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Health Care reform...dont want political
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<blockquote data-quote="Marguerite" data-source="post: 299980" data-attributes="member: 1991"><p>Tina, I hear you. But the trouble is, the alternative is private industry managing it and frankly, it's both too big and too important for the profit motive to rule here. Only the governemtn CAN handle it, unfortunately. But they need to delegate to a specially set up government body whose sole task is policing/administering the health care system. It also needs to link in to taxation, in order to make payment for it fair and equitable.</p><p></p><p>I hope your government listens to countries like ours who already have learned a great deal on how to beat the fraudsters. But as I have said, the price is a great deal of watering down of personal freedom (especially for those wanting to have the chance to commit fraud).</p><p>What you describe about the doctor you worked for, I saw in Australia's first version of our state-based health system. Now our computer assists have programming to catch this very sort of fraud. A doctor whose practice gets "flagged" by our Health Insurance Commission, first has to "please explain". He has to justify his billing, or his requests for tests, or whatever it is that has alerted the computer to a possible fraud. His accounts are taken out and inspected, even his patients may be interviewed and his appointment books double-checked to se if Patient X really did come in that day. Patient files are on computer and the files will be checked to see if the doctor made any notes on the patient visit that day. naturally, our sysgem doesn't like to do this too often, but a doctor who repeatedly gets flagged will face such an audit. (And it's a committee he has to face, a committee themselves subject to honesty audits and whose own work is scrutinised by the computer programs. THAT is what scaress other countries about health care systems like ours. Is it handing too much power to computers?)</p><p></p><p>These doctors being investigated are given a choice - face an audit, or voluntarily choose to not practice for a period of time.</p><p></p><p>I spent some time as a volunteer patient advocate on a number of levels. I was invovled in charity work, in associated journalism and I personally met a number of doctors who faced the audit. Some fought, one or two survived the first few audits. But about half of therm knew they had bent the rules sufficiently, so it was better for them to "take a break" from medical practice, than to have to determine how many books they had to work over, to cover the tracks of their fraud. </p><p></p><p>I have seen the attitude of doctors change as the system tightened up. I've seen the protests in the media, I've had some of these doctors cry on my shoulder about having to face an audit. </p><p></p><p>There are drawbacks now as a patient - I go to see my GP and he/she is wary about not ordering too many tests at the one time. It means more blood draws for me, if the first tests are negative. But a doctor MUST ALWAYS be able to justify ALL tests ordered and justify them AFTER the fact, or be required to pay back the costs of ALL tests ordered for ALL their patients over the previous year.</p><p></p><p>So I've personally experienced doctors ordering too few tests, rather than too many.</p><p>Example - I've just had whooping cough. The GP ordered tests but a few at a time. When th blood tests came back negative, she would test for a differential diagnosis. When THAT came back negative, she tested for the first tests again (nervously) in case I was slow to sero-convert. Eventually she referred me to a specialist whose opinion justified one last battery of tests.</p><p>My presenting symptoms looked like pneumonia, so she ordered a chest X-ray. negative. Then a few days later I reported symptoms which sounded like broken rib. But it was too soon to order another chest X-ray. I had to wait until symptoms persisted for another few weeks, especially since a positive finding would not have resulted in any change in treatment. It was finally another specialist who ordered the second chest X-ray (much to my GP's gratitude - it saved her risking being flagged by the HIC computer). </p><p></p><p>I am so glad I am not a doctor - but I AM glad I'm a patient in a country with a health care system like this.</p><p></p><p>Ten years ago, twenty years ago, such fraud as you describe would have been much harder to police. It did happen, but has dwindled as our computer systems became ever more sophisticated.</p><p></p><p>If your President Obama's health people work hand in hand with, say, Australia's Heralth Insurance COmmission, I'm sure you could get some fabulous computer software that will help you put in place a highly effective health care system which is also (mostly) immune to fraud. Of course some will get through, such computer programming still tends to be reactive rather than proactive. </p><p></p><p>But in order for this to happen, your media and adversarial people (who like to make a fuss and complain because it gets them media attention) will have a lot of fodder to cause a great deal of angst. The more fuss thye make, the more a really effective system will get watered down. For example, about ten years ago the Aussie government proposed bringing in a microchipped Medicare card which would have meant each of our cards would have had not just our Medicare number on it - equivalent to Social Security number - but in the microchip would have been other contact information, the sort of stuff you get in your passport, and also possibly even your medical history. From some angles, absolutely brilliant idea. But scary, in a George Orwell sort of way.</p><p></p><p>And it never happened. The media's campaign killed it.</p><p></p><p>But I strongly suspect our new government is gonig to have more success now. Our credit cards now mostly have microchips in them and they slipped under the radar.</p><p></p><p>The US is far more 'touchy' on civil liiberty issues than Australia (although phrases such as "the nanny state" get bandied around a lot here too, especially in relation to things like gun laws). So whether your government will be able to beat us to the punch on this one - I don't think so. But if your government succeeds in getting this happening, it could help you steal a march on us. It could happen after all.</p><p></p><p>For your sakes, I hope so. We've lived with this for over 30 years and our standard of living is so much better, purely as a result. It seems to me to be such a glaring deficit in the US lifestyle.</p><p></p><p>I mean - what more do you need in the US, once you can get good health care for everybody?</p><p></p><p>Marg</p></blockquote><p></p>
