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The Hospital Charging Games  
User currently offlineKen777 From United States of America, joined Mar 2004, 8278 posts, RR: 8
Posted (1 year 4 months 1 week 6 days 16 hours ago) and read 2758 times:


Some good examples:

There has been a huge amount of complaints blaming President Obama for all the increases in private health insurance. This week the public is finally getting some real data on the charges from various hospitals around the country and it's easy to see why people (and companies) paying health insurance premiums are hit with huge costs.

One of two WaPo articles is rich in comparisons and provides the ability for you to check your won state:

Quote:

For the first time, the federal government will release the prices that hospitals charge for the 100 most common inpatient procedures. Until now, these charges have been closely held by facilities that see a competitive advantage in shielding their fees from competitors. What the numbers reveal is a health-care system with tremendous, seemingly random variation in the costs of services.
Quote:

In downtown New York City, two hospitals 63 blocks apart varied by 321 percent in the prices they charged to treat complicated cases of asthma or bronchitis. One charged an average of $34,310; the other billed, on average, $8,159.
Quote:

Elsewhere, Las Colinas Medical Center just outside Dallas billed Medicare, on average, $160,832 for lower joint replacements.

Five miles away and on the same street, Baylor Medical Center in Irving, Tex., billed the government an average fee of $42,632.

It helps to remember that Medicare pays set fees regardless of the rip off prices some hospitals hope for. It's the uninsured individuals without insurance that take the list price hits. And they cannot pay those high rates. Private insurance companies negotiate discounts in the 25% to 33% levels - but that still leaves them paying big time for some of those rip off prices. That $160,832 bill in Texas is still a big hit for private insurance companies.

Looking at those numbers makes it clear that it's not all "ObamaCare". The insurance industry hasn't really cared about price increases in the past because they simply pass the costs on to you. Now days employers are passing on some of that nanny care cost onto the employees, as well as (obviously) paying less in wages & salaries.

63 replies: All unread, showing first 25:
 
User currently offlineDocLightning From United States of America, joined Nov 2005, 19712 posts, RR: 58
Reply 1, posted (1 year 4 months 1 week 6 days 8 hours ago) and read 2691 times:

Quoting Ken777 (Thread starter):
It helps to remember that Medicare pays set fees regardless of the rip off prices some hospitals hope for. It's the uninsured individuals without insurance that take the list price hits. And they cannot pay those high rates. Private insurance companies negotiate discounts in the 25% to 33% levels - but that still leaves them paying big time for some of those rip off prices. That $160,832 bill in Texas is still a big hit for private insurance companies.

One hospital was charging $7 for an alcohol pad that costs 1¢. Why someone isn't in jail over that is beyond me.


User currently offlineseb146 From United States of America, joined Nov 1999, 11657 posts, RR: 15
Reply 2, posted (1 year 4 months 1 week 6 days 7 hours ago) and read 2691 times:

Quoting DocLightning (Reply 1):
Why someone isn't in jail over that is beyond me.

It's private corporations. And, private corporations should be able to charge "market value" for products. The right does not care about people as long as corporations can profit off human suffering. No one will be in jail as long as corporations profit.



Life in the wall is a drag.
User currently offlineDocLightning From United States of America, joined Nov 2005, 19712 posts, RR: 58
Reply 3, posted (1 year 4 months 1 week 6 days 7 hours ago) and read 2682 times:

Quoting seb146 (Reply 2):
It's private corporations. And, private corporations should be able to charge "market value" for products.

Yah. Especially when there is a 70,000% markup (did I get my zeros right) and the patient is there not by choice and has no opportunity to comparison shop.


User currently offlinemoo From Falkland Islands, joined May 2007, 3948 posts, RR: 4
Reply 4, posted (1 year 4 months 1 week 6 days 3 hours ago) and read 2645 times:

Quoting seb146 (Reply 2):
The right does not care about people as long as corporations can profit off human suffering. No one will be in jail as long as corporations profit.
Quoting DocLightning (Reply 3):
Yah. Especially when there is a 70,000% markup (did I get my zeros right) and the patient is there not by choice and has no opportunity to comparison shop.

And yet why is there such a big issue in the US about the government providing medical services for you, in place of private companies?

You can bitch and moan about the NHS all day long with valid complaints, but I'd still take it over any other healthcare service in the world. I can walk into any A&E in the country, get my ailment treated and not have to worry about any bill at the end of it. I cant believe some people don't want that...


User currently offlineQFA380 From Australia, joined Jul 2005, 2074 posts, RR: 1
Reply 5, posted (1 year 4 months 1 week 6 days 1 hour ago) and read 2622 times:

That is one of the problems with hospitals, comes down to simple economics in that there is price inelasticity with high market power for the hospitals due to their location. You pay what the hospital closest to you demands. Not only that the 'you' is not the consumer of the healthcare, it is the consumers of the healthcare insurance. Naturally people have absolutely no incentive whatsoever to care about the price the hospital is charging when it can just be passed onto the insurance company. This is all fine and dandy when the payer of the healthcare is simultaneously the provider in the case of government run systems in Australia, the UK etc but in the US there is a massive misalignment of incentives.

Quoting Ken777 (Thread starter):
Now days employers are passing on some of that nanny care cost onto the employees, as well as (obviously) paying less in wages & salaries.

This is necessarily a good thing. By passing the costs onto the actual consumers you are reducing the agency costs of someone else determining the characteristics of your care and what you pay for that care.

One of the problems however is that insurance companies and hospitals are in cahoots. Your insurance company should be ensuring that you receive the best treatment for the lowest price, trying to keep premiums down, but again it comes down to the fact that for an employer there is high switching costs to a cheaper plan who bargain more effectively. If you were directly paying for your insurance, you'd ensure you were paying the lowest you had to.

You come around to one of the biggest issues being the fact that there are disincentives for consumers to choose their own plan. You don't pay tax if your employer pays but you do if you pay for it. Even if the same plan costs you $2000 more than it would elsewhere, having the employer pay saves you $3000 that you would have paid in taxes. Naturally the insurers would not want insurance to be tax deductible, then employers would give their employees a pay rise and cut their plan. Plenty would opt for a cheaper plan with lower coverage and naturally the insurers want to make sure that a 25 year old male is paying for IVF coverage.


User currently offlinefr8mech From United States of America, joined Sep 2005, 5453 posts, RR: 14
Reply 6, posted (1 year 4 months 1 week 6 days 1 hour ago) and read 2619 times:

Quoting DocLightning (Reply 1):
One hospital was charging $7 for an alcohol pad that costs 1¢. Why someone isn't in jail over that is beyond me.


How much does it cost for the hospital to apply that pad? Salary for the nurses, the nurses assistants, the doctors, the orderlies, the insurance, etc? You know, the overhead for operating a hospital.

I'm not saying that $7 is the right number, but, I really don't think $.01 is the right number either.

The blame for this falls squarely on the shoulders of the insurance companies, the medical provider industry and the consumer. How's that for a broad net?

The insurance companies have leveraged their market power to "force" providers to accept negotiated rates. Don't accept our rates: you're out of network. I'm going to guess that these rates, sometimes, don't cover the actual costs of the service, nor provide for an adequate profit for the hospital and its investors.

The medical providers will charge what, amounts to, confiscatory fees for services provided to non-insurance patients. They know they won't get a bunch of that money. They know they'll get only a fraction of it, in many cases. So, they get to write-off the loss or petition the government (state and/or federal) for relief.

What about us? Show of hands: how many of us actually shop for our non-emergency medical care? Elective surgeries? Or, do we just talk to our doctor, get them to set it up, clear it with the insurance folks and have it done?

I tried to shop around when I had a vasectomy and then again when I had a partial mastoidectomy (cholesteatoma). And, it was darn near impossible to nail the providers down on a price. And, understandably so. Way too many variables. Yeah, my insurance company's website had some information about common and customary charges, but, is that the negotiated rate or the rate the provider would charge if there weren't all the external factors?

I called the hospital where my surgery was to be performed and asked if someone could tell me what the basic per hour cost was for the use of an operating room? I'm sure that the person looked at the phone like I was some kind of three-eyed, purple question-asking monster. What I found out was that, first, they charge per minute and second, until a surgery is booked and the insurance, including Medicaid/Care is, checked, they would be unable to give me a basic rate. My mastoidectomy ran about $175/min for what turned out to be a 5 hour (300 minute) surgery. If I think about it, I'll see if I can find the detailed billing and see what the "insurance write-off" was.

It seems to me that those of us with insurance don't seem to care very much about how much a procedure costs. We are disassociated from the actual cost, the charged cost and the actual payment to the provider (except for some co-insurance or co-pay or deductible). I really can't think of any other industry where this is the case.

And, short of scrapping the whole system and starting from the beginning, I don't know how to fix it or if it can be fixed.

I can tell you that putting more people under an insurance umbrella where even more folks are disassociated from the true costs, isn't going to help. Neither is shutting them away from healthcare.

I found that when we went to an HSA type insurance, we are a lot more careful about our medical spending. I had a conversation with my doctor about his rates and compared them to other providers...again, a lot of those guys were unwilling..or in some cases...unable to provide me with a rate schedule, except in very broad terms.

Have you guys noticed that a lot of practices, at least in this area, have started to affiliate themselves, and taking on the name, of large medical providers? Baptist Health and Norton's are big here. More and more general practices are affiliating themselves with one of these two corporations? Why?

My guess is because the bigger medical provider networks (corporations) have been pushing back against the insurers and demanding higher negotiated rates to more accurately reflect the level of service provided. It's the market trying to exert itself in a highly regulated and irregular market. It may reach balance, but I'm afraid there are too many external forces involved for the medical market to find balance anytime soon.

Ken, you call it a game or games, I call it medical providers adapting to external costs and factors that they have little or no control over.

[Edited 2013-05-10 06:03:29]


When seconds count...the police are minutes away.
User currently offlinefalstaff From United States of America, joined Jun 2006, 6104 posts, RR: 28
Reply 7, posted (1 year 4 months 1 week 6 days ago) and read 2596 times:
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Quoting fr8mech (Reply 6):
The blame for this falls squarely on the shoulders of the insurance companies, the medical provider industry and the consumer. How's that for a broad net?

You bet. My doctor charges $65 for a for an office visit if you pay cash, my insurance company is charged $120.

I know all you lefties hate Rush Limbaugh, but he made a good point a few years ago when he was in the hospital, in Hawaii. He paid his bill in full personally and the hospital knocked something like $30,000 of his bill because there was no insurance. Why is that? Sounds to me like their are a lot of costs associated with insurance billing.

