socialised health care

Commy

catefrances wrote:

it is a damn shame that government dont take the lives of their citizens as seriously as they do an oil pipeline in central asia.

it is. and I think that's why its so hard to get anything done about healthcare in the US. there's money to made by keeping it the way it is.

capitalism, continuing to do what's best for the bank account.

catefrances

Commy wrote:

catefrances wrote:

it is a damn shame that government dont take the lives of their citizens as seriously as they do an oil pipeline in central asia.

it is. and I think that's why its so hard to get anything done about healthcare in the US. there's money to made by keeping it the way it is.

capitalism, continuing to do what's best for the bank account.

only when the last tree has died
and the last river been poisoned
and the last fish been caught
will we realise we cannot eat money

Heineken Helen

RM291946 wrote:

How can anyone in their right mind think this is a good idea for us? Coming from a socialist country, I know how bad it is..People waiting for months to get treatments, sometimes even years. Imagine someone with cancer being made to wait for chemo. It happens. And why should we pay for the health care of the wealthy..Let it roll out of their own damned pockets.

so it's better to die cos you can't afford it? :? YEH, I can see how THAT makes sense :roll:

I've luckily never had any major issues but anytime I've had something wrong, I've had it sorted straight away. And with a professional attitude... they were fantastic... not QUITE free in Ireland, semi free, but still fantastic. It's free here in England and it's pretty cool actually. I don't think there should be a situation anywhere where somebody can't afford to be sick that's just really sad.

Heineken Helen

RM291946 wrote:

Well, in small towns, there usually isn't much choice, regarding doctors, at all..free or not.
But yea, there are, in my experience, more than one doc at the clinics and you can choose. At the VA, forget it, you don't get a choice at all..so if that is anything to go by as an example of how it would be here....things would not be good. And the best part about the clinics is it's all women that work in them, so you need not be uncomfortable if you have issues being around men for those kind of exams.

But I live in an area where I have so far found 5 of the clinics..

After a few weeks living here in England, I'd to sign up to a clinic. I was able to tell them I wanted a woman doctor (not a HUGE deal for me, but I'd feel more comfortable) and they asked me which one would I prefer... since I didn't know I just said any of them. It was not an issue at all. Anytime I've gone to a doctor at home, I've requested a woman and got one.

decides2dream

Commy wrote:

catefrances wrote:

it is a damn shame that government dont take the lives of their citizens as seriously as they do an oil pipeline in central asia.

it is. and I think that's why its so hard to get anything done about healthcare in the US. there's money to made by keeping it the way it is.

capitalism, continuing to do what's best for the bank account.

that, and amazingly some citizens are still against it! americans in general, for whatever reason, are very anti-tax, anti social programs, and like to keep government out of what they deem their private lives. of course, there is much there that makes zero sense but that's besides the point. personally, i think socialized medicine for ALL would be an excellent idea. we DO already have some form of socialized medicine, but you have to be extremely poor, or old, or both...to actually get to it. there are some other instances, free clinics and such, but overall...the average worker, no socialized medicine. i will never understand why there are some in this country who don't want it...but i have seen it argued by many on this very board being agsainst it, think the government will fuck it up, etc...but really...don't think that is so. as i said, i jkust think america as a whole has had a particular mindset 0f 'freedom'...of keeping government out, but that definitely seems to be changing. i have excellent health coverage and always have, thankfully......but without employment and/or without a parent with coverage and being their dependent...or a spouse with good coverage...then what? if i keep at my job and all sure my firm will continue my insurance, covering 70% of the cost...but why sould ANYone have that worry in old age, when you need good health coverage the most? i most definitely support such change and think it will be for the betterment of all citizens.

_

RM291946 wrote:

There are abortion clinics that are free.

Really? I've never heard of a free abortion clinic in the United States. I'd love to know about the ones to which you're referring. And are there any in New Mexico?

_

RM291946 wrote:

For the truely poor, there is medicaid. It is strict as hell, which is good, cos if you don't really need it, don't even bother trying. It works out well. Provided they accept it, you can go to private doctors. It's flaw is in getting it in the first place. strict is good, but they are also corrupt. The doctors who examine you, to see if you qualify, are given incentive to report that you don't. With a lot of cases, they can't get away with that. But for conditions that cannot be physically proven, such as certain mental or mood disorders, it's easy for them to say no.

