<p>Documentation for “Patients who are covered by Medicaid do not… take advantage of preventative services any more than uninsured poor people,” please?</p>
<p>Here’s an interesting example of what happens when poor people can enroll in Medicaid. A free clinic in rural Arkansas is closing down, because now their patients can go to regular medical offices. Note that free clinics, unlike regular doctors offices, are limited in the tests and treatments they offer.
<a href=“http://www.menastar.com/”>http://www.menastar.com/</a></p>
<p>This NY Times article shows what happens when the govt is financing our health care. Political influence and corruption are never far behind when our politicians are dictating billions of dollars of federal reimbursements of health care costs.</p>
<p>So you’re saying that the Florida doctor isn’t fleecing insurance companies too? For example, you say he is not fleeing insurance companies that offer Medicare supplemental? Why would you believe this?</p>
<p>Also, the opthamologist billing issue is caused in part not by the government, but by Genentech’s greed. Genentech makes Lucentis ($2000 a dose, for macular degeneration). Genentech also makes Avastin ($50 a dose for macular degeneration, also used for some cancers). Genentech does not want doctors to use Avastin for macular degeneration, although many doctors say it is identical in all important ways to Lucentis. </p>
<p>But it’s not identical in price. So Genentech deliberately makes it difficult to use Avastin for eyes. They don’t package it in the right sizes. </p>
<p>“So you’re saying that the Florida doctor isn’t fleecing insurance companies too?”</p>
<p>If you have any evidence that it is happening to the insurance companies, let’s see it. One thing for sure is that you wouldn’t have these doctors lobbying politicians (of one particular party) with gobs of cash if it wasn’t govt money being used to pay these doctors.</p>
<p>There’s an article in the LA Times today explaining some of this. Some doctors in a medical group are billing Medicare under one doctor’s name. Some of the huge dollars are reimbursements for expensive oncology drugs. So much of the raw data is misleading without further explanation. Apparently, no one told the doctors in advance that this information was going to be published. </p>
<p>To me the lesson of the story is that if you get your money from the public, expect that it will be public record someday. </p>
<p>Yes, and some of the huge dollars are the 6% of the expensive oncology drugs’ price that goes straight into the doctors’ pockets. Is there any reason why doctors should be able to rake off a percentage of the cost of the drugs they administer? Isn’t this a recipe for doctors using expensive drugs instead of cheap ones? And is there any justification for drug makers like Genentech to pay kickbacks, oh excuse me, “rebates,” to doctors who use lot of their ridiculously expensive drugs? </p>
<p>I think publicizing these payments is great! Even if doctors are following the law and not using expensive drugs instead of cheap ones that work just as well, we can now look at the result of the current reimbursement scheme and see if we think it might be tweaked. </p>
<p>For example, if they insist on paying doctors a percentage of the drug price (though I think the percentage should be zero) that amount should be capped at $2 or something like that. And kickbacks should be illegal.</p>
<p>I’m sure that the doctors are telling the truth that they didn’t know the info would be released. However, it was public information, and the subject of a lawsuit.</p>
<p>I am surprised percentage of drugs back to doctors would be considered legal. I always thought they get free vacations to Hawaii in guise of drug review conference.</p>
<p>Me too. And I think Medicare should claw back those kickbacks. Mr. Fang says they can do it administratively-- if they are reimbursing for a $2000 drug, but the drug actually only cost $1900 after the kickback, then Medicare can and should get that $100 back.</p>
<p>After that, kickbacks should be made illegal. And Medicare should pay a fixed amount, or at least a capped amount, for drug administration, in order not to encourage doctors to use expensive drugs when cheap ones work just as well.</p>
<p>“Even if doctors are following the law and not using expensive drugs instead of cheap ones that work just as well”</p>
<p>Are you a doctor? It’s easy for you to say which drugs work better for a particular individual, but it is never quite as easy as you like to make it. I will tell you this…I certainly don’t want CF and her govt buddies dictating what drugs cancer patients have to take. </p>
<p>This is not a case of substituting the cheap antibiotic generic for the brand name drug. It’s a lot trickier prescribing the correct drugs for cancer patients. </p>
<p>You haven’t provided any justification for doctors getting paid a percentage of the drug cost, GP. Nor have you provided any justification for kickbacks being legal.</p>
<p>If your idea of freedom is freedom for my doctor to, unbeknownst to me, take kickbacks from a drug company when she is deciding what drug to give me, I don’t want her to have that freedom.</p>
<p>“You haven’t provided any justification for doctors getting paid a percentage of the drug cost, GP.”</p>
<p>As far as I can tell this is not allowed or done with private insurance companies. Medicare pays doctors 6% of the price of the drug. This is the govt requiring taxpayer dollars to be paid in this fashion. It is probably not a mystery why this is happening. Lobbying and huge campaign contributions to the politicians who write our laws (Obamacare) is probably why doctors are reimbursed this way.</p>
<p>I was unable to determine whether private insurers pay doctors a percentage of the drug cost. I suspect they do, because private insurers tend to use the same reimbursement schemes as Medicare, but I couldn’t find out either way. Anyone out there know the answer?</p>
<p>I did find out why Medicare reimburses doctors 106% of the average sales price of the drug, though-- it’s to compensate doctors for having to buy and store the drugs before administering them. But it does mean that high-volume users of expensive drugs are going to profit. First, high-volume users can negotiate lower prices for the drug, They’re not paying the average sales price but something lower, so they are going to be getting not 106% of their costs, but 110%, 120% or more. Second, high volume users don’t have to worry about the carrying cost. If you are doing 16 eye procedures a day, your drugs are not sitting around moldering in inventory for months tying up your cash flow.</p>
<p>At the same time, lower-volume users are going to make less money per procedure. The high volume users are paying less than the average sales price for the drug, which implies the lower-volume users are paying more. </p>
<p>But low-volume or high-volume, doctors are incentivized to use expensive drugs instead of cheap ones. And that’s no good.</p>
<p>Don’t know about what’s good for the country but in the context of the largest piece of social legislation passed in decades, it’s ridiculously fortuitous.</p>
<p>If the Census people had wanted to look above it, they’d have dualed the survey formats - losing continuity is about the cardinal sin.</p>
<p>The Census is DoL. And one of the more independent operations. Sure, they could have catered to ACA needs, that’s not their point. Next, the Big Naysayer will tell us it’s conspiracy to hide something. </p>
<p>Try looking for the straight scoop, not settling for the pre-digested by those who want to make something wretched out of this. The Census is a snapshot- in part, these question fixes will provide more accurate info in the snapshot answers. </p>