I think a lot of the high cost of health care is the fact that health care providers can jack up their price because they health insurance companies will pay. I don't see "Obamacare" helping the problem; I can only see it getting worse. If the government or a private insurer has to pay a private firm for their services they can charge whatever they because they know they'll get it.

Quoting fr8mech (Reply 6):
How much does it cost for the hospital to apply that pad? Salary for the nurses, the nurses assistants, the doctors, the orderlies, the insurance, etc? You know, the overhead for operating a hospital.

A lot of people don't think about stuff like that. Just like when they get their car repaired; people always complain about the labor rate. Nobody want to pay anyone for their time.



My mug slaketh over on Falstaff N503
User currently offlinemoo From Falkland Islands, joined May 2007, 3948 posts, RR: 4
Reply 8, posted (1 year 4 months 1 week 6 days ago) and read 2590 times:

Quoting falstaff (Reply 7):
Why is that? Sounds to me like their are a lot of costs associated with insurance billing.

I do know that there can be a wait of up to a year between the hospital submitting the bill and receiving the payment from the insurance companies, so getting paid immediately is a huge thing for them.


User currently offlineaaron747 From Japan, joined Aug 2003, 8153 posts, RR: 26
Reply 9, posted (1 year 4 months 1 week 6 days ago) and read 2590 times:

Quoting DocLightning (Reply 1):
One hospital was charging $7 for an alcohol pad that costs 1¢. Why someone isn't in jail over that is beyond me.

The series that ran in The Atlantic a few months ago had incredible chargemaster fees at one particular hospital in Texas. $70 for a gauze pad on the itemized billing, when you can get a box of 50 at Wal-Mart for $6.

Quoting moo (Reply 4):
You can bitch and moan about the NHS all day long with valid complaints, but I'd still take it over any other healthcare service in the world. I can walk into any A&E in the country, get my ailment treated and not have to worry about any bill at the end of it. I cant believe some people don't want that...

That's the best thing about it - the peace of mind. People can focus on what they need to without having to stress over what kind of bills they will be saddled with.

I'll admit the tax hit for the NHS in Japan is a pretty big bite, but it's still a hell of a lot cheaper overall than comparable coverage I've had in the US.

Quoting fr8mech (Reply 6):
What about us? Show of hands: how many of us actually shop for our non-emergency medical care? Elective surgeries? Or, do we just talk to our doctor, get them to set it up, clear it with the insurance folks and have it done?

That's the great thing about living under a system like this one. Need something your doctor can't do? Talk to them, they'll set up a referral, get an appointment and you go. Nothing else you need to do. No permission to seek. Nothing to clear. And the billing won't change.



If you need someone to blame / throw a rock in the air / you'll hit someone guilty
User currently offlinefr8mech From United States of America, joined Sep 2005, 5453 posts, RR: 14
Reply 10, posted (1 year 4 months 1 week 6 days ago) and read 2580 times:

Quoting aaron747 (Reply 9):
That's the great thing about living under a system like this one. Need something your doctor can't do? Talk to them, they'll set up a referral, get an appointment and you go. Nothing else you need to do. No permission to seek. Nothing to clear. And the billing won't change.

Actually, my insurance is set-up the same way. I don't necessarily seek permission from my insurer. Of course, while my procedures may not have been absolutely medically necessary (vasectomy and the mastoidectomy), they also weren't cosmetic in nature.

I don't have to seek permission because I am more invested in my health care costs because of my HSA and the high deductible that comes with it.

Quoting moo (Reply 8):
so getting paid immediately is a huge thing for them.

Especially when you are only allowed to charge right at or below your margin.

Quoting aaron747 (Reply 9):
$70 for a gauze pad on the itemized billing, when you can get a box of 50 at Wal-Mart for $6.

Can you get the doctor, nurse, insurance, hospital setting, antiseptic and everything else that comes with a medical professional in a medical setting applying that dressing for the other $64 at Walgreens?
When you look at it from that perspective, maybe $70 isn't really that much.



When seconds count...the police are minutes away.
User currently offlineaaron747 From Japan, joined Aug 2003, 8153 posts, RR: 26
Reply 11, posted (1 year 4 months 1 week 5 days 23 hours ago) and read 2565 times:

Quoting fr8mech (Reply 10):
I don't have to seek permission because I am more invested in my health care costs because of my HSA and the high deductible that comes with it.

Yeah but I'm getting exactly the same as everyone else, without having to shop for plan A or B. If I want even more options, there are private options my employer provides.

Quoting fr8mech (Reply 10):
Can you get the doctor, nurse, insurance, hospital setting, antiseptic and everything else that comes with a medical professional in a medical setting applying that dressing for the other $64 at Walgreens?
When you look at it from that perspective, maybe $70 isn't really that much.

Except that it is. The $70 gauze pad is in addition to the $250 injection of lidocaine, $120 saline drip, $1100 blood panel, and on it goes. The chargemaster markup is applied by the hospital billing system to every last facet of that hospital setting, and it is set well above the actual cost of services rendered.



If you need someone to blame / throw a rock in the air / you'll hit someone guilty
User currently offlinefr8mech From United States of America, joined Sep 2005, 5453 posts, RR: 14
Reply 12, posted (1 year 4 months 1 week 5 days 23 hours ago) and read 2550 times:

Quoting aaron747 (Reply 11):
Yeah but I'm getting exactly the same as everyone else, without having to shop for plan A or B. If I want even more options, there are private options my employer provides.

Exactly, you are getting the same thing everyone else is getting, whether you need it or not. One size can not fit all. You may be subsidizing someone else's bad habits, or vice-versa.

I'm not going to get into a discussion about socialized medicine or the Orwellian-named Affordable Care Act. It is the law. I will comply with it as well as I can and I (as well as everyone else participating in this economy) will suffer or enjoy its consequences as the case may be. I truly hope that I am wrong and everything comes up roses and daisies, but I have my doubts.

Quoting aaron747 (Reply 11):
Except that it is. The $70 gauze pad is in addition to the $250 injection of lidocaine, $120 saline drip, $1100 blood panel, and on it goes. The chargemaster markup is applied by the hospital billing system to every last facet of that hospital setting, and it is set well above the actual cost of services rendered.

As it should be. Look, I can't quantify how much overhead should be applied to a bandage vs. a unit of blood vs. cardiac intervention during a heart attack. There are bean-counters that do that. The best I can do is monitor what is happening and make sure it is accurate.

Again, I think it goes back to the disassociation we have with the actual and true cost of care and the fact that insurance companies leverage their position and drive the reimbursement rate down. That's not necessarily a bad thing, but, I'm thinking that a lot of insurance companies try to flat-rate (one size fits all) a lot of procedures and I don't think medicine, especially hospital based medicine, lends itself very well to that kind of business model.



When seconds count...the police are minutes away.
User currently offlineAesma From France, joined Nov 2009, 6663 posts, RR: 11
Reply 13, posted (1 year 4 months 1 week 5 days 21 hours ago) and read 2515 times:

Quoting aaron747 (Reply 9):
That's the best thing about it - the peace of mind. People can focus on what they need to without having to stress over what kind of bills they will be saddled with.

Also true for doctors not having to worry about getting paid, or worse denying care because a patient can't pay.

In fact there is a trend here of young doctors not even wanting to own their office, they'd rather be employees of a company or even a city, get a good salary (but probably 1/10th of a US doctor), not too many hours, vacations, colleagues...



New Technology is the name we give to stuff that doesn't work yet. Douglas Adams
User currently offlineDocLightning From United States of America, joined Nov 2005, 19712 posts, RR: 58
Reply 14, posted (1 year 4 months 1 week 5 days 20 hours ago) and read 2495 times:

Quoting moo (Reply 4):
I cant believe some people don't want that...

Actually, I'm a big fan of copays. And higher copays at the ER than at the office. They save money not directly (the copay is usually nominal), but by reducing the number of inappropriate ER visits for things like babies with colds.

One of the big issues in this country is the amount of ER visits that wind up being over stupid stuff. And for patients on Medicaid, the ambulance and ER is free. So you can call 911 over a baby with a cold ten times a year and get taken to the ER where the doctor will prescribe tylenol that you will get for free. A $600 bottle of Tylenol. A simple $10 copay for EMS and $10 copay for the ER isn't going to kill anyone (those of us who work for a living get $200-500 copays for using the ER, even if for legitimate reasons) and will cut down on unnecessarily expensive medical encounters.

Another elephant in the room that nobody wants to talk about is incompetent doctors. Case in point: I have a 2yo patient to whose parents I finally had to say: "He is going to get lung cancer. It will be decades, but it will happen." Why? Because every single time the kid gets a cold they haul him to the ER (reference above) and then the idiot ER doc orders a CBC, CMP, blood cultures, a cathed urinalysis, and an X-ray. The child then gets diagnosed with a pneumonia that doesn't actually exist and gets a shot of ceftriaxone (a "big gun" antibiotic) and a prescription for amoxicillin at a spectacular underdose.

The 2yo in question has had 16 chest X-rays in his life. Each of which is actually 2 X-rays (one lateral, one postero-anterior), so 32 X-rays in his two years on this mortal coil. He has been diagnosed with pneumonia ten times, been given ceftriaxone five times, and had god-knows-how-much blood drawn. And while I certainly fault his parents for not understanding that 2yo kids get sick and get fevers and manage to survive, I also fault ER docs who can't recognize a cold.

And it's not malpractice insurance that's the issue. The case described above is malpractice. The doc may think he's covering his butt, but what he's actually doing is increasing his risk. I could TEAR HIM APART on a witness stand. "Blood cultures and injected antibiotics are appropriate if you suspect one of two things: complicated pneumonia or sepsis. In either case, the child should be admitted. You chose to discharge him home, although your actions suggest you thought he had one of these diagnoses. Why? You instrumented this child's genitals, although he had fever with a clear source (nasal congestion and cough). Why?" (There is no correct answer to those questions)

I submit that it is incompetence and that this is a major reason why healthcare is so expensive. I am NOT arguing that hospitals overcharging is not also an issue. They are by no means mutually exclusive.


User currently offlinefr8mech From United States of America, joined Sep 2005, 5453 posts, RR: 14
Reply 15, posted (1 year 4 months 1 week 5 days 17 hours ago) and read 2470 times:

Quoting DocLightning (Reply 14):
Actually, I'm a big fan of copays. And higher copays at the ER than at the office. They save money not directly (the copay is usually nominal), but by reducing the number of inappropriate ER visits for things like babies with colds.


I fully agree. I'd go so far as suggesting that the co-pay/co-insurance be higher if the ER determines that it was not a true emergency...but, that does get a bit subjective. Wishful thinking.

Quoting DocLightning (Reply 14):
Medicaid, the ambulance and ER is free.


