The Money Mustache Community
Other => Off Topic => Topic started by: effigy98 on June 29, 2018, 05:39:15 PM
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I mean if this is not another warning sign that something bad is about to hit our economy, I don't know what is... When greed gets this out of a line, we usually crash.
Summary:
More than 80% of doctors who filed Medicare claims in 2016 for H.P. Acthar Gel -- a drug best known for treating a rare infant seizure disorder -- received money or other perks from the drugmakers. Medicare paid nearly $2 billion over five years.
In 2001, Questcor Pharmaceuticals paid a mere $100,000 for the rights to the drug.
The company first raised the price from $40 to $750 a vial shortly after acquiring it. The price doubled over the next few years. Then, on August 27, 2007, the price shot up overnight from $1,600 to $23,000 a vial.
Why would Medicare pay nearly $2 billion over five years when there was a far cheaper alternative? You can thank lawmakers for that: Medicare is not allowed to negotiate drug prices or tell doctors what drugs to prescribe. "Our Congress has told the Medicare program, you cannot control drug prices," says Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota. He directs the College of Pharmacy's PRIME Institute, which studies economic and policy issues related to pharmaceuticals. "We don't have any government process for evaluating, regulating and managing drug prices."
http://www.wowt.com/content/news/Medicare-spent-2-billion-for-one-drug-as-the-manufacturer-paid-doctors-millions-486962401.html
There is a very interesting NetFlix show on that covers this called Dirty Money, #3 Drug Short... A company called Valeant started doing this and wallstreet LOVED it, so many other drug makers started doing this (still to this day) and it is perfectly legal to do so.
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It’s not just the drug companies. I had a diagnostic colonoscopy in February (all clear!) and as I have a high-deductible health plan, I received bills from 1) the gastroenterologist who actually performed the procedure ($800), 2) the outpatient surgical center where it was performed ($650), 3) the anesthesiologist ($150), and 4) the nurse anesthetist ($150). The bills came from four different business entities, one of which was out of state.
To me, that is insane. And none of this info was made available before the test.
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The drug price increase is a lot worse than receiving a few separate bills for a colonoscopy, though.
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The drug price increase is a lot worse than receiving a few separate bills for a colonoscopy, though.
I don’t think I stated otherwise. I gave a perspective that it isn’t only the drug companies. I’m in a position to afford a $1700 routine procedure. Someone else may not be. I think it’s ridiculous that it costs so much. AND I think it’s insane that the list price for my good friend’s cancer meds is $13,000 per month. One can care about multiple things at once.
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We paid $2,200 for an ER visit that considered off two stitches in my son's finger and a few xray's after he was bitten by a rabbit. So bad.
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The drug price increase is a lot worse than receiving a few separate bills for a colonoscopy, though.
I don’t think I stated otherwise. I gave a perspective that it isn’t only the drug companies. I’m in a position to afford a $1700 routine procedure. Someone else may not be. I think it’s ridiculous that it costs so much. AND I think it’s insane that the list price for my good friend’s cancer meds is $13,000 per month. One can care about multiple things at once.
Yes, the cancer meds goes back to the drug pricing discussion. That's crazy.
I also had a diagnostic colonoscopy 9 years ago that came back clear. The amount billed to the insurance company way back then was in the ballpark of the figures you gave, so it didn't look like there was a dramatic price increase in cost compared to those drugs mentioned by the OP. However, I had to pay $300 out of pocket, which I wasn't happy out. Another difference is that many of these healthcare providers are just scraping by. They would actually lose money if all they had were Medicaid and Medicare patients since those programs don't pay for the real cost of the healthcare services.
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The drug price increase is a lot worse than receiving a few separate bills for a colonoscopy, though.
I don’t think I stated otherwise. I gave a perspective that it isn’t only the drug companies. I’m in a position to afford a $1700 routine procedure. Someone else may not be. I think it’s ridiculous that it costs so much. AND I think it’s insane that the list price for my good friend’s cancer meds is $13,000 per month. One can care about multiple things at once.
Yes, the cancer meds goes back to the drug pricing discussion. That's crazy.
I also had a diagnostic colonoscopy 9 years ago that came back clear. The amount billed to the insurance company way back then was in the ballpark of the figures you gave, so it didn't look like there was a dramatic price increase in cost compared to those drugs mentioned by the OP. However, I had to pay $300 out of pocket, which I wasn't happy out. Another difference is that many of these healthcare providers are just scraping by. They would actually lose money if all they had were Medicaid and Medicare patients since those programs don't pay for the real cost of the healthcare services.
Ah. Mine was $1700 out of pocket on my end (after what the insurance wrote off). I must not have made that clear.
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It mostly boils down to a system built out on third-party payments. Pricing is incredibly opaque and convoluted because most medical bills go through insurance or to the government. The end consumer has few or no price signals to navigate the market and limited choices. If Doctor A offered appointments at $50 each and had similar ratings to Doctor B who charged $100 for the same service, Doctor A would soon have more business than they could handle. Instead, we have no idea what the price will be beforehand in most cases and hope that our insurance will cover it.
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Mike in ABC:
Pricing is incredibly opaque and convoluted because most medical bills go through insurance or to the government.
There's people out there that have this glassy eyed look wear T shirts showing their love for the free market and drool when they talk about "market forces." Medicine gets pretty complicated quickly. A true free market allows choice. It allows comparison shopping. Even if the folks in the front rooms of the clinics knew the prices of your treatment, would you be able to comparison shop? It's akin to a gnat trying to steer an elephant.
The only way to get those prices down is to have Uncle Sam himself negotiate with the medical industry to force prices down. There's an obvious precedent for this action as other countries are able to do it.
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According to the AHRQ, healthcare is expensive because a small population (20-25%) of all medical cases requires extraordinary care, either at birth or for chronic conditions in later years. Pharma companies are allowed long periods of patent exclusivity for medicines that in many cases were developed from NIH-funded studies and are administered to elderly patients covered by Medicare insurance that is Congressionally-limited from negotiating drug prices. Hospitals also tend to charge exorbitant rates for many procedures to cover malpractice costs, ensure profitability (in some cases extreme), and budget for losses due to uninsured people using emergency rooms. It’s a clusterf*ck.
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Mike in ABC:
Pricing is incredibly opaque and convoluted because most medical bills go through insurance or to the government.
There's people out there that have this glassy eyed look wear T shirts showing their love for the free market and drool when they talk about "market forces." Medicine gets pretty complicated quickly. A true free market allows choice. It allows comparison shopping. Even if the folks in the front rooms of the clinics knew the prices of your treatment, would you be able to comparison shop? It's akin to a gnat trying to steer an elephant.
The only way to get those prices down is to have Uncle Sam himself negotiate with the medical industry to force prices down. There's an obvious precedent for this action as other countries are able to do it.
If you're having a heart attack the ambulance is going to take you to the nearest hospital and that will be that. If you need to get an MRI, or have an elective surgery, or choose a specialist there is typically time to comparison shop - if that were possible. Once again though, if your insurance company, whether private or government, is picking up the bill there's not really an incentive for consumers to find a better deal or for suppliers to offer one. If most people were paying direct for healthcare it would not fix all of the problems but I think it would certainly make some improvements. If nothing else it might stop hospitals from arbitrarily making up prices, and medical supply companies from getting away with exorbitant markups. i.e. a surgical screw that costs a $500 on an itemized hospital bill and is little different than something from a hardware store.
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The drug price increase is a lot worse than receiving a few separate bills for a colonoscopy, though.
I don’t think I stated otherwise. I gave a perspective that it isn’t only the drug companies. I’m in a position to afford a $1700 routine procedure. Someone else may not be. I think it’s ridiculous that it costs so much. AND I think it’s insane that the list price for my good friend’s cancer meds is $13,000 per month. One can care about multiple things at once.
Yes, the cancer meds goes back to the drug pricing discussion. That's crazy.
I also had a diagnostic colonoscopy 9 years ago that came back clear. The amount billed to the insurance company way back then was in the ballpark of the figures you gave, so it didn't look like there was a dramatic price increase in cost compared to those drugs mentioned by the OP. However, I had to pay $300 out of pocket, which I wasn't happy out. Another difference is that many of these healthcare providers are just scraping by. They would actually lose money if all they had were Medicaid and Medicare patients since those programs don't pay for the real cost of the healthcare services.
Ah. Mine was $1700 out of pocket on my end (after what the insurance wrote off). I must not have made that clear.
No you did. You have a high deductible. My plan only has a $100 deductible, but there was a co-pay for me. I plan to have one more under my work plan before I FIRE since I'm not sure what it would cost me after I FIRE.
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Healthcare is about the only subject that nearly every American can agree on. Everyone knows it sucks, but we don't see to have the will to fix it.
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I've been on this drug for less than a year, and in that time the cost has gone up almost $400 per month:
https://www.nytimes.com/2018/01/06/business/humira-drug-prices.html
Over the last six years the price of it has increased 100%. The last couple people I mentioned this to shrugged it off with "But isn't there a copay assistance card?" That isn't the point.
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Healthcare is about the only subject that nearly every American can agree on. Everyone knows it sucks, but we don't see to have the will to fix it.
Vote democrat. Once they control all of government, as the rebuplicans do now, we may finally see the ‘public option’ that they were 1-2 votes away from last time. Once everyone signs up for that , ,which they will, the whole current system is destroyed.
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Bucksandreds:
Vote democrat. Once they control all of government, as the rebuplicans do now, we may finally see the ‘public option’ that they were 1-2 votes away from last time. Once everyone signs up for that , ,which they will, the whole current system is destroyed.
The last 30 or so years have seen conservative forces seize total control of the GOP and the Democrats as well. The Democrats will NOT do this for you. They have had chances in the past. The only way that change can be nudged along is via a very strong grass roots organization.
The power of big corporations is very strong in these times. They control the media and so can easily sway public opinion.
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It’s not just the drug companies. I had a diagnostic colonoscopy in February (all clear!) and as I have a high-deductible health plan, I received bills from 1) the gastroenterologist who actually performed the procedure ($800), 2) the outpatient surgical center where it was performed ($650), 3) the anesthesiologist ($150), and 4) the nurse anesthetist ($150). The bills came from four different business entities, one of which was out of state.