Huh? What incentive do doctors get to deny patients Medicaid? And why would they do this when it's in their own best interest for the patients to have a payer source?

Also, if, as you said, you think the Medicaid system works out well, why would you have a problem with a single-payer system, which would be very similar?

Flutter Girl

scb wrote:

RM291946 wrote:

For the truely poor, there is medicaid. It is strict as hell, which is good, cos if you don't really need it, don't even bother trying. It works out well. Provided they accept it, you can go to private doctors. It's flaw is in getting it in the first place. strict is good, but they are also corrupt. The doctors who examine you, to see if you qualify, are given incentive to report that you don't. With a lot of cases, they can't get away with that. But for conditions that cannot be physically proven, such as certain mental or mood disorders, it's easy for them to say no.

Huh? What incentive do doctors get to deny patients Medicaid? And why would they do this when it's in their own best interest for the patients to have a payer source?

Also, if, as you said, you think the Medicaid system works out well, why would you have a problem with a single-payer system, which would be very similar?

I found out about the clinics who do that thru a friend after she was raped. The hospital told her about the clinic

Government doesn't want to pay to help people, therefore the more applications denied, the better, according to them. same way it works at the VA. I would imagine they get the same sort of incentive the VA docs got for denials..nice sized bonuses. I'm on my 10th application, I know folk who are on their 19th or 20th applications. This time I got a lawyer tho, one of those free ones, well he gets part of the back pay when we win..so if anyone is getting denied, I suggest you go find a lawyer. Mine literally wrote the book on fighting social security, medicaid, and DCF..LoL, my doc showed it to me when referring the guy to me.

I don't know anything about the single payer system :? Could you tell me what it is?

Flutter Girl

Decides and Helen- did you read my post about the Veteran's Hospital? It detailed what our already-existing socialised health care system is like, showing how bad it is and explaining how if it were nationwide, it would be even worse. Besides, like I said, why should my taxes pay for some fat rich slob when he has a heart attack from his over-indulgences? Fixing Medicaid is the best answer. Those of us who truely do need it would get health care, and those who can afford it, should pay for it on their own. Using taxes to pay for everyones health care means, in one way, that the poor are helping to pay to take care of those who are more fortunate. That's plain assinine.

I think, in addition to fixing medicaid, the best thing we can do to correct the health care system here is to
regulate cost of medicine

regulate cost of necessary treatments, meaning if you want bigger chuchi's you're on your own, but brain surgery should not be a quality-goes-to-the-highest-bidder system.

and regulate private insurance companies..no more denying chemo for cancer patients, etc..

Heineken Helen

RM291946 wrote:

Decides and Helen- did you read my post about the Veteran's Hospital? It detailed what our already-existing socialised health care system is like, showing how bad it is and explaining how if it were nationwide, it would be even worse. Besides, like I said, why should my taxes pay for some fat rich slob when he has a heart attack from his over-indulgences? Fixing Medicaid is the best answer. Those of us who truely do need it would get health care, and those who can afford it, should pay for it on their own. Using taxes to pay for everyones health care means, in one way, that the poor are helping to pay to take care of those who are more fortunate. That's plain assinine.

I think, in addition to fixing medicaid, the best thing we can do to correct the health care system here is to
regulate cost of medicine

regulate cost of necessary treatments, meaning if you want bigger chuchi's you're on your own, but brain surgery should not be a quality-goes-to-the-highest-bidder system.

and regulate private insurance companies..no more denying chemo for cancer patients, etc..

Well at least you're offering solutions.. and not bad ones either. The thing that gets me is that people can't afford to get sick or people lose their houses cos they need chemo or something... and that's simply disgusting... but i'm sure we're all in agreement there. Of course there are problems to free healthcare... and the NHS doesn't come without downsides... but probably the only country in the world with near to perfect healthcare is Cuba... but don't quote me on that. In Ireland, they brought in that you have to pay to even visit your gp, sometimes up to 50euro just for a 15 minute visit. Almost immediately peoples attitudes changed and potential serious issues they had 'might just go away' so they leave it til it gets bad and then it's a HUGE issue.

Problem with giving medicaid to only those who are poor... is that it's the middle people who suffer. Sometimes there are advantages to being unemployed for this reason. If you have a job and it pays what's considered 'decent' money, you might be getting by and having a LITTLE bit of a life... but you're considered able to afford these things... and many people in those situations can't.

