Author Topic: The problem with our healthcare  (Read 7448 times)

accolay

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Re: The problem with our healthcare
« Reply #50 on: March 09, 2017, 04:34:46 AM »
Giving free, accessible, and private birth control to all women and girls would placate both sides of the abortion debate.

I agree with everything you said...but this one is a real sticking point. We can't even agree on how to educate on sex education let alone giving free birth control to females. Conservatives will always be against this. If it's not because of religion, then because they don't want anybody to get anything "free" even if it saves money down the road. They're big on principles even if it means shooting themselves in the foot.

Abe

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Re: The problem with our healthcare
« Reply #51 on: March 09, 2017, 07:34:01 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 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.

I agree, and mention that in the second half of my post. However I think it'll take more scarcity of resources to change perspective rather than time alone. We are in the phase of healthcare just past the upswing in quality. Just 40 years ago, people routinely died of major heart attacks because of limited technology to treat them, for example. Or many cancers, even. Now we've plateaued in healthcare improvement with technology and are relying on societal changes, which is of course a lot harder. Unfortunately, we are far behind in understanding the utility of certain technologies on a societal level. A good example is the expanded use of cardiac stents from their original indication (heart attacks) to other symptoms (intermittent chest pain, or even asymptomatic narrowing of the arteries). Approximately 5 million stents later, a trial demonstrated no benefit to stenting for these other indications. Yet, it is still commonly done. Why? Greed, expectations, inertia?
« Last Edit: March 09, 2017, 07:37:47 PM by Abe »

WhiteTrashCash

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Re: The problem with our healthcare
« Reply #52 on: March 09, 2017, 08:05:57 PM »
Much of the ridiculous cost for healthcare at hospitals doesn't come from regulations. It comes from having to make up for the cost of uninsured patients. Before the ACA, poor people wouldn't get preventative care and then when the situation got really bad they would go to the emergency room with no insurance and get healthcare for free. Well, technically, they were billed for it, but then they would declare bankruptcy since they couldn't afford the bills and the debt would be wiped out. The hospitals still need to pay for the services, so they raise the bills for everyone else. The ACA mostly put an end to that, which is why health costs weren't increasing anywhere near as quickly over the past few years.

Soon, that will be a thing of the past, though, because my fellow White Trash voted to outlaw the ACA. They don't really understand healthcare. They don't get that the ACA did more good than harm.

EnjoyIt

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Re: The problem with our healthcare
« Reply #53 on: March 10, 2017, 03:50:15 PM »
Much of the ridiculous cost for healthcare at hospitals doesn't come from regulations. It comes from having to make up for the cost of uninsured patients. Before the ACA, poor people wouldn't get preventative care and then when the situation got really bad they would go to the emergency room with no insurance and get healthcare for free. Well, technically, they were billed for it, but then they would declare bankruptcy since they couldn't afford the bills and the debt would be wiped out. The hospitals still need to pay for the services, so they raise the bills for everyone else. The ACA mostly put an end to that, which is why health costs weren't increasing anywhere near as quickly over the past few years.

Soon, that will be a thing of the past, though, because my fellow White Trash voted to outlaw the ACA. They don't really understand healthcare. They don't get that the ACA did more good than harm.

Although I agree that hospitals cover the cost of uncompensated care via increasing the cost to the insured and self pay patients that actually pay, but the ACA did not make the cost of going to the Emergency Room free.  Looking at the balance sheet of my hospital I see plenty of people with insurance who do not pay their very high deductible.  It is as if the insurance did nothing for them except line the pockets of the insurance company. This may be why the cost of healthcare has not risen at the same rate these last 3 years.  People are now willing to ration their own expenses to keep their own costs down. 

I agree, and mention that in the second half of my post. However I think it'll take more scarcity of resources to change perspective rather than time alone. We are in the phase of healthcare just past the upswing in quality. Just 40 years ago, people routinely died of major heart attacks because of limited technology to treat them, for example. Or many cancers, even. Now we've plateaued in healthcare improvement with technology and are relying on societal changes, which is of course a lot harder. Unfortunately, we are far behind in understanding the utility of certain technologies on a societal level. A good example is the expanded use of cardiac stents from their original indication (heart attacks) to other symptoms (intermittent chest pain, or even asymptomatic narrowing of the arteries). Approximately 5 million stents later, a trial demonstrated no benefit to stenting for these other indications. Yet, it is still commonly done. Why? Greed, expectations, inertia?