To me, that is insane. And none of this info was made available before the test.
It's been my experience that your insurance company would negotiate those prices down, ie. here's what we allow you to charge. I have a$10k deductible and have mostly been very pleased with the difference between what is chargeed and what I owe.
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We paid $2,200 for an ER visit that considered off two stitches in my son's finger and a few xray's after he was bitten by a rabbit. So bad.
Yes, they love to throw in an xray or two. I had a wood chip in my eye I couldn't get out, nervous doctor got
it out with a hypodermic needle and then insisted on an xray.
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I've been on this drug for less than a year, and in that time the cost has gone up almost $400 per month:
https://www.nytimes.com/2018/01/06/business/humira-drug-prices.html
Over the last six years the price of it has increased 100%. The last couple people I mentioned this to shrugged it off with "But isn't there a copay assistance card?" That isn't the point.
A friend just had his Crestor go from $90 to $900 every 3 months. This was some change that moved the drug from tier 2 to tier 3. He ended up going to the generic that came out in 2016, which is $10, but free to him on his insurance.
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It’s not just the drug companies. I had a diagnostic colonoscopy in February (all clear!) and as I have a high-deductible health plan, I received bills from 1) the gastroenterologist who actually performed the procedure ($800), 2) the outpatient surgical center where it was performed ($650), 3) the anesthesiologist ($150), and 4) the nurse anesthetist ($150). The bills came from four different business entities, one of which was out of state.
To me, that is insane. And none of this info was made available before the test.
It's been my experience that your insurance company would negotiate those prices down, ie. here's what we allow you to charge. I have a$10k deductible and have mostly been very pleased with the difference between what is chargeed and what I owe.
These were my out of pocket costs AFTER the insurance negotiations. I don't have the statements in front of me, but I remember that the actual costs pre-negotiation were about $300 higher each for the anesthesiologist and nurse anesthetist.
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Bucksandreds:
Vote democrat. Once they control all of government, as the rebuplicans do now, we may finally see the ‘public option’ that they were 1-2 votes away from last time. Once everyone signs up for that , ,which they will, the whole current system is destroyed.
The last 30 or so years have seen conservative forces seize total control of the GOP and the Democrats as well. The Democrats will NOT do this for you. They have had chances in the past. The only way that change can be nudged along is via a very strong grass roots organization.
The power of big corporations is very strong in these times. They control the media and so can easily sway public opinion.
Geez, didn't we just go through Government Obamacare where we were going to have $2500 decrease in health insurance cost and mine went from $4,300 a year to $11,200 a year for my family. And that is not Obamacare that's private BCBS. I guess some of you haven't heard about $700 hammers and $1,000 toilets to the goverment. And aren't all these drug increases happening under Obamacare? Also should hardworking taxpayers be subsidizing healthcare costs for people that have $1,000,000 of Net Worth? That's government regulation at work.
Not that I wouldn't take advantage of it. Although stupidly, I have not, and it has cost me over $35k the last 5 years. My AGI is usually in the 30 thousands so I could have been heavily subsidized.
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I've been on this drug for less than a year, and in that time the cost has gone up almost $400 per month:
https://www.nytimes.com/2018/01/06/business/humira-drug-prices.html
Over the last six years the price of it has increased 100%. The last couple people I mentioned this to shrugged it off with "But isn't there a copay assistance card?" That isn't the point.
A friend just had his Crestor go from $90 to $900 every 3 months. This was some change that moved the drug from tier 2 to tier 3. He ended up going to the generic that came out in 2016, which is $10, but free to him on his insurance.
Switcheroos like that are great when they work. For too many important prescriptions, there aren't necessarily cheaper alternatives.
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Geez, didn't we just go through Government Obamacare where we were going to have $2500 decrease in health insurance cost and mine went from $4,300 a year to $11,200 a year for my family. And that is not Obamacare that's private BCBS. I guess some of you haven't heard about $700 hammers and $1,000 toilets to the goverment. And aren't all these drug increases happening under Obamacare? Also should hardworking taxpayers be subsidizing healthcare costs for people that have $1,000,000 of Net Worth? That's government regulation at work.
Not that I wouldn't take advantage of it. Although stupidly, I have not, and it has cost me over $35k the last 5 years. My AGI is usually in the 30 thousands so I could have been heavily subsidized.
Hardworking taxpayer here. Yes we should subsidize healthcare for everyone and allow the government to negotiate prices on drugs and services. Having a healthcare system that isn't tied to employment is much better for society overall. It promotes freedom and allows for more potential entrepreneurs to take risks. I wouldn't get too hung up on net worth either. ACA subsidies are based on income and a "million dollars" ain't what it used to be. I wouldn't object to my in-laws receiving an ACA subsidy on their 40k a year pension.
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Geez, didn't we just go through Government Obamacare where we were going to have $2500 decrease in health insurance cost and mine went from $4,300 a year to $11,200 a year for my family. And that is not Obamacare that's private BCBS. I guess some of you haven't heard about $700 hammers and $1,000 toilets to the goverment. And aren't all these drug increases happening under Obamacare?
You could say it happened despite Obamacare, but it would have happened anyway.
Also should hardworking taxpayers be subsidizing healthcare costs for people that have $1,000,000 of Net Worth?
Absolutely. Net worth is NOT income. People should NOT be penalized for saving, and net worth includes your home to boot. In fact, my stash investments alone are considerably more than that, but net worth boosts that number even higher since that includes my home. I certainly plan to use the ACA premium tax credit when I FIRE, maybe CSR as well. I didn't save over $1M to spend it on healthcare insurance! Being a single person, I already paid higher taxes my entire working career, so this will be my chance to get a little bit back from the system.
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Consumer Reports had an article in a recent issue on drug costs. They found that Costco offered the best prices for consumers in general. Various branches of CVS had wildly different prices for the same drug, even at stores in the same town.
Me, if I ever need a prescription on a regular basis, I'll be researching Canadian prices.
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Consumer Reports had an article in a recent issue on drug costs. They found that Costco offered the best prices for consumers in general. Various branches of CVS had wildly different prices for the same drug, even at stores in the same town.
Me, if I ever need a prescription on a regular basis, I'll be researching Canadian prices.
I saw a news story a while back that stated that if you are paying out of pocket instead of using insurance, you should ask a pharmacy if that is the best price you can get for a drug. Otherwise, they may charge you a higher price than you could get otherwise.
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Americans need a Tommy Douglas.
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Bucksandreds:
Vote democrat. Once they control all of government, as the rebuplicans do now, we may finally see the ‘public option’ that they were 1-2 votes away from last time. Once everyone signs up for that , ,which they will, the whole current system is destroyed.
The last 30 or so years have seen conservative forces seize total control of the GOP and the Democrats as well. The Democrats will NOT do this for you. They have had chances in the past. The only way that change can be nudged along is via a very strong grass roots organization.
The power of big corporations is very strong in these times. They control the media and so can easily sway public opinion.
Geez, didn't we just go through Government Obamacare where we were going to have $2500 decrease in health insurance cost and mine went from $4,300 a year to $11,200 a year for my family. And that is not Obamacare that's private BCBS. I guess some of you haven't heard about $700 hammers and $1,000 toilets to the goverment. And aren't all these drug increases happening under Obamacare? Also should hardworking taxpayers be subsidizing healthcare costs for people that have $1,000,000 of Net Worth? That's government regulation at work.
Not that I wouldn't take advantage of it. Although stupidly, I have not, and it has cost me over $35k the last 5 years. My AGI is usually in the 30 thousands so I could have been heavily subsidized.
The ACA only attempted to solve half the problem. In my opinion it tried to solve the wrong one. It's a system to give everybody insurance, but does nothing to state how much what the insurance is covering should cost. The drug increases being discussed aren't happening "under Obamacare." That's not the purpose of the ACA. Patent laws seem to be one of a few factors in drug prices. A company can buy the rights to a drug and jack up the price 500% because the drug is needed and nobody else is providing it. There's no law to say they can't, and I'm sure they're paying Congress handsomely for the privilege.
Just giving everyone insurance is similar to the Democrat solution to student loans - just give them to everybody no matter the cost. Drug companies and hospitals (just like universities) are under no obligation or incentive to control costs if the government or the insurance companies are going to keep paying them. Conversely, it appears that the ACA mandated certain things be covered, but then limited what the government would reimburse and resulted in either increased rates or simply bowing out of the market. Instead of a national market for insurance, you have 50 vastly different ones.
I had an MRI a few months ago. The bill was for $1500, but my insurance (TRICARE) only paid them $250. I pay nothing out of pocket. Was the cost of the MRI actually $1500, was the imaging center trying to high-ball the price, or was my government-funded insurance being stingy? We have no way of knowing. If a child, a middle age person, and an elderly person go into the hospital for exactly the same thing, you can guarantee they'll all get different bills. The quality of insurance coverage also seems to be a factor in the bill as well.
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I had an MRI a few months ago. The bill was for $1500, but my insurance (TRICARE) only paid them $250. I pay nothing out of pocket. Was the cost of the MRI actually $1500, was the imaging center trying to high-ball the price, or was my government-funded insurance being stingy?
Healthcare facilities take a hit on insufficient payments such as from Medicare and Medicaid. I've heard of hospitals having increased volume while losing money due to the increase in Medicare and Medicaid patients. Someone else paying has to make up the difference. Not everyone could get a Medicare rate if the facility is to survive. They've already been known to start cutting different services. Healthcare facilities should be compensated fairly.
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Agreed about the ACA not controlling costs. We need better cost controls in the US by leveraging the bargaining power of a large provider or single provider. Other countries don't pay anywhere close to what we do for routine procedures like MRIs etc. For example a heart sonogram in Japan costs about $150 whereas in the US, it costs $1,000-8,000. Their system allows providers to charge a premium for new, state of the art technology but then the costs must go down over time. Since MRIs etc are 1980's technology it is now priced as a commodity in most countries. We need to stop being suckers and allowing big business to control policy.
