Discussion in 'Politicants' started by Indy, Feb 8, 2019.
We were discussing pharma, high drug costs and accessibility. I was pointing out that Medicare, under part D, does not control the negotiation of drug prices or coverage. Congress gave that to the private sector Insurance companies and Pharma, not Medicare.
I get it, you don't like Medicare medical. You have had your own experiences. Can it be improved? Yes. Is privatization the answer? IMO and experience, no.
My wife and I have been generally satisfied with it. However, we pay as much for the 20% gap covered by private Insurance companies as we do for the 80% covered by Medicare. So our main issue and disatisfaction is with the Insurance companies.
My 87 year old dad lost an arm in an accident, has been air vacced, has had several heart surgeries, pace maker, stents, shoulder replacement for his good arm, knée replaced. My 85 year old mom had her knee replaced, issues from mini-strokes, etc. All while they are under Medicare + Supplemental. They have never had an issue with payment coverage, treatment or access to doctors or services. They live in rural Tennessee.
Its not that I dont "like Medicare."
I feel like i could save them millions. Forking over 10k in reimbursements for a precedure, which could be done more efficiently at another location for 2k reimbursement payment, wastes $ and makes no sense.
If you really believe you can ...
I sincerely encourage you to leave a comment for them. I have no doubt there are many ways to improve the current system and situation.
I know it's not the same thing, but it's government, so it's related.
I have a colleague that covers a VA in her area, and that VA pays list price, by choice, for literally all consumables they order from her. She has tried on multiple occasions to get them signed onto a contract that would guarantee their business for a period of time and allow them to receive significantly discounted pricing. Every time she tries, they tell her they don't want lower pricing because then they would "lose their normally budgeted funds."
It's mind-boggling how many different ways the government can find to waste money.
Well, follow the line of logic and it leads to congressional directives to "save money." It seems simple when looking at the wreckage, but it happens for a reason. They wouldn't be able to sign a contract guaranteeing their business for a period of time because any such contract would have to be competed-- and if they competed it, by law price would be one of the primary criteria, and they could end up "saving" money by getting inferior product or service. Contracting law for the government is dense and illogical. And it comes from Congress.
If you want to find the waste, look no further than the incoherence of the legislative branch.
VA's sign contracts with us all the time. They're typically set up as 1 year contracts with 2-4 Option years, so I guess "guarantee" wasn't the best word to use. But they rarely fail to exercise their Options because switching vendors at that point wouldn't make much sense.
Not disagreeing with your comment (contracting law for the government is dense and illogical), but I don't think they're choosing to avoid a contract because they're afraid they'll be forced to purchase inferior products.
Military bases overpay too. Reps used to want the Ft Campbell account for any product. As long as the invoice was under $2500, they would use a credit card and not look at pricing.
In my previous role, we used that rule to our advantage with government accounts all the time. IIRC, the credit card limit for some was $3,000.
Whenever a government account needed a preventative Maintenance, we’d find whatever way we could to keep the bill under that number so they could pay for it quickly and easily. Not necessarily an abuse on their end, as the PM’s weren’t frivolous by any means. But it’s funny that these rules are so widely known and utilized.
So, who is at fault? Government spending requirements/rules, or businesses that knowingly exploit it?
NOTE: This is not a shot at anyone here, just a general question.
but see, this is the same sort of mechanism that you were deriding. it actually takes 3 parties to waste government money, working as a team: bad laws, regs, and policies from a long gone session of Congress, an opportunistic contractor, and a lazy/negligent/ignorant government worker. and the real hoot is, it is sometimes impossible to distinguish between wasteful spending versus proper spending without being on the granular level of the office procuring the good or service. to cut back on that stuff, 2 of the 3 parties have to step up. One of them should be the federal worker because it is literally their job. the other should be Congress for the same reason. but that doesnt make the contractor picking at the bones of the American people from time to time blameless.
both. VA as well. With all the VA troubles the past few decades, they should have allowed local negotiations. Instead they ended up paying higher prices than the hospitals attached to them. For example Vandy may use Stryker for implants and pay $100 for a titanium screw, and any competitor with a similar product has to meet the local negotiated contract. Those same doctors walk across the hall to the VA using the same screws and VA national contract pays $200 for the implant. Not many sales reps will charge the lesser amount when the buyer says I want to pay you double.
I think the contract situation I provided and the $2,500 rule Leg Dude provided are two very different cases.
I definitely think companies exploit the rules, but the government also seems pretty good at just wasting money in healthcare on its own.
I'm not disagreeing with you, but my example doesn't really meet your criteria.
I've seen government accounts let large, important medical devices go down for multiple months because they don't have the funds to repair them in their budget and the contractual process is too long to get any sort of maintenance agreement in place.
Think about it. A vendor isn't going to let you put a maintenance contract on a medical device unless they know for a fact it's working properly. How do they figure out if it's working properly? By doing a preventative maintenance or some sort of routine "check up." But once they do that preventative maintenance or routine check up, that "all good" status doesn't last forever, and the government is incapable of putting a maintenance contract in place with any sort agility. So you get your PM done, and by the time the contract is ready 6 months later, you need another preventative maintenance because who knows what could have gone wrong with the instrument in the last 6 months?
We exploited the $3,000/$2,500 rule to make sure the VA could pay for the preventative maintenance right before the contract was ready to be put in place. It was for their benefit. Eventually, we starting baking the PM cost into the contract, though that puts the vendor at significant risk. But it became one of the only realistic ways to do business with them.
I get it, but the only ones who can address this issue are lawmakers.
No argument here.
Lawmakers are the ones that [uck fay] everything up 6 ways from Sunday. We need to get them the hell away from as much as possible.
so what, anarchy? Do I needto learn to play the fire throwing guitar at 60 mph?
I don't look good in leather in chains.
This escalated quickly.
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