Author Topic: The problem with our healthcare  (Read 7537 times)

EnjoyIt

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The problem with our healthcare
« on: March 07, 2017, 07:57:15 AM »
There is no conversation about the cost of care, we only talk about who will pay for it.  It makes no difference if it is Obamacare or Trumpcare.  In the long run the system is fucked because the cost is too high.  Too much bureaucracy in our healthcare.  Until we have complete transparency in cost, decrease regulatory waste, and remove the insurance middleman from most medical issues, the cost will continue to rise. There is no reason why gauze should cost $50 dollars at a hospital and $3 at a pharmacy.  There is no reason why a physician can't tell their patient how much a procedure will cost because it varies by different insurance companies.

I just looked at Anthem and they made $18 billion last year and another $18 billion in 2015. Interestingly they made $14 billion in 2013 so Obamacare is great for the insurance companies. I'm sure blue cross and the other players are not that far off.  These companies are like dirty bookies skimming cash from the top increasing the cost of healthcare for everyone.  I just looked at the balance sheet for a large non for profit hospital system in my area.  According to their figures Medicare/Medicaid together cover about 81% of what it costs to care for those patients.  If every patient was on government insurance, that hospital would be out of business. Therefor single payer is not the answer either.  The cost of care needs to come down and it must happen soon.  The system is imploding and it makes no difference which president cares the most.

We need to stop talking about who will pay and start talking about how much we all pay.

ltt

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Re: The problem with our healthcare
« Reply #1 on: March 07, 2017, 09:01:20 AM »
Yes, agree very much.  There shouldn't be a "co-pay" if I can simply walk into the doctor for an office visit, pay him directly, and not have to run anything through insurance.  I simply pay him the $20 or $30 or whatever he/she would charge.  I don't need it to be run through insurance.  Because realistically, a doctor visit is not worth $100 that is charged---it's because insurance is in the middle of it trying to make their profit.

Insurance companies are in the business to make money, and somehow have managed to wedge themselves into the hospital/doctor/patient relationship.  I've never seen anything like it in all my years alive.

What I do find interesting is that no (and I'm not trying to start a debate here) candidate has ever brought up the issue of pushing insurance companies out of the picture.  They are just so entrenched in everything.  And there is no reason why families should go bankrupt/destitute over medical bills.  That's just wrong. 

I'll give some recent examples about waste.  Husband went for annual physical.  While waiting, he had to fill out forms.  One was a "depression screen."  What he didn't know was that he was charged for filling out that form--$40!  Yikes!

Another, he had to go learn about how to give himself a shot.  So, he goes to our local hospital into room # xxxx, only to find out that room #xxxx is a very, very large conference-style/large gathering room manned by a receptionist and, I believe, a nurse, who show him how to give himself a shot, and asked him if he knows how to read food labels.  Talk about waste.   He mentioned stuff like this could have simply been done in the doctor's office. 

I could go on and on, but I'm sure there are lots of other people on hear who have stories to tell. :)

talltexan

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Re: The problem with our healthcare
« Reply #2 on: March 07, 2017, 09:05:53 AM »
It sounds as though you are still advocating fee-for-service.

The most radical proposals for changing our system involve dropping that model entirely.

steviesterno

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Re: The problem with our healthcare
« Reply #3 on: March 07, 2017, 09:26:08 AM »
if we're going to socialize medicine, we have to socialize the system. don't make me pay out of pocket 200k for a degree, and then make me fight for every dollar I get. I have to charge $100 a visit because by the time it's all said and done, I'll make $33 or so.

you either have to socialize the whole thing (free medical education, get paid a living wage to not work shitty hours, etc) or go full consumerism (nobody gets free care). but we have hospitals who treat anyone that can't afford it has to pay for supplies and staff by milking the people that can.

It's bullshit.

Source: I'm an American Doctor. Medicare pays me like $18 a visit.

EnjoyIt

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Re: The problem with our healthcare
« Reply #4 on: March 07, 2017, 09:27:46 AM »
It sounds as though you are still advocating fee-for-service.

The most radical proposals for changing our system involve dropping that model entirely.

Once again you confused the picture and talk about how we pay for healthcare instead of talking about cost.  Capitation was a model this country attempted a few decades ago.  Unfortunately it failed due to the rising costs of healthcare.  Remember the money must come from somewhere.  Someone must pay for the care no matter what model we use.  You want the rich and middle class to pay for it then fine, but the cost of care must still come down otherwise it will continue outpacing the rich and middle class's desire to continue funding it for everyone else and themselves.

I think if you have a sore throat and go to your doctor then fee for service is exactly what we want.  If you have a true medical emergency then we need to make sure you don't go bankrupt over it which is where insurance must come into play.  The reason fee for service isn't working is because there is no transparency over the fee and therefor no need to compete and lower the cost to the patient.  Look at the post above by Itt.  The reason why the visit is so expensive is because the health insurance company needs to get their cut.  Plus regulations have forced this doctor to have a very expensive computer system and a billing/coding operation all which costs money.  I'm sure Itt would have rather cut his insurance premiums by 75% and instead paid $50 for the visit.  The doc would have been thrilled to cut his expenses and receive $50 instead of having to fight with the insurance company to get $100 and then pay for all the waste and bureaucracy in his office.

NCSteve

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Re: The problem with our healthcare
« Reply #5 on: March 07, 2017, 09:28:59 AM »
"Who knew our healthcare system could be so complicated?"-President Donald Trump

-part of the current problem

EnjoyIt

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Re: The problem with our healthcare
« Reply #6 on: March 07, 2017, 09:50:35 AM »
Still no conversation about the cost of care, only talking about who will pay for it.  It makes no difference if it is Obamacare or Trumpcare.  In the long run the system is fucked because the cost is too high.  Too much bureaucracy in our healthcare.  Until we have complete transparency in cost, decrease regulatory waste, and remove the insurance middleman from most medical issues, the cost will continue to rise. There is no reason why gauze should cost $50 dollars at a hospital and $3 at a pharmacy.  There is no reason why a physician can't tell their patient how much a procedure will cost because it varies by different insurance companies.We need to stop talking about who will pay and start talking about how much we all pay.

Yes. Exactly

I just looked at the balance sheet for a large non for profit hospital system in my area.  According to their figures Medicare/Medicaid together cover about 81% of what it costs to care for those patients.  If every patient was on government insurance, that hospital would be out of business. Therefor single payer is not the answer either.  The cost of care needs to come down and it must happen soon.  The system is imploding and it makes no difference which president cares the most.

We need to stop talking about who will pay and start talking about how much we all pay.

Well, not exactly. Medicare and Medicaid have a margin built into their pricing so it should cover the cost of care. The hospital systems, even the "not for profit systems" are at fault if they cannot provide care in that pricing. Well, at least to some extent.
Ever wonder why hospital systems continually put up new buildings and renovate their hospitals? Pull up some hospital system's 990's and check out how much their administration makes.
Yes the insurance industry is a problem, but the hospitals are equally if not more culpable.IMHO

Bean counter, you are correct that the hospitals are at fault for not making a profit out of the low reimbursement from medicare/medicaid.  That is why more patients are being sent home instead of being admitted, length of stay is being decreased so that you may be discharged at 11pm at night and have some tests still done as out patient and even still the cost of care outpaces reimbursement.  Take a look inside of a hospital.  Entire departments exist just to comply with regulatory burdens that provide no patient benefit and even sometimes cause harm to the patient.  Another department exists for coding and billing, and fighting with medicare/medicaid to pay the bill.  This cost is offset by self pay and the insured.

