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An American Way to Economic Stimulus (based on observing my wife for 40 years)

18 Aug

 

For some reason we seem to focus our economic stimulus on automobiles, bridges and the promise of new technology to make us green…all wrong!

Auto stimulus placates the UAW and more autos make the need to build roads and bridges that much greater.  Building bridges and fixing roads gives jobs to people who build bridges and fix roads and gives states more money to spend and technology, well the current thrust for technology is to build giant monster wind generators across the land and at sea and to make the American West look like a solar panel version of Levittown.  And guess what, if we do all that green stuff successfully it may be able to generate as much as 10% of our energy needs.  Whoopee!

scissors_clipping_coupons_md_clrI have a better idea…coupons.  You heard right, the good old American bargain that gets those shopping juices flowing and people to the stores.  Look at it this way, consumers make up the bulk of US buying and stimulate the economy more than anything else stimulates.  Small business is the driver of new jobs and the economy so unless you believe that autoworkers and construction people can stimulate us into a robust economy you have to get to the average person. At the risk of incurring the wrath of N.O.W., that average person in this case is a woman.

A stimulus check is saved and lowering payroll taxes is not even noticed, but a coupon, well a coupon gets a place of honor on the dinner table or kitchen counter or is placed in a special folder within the pocketbook.  It means something; it’s real money and it gets people buying.  Who does not want a bargain?

So here is my plan, the federal government issues coupons, you take the coupon to the store of choice and shop to you drop.  The retailer turns in the coupon for the cash from the government (well it is really from you but, hey if it’s from the government we all know it’s free).  Think of it as reverse ration books (assuming you know what that is). 

You get to use the coupon to buy anything you like, take a vacation, dine out, whatever. Except you cannot use it for necessities like food, gasoline or utility bills and the like, you gotta spend, spend, spend at your local store or restaurant.  

Oh, Mr. Obama I can't thank you enough

Oh, Mr. Obama I can't thank you enough

But, here is the catch, the coupon expires in thirty days and they are issued in waves across America, not all at once and then we start over again.  Now, given the American penchant for spending, once we are in the store and we see a sign that says half off or two for one, we buy more even without the coupon, we use the plastic and Citibank now has more of our money to repay the government that lent them our money in the first place.  Why not just borrow from the banks directly while you shop and cut out the middleman?  You realize that we were all happy being in debt and borrowing from our futures, it was only when we were told that we were in

Hey, I'm doing my part

Hey, I'm doing my part

debt that we became unhappy.

I bet if we used coupon economics Linens and Things would still be in business.

There you have it, simple, something Americans can relate to, you avoid giving money to the states to give to the towns to give back to us after everyone has taken a cut and you stimulate like never before.

Whats’ really wrong with the health care system, a real life example

18 Aug

Ok, so we all know there is a great deal that could be improved starting with our own behavior at times, but there is also something fundamentally wrong with incentives to provide more and more services and to bill in such a way as to maximize reimburement.  Perhaps you have read about the famous Ear Infection on these pages. Following is the text of a memo I am leaving with members of Congress when I meet with them.  Perhaps you will see an idea for providing your own input to the people who would reform our system.  The Explanations of Benefits are not attached

_________________________________________________________

Attached are the actual Explanation of Benefits forms from an ear infection episode for an adult woman.  The result was the placement of a drain in the ear similar to what is done with many small children. 

The total charges for this episode were $18,120, including the charges of $13,110 for a ten-minute procedure in an outpatient surgical center. 

Write down CPT 233, 455,320,123,333

Write down CPT 233, 455,320,123,333

This is a good example of what if fundamentally wrong with our health care delivery and reimbursement system.  The costs are too high and the payment system is skewed toward providing more and more services. 

Note that on many occasions of a single office visit there is billing for several separate procedures, on February 27 four procedures for a total of $695 and on April 30 six procedures for a total of $2,005.  Remember, regardless what the EOB says regarding the “type of services” all these services were for an ear infection in one ear.  

According to the surgeon, the placement of the drain took a total of ten minutes, yet the charge for use of the surgical center was over $13,000.  From the time my wife walked into the center for the procedure to the time we left was no more than 90 minutes. 

Interestingly a group of fifty doctors, including the specialist who inserted the drain, owns the surgical center. 

Also, note the difference between billed charges allowed, and accepted charges.  Why should some people pay more and other less for the same procedure?  If a given charge is acceptable for people with coverage why not for all patients? 

This is a large self-insured employer group; the “carrier” does not function as an insurer, but rather a third party claims administrator. 

The fundamental questions are:

Why is one office visit divided into numerous costly procedures? 

Why are physicians allowed to refer to facilities they own? 

Why does it cost over $13,000 to use an outpatient center for 90 minutes? 

Why is a follow up visit following the procedure not included in the fee for the surgical procedure?

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