Tonight's topic: DSH funding, or Disproportionate Share Hospitals [sorry, no DFHs
here]. Basically, it's hoped that all hospitals will do their part to provide charity care to the poor and uninsured. To encourage this, Medicare/Medicaid will pay extra money to those hospitals in an area that end up treating more than their fair share of the indigent.
From the White House fact sheet:
Reduce subsidies to hospitals for treating the uninsured as coverage increases. Instead of paying hospitals to treat patients without health insurance, we should give people coverage so that they have insurance to begin with. As health reform phases in, the number of uninsured will go down, and we would be able to reduce payments to hospitals for treating those previously uncovered. This would be done by establishing a new mandatory mechanism to better target payments to hospitals for unreimbursed care remaining after coverage increases. Beginning in FY 2013, payments would be gradually phased down so that by 2019, funding would equal 25 percent of Medicare/Medicaid Disproportionate Share Hospitals (DSH) funding in 2013, and updated by inflation.
Sounds straightforward, doesn't it? If everybody's got insurance, then nobody's uninsured, and they can all go to the hospital whenever they need to, and the hospital will be paid. No more charity care needed, right?
Small problem... The money right now goes directly from the government taxpayers to the hospitals. If instead we direct that money to subsidies to poor people so they can buy insurance, then the insurance companies get to skim their 18.4% off the top before paying the hospitals.
Of course, if all the money that would have gone to DSH payments instead goes to pay for expanded Medicaid for poor people, that would cut out the private insurers, wouldn't it, since Medicaid is a public program? Not so fast privateer breath, in 2004 61% of Medicaid enrollees were in managed care [private insurance] programs.
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RENTS!!!!
An absolutely classic example of rent-seeking behavior by the insurance companies being rewarded by the Finance Wing of the FKDP
-- that's what the 18.4% is: A rent.
It's beautiful in its simplicity! Boss Tweed has nothing on these guys.
Deep thought: Rents can never be open and transparent. People get pissed about them.
UPDATE I love that the 18.4% comes off the top, too. In Hollywood, that's a very sweet deal.
UPDATE We really need a better word than rent. I would argue that all of the "blood-sucking" and "parasite" metaphors are, at bottom, about rent. So the right polemical tool should not be hard to find.
First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi
question
how do you know that the DSH payments go directly from taxpayer -> hospital with no 3rd party involved?
That's how I read the Fact Sheet
Hipp?
First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi
ouch. bad blogger!
i was just repeating what i had read on other sites and didn't go looking for confirmation from primary sources.
did a little checking around the cms website, and will need to do more [i knew it was complicated, but i had no idea just how complicated the scheme is].
as i understand it so far, from preliminary digging around, it looks like the hospitals can apply to either medicare or medicaid for dsh payments. medicare's payment method seems to be straightforward, but their application process is screwy and apparently, because of this, hospitals generally prefer to apply to medicaid. the federal govt [via medicaid] then gives the $$ to the states and the states have the final say on exactly how it gets doled out to the hospitals that applied for payment. whether the states use a third-party payer of some kind or not, i haven't found out yet.
a convoluted process to be sure, and one that would be [mostly] eliminated under single payer, since under hr 676 hospitals would be under global budgeting [though this would likely still entail some dsh-style adjustments in payments to hospitals]
it's entirely possible [though i doubt it, really] that yes, giving the dsh money to people as subsidies to spend on private insurance could end up being cheaper and more efficient after all, though i sincerely hope that's not the case.
Umm...
(comment edited out. I just saw the comment above, not the post itself, for some reason. Sorry for confusion!)
We can't afford not to have single-payer!
And, this is exactly
why Boston Medical is suing Massachusetts.
The liberty of democracy is not safe if people tolerate growth of private power to a point where it becomes stronger than their democratic state itself. That, in its essence, is fascism.---FDR
Details and link, please
Seeing as how as MA goes, so goes the nation. Thanks!
First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi
Here's a start:
http://www.boston.com/news/local/massach...
Lot's more if you google: boston medical suing the state.
The liberty of democracy is not safe if people tolerate growth of private power to a point where it becomes stronger than their democratic state itself. That, in its essence, is fascism.---FDR
Tribute
tribute (n.)
1. A payment in money or other valuables made in acknowledgement of submission.
2. A payment or tax given by a feudal vassal to an overlord.
3. Payment exacted by dominant parties from lesser parties under duress or coercion.
heh
i was thinking protection, noun, money paid to racketeers for a guarantee against threatened violence myself, but i think yours fits better.