Today more and more providers are dropping medicare/medicaid. Some are dropping insurance all together and going for self pay and have the patient send the bill to the insurance company.  Life is usually easier for those providers.  In my town free standing Emergency Departments and Urgent cares are all over the place.  They do not take medicare/medicaid because it is just not cost effective. I am still waiting for the day a hospital opens up that stops taking medicare/medicaid patients.  There is a free standing ED down the street that has a very transparent pricing model. $800, $1000, $1200 depending on the complexity of care provided.  You know exactly how much you will pay by going in there.  Compare that to the nearby Hospital where you will pay anywhere near $2k-$10k depending on how lucky you are with in network vs out of network and the tests ordered.

Government insurance is not the answer. Cutting cost is the answer.  Who will pay for care is a secondary problem.

MrsWolfeRN

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Re: The problem with our healthcare
« Reply #7 on: March 07, 2017, 09:52:43 AM »
What about HCAHPS. My hospital spends money on private rooms with 90 cable channels and room service in order to get 5% more reimbursement. They even have comment cards like you get at Denny's. This is despite the fact that patient satisfaction actually increases mortality. What if they spent that money on medical research that can actually help people?

EnjoyIt

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Re: The problem with our healthcare
« Reply #8 on: March 07, 2017, 10:02:57 AM »
What about HCAHPS. My hospital spends money on private rooms with 90 cable channels and room service in order to get 5% more reimbursement. They even have comment cards like you get at Denny's. This is despite the fact that patient satisfaction actually increases mortality. What if they spent that money on medical research that can actually help people?

HCAPS is a perfect example of waste.  All the hospitals are trying to increase patient satisfaction paying tons of money on collecting survey results and trying to improve them.  Interestingly enough the way patient satisfaction works is that only the top hospitals get an extra few percent in reimbursement. Therefor the rest of the hospitals are just wasting their money.

Another example of waste is the time spent clicking away on a computer by the nurse.  Nurses today must check so many boxes on a computer that they have less time to spend with patients.  Therefor hospitals must hire more nurses and more techs to pick up the slack. Plus every nurse needs to have their own computer workstation which can cost as much as $10k for a portable workstation or (computer on wheels.)

MrsWolfeRN

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Re: The problem with our healthcare
« Reply #9 on: March 07, 2017, 10:16:32 AM »
Another example of waste is the time spent clicking away on a computer by the nurse.  Nurses today must check so many boxes on a computer that they have less time to spend with patients.  Therefor hospitals must hire more nurses and more techs to pick up the slack. Plus every nurse needs to have their own computer workstation which can cost as much as $10k for a portable workstation or (computer on wheels.)

Agree, although you are not allowed to refer to them as COWs anymore because you might offend someone (I wish I was joking but I'm not). Anyway these are quickly being replaced with iPads.

 Another source of nursing waste is to pay a nurse to do something an aide can do so that your hospital can brag about having better RN staffing ratios and get magnet status.

Also having layers of administration doesn't help.

Roland of Gilead

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Re: The problem with our healthcare
« Reply #10 on: March 07, 2017, 10:24:28 AM »
We need to fix the drug industry too.

It is ridiculous that it takes nearly a decade to bring a drug to the market with all of the meetings, tests, trials, more meetings.

If we want cheap drugs, we need cheap drug testing.

Scortius

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Re: The problem with our healthcare
« Reply #11 on: March 07, 2017, 10:26:58 AM »
I agree completely that the problem is not going to be solved by switching around insurance rules.  Unfortunately, in the US we seem to believe that we should follow free market principles in everything we do.  Thus, health care is designed as a capitalistic free-market system where insurance providers and hospitals supposedly compete to offer the best service at the lowest price.   That sounds great until you realize that health care is not a free market system, rather, it is a captive market system.  Yes, you can afford to be selective when it comes to more passive ailments like the flu or a broken bone, but people do not have the opportunity to shop around for the best price when they have a life-threatening emergency such as a heart attack, or God forbid, cancer.  And sure enough, it is the larger life-threatening illnesses that will drive any ordinary person to bankruptcy without proper insurance.  Given the nature of those illnesses, hospitals have no incentive to lower costs, as patients (or their insurance) will really have no choice but to pay whatever the hospital asks.

It's time we start looking at catastrophic health-care as a human right, similar to how we look at our needs for clean water, affordable electricity, available transportation, police and fire protection, and legal representation.  Until we do, health care costs will continue to rise (in a similar fashion to college education costs) because people simply do not have the option of 'shopping around'.

Daisy

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Re: The problem with our healthcare
« Reply #12 on: March 07, 2017, 10:28:51 AM »
EnjoyIt for president!

I've been complaining (probably just to myself) about the insurance middleman for routine care for a long time.

I asked my chiropractor once why he doesn't  just go cash only. He'd save money on extra computers and aides to manage insurance claims and cut his costs. He said many people won't  go if it's not covered by insurance.

Same thing with some "alternative" care. People won't  try going to get acupuncture or homeopathy or other things line that because "it's not covered by insurance", even though it may be more effective care for their particular condition, and in the long run cost less because it may actually fix their issue. (I have personal experience with this.)


« Last Edit: March 07, 2017, 10:30:49 AM by Daisy »

scantee

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Re: The problem with our healthcare
« Reply #13 on: March 07, 2017, 10:54:00 AM »
People talk about the high cost of healthcare all the time. Maybe you're not paying attention to those conversations, which often lose people when they veer into the highly technical, but it is not as if they aren't happening.

The challenge with implementing a blanket charge to reduce cost is that it is really, really, hard. There are thousands of unintended negative consequences that will come with a reduction of costs and people who work in healthcare policy absolutely know that and are thinking of that when they consider ways to reduce costs. This is why there is no straightforward answer for how we approach this problem.

One example of this: for whatever reason, in the U.S., we've decided that we want healthcare to be one of our main industries for employing people and paying them a livable wage. Now, you might not think that's right, but the fact is that is where we are at this point. Healthcare is a huge industry that supports middle-class (and up) wages that in turn support many other industries (e.g., real estate/housing, food service, transportation, construction/building, medical technologies, and on and on). A drastic and quick reduction in healthcare costs would lead to millions of people losing their jobs and many other experiencing a substantial decrease in pay and benefits, the effects of which would ripple out to many other industries not formally tied to healthcare. This would almost certainly throw our entire economy into a major recession.

So we know that reducing costs needs to happen gradually, using multiple methods that are implemented strategically so as not to shock the system in ways that lead to a huge economic downturn. One of the promising methods to reduce costs is an all-payer model. Maryland has successfully used such a model for decades. More recently, they've added a fixed revenue model to limit growth in costs. These methods have been very successful and hold great promise for reducing costs in other states.

That answer is probably not the passionate rallying cry you're looking for, but the truth is that in reality these are the kinds of boring policies that actually lead to cost reductions over time, without causing major economic upset.

If you're truly interested in this topic, I suggest you look at the Center for Medicare & Medicaid Innovation Center which promotes and conducts all sorts of research on this very topic. It's a great resource for learning more about what is going on at the federal and state levels to address this issue.
« Last Edit: March 07, 2017, 11:10:16 AM by scantee »

Kiwi Fuzz

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Re: The problem with our healthcare
« Reply #14 on: March 07, 2017, 10:59:27 AM »
From my understanding, as a former resident of a 'single payer system' country and as a person working in the health insurance industry, I believe it's a complicated situation that can't really be boiled down to a single line item. But I would suggest that one big issue seems to be economy of scale - or rather lack thereof.