Denying people chemo is disgusting... the lowest of the low.

_

RM291946 wrote:

I found out about the clinics who do that thru a friend after she was raped. The hospital told her about the clinic

Government doesn't want to pay to help people, therefore the more applications denied, the better, according to them. same way it works at the VA. I would imagine they get the same sort of incentive the VA docs got for denials..nice sized bonuses. I'm on my 10th application, I know folk who are on their 19th or 20th applications. This time I got a lawyer tho, one of those free ones, well he gets part of the back pay when we win..so if anyone is getting denied, I suggest you go find a lawyer. Mine literally wrote the book on fighting social security, medicaid, and DCF..LoL, my doc showed it to me when referring the guy to me.

I don't know anything about the single payer system :? Could you tell me what it is?

I'm sorry about your friend who was raped. In New Mexico, however, there are no free abortion clinics. There are family planning clinics that use federal Title X funds to provide cheap/free services to those who qualify - but it's a federal law that abortions cannot be provided using these funds. Plus, these funds can only be used to provide services to specific populations of people. There are still many, many people who must pay for their services.

I'm sorry you're having trouble getting Medicaid. I agree that there are plenty of kinks in the system that need to be worked out. I understand that the government has an incentive to provide Medicaid for fewer people or pay for fewer claims. But the doctors themselves have an incentive to set people up with Medicaid so they will get paid. They don't get bonuses for not signing people up. This is why many hospital systems (in the states where this is available) have had their employees trained to set people up with Medicaid. Not only do they do this to get MORE of their patients on Medicaid, but it would be illegal for them to deny Medicaid to someone who actually qualifies. (Plus, ultimately only the Medicaid office - not anyone from a doctor's office - can approve or deny a Medicaid application.)

I think there are a lot of varied ideas people have about universal healthcare. Many people call it socialized medicine. But I've found that many (probably not all) of the ideas being proposed aren't really calling for medicine to be socialized. By this, I mean that it won't be like the military where the delivery of healthcare is managed by the government. What many people are calling for is just that the government PAY for the healthcare, kind of like they do now with Medicaid, only everyone would be covered so it wouldn't be so difficult to figure out whether or not you qualify. The delivery of services, however, would remain private - and people could use their coverage to see whatever doc they want. This would greatly improve the system because: 1. everyone would be covered automatically (perhaps with citizenship requirements), 2. the beauracracy & overhead would be cut dramatically, and 3. the purpose would be to provide healthcare, not to make a profit. Here's a link to some more info from Physicians for a National Health Program:
http://www.pnhp.org/

Oh yes, and your taxes wouldn't be going to pay for rich people's healthcare because they would be contributing taxes too.

Flutter Girl

Heineken Helen wrote:

RM291946 wrote:

Decides and Helen- did you read my post about the Veteran's Hospital? It detailed what our already-existing socialised health care system is like, showing how bad it is and explaining how if it were nationwide, it would be even worse. Besides, like I said, why should my taxes pay for some fat rich slob when he has a heart attack from his over-indulgences? Fixing Medicaid is the best answer. Those of us who truely do need it would get health care, and those who can afford it, should pay for it on their own. Using taxes to pay for everyones health care means, in one way, that the poor are helping to pay to take care of those who are more fortunate. That's plain assinine.

I think, in addition to fixing medicaid, the best thing we can do to correct the health care system here is to
regulate cost of medicine

regulate cost of necessary treatments, meaning if you want bigger chuchi's you're on your own, but brain surgery should not be a quality-goes-to-the-highest-bidder system.

and regulate private insurance companies..no more denying chemo for cancer patients, etc..

Well at least you're offering solutions.. and not bad ones either. The thing that gets me is that people can't afford to get sick or people lose their houses cos they need chemo or something... and that's simply disgusting... but i'm sure we're all in agreement there. Of course there are problems to free healthcare... and the NHS doesn't come without downsides... but probably the only country in the world with near to perfect healthcare is Cuba... but don't quote me on that. In Ireland, they brought in that you have to pay to even visit your gp, sometimes up to 50euro just for a 15 minute visit. Almost immediately peoples attitudes changed and potential serious issues they had 'might just go away' so they leave it til it gets bad and then it's a HUGE issue.