I didn't know that. Needs to be fixed.

Quoting DocLightning (Reply 14):
And it's not malpractice insurance that's the issue. The case described above is malpractice. The doc may think he's covering his butt, but what he's actually doing is increasing his risk. I could TEAR HIM APART on a witness stand.


Is it incompetenace or defensive medicine? Proabably a little of both.

Like I noted above, there are a lot of externalities that go into the pricing of medical services and to make the blanket statement that hospitals (or other providers) are gouging patients or playing games is jumping to conclusions. They could be, but then again, they may not be.



When seconds count...the police are minutes away.
User currently offlineDocLightning From United States of America, joined Nov 2005, 19712 posts, RR: 58
Reply 16, posted (1 year 4 months 1 week 5 days 13 hours ago) and read 2436 times:

Quoting fr8mech (Reply 15):
I fully agree. I'd go so far as suggesting that the co-pay/co-insurance be higher if the ER determines that it was not a true emergency...but, that does get a bit subjective. Wishful thinking.

I used to think that, but that opinion quickly got bashed down by this argument: "So are you telling me that you want to deal with the patient arguing and begging and pleading and threatening you to get to sign off that it was a medically necessary visit?"

Yah. Good point. I figure that the copay needs to be roughly commensurate to the income. If you're on medicaid, then $10 is a six-pack that you have to give up to go to the ER. If you're Blue Cross, then $150 is a really nice night out on the town.

Quoting fr8mech (Reply 15):
Is it incompetenace or defensive medicine? Proabably a little of both.

30% defensive, 70% idiocy would be my guesstimate, but the result is to increase exposure to malpractice, not decrease it.


User currently offlinefalstaff From United States of America, joined Jun 2006, 6104 posts, RR: 28
Reply 17, posted (1 year 4 months 1 week 5 days 13 hours ago) and read 2422 times:
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Quoting DocLightning (Reply 16):
$10 is a six-pack

Two and a 1/2 cheap six packs in Detroit. The kind of guy who buys a $10 six in these parts likely has good insurance.

Quoting DocLightning (Reply 14):
One of the big issues in this country is the amount of ER visits that wind up being over stupid stuff. And for patients on Medicaid, the ambulance and ER is free. So you can call 911 over a baby with a cold ten times a year and get taken to the ER where the doctor will prescribe tylenol that you will get for free.

and that causes long response times for an ambulance. In Detroit the wait time for an Ambulance is 30-40 minutes usually. Just down the road in Taylor, our response time is less than 6 minutes. "They" say the slow response times in Detroit are due to the unnecessary emergency calls.

A friend of mine used to be a EMT, in Detroit, before she quit to be a stay at home mom. She told me stories of ambulance runs where the "patient" had a yeast infection or a splinter in their finger. Sometimes people just wanted a ride to the hospital to visit somebody. I'd like to think only Detroit is that screwed up, but I know better.

My aunt is a retired emergency room head nurse, in rural western Pennsylvania, and she always talked about the huge numbers of people who had no serious problems clogging up their emergency room with non emergencies. She would see the same people over and over and over and over again.



My mug slaketh over on Falstaff N503
User currently offlineDocLightning From United States of America, joined Nov 2005, 19712 posts, RR: 58
Reply 18, posted (1 year 4 months 1 week 5 days 9 hours ago) and read 2401 times:

Quoting falstaff (Reply 17):
My aunt is a retired emergency room head nurse, in rural western Pennsylvania, and she always talked about the huge numbers of people who had no serious problems clogging up their emergency room with non emergencies. She would see the same people over and over and over and over again.

The best one I ever saw was a 5yo boy: "He was complaining his ear was hurting earlier today, but then it went away." I should add that it was 4AM. They had woken the comfortably sleeping child up at 0400 to take him to the ED because he mentioned that his ear hurt 12 hours earlier. By EMS. No, I am not making it up.

I am guessing that they got high, got paranoid, and then decided to call 911.


User currently offlinefr8mech From United States of America, joined Sep 2005, 5453 posts, RR: 14
Reply 19, posted (1 year 4 months 1 week 5 days 2 hours ago) and read 2373 times:

Quoting DocLightning (Reply 16):
I used to think that, but that opinion quickly got bashed down by this argument: "So are you telling me that you want to deal with the patient arguing and begging and pleading and threatening you to get to sign off that it was a medically necessary visit?"


Yeah, that's why I said it was wishful thinking. But, the problem has to be fixed.

I'm still floored by:

Quoting DocLightning (Reply 14):
And for patients on Medicaid, the ambulance and ER is free.


It's ridiculous. It's like telling a drunk he can get a state-paid-for ride to the liquor store. Why not take advantage of it?

It's the same old thing...we are incentivizing bad behaviour. And, that drives up the cost of healthcare. Not just because someone has to pay for that crap, but because it uses valuable resources and time that can be better spent elsewhere.

Again, it's not the only reason, but it's a chunk.

Quoting falstaff (Reply 17):
and she always talked about the huge numbers of people who had no serious problems clogging up their emergency room with non emergencies


So, 10 or so years ago, I'm in the ER because I took the tip of my finger off with a table saw and I'm sitting talking to one of the triage nurses (a friend of mine) when in WALKS a guy complaining of a numb leg and foot and "oh yeah, I'm having trouble breathing". Guess who gets to go to the front of the line? People know how to game the system.



When seconds count...the police are minutes away.
User currently offlineRedd From Poland, joined Jan 2013, 97 posts, RR: 0
Reply 20, posted (1 year 4 months 1 week 5 days ago) and read 2358 times:

Quoting moo (Reply 4):
You can bitch and moan about the NHS all day long with valid complaints, but I'd still take it over any other healthcare service in the world. I can walk into any A&E in the country, get my ailment treated and not have to worry about any bill at the end of it. I cant believe some people don't want that...

I'm with you 100% on that, I don't see how any government can allow basic health care to be for profit. It's a conflict of interest and a basic right as a tax payer and as a human being IMO.


User currently offlineaa757first From United States of America, joined Aug 2003, 3350 posts, RR: 7
Reply 21, posted (1 year 4 months 1 week 4 days 22 hours ago) and read 2348 times:

Quoting Ken777 (Thread starter):
It helps to remember that Medicare pays set fees regardless of the rip off prices some hospitals hope for. It's the uninsured individuals without insurance that take the list price hits. And they cannot pay those high rates. Private insurance companies negotiate discounts in the 25% to 33% levels - but that still leaves them paying big time for some of those rip off prices. That $160,832 bill in Texas is still a big hit for private insurance companies.

Depends on the market. In markets with strong payors (ie, one insurance company, many hospitals), the discount is huge. In markets with strong providers (ie, many payors, few hospitals), the discount is less.

I live in a strong payor city and I think my acute care eye exam was about 50% off the charge master price, or $85.

Of course, who really gets screwed in this are the private practice doctors. My health system probably negotiates on behalf of 1,000 physicians in the area and we probably have about 1,500 beds. We can negotiate. Drs. Patel & Smith, P.C. can't because they're just two physicians. They get the base contract and they can either sign or not sign.

The argument that uninsured patients pay the charge master price is ridiculous. You can charge an uninsured patient $4,000 for an ER visit, but guess what, they can't probably can't pay that much. So the charges usually get reduced to around what an insured patient will pay.

Quoting Ken777 (Thread starter):
Looking at those numbers makes it clear that it's not all "ObamaCare". The insurance industry hasn't really cared about price increases in the past because they simply pass the costs on to you. Now days employers are passing on some of that nanny care cost onto the employees, as well as (obviously) paying less in wages & salaries.

I personally think you're pointing the finger at the wrong party. It's the health systems that are really driving up costs. Every so many years, every payor sits down with a participating health system and they hammer out a deal. The insurer tries to drive the costs as low as possible and hospitals do the opposite. How it plays out in your city depends on the strength of the payors.

Quoting fr8mech (Reply 6):
I found that when we went to an HSA type insurance, we are a lot more careful about our medical spending. I had a conversation with my doctor about his rates and compared them to other providers...again, a lot of those guys were unwilling..or in some cases...unable to provide me with a rate schedule, except in very broad terms.

HSAs: good idea, but the system isn't compatible with them. In my last job, I had some patient contact in an outpatient office. When HSA patients called up to get a quote I couldn't give them any information at all. The system just doesn't allow for it at this point. Hopefully that will change, but until it does, HSAs aren't that useful.

Quoting fr8mech (Reply 6):
Have you guys noticed that a lot of practices, at least in this area, have started to affiliate themselves, and taking on the name, of large medical providers? Baptist Health and Norton's are big here. More and more general practices are affiliating themselves with one of these two corporations? Why?

My guess is because the bigger medical provider networks (corporations) have been pushing back against the insurers and demanding higher negotiated rates to more accurately reflect the level of service provided. It's the market trying to exert itself in a highly regulated and irregular market. It may reach balance, but I'm afraid there are too many external forces involved for the medical market to find balance anytime soon

One reason is, at least theoretically, there are economies of scale to be gained. But, like you point out, it also allows for better negotiation. I don't know much about medical billing, but I also understand that the outpatient visits can bill a facility charge if they're associated with a hospital.

By the way, most of these provider networks are, at least nominally, 501(c)(3)s.

Quoting falstaff (Reply 7):
I think a lot of the high cost of health care is the fact that health care providers can jack up their price because they health insurance companies will pay. I don't see "Obamacare" helping the problem; I can only see it getting worse. If the government or a private insurer has to pay a private firm for their services they can charge whatever they because they know they'll get it.

Exactly. It's like Milton Friedman said: the best, most efficient way to spend money is to spend your money on yourself. The worst way to spend money is spending someone else's money on someone else, which is pretty much what health insurance does.

Quoting aaron747 (Reply 9):
That's the best thing about it - the peace of mind. People can focus on what they need to without having to stress over what kind of bills they will be saddled with.

I have that too and so do most Americans. My employer's health care costs $30 a paycheck, has low copays and allows me to see any licensed provider in the world. If I were to be admitted to one of my employer's hospitals, the inpatient bill would be $0.

Quoting DocLightning (Reply 14):
I submit that it is incompetence and that this is a major reason why healthcare is so expensive. I am NOT arguing that hospitals overcharging is not also an issue. They are by no means mutually exclusive.

Have you ever read Redefining Healthcare? One of the author's key points is something like 30% of the medical care Americans receive is unnecessary. I think consumers having some financial interest in the game would change this. Imagine if a doctor had to explain the value of every test to a patient. Now, of course, they don't care because their insurance company will pay for it. But even if they just had to pay, say, 10% of the cost of each test, I feel like they'd think more about the tests they're having done and force their doctor to think like that as well.