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I had an MRI a few months ago. The bill was for $1500, but my insurance (TRICARE) only paid them $250. I pay nothing out of pocket. Was the cost of the MRI actually $1500, was the imaging center trying to high-ball the price, or was my government-funded insurance being stingy?
Healthcare facilities take a hit on insufficient payments such as from Medicare and Medicaid. I've heard of hospitals having increased volume while losing money due to the increase in Medicare and Medicaid patients. Someone else paying has to make up the difference. Not everyone could get a Medicare rate if the facility is to survive. They've already been known to start cutting different services. Healthcare facilities should be compensated fairly.
It seems like the system needs to meet somewhere in the middle. The medical facility needs to present an honest assessment of their costs while government-provided insurance needs to compensate at a reasonable rate. One can't work without the other.
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We paid $2,200 for an ER visit that considered off two stitches in my son's finger and a few xray's after he was bitten by a rabbit. So bad.
Neat. I paid about $20 for a few stitches after I was all boozed up in Thailand and slashed my finger on a piece of beach glass. And this was at like 11:00 at night too. Lots of clinics everywhere to deal with drugged up tourists who think muddy island roads and poorly maintained motorbikes is the perfect way to learn how to ride.
The reason is simple. For the vast majority of people in the US, they are wholly disconnected from the true price of medicine, so there is really no incentive to keep prices low, because there are no checks. Just like I was a hell of a lot more liberal with my flight decisions when work is paying vs my own vacation.
If anything most people frequenting high end medical services have a long term interest in these high prices, as they most likely own all sorts of these health and drug companies indirectly via retirement funds. Then you have a bit of a cartel effect too, as the numbers of doctors are regulated and if everyone else is charging this, why wouldn't you? Why were eyeglasses up until recently just "accepted" to cost $300 for what amounts to 50 cents of plastic remolded?
The only people who do see the real costs are people without insurance, and taken as a whole, they're pretty much the poorest strata of society, so no one gives a shit about them. In short, it's a very roundabout way of transferring money from the public to the top.
How much should a few stitches cost? What's a "fair" price? 10 minutes of time for someone at a nurse skill level, a bit of alcohol, and a bit of filament? For a procedure that can be literally done on a street corner? How is it a Thai clinic can make money doing the same procedure at literally 1% of the cost? It's because insurance is much rarer there, and no one would go if it cost what it did in the US. It's more of a true market since the people consuming the service actually feel the cost.
As soon as true costs borne by the consumer are disconnected from them, the price is free to run amok. Look at education or housing as other classic examples. While the cost is eventually borne by the consumer (via loans), is well deferred and structured into payments, so you don't feel the sting as sharply. As a consequence, you saw increases in tuition and housing that would never happen if people had to save and pay for things like they did before.
Getting slightly off topic, but I find it fascinating from a behavior economics point of view what happens. Homes, education, and health care are all important, but expensive, so various programs pop up to help out. (CHMC/US equivalent, student loan programs, health insurance) -> As these kick in, it becomes more accessible, demand increases, and prices rise -> Now, prices for everything has skyrocketed, everything is just as inaccessible as before, but home builders/early owners, universities, and insurance companies/hospitals are all making out like bandits.
But you wouldn't believe it listening to them. Because their non-mustachian ideals dictate that if home prices/tuition/premiums double every 5 years, then they need to spend this influx of cash on *anything* lest they show a budgetary surplus and get their piece of the pie cut next year.
....And this just carries on until it can't
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Healthcare facilities take a hit on insufficient payments such as from Medicare and Medicaid. I've heard of hospitals having increased volume while losing money due to the increase in Medicare and Medicaid patients. Someone else paying has to make up the difference.
Just what is meant by insufficient? Are they actually losing money or simply not generating the profit that some geezer in the back office wants them to get? Factories have closed. They have closed not that they were not profitable. They have closed because the owners could move the work elsewhere and make more money. People who worked at those factories were out on the streets.
You can't believe almost anything from the bean-counters. There is a special place in hell for them.
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Healthcare facilities take a hit on insufficient payments such as from Medicare and Medicaid. I've heard of hospitals having increased volume while losing money due to the increase in Medicare and Medicaid patients. Someone else paying has to make up the difference.
Just what is meant by insufficient? Are they actually losing money or simply not generating the profit that some geezer in the back office wants them to get?
Losing money. We're talking about non-profit hospitals as well. There's a lot of overhead in hospitals. Earlier someone commented on what's involved with getting stitches in the ER. The poster was over-simplifying a procedure and what all is involved behind the scenes. It's a lot different than using a needle and thread in a back alley.
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Well I'm looking for a suture kit and Lidocaine to keep in the fridge (assuming it doesn't cost $23,000 for a vial)
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People should NOT be penalized for saving, and net worth includes your home to boot. In fact, my stash investments alone are considerably more than that, but net worth boosts that number even higher since that includes my home. I certainly plan to use the ACA premium tax credit when I FIRE, maybe CSR as well. I didn't save over $1M to spend it on healthcare insurance! Being a single person, I already paid higher taxes my entire working career, so this will be my chance to get a little bit back from the system.
Presumably this money you will be "getting back" from the system will come from the taxes paid by the children of those families that were paying lower taxes than you during your working life?
I say this as a single person without children myself. And while it is a little annoying that people receive dramatic tax cuts simply for marrying someone else, it certainly does make sense for us to incentivize people to have at least a few children. Right now birth rates are well below replacement in the USA and have been dropping rapidly* since the 2007/08 economic crash. While both our economy and our ecology could make do with somewhat fewer people than are alive today, trust me that neither you nor I want to live our more elderly years in a country where the population is falling too rapidly.
*Well rapid by demographic standards. In 2008 we were at 2.12 births per woman, we're now at 1.75 births per woman and continuing to fall. Given the current trendline (always a risky way to try to predict the future), we'll be looking at Italy level numbers in another 4-5 years.
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I had an MRI a few months ago. The bill was for $1500, but my insurance (TRICARE) only paid them $250. I pay nothing out of pocket. Was the cost of the MRI actually $1500, was the imaging center trying to high-ball the price, or was my government-funded insurance being stingy?
Healthcare facilities take a hit on insufficient payments such as from Medicare and Medicaid. I've heard of hospitals having increased volume while losing money due to the increase in Medicare and Medicaid patients. Someone else paying has to make up the difference. Not everyone could get a Medicare rate if the facility is to survive. They've already been known to start cutting different services. Healthcare facilities should be compensated fairly.
A few years ago I had an MRI of my back, I told them I didn't have insurance and wanted the best price.
They said it would be $380, I said, OK let's set a date. They ask can you come back at 9pm.
I had to wait a whole 8 hours for an MRI!!
When I mentioned this to my doc, he said, ya, we have a glut of MRI machines in the area.
I'll never know if the insurance company would have negotiated a better price.
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Geez, didn't we just go through Government Obamacare where we were going to have $2500 decrease in health insurance cost and mine went from $4,300 a year to $11,200 a year for my family. And that is not Obamacare that's private BCBS. I guess some of you haven't heard about $700 hammers and $1,000 toilets to the goverment. And aren't all these drug increases happening under Obamacare?
You could say it happened despite Obamacare, but it would have happened anyway.
Also should hardworking taxpayers be subsidizing healthcare costs for people that have $1,000,000 of Net Worth?
Absolutely. Net worth is NOT income. People should NOT be penalized for saving, and net worth includes your home to boot. In fact, my stash investments alone are considerably more than that, but net worth boosts that number even higher since that includes my home. I certainly plan to use the ACA premium tax credit when I FIRE, maybe CSR as well. I didn't save over $1M to spend it on healthcare insurance! Being a single person, I already paid higher taxes my entire working career, so this will be my chance to get a little bit back from the system.
Just to take the other side, so you have this very nice home as part of your net worth, and you also have a big stash.
But the kid just out of college living in a rental with a fair income should subsidize you.
Just feeling contrary today. :-)
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I had an MRI a few months ago. The bill was for $1500, but my insurance (TRICARE) only paid them $250. I pay nothing out of pocket. Was the cost of the MRI actually $1500, was the imaging center trying to high-ball the price, or was my government-funded insurance being stingy?
Healthcare facilities take a hit on insufficient payments such as from Medicare and Medicaid. I've heard of hospitals having increased volume while losing money due to the increase in Medicare and Medicaid patients. Someone else paying has to make up the difference. Not everyone could get a Medicare rate if the facility is to survive. They've already been known to start cutting different services. Healthcare facilities should be compensated fairly.
A few years ago I had an MRI of my back, I told them I didn't have insurance and wanted the best price.
They said it would be $380, I said, OK let's set a date. They ask can you come back at 9pm.
I had to wait a whole 8 hours for an MRI!!
When I mentioned this to my doc, he said, ya, we have a glut of MRI machines in the area.
I'll never know if the insurance company would have negotiated a better price.
It sounds like you got a better price. The average MRI cost is $2611 (googled). Maybe it was an older outdated MRI machine.
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Geez, didn't we just go through Government Obamacare where we were going to have $2500 decrease in health insurance cost and mine went from $4,300 a year to $11,200 a year for my family. And that is not Obamacare that's private BCBS. I guess some of you haven't heard about $700 hammers and $1,000 toilets to the goverment. And aren't all these drug increases happening under Obamacare?
You could say it happened despite Obamacare, but it would have happened anyway.
Also should hardworking taxpayers be subsidizing healthcare costs for people that have $1,000,000 of Net Worth?
Absolutely. Net worth is NOT income. People should NOT be penalized for saving, and net worth includes your home to boot. In fact, my stash investments alone are considerably more than that, but net worth boosts that number even higher since that includes my home. I certainly plan to use the ACA premium tax credit when I FIRE, maybe CSR as well. I didn't save over $1M to spend it on healthcare insurance! Being a single person, I already paid higher taxes my entire working career, so this will be my chance to get a little bit back from the system.
Just to take the other side, so you have this very nice home as part of your net worth, and you also have a big stash.
But the kid just out of college living in a rental with a fair income should subsidize you.
Just feeling contrary today. :-)
Well, only after I FIRE, and if I can keep my MAGI low enough, which I should be able to do, and assuming the ACA doesn't change, and that's not a certainty, either.