Problem with giving medicaid to only those who are poor... is that it's the middle people who suffer. Sometimes there are advantages to being unemployed for this reason. If you have a job and it pays what's considered 'decent' money, you might be getting by and having a LITTLE bit of a life... but you're considered able to afford these things... and many people in those situations can't.

Denying people chemo is disgusting... the lowest of the low.

Thank you LoL..

That's one thing..What is considered "able to afford". It should be based on cost of living. If you can fully afford cost of living and insurance, then you can afford insurance. But if you are cutting into that cost so that you can afford the insurance, then you are too poor for it. Of course, regulation placed on private insurance companies can help this immensly, paired with the other 2 suggestions, they won't be able to blame a high cost they place on their coverage on the cost of medicine and treatments. That plus giving incentive to doctors to keep their patients coming in for regular checkups and keeping them healthy..To pay for me to go see my doc for a 60$ office visit and a free inhaler for bronchitis is hella cheaper than the more than 10,000$ it would cost to treat me in emergency care in the hospital for pnuemonia.

With most every insurance company there is still at least a small fee for office visits and medicine. At mine when I was insured I payed 5$ for office visits and the same for prescriptions. 5$ out of my pocket is just enough to keep me from scheduling an appt for a runny nose, but very affordable to keep from discouraging me from going when I know I have something that requires a doctor, and to go for regular check-ups.

With medicaid you don't pay anything. Which is good for the poorest. For those who can reasonably afford some insurance, or at least some of the medical costs, there is medicare.

There was actually a major to-do about one girl whose insurance refused to pay for cancer treatment on the basis that it was 'expirimental,' but doctos clearly stated that it proved to have good results with all previous cases it was used for, and with the girl, they said she had 2 options...that 'expirimental' treatment, or death. Hours after negative publicity finally caused the insurance company to approve the procedure, she was on her way in to get it done when she died.

Flutter Girl

scb wrote:

I'm sorry about your friend who was raped. In New Mexico, however, there are no free abortion clinics. There are family planning clinics that use federal Title X funds to provide cheap/free services to those who qualify - but it's a federal law that abortions cannot be provided using these funds. Plus, these funds can only be used to provide services to specific populations of people. There are still many, many people who must pay for their services.

I'm sorry you're having trouble getting Medicaid. I agree that there are plenty of kinks in the system that need to be worked out. I understand that the government has an incentive to provide Medicaid for fewer people or pay for fewer claims. But the doctors themselves have an incentive to set people up with Medicaid so they will get paid. They don't get bonuses for not signing people up. This is why many hospital systems (in the states where this is available) have had their employees trained to set people up with Medicaid. Not only do they do this to get MORE of their patients on Medicaid, but it would be illegal for them to deny Medicaid to someone who actually qualifies. (Plus, ultimately only the Medicaid office - not anyone from a doctor's office - can approve or deny a Medicaid application.)

I think there are a lot of varied ideas people have about universal healthcare. Many people call it socialized medicine. But I've found that many (probably not all) of the ideas being proposed aren't really calling for medicine to be socialized. By this, I mean that it won't be like the military where the delivery of healthcare is managed by the government. What many people are calling for is just that the government PAY for the healthcare, kind of like they do now with Medicaid, only everyone would be covered so it wouldn't be so difficult to figure out whether or not you qualify. The delivery of services, however, would remain private - and people could use their coverage to see whatever doc they want. This would greatly improve the system because: 1. everyone would be covered automatically (perhaps with citizenship requirements), 2. the beauracracy & overhead would be cut dramatically, and 3. the purpose would be to provide healthcare, not to make a profit. Here's a link to some more info from Physicians for a National Health Program:
http://www.pnhp.org/

Oh yes, and your taxes wouldn't be going to pay for rich people's healthcare because they would be contributing taxes too.

I'd have to check into it, maybe there is a way to request the opening of a clinic there..

The doctors I am referring to are the ones specifically paid by medicaid and the state to meet with and review new cases..Meaning if you have bipolar (yea I'm a mess), medicaid will schedule an appt for you to see one of their own shrinks who will do a generic, pointless evaluations (wtf does my ability to count backwards have to do with extreme mood swings?!) These are the doctors who are given incentive to reject your claim. One said I was faking it. Another said I was just a little down and just need to get a job. Yet another didn't even stick around, she was headed out when I showed for my appt. Her secretary was the one who interviewed me.

