gall bladder removed and happens to mention that he has been having some neurological problems, like vertigo, ...guess what...His doctor decides that he needs an MRI to check for an acoustic neuroma. So, we bring him down and take the scan-Free of Charge! These free exams can take up about 15% of our workday, so go back and do the math to see the money we lose per day per month per year, etc,etc,etc.
It gets even better...with the advent of ObamaCare, the amount we are going to be paid as of July 1, 2011, will be determined by our HCAHPS Satisfaction scores! In order to get paid the full amount, 99% of the people surveyed need to answer ALWAYS to the questions that they are asked. (In the case of Mr. Jones, he could potentially complain that he had to wait til the evening to have his MRI. An MRI that could have waited until he recovered from his GB surgery and he could have returned @ his convenience). In the case of the university hospital that I work at, it has been nationally determined that if you come to our facility, you have TWICE the chance of surviving vs any other university hospital in the nation! That is the ULTIMATE SATISFACTION as far as I can tell...
Tell me what survey you have ever filled out in which you gave the place in question perfect scores across the board.
Our politicians made these rules. Maybe we should pay them according to their satisfaction ratings...hmmm, pretty sure it isn't anywhere near 99%. Think of the money we could save! We may have found a way to put a dent in the current deficit in DC!
Off my soap box for now...Oh, I failed to mention that if we provide a service to a person who has no insurance but doesn't qualify for Medicaid/Medicare, and we charged them something less than the CMS rate, it is considered Medicare fraud!...Ok, I'm done for now. :cool:

I'm not being sarcastic with this question.. Do you have any insight on how Medicare determines what prices they'll pay? I know in some cases it seems like it comes "out of a hat" but I beleive there is a review of SOME kind.

The "more MRI scanners in City X than Canada" isn't nearly as true as it used to be. The count for Canada is 222 as of June 2010 and the US has 7950 as of July 2010 (latest figures from NumberOf.net). Canada has 1/10th our population so a more accurate, adjusted comparison would say 222 to about 800. Now, other surveys say that doctors who own their own MRIs order 4 times as many MRIs as doctors who don't, but there's controversy in how those numbers were attained.

Don't get me started on DRG days... How a doctor handled my grandmother concerning DRG days should have been criminal - but that's a story for another time.

But more than anything else, let me say a sincere THANK YOU for taking the time to write what you did.

the subject of the thread was Obama VS Carter ....not ones opinion of the credibility or not of the media involved. What we used to call a "lateral arabesque" ....a more polite way of stating BS!!!!!

How about an opinion on the subject presented....Obama VS Carter.

In my humble opinion, on the subject of the thread, Obama makes Carter look good!! Carter was a wishy washy, take no risks and offend no one president....and acted that way. And there were times one felt some of what he did was for the good of the country.

Obama is a wishy washy, takes no risks and offend none president...but TALKS as if he isn't/wasn't. And there is nothing we have seen this president do that is for the good of the country.

Subject....CARTER VS OBAMA!!!!

btk

Carter was ineffective and weak. Obama is very dangerous. Bailouts, Obamacare etc. is shaping the USA's future.

Do You Mean The Same President Obama
 

who ordered the strike that took out Bin Laden? Former defense secretary Bob Gates, a Republican appointed to the cabinet by President Bush, called Obama's decision to go into Pakistan and get Bin Laden the gutsiest decision he's ever seen by any president. Is that the wishy washy,take no risk president you are refering to?

Clandestine missions are carried out every day that the public will never be privy to. If the mission had failed the public might never know. So, there really was no risk. Although it would have been nice if Clinton had given an order when they had him in their sites. Then 9-11 would never have happened.

So you know more about
 

these decisions and how these missions are carried out than the former Secretary of Defense? Seems logical to me.

I'm telling you that if the mission failed, nobody would have known. I know for a fact that many things happen in the military that stays in the military. Do you really think the mainstream media would dig into their idol's failures?

I'm willing to bet that if it was a failure and it became known, he would blame someone else, like he does with all his failures.

Lets Just Say
 

I'm not surprised that you wouldn't give the President any credit for getting Bin Laden. You remind me of another conservative poster who was clearly mad that Obama, and not Bush, was the one who got him.

I'm not mad at anybody. Just telling you the facts. The Navy SEALs are the only ones's who should take credit. Bush didn't get Sadamm. The Army did.