In single payer systems the government has bulk buying power with pharmaceutical companies, hospitals, medical equipment providers and so on. Companies compete for the government contracts since the sheer scale of the contract makes it worth their while - even if the reimbursements/profit margins are lower than they would receive for individual or smaller contracts - on the that scale it makes them a profit. Medicaid/Medicare already does this.

The other issue seems to be that individual employers are forced to pick up the administration of benefits where in a single payer system the government would. I realize that there are doubts about the efficiency of government in the USA but bear with me a moment. In single payer systems you have, again, economy of scale. In the US system employers attempt to grasp at the economy of scale by employing middle men. Instead of employing 2 dozen HR personnel they can simply contract an HR Outsourcing firm at a lower cost. Instead of a doctor hiring ten receptionists they can simply contract a medical billing company at a lower cost. Due to the nature of private business each 'middle man' must, by necessity, take their cut. It wouldn't necessarily be cheaper for the employer to hire all those HR staff members.

I don't have a solution to this. Much smarter people than I have developed ideas and theories - I'm simply pointing out that there's many moving parts when talking about lowering cost to consumers for healthcare in the US.

The Atlantic claims US Healthcare costs are already down 2 Trillion.
The Fiscal Times has a list of things that are already happening to lower costs.
Harvard Business Review has this article about how much costs could be lowered via various avenues
This Fortune article seems to boil down to increasing Market Competition.

Take your pick - they're probably all worth a try.

At the end of the day I would keep in mind that healthcare is a social good. We don't let people die in the streets, instead we let the hospital go unpaid when they declare bankruptcy after receiving treatment which increases costs for those who can pay, and I doubt anyone is suggesting that we should withhold treatment. It's never going to be as easy as letting the free market decide - healthcare is not always something that one can shop around for (as in cases of life and death emergencies with the patient may not even be conscious) - but we can put systems in place to increase competition and pricing (and health outcome) transparency.

golden1

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Re: The problem with our healthcare
« Reply #15 on: March 07, 2017, 11:12:43 AM »
Reducing costs in health care involves having difficult conversations that people don't want to have, because we don't deal with death very well in our culture.  We see death as an abomination to be fought at all costs instead of a necessary part of life.  I think something like 50% of your health care dollars are spent in the last 6 months of your life.  I am all for doing something like this guy personally:  https://www.theatlantic.com/magazine/archive/2014/10/why-i-hope-to-die-at-75/379329/

Just making sure people make an end of life plan would save vast amounts of money without changing anything else.  I don't want to spend the last few months or years of my life in a hospital undergoing procedures.  Let me go. 

But no.  Then people start screaming about death panels. 

justchristine

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Re: The problem with our healthcare
« Reply #16 on: March 07, 2017, 11:16:04 AM »
Last night I saw a commercial during the local news for a health care service company. Basically a no frills basic service in their clinic or through house calls with a set price list for basic labs/services.  They don't take insurance and are selling that as their means of keeping costs low.  From their website, it looks like they only treat basic ailments but it is an interesting concept and a hell of a lot cheaper than what my employer will be paying for the annual exam and labs that I just had.  I'd be interested to see if this sort of thing catches on.

Fish Sweet

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Re: The problem with our healthcare
« Reply #17 on: March 07, 2017, 11:34:56 AM »
We need to fix the drug industry too.

It is ridiculous that it takes nearly a decade to bring a drug to the market with all of the meetings, tests, trials, more meetings.

If we want cheap drugs, we need cheap drug testing.

I understand where you're coming from, but I think drug testing is one of those areas you really can't skimp out on.  Remember thalidomide?  Diethylstilbestrol?  Without "all the meetings, tests, trials, more meetings" you can end up with drug products that permanently impact people, leave them disabled, at high risk of cancer, or who know what else, and continue to impact the and their families for generations after the fact.  And that's just on the drug end of things.  Without proper vetting, ethics, and oversight of the trials and experimentation, you end up with stuff like the Tuskegee syphillis experiment.  Bad Shit has happened in the past, which is why we end up with so many rules and regs today.

More generally, it's easy to say things like "cut out all the onerous regulations and bureaucracy, nurses shouldn't have to check off so many ticky boxes instead of actually caring for their patients," and well... I get it.  I'm not a nurse, but at my job I also have to check off many boxes to indicate that I've done X or Y, and sometimes end up spending more time "following procedure" than actually getting my job done.  But if I don't check off a box and leave something undone, nobody will suffer, get sick, or die.  My layman's understanding is the incorporation of checklists into hospitals and doctors' routines has actually served to streamline the process and save lives, because humans are fallible and checklists less so.  What does it take to balance cost efficiency, practicality, and effectiveness with the truth that lives are on the line, and without regulation or oversight we've seen some pretty egregious breaches of trust and ethics, or less egregious breaches of just plain carelessness or human error.

I don't have any helpful answers to contribute, unfortunately, just the thought that the health care industry is one of the hardest industries to strip back in terms of regulation and bureaucracy, and there are both good and bad reasons for that.

Roland of Gilead

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Re: The problem with our healthcare
« Reply #18 on: March 07, 2017, 12:22:23 PM »
We need to fix the drug industry too.

It is ridiculous that it takes nearly a decade to bring a drug to the market with all of the meetings, tests, trials, more meetings.

If we want cheap drugs, we need cheap drug testing.

I understand where you're coming from, but I think drug testing is one of those areas you really can't skimp out on.  Remember thalidomide?  Diethylstilbestrol?  Without "all the meetings, tests, trials, more meetings" you can end up with drug products that permanently impact people, leave them disabled, at high risk of cancer, or who know what else, and continue to impact the and their families for generations after the fact.  And that's just on the drug end of things.  Without proper vetting, ethics, and oversight of the trials and experimentation, you end up with stuff like the Tuskegee syphillis experiment.  Bad Shit has happened in the past, which is why we end up with so many rules and regs today.


But Trump said drug prices are high and he is going to get cheap drugs.  I was just giving a simple solution like his simple statement.

Fish Sweet

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Re: The problem with our healthcare
« Reply #19 on: March 07, 2017, 12:46:27 PM »
But Trump said drug prices are high and he is going to get cheap drugs.  I was just giving a simple solution like his simple statement.

Well shoot. If Trump says so, then consider all my concerns gone. :D

accolay

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Re: The problem with our healthcare
« Reply #20 on: March 07, 2017, 01:07:49 PM »
What about HCAHPS. My hospital spends money on private rooms with 90 cable channels and room service in order to get 5% more reimbursement. They even have comment cards like you get at Denny's. This is despite the fact that patient satisfaction actually increases mortality. What if they spent that money on medical research that can actually help people?

I would argue that a lot of extras that hospitals have are because people want them, but don't fully understand how that affects cost.

There are a lot of easy ways to affect the cost of health care...or just pay for it out of pocket...

Private rooms? Going back to multiple room wards is the way.
HIPPA? I've heard privacy is dead anyway.
Gloves for procedures? Gone!
Free aromatherapy in the waiting room (I've heard of this) gone!
What? You want a TV in your room? All the rooms on your multiple bed ward now have just beds and curtains. Windows if you're lucky.
Free wifi? Gone!
If you want food, your family better bring it for you.
Same for extra blankets.
Get used to walking out to the bathroom. There's only a few on the floor you're on now.
Handicap access? There's only so many people with those problems, why build it in for convenience...that adds cost.
Ceiling lifts? If you're too big to be moved, I guess you just wont get the care you need.
CEO executive pay down to normal levels

I always like Back to the Future movies...why not do it with healthcare? Back to the 1950s...I can't wait!