Quoting Redd (Reply 20):
I'm with you 100% on that, I don't see how any government can allow basic health care to be for profit. It's a conflict of interest and a basic right as a tax payer and as a human being IMO.

Most healthcare in the United States is neither delivered nor financed by a for profit corporation.


User currently offlinemdsh00 From United States of America, joined May 2004, 4125 posts, RR: 8
Reply 22, posted (1 year 4 months 1 week 4 days 20 hours ago) and read 2336 times:

Coming late to this thread...

Quoting DocLightning (Reply 14):
The 2yo in question has had 16 chest X-rays in his life. Each of which is actually 2 X-rays (one lateral, one postero-anterior), so 32 X-rays in his two years on this mortal coil. He has been diagnosed with pneumonia ten times, been given ceftriaxone five times, and had god-knows-how-much blood drawn. And while I certainly fault his parents for not understanding that 2yo kids get sick and get fevers and manage to survive, I also fault ER docs who can't recognize a cold.

And it's not malpractice insurance that's the issue. The case described above is malpractice. The doc may think he's covering his butt, but what he's actually doing is increasing his risk. I could TEAR HIM APART on a witness stand. "Blood cultures and injected antibiotics are appropriate if you suspect one of two things: complicated pneumonia or sepsis. In either case, the child should be admitted. You chose to discharge him home, although your actions suggest you thought he had one of these diagnoses. Why? You instrumented this child's genitals, although he had fever with a clear source (nasal congestion and cough). Why?" (There is no correct answer to those questions)

How prevalent is this in the Peds side or does it also happen because of overbearing parents? I remember as a medical student, I would see residents getting chewed out when they wouldn't prescribe Abx for a URI, and on the flip-side see a good deal of LPs on babies with moderate fevers.

Once as a med student I had this mom bring her 4 year old into the ER for what was clearly a viral URI. I explained to her and she goes hysterical and was like: "OH MY GOD BUT SHE DOESN'T WANT TO EAT!!!. (while the kid is drinking some apple juice)." Because I was just a med student at the time, I felt like asking her if she feels hungry when she has a cold.



"Look Lois, the two symbols of the Republican Party: an elephant, and a big fat white guy who is threatened by change."
User currently offlineKen777 From United States of America, joined Mar 2004, 8278 posts, RR: 8
Reply 23, posted (1 year 4 months 1 week 4 days 17 hours ago) and read 2295 times:

Quoting DocLightning (Reply 3):
Especially when there is a 70,000% markup (did I get my zeros right) and the patient is there not by choice and has no opportunity to comparison shop.



At some point we might see national politicians growing a pair and addressing this problem. Pulling tax-exempt status is one really big way to get their attention. As are windfall profit taxes.

Quoting QFA380 (Reply 5):
You pay what the hospital closest to you demands.

Actually I don't. Surgery for a ruptured cervical disk was at a private hospital a few miles past my "local hospitals", as was the private hospital I went to for surgery for kidney cancer. Both were under Medicare + Medigap and both hospitals were happy to take the government payment.

Because I have MediGap I don't have to worry about the costs, but I know Medicare pays set fees so going to a small private hospital didn't cost more. If I was still paying for private insurance then I would focus on what I would have to pay. The $1,000 deduction and 20% of amounts over that.

Quoting QFA380 (Reply 5):
Naturally people have absolutely no incentive whatsoever to care about the price the hospital is charging when it can just be passed onto the insurance company.

If I was still paying for private insurance then I would focus on what I would have to pay. The $1,000 deduction and 20% of amounts over that can add up to a large amount of money and people do learn to focus on those costs.

Quoting fr8mech (Reply 6):
How much does it cost for the hospital to apply that pad? Salary for the nurses, the nurses assistants, the doctors, the orderlies, the insurance, etc? You know, the overhead for operating a hospital.

Look at the cost of a room - those hospitals are not competing with Motel 6. Their daily rate is more than sufficient to cover minor supplies like an alcohol pd or a bandaid. Same with Tylenol. The room cost is more than sufficient.

Quoting fr8mech (Reply 6):
It seems to me that those of us with insurance don't seem to care very much about how much a procedure costs.

I used to watch bills come in when I was paying for private care. With a $1,000 deductible and then 20% co-pay I was actually pretty interested in the costs.

Quoting fr8mech (Reply 6):
We are disassociated from the actual cost, the charged cost and the actual payment to the provider

Not if you have a 20% co-pay.

Even with Medicare I look at the CMS statements - especially after surgery and satisfy myself that the bill is legitimate.

Quoting fr8mech (Reply 6):
And, short of scrapping the whole system and starting from the beginning, I don't know how to fix it or if it can be fixed.

It is a step by step process for the US. There are a few major steps being taken with Obama Care. Pre-existing conditions is huge and should have been done generations ago. The other huge change is expansion of the Medicaid umbrella to cover people who are under 133% of the poverty level. Currently there are states (like Alabama and Louisiana) that consider a family makes too much if they make over $275 a MONTH. That should make any moral person gag. It's clear that those states might have an umbrella but they basically keep it closed.

Hopefully the next step will be to bring all Medicaid plans into Medicare, eliminating the need for those 50 state level administrative costs.

Quoting fr8mech (Reply 6):
I can tell you that putting more people under an insurance umbrella where even more folks are disassociated from the true costs, isn't going to help.

If there is universal care under a Medicare system then costs are what Medicare says they are - just like today. That leaves those who want private insurance. As shown in Australia private insurance costs takes a huge dive when the burden of paying for the uninsured is taken off their backs. That's why my Aussie insurance was 80% LESS than my US insurance. I paid FIVE times MORE for the US policy that was not as comprehensive as the Aussie one.

That lower private insurance premium puts significant pressure on hospitals to lower prices. Large hospitals needs to be competitive, or the small private hospitals will take their patients away.

To really put pressure on massive overcharging you also need to let Medicare offer a public option for "private insurance." Medicare Private in Australia works really well.

Quoting fr8mech (Reply 6):
Ken, you call it a game or games, I call it medical providers adapting to external costs and factors that they have little or no control over.

Actually it is a game - just look at the different in costs in the story linked

The picture & cost breakdowns in Miami Florida present a different story than you are taking. Those two hospitals are around 1,000 feet apart - the CEOs can wave to each other from their office balconies while having their morning coffee & Danish. The University of Miami Hospital has plenty of control on what they charge and they charge big time.

And it's the same with M D Anderson in Houston. That is part of the University of Texas System, but with a compensation package of over $1 Million the CEO of MDA makes more than the President of the University of Texas itself.

Wanna bet on how big time MDA charges?

Quoting falstaff (Reply 7):
My doctor charges $65 for a for an office visit if you pay cash, my insurance company is charged $120.

WHich is probably what he would eventually get from your insurance company after discounts. What's the difference? You simply paid more than you should. Let the insurance company pay and keep your cash.

Quoting falstaff (Reply 7):
. I don't see "Obamacare" helping the problem

If you have a kid with a pre-existing condition. are a uni graduate still trying to find a job, can't get coverage in backward states like Alabama & Texas because you earn over $300 a MONTH - but can't even begin to afford private insurance, etc then ObamaCare is helping big time. If you are one of those getting a refund check because of insurance companies overcharging then ObamaCare is going to look even better to you.

Quoting falstaff (Reply 7):
If the government or a private insurer has to pay a private firm for their services they can charge whatever they because they know they'll get it.

That is changing and the public disclosure of pricing differences in the article is simply another step in bringing sanity back to the system.


User currently offlinefr8mech From United States of America, joined Sep 2005, 5453 posts, RR: 14
Reply 24, posted (1 year 4 months 1 week 4 days 16 hours ago) and read 2285 times:

Quoting Ken777 (Reply 23):
Look at the cost of a room - those hospitals are not competing with Motel 6. Their daily rate is more than sufficient to cover minor supplies like an alcohol pd or a bandaid. Same with Tylenol. The room cost is more than sufficient.


So, now you're an accountant and actuary for a medical provider. Unless you are an insider or sift through a 10Q (if the provider is publicly owned) and the associated financial documents, you can't possibly know how much it costs to apply a band-aid in a hospital setting by a professional.

Quoting Ken777 (Reply 23):
As are windfall profit taxes.


Ah yes, the Liberal battle cry. Make too much money and we'll tax you more. Make way TOO much money we'll tax you even more and teach you a lesson for being efficient or innovative or progressive or for making good decisions or for just being lucky.

Quoting Ken777 (Reply 23):
Even with Medicare I look at the CMS statements - especially after surgery and satisfy myself that the bill is legitimate


Good for you. I wish everybody would do that. When I requested detailed billing from the hospital, they tried to charge me $5. I challenged them to show where I agreed to that provision in all the pre-admission/op paperwork I read and signed.



When seconds count...the police are minutes away.
User currently offlineaaron747 From Japan, joined Aug 2003, 8153 posts, RR: 26
Reply 25, posted (1 year 4 months 1 week 4 days 16 hours ago) and read 2320 times:

Quoting aa757first (Reply 21):
If I were to be admitted to one of my employer's hospitals, the inpatient bill would be $0.

What would happen after being admitted to the nearest facility on an emergency basis and needing several days' worth of critical care? People often find they have bills over $100,000 after things like that.



If you need someone to blame / throw a rock in the air / you'll hit someone guilty
User currently offlineDocLightning From United States of America, joined Nov 2005, 19712 posts, RR: 58
Reply 26, posted (1 year 4 months 1 week 4 days 10 hours ago) and read 2294 times:

Quoting mdsh00 (Reply 22):
How prevalent is this in the Peds side or does it also happen because of overbearing parents?

I am blaming the doctor because in my office I don't have an X-ray on-site and I prescribe antibiotics (for all reasons) maybe 1-2x/wk during the winter and much less than that during the summer. I rarely have trouble talking parents out of it.

I certainly have never had a parent demand blood cultures and ceftriaxone. No, it's "defensive medicine" that increases cost and risk.

Quoting mdsh00 (Reply 22):
Once as a med student I had this mom bring her 4 year old into the ER for what was clearly a viral URI. I explained to her and she goes hysterical and was like: "OH MY GOD BUT SHE DOESN'T WANT TO EAT!!!.

  

"Most people don't when they're sick. I promise you she won't starve if she doesn't eat much for a few days."

Invariably, the child is overweight.


User currently offlineKen777 From United States of America, joined Mar 2004, 8278 posts, RR: 8
Reply 27, posted (1 year 4 months 1 week 22 hours ago) and read 2169 times:

Quoting fr8mech (Reply 24):
So, now you're an accountant and actuary for a medical provider.