Scarcity of resources is the reality.  People expect everything for everyone and they expect it immediately.  The reality is that we do not have those resources to have everything. People just don't realize that. People thing we can just tax the person making a little more than them to cover all those extra costs. There is a limit to this strategy.

Abe

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Re: The problem with our healthcare
« Reply #54 on: March 11, 2017, 09:52:35 AM »
Much of the ridiculous cost for healthcare at hospitals doesn't come from regulations. It comes from having to make up for the cost of uninsured patients. Before the ACA, poor people wouldn't get preventative care and then when the situation got really bad they would go to the emergency room with no insurance and get healthcare for free. Well, technically, they were billed for it, but then they would declare bankruptcy since they couldn't afford the bills and the debt would be wiped out. The hospitals still need to pay for the services, so they raise the bills for everyone else. The ACA mostly put an end to that, which is why health costs weren't increasing anywhere near as quickly over the past few years.

Soon, that will be a thing of the past, though, because my fellow White Trash voted to outlaw the ACA. They don't really understand healthcare. They don't get that the ACA did more good than harm.

Although I agree that hospitals cover the cost of uncompensated care via increasing the cost to the insured and self pay patients that actually pay, but the ACA did not make the cost of going to the Emergency Room free.  Looking at the balance sheet of my hospital I see plenty of people with insurance who do not pay their very high deductible.  It is as if the insurance did nothing for them except line the pockets of the insurance company. This may be why the cost of healthcare has not risen at the same rate these last 3 years.  People are now willing to ration their own expenses to keep their own costs down. 

Out of interest, what fraction of ICU care at your hospital gets covered by insurance? Also, what's your ICU/floor ratio for beds? Ours is close to 20%, which I think is egregious but the ICUs are always full...mostly it seems Medicare is picking up the tab since they are mostly 70+ year olds.

EnjoyIt

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Re: The problem with our healthcare
« Reply #55 on: March 11, 2017, 06:00:45 PM »
Our ICU seams to be about 15% of the hospital beds but when you add step down or IMCU that number doubles. I honestly do not know he percentage, but sicker patients tend to be over 65 and therefor Medicare.

We are really good at moving them out quickly. Since length of stay costs money and the hospital pushes the intensivists to move them out ASAP. Obviously when they are stable. Bounce backs from floor to ICU are also counted and are rare.

babybug

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Re: The problem with our healthcare
« Reply #56 on: March 12, 2017, 08:40:44 PM »



Soon, that will be a thing of the past, though, because my fellow White Trash voted to outlaw the ACA. They don't really understand healthcare. They don't get that the ACA did more good than harm.

This is a one-dimensional view of a complex and difficult issue.  Someone always pays for healthcare. Of course ACA benefitted some, I mean you spend $1 trillion of taxpayer funds, someone will be helped.

But many many others (private sector workers who don't qualify for subsidies) are seeing premiums & copays double and triple and coverage cut. And businesses are burdened, can't grow or hire full time for same reasons.  ACA is overall a costly burden on the economy.

But I think this insightful post is about the actual insane *cost* and how much goes to the middleman, the onerous regulations (many just political in nature), and sheer dumb waste. It's a lot.

And the profiteering insurers and big pharma etc, are not letting their golden goose die.  It doesn't matter Obamacare vs Trumpcare vs Ryancare.  Their armies of lobbyists are fighting tooth and nail to ensure the status quo stays.




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EnjoyIt

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Re: The problem with our healthcare
« Reply #57 on: March 13, 2017, 07:04:10 AM »



Soon, that will be a thing of the past, though, because my fellow White Trash voted to outlaw the ACA. They don't really understand healthcare. They don't get that the ACA did more good than harm.

This is a one-dimensional view of a complex and difficult issue.  Someone always pays for healthcare. Of course ACA benefitted some, I mean you spend $1 trillion of taxpayer funds, someone will be helped.

But many many others (private sector workers who don't qualify for subsidies) are seeing premiums & copays double and triple and coverage cut. And businesses are burdened, can't grow or hire full time for same reasons.  ACA is overall a costly burden on the economy.

But I think this insightful post is about the actual insane *cost* and how much goes to the middleman, the onerous regulations (many just political in nature), and sheer dumb waste. It's a lot.