We can just go a little further and be like every third world public health care out there. And mostly just die. Think of the money we'll save in nursing home costs!
« Last Edit: March 07, 2017, 01:13:27 PM by accolay »

skp

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Re: The problem with our healthcare
« Reply #21 on: March 07, 2017, 01:13:32 PM »
I am a nurse in a hospital so in a way I am both a supplier and a consumer.  I also feel there is no use focusing solely on how we "supply" the healthcare without addressing the cost of the healthcare.  I don't think getting rid of insurance companies is going to help at all. 
I recently had a $2300 bill for 3 stitches in the ER.  I have a $1500 deductible.  Had I known the stitches were going to cost that much I would not have gotten them.  When you get a car repaired you get an estimate.  You can decide what work you want done and what you can do without.  When you go to the hospital you are given no choices on what tests you want and don't want and you have no idea what the bill is going to be. I drive a Honda Civic.  I don't drive a Cadillac.  I think you need some skin in the game.     If you have insurance people don't care so much about costs.  If you have to pay, you do.   It is interesting to me that people will suddenly withdraw care for critically ill patients when they are out of Medicare days and they are suddenly going to be responsible for the bill.  Then they suddenly care about what services they are using.   
Also,  I think one of the big problems is the way hospitals are reimbursed.  Hospitals get paid partially on patient "satisfaction" scores.  Some of the areas that are being measured are pain relief- leading to overmedication and drug addiction issues and if the people like the environment- leading to constant expensive unnecessary remodeling.  The staff is actually being paid incentives to "be nice" to the patients and getting high satisfaction scores.  We recently got new flooring but have really old EKG monitors.  CEOs get raises and bodyguards.  Hospitals are supposedly non profit and figure out ways to spend the money instead of lowering the costs.

accolay

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Re: The problem with our healthcare
« Reply #22 on: March 07, 2017, 01:18:44 PM »
We need to fix the drug industry too.

It is ridiculous that it takes nearly a decade to bring a drug to the market with all of the meetings, tests, trials, more meetings.

If we want cheap drugs, we need cheap drug testing.

Reminds me of that sketch from Monty Python
Man loses his job, tells children:
"I've got no option but to sell you all for scientific experiments."
https://www.youtube.com/watch?v=ddN6WHBmBmI

katsiki

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Re: The problem with our healthcare
« Reply #23 on: March 07, 2017, 02:33:51 PM »
My employer just switched to a somewhat unique model.  It is HDHP w/ an HRA but most coverage is through a concierge or direct primary care physician.  DPC covers primary care and optionally pediatrics.  They also dispense drugs at cost (supposedly).  It is brand new so I cannot say much on how well it works.  However, I found it very interesting that they only charge $50 per month for any joe off the street to sign up.  This gives you access to the doctors by office visit, text, email, etc.  An interesting model.  I really think that this type of thinking is what is needed to fix healthcare in America.

I have been told that doctors charge the insurance companies several hundreds for a routine office visit.  Obviously, $50 per month gets you that and more.  Is the real cost $20 per visit, less?  Also, DPC gets rids of the insurance and paperwork load on the doctor and (usually) required staff.
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accolay

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Re: The problem with our healthcare
« Reply #24 on: March 07, 2017, 03:03:28 PM »

I recently had a $2300 bill for 3 stitches in the ER.  I have a $1500 deductible.  Had I known the stitches were going to cost that much I would not have gotten them.

While I agree that $2300 seems like a lot of money for three stitches on it's face, you're not really paying for just 3 stitches with an emergency room visit.

You're paying for the emergency room to be staffed in order to triage and then see you in an expedient manner, staffed 24/7/365. Depending on the Trauma Level of the hospital, you're also paying that hospital to have all those other specialties staffed too.
You paid for the MD/PA 's time to see you and then stitch you up.
You paid for the sterile equipment used to stitch you up from drape to needle and whatever used to wash out the wound.
You paid for the person to sit there and triage you.
You paid for a nurse to see you.
You paid for someone to probably take your vital signs
You paid for maintenance of the facility, rooms parking lot, etc.
You paid a janitor or other to clean the room you stayed in. And the consumables such as chemicals etc. used.
You paid for salaries of executives/managers from the CEO down to the nurse manager and staffing office, security, valet parking attendants etc. etc. etc.

And probably more. The point is, it's not just three stitches built into that cost.

But I do agree that we should know how much things cost up front- hospitals and clinics should provide that information readily. But unless you're unconscious, you can nearly always tell them what tests/procedures you do or do not want done to you-sometimes not in your best interest to refuse though. I think the onus of knowing about insurance billing/pricing is already there if you have insurance by looking up what is and what is not covered prior to making an appointment. Otherwise you can get stuck paying large uncovered medical bills.

mm1970

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Re: The problem with our healthcare
« Reply #25 on: March 07, 2017, 05:22:07 PM »
Quote
I have been told that doctors charge the insurance companies several hundreds for a routine office visit.  Obviously, $50 per month gets you that and more.  Is the real cost $20 per visit, less?  Also, DPC gets rids of the insurance and paperwork load on the doctor and (usually) required staff.

My doctor spent 15-20 minutes with me at my last routine visit.

Is that worth only $20?

My doctor's time is only worth $80? 

Actually, $80 for a PCP, might be kind of close.

But that does not include, the nurse, assistant, receptionist, rent, electricity, heat, computers...etc.

My hour long dental appointment costs $250.  That pays the dentist (who usually sees 2-3 patients in that time), two hygienists, the receptionist, rent, billing, heat, electricity, equipment...

inline five

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Re: The problem with our healthcare
« Reply #26 on: March 07, 2017, 07:07:47 PM »
1) No incentive on the patients part to shop around
2) No incentives for patients to stay healthy and lower their premiums, or use lower cost options if available
3) The margins on health insurers are very low. They actually do the public a service and lower costs by negotiating with the providers.
4) Tort and other laws preventing cheap fix-it places from offering cheap visits
5) A sensible conversation about keeping a lid on costs for those with terminal illnesses near the end of their lives

I think we need a hybrid, one where we pay a insurance (or government taxes us on it) for a high deductible plan (say above $5k, and you could even get a rider for coverage above say $2k-$5k) and when you need something major done you go to an agent similar to a mortgage broker who shops around for you and presents various options.

Competition is exactly what lowers costs.

You don't use your car insurance monthly, or your home owners, why should health insurance be any different?

The R's have no clue how to fix the system and they KNOW taking away insurance now is slitting their own throats. It's almost comical watching what they are doing.

accolay

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Re: The problem with our healthcare
« Reply #27 on: March 07, 2017, 07:30:04 PM »
1) No incentive on the patients part to shop around

Problem: How does one shop around when in an emergency medical situation?

moof

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Re: The problem with our healthcare
« Reply #28 on: March 07, 2017, 07:38:52 PM »
We need to fix the drug industry too.

It is ridiculous that it takes nearly a decade to bring a drug to the market with all of the meetings, tests, trials, more meetings.

If we want cheap drugs, we need cheap drug testing.
Not wo fast.  We already have explosive cost growth for OLD medicines thanks to what can only be pricing collusion.  Look up the price correlation plots for insulin as a prime example.  Competitors track each other nearly perfectly for a medicine that has been around for many decades.