The process is you apply, you see one of their doctors for evaluation, and medicaid either denies, or approves your application based on that doctor's assessment.

I have plenty of doctors who have said without doubt I have it and have had it since age 7. Including one doing a free evaluation during national mental health month (October, for those who think they might need that), and a research centre, who would only be hurting themselves to misdiagnose me cos I wasn't paying them anything, they were paying me. Why would they waste their funding on a liar, and moreso why would they waste their time trying to find answers about bipolar on someone who doesn't have it?

The only reason I get free care for that is cos Gov.Crist hooked me up with the clinic and got things waivered so I don't pay for the doctor visits (the United Way pays part, and the clinic just eats the rest of the cost..), and my love, Ramon, a blessing who works there, he gets the company who makes my medicine to give it to me for free.

Getting the government to pay for the healthcare of everyone would be a huge burdon on the poor and middle classes because expanding the program to insure everyone, and not just the poor, means taxes will need to be raised (they gotta get the money for it somehow). The rich can afford higher taxes. We can't...

That's why medicaid was created instead of nationwide government insurance..

_

RM291946 wrote:

I'd have to check into it, maybe there is a way to request the opening of a clinic there..

But who would pay for it?

The process is you apply, you see one of their doctors for evaluation, and medicaid either denies, or approves your application based on that doctor's assessment.

Hmm.... that's totally not the way it works here.

Getting the government to pay for the healthcare of everyone would be a huge burdon on the poor and middle classes because expanding the program to insure everyone, and not just the poor, means taxes will need to be raised (they gotta get the money for it somehow). The rich can afford higher taxes. We can't...

Actually, we (the American taxpayers) already pay more per capita for governement-funded healthcare than other nations. The only difference is that we're not all getting care. Without such huge overhead we could get more care for the same amount of money. (Check out the website I cited before.) This wouldn't hurt the poor at all - it could only help them. IF taxes did have to be raised some, it should be raised only for those who can afford it.

Flutter Girl

scb wrote:

RM291946 wrote:

I'd have to check into it, maybe there is a way to request the opening of a clinic there..

But who would pay for it?

The process is you apply, you see one of their doctors for evaluation, and medicaid either denies, or approves your application based on that doctor's assessment.

Hmm.... that's totally not the way it works here.

Getting the government to pay for the healthcare of everyone would be a huge burdon on the poor and middle classes because expanding the program to insure everyone, and not just the poor, means taxes will need to be raised (they gotta get the money for it somehow). The rich can afford higher taxes. We can't...

Actually, we (the American taxpayers) already pay more per capita for governement-funded healthcare than other nations. The only difference is that we're not all getting care. Without such huge overhead we could get more care for the same amount of money. (Check out the website I cited before.) This wouldn't hurt the poor at all - it could only help them. IF taxes did have to be raised some, it should be raised only for those who can afford it.

Taxes would pay for it, same as here.

In your state?

If the taxes were raised for it, now you know as well as I do the government is not going to use good sense, they will dole the burdon out to everyone. And in reality, when taxes are raised it hits the poor and middle class, cos the rich can afford good lawyers to find any grant, program, and/or loophole to get them out of paying more. so the only ones burdoning the higher cost would be us..the little folk..

I still wouldn't be happy knowing any of my money was funding the health care of Bill Gates and the like...As said, let it roll out of their own damned bank accounts.

_

RM291946 wrote:

Taxes would pay for it, same as here.

Yeah, see that's what I don't get. The federal government has been barred since 1976 from using taxpayer money to pay for abortion except in about 1% of cases. So I know there will never be a free abortion clinic here and I don't understand how there could be one elsewhere.

In your state?

Yes, in my state. Although, since Medicaid is a federally-funded program, it doesn't seem like it would be vastly different in other states.

If the taxes were raised for it, now you know as well as I do the government is not going to use good sense, they will dole the burdon out to everyone. And in reality, when taxes are raised it hits the poor and middle class, cos the rich can afford good lawyers to find any grant, program, and/or loophole to get them out of paying more. so the only ones burdoning the higher cost would be us..the little folk..

I still wouldn't be happy knowing any of my money was funding the health care of Bill Gates and the like...As said, let it roll out of their own damned bank accounts.