And the profiteering insurers and big pharma etc, are not letting their golden goose die.  It doesn't matter Obamacare vs Trumpcare vs Ryancare.  Their armies of lobbyists are fighting tooth and nail to ensure the status quo stays.




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Exactly, while we quibble over who pays for health care, those big industries are continuing to laugh their way to the bank.  Just think about how much less expensive healthcare would be to deliver if you remove the middle man from the majority of non catastrophic issues.  Even if the middle man is the government, it costs a lot of money to hire people and comply with billing and coding regulations to bill the government.  It then costs the government lots of money to hire people to review all the billing and coding, have panels to review, evaluate and deny claims, and send checks to biller.

So many people think that government should do all these amazing things, but they just don't realize that the healthcare dollar is finite and therefor you have to ration utilization and decrease cost.  That is what socialized medicine in other countries do. They ration utilization.

Something as simple as getting a prescription costs way to much money to operate.  The pharmacy needs to hire a person who will look at every script and send it to either the government or the insurance company for approval.  Someone at the government and at the insurance company needs to evaluate that script and approve payment.  Only then can the pharmacist fill it.  All those people,  computers, and software that are involved costs money and are wasteful.  Not to mention the insurance company needs to make a profit on the transaction also adding to the cost.  So instead of paying $7 for a prescription, you are now paying $10.  There is no need for the insurance or government middleman in this process.  On the other hand if you require $250/day medication, for the rest of your life, well then insurance and/or government can step in to reimburse you for your cost.

golden1

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Re: The problem with our healthcare
« Reply #58 on: March 13, 2017, 07:48:52 AM »
If you were to redesign the health care system from scratch, how would you design it? 

I really feel like much of the medical system is just run plain inefficiently.  I hate going to the doctor where they make me fill out the same form every time.  I also hate that half the time I go to the doctor, I end up getting sick afterwards from something I picked up while there.  I hate talking to my doctor, because he or she seems really overwhelmed and unempathetic most of the time.  I don't blame them, I just think they are overloaded. 

If I have something minor, like bronchitis or a UTI, what I realized is that the worst part of it is that I have to haul my uncomfortable ass to the doctor, talk to them for 15 minutes, maybe do a test, and then get a prescription or a note to give my employer.  I am sure I probably have made other people sick doing this.  (As an aside, I always wonder how doctors and nurses avoid just being sick all the time) I end up having to be annoyed for 3-4 hours instead of being home resting.  Maybe there is no way around this, but it sure is annoying.  They just opened up one of those urgent care clinics across town - maybe that is a better option now.   


Jouer

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Re: The problem with our healthcare
« Reply #59 on: March 13, 2017, 08:59:21 AM »
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. 
<snip>

Those stiches would have cost you $250 in Canada if you didn't have insurance. i.e. didn't have your health card with you from another province or were from out of Country. Not trying to get into the debate about what system is better/best - just showing you an example of bloated costs, likely due to insurance companies being involved.

(Our doctors are still rich. Our nurses well paid.)

eyePod

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Re: The problem with our healthcare
« Reply #60 on: March 13, 2017, 11:14:48 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.

It's getting cheaper every day to bring a drug to market. Companies can do it faster, with less overhead (thanks to single use technologies - there are a lot of virtual companies that get it done using contract manufacturing), and more reliably as well.

The issue is as we get better in understanding how these drugs are working, we're making drugs that are more complex which require better/more extensive testing to show that Drug A = Drug A = Drug A. I don't see a good solution for it especially if I'm going to be getting injected with it.

Pills are a different matter since that's just basically baking.
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ncornilsen

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Re: The problem with our healthcare
« Reply #61 on: March 13, 2017, 11:43:45 AM »
If you were to redesign the health care system from scratch, how would you design it? 

I really feel like much of the medical system is just run plain inefficiently.  I hate going to the doctor where they make me fill out the same form every time.  I also hate that half the time I go to the doctor, I end up getting sick afterwards from something I picked up while there.  I hate talking to my doctor, because he or she seems really overwhelmed and unempathetic most of the time.  I don't blame them, I just think they are overloaded. 

If I have something minor, like bronchitis or a UTI, what I realized is that the worst part of it is that I have to haul my uncomfortable ass to the doctor, talk to them for 15 minutes, maybe do a test, and then get a prescription or a note to give my employer.  I am sure I probably have made other people sick doing this.  (As an aside, I always wonder how doctors and nurses avoid just being sick all the time) I end up having to be annoyed for 3-4 hours instead of being home resting.  Maybe there is no way around this, but it sure is annoying.  They just opened up one of those urgent care clinics across town - maybe that is a better option now.