I've taken enough accounting courses over the years to be able to make a simple, rational statement on overheads.

I've also worked with my wife some years back when she was the Physical Therapy Department Head and was stuck with budgets. Overhead can include a lot of things. In those days orderlies would bring the patient to the department for treatment. There was no "transport charge" (even though it was more expensive than a bandaid.) nor were there charges for the clean sheets on the treatment tables, or the gel for the ultrasound treatment. And if a patient needed a ban aid it was F-R-E-E. Part of overhead, just like your room charge covers a lot of overhead.

Quoting fr8mech (Reply 24):
Ah yes, the Liberal battle cry.

You must not have read the links I posted and noted the differences in charges. It would seem that eny employee getting nanny care from their employer would focus very sharply on those differences and look for ways to bring them down. Employers paying out ridiculous insurance premiums to give their employees nanny care would be just as concerned.

Considering the impact on nanny care costs as well as some minimal moral it should be clear that windfall profit taxes are a minimal way of motivation. Far better than a law listing allowed charges.


User currently offlinefr8mech From United States of America, joined Sep 2005, 5453 posts, RR: 14
Reply 28, posted (1 year 4 months 1 week 21 hours ago) and read 2159 times:

Quoting Ken777 (Reply 27):
I've taken enough accounting courses over the years to be able to make a simple, rational statement on overheads.

I've got a minor in accounting and my wife is a CPA and I'm not comfortable make that "simple, rational statement" on health care provider overhead.

Quoting Ken777 (Reply 27):
You must not have read the links I posted and noted the differences in charges.

I read them. But, you haven't clearly absorbed the problem. Just like higher education, the problem is a disassociation of costs to the consumer. The consumer does not care how much a procedure costs at a particular provider because the insurer will pick up the tab. That's the problem in a nutshell. There are externalities, but so long as the consumer is removed from the actual process of paying for a procedure, then the consumer will go for convenience or prestige. Providers don't help, since most will not post up-front pricing on even the simplest of procedures. That makes shopping around very hard for the consumer.

Taxing the insurance company or the medical provider will just increase costs.



When seconds count...the police are minutes away.
User currently offlinebhill From United States of America, joined Sep 2001, 972 posts, RR: 0
Reply 29, posted (1 year 4 months 1 week 20 hours ago) and read 2133 times:

Costco should open hospitals...and PHARMACEUTICAL factories....Admin overhead..CEO salaries...and drug costs...those are the largest health care costs for my family. We are healthy, only see the doc for yearly checkups, or med checks in my case, but I had to change to generic meds because of copay's because my insurance company does not think adults need Concerta, I'm fine with generics, but damn....My head was ready to explode after I read the Time piece "Bitter Pill".....and the back pedaling begins...The AHA trumpets how much in "uncompensated care " is given....someone should ask..."Is that amount based on your Chargemaster rates, or negotiated rates that insurance companies get?

Here is an example:

Topical Rx cream...US = $235 for a 15gm tube. $39 from Canada....

Here is the kicker...the FDA sez...drugs from other contries are not as safe...

Bullshit, I take generic Ritalin...made in.....

Israel. And purchsed at my local pharmacy...

I find it hard to believe that only citizens of the US...and only us...are taking medications deemed "safe"...sure feel sorry for the rest of you folks outside the borders...........................................................

This country is going to go broke...not from defense spending, etc, but form uncontrolled healthcare costs. Obama tried, but between the GOP and the lobbyists...

We need single payor health care...period.



Carpe Pices
User currently offlineDocLightning From United States of America, joined Nov 2005, 19712 posts, RR: 58
Reply 30, posted (1 year 4 months 1 week 19 hours ago) and read 2127 times:

Quoting aa757first (Reply 21):
One of the author's key points is something like 30% of the medical care Americans receive is unnecessary

I find that figure shocking. Pleasantly shocking.   I'd have put it at 60%.

Quoting bhill (Reply 29):
We need single payor health care...period.

I don't like the idea of single-payor healthcare. So what happens when the gubmint suddenly says: "We're cutting all doctors' pay by 30%"?

If an insurer says that, I drop their contract. If the gubmint says that and they're the only payor, I have no recourse.

I prefer the Australian or Japanese models a lot more.


User currently onlineFlighty From United States of America, joined Apr 2007, 8544 posts, RR: 2
Reply 31, posted (1 year 4 months 1 week 19 hours ago) and read 2119 times:

Quoting seb146 (Reply 2):

It's private corporations. And, private corporations should be able to charge "market value" for products. The right does not care about people as long as corporations can profit off human suffering. No one will be in jail as long as corporations profit.

Medicine has nothing to do with market value at all. That is why it is so inefficient and organizationally dysfunctional, even if individual doctors and nurses are great.

By contrast, dentists are pretty much cash market. Fee for service. Dentists don't have all this dysfunction and wild billing chicanery. They are not ideal, just about 100 times less bad. Because Dentists do provide services at (more or less) market value.

[Edited 2013-05-15 12:29:23]

User currently offlinefr8mech From United States of America, joined Sep 2005, 5453 posts, RR: 14
Reply 32, posted (1 year 4 months 1 week 18 hours ago) and read 2102 times:

Quoting bhill (Reply 29):
Topical Rx cream...US = $235 for a 15gm tube. $39 from Canada....

Ask yourself why? My understanding is that the Canadian government either caps the prices or subsidizes the cost. My guess is it caps the price and tells Pfizer, J&J, Glaxo, et al., that in order to do business in Canade, you can't charge more than 'X' for a particular product.

Well, they do want to do business, so they look at unregulated or semi-regulated places to sell their product at large mark-ups, so that they can recoup their R&D costs, marketing costs, legal fees, regulatory fees (and hoops), etc.

So, if the above scenario is true (I'm just thinking out loud), the reason that drugs are so expensive in the US is because of the Canadian government, among other things.

So, what do we have, again: government intervention into the free market that skews the market.

[Edited 2013-05-15 13:51:20]


When seconds count...the police are minutes away.
User currently offlineKen777 From United States of America, joined Mar 2004, 8278 posts, RR: 8
Reply 33, posted (1 year 4 months 1 week 11 hours ago) and read 2069 times:

Quoting fr8mech (Reply 28):
I've got a minor in accounting and my wife is a CPA and I'm not comfortable make that "simple, rational statement" on health care provider overhead.

I'm very comfortable with my concept of overhead in health care, but then, as I said before, my wife worked in a PT Department - and was Department Head at one hospital.

Let's say that a surgical patient wets his bed in his room after surgery because of the meds he was given.

Should he be charged for another sets of sheets? Or the extra labor to change the sheets? That has a higher cost value than a bandaid.

Since the costs of a room at a hospital is significantly higher than staying at a Holiday Inn Express it is reasonable to assume that there is more covered than just the room. Of course a need for another roll of toilet paper under your system would result in a toilet paper replacement charge.

Looking around and you can see that hospital changing has gotten out of hand. You wife can help you understand how this insanity impacts employers and their ability to deliver nanny care to employees. It also negatively impacts costs used in cost accounting for products.

But, hey, your wife is a CPA and makes the big money so you can ignore the crisis in US Medicine.

Quoting fr8mech (Reply 28):
Taxing the insurance company or the medical provider will just increase costs.

Insurance companies are slowly learning that simply passing off cost increases (with increases in profits) is hitting a brick wall.

Windfall profits (or charges) is one way to put pressure on hospitals - especially those who take federal funding.

Another approach is obviously to cut off all research funding for those grossly overcharging. ANy doctor looking to do any significant research will be looking elsewhere very quickly. Nothing like taking away federal funds to lower the stature of these hospitals. I guess that is your preference.

Quoting fr8mech (Reply 28):
The consumer does not care how much a procedure costs at a particular provider because the insurer will pick up the tab.

Best argument ever for expanding Medicare. I don't have to worry about the DI VInci surgery to take out a malignant tumor off my kidney because I'm on Medicare and they determine the costs of the whole thing - doctors & hospitals. That means I don't have to worry about rip off charges. I also pay for a MediGap policy so I don't have to worry about the impact a very large hospital bill (like my wife had) - I pre-pay for those risks to be covered.

Not on Medicare? You get the rip off charges and will eventually pay for those rip offs one way or another.


User currently offlineaa757first From United States of America, joined Aug 2003, 3350 posts, RR: 7
Reply 34, posted (1 year 4 months 5 days 15 hours ago) and read 1965 times:

Quoting aaron747 (Reply 25):
What would happen after being admitted to the nearest facility on an emergency basis and needing several days' worth of critical care? People often find they have bills over $100,000 after things like that.

The insurance covers all licensed providers. There would just be an out-of-pocket charge. Even very restrictive HMO plans allow a patient to seek emergency care at an out-of-network hospital. I think you'd be hard pressed to find very many cases of an insured patient going bankrupt because they had to undergo emergency care out-of-network.

Quoting Ken777 (Reply 27):
I've also worked with my wife some years back when she was the Physical Therapy Department Head and was stuck with budgets. Overhead can include a lot of things. In those days orderlies would bring the patient to the department for treatment. There was no "transport charge" (even though it was more expensive than a bandaid.) nor were there charges for the clean sheets on the treatment tables, or the gel for the ultrasound treatment. And if a patient needed a ban aid it was F-R-E-E. Part of overhead, just like your room charge covers a lot of overhead.

This is already how it works. Outpatient billing is done a CPT basis: the physician codes a diagnosis and then the procedures (including the office visit) he/she performed. The provider is then paid based on the CPT codes submitted.

Inpatient billing, at least for Medicare and Medicaid, is done a DRG basis. Hospitals are paid based on the diagnosis of the patient, not the number of bandages affixed to the patient's body. Some commercial contracts pay based on service, but many pay on a per diem rate.

So, again, the charge master is meaningless. It's much like going private vendors as a tourist in India. The sticker price may be Rs/750, but in practice no one pays more than Rs/400.

Quoting Ken777 (Reply 33):
Best argument ever for expanding Medicare. I don't have to worry about the DI VInci surgery to take out a malignant tumor off my kidney because I'm on Medicare and they determine the costs of the whole thing - doctors & hospitals. That means I don't have to worry about rip off charges. I also pay for a MediGap policy so I don't have to worry about the impact a very large hospital bill (like my wife had) - I pre-pay for those risks to be covered.

Medicare doesn't determine the cost of the service, it determines what it pays for the service. Medicare pays roughly 20% (of course, opinions vary) below cost. The loss is covered by patients with commercial insurance (BCBS, Aetna, etc). It's called cost shifting and it's vital to most hospital's survival.

And "not worrying about rip off charges" isn't unique to Medicare. Most private insurance plans are copay based, so we pay a set fee when we're admitted to the hospital.