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Not sure if anyone's seen this, but Vox.com has started to collect ER bills from across the US - https://erbills.vox.com/ (https://erbills.vox.com/). For this Canadian, it's been an eye-opening read. The number of families with good insurance who still end up with significant bills for minor visits just blows my mind. I really don't understand why this isn't a bigger issue across the country.
Forget single payer, how hard could it be to legislate price transparency? If there are such things as insurance networks, why not legislate that any charge outside the network must be agreed to up front? How are hospitals within an insurance network allowed to even hire people who are not part of it?
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Americans need a Tommy Douglas.
Not if it leads to a Canadian style system. The US is usually ranked about #37 in regards to healthcare compared to other countries. Canada comes in at #30. No thanks, please give me a system like France or Switzerland that comes in the top five on a consistent basis.
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People should NOT be penalized for saving, and net worth includes your home to boot. In fact, my stash investments alone are considerably more than that, but net worth boosts that number even higher since that includes my home. I certainly plan to use the ACA premium tax credit when I FIRE, maybe CSR as well. I didn't save over $1M to spend it on healthcare insurance! Being a single person, I already paid higher taxes my entire working career, so this will be my chance to get a little bit back from the system.
Presumably this money you will be "getting back" from the system will come from the taxes paid by the children of those families that were paying lower taxes than you during your working life?
In part, yes.
I say this as a single person without children myself. And while it is a little annoying that people receive dramatic tax cuts simply for marrying someone else, it certainly does make sense for us to incentivize people to have at least a few children. Right now birth rates are well below replacement in the USA and have been dropping rapidly* since the 2007/08 economic crash. While both our economy and our ecology could make do with somewhat fewer people than are alive today, trust me that neither you nor I want to live our more elderly years in a country where the population is falling too rapidly.
*Well rapid by demographic standards. In 2008 we were at 2.12 births per woman, we're now at 1.75 births per woman and continuing to fall. Given the current trendline (always a risky way to try to predict the future), we'll be looking at Italy level numbers in another 4-5 years.
I'm not opposed to the way things are now as to tax credits for kids, property tax funding for schools, etc. But I'm not going to feel guilty for legally using a taxpayer subsidized program, either.
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I had an MRI a few months ago. The bill was for $1500, but my insurance (TRICARE) only paid them $250. I pay nothing out of pocket. Was the cost of the MRI actually $1500, was the imaging center trying to high-ball the price, or was my government-funded insurance being stingy?
Healthcare facilities take a hit on insufficient payments such as from Medicare and Medicaid. I've heard of hospitals having increased volume while losing money due to the increase in Medicare and Medicaid patients. Someone else paying has to make up the difference. Not everyone could get a Medicare rate if the facility is to survive. They've already been known to start cutting different services. Healthcare facilities should be compensated fairly.
A few years ago I had an MRI of my back, I told them I didn't have insurance and wanted the best price.
They said it would be $380, I said, OK let's set a date. They ask can you come back at 9pm.
I had to wait a whole 8 hours for an MRI!!
When I mentioned this to my doc, he said, ya, we have a glut of MRI machines in the area.
I'll never know if the insurance company would have negotiated a better price.
It sounds like you got a better price. The average MRI cost is $2611 (googled). Maybe it was an older outdated MRI machine.
Just for comparison purposes, I had an MRI done on my shoulder a few years ago. There was no charge to me, however I had to wait about 5 weeks and my appointment was at 03h00 in the morning.
Now it wasn't an urgent case. So this was probably an example of effective use of our public health dollars.
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Not sure if anyone's seen this, but Vox.com has started to collect ER bills from across the US - https://erbills.vox.com/ (https://erbills.vox.com/). For this Canadian, it's been an eye-opening read. The number of families with good insurance who still end up with significant bills for minor visits just blows my mind. I really don't understand why this isn't a bigger issue across the country.
Forget single payer, how hard could it be to legislate price transparency? If there are such things as insurance networks, why not legislate that any charge outside the network must be agreed to up front? How are hospitals within an insurance network allowed to even hire people who are not part of it?
Are those the original bills or the statements of what people are paying after their insurance discounts it? I've never paid more than $100-200 out of pocket for any medical bills and they've run the gamut from $100 doctor visit to $10,000+ hospital stays. In the case of those ER and hospital bills my insurance has usually paid around 30-40% of the face value of the original bill.
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Americans need a Tommy Douglas.
Not if it leads to a Canadian style system. The US is usually ranked about #37 in regards to healthcare compared to other countries. Canada comes in at #30. No thanks, please give me a system like France or Switzerland that comes in the top five on a consistent basis.
Is that the WHO ranking? That is pretty weighted to efficiency, rather than outcomes. Commonwealth fund puts the US at 11, with France at 10 overall. https://www.commonwealthfund.org/chart/2017/health-care-system-performance-rankings (https://www.commonwealthfund.org/chart/2017/health-care-system-performance-rankings) Canada doesn't come out much better at 9.
In any case it's clear that the US spends a higher percentage of GDP on health care at 16.6%, and in many cases gets worse outcomes. (E.g. infant mortality) Really it depends on what you are looking for. I would never argue that Canada has the best system, but there are no worries about the cost of catastrophic care, or of losing health care access with job loss or poverty.
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Not sure if anyone's seen this, but Vox.com has started to collect ER bills from across the US - https://erbills.vox.com/ (https://erbills.vox.com/). For this Canadian, it's been an eye-opening read. The number of families with good insurance who still end up with significant bills for minor visits just blows my mind. I really don't understand why this isn't a bigger issue across the country.
Forget single payer, how hard could it be to legislate price transparency? If there are such things as insurance networks, why not legislate that any charge outside the network must be agreed to up front? How are hospitals within an insurance network allowed to even hire people who are not part of it?
Are those the original bills or the statements of what people are paying after their insurance discounts it? I've never paid more than $100-200 out of pocket for any medical bills and they've run the gamut from $100 doctor visit to $10,000+ hospital stays. In the case of those ER and hospital bills my insurance has usually paid around 30-40% of the face value of the original bill.
It depends. For each bill they choose they go into detail about what was covered (if anything). There was one recently about a man who had insurance, and actually checked before he had surgery if the hospital was in his network https://www.vox.com/2018/5/23/17353284/emergency-room-doctor-out-of-network (https://www.vox.com/2018/5/23/17353284/emergency-room-doctor-out-of-network). It was, but the surgeon wasn't, so he ended up with a $7,900 bill.
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Not sure if anyone's seen this, but Vox.com has started to collect ER bills from across the US - https://erbills.vox.com/ (https://erbills.vox.com/). For this Canadian, it's been an eye-opening read. The number of families with good insurance who still end up with significant bills for minor visits just blows my mind. I really don't understand why this isn't a bigger issue across the country.
Forget single payer, how hard could it be to legislate price transparency? If there are such things as insurance networks, why not legislate that any charge outside the network must be agreed to up front? How are hospitals within an insurance network allowed to even hire people who are not part of it?
Are those the original bills or the statements of what people are paying after their insurance discounts it? I've never paid more than $100-200 out of pocket for any medical bills and they've run the gamut from $100 doctor visit to $10,000+ hospital stays. In the case of those ER and hospital bills my insurance has usually paid around 30-40% of the face value of the original bill.
It depends. For each bill they choose they go into detail about what was covered (if anything). There was one recently about a man who had insurance, and actually checked before he had surgery if the hospital was in his network https://www.vox.com/2018/5/23/17353284/emergency-room-doctor-out-of-network (https://www.vox.com/2018/5/23/17353284/emergency-room-doctor-out-of-network). It was, but the surgeon wasn't, so he ended up with a $7,900 bill.
I'm not sure if that was a case of having to pay out of network deductible or balance billing, but it takes me back to the balance billing discussion in the ACA thread. The state you are getting care in makes a difference as well:
https://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/msg1983956/#msg1983956
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Dreamfire:
The state you are getting care in makes a difference as well:
I guess almost anywhere in the US you shouldn't go to the doctor until you are in the state of absolute misery.
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Thanks to a helpful relative, i just bought an annual supply of medications from Israel for $180 that was costing me $3,000 here. This is basic and widely used medication, nothing fancy. So ridiculous. We are getting royally **&&%% and can't seem to do anything about it. I hope this is THE issue of the midterm elections.
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It’s not just the drug companies. I had a diagnostic colonoscopy in February (all clear!) and as I have a high-deductible health plan, I received bills from 1) the gastroenterologist who actually performed the procedure ($800), 2) the outpatient surgical center where it was performed ($650), 3) the anesthesiologist ($150), and 4) the nurse anesthetist ($150). The bills came from four different business entities, one of which was out of state.
To me, that is insane. And none of this info was made available before the test.
It's been my experience that your insurance company would negotiate those prices down, ie. here's what we allow you to charge. I have a$10k deductible and have mostly been very pleased with the difference between what is chargeed and what I owe.
These were my out of pocket costs AFTER the insurance negotiations. I don't have the statements in front of me, but I remember that the actual costs pre-negotiation were about $300 higher each for the anesthesiologist and nurse anesthetist.
I just open some mail from BCBS, it is the billing for some blood tests for my yearly checkup.
Three tests, Lipid Panel, PSA and Comprehensive E metabolic, Amount billed $360.90, Amount allowed $29.56.
I don't know what it all means, but I suspect there is some profit for the blood test provider even at $29.56.
That's kinda sick if someone actually had to pay $360.90.
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Americans need a Tommy Douglas.
Not if it leads to a Canadian style system. The US is usually ranked about #37 in regards to healthcare compared to other countries. Canada comes in at #30. No thanks, please give me a system like France or Switzerland that comes in the top five on a consistent basis.
Is that the WHO ranking? That is pretty weighted to efficiency, rather than outcomes. Commonwealth fund puts the US at 11, with France at 10 overall. https://www.commonwealthfund.org/chart/2017/health-care-system-performance-rankings (https://www.commonwealthfund.org/chart/2017/health-care-system-performance-rankings) Canada doesn't come out much better at 9.
