Word: shield
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...forget about cost controls as part of a bargain to keep the medical profession from opposing the program. Instead, one of the ways the Government reimburses hospitals for the care of Medicare-Medicaid patients is on a "cost plus" basis, and it asks few questions about the cost. Blue Shield and commercial insurers generally pay "usual, customary and reasonable" physicians' fees (U.C.R. in medical jargon). That gives doctors an incentive to charge all patients top dollar, so that they can establish those fees as U.C.R...
...fumbling attempts to contain costs have not worked. In Massachusetts, for example, Blue Shield has established maximum fees for various medical procedures but so far has refused to tell doctors what the maximums are, lest everybody charge them. Many doctors do anyway. A Boston specialist's secretary explains: "Suppose we charge $45 for a service and then we learn that another doctor is being paid $65 for the same service. We then cannot ask $65 even though we may be as good or perhaps better. Blue Shield permits us to raise our prices by a small percentage from time...
...income or age, be covered. He has backed away from his earlier advocacy of making the Government the basic insurer. Instead, he would inject competition into the scheme by letting people choose whether they wanted to be protected by a consortium of commercial insurance companies, by Blue Cross-Blue Shield, or by joining independent group health plans or health maintenance organizations (H.M.O.s). Employers would be liable for the premium payments, estimated at $11.4 billion a year more than they pay now, but they could require workers to provide up to 35% of that amount. The workers' share would be related...
...first essential is to reform insurance practices. Some beginnings have been made: Blue Cross-Blue Shield will no longer automatically pay for a battery of tests administered to every patient who enters a hospital unless each test is specifically ordered by the attending physician. Insurance policies should be rewritten to pay for lab tests and other care administered in a doctor's office rather than a hospital. If Congress will not push the Blue plans and private insurers in this direction, corporations could and should. Exxon, General Motors and AT&T have the bargaining power that individual patients lack...
...owner of the program. Broadcasters are sure to make an angry challenge of this aspect of the proposed FCC ruling in Congress. Quite as important as the effect of the proposed ruling is the shift in FCC philosophy that it indicates. The FCC had always been eager to shield local broadcasters from cable competition. But Philip Verveer, director of the FCC cable bureau, now justifies the proposed new ruling with a rhetorical question: "Why interfere with consumer preference...