GetItRight

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Re: The problem with our healthcare
« Reply #29 on: March 07, 2017, 07:58:31 PM »
Ever ask for a quote to patch you up while you're unable to walk and bleeding out? They look at you like you're crazy and if you persist tell you they can get a price within a couple weeks. Then they try to sell you some drugs and a wheelchair at 20x market rate on your way out.

Get government out of medicine and trauma treatment. Eliminate the AMA, all other lobbyist groups, eliminate all medical licensing, and get the government out of medical treatment altogether. That is the way to restore transparency in pricing and restore a price competitive market.

katsiki

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Re: The problem with our healthcare
« Reply #30 on: March 07, 2017, 08:04:15 PM »
Quote
I have been told that doctors charge the insurance companies several hundreds for a routine office visit.  Obviously, $50 per month gets you that and more.  Is the real cost $20 per visit, less?  Also, DPC gets rids of the insurance and paperwork load on the doctor and (usually) required staff.

My doctor spent 15-20 minutes with me at my last routine visit.

Is that worth only $20?

My doctor's time is only worth $80? 

Actually, $80 for a PCP, might be kind of close.

But that does not include, the nurse, assistant, receptionist, rent, electricity, heat, computers...etc.

My hour long dental appointment costs $250.  That pays the dentist (who usually sees 2-3 patients in that time), two hygienists, the receptionist, rent, billing, heat, electricity, equipment...

It would be great if someone familiar with the real costs could chime in here.

What I have heard is that doctors are compensated to have you come in for everything.  ie cold - gotta come in whereas most adults already know what is needed. 

I was thinking then along the lines of $500 for a routine check-up.  This is minimal time with the doctor as you mentioned.  The doctor may do 15 of those in a day.  $7,500 in a day billed to insurance.  It gets negotiated down but that requires a lot of paperwork. 

If we could get medicine to be more efficient, I wonder what the costs could be reduced to.

I completely agree with you that the doctor's time is valuable and they should be compensated.  I wonder though how much fluff is added to the cost due to the 'system' - insurance, regulatory overhead, etc.
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Scortius

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Re: The problem with our healthcare
« Reply #31 on: March 07, 2017, 08:15:51 PM »
Ever ask for a quote to patch you up while you're unable to walk and bleeding out? They look at you like you're crazy and if you persist tell you they can get a price within a couple weeks. Then they try to sell you some drugs and a wheelchair at 20x market rate on your way out.

Get government out of medicine and trauma treatment. Eliminate the AMA, all other lobbyist groups, eliminate all medical licensing, and get the government out of medical treatment altogether. That is the way to restore transparency in pricing and restore a price competitive market.

How does one restore a competitive market in the absence of regulation if the person responsible for making a price-conscious decision is unable to walk and currently bleeding out?

EnjoyIt

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Re: The problem with our healthcare
« Reply #32 on: March 07, 2017, 08:37:51 PM »
1) No incentive on the patients part to shop around

Problem: How does one shop around when in an emergency medical situation?

I hear this complaint all the time, but the reality is that most people who need healthcare are not in an emergency situation.  Most people are not having heart attacks or bleeding out of all their orifices.  The reality is that most people have plenty of time to hit the internet and review their options.  My nearby emergency department sees about 170 patients per day.  30 of which come by ambulance of those 30 only a small handful have a real emergency.  The rest could have driven themselves or have a friend drive them.  Which goes back to the point of insurance.  It is those emergencies and very high unexpected costs that insurance should cover.  That is by definition what insurance is.  It is a policy you buy incase bad shit happens.  Insurance is not to pay for everyday events.

Obamacare tried to create some incentive on the patient, but without true price transparency it is impossible to make a sensible decision.

As for your other comment on clicking boxes.  Let me give you an example of useless clicking on my part. I am an ER physician.  When I have a patient that does not meet criteria for getting thrombolyitic therapy (clot busting medication) for a stroke I must specifically document the words "medication not given due to . . . ." even though other areas of my chart document the same thing.  Why? because  the stroke regulatory body is filled with people who need to review my chart and it needs to be spelled out for them very very clearly.  The facts are already in the history and physical exam.  They are just too clueless regarding medicine to look there. Examples of more clueless clicking.  If I do not specify minor items in my chart I get paid less for my work.  For example if I have a patient with a heart attack but don't specify the severity of pain, I will get reimbursed about 60% less for that care.  Idiotic waste of my time but I must make sure I click all the right boxes.  Neither of the above improve patient outcomes they just take up my time and therefor decrease my time with patients.  It has gotten so bad that many ER physicians hire scribes to help them keep up with the documentation burden.  Who do you think pays for those scribes?

Also when 1 person makes a mistake then usually the next step is not fixing the nurse who made the mistake, but add extra steps in the process so that mistake can't be made.  Although at first glance it might seam like a great idea, but overtime these extra steps and check boxes and clicks pile up. Before you know it nurses spend 80% of their day clicking on the computer making sure each and every step is properly documented.  The better process would be to teach the 1st nurse how not to make that mistake and then if needed teach all the other nurses the same.  We talk about lifestyle creep on this forum.  I call it documentation creep and so far I see nothing stopping this juggernaut of waste.

I find it funny how some people agree with everything our bloated government wants to do.  If the government dictates it must be correct and right unless its the other party and therefor everything is wrong.  No, stop and evaluate each item yourself and let your brain make the decision as opposed to following party lines.  Reality is that both parties are full of corruption and waste.

EnjoyIt

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Re: The problem with our healthcare
« Reply #33 on: March 07, 2017, 08:56:20 PM »
Quote
I have been told that doctors charge the insurance companies several hundreds for a routine office visit.  Obviously, $50 per month gets you that and more.  Is the real cost $20 per visit, less?  Also, DPC gets rids of the insurance and paperwork load on the doctor and (usually) required staff.

My doctor spent 15-20 minutes with me at my last routine visit.

Is that worth only $20?

My doctor's time is only worth $80? 

Actually, $80 for a PCP, might be kind of close.

But that does not include, the nurse, assistant, receptionist, rent, electricity, heat, computers...etc.

My hour long dental appointment costs $250.  That pays the dentist (who usually sees 2-3 patients in that time), two hygienists, the receptionist, rent, billing, heat, electricity, equipment...

It would be great if someone familiar with the real costs could chime in here.

What I have heard is that doctors are compensated to have you come in for everything.  ie cold - gotta come in whereas most adults already know what is needed. 

I was thinking then along the lines of $500 for a routine check-up.  This is minimal time with the doctor as you mentioned.  The doctor may do 15 of those in a day.  $7,500 in a day billed to insurance.  It gets negotiated down but that requires a lot of paperwork. 

If we could get medicine to be more efficient, I wonder what the costs could be reduced to.

I completely agree with you that the doctor's time is valuable and they should be compensated.  I wonder though how much fluff is added to the cost due to the 'system' - insurance, regulatory overhead, etc.