In any case it's clear that the US spends a higher percentage of GDP on health care at 16.6%, and in many cases gets worse outcomes. (E.g. infant mortality) Really it depends on what you are looking for. I would never argue that Canada has the best system, but there are no worries about the cost of catastrophic care, or of losing health care access with job loss or poverty.
In Canada the provinces run the health care system, with some financial transfers and coordination from the feds. Not everything is covered. My podiatry treatment and surgery a few years ago was out of pocket, OHIP did not cover it and neither did my private health insurance. I think (could be wrong) that in France and the UK it is federal? Not sure how much difference it would make. And yes, we know our system is not perfect, and we bitch about wait times, but reading stories about American health care costs does have us appreciate our system. I was recently in a discussion with 4 people who have had their gall bladders out, and it was all about healing times, nothing about cost - because they were all covered under OHIP, and their care was paid for with our taxes. And we know it, we do not think it is "free", but it is universal.
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BDTretire:
That's kinda sick if someone actually had to pay $360.90.
Someone did - The insurance company. You did and your employer via premiums.
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I'm just here to complain. I had blood work done, the regular first routine screen, due to some wacky possible amenorrhea. Like, this is the very first thing to do before taking any further steps. The blood draw was for 5 different tests, one of which was to confirm I wasn't pregnant. Spoiler alert: I'm not, I already knew that.
This cost $500 with fair but not great insurance coverage! Not a HDHP! I was shocked at how expensive such a routine procedure was.
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Why is healthcare so expensive?
Here's a non-exhaustive list, in no particular order:
- unnecessary diagnostics ordered by doctors who are paranoid about being sued
- no price transparency for the customer
- prices/payments are tied to amount of services performed, not outcomes
- excessive amount of (potentially unnecessary) time and expense of schooling required for healthcare providers
- lots of middle-men in the process (insurance companies, PBAs, hospital groups "facility fees")
- government laws/regulation that is mostly written as the result of lobbying from insurance and pharma companies
- convoluted tax structures for employer based group coverage vs individual coverage
- profit motive
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This is just pennies in the healthcare mess, but I have 3 examples of ‘mistakes’ (I’m a nobody, and if this happened to us 3 times, that we know of, I would think this happens to many, especially if they do not check their bills)
1. I was going to sit on the couch and read a book to my three kids, all under 4. I sat on my daughter’s elbow, it sort of just hung there, hurting. Took her to the ER, they took an xray, and I was told she dislocated it but on the ride there, it popped back in.
I received a bill for several medical procedures, that included paying for the doctor’s putting the elbow back in place. It was $800. Easy enough to rectify, I made a call, explained what happened, the charges for that procedure were removed.
2. I received a bill in the mail, from a hospital, for brain surgery (this was 20 years before my car accident/traumatic brain injury) It was a little over $10,000. Again, easy to rectify with a phone call because I hadn’t used that hospital in 10 years.
3. I can’t remember the condition, but our doctor had TheHusbandHalf go to the hospital and have an MRI (body trunk). Whatever it was, we and our Dr knew it was a soft tissue problem and would not show up on an xray. Since the Dr had ordered an MRI, that’s what they did. It showed whatever the problem was.
Within a week we got a call from the hospital that our insurance would not pay for the MRI because they require an xray to be done first which is cheaper, to rule out something the xray reveals.
I would have said no because having unnecessary x rays taken is not good, but THH went and had it done. They already told us we would not have to pay for the x ray because it was their mistake to not call the insurance co (they don’t even have to call, it’s right there on the computer using THH’s name) they just could not get reimbursed for the MRI if an x ray had not been taken. It was about $800.
Those are minor examples of mistakes, and pennies compared to the problem, but what about the mistakes that are not caught?
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BDTretire:
That's kinda sick if someone actually had to pay $360.90.
Someone did - The insurance company. You did and your employer via premiums.
Nope! I have $10,000 deductible, the insurance company pays nothing until I spend $10,000.
BCBS negotiates the allowed price with the testing company and I pay that price.
I'm self employed with a private policy I pay for.
I need to check and see what is actually covered, Obamacare, forced some changes on my policy like covering part of a wellness checkup, a colonoscopy every 5 years and birth control.
That was great, since Obamacare my premium went from $4300 to $11,200. /s/
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This is just pennies in the healthcare mess, but I have 3 examples of ‘mistakes’ (I’m a nobody, and if this happened to us 3 times, that we know of, I would think this happens to many, especially if they do not check their bills)
1. I was going to sit on the couch and read a book to my three kids, all under 4. I sat on my daughter’s elbow, it sort of just hung there, hurting. Took her to the ER, they took an xray, and I was told she dislocated it but on the ride there, it popped back in.
I received a bill for several medical procedures, that included paying for the doctor’s putting the elbow back in place. It was $800. Easy enough to rectify, I made a call, explained what happened, the charges for that procedure were removed.
2. I received a bill in the mail, from a hospital, for brain surgery (this was 20 years before my car accident/traumatic brain injury) It was a little over $10,000. Again, easy to rectify with a phone call because I hadn’t used that hospital in 10 years.
3. I can’t remember the condition, but our doctor had TheHusbandHalf go to the hospital and have an MRI (body trunk). Whatever it was, we and our Dr knew it was a soft tissue problem and would not show up on an xray. Since the Dr had ordered an MRI, that’s what they did. It showed whatever the problem was.
Within a week we got a call from the hospital that our insurance would not pay for the MRI because they require an xray to be done first which is cheaper, to rule out something the xray reveals.
I would have said no because having unnecessary x rays taken is not good, but THH went and had it done. They already told us we would not have to pay for the x ray because it was their mistake to not call the insurance co (they don’t even have to call, it’s right there on the computer using THH’s name) they just could not get reimbursed for the MRI if an x ray had not been taken. It was about $800.
Those are minor examples of mistakes, and pennies compared to the problem, but what about the mistakes that are not caught?
My son was hit by a hit and run bicyclist, knocked unconscious for a short time, someone found him, called an ambulance that took him to the emergency room. When the bill came I started looking over billing codes. The just over 1" laceration that was sutured, was coded as a 3" laceration.
I didn't fight the issue, just glad he was OK. But my daughter stopped to see him the next day, she report to me that he was in worse condition than he was letting on. He had small cuts, scratches and bruises on several areas
of his body. She had to clean him up, because the hospital left him with blood mated hair, took also cleaned up the minor wounds.
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I had an MRI a few months ago. The bill was for $1500, but my insurance (TRICARE) only paid them $250. I pay nothing out of pocket. Was the cost of the MRI actually $1500, was the imaging center trying to high-ball the price, or was my government-funded insurance being stingy?
Healthcare facilities take a hit on insufficient payments such as from Medicare and Medicaid. I've heard of hospitals having increased volume while losing money due to the increase in Medicare and Medicaid patients. Someone else paying has to make up the difference. Not everyone could get a Medicare rate if the facility is to survive. They've already been known to start cutting different services. Healthcare facilities should be compensated fairly.
A few years ago I had an MRI of my back, I told them I didn't have insurance and wanted the best price.
They said it would be $380, I said, OK let's set a date. They ask can you come back at 9pm.
I had to wait a whole 8 hours for an MRI!!
When I mentioned this to my doc, he said, ya, we have a glut of MRI machines in the area.
I'll never know if the insurance company would have negotiated a better price.
You all got better deals than I did. I had two MRIs recently and my bill was $2000. The total bill from the hospital was something like $11,000, so my insurance paid about $9,000.
I had no idea what they were going to cost going in. That only seems to happen in the medical industry, and it drives me nuts. A doctor tells you to have a procedure, but he has no idea what it will cost. You call the hospital and they tell you to call your insurance company. You call them, and they say it depends on how it's coded. No one can give you a straight answer.
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FWIW just talked to a co-worker that went to Germany for back surgery for three new discs. In the states it would've cost insurance roughly $450,000. It came with a second gen medical implant that severely restricted movement. 50% probability of slight recovery and 50% chance of "you won't improve". The newest generation is not FDA approved because the maker of the 2nd gen one keeps suing the maker of the 3rd gen (made in CA) and the FDA will not approve with pending lawsuits.
Went to Germany, got a lifetime warranty on the procedure if he were to ever have issues, implants last >25 years, and the surgeon gave him a 97% chance of "full recovery like he was young again". He's good and has full range of movement. No limitations on lifestyle. Third gen implant from the US. $50k.
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This is just pennies in the healthcare mess, but I have 3 examples of ‘mistakes’ (I’m a nobody, and if this happened to us 3 times, that we know of, I would think this happens to many, especially if they do not check their bills)
1. I was going to sit on the couch and read a book to my three kids, all under 4. I sat on my daughter’s elbow, it sort of just hung there, hurting. Took her to the ER, they took an xray, and I was told she dislocated it but on the ride there, it popped back in.
I received a bill for several medical procedures, that included paying for the doctor’s putting the elbow back in place. It was $800. Easy enough to rectify, I made a call, explained what happened, the charges for that procedure were removed.
2. I received a bill in the mail, from a hospital, for brain surgery (this was 20 years before my car accident/traumatic brain injury) It was a little over $10,000. Again, easy to rectify with a phone call because I hadn’t used that hospital in 10 years.
3. I can’t remember the condition, but our doctor had TheHusbandHalf go to the hospital and have an MRI (body trunk). Whatever it was, we and our Dr knew it was a soft tissue problem and would not show up on an xray. Since the Dr had ordered an MRI, that’s what they did. It showed whatever the problem was.
Within a week we got a call from the hospital that our insurance would not pay for the MRI because they require an xray to be done first which is cheaper, to rule out something the xray reveals.
I would have said no because having unnecessary x rays taken is not good, but THH went and had it done. They already told us we would not have to pay for the x ray because it was their mistake to not call the insurance co (they don’t even have to call, it’s right there on the computer using THH’s name) they just could not get reimbursed for the MRI if an x ray had not been taken. It was about $800.
Those are minor examples of mistakes, and pennies compared to the problem, but what about the mistakes that are not caught?
My son was hit by a hit and run bicyclist, knocked unconscious for a short time, someone found him, called an ambulance that took him to the emergency room. When the bill came I started looking over billing codes. The just over 1" laceration that was sutured, was coded as a 3" laceration.