You continue to ignore my
 

main point. Former Secretary Gates, a Republican appointee and one of the most respected men in Washington- by both sides of the aisle-called Obama's decision to stage the raid the gutsiest decision he's ever seen by any American President. You seem to think that this praise is somehow not valid, reasoning that there was no political risk to Obama since the raids' failure would never have been reported. I say that Gates knows a hell of a lot more than you or me, or anyone else posting here, and this is good enough for me. Your assertion that the media would never have reported on a failed raid is absolute BS.

I don't understand why you are all picking on Obama. He kept his promises of "hope" and " change". He just didn't define it to me "hope the changes I made don't continue to spiral the economy downward any farther" Suddenly Greece is looking like a wealthy country next to us. Atta way Barack! Thank God you had the foresight to add Biden on your team

If you remember, a little less than two years ago
this administration actually charged and attempted to court-martial 3 Navy Seals from Seal Team Six when
a terrorist suspect, whom they captured, complained they had punched him during the take down and bloodied
his nose. This administration further commented how brutal they were. The left were calling them Nazi's and
Baby Killers. Now all of a sudden, the very brave men they vilified are now heroes?
Seems Obama needed a boost in his ratings and his waterboy, Gates, contributed.

What next Obama hires Jane Fonda to entertain the troops and visit military hospitals

That's A Stretch
 

and you know it. Do me and everyone else here a favor, and admit to the fact that you despise the President, and under no circumstances will you give him credit for anything he does. You remind me of the loonies on the left who were calling Bush and Chaney war criminals. Neither you nor them are capable of any rational, objective thinking.

When I show you the hypocrisy of this administration, you refuse to see. I guess love is blind.
Obama is the one who wanted to bring Bin Laden to court one minute and then flip flops and wants to kill him the next, when his ratings get low.
He is against wars and then bombs innocent Libyan citizens.

Sorry, but he consistently
 

advocated killing Bin Laden. You conservatives hate the fact that it was Obama, and not Bush, who got the job done. Why can't you admit that you hate the man and will never give him any credit for anything. At least then, we'll all know where you stand and the source of your animus to all things proposed by this President. And don't say it's because he's a socialist, because any thoughtful person knows that that is far from the truth.

Don't hate the man
 

Just his liberal progressive philosophy. Oh, is that another name for socialism?

All I know after reviewing is that the constant here is that you pretty much totally IGNORE what critiques are made of this President..you NEVER respond to facts presented and continually want to talk party politics or Bush.

I have heard no poster say that they disagree with everything this President has done, but it appears that you think all he does is correct, or you would not ignore what folks say and respond with parties and Bush !

Maybe you dont realize you are doing it, but ...wow.....

Sorry, but you are
 

wrong. There are things about Obama I don't like, and will admit that he has made mistakes. On the other hand, I feel the need to defend him from the blind hatred and lunacy prevalent on this forum.

Listen to Rags 123 Actor. He seems to be very observant bystander.

I dont want to get into it with you again, but have you heard about the press conference today where for about 10 minutes Carney ducked questions on what plan does the President have and finally admitted he HAS NONE !!!

NO PLAN by the President of the US on a serious budget crisis only a threat of a veto...and that threat given right after calling for compromise.

Look this guy has been all his life and continues to be...it is his way or the highway and yet you defend him.

It is not mistakes that are scary..nobody is perfect...it is the total open lying and lack of leadership. Read the polls...folks are running from this guy in droves. This morning on Morning Joe, former rep Ford who always supports him...this morning he expressed his displeasure on how he is handling this.

I dont care if Mickey Mouse runs against this guy..he must be defeated.

You can call me the regular names..racist, Bushie, far right nut case...whatever....none of that fits...READ ABOUT THIS MAN...READ HIS BACKGROUND..INVESTIGATE THINGS HE HAS SAID AND NOT DONE....Do what nobody in the media did in 2008

Really?; well that's interesting if true. There are mistakes that you feel this President has made? You've never in any posting ever indicated this that I remember. Not even in your previous persona. Please refresh my memory.

Well for one I
 

posted that I was very upset when he came out in favor of Israel retreating to pre-1967 borders. I also am willing to admit that the stimulus plan failed to do what he said it would. I also agree with other posters who complained about the backroom deals he made to get his healthcare plan through, although I think a lot of that had to do with the culture of Washington, and how legislation gets enacted there. Happy now? I've now found fault with the president three more times than you ever have with any Republican. And I have no idea what you are mean when you refer to my previous persona.