I am an ER doctor and can only talk about the ER with confidence. Let talk about the person above with the $2250 bill for 3 stitches.  If that same person went into an urgent care and saw a nurse practitioner or PA their bill would probably have been closer to $200.  Urgent cares have lower overhead and less regulations.  Plus since you are paying cash or by credit card they don't need to deal with insurance companies.  If that person went to a free standing ER the price would have been ~$1k.  They would have seen an ER physician who costs more as well as pay for the increased overhead of a free standing emergency department which usually do deal with insurance companies.  Lets be honest.  This patient had a cut that was maybe 1-2cm in length.  They were not bleeding all over the place, and had plenty of time to review all their options.  Unfortunately there is little price transparency in the hospital and most patients do not know how to figure out their options.  So like many others they head to their nearest big hospital emergency department and get stuck with a $2250 bill.  For the record, depending on the location of the cut, how complex it is, the ER doctor would get anywhere from $35-$150 for the repair.  This does not include the physician's overhead costs such as billing and coding and administrative costs which may be as high as 20%

accolay

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Re: The problem with our healthcare
« Reply #34 on: March 08, 2017, 01:52:56 AM »
I find it funny how some people agree with everything our bloated government wants to do.  If the government dictates it must be correct and right unless its the other party and therefor everything is wrong.  No, stop and evaluate each item yourself and let your brain make the decision as opposed to following party lines.  Reality is that both parties are full of corruption and waste.
That's true. Both parties have their corruption and waste. But there are real differences between the two majority parties. However, that's beyond the scope of this thread. For the record though, I agree with the majority of principles of the representatives I voted for.
Quote
It is a policy you buy incase bad shit happens.  Insurance is not to pay for everyday events.
An excellent argument for a universal health system. Get rid of insurance altogether. Brilliant!

As far as shopping around for care, I agree EDs are really majority non-emergency care. But there will always be people who can neither afford the ED, nor urgent care.

As another one who does and has done many of those clicks, MDs may know about why they're clicking what they're clicking, but as an RN, I have no idea what relates to reimbursement or regulation. If there isn't time to chart, patient care comes first. If something important happens, I do something or there is a change that gets charted, but otherwise the vast majority of the charting for inpatient care is repetitive and I believe quite unnecessary. Filling in boxes to fill in boxes.

CBnCO

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Re: The problem with our healthcare
« Reply #35 on: March 08, 2017, 04:32:41 AM »
My employer just switched to a somewhat unique model.  It is HDHP w/ an HRA but most coverage is through a concierge or direct primary care physician.  DPC covers primary care and optionally pediatrics.  They also dispense drugs at cost (supposedly).  It is brand new so I cannot say much on how well it works.  However, I found it very interesting that they only charge $50 per month for any joe off the street to sign up.  This gives you access to the doctors by office visit, text, email, etc.  An interesting model.  I really think that this type of thinking is what is needed to fix healthcare in America.

I have been told that doctors charge the insurance companies several hundreds for a routine office visit.  Obviously, $50 per month gets you that and more.  Is the real cost $20 per visit, less?  Also, DPC gets rids of the insurance and paperwork load on the doctor and (usually) required staff.

There was another thread a while ago on "Direct Primary Care" and I think it's an innovative, free market model that should be expanded. Of course, the insurance lobby is not a fan; but, if you can charge $50-$100 per month for expanded primary care that includes more personalized care and emphasizes prevention I'm all for it. And, the docs who have gone this direction seem to make equal to or more $ than in a traditional setting where they see 4-5x more patients. I think a DPC model with an overriding catastrophic insurance policy is a model worth looking at and, in fact, what health care looked like when insurance was first introduced in the early-mid 1900's where you paid the family doc cash and then had a hospital (catastrophic) policy



CBnCO

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Re: The problem with our healthcare
« Reply #36 on: March 08, 2017, 05:17:48 AM »
Some good responses so far! I'll add my two cents:

First, I happen to disagree that obtaining care given or paid for by others is some kind of right. You never have the right to take another's money to pay for your care or to demand that health practitioners service you for free. Thus, the solutions I tend to gravitate toward are health education, prevention (diet & exercise), and market based reforms when it comes to care and financing care.

The folly of the current healthcare debate to me is that the current problematic system is a result of government regulation gone wrong. They regulate what drugs are available, who can provide medical services (licensing, accreditation, etc.), what insurance policies are available and where they can be sold, malpractice & tort policy, etc. All of this has led to complexity and high cost. Now, instead of recognizing the root of the problem and letting the market sort it out, we're choosing to employ the same politicians who created the mess to fix it via new, gargantuan government run programs.

- Core to the k-12 curriculum should be health education (screw you Doritos and Mountain Dew manufacturers!)
- Medical training and education opportunities should be expanded, more doctors = more competition
- Unleash the entrepreneurs! Direct Primary Care is one example; but, I can only imagine what new healthcare models could be concocted if allowed by the government
- The test for tort cases should be limited to gross negligence
- Insurance should be reserved for catastrophic events
- People in a modern society should voluntarily agree to help poor people obtain decent care when needed and I think there are some great private charities that can handle the administration of these programs better than any elected or appointed official. At the same time, I would choose to send 50 underprivileged kids to college before I'd give a 95 year old millions in cancer treatments.

I think some core MMM principles apply to healthcare: take care of yourself through proper diet and exercise and your healthcare expenses will be less, educate yourself and shop around for the best deals, learn to do some things yourself when practical, etc. The successful Mustachian doesn't accept the typical "system" as gospel, so I am a bit surprised when I see some posts advocating for one government run system or another. Good topic, good debate!


misshathaway

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Re: The problem with our healthcare
« Reply #37 on: March 08, 2017, 06:29:14 AM »
I'll give some recent examples about waste.  Husband went for annual physical.  While waiting, he had to fill out forms.  One was a "depression screen."  What he didn't know was that he was charged for filling out that form--$40!  Yikes!

I refused to fill it out. Insurance got billed the $40 anyway because my doctor literally said "Do you ever feel down? You know you can always come to me if depression becomes an issue" Or something to that effect, but about as subtle. $40, ka-ching! I love my primary care physician otherwise so I'm going to hold him blameless.

I was so mad after I got the EOB, even though I didn't have to pay it, that I looked up the reason for this. It's a current preventative recommendation and might have something to do with a standard of care that gives funding credits.

Next year I am going to preempt by asking about it and refusing the whole thing outright before the exam.
Passed ER first year anniversary - settling in

runewell

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Re: The problem with our healthcare
« Reply #38 on: March 08, 2017, 06:39:15 AM »
Yes, agree very much.  There shouldn't be a "co-pay" if I can simply walk into the doctor for an office visit, pay him directly, and not have to run anything through insurance.  I simply pay him the $20 or $30 or whatever he/she would charge.  I don't need it to be run through insurance.  Because realistically, a doctor visit is not worth $100 that is charged---it's because insurance is in the middle of it trying to make their profit.

So when you need a $50,000 operation, how are you going to pay for that?  You'll probably need a cashier's check.
Also, if you think you are going to get a doctor appointment for $20, you're crazy.  If you don't think it is worth $100, I guess you'll just have to stay at home and hope for the beset?
Please leave Dicey out of this! Have you not been paying any attention? Trolls are not welcome here!

katsiki

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Re: The problem with our healthcare
« Reply #39 on: March 08, 2017, 06:40:45 AM »
My employer just switched to a somewhat unique model.  It is HDHP w/ an HRA but most coverage is through a concierge or direct primary care physician.  DPC covers primary care and optionally pediatrics.  They also dispense drugs at cost (supposedly).  It is brand new so I cannot say much on how well it works.  However, I found it very interesting that they only charge $50 per month for any joe off the street to sign up.  This gives you access to the doctors by office visit, text, email, etc.  An interesting model.  I really think that this type of thinking is what is needed to fix healthcare in America.

I have been told that doctors charge the insurance companies several hundreds for a routine office visit.  Obviously, $50 per month gets you that and more.  Is the real cost $20 per visit, less?  Also, DPC gets rids of the insurance and paperwork load on the doctor and (usually) required staff.