This is probably pretty common. Something similar happened to me and I contacted the insurance company about it. They didn't care. After many faxes (!) and emails and letters, the provider finally backed down.
It's almost as if the insurance company makes as much money whether they pay a provider $5000 or $7500.*
* Yes, I realize that this is indeed what occurs. Insurance takes their 20% cut and everyone but the patient is happy.
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3. I can’t remember the condition, but our doctor had TheHusbandHalf go to the hospital and have an MRI (body trunk). Whatever it was, we and our Dr knew it was a soft tissue problem and would not show up on an xray. Since the Dr had ordered an MRI, that’s what they did. It showed whatever the problem was.
Within a week we got a call from the hospital that our insurance would not pay for the MRI because they require an xray to be done first which is cheaper, to rule out something the xray reveals.
I would have said no because having unnecessary x rays taken is not good, but THH went and had it done. They already told us we would not have to pay for the x ray because it was their mistake to not call the insurance co (they don’t even have to call, it’s right there on the computer using THH’s name) they just could not get reimbursed for the MRI if an x ray had not been taken. It was about $800.
I see this all the time. My career has rewarded me with a list of injuries that have required MRIs, CT scans, and physical therapy. Before I was authorized to do any of that I had to get an x-ray. Out of two shoulder injuries, a neck injury, a hip injury, and two knee injuries, only one of those showed up or even would have shown up on an x-ray. The x-ray was the prerequisite to the MRI or the therapy sessions every single time. On the flip side, my very first knee injury was misdiagnosed for 6 months because the clinic (doctor or insurance I can't say) would not authorize an MRI until I had gone through a specific number of therapy sessions. At the end when it wasn't doing any good I got the exam and they discovered the damage was so severe that surgery was always going to be the solution.
Since I have to move every two years, I have to restart treatment with different clinics a lot - most of the time from scratch, and always beginning with medications and x-rays.
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BTDretire:
That was great, since Obamacare my premium went from $4300 to $11,200. /s/
Premiums were going up fast prior to Obamacare. Is there a definite cause and effect between the passing of the ACA and the raising of your premium. I have read that thee is nothing in the ACA that will control prices.
After hearing of drug companies buying out a small drug company so that they can greatly raise the price of a specific drug that will keep a few people alive, it doesn't seem out of bounds that premiums may be going up due to pure old fashioned greed.
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Thanks to a helpful relative, i just bought an annual supply of medications from Israel for $180 that was costing me $3,000 here. This is basic and widely used medication, nothing fancy. So ridiculous. We are getting royally **&&%% and can't seem to do anything about it. I hope this is THE issue of the midterm elections.
Wow. Insane.
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BTDretire:
That was great, since Obamacare my premium went from $4300 to $11,200. /s/
Premiums were going up fast prior to Obamacare. Is there a definite cause and effect between the passing of the ACA and the raising of your premium. I have read that thee is nothing in the ACA that will control prices.
After hearing of drug companies buying out a small drug company so that they can greatly raise the price of a specific drug that will keep a few people alive, it doesn't seem out of bounds that premiums may be going up due to pure old fashioned greed.
The ACA does include cost controls. I assume BTDretire's premiums have gone up significantly because he's not getting the PCT, or he's just excluding it from his figure, and unsubsidized premiums have gone up significantly in some markets, in part due to sabotage from the republicans.
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well because it's a quality one
Nope.
https://politicsmaven.io/theintellectualist/news/u-s-healthcare-ranked-worst-in-the-developed-world-Lf4vxMmXZ02Jwpf8_9_aTQ/
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BTDretire:
That was great, since Obamacare my premium went from $4300 to $11,200. /s/
Premiums were going up fast prior to Obamacare. Is there a definite cause and effect between the passing of the ACA and the raising of your premium. I have read that thee is nothing in the ACA that will control prices.
After hearing of drug companies buying out a small drug company so that they can greatly raise the price of a specific drug that will keep a few people alive, it doesn't seem out of bounds that premiums may be going up due to pure old fashioned greed.
Yep. I think folks have short memories and/or don't understand healthcare premiums were rising rapidly before the ACA was passed. And there are mixed outcomes. For instance, many low income folks who were having to pay outrageous prices for premiums, saw a significant drop in their premiums. I have a family member who just stopped paying because they really couldn't afford the premiums and still afford even the most basic necessities to live. After the ACA they could finally afford health insurance. I myself, saw literally no change in my employer sponsored healthcare premiums even after the ACA was passed. And some folks saw some major increases.
I will say for the flaws that still existed in the ACA, it was a step in the right direction to get everyone covered.
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BTDretire:
That was great, since Obamacare my premium went from $4300 to $11,200. /s/
Premiums were going up fast prior to Obamacare. Is there a definite cause and effect between the passing of the ACA and the raising of your premium. I have read that thee is nothing in the ACA that will control prices.
I know there was, they can't give away a physical, colonoscopy, birth control, more mental healthcare and drug treatment and not charge more for it. ( I think all of those things were forced on my private policy by Obamacare)
I had been getting 7% and 8%increases per year until Obamacare started, then I got an 18.4% increase, the next year it was 19.2% and then a 24.2% increase, after that it dropped down to a 9% increase.
After hearing of drug companies buying out a small drug company so that they can greatly raise the price of a specific drug that will keep a few people alive, it doesn't seem out of bounds that premiums may be going up due to pure old fashioned greed.
Yes, there are some problems in that area.
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BTDretire:
Yes, there are some problems in that area.
Great wording - Reminds me of "collateral damage" or "right to work state" or even I dare say, "free market."
Then there is "death tax" for inheritance tax and the "death panel."
Well, as long as we have "free market" insurance, you can shop around for a better price,...........right.
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US doctors start off making about 4X their UK counterparts; and it goes up from there.
Then again, given the level of stress and work, I don't think I want the med student who now only makes $80k to be cutting me open...
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Probably because the USA as a society has accepted the idea that healthcare is a for profit commodity and the for profit corporations know that most people are likely to pay any asking price for the promise of fixing whatever ails them.
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US doctors start off making about 4X their UK counterparts; and it goes up from there.
Then again, given the level of stress and work, I don't think I want the med student who now only makes $80k to be cutting me open...
Medscape UK salary report:
GP (general practitioner, equivalent to Family or Internal Medicine in US):
Mean 104k pounds
Family Medicine in US
Mean $220k = 166 UK pounds
US physicians make 1.6x the UK physicians' salaries. However, physicians in the US have to deal with significantly more insurance-related paperwork and work longer non-patient care hours per week as a result. It's not 60% more, so we are a bit more highly compensated. However, it's not 400%.
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US doctors start off making about 4X their UK counterparts; and it goes up from there.
Then again, given the level of stress and work, I don't think I want the med student who now only makes $80k to be cutting me open...
Medscape UK salary report:
GP (general practitioner, equivalent to Family or Internal Medicine in US):
Mean 104k pounds
Family Medicine in US
Mean $220k = 166 UK pounds
US physicians make 1.6x the UK physicians' salaries. However, physicians in the US have to deal with significantly more insurance-related paperwork and work longer non-patient care hours per week as a result. It's not 60% more, so we are a bit more highly compensated. However, it's not 400%.
Yes and in the UK the education is mostly state funded. Medical education also starts right out of high school (after A levels at 18.. Normal kids "graduate" high school at 16). So you do't have to go get the bachelors degree as a pre-requisite.
I know this because my Niece is in medical school in the UK. I also have physician friends here in the US with school loans in the +$300k range. My Niece will have to spend about $15k on her entire education.
Side note.. I would have LOVED to ave had the opportunity to be a Doctor but that opportunity simply didn't present itself to me in the 1980's Britain. So I became an engineer instead.. I still wonder "what if" even today..:)
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Exflyboy:
I also have physician friends here in the US with school loans in the +$300k range
It looks like the way they do the doctor training may be better as well. I wonder if the cost of medical training is inflated like the medical treatment and the drugs. If the system was overhauled, could more doctors be trained at less cost? This could mean that they could actually spend time with the patient. When I go to the doctor for a checkup, all of the actual work seems to be done by others.
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US doctors start off making about 4X their UK counterparts; and it goes up from there.
Then again, given the level of stress and work, I don't think I want the med student who now only makes $80k to be cutting me open...
Medscape UK salary report:
GP (general practitioner, equivalent to Family or Internal Medicine in US):
Mean 104k pounds
Family Medicine in US
Mean $220k = 166 UK pounds
US physicians make 1.6x the UK physicians' salaries. However, physicians in the US have to deal with significantly more insurance-related paperwork and work longer non-patient care hours per week as a result. It's not 60% more, so we are a bit more highly compensated. However, it's not 400%.
Yes and in the UK the education is mostly state funded. Medical education also starts right out of high school (after A levels at 18.. Normal kids "graduate" high school at 16). So you do't have to go get the bachelors degree as a pre-requisite.
I know this because my Niece is in medical school in the UK. I also have physician friends here in the US with school loans in the +$300k range. My Niece will have to spend about $15k on her entire education.
Side note.. I would have LOVED to ave had the opportunity to be a Doctor but that opportunity simply didn't present itself to me in the 1980's Britain. So I became an engineer instead.. I still wonder "what if" even today..:)
Ha, I had come home from an overnight call and completely forgot to include the opportunity cost part of it in the equation. My loans are paid off, but many of my friends who graduated at the same time are still paying them. Thanks for noting that.
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US doctors start off making about 4X their UK counterparts; and it goes up from there.
Then again, given the level of stress and work, I don't think I want the med student who now only makes $80k to be cutting me open...
Medscape UK salary report:
GP (general practitioner, equivalent to Family or Internal Medicine in US):
Mean 104k pounds
Family Medicine in US
Mean $220k = 166 UK pounds
US physicians make 1.6x the UK physicians' salaries. However, physicians in the US have to deal with significantly more insurance-related paperwork and work longer non-patient care hours per week as a result. It's not 60% more, so we are a bit more highly compensated. However, it's not 400%.
Yes and in the UK the education is mostly state funded. Medical education also starts right out of high school (after A levels at 18.. Normal kids "graduate" high school at 16). So you do't have to go get the bachelors degree as a pre-requisite.