Quoting DocLightning (Reply 30):
I don't like the idea of single-payor healthcare. So what happens when the gubmint suddenly says: "We're cutting all doctors' pay by 30%"?

I have trouble understanding why anyone thinks single payor is an ideal solution.


User currently offlineKen777 From United States of America, joined Mar 2004, 8278 posts, RR: 8
Reply 35, posted (1 year 4 months 5 days 12 hours ago) and read 1944 times:

Quoting aa757first (Reply 34):
The insurance covers all licensed providers.

But not all licensed providers accept all insurance companies. When I went to MD Anderson for a second opinion they told me (the day before the appointment) that they did not accept my health insurance so I needed to bring $14,300 with me for that appointment for a second opinion.

Reason for not accepting my insurance? Probably because that saved them the 25% to 30%+ insurance discount. I went down the street and had a second opinion from a doctor who had MDA experience - for $85 out of pocket costs.

Quoting aa757first (Reply 34):
It's called cost shifting and it's vital to most hospital's survival.

When I needed a cervical discectomy I went to the same surgeon who did my first discectomy 20 years before. He (and some fellow neurosurgeons) own a small private hospital where I could have the surgery. I asked him if there was a problem with my being on Medicare. His response was that they operate on a LOT of Medicare AND Medicaid patients and were quite happy with their relationship with the government. Because they had a sufficient level of Medicare & Medicaid patients they were actually paid a higher rate than hospitals that limited these patients.

Same thing when I had surgery in January to have a tumor cut off my kidney. The surgeon had an ownership position and disclosed that, but he was very happy to work in the small, private hospital and I was able to have the surgery done with a Di Vince robot.

In both cases there was no "cost shifting" involved. There was, however, a very impressed patient (and patient's wife) with these small hospitals, the care given and even the quality of the food. Good way to get patient recommendations.

Quoting aa757first (Reply 34):
I think you'd be hard pressed to find very many cases of an insured patient going bankrupt because they had to undergo emergency care out-of-network.

But you will find a lot of patients filing bankruptcy because the 20% co-pay on some big time medical bills is beyond their reasonable ability to repay. Start with a high deductible and then an expensive medical condition and bankruptcy can be a real risk. I can't remember the exact numbers, but well over 50% of bankruptcies were related to medical bills and over 60% of those filings were by people with "health insurance". That's the American Way.

Quoting aa757first (Reply 34):
I have trouble understanding why anyone thinks single payor is an ideal solution.

If you look at places with a system that people considers a "single payer system" you find that there is a significant private insurance market - and profitable at that.

In Australia, where I have some direct experience, there is a Medicare Tax that basically covers everyone in Australia. You pay that tax like we have to pay FICA taxes. If you need hospital care you get it without charges. You might find that you are being treated by a well supervised resident if that is all you need. You might also find you are being treated by a Professor if that is what is needed. That same Professor, BTW, may well have a private practice.

Because everyone is covered by Medicare there is no need for cost shifting and that allows for private insurance premiums to be well below the costs in the US. As I said before, my US heath insurance premiums were five times the Aussie premiums - and the Aussie insurance was far better than the US policy. That private insurance gets you into the private hospitals in Australia as well as the public hospitals.

The other thing that most conservatives conveniently overlook is that a system like Australia's take the unnecessary financial burden of employer nanny care off the back of the employer. Just think of all that companies could do if they get rid of that albatross.


User currently offlineDocLightning From United States of America, joined Nov 2005, 19712 posts, RR: 58
Reply 36, posted (1 year 4 months 5 days 11 hours ago) and read 1942 times:

Quoting Ken777 (Reply 35):
If you look at places with a system that people considers a "single payer system" you find that there is a significant private insurance market - and profitable at that.

Not necessarily. Look at the NHS. OMG, I'd hate to be a physician in that system. I rotated there for a month and I left thanking the lord I didn't have to be a doctor in the UK. Now, Spain on the other hand... It really depends on the country.

Anyway, I think that the US is too large and varied to have a single payor handle it. And I don't like the idea that there is no room for negotiation. Pay would be fixed and physicians would have very little power at setting policy.


User currently offlineaa757first From United States of America, joined Aug 2003, 3350 posts, RR: 7
Reply 37, posted (1 year 4 months 4 days 17 hours ago) and read 1879 times:

Quoting Ken777 (Reply 35):
But not all licensed providers accept all insurance companies. When I went to MD Anderson for a second opinion they told me (the day before the appointment) that they did not accept my health insurance so I needed to bring $14,300 with me for that appointment for a second opinion.

True, but I've personally never come across a hospital that didn't accept BCBS.

Quoting Ken777 (Reply 35):
When I needed a cervical discectomy I went to the same surgeon who did my first discectomy 20 years before. He (and some fellow neurosurgeons) own a small private hospital where I could have the surgery. I asked him if there was a problem with my being on Medicare. His response was that they operate on a LOT of Medicare AND Medicaid patients and were quite happy with their relationship with the government.

Well, what else was he going to say? I work for a large, academic medical center and the physicians would say the same exact thing. We take care of a lot of Medicare and Medicaid patients, but they're covered by the patients who have commercial insurance.

"Payor mix" (balance of commercial, governmental and uninsured patients) is a huge thing fueling hospital mergers.

Quoting Ken777 (Reply 35):
But you will find a lot of patients filing bankruptcy because the 20% co-pay on some big time medical bills is beyond their reasonable ability to repay.

Again, I've personally never seen a patient who didn't have an out-of-pocket maximum.

Quoting Ken777 (Reply 35):
If you look at places with a system that people considers a "single payer system" you find that there is a significant private insurance market - and profitable at that.

Single payor = one payor who pays for healthcare. If there's two or more payors, it clearly isn't single payor.


User currently offlineKen777 From United States of America, joined Mar 2004, 8278 posts, RR: 8
Reply 38, posted (1 year 4 months 4 days 14 hours ago) and read 1857 times:

Quoting DocLightning (Reply 36):
OMG, I'd hate to be a physician in that system.

IIRC, there are "private doctors" who do very well. Just like other countries. Too bad you couldn't have gotten a rotation through New Zealand - my wife has a friend who just spent a year that and the physician husband totally loved practicing medicine in a hospital there. I believe it is what location you are exposed to that sets your opinion on "socialized medicine".

Quoting DocLightning (Reply 36):
I think that the US is too large and varied to have a single payor handle it.

We handle Medicare and have for a long time. That can be built upon without too much of a problem. There needs to be investments made to expand primary care facilities & personnel. Investments in education for doctors, nurses and various therapists & technicians. Bu we need that anyway.

IMO the biggest problem, like in private medicine, is fraud. The more data stored in one database the faster it is to identify medical fraud.

Quoting DocLightning (Reply 36):
And I don't like the idea that there is no room for negotiation. Pay would be fixed and physicians would have very little power at setting policy.

Again, countries like Australia have a private system as well as a Medicare system. Some doctors stick with one or the other - and some have a foot in both. My sister-in-law Down Under had surgery in one of private hospitals and her doctor works both as a Professor and in a limited private practice. It's only those who want to work only in a public hospital that will take the fixed pay/salary.

Quoting aa757first (Reply 37):
Again, I've personally never seen a patient who didn't have an out-of-pocket maximum.

Maybe I should PM you a photo of my wife. 18 months of chemo for ALL and no cap. Plus private insurance companies playing every game they could think of.

Quoting aa757first (Reply 37):
Single payor = one payor who pays for healthcare.

SIngle payer IMO indicates core health care for all. Some private medicine continues - how many single payer systems do you know that pay for face lifts of boob jobs? There are also private insurance companies that operate quite profitability. In Australia the private market is so successful that the government owned Medicare started a private insurance company (Medicare Private) and it competes very well in the private market. But then that is because health care providers do not have to write off bills for those who can't pay.


User currently offlineDocLightning From United States of America, joined Nov 2005, 19712 posts, RR: 58
Reply 39, posted (1 year 4 months 4 days 6 hours ago) and read 1838 times:

Quoting Ken777 (Reply 38):
SIngle payer IMO indicates core health care for all.

And that is where we have a clash of definitions. We may well be in violent agreement.  

I define "single-payor" as: "there is one insurance that pays for stuff done in a medical setting." You are defining it as "universal healthcare."

I submit that your definition is incorrect. "Single-payor" is one sort of universal healthcare, but there are other types.


User currently onlinemelpax From Australia, joined Apr 2005, 1621 posts, RR: 1
Reply 40, posted (1 year 4 months 4 days 2 hours ago) and read 1818 times:

Quoting Ken777 (Reply 35):
In Australia, where I have some direct experience, there is a Medicare Tax that basically covers everyone in Australia. You pay that tax like we have to pay FICA taxes. If you need hospital care you get it without charges. You might find that you are being treated by a well supervised resident if that is all you need. You might also find you are being treated by a Professor if that is what is needed. That same Professor, BTW, may well have a private practice.

That pretty much sums it up with the public system here, the same applys also if you're treated as a private paitent in a public hospital. However the major advantage with having private insurance here is that there is no waiting time if you need non-life threatening surgery. Not uncommon for people to have to wait for months or longer in the public system for knee surgery & the like, whereas those who have private cover will usually have the surgery done in a matter of days. If you need urgent treatment under the public system you'll be dealt with promptly & quite often it would be the same specalists & even the same hospital if major surgery is involved - most private hospitals here are generally smaller than public hospitals & quite often will have their own specalities, usually with things like minor surgery, obstetrics, rehab & a few also have caridac units. Major surgeries here are generally done at a large public hospital.

Quoting Ken777 (Reply 35):
The other thing that most conservatives conveniently overlook is that a system like Australia's take the unnecessary financial burden of employer nanny care off the back of the employer. Just think of all that companies could do if they get rid of that albatross.

If employers here suddenly became responsible for providing their employees with healthcare as in the US, there would be uproar & the usual cries from business about it being another impost & additional cost to business. Very few employers here provide health insurance to their employees, those that do generally do it in the name of staff retention, more common to see employers provide discounted insurance to their staff after approaching an insurer, again, in the name of staff retention, etc.



Essendon - Whatever it takes......
User currently offlinemad99 From Spain, joined Mar 2012, 561 posts, RR: 0
Reply 41, posted (1 year 4 months 3 days 7 hours ago) and read 1769 times:

Quoting DocLightning (Reply 36):
Look at the NHS. OMG, I'd hate to be a physician in that system. I rotated there for a month and I left thanking the lord I didn't have to be a doctor in the UK. Now, Spain on the other hand... It really depends on the country.

Are you saying you've worked as a physician in the UK?

The way i interpret your comment on Spain, its sounds as if you are saying its better than the UK?