There was another thread a while ago on "Direct Primary Care" and I think it's an innovative, free market model that should be expanded. Of course, the insurance lobby is not a fan; but, if you can charge $50-$100 per month for expanded primary care that includes more personalized care and emphasizes prevention I'm all for it. And, the docs who have gone this direction seem to make equal to or more $ than in a traditional setting where they see 4-5x more patients. I think a DPC model with an overriding catastrophic insurance policy is a model worth looking at and, in fact, what health care looked like when insurance was first introduced in the early-mid 1900's where you paid the family doc cash and then had a hospital (catastrophic) policy

That is my understanding of this outfit we're using.  As long as they can get to a certain # of patients, their financial needs are met.  They provide better, more personalized care to the smaller number of patients.

Your comment about the early-mid 1900's is interesting to me.  It really does seem that going back to a simpler model would save a lot of costs and headaches.
"busy eating lentils in a van by the river"

golden1

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Re: The problem with our healthcare
« Reply #40 on: March 08, 2017, 07:38:10 AM »
Enjoyit, thank you for your perspective.  It is always good to hear a Dr.s opinion, since they are in the middle of the whole thing.

Quote
As for your other comment on clicking boxes.  Let me give you an example of useless clicking on my part. I am an ER physician.  When I have a patient that does not meet criteria for getting thrombolyitic therapy (clot busting medication) for a stroke I must specifically document the words "medication not given due to . . . ." even though other areas of my chart document the same thing.  Why? because  the stroke regulatory body is filled with people who need to review my chart and it needs to be spelled out for them very very clearly.  The facts are already in the history and physical exam.  They are just too clueless regarding medicine to look there. Examples of more clueless clicking.  If I do not specify minor items in my chart I get paid less for my work.  For example if I have a patient with a heart attack but don't specify the severity of pain, I will get reimbursed about 60% less for that care.  Idiotic waste of my time but I must make sure I click all the right boxes.  Neither of the above improve patient outcomes they just take up my time and therefor decrease my time with patients.  It has gotten so bad that many ER physicians hire scribes to help them keep up with the documentation burden.  Who do you think pays for those scribes?

Also when 1 person makes a mistake then usually the next step is not fixing the nurse who made the mistake, but add extra steps in the process so that mistake can't be made.  Although at first glance it might seam like a great idea, but overtime these extra steps and check boxes and clicks pile up. Before you know it nurses spend 80% of their day clicking on the computer making sure each and every step is properly documented.  The better process would be to teach the 1st nurse how not to make that mistake and then if needed teach all the other nurses the same.  We talk about lifestyle creep on this forum.  I call it documentation creep and so far I see nothing stopping this juggernaut of waste.

I assure you, this isn't just a problem in the medical field.  In my tech company, we have a system of cumbersome procedures in place in order to make sure that people don't make mistakes.  It takes several full time people to maintain this system and a good portion of people's work day is spent dealing with logistics programs and procedures.

I see this more of a civilization complexity problem, and we definitely could use less cumbersome ways of reducing human error.  However, as a patient, it comforts me to know that things are being double and triple checked so that nothing happens to me during a procedure, so part of me is okay with this, despite increased cost. 

Quote
I am an ER doctor and can only talk about the ER with confidence. Let talk about the person above with the $2250 bill for 3 stitches.  If that same person went into an urgent care and saw a nurse practitioner or PA their bill would probably have been closer to $200.  Urgent cares have lower overhead and less regulations.  Plus since you are paying cash or by credit card they don't need to deal with insurance companies.  If that person went to a free standing ER the price would have been ~$1k.  They would have seen an ER physician who costs more as well as pay for the increased overhead of a free standing emergency department which usually do deal with insurance companies.  Lets be honest.  This patient had a cut that was maybe 1-2cm in length.  They were not bleeding all over the place, and had plenty of time to review all their options.  Unfortunately there is little price transparency in the hospital and most patients do not know how to figure out their options.  So like many others they head to their nearest big hospital emergency department and get stuck with a $2250 bill.  For the record, depending on the location of the cut, how complex it is, the ER doctor would get anywhere from $35-$150 for the repair.  This does not include the physician's overhead costs such as billing and coding and administrative costs which may be as high as 20%

Oh man, preaching to the choir here.  The use of the ER as an urgent care clinic needs to stop.  Not only is it costly, but it really is an unpleasant patient experience to wait in an ER for hours for something relatively minor because you don't have any other options.  We just had a private urgent care clinic open in our town.  The one at our local hospital has extremely limited hours, so you often end up going to the ER.  There needs to be a better solution across the board for when you have something that needs drop in care  but not full ER services. 

accolay

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Re: The problem with our healthcare
« Reply #41 on: March 08, 2017, 08:08:43 AM »
Reducing costs in health care involves having difficult conversations that people don't want to have, because we don't deal with death very well in our culture.  We see death as an abomination to be fought at all costs instead of a necessary part of life.  I think something like 50% of your health care dollars are spent in the last 6 months of your life.  I am all for doing something like this guy personally:  https://www.theatlantic.com/magazine/archive/2014/10/why-i-hope-to-die-at-75/379329/

Just making sure people make an end of life plan would save vast amounts of money without changing anything else.  I don't want to spend the last few months or years of my life in a hospital undergoing procedures.  Let me go. 

But no.  Then people start screaming about death panels.

I was thinking about your post last night while taking care of a basically brain dead patient, the family who wants everything done to keep them alive because they hope they might....I dunno...have some kinda miracle? The patient will end up at a nursing home, probably eventually with recurrent pneumonias and more hospital stays in the ICU since they'll probably be vent dependent to breathe. A slow death.

Something that hasn't been mentioned is the rationing of care. I know I know, but I'll argue that we already ration care. What is the point of keeping a human only physically alive? I know that could turn into a slippery slope...but I think our society needs to talk about it. They do this in other countries with universal health care especially with certain surgeries and organ transplants.

A coworker mentioned that we should all have this discussion at least yearly when we visit our primary. I've discussed with my wife: If i come to the point of not being able to communicate, feed myself or wipe my ass...let me die. I don't want to be a vegetable. Not a quad either, thank you.

Roland of Gilead

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Re: The problem with our healthcare
« Reply #42 on: March 08, 2017, 09:49:10 AM »
First, I happen to disagree that obtaining care given or paid for by others is some kind of right. You never have the right to take another's money to pay for your care or to demand that health practitioners service you for free.

The government does have the right to take your money and use it to pay for things other people need.  It is called society.

You go to private school.  The government takes your money from property tax and pays for some other person's child to go to public school.

You have an extensive Kindle library.  The government takes your money and uses it to build a library to provide free books for other people.

They do these things to make society seem like a better option.

EnjoyIt

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Re: The problem with our healthcare
« Reply #43 on: March 08, 2017, 05:26:10 PM »

Oh man, preaching to the choir here.  The use of the ER as an urgent care clinic needs to stop.  Not only is it costly, but it really is an unpleasant patient experience to wait in an ER for hours for something relatively minor because you don't have any other options.  We just had a private urgent care clinic open in our town.  The one at our local hospital has extremely limited hours, so you often end up going to the ER.  There needs to be a better solution across the board for when you have something that needs drop in care  but not full ER services.

Our current model pays our primary care physicians too little for what is expected of them.  Therefor most doctors these days specialize and we ended up with a shortage of primary care.  Not to mention their days are so busy clicking all the right boxes that they just don't have the time to add another patient to their day and tell them to go to the ER.  Their reimbursement has been cut for decades while their cost of operation increases so they end up billing insurance companies for depression counseling and smoking cessation counseling and anything else they can do to bring their paychecks back to what they used to make even 5 years ago.