I know this because my Niece is in medical school in the UK. I also have physician friends here in the US with school loans in the +$300k range. My Niece will have to spend about $15k on her entire education.
Side note.. I would have LOVED to ave had the opportunity to be a Doctor but that opportunity simply didn't present itself to me in the 1980's Britain. So I became an engineer instead.. I still wonder "what if" even today..:)
Ha, I had come home from an overnight call and completely forgot to include the opportunity cost part of it in the equation. My loans are paid off, but many of my friends who graduated at the same time are still paying them. Thanks for noting that.
I still think you have the best job in the World so even at $300k I would have done it. Of course being FIRED thats easy for me to say now. As a starving med student watching the bills rack up at 7.5% I might have a slightly different view..:)
Note my UK engineering education was also state funded, a number of young engineers working for me in my last grown up job (US) had school loans pushing $100k.
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The short answer to your question @pecunia is yes, we could be more efficient in training MDs. The US takes eight years from high school graduation to the awarding of a MD/DO, while most other first world countries (the german system is the one I am most familiar with) manage the same training in six years.
The biggest difference is that medicine in most countries is something you go straight into out of high school (like a trade school), while in the USA we ask potential med students to first get a regular 4 year college degree, and only then divert them to specialized and dedicated medical training.
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The biggest difference is that medicine in most countries is something you go straight into out of high school (like a trade school), while in the USA we ask potential med students to first get a regular 4 year college degree, and only then divert them to specialized and dedicated medical training.
It would be somewhat interesting as to whether the doctors think the extra two years was a good use of time. I assume the added training is in things like music appreciation, Sociology, US history, etc. that are not needed for one's career as a physician but valuable as a human being.
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The biggest difference is that medicine in most countries is something you go straight into out of high school (like a trade school), while in the USA we ask potential med students to first get a regular 4 year college degree, and only then divert them to specialized and dedicated medical training.
It would be somewhat interesting as to whether the doctors think the extra two years was a good use of time. I assume the added training is in things like music appreciation, Sociology, US history, etc. that are not needed for one's career as a physician but valuable as a human being.
You have to be kidding me right?.. Extra 4 years (not 2) of school loans and also not earning any money.. Complete waste of time and $$.
Then again this is coming from a Brit where we consider the ONLY reason to go to University in the first place is to study for the career we are training for. The concept of the "college experience" is not in our vocabulary. At least it wasn't in my generation.. I suspect it might be a little different now.
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I think it is 2 years. Dedicated med school only takes four years in the USA after a 4 year college degree, 6 years for med school out of high school in Germany.
Or is the British system 4 years total? (I've no exposure to medical training in the UK.) If so, that suggests the american approach to turning out MDs is even more over designed than I realized.
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Already mentioned briefly a few times but:
https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557
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Oh I see.. No you're right.. The British system is 6 years.
But then thats 6 years of dedicated medical training.. How then does the US system turn out a Dr in only 4 years after a bachelors in basket weaving?
I assume the feeder degree is required to be in a STEM field??
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Oh I see.. No you're right.. The British system is 6 years.
But then thats 6 years of dedicated medical training.. How then does the US system turn out a Dr in only 4 years after a bachelors in basket weaving?
I assume the feeder degree is required to be in a STEM field??
Not required, but it tends to work out that way. You take a test with lots of questions on physics, chemistry, and biology (the MCAT) and the scores on that are a big part of your application to med schools. So technically you could major in anything you want and you might still get into med school, but most pre-meds major in biology or something similar.
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Oh I see.. No you're right.. The British system is 6 years.
But then thats 6 years of dedicated medical training.. How then does the US system turn out a Dr in only 4 years after a bachelors in basket weaving?
I assume the feeder degree is required to be in a STEM field??
Yes, they take a lot of biology, anatomy, and some chemistry as a pre-med undergraduate student. Not all of that the year degree is BS.
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Oh I see.. No you're right.. The British system is 6 years.
But then thats 6 years of dedicated medical training.. How then does the US system turn out a Dr in only 4 years after a bachelors in basket weaving?
I assume the feeder degree is required to be in a STEM field??
Yes, they take a lot of biology, anatomy, and some chemistry as a pre-med undergraduate student. Not all of that the year degree is BS.
My undergrad degree is in biochem, and many of my classmates were pre-med. Our coursework included vertebrate anatomy, physiology, microbiology, molecular bio, genetics, organic chemistry, biochemistry, analytical chemistry, and physical chemistry, plus labs. Some of the possible electives included classes like immunology and human anatomy. That time wasn't wasted for the pre-med majors.
I do see the value in protracted professional programs. One of my cousins went through a 5-year physician assistant program (undergrad + masters) at my undergrad alma mater, which also offered a 6-year dental program (undergrad + DDS). I suspect MD could also be compressed into 6 years without a loss of essential coursework.
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Thanks to a helpful relative, i just bought an annual supply of medications from Israel for $180 that was costing me $3,000 here. This is basic and widely used medication, nothing fancy. So ridiculous. We are getting royally **&&%% and can't seem to do anything about it. I hope this is THE issue of the midterm elections.
Agree. "According to a column in the Los Angeles Times, Lilly began selling Humalog in the mid-1990s at $21 per vial. But since then, the company has substantially raised the price of Humalog, its insulin product. According to The Nation, the price of a vial of this insulin went up to nearly $270 from $74 over the 10 years that Azar worked at Eli Lilly." from Newsweek, http://www.newsweek.com/man-turning-diabetes-unaffordable-put-charge-americas-health-719824
In London a few weeks ago, I thought I would research the price of insulin. The price of a box of Tresiba insulin in London is about $100 in U.S. dollars. In the U.S., that same box of insulin is more than $500 at a DISCOUNT pharmacy. Without insulin, Type 1 diabetics die. Type 1 diabetics can eat right, exercise, and will never be able to live without insulin, because their pancreas cannot produce insulin. Without good health care and expensive medications, diabetics become disabled. They lose their eyesight and lose limbs to amputation. It is VERY short sighted to put people like that on high-deductible insurance plans. How many middle-class people have $10,000 a year available to them for premiums and then another $10,000 a year for the deductible? And, it seems that the Republicans are continually trying to remove the protection for people with pre-existing health conditions to be able to buy insurance at all, at any price. Bankruptcy is a very real fear for some of us. (And, many people in the 50 to 65 age-range have tried desperately to get employment with good health insurance, to no avail.)
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From Doug Ules article:
And when economists like me look at medicine in America – whether we lean left or right politically – we see something that looks an awful lot like a cartel.
I wonder how many doctors are anti union.
n the United States, the supply of doctors is tightly controlled by the number of medical school slots, and more importantly, the number of medical residencies.
In recent years, the number of medical residents has become so restricted that even the American Medical Association is pushing to have the number of slots increased. The major obstacle at this point is funding. It costs a teaching hospital roughly $150,000 a year for a residency slot. Most of the money comes from Medicare, with a lesser amount from Medicaid and other government sources.
Huh! The government is subsidizing medical education.
Will the supply of doctors follow "market rules" for other commodities? If there were more doctors would it help decrease medical costs?
Seems like a good use of government money educating people who save the lives of others. If there were lots of doctors and they were sent overseas to help people, it could even generate more good will than those wars in the Middle East.
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If there were lots of doctors and they were sent overseas to help people, it could even generate more good will than those wars in the Middle East.
Doctors Without Borders/Médecins Sans Frontiers already exists. Also Hydro-geologists Without Borders.
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Seems like a good use of government money educating people who save the lives of others. If there were lots of doctors and they were sent overseas to help people, it could even generate more good will than those wars in the Middle East.
[/quote]
Cuba has long sent teams of Drs to assist in other countries all around the world, despite being far from rich as a nation.
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What you mean the Yemenies picking up parts of cluster bombs with "proudly made in the USA" after they leveled their neighbourhood.. You mean that DOESN'T win hearts and minds?
Gosh!
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PHysician salaries made up 10% of total healthcare costs in the US in 2008. Since then wages have stagnated to slightly decreased while spending has increased substantially. Like everyone else, physician income have gone down when adjusted for inflation. Thus decreasing wages further would have a small effect on total healthcare spending. You will have a decrease in good candidates once physician salaries drop below or equal to other fields requiring advanced training, due to the added stressors associated with being a physician. However, there are much larger fish to fry. I would start with unnecessary drug spending and hospitalization for futile ICU care, which approaches 30% of all spending by Medicare and a slightly lower amount for private insurers. That’s much less popular, despite likely being more effective, because of the optics. Remember death panels killing grandma? However, that is a major component of all other developed countries semi-socialized healthcare systems.
Regarding “cartels” - physicians are a cartel only as much as any field that self-accredidates is. Thus most professional fields are cartels by the economic definition. The AMA has tried to expand residencies to increase the supply and is very worried about the decrease in physicians as older ones retire. However, unlike most cartels, physicians do not “fix” their prices, they are very aggressively negotiated by insurance companies.
TLDR: physician salaries are a small and decreasing fraction of healthcare cost in the US. If physicians are a cartel, they are a very ineffective one. This trend will likely continue due to competitive pressures from other sectors of the healthcare industry. Cost savings will be higher with other, less popular, means.
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Remember death panels killing grandma? However, that is a major component of all other developed countries semi-socialized healthcare systems.
Huh? The elderly are not hung out in the wind, end of life care is a good chunk of our costs too. I've seen our health care system do everything it could for both of my elderly parents in the last years of their lives. I've seen the health care system support my aging friends. And we do get old, Canadians on average live longer than Americans. At the other end of life, having a baby costs nothing, no hospital fees. I was shocked the first time someone on the forums posted how much her delivery cost.
Can't find the source at the moment, but I remember reading that a lot of our savings is less paperwork, plus people get health care sooner so the treatment cost is less because they are not as sick when they start treatment, plus drug costs are much less because of one purchaser negotiating. OHIP doesn't cover everything, the rest is out of pocket or private insurance.
You may have noticed that all the angsty posts and threads on the forums about retirement and health care are from Americans. Think of the peace of mind public health care would bring to your fellow Americans. And it is not "free", we all know we are paying for it through our taxes. There is no reason your individual states couldn't run it just like our individual provinces do.
