It will be a sad fact that those who propose a government run health care system, are misinformed about containment of health care costs. They argue that ‘non-entrepenurial’ systems elimlinate abuse and misuse of health care resources. The end game of reducing costs to the patient, and payor is offset by the increase in bureaucracy. Institutions, and provider groups will hire watchdogs as overseers to monitor the ‘quality’ of healthcare. The expense of this will be considerable to providers organization. The cost however will be absorbed and shifted to the ‘producers’ of the organization. I was mistaken about this in my own ‘opinions’ about containing costs until I worked at a military hospital as a civilian contractor. These organizations compete internally for allocation of ‘fixed dollars’ by ‘proving’ they produce. Departmental budgets are determined by ‘utilization, which is monitored by evaluating RVUs generated by providers. If RVUs diminish so too does there budget. (or overall institution). Coding experts regularly ‘train’ providers to ‘upcode’ their services. The military in particular has their own system of using
CPT codes. I would be honest in stating that this is not due to greed, but the fear that by not reporting every RVU nickel that department would be penalized. The emphasis is to ‘spend every dollar’ each fiscal year for fear of losing it in the next billing cycle. I was amazed one day to see an emergency patient who came in with a ‘simple migraine headache’ The ER provider note’s treatment plan included a “screening MRI”. Perhaps this is the new paradigm for younger providers who do rely much more heavily upon technology. Providers in this environment also seem to order more lab tests because they don’t think it ‘costs’ the system’ when a patient (or they ) never see a ‘bill’ to whomever supplies the services. Particularly in the military these services are provided by ‘outside contractors’ who must be reimbursed as well.
Those who observe “our system’ from 40,000 feet really have inadequate knowledge of how the systems work internally. Those who regulate have little involvement in how and how much it costs to regulate. That is contracted out to third parties, whose costs are ‘hidden’ Congressman Pete Stark frequently tell us the overhead for medicare is 2-3%. That is just not true. Medicare costs us much more due to cost shifting to private payors and hospitals because their rates are miserably low, and other payors pick up the difference. Medicare and Medicaid do share in only a portion of the costs of the uninsured. This is passed on to County and State governments. Statistic lie.
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