> Cam wrote: > So private industry runs it - is this why it's so efficient (as > opposed to other govt agencies) as Judah claims is it? >
I don't know what Judah is talking about, but when you say "run" I'd ask again what you mean. You have to understand insurance. I'd give you an analogy, but you don't appreciate them so blah, I won't. Basically in healthcare you have: patient -> provider -> plan administrator -> payer So what does "run" mean? The whole system? That's everyone so nobody runs that. In the case of Medicare the government is the "payer" so it sets rules on payment. But that's no different than any other payer such as your company if it's self-insured or your plan if not. And with Medicare there are only as many plans as there are companies to invent them. Example, let's say you start Cam-Chi Health. You might decide that since medical care is getting better and people healthier you think you can make some sweet moola in "health arbitrage". So the Cam-Chi plan asks members to sign over their Medicare benefits to Cam-Chi health and in return you provide extra services and coverage that your target group doesn't get with other plans. So I enroll in Cam-Chi and go get an eye exam and my provider files a claim. You pay it. Medicare doesn't know or care. I sprain my ankle and have it treated. My provider files a claim with Cam-Chi. You pay it. Then you go to Medicare to get reimbursed. See, Cam-Chi's profit plan is that I'll go to doctor less than Medicare will pay out in a standard year (capitation), and maybe I have a unique arrangement with a provider group(s), and maybe hospitals, for low cost health care. Medicare could care less. Confused? Or does it make sense? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| Adobe® ColdFusion® 8 software 8 is the most important and dramatic release to date Get the Free Trial http://ad.doubleclick.net/clk;207172674;29440083;f Archive: http://www.houseoffusion.com/groups/cf-community/message.cfm/messageid:288650 Subscription: http://www.houseoffusion.com/groups/cf-community/subscribe.cfm Unsubscribe: http://www.houseoffusion.com/cf_lists/unsubscribe.cfm?user=89.70.5