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Retiredat63:
You may have noticed that all the angsty posts and threads on the forums about retirement and health care are from Americans. Think of the peace of mind public health care would bring to your fellow Americans. And it is not "free", we all know we are paying for it through our taxes. There is no reason your individual states couldn't run it just like our individual provinces do.
High taxes up there. Gas costs a lot. However, facts and figures show that health care is less expensive per capita and more complete. Given the fact that some people have NO health care, it certainly does seem like it would be an improvement for the common welfare.
Abe:
However, unlike most cartels, physicians do not “fix” their prices, they are very aggressively negotiated by insurance companies.
I guess because the prices are not "fixed" is one reason you can never get a clean answer as to what something will cost when you visit a clinic. They tell me, "Why do you ask? You have insurance." Right. I have premiums too.
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Retiredat63:
You may have noticed that all the angsty posts and threads on the forums about retirement and health care are from Americans. Think of the peace of mind public health care would bring to your fellow Americans. And it is not "free", we all know we are paying for it through our taxes. There is no reason your individual states couldn't run it just like our individual provinces do.
High taxes up there. Gas costs a lot. However, facts and figures show that health care is less expensive per capita and more complete. Given the fact that some people have NO health care, it certainly does seem like it would be an improvement for the common welfare.
Taxes - someone somewhere on the forums did an analysis of their taxes and health care premiums after moving from Canada to the US. Ended up a wash. Lower taxes, higher health care costs after the move. Six of one, half a dozen of the other. But I like the idea that everyone has access to health care, just like everyone has access to education. I pay lots of taxes, and I am happy that I am supporting those things.
Gas - should cost a lot. Higher prices lower consumption, so less driving and at slower speeds in smaller vehicles, which is good. Those trucks that give off huge smoke (what is it, rolling coal or something?) I have never seen here, too much waste. Not to mention less CO2 in the air. Most European countries pay a lot more than we do.
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Healthcare in the US is so expensive because of our culture's hyper obsession with the "free market" and profit over people.
Healthcare and insurance companies buy politicians so there are no sensible laws about price caps passed ever. This allows companies to price gouge people at their most vulnerable and charge sky high prices because there often is no real choice.
If I came into an area hit by a natural disaster and started charging sky high prices for necessary items like water and food, that would be price gouging and illegal. But if I am big Pharma and do the same thing by charging a cancer patient sky high prices for chemotherapy, that is ok. If you suggest otherwise in our culture, people from the right immediately accuse you of being a socialist that wants to destroy this country.
Case in point:
My teenage son has cancer. We have had more than $2 Million in medical expenses for the past 2 years. One of the drugs he takes at home (a pill that requires no medical staff or equipment to administer) costs $11,000 per month. There is no generic. Our free market choice is to give it to him or let his cancer grow out of control and most likely kill him.
The research for this drug was largely funded by the taxpayers. The CEO of the company that makes it received $18 Million in compensation for just 2017.
Now we don't actually pay $11K per month for it - it is covered by insurance, so we all pay for this.
But to many people, especially those from the supposedly "pro-life" (as long as you are still an embryo, unfortunately my son is past that stage) "all lives matter" (as long as you aren't disabled) and "family values" party, they think it will be the downfall of the nation if we pass a law that prohibits healthcare companies from taking advantage of sick kids to financially rape the system.
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@CindyBS , I agree completely. I worked for over 40 years in healthcare in countries with competent public health systems. It is fundamentally an ideological decision about supporting your whole population to access a reasonable level of care.
As far as I am aware no country that has so called "socialised medicine" has any popular movement to dismantle it.
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One of the drugs he takes at home (a pill that requires no medical staff or equipment to administer) costs $11,000 per month. There is no generic. ... The research for this drug was largely funded by the taxpayers.
Completely agree healthcare for life threatening conditions is inherently not a "free" market.
However I'm curious which drug this is. Is the name something you'd be comfortable sharing?
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One of the drugs he takes at home (a pill that requires no medical staff or equipment to administer) costs $11,000 per month. There is no generic. ... The research for this drug was largely funded by the taxpayers.
Completely agree healthcare for life threatening conditions is inherently not a "free" market.
However I'm curious which drug this is. Is the name something you'd be comfortable sharing?
Drug is called Dasatinib, sold under the brand name Sprycel. It is for a rare, aggressive type of leukemia.
Here is the wikipedia on it and an excerpt (bolded parts my emphasis):
https://en.wikipedia.org/wiki/Dasatinib
"The Union for Affordable Cancer Treatment objected to the price of dasatinib, in a letter to the U.S. trade representative. The average wholesale price in the U.S. is $367 per day, twice the price in other high income countries. The price in India, where the average annual per capita income is $1,570, and where most people pay out of pocket, is Rs6627 ($108) a day. Indian manufacturers offered to supply generic versions for $4 a day, but, under pressure from the U.S., the Indian Department of Industrial Policy and Promotion refused to issue a compulsory license.[4]
Bristol-Myers Squibb justified the high prices of cancer drugs with the high R&D costs, but the Union of Affordable Cancer Treatment said that most of the R&D costs came from the U.S. government, including National Institutes of Health funded research and clinical trials, and a 50% tax credit. In England and Wales, the National Institute for Health and Care Excellence recommended against dasatinib because of the high cost-benefit ratio.[4]
The Union for Affordable Cancer Treatment said that "the dasatinib dispute illustrates the shortcomings of US trade policy and its impact on cancer patients"[4"
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Retiredat63:
You may have noticed that all the angsty posts and threads on the forums about retirement and health care are from Americans. Think of the peace of mind public health care would bring to your fellow Americans. And it is not "free", we all know we are paying for it through our taxes. There is no reason your individual states couldn't run it just like our individual provinces do.
High taxes up there. Gas costs a lot. However, facts and figures show that health care is less expensive per capita and more complete. Given the fact that some people have NO health care, it certainly does seem like it would be an improvement for the common welfare.
Abe:
However, unlike most cartels, physicians do not “fix” their prices, they are very aggressively negotiated by insurance companies.
I guess because the prices are not "fixed" is one reason you can never get a clean answer as to what something will cost when you visit a clinic. They tell me, "Why do you ask? You have insurance." Right. I have premiums too.
They usually can give a list price if you pay out of pocket, which tells you at least the high end of the cost (since insurance companies always negotiate lower prices) but that doesn't really answer what an insured person is going to be billed.
The main reason a lot of places don't give clear prices on routine things is usually due to a non-disclosure agreement with insurance companies. For example, if my hospital has a contract with Insurance A, they will agree that X lab costs $Y for those patients with Z diagnosis, and the patients will owe W% of the cost. Generally patients will know what the W% is, but not the other numbers.
The contract almost always says you cannot disclose the cost because then:
1) people from Insurance B will find out and say "hey, why is Anthem paying $Y+5 ?!" and potentially switch to Insurance A
2) people from Insurance A through Z will realize they are paying significantly more in premiums than they are getting back
3) people at that hospital may go to a different one with a cheaper negotiated payment if they care how much the insurance company is paying (above their out of pocket expenses)
It's nuts, but the only other option is for the hospital to not take those patients' insurance, because, in general, the hospital system is usually a much smaller corporate entity than the insurance company. Generally what happens if the hospital balks and wants to be paid more is the insurance company no longer will pay for anything at that hospital (make them out-of-network). There are usually more hospitals than insurance companies in a given area.
Now, this generally matters to you if the insurance company refuses to pay because they didn't think that the test was necessary for a given disease / diagnosis. This happens a lot, and then there's much arguing back and forth. A good example I have is with patients who have high-risk cancers. Sometimes I will want to get a CT. If national guidelines indicate a CT is necessary, almost all the companies will pay without question and the patient only has the co-pay. They may specify it has to be done with a contracted imaging company, the cancer diagnosis confirmed by their physicians, etc. However, if these steps aren't followed exactly, they may refuse to pay any portion and the patient gets the whole bill (often without the physician even knowing). Even worse, if the guidelines say "consider a CT" or don't mention it at all, almost no insurance company will pay without an argument (called a "face-to-face" in the jargon - apparently people talked in person before computers). They may then agree to pay with certain stipulations like above, or just refuse entirely. Then the patient either pays all of it or forgoes the test. Either way only the insurance company wins.
Now, there are fraudulent practices by physicians and hospitals that the insurance companies are doing all of the above to prevent, so it goes both ways with the paperwork. This would be fixed in large part of physicians were salaried and hospitals were nationalized (like in a lot of other countries).
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This is why the golden words need to be uttered before you as a patient agree to ANY treatment..
"Is it PRE-APPROVED"?
I will not get any test or accept any procedure unless I hear it is pre-approved by my insurance company.. I really don't care if I'm considered to be a PITA.
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Abe:
The contract almost always says you cannot disclose the cost because then:
1) people from Insurance B will find out and say "hey, why is Anthem paying $Y+5 ?!" and potentially switch to Insurance A
2) people from Insurance A through Z will realize they are paying significantly more in premiums than they are getting back
3) people at that hospital may go to a different one with a cheaper negotiated payment if they care how much the insurance company is paying (above their out of pocket expenses)
This reminds me of ragged merchants bantering back and forth in the desert over the proper price to pay for a melon. The difference is that they are bartering with people's lives. Sort of disgusting.
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Abe:
The contract almost always says you cannot disclose the cost because then:
1) people from Insurance B will find out and say "hey, why is Anthem paying $Y+5 ?!" and potentially switch to Insurance A
2) people from Insurance A through Z will realize they are paying significantly more in premiums than they are getting back
3) people at that hospital may go to a different one with a cheaper negotiated payment if they care how much the insurance company is paying (above their out of pocket expenses)
This reminds me of ragged merchants bantering back and forth in the desert over the proper price to pay for a melon. The difference is that they are bartering with people's lives. Sort of disgusting.
"Sort of"?... How about "Is!"?
We already know that some people simply can't afford HC. But thats OK, if you have more than say $2M on the stock market you will make more from the HC cartel than you will ever pay,.. Way more if you have $10M+
It really is disgusting!