The Fraudulent American Healthcare System

In the past 5 years, our country’s healthcare has been as weak and lack-luster as Barack Obama’s promises.

Yes, all you liberals out there i actually said that.

And I have proper grounds to say it because I am in the healthcare field.  I get past all the red tape in hospitals and other medical facilities that most people living in this nation do not.

If you are an illegal immigrant, chances are I’m not your biggest fan, nor do I agree with standardized healthcare.

Yes its nice in theory for everyone in this country to have health insurance.

Guess what?

It is not economically feasible and working class Americans should not have to carry the weight of others.  If that is the case, then maybe some poiticians should donate some of their bloated salaries to the less fortunate. Before I go on some political rant Im going to educate you on some topics that will affect you and your loved-ones in the future.

I’m just gonna scratch the surface here so let it marinate in your head like some A1 on a porterhouse.

The Healthcare System is in Shambles

First off, hospitals and surgery centers will be looking to standardize to the leat expensive products in the next few years.

Yes I am a vendor and I sell medical products to surgeons, hospitals, and surgery centers.  The products I sell are generally more expensive than others that are similar to mine. But mine are also the best for patients with the best post-operative outcomes.

When it comes to surgery, wouldnt you want to have the best products implanted into your body while a stranger is cutting into like Dexter?

The reason why hospitals are looking for the cheapest products available, is mostly due to insurance companies and their reimbursement contracts.  For instance, some insurance companies reimburse for products in surgery, better than others.

It isnt really if one insurance company is better than another, but more of what contract was negotiated to a hospital district or surgery center.  But what insurance comopany you carry under your umbrella, will most likely decide what products you will receive when you go under the knife.

OK, so lets go a little deeper now.

Most surgery centers are physician owned.

When a surgery center opens, the center, doctors, and insurance companies negotiate terms on types of procedures that will be performed, products used, reimbursement conditions, etc.  When a contract is being negotiated, the insurance company will try to wear down a center into quickly agreeing to terms that ultimately favors the insurance company.  If the center balks at the terms, than the insurance company will try to scare the center into teling them they cannot start doing surgery because these new terms will takes months evena  year to bring to the table again.  So either the center will stick to their guns and sit tight, or sign a contract with insurers that utimately favors the insurance carrier in the long run.  In some cases, a surgery will not be reimbursable at all, a small percentage, or 100 percent.  Sometimes, a facility can actually make a percentage over the cost of a product depending on the insurance carrier.

When a surgeon does a certain type of procedure he will do it in the surgery center or a hospital.  If it is a surgery that allows the patient to go home the same day, you better believe he will do anything in his power to do it at the surgery center.  Why? Because he owns it and wants the reimbursement to go directly into his pocket or the center’s.  Now if he brings it to the hospital, its because he knows that the insurance carrier does not reimburse for the surgery well, and he will let the hospital eat the cost.  Why does he care, the hospital has deeper pockets and he doesn’t have to pay for the supplies being used.

Some insurers will only reimburse if the products are a certain price.  For instance, if a product a doctor wants to use costs 2000 dollars, and the insurance company only reimburses for products over 2500, he most likely will not get any money recouped for that product, and probably take it to the hospital.  If its 2500 or over, he will get full monies back and maybe even a little more.  Some hospitals and surgery centers will try to make vendors or medical supply companies charge over their list fee so they can get proper reimbursement.

Guess what?

That’s called fraud.

And it happens everyday, everywhere.

So now insurance companies are catching on to these fraudulent claims and they are doing everything in their powers to break current contracts and go back to the table and renegotiate.  Insurance companies are putting a stop to certain reimbursements on products that they once paid for.  This in turn, is making hospitals and surgery centers look for the cheapest and less-expensive products out there.  Which are also most likely the ones that are most harmful to the patient.  Do you really think that a person with little or no insurance is getting top-notch healthcare?

Patients with the best insurances aren’t getting much better.

Obama imposed a tax hike on medical equipment companies not too long ago.

It was an extra 10% based on revenue that the companies claimed.  This in turn puts a strain on not only the healthcare field, but the medical equipment companies to supply new and innovative products for patients ailments.  These are millions of dollars a year that are going to the government that can be used for more research and development, engineering, safety, etc.  We are over-looking our future in regards to the health of this country.

The slogan for healthcare in this country was something along the lines of “we put patient care first.”

Now its “we put patient care first if its cost effective.”


6 Responses to The Fraudulent American Healthcare System

  1. Thanks for the details — I have sensed right along that this kind of stuff happens, and I appreciate having the facts, which will give me a strong position with which to argue for change.

  2. Charles Hice (Tenn Man) says:

    Has anyone thought about the “returning” service men/women? The local VA is already getting packed. Do people understand that man of us have co pays. And, ambulances (except private) are not allowed on VA grounds. (That is the way in Ohio)>

    And, if the VA is your primary, then the local hospital does not want us. Understandable.
    But, the VA is not the nearest facility.

    The VA has outsourced payments. If you do not pay on time, they take it out of your pension.
    Not complaining. But, there is so much waste in health care. And, to be honest, many people do not take care of themselves.
    I will read the article again. Thanks. Hello World!
    Tenn Man
    Charles Charles

    • Peter says:

      The VA has some of the worst products i have seen. It’s so sad that veterans get mediocre for what they have endured for this country

  3. sideview says:

    every country battles, how to keep medicine going forward, allow those who can pay for the elective stuff do so, and yet meet government commitment for basic care to the others.

    • Peter says:

      Just because a surgery is considered elective doesn’t mean that it isn’t necessary. There is just a longer window before it becomes a major issue

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