My experiences with health care here in Spain have been vary good so far. It would be interesting to hear your comments regarding the two.


User currently offlinebhill From United States of America, joined Sep 2001, 972 posts, RR: 0
Reply 42, posted (1 year 4 months 2 days 20 hours ago) and read 1728 times:

Well, with respect Doc, if healthcare keeps going in the same fashion, you are not going to have ANY patients to pay for your services, that 50% of bankruptcies because of health care costs is actually 62%..of which 78% of those folks HAD HEALTH INSURANCE. I could go for a parallel private system, but not if it will suck resources from the single payer system. As for payers dictating what you are paid per procedure...or not...they do that now. Perhaps a mix of Medicare/Private is the way to go. Other countries have shown it can work. American needs to stop having "champagne taste but beer money" with regards to the "desired" level of healthcare...we cannot afford it anymore. But, as we are a nation of capitalist haves and have nots, SOMEBODY will get the short end...


Carpe Pices
User currently offlineDocLightning From United States of America, joined Nov 2005, 19712 posts, RR: 58
Reply 43, posted (1 year 4 months 2 days 17 hours ago) and read 1704 times:

Quoting bhill (Reply 42):
Well, with respect Doc, if healthcare keeps going in the same fashion, you are not going to have ANY patients to pay for your services, that 50% of bankruptcies because of health care costs is actually 62%..of which 78% of those folks HAD HEALTH INSURANCE. I could go for a parallel private system, but not if it will suck resources from the single payer system. As for payers dictating what you are paid per procedure...or not...they do that now.

They do, but they have to compete. If BC/BS decides to unilaterally cut reimbursements by 30%, I can just drop them and their patients. As will just about everyone else who contracts with them. Enough physicians do that and nobody has BC/BS anymore. When it's the government as the sole option, they can drop my pay as much as they like and my only recourse is to move to a different country.

Quoting mad99 (Reply 41):

Are you saying you've worked as a physician in the UK?

I rotated in a hospital in London and I rotated in a hospital in Leganes (Comunidad de Madrid). I would much rather work as a physician in Spain than in the UK.

I am not trashing all socialized medicine. I'm saying that some countries do it better than others.


User currently offlineKen777 From United States of America, joined Mar 2004, 8278 posts, RR: 8
Reply 44, posted (1 year 4 months 1 day 21 hours ago) and read 1628 times:

Quoting DocLightning (Reply 39):
I submit that your definition is incorrect. "

It may well be.   

What I really want to see is a system where people can afford to get basic care in appropriate settings (not always the ER) and where there is no need for cost shifting like we have today.

I also believe in integrating a "Universal Medicare" with a private insurance market. The major difference would be dramatic declines in the costs of private insurance. Like an 80% decline. Before you start crying for the poor insurance companies I'll note that in Australia they were so successful that the Government decided to join the party with Medicare Private. BTW, you pay your Medicare taxes even if you also buy private.

Quoting melpax (Reply 40):
However the major advantage with having private insurance here is that there is no waiting time if you need non-life threatening surgery.

I had to wait over a month for surgery when a tumor the size of a golf ball was discovered on my kidney. The reason was that the Di Vinci robot was booked until then. In the US there is a huge supply of high tech stuff, like MRIs and Di Vinci robots, but there are also a lot of doctors booking those high tech devices.

Quoting melpax (Reply 40):
Not uncommon for people to have to wait for months or longer in the public system for knee surgery & the like, whereas those who have private cover will usually have the surgery done in a matter of days.

Back in the "old days" when knee replacement was relatively new the better bone docs were not in a rush to operate at the first twinge of pain. Other than that level of caution you could get into surgery when the surgeon had an open spot on his surgical calendar. That might not be a matter of days unless there is a genuine emergency - and then other patients can be pushed back to make room for you. Or you can be at the end of the surgeon's schedule for the day.

Quoting DocLightning (Reply 43):
When it's the government as the sole option, they can drop my pay as much as they like and my only recourse is to move to a different country.

I don't believe that we will ever have the sole government payment program - there will always be too much money in health care for private insurance companies. Reality is that they can afford to deliver $1 Billion in political "contributions". That political pressure will ensure private care as well as public care. The prime objectives should be to expand coverage to everyone and to cut cost shifting at the knees.


User currently offlinebhill From United States of America, joined Sep 2001, 972 posts, RR: 0
Reply 45, posted (1 year 4 months 1 day 20 hours ago) and read 1609 times:

Melpax, if what you say is true, and following the "supply and demand" belief, then why have'nt health care costs come down? As for waiting times, see what happens when your employer changes plans, and a therapy or medicine you have been on for quite some time and doing well with has to go through the "prior authorization" process....you will be waiting all right. Possibly weeks. While I appreciate containing costs and have no problems with generics, let the docs pratice medicine, not the insurance companies. Because after all is said and done, and a ton of overhead/admin time and money spent, the insurance company discovers that the doc and patient already tried the cheaper alternatives...GRRRRRRRRR. Every frikken year, as they don;t know if your issue is resolved...here a clue, yer not buying the same damn med....


Carpe Pices
User currently offlineKen777 From United States of America, joined Mar 2004, 8278 posts, RR: 8
Reply 46, posted (1 year 4 months 1 day 18 hours ago) and read 1578 times:

Quoting bhill (Reply 45):
then why have'nt health care costs come down?

There are a lot of factors related to costs of health care and advancements are a big part of the costs. My last surgery started when an ultrasound identified a spot on the right kidney, the CT Scan that followed presented a clear picture of the tumor and the surgery involved included a Di Vinci robot.

Talk about technology. The oldest was an ultrasound. My wife got the first one in TUL (she worked at the hospital and was a friend of the Department Head that got the machine. That was about October 1971.

CT Scans came a lot later and the Di Vince even later.

Those technologies do increase costs, but often they can identify a problem that is far more expensive if a diagnosis is delayed.

These these types of costs are different than costs related to cost shifting. We need to address cost shifting, but that doesn't mean that we need to stop investing in medical advances.


User currently offlineDocLightning From United States of America, joined Nov 2005, 19712 posts, RR: 58
Reply 47, posted (1 year 4 months 1 day 17 hours ago) and read 1570 times:

I wonder, to get back to the original topic, why nobody has gone after the hospitals using criminal law.

OK. You're in a car accident. You get taken to the hospital by EMS unconscious. You have no way to check prices prior to going (nor do hospitals generally publish prices). You are treated and eventually released.

You get a bill and such nonsense as $70 for a gauze pad and $5,000 for a simple venipuncture show up on your bill. If you don't pay, they send collections after you and ruin your credit.

That's extortion. If in ANY OTHER industry, you were FORCED to purchase a product without being informed of the price ahead of time and then the price for that product was 7,000 times the market price and you were threatened with collections and your credit report, that would be illegal on multiple levels. So why hasn't anyone gone after them?

And that's precisely why I roll my eyes when people use the words "free market" in talking about healthcare. For the patient, it isn't a free market. You rarely get to choose when you get sick and what hospital you will be treated at.

But any part of comprehensive healthcare reform is going to have to include hospital billing reform. If insurance companies can be regulated to spend 85% of gross revenue on patient care, hospitals could get a similar regulation.

And a similar rule for drug manufacturers. You simply shouldn't be allowed to sell a drug in the US for 5,000% of what you sell it for in Canada.


User currently offlineKen777 From United States of America, joined Mar 2004, 8278 posts, RR: 8
Reply 48, posted (1 year 4 months 1 day 16 hours ago) and read 1551 times:

Quoting DocLightning (Reply 47):
But any part of comprehensive healthcare reform is going to have to include hospital billing reform.

The only realistic approach is to expand Medicare to cover all public health care - like Australia. That results in Medicare establishing the fair cost of care. Most hospitals can continue at the same level of performance if we move in that direction. There will be some hospitals that continue with gross over charging, but I believe that a lot of those can be motivated with federal research funding.

Quoting DocLightning (Reply 47):
You simply shouldn't be allowed to sell a drug in the US for 5,000% of what you sell it for in Canada.

Since the Pharma Industry basically wrote W's Medicare Plan D there is room for movement there. Lots of money will be available to fight it as this industry is one that can afford $1 Billion or more for lobbying.


User currently offlineDano1977 From British Indian Ocean Territory, joined Jun 2008, 499 posts, RR: 0
Reply 49, posted (1 year 4 months 1 day 6 hours ago) and read 1509 times:

Quoting DocLightning (Reply 47):

A friend of mine was ski-ing in Colorado, and being an idiot wrecked his knee quite badly. He contacted his travel insurance, and within 12hrs they had a representative at his side and arranging a private medical repatriation flight back to the UK.

Once back in the UK, he was at a private non NHS hospital to have the surgery carried out to fix his knee.


I'm only quoting what he said, so for all I know could be BS, but the reason the insurance company did this, because despite the cost of the flight and other associated costs, it worked out cheaper, than keeping him in an American hospital.



Children should only be allowed on aircraft if 1. Muzzled and heavily sedated 2. Go as freight
User currently onlinemelpax From Australia, joined Apr 2005, 1621 posts, RR: 1
Reply 50, posted (1 year 4 months 1 day 2 hours ago) and read 1484 times:

Quoting Ken777 (Reply 44):
Before you start crying for the poor insurance companies I'll note that in Australia they were so successful that the Government decided to join the party with Medicare Private. BTW, you pay your Medicare taxes even if you also buy private.

The Medicare levy is 1.5% of your taxable income. Everyone who pays tax here pays this. However, if your income is over $84K for a single person, or $168K for a family, and if you haven't got private hospital cover, you then have to pay an additional 1% as a 'surcharge'. For those with cover, the you get a rebate from the govenment towards your insurance, depending on your income.

http://www.privatehealth.gov.au/heal...rance/incentivessurcharges/mls.htm

Quoting bhill (Reply 45):

I don't know what the situation is in the US, but if you have private cover here, generally the only delay with getting surgery would be the availability of your surgeon or equipment availibility as per Ken's post. The insurers here do not have a big say in what treatment you are given, unlike the US. My dad suffered a heart attack a few years back, although we didn't know it at the time. We took him up to the closest hospital with an ER, a private hospital 2 minutes from home that also has a cardiac unit. This was at 6AM. He was seen straight away by a cardiologist who decided on putting in a stent. The only delay was waiting for the rest of the theatre staff to arrive for work, by 8AM he had the stent put in & was an ICU ward. He was in for 5 days, the only cost out of his pocket was $350 for using the private ER (the fee wasn't covered by the insurer). The only time that his insurer (which was Medibank) was contacted was when he first went in to the ER, to confirm what level of coverage he held.