I guess I must have
 

missed something. The latest polls I've seen on the debt ceiling issue show that by a wide margin, people blame the Republicans in the House for the continuing stalemate. People want politicians in Washington who are willing to compromise. I listened to the president's speech last night and he laid out a fairly reasonable plan. Apparently not to your liking. I think your emotions are interfering with your thinking here.

Well, it serves no purpose to criticize those out of power. I have to agree with your assessment of things Obama has done in a wrongheaded way and am surprised by your candor, frankly.

I have criticized Bush often, but not since he's been out of office. He's been exemplary in his conduct since leaving office and Clinton doesn't do near as well, and Carter is an absolute disgrace, to this day.

I absolutely have no love for John McCain and swore I wouldn't vote for him in 2008; but in the end I did because I had no choice because I knew the Marxist that was running against him, even thought McCain is a RINO or a flip-flopper in the first order at best.

You seem to write like someone I know. It's very reminiscent. I could be wrong.

Just so you'll know
 

Carter is my least favorite president ever. I voted for Bush in 2004, because I did not like Kerry. I agree with you about Bush's behavior since he left office, and think he's a good guy who never should have been president. BTW, I also think Obama made a huge mistake when he took office by not focusing all his energies on jobs, not healthcare. He mistakenly thought that his stimulus plan would get the economy growing again, and he was wrong.

Holy moly!!! Jekyll and Hyde?

I voted for Bush only because I did not want Gore or Kerry for President.
I was disappointed in his fiscal irresponsibility. I also agree that Obama should have focused on Jobs and not healthcare. But I do not understand your constant defending of Obama.

I for one would be interested to hear those specifics that you heard. Seem the Presidential press secy is not even aware of a plan that is actually written down.

Please share...SPECIFICS please,not his usual generalities !

I Basically Support The Democratic
 

agenda but am willing to find fault with Obama or any other Democrat when it is warranted. It's easy for me to defend the President when he is attacked by a bunch of intolerant, hatemongers which unfortunately some of his critics are. I remember all too clearly the birth certificate issue, and the charges that he's really a Muslim, he's a terrorist, he's hates America,etc. It's shameful really, and there's nothing you can say to me to get me to believe that many of his detractors don't feel this way.

This is very predictable and a great example....

You are asked to detail exactly what the Presidents plan is, and you can only say that you agree with the Democratic PARTY agenda. Thats it.

Secondly, it is inevitable that when you criticize this President, you will be charged with being intolerant, hate monger...then you go to the race issue,,,,,it is totally inevitable.

I might add, that you forget that our previous president was called so much more in so much more graphic language, but I suppose that was just fine,

Again, and I have experienced this first hand...crticize the President and you will NOT hear about the issues or specifics....BUT YOU WILL HEAR how you are a racist, a hatemonger and any other personal issues that can be thought of.

You make everyones case on this one....very very very typical.

I guess I'm not qualified to discuss
 

in detail every aspect of our budget and where cuts should and shouldn't be made, as you seem to think you are. . I know enough that I don't want to see Medicare turned into a voucher program as Rep. Ryan advocates. I also know that Sen. Reid's plan has more cuts in spending than Boehner's plan, because it includes more cuts in our bloated defense budget. I also know that I'd rather see the wealthiest 1-2 percent pay some additional taxes than to see us cut Pell grants , healthcare services to the needy, etc. And no, it is not inevitable that when you criticize the president you will be called a racist and a hatemonger. When you question where he was born, his religion, his love of country, then yes I believe those are hateful and many on the right are guilty of this. Questioning him on legitimate issues is fine. Got it now, or is this too complicated for you?

I think I was responding
 

in kind.

Alinsky's Rule
 

"Ridicule is man's most potent weapon. It is almost impossible to counteract ridicule. Also it infuriates the opposition, which then reacts to your advantage."


Overuse, don't ya think?

yes!

I agree. If you were talking face to face with a person, you would think very, very hard before you ridiculed him. There is a chance that you might get a swollen eye or worse.
Anyways, I feel that it takes a coward to do it behind a computer, where you can feel safe and secure, while you are demeaning other people. Just saying, that's all.

I've been called names
 

and insulted on this forum more times than I can count. We all get carried away, and say things in the heat of the moment that we later regret.

Almost sounds like a pre election participant....

anonymity is the most efficient amplifier!!!

btk

Yes, your right, of course. It is human nature to strike back when you feel like you have been attacked. I am as guilty as anyone. Sometimes I walk away and come back later when I calm down.