In 2017 a new reimbursement structure has come out and it dictates that doctors need to meet certain measures such as have the correct expensive computer software, talk about certain health issues with patients, and a few other metrics. The top percent of doctors that are willing to spend the money and learn all the steps will get up to a 9% increase in reimbursement.  Sounds great right?  Well all the other docs will get nothing or worse get reimbursement cut by 9%.  9% can be the difference between keeping your doors open and forced into retirement. CMS believes that about 10% of small practice physicians will be able to comply with these regulations so they should expect a 9% payout but 2020.  This new reimbursement structure will be putting physicians out of business.

EnjoyIt

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Re: The problem with our healthcare
« Reply #44 on: March 08, 2017, 05:37:44 PM »
First, I happen to disagree that obtaining care given or paid for by others is some kind of right. You never have the right to take another's money to pay for your care or to demand that health practitioners service you for free.

The government does have the right to take your money and use it to pay for things other people need.  It is called society.

You go to private school.  The government takes your money from property tax and pays for some other person's child to go to public school.

You have an extensive Kindle library.  The government takes your money and uses it to build a library to provide free books for other people.

They do these things to make society seem like a better option.

I don't see anything wrong with healthcare being accessible for those that can't afford it.  Actually I think we as a rich society should go out of our way to provide medical care for every American.  Though I strongly disagree that those who can't afford it should have the same expectations as those who pay.  There is no reason why free care needs to happen immediately unless it is a medical emergency.  There is no reason why those receiving free care need to have private rooms with cable television.  There is no reason why free care needs to have the latest robotic procedures available to them when lower cost options are just as good or close to it.  There is no reason why we need to perform expensive therapies on patients who have minimal brain function with no quality of life. There is no reason why anyone can force me to give you my most undivided attention for free.  I am happy to help those in need and currently provide about 25% of my care for free.  But I sure as hell don't owe anything to these people other than what I want to give. Well, except the government has created laws that actually force me to take care of every patient.  Even when they curse or spit or are drug addicts trying to fool me into getting them high. 

Roland of Gilead

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Re: The problem with our healthcare
« Reply #45 on: March 08, 2017, 06:17:27 PM »
The problem we have here seems to be that rich people want to be treated special.

If everyone has healthcare, they worry they will not have special treatment.

So we could maybe have a two tier healthcare system sort of like flying coach and flying first class.

Everyone gets coach healthcare which includes basics and uses drugs that have gone generic.

If you upgrade to first class healthcare, you get the private room, nurse in short skirt, latte flavored jello


MrsWolfeRN

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Re: The problem with our healthcare
« Reply #46 on: March 08, 2017, 07:10:44 PM »
The problem we have here seems to be that rich people want to be treated special.

If everyone has healthcare, they worry they will not have special treatment.

So we could maybe have a two tier healthcare system sort of like flying coach and flying first class.

Everyone gets coach healthcare which includes basics and uses drugs that have gone generic.

If you upgrade to first class healthcare, you get the private room, nurse in short skirt, latte flavored jello



My hospital actually has a VIP unit with gold plated everything. Floated there once and they even have nicer toilet paper. Regular rooms are really nice too (100 cable channels, mini fridge, pullout couch for the family) and we have better staffing ratios than most places. I still wish the $$ would be spent on research instead of cable TV and room service.

I am for universal Medicare ( not good for me now, but great if I FIRE).

 To really fix healthcare, we need to spend $ to avoid spending $$$$ down the road. This will also not be an overnight fix.

Here are some ideas, feel free to add to the list:

Increase funding for education for poor children, including health literacy. Why not throw in some financial education while we're at it and turn everyone into badass mustachians. Higher literacy (measured by grade level) directly impacts chronic disease burden and life expectancy. Why not also instill a sense of public mindedness ("I should not go to the ER for my poison ivy because it will take the Dr's time away from someone who is really sick").

Encourage people to improve their health rather than treating disease down the road. Provide preventive care and chronic disease management. Insulin is much cheaper than dialysis. BP meds are cheaper than putting a 30 year old in a nursing home because of a stroke.

Provide basic dental care for low income people. It costs millions to take care of one guy with a brain abscess from a tooth. Also it would cut down on frivolous ER visits.

Cut off a-holes who abuse the system.

Do not admit people to the hospital for being drunk. Or for headaches, or back pain, or the flu unless they are actually at risk of dying.

Get rid of f***ing Press-Ganey.

Giving free, accessible, and private birth control to all women and girls would placate both sides of the abortion debate.

Increase research into finding the most cost effective way to solve a problem. Fund more studies for prevention, vaccines, and cures.

Use evidence based treatments. Sometimes lower tech has better outcomes than higher tech.

Bargain with the drug companies for a cheaper price like every other country does. Ban advertising for prescription drugs. Punish Pharma-bro and his ilk.

Look at what other countries are doing instead of trying to reinvent the wheel. Cuba has the same life expectancy as the US, and lower infant mortality.

Edit: forgot to add that we should encourage everyone to have the end of life conversation before it is needed. Maybe we should make it a form at the DMV. I have seen many people kept alive when I wouldn't want to be if I were in their situation.
« Last Edit: March 08, 2017, 07:26:14 PM by MrsWolfeRN »

Abe

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Re: The problem with our healthcare
« Reply #47 on: March 08, 2017, 07:29:37 PM »
I know several have mentioned this, but we really need to cut down on ICU use and third-line chemotherapy, etc for terminally ill people. How we define terminally ill is something to be addressed as a society, but everyone in the healthcare industry profits off the backs of Medicare and private insurers by providing essentially futile care to minimally prolong the life of someone (usually at high cost to quality of life). This costs a thousand times more than whether your anti-hypertensive medication is $50 or $5 a month, or if your hospital has crappy floors or nice floors. Unfortunately I doubt this will be addressed. Why? 1: No one has any interest in addressing this because it reeks of "death panels" and is a form of rationing. 2: If there's one thing everyone on this board can agree on, it's that the average America hates talk of fiscal discipline, regardless of the cost to themselves or society.

Our ICUs are full of 70+ year olds who have had high risk operations or other interventions  with minimal gains in quality of life, low expectations of recovery and are now suffering the expected complications of the end stages of their specific chronic diseases. That's on us as physicians for not setting realistic expectations early and a society for expecting miracles.
« Last Edit: March 08, 2017, 07:37:29 PM by Abe »

accolay

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Re: The problem with our healthcare
« Reply #48 on: March 09, 2017, 04:26:24 AM »
If you upgrade to first class healthcare, you get the private room, nurse in short skirt, latte flavored jello
You really want me in a skirt? Ok...but I'm a dude with skinny and hairy legs. Not to mention the possibility of body fluids on your legs. Gross.

accolay

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Re: The problem with our healthcare
« Reply #49 on: March 09, 2017, 04:30:05 AM »
I know several have mentioned this, but we really need to cut down on ICU use and third-line chemotherapy, etc for terminally ill people. How we define terminally ill is something to be addressed as a society, but everyone in the healthcare industry profits off the backs of Medicare and private insurers by providing essentially futile care to minimally prolong the life of someone (usually at high cost to quality of life).

This is all well and good...but a lot of times when it comes down to it, people do not have the capacity to say no to more medicine and interventions. It's going to take time to change society's perspective.