Essendon - Whatever it takes......
User currently offlinepvjin From Finland, joined Mar 2012, 1262 posts, RR: 3
Reply 51, posted (1 year 4 months 1 day 1 hour ago) and read 1477 times:

Why not just pay some more taxes and let the government cover most of the healthcare services? That would sure keep the prices down for an individual, funding shouldn't be a problem if you also cut some money from enormous US military machine which is mostly just waste of money.

It's insane that people have to die just because they lack money. Also all those stories about people going totally bankrupt because of enormous healthcare costs, they are plain disgusting and make me realize how lucky I'm to live in this welfare state... I just hope idiots won't destroy it all by voting some disgusting right wing government into power.



"A rational army would run away"
User currently offlineKen777 From United States of America, joined Mar 2004, 8278 posts, RR: 8
Reply 52, posted (1 year 4 months 22 hours ago) and read 1472 times:

Quoting melpax (Reply 50):
The Medicare levy is 1.5% of your taxable income. Everyone who pays tax here pays this. However, if your income is over $84K for a single person, or $168K for a family, and if you haven't got private hospital cover, you then have to pay an additional 1% as a 'surcharge'.

Our basic Medicare is far more than that basic 1.5% - a result of cost shifting. Until we expand Medicare to cover everyone at a core level of care we will continue to pay massively more than other countries.

Quoting pvjin (Reply 51):
Why not just pay some more taxes and let the government cover most of the healthcare services?

Because most Americans don't realize that would be the less expensive approach to health care.


User currently onlineFlighty From United States of America, joined Apr 2007, 8544 posts, RR: 2
Reply 53, posted (1 year 4 months 22 hours ago) and read 1471 times:

Quoting Dano1977 (Reply 49):
I'm only quoting what he said, so for all I know could be BS, but the reason the insurance company did this, because despite the cost of the flight and other associated costs, it worked out cheaper, than keeping him in an American hospital.

Colorado sees a ton of that. Skiiers are often youngish and might not have a corporate or government career at the moment. Horrors, how dare they, but it is true.


My friend broke her ankle there. She was young and had no medical insurance, because her government career had not begun yet. $35,000

[Edited 2013-05-22 09:24:09]

User currently offlinestarbuk7 From United States of America, joined Apr 2008, 599 posts, RR: 5
Reply 54, posted (1 year 4 months 21 hours ago) and read 1465 times:

Quoting pvjin (Reply 51):
Why not just pay some more taxes and let the government cover most of the healthcare services? That would sure keep the prices down for an individual, funding shouldn't be a problem if you also cut some money from enormous US military machine which is mostly just waste of money.


Sorry, I am tired of 'paying more taxes'. Been doing that for the last several years watching my paycheck going down, no pay increases and all my other bills going up, including health care costs. Getting harder and harder to make ends meet for the less than 50% of us who actually pay taxes in this country.

And as for our military you being from Finland its nunya business.


User currently offlinebhill From United States of America, joined Sep 2001, 972 posts, RR: 0
Reply 55, posted (1 year 4 months 18 hours ago) and read 1451 times:

pvjin, because the Health Insurance lobby would never allow it, it's why Obama had to make the concessions he made and why the GOP could never get reform done, they would be shooting themselves in the foot.. The health insurance industry in the US is a for profit industry. I do not have a problem with profits, really, I don't. But health care in the US is more akin to the airline industry, we all know the weirdness in ticket pricing. And the pharmaceutical industry....why must the US pay to subsidize the cost of drugs in other countries because those countries put the hammer down on drug pricing? I am just wondering when the health care industry will wake up and discover that they will eventually price themselves into...I don't even know what to call it.


Carpe Pices
User currently offlineDocLightning From United States of America, joined Nov 2005, 19712 posts, RR: 58
Reply 56, posted (1 year 4 months 18 hours ago) and read 1452 times:

Quoting starbuk7 (Reply 54):
Sorry, I am tired of 'paying more taxes'. Been doing that for the last several years

No you haven't. You've been paying LESS taxes for the last several years. There have been NO tax hikes unless you make over $250K and even that was modest.

But if you have health insurance, you're paying a "tax" already. And that tax pays for the emergency room bill for Laqueisha who has been in the ER fifteen times this month for "pain" caused by withdrawal from the pills she likes to pop. It's also paying for that uninsured baby in the ICU for whooping cough because he was born in a state that doesn't insure all kids and so he never got vaccines.

And if you don't have health insurance, then I am paying a "tax" for your next ER visit when you step on a nail.

[Edited 2013-05-22 13:31:12]

User currently offlineKen777 From United States of America, joined Mar 2004, 8278 posts, RR: 8
Reply 57, posted (1 year 4 months 17 hours ago) and read 1439 times:

Quoting starbuk7 (Reply 54):
Sorry, I am tired of 'paying more taxes'. Been doing that for the last several years watching my paycheck going down,

You work for a company that hands out nanny care then you can see why costs are going up. But then you probably have VA Medical available since you're retired from the Navy.

Quoting starbuk7 (Reply 54):
no pay increases

Going back a decade I found that my "pay" took continual hits from the increases in health insurance. My premiums doubled in the first 4 years of Bush/Cheney. That impacted my pay and those types of increases will continue to impact pay increases you'd like as long as we maintain our current insurance industry led system.

Quoting starbuk7 (Reply 54):
for the less than 50% of us who actually pay taxes in this country.

Actually everyone with money in their pockets pays taxes. Start with sales taxes. Then toss in all the taxes related to putting gas in your car. Now look at property taxes (which is included in rent if you rent) and all the other state and federal taxes. Got an income from working? FICA is, what, 15.2%? Folks making $2.35 an hour waiting tables pays that FICA - and they don't get a refund at the end of the year.

Now there is a large group of folks that don't have an Income Tax liability because of the GOP's Socialist Cash Hand Our that the Republicans added into their "Contract With America". That's $1,000.00 per child per year. Republicans try to hide the Socialism part of that cash hand out by calling it a "Tax Credit". That's one of those "a rose by any other name" bits and it doesn't hide the impact that hand out has on the tax liabilities of families. Buy, hey, that multi trillion dollar handout did help the GOP win the election in 1996. And YOU are still paying for that political victory.

Quoting bhill (Reply 55):
The health insurance industry in the US is a for profit industry.

No doubt about that. They are, for some reason, unable to see the profit potential of moving everyone to Medicare with private Medicare Gap available as their profit stream. The fact that the Aussie Government started a private health insurance company pretty well screams the profit potential.

Quoting bhill (Reply 55):
why must the US pay to subsidize the cost of drugs in other countries because those countries put the hammer down on drug pricing?

Because the pharma industry has a lot of money and they know how to use it when it comes to politicians. They wrote the Medicare Part D law making it illegal for the government to negotiate prices for Medicare patients. And W signed that Pharma Law with a big smile.


User currently offlinemirrodie From United States of America, joined Apr 2000, 7443 posts, RR: 62
Reply 58, posted (1 year 4 months 11 hours ago) and read 1424 times:
Support Airliners.net - become a First Class Member!

Quoting DocLightning (Reply 14):
Actually, I'm a big fan of copays. And higher copays at the ER than at the office. They save money not directly (the copay is usually nominal), but by reducing the number of inappropriate ER visits for things like babies with colds.

Agreed and wholly agree on the waste that I see on the medicaid end of it.

Like you, Doc, I see a ton of issues in everyday practice that have my SMH and rolling my eyes....



Forum moderator 2001-2010; He's a pedantic, pontificating, pretentious bastard, a belligerent old fart, a worthless st
User currently offlinecasinterest From United States of America, joined Feb 2005, 4626 posts, RR: 2
Reply 59, posted (1 year 4 months 9 hours ago) and read 1416 times:

I personally still love the fact that Doctors can " Mess up Royally" and still get to practice and charge more to fix what they didn't fix in the first place. I also love that Insurance companies can deny coverage and force collections on items they were legally obligated to pay. Those two issue, and the lack of transparent charges for consumers are the crux of the issues in health care.


Older than I just was ,and younger than I will soo be.
User currently offlinemad99 From Spain, joined Mar 2012, 561 posts, RR: 0
Reply 60, posted (1 year 4 months 7 hours ago) and read 1400 times:

Quoting DocLightning (Reply 43):
I rotated in a hospital in London and I rotated in a hospital in Leganes (Comunidad de Madrid). I would much rather work as a physician in Spain than in the UK.

That's interesting. My experiences with the NHS are positive but, touch wood, I've never had any serious health problems.

Here in spain we've had two kids born here, again nothing major but so far extremely satisfied. Friends of ours have a 10 yo boy who had bone cancer and part of the cure was to cut out 8cm of leg bone (shorting the leg) and they are vary happy with the care provided.



Quoting DocLightning (Reply 56):
And if you don't have health insurance, then I am paying a "tax" for your next ER visit when you step on a nail.

This is it. Everyone has health issues and the lights stay on at hospital so even if you have nothing someone pays!


User currently offlinestarbuk7 From United States of America, joined Apr 2008, 599 posts, RR: 5
Reply 61, posted (1 year 4 months 2 hours ago) and read 1379 times:

Quoting DocLightning (Reply 56):
No you haven't. You've been paying LESS taxes for the last several years. There have been NO tax hikes unless you make over $250K and even that was modest.


Yes, they have, and I do not make near that much. Just this last January first Medicare and Social Security deductions went up to the toon of $75 buck a paycheck. Plus CA, if you haven't noticed, raised taxes this year as well.


User currently offlinebhill From United States of America, joined Sep 2001, 972 posts, RR: 0
Reply 62, posted (1 year 3 months 4 weeks 1 day 16 hours ago) and read 1349 times:

Damn, I stumbled upon this today......

http://www.opensecrets.org/lobby/top.php?indexType=i&showYear=2013

"Better life through chemicals...." Indeed...



Carpe Pices
User currently offlineaaron747 From Japan, joined Aug 2003, 8153 posts, RR: 26
Reply 63, posted (1 year 3 months 4 weeks 1 day 13 hours ago) and read 1325 times:

Quoting aa757first (Reply 34):

Again when you start mentioning network and out of network, that's where I lose interest. In this country, any provider, public or private, is accepted. You, as a patient, never have to think about what-ifs. Just bring your insurance card and some cash or credit for the co-pay and that's it. No manuals to read, no nothing.

And like Doc said, the triple-payer model is great. The government can't arbitrarily change rates because employers and users are payers in the system too. It's a free market for thr doctors themselves...provide good service, you'll have a steady stream of patients and earn more. Specialize in a difficult branch of medicine and you'll earn more.



If you need someone to blame / throw a rock in the air / you'll hit someone guilty
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