[QUOTE="Marguerite, post: 299980, member: 1991"] Tina, I hear you. But the trouble is, the alternative is private industry managing it and frankly, it's both too big and too important for the profit motive to rule here. Only the governemtn CAN handle it, unfortunately. But they need to delegate to a specially set up government body whose sole task is policing/administering the health care system. It also needs to link in to taxation, in order to make payment for it fair and equitable. I hope your government listens to countries like ours who already have learned a great deal on how to beat the fraudsters. But as I have said, the price is a great deal of watering down of personal freedom (especially for those wanting to have the chance to commit fraud). What you describe about the doctor you worked for, I saw in Australia's first version of our state-based health system. Now our computer assists have programming to catch this very sort of fraud. A doctor whose practice gets "flagged" by our Health Insurance Commission, first has to "please explain". He has to justify his billing, or his requests for tests, or whatever it is that has alerted the computer to a possible fraud. His accounts are taken out and inspected, even his patients may be interviewed and his appointment books double-checked to se if Patient X really did come in that day. Patient files are on computer and the files will be checked to see if the doctor made any notes on the patient visit that day. naturally, our sysgem doesn't like to do this too often, but a doctor who repeatedly gets flagged will face such an audit. (And it's a committee he has to face, a committee themselves subject to honesty audits and whose own work is scrutinised by the computer programs. THAT is what scaress other countries about health care systems like ours. Is it handing too much power to computers?) These doctors being investigated are given a choice - face an audit, or voluntarily choose to not practice for a period of time. I spent some time as a volunteer patient advocate on a number of levels. I was invovled in charity work, in associated journalism and I personally met a number of doctors who faced the audit. Some fought, one or two survived the first few audits. But about half of therm knew they had bent the rules sufficiently, so it was better for them to "take a break" from medical practice, than to have to determine how many books they had to work over, to cover the tracks of their fraud. I have seen the attitude of doctors change as the system tightened up. I've seen the protests in the media, I've had some of these doctors cry on my shoulder about having to face an audit. There are drawbacks now as a patient - I go to see my GP and he/she is wary about not ordering too many tests at the one time. It means more blood draws for me, if the first tests are negative. But a doctor MUST ALWAYS be able to justify ALL tests ordered and justify them AFTER the fact, or be required to pay back the costs of ALL tests ordered for ALL their patients over the previous year. So I've personally experienced doctors ordering too few tests, rather than too many. Example - I've just had whooping cough. The GP ordered tests but a few at a time. When th blood tests came back negative, she would test for a differential diagnosis. When THAT came back negative, she tested for the first tests again (nervously) in case I was slow to sero-convert. Eventually she referred me to a specialist whose opinion justified one last battery of tests. My presenting symptoms looked like pneumonia, so she ordered a chest X-ray. negative. Then a few days later I reported symptoms which sounded like broken rib. But it was too soon to order another chest X-ray. I had to wait until symptoms persisted for another few weeks, especially since a positive finding would not have resulted in any change in treatment. It was finally another specialist who ordered the second chest X-ray (much to my GP's gratitude - it saved her risking being flagged by the HIC computer). I am so glad I am not a doctor - but I AM glad I'm a patient in a country with a health care system like this. Ten years ago, twenty years ago, such fraud as you describe would have been much harder to police. It did happen, but has dwindled as our computer systems became ever more sophisticated. If your President Obama's health people work hand in hand with, say, Australia's Heralth Insurance COmmission, I'm sure you could get some fabulous computer software that will help you put in place a highly effective health care system which is also (mostly) immune to fraud. Of course some will get through, such computer programming still tends to be reactive rather than proactive. But in order for this to happen, your media and adversarial people (who like to make a fuss and complain because it gets them media attention) will have a lot of fodder to cause a great deal of angst. The more fuss thye make, the more a really effective system will get watered down. For example, about ten years ago the Aussie government proposed bringing in a microchipped Medicare card which would have meant each of our cards would have had not just our Medicare number on it - equivalent to Social Security number - but in the microchip would have been other contact information, the sort of stuff you get in your passport, and also possibly even your medical history. From some angles, absolutely brilliant idea. But scary, in a George Orwell sort of way. And it never happened. The media's campaign killed it. But I strongly suspect our new government is gonig to have more success now. Our credit cards now mostly have microchips in them and they slipped under the radar. The US is far more 'touchy' on civil liiberty issues than Australia (although phrases such as "the nanny state" get bandied around a lot here too, especially in relation to things like gun laws). So whether your government will be able to beat us to the punch on this one - I don't think so. But if your government succeeds in getting this happening, it could help you steal a march on us. It could happen after all. For your sakes, I hope so. We've lived with this for over 30 years and our standard of living is so much better, purely as a result. It seems to me to be such a glaring deficit in the US lifestyle. I mean - what more do you need in the US, once you can get good health care for everybody? Marg [/QUOTE]
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