But what I'm saying is:

1. I don't believe taxes would have to be raised for it. Or, if they were, they wouldn't have to be raised in a way that actually cost any extra money since the money being paid to for-profit insurance companies could just be redistributed.

2. Your money wouldn't fund the health care of Bill Gates; his own money would fund it through his taxes. I understand that many rich people get out of paying their "fair share" of taxes, but it's not like they don't pay any taxes at all.

dunkman

scb wrote:

Actually, we (the American taxpayers) already pay more per capita for governement-funded healthcare than other nations.

really? i'd be interested to see the figures on that... any link?

_

dunkman wrote:

scb wrote:

Actually, we (the American taxpayers) already pay more per capita for governement-funded healthcare than other nations.

really? i'd be interested to see the figures on that... any link?

I learned this from a lecture by Physicians for National Health Care. Here's a link to the part of their website that talks about it: http://www.pnhp.org/single_payer_resources/60_percent_of_health_spending_is_already_publicly_financed_enough_to_cover_everyone.php
The website also links to an article.

Flutter Girl

scb wrote:

RM291946 wrote:

Taxes would pay for it, same as here.

Yeah, see that's what I don't get. The federal government has been barred since 1976 from using taxpayer money to pay for abortion except in about 1% of cases. So I know there will never be a free abortion clinic here and I don't understand how there could be one elsewhere.

In your state?

Yes, in my state. Although, since Medicaid is a federally-funded program, it doesn't seem like it would be vastly different in other states.

If the taxes were raised for it, now you know as well as I do the government is not going to use good sense, they will dole the burdon out to everyone. And in reality, when taxes are raised it hits the poor and middle class, cos the rich can afford good lawyers to find any grant, program, and/or loophole to get them out of paying more. so the only ones burdoning the higher cost would be us..the little folk..

I still wouldn't be happy knowing any of my money was funding the health care of Bill Gates and the like...As said, let it roll out of their own damned bank accounts.

But what I'm saying is:

1. I don't believe taxes would have to be raised for it. Or, if they were, they wouldn't have to be raised in a way that actually cost any extra money since the money being paid to for-profit insurance companies could just be redistributed.

2. Your money wouldn't fund the health care of Bill Gates; his own money would fund it through his taxes. I understand that many rich people get out of paying their "fair share" of taxes, but it's not like they don't pay any taxes at all.

I was taking a guess about the taxes..Maybe some org like planned parenthood pays for it or more than one org, or they take donations :?

One of my issues with socialised insurance is if it means prices for doctors cannot be set by the doctors, will it be a set standard across the board..Cos if that is the case we will run into the same problem as we have with the VA. It's unfortunate, but money often is a motivating factor for doctors to do a better job. If they charge a lot but do a crap job, they lose patients. The better a job they do, the higher traffic they get, the bigger their annual income. That is one of the largest issues with the VA.

I don't understand about the medicaid either. Everyone I know who has had to deal with them and trying to get on it has had the same experiences as I have And that's a lot of folk, just those with bipolar. I'm on a message forum for that where that is prolly the most common complaint. Right up next to being pissed that people always mistake it for a mental condition. We're perfectly sane, in fact we have a tendency to have a higher intelligence

_

RM291946 wrote:

One of my issues with socialised insurance is if it means prices for doctors cannot be set by the doctors, will it be a set standard across the board..Cos if that is the case we will run into the same problem as we have with the VA. It's unfortunate, but money often is a motivating factor for doctors to do a better job. If they charge a lot but do a crap job, they lose patients. The better a job they do, the higher traffic they get, the bigger their annual income. That is one of the largest issues with the VA.

Maybe we just have different experiences/perspectives. Although I have never been a patient at the VA, I have always received my medical care from either military hospitals or state/university hospitals and I've had no major complaints about the care itself.

At the university medical center where I currently work, most of our patients are either on Medicaid (which, as you said, sets the price they pay) or simply don't pay at all. Our doctors get paid much less than doctors with private practices. And yet we provide the best care in the state.

I'm actually not entirely sure I understand your argument. You said they'll do a better job so they can get more patients so they will have a bigger salary. That seems to be incentive to do a GOOD job, not a bad one. Plus, they would make more money because they wouldn't have to pay so many people to deal with the insurance companies or spend so much time trying to figure out various billing procedures.