My thoughts:

-everyone is required to have a catastrophic plan. Yearly stop-loss of $10,000. Maybe even nationalize this part. 1 preventative checkup per year, zero help with costs until the $10,000 mark. Maybe make costs the same, per person, no matter what, perhaps?
-Requirements for insurance policies are standardized across all 50 states.  These policies ought to be cheap, I mean they only have to cover up to $10,000 per year.
-It will become illegal for employers to do anything but provide a voucher that the employee can use to secure their own coverage.
-You can deny coverage for pre-existing conditions again, and the ratio of cost to young/old can increase a bit so we aren't forcing the young to subsidize the old. (fuck you baby boomers, you've looted this country enough.)

I'm not sure how to do it exactly, but I'd like to see more transparency in pricing for care. Emergency procedure's are a whole 'nother kettle of fish, but for non-emergency stuff certain should be do-able. Ideally people would be given enough information to make healthcare consumption decisions, while also feeling the economic impact of those decisions, to make this market work a bit more efficiently.

mm1970

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Re: The problem with our healthcare
« Reply #62 on: March 13, 2017, 12:44:09 PM »
Quote
preventative checkup per year, zero help with costs until the $10,000 mark. Maybe make costs the same, per person, no matter what, perhaps?

Out of curiosity, what happens to a family of 4 who only makes $40k per year?

golden1

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Re: The problem with our healthcare
« Reply #63 on: March 13, 2017, 12:51:43 PM »
Quote
-everyone is required to have a catastrophic plan. Yearly stop-loss of $10,000. Maybe even nationalize this part. 1 preventative checkup per year, zero help with costs until the $10,000 mark. Maybe make costs the same, per person, no matter what, perhaps?
-Requirements for insurance policies are standardized across all 50 states.  These policies ought to be cheap, I mean they only have to cover up to $10,000 per year.
-It will become illegal for employers to do anything but provide a voucher that the employee can use to secure their own coverage.
-You can deny coverage for pre-existing conditions again, and the ratio of cost to young/old can increase a bit so we aren't forcing the young to subsidize the old. (fuck you baby boomers, you've looted this country enough.)

I like parts of this, but the last caveat is troublesome, mostly because I have kids who have pre-existing conditions, and for them to be penalized through no fault of their own seems like they will be put at a disadvantage. 

Also, I have a feeling that the effect of this is that many procedures will suddenly rise in price to $10,001 in order to soak the cap.  Not sure what can be done about this though. 

i'd also pair this with death panels so that we aren't incentivized to pump money into the last 6 months of a persons life. 

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Re: The problem with our healthcare
« Reply #64 on: March 13, 2017, 03:00:24 PM »
Politicians don't want to try to fix the 3,000 pound gorilla in the room- obesity.  Poor diet and poorly designed car reliant suburbs means the US has a terribly unhealthy population. 

Also, the government over regulates the actual business of healthcare.  Ask any doctor or any hospital.  The cost to comply and buy malpractice insurance is sky high.  Ever heard of a certificate of need in retail?  Healthcare has these all over the place, you can't even open up a hospital without one.  The government must "certify" the need???   WTF?  That's not freedom.

I say go self pay, with a health sharing plan instead.  Self pay isn't scary if you lead a healthy lifestyle.  Outside of having babies, we've never come close to meeting our deductibles. 
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Cwadda

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Re: The problem with our healthcare
« Reply #65 on: March 13, 2017, 03:14:48 PM »
No one in the government negotiates with the drug companies, we just keep paying whatever it is. Trump said he was going to negotiate with them, and this is something I actually agreed with him on, but he hasn't done anything. He's only made them benefit more. I'm not surprised.

fasteddie911

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Re: The problem with our healthcare
« Reply #66 on: March 13, 2017, 03:19:21 PM »
I agree with most of what's been said so far.  I'm with the OP, get rid of the insurance company middle-man in its current form and save 20% on insurance premiums.  In various cities across the country I see large hospital systems buying up smaller hospitals, practices, etc.  Maybe what could happen is that we start paying directly into the hospital system for our care, similar to the Kaiser system, eliminating insurance companies in their current form.  Most people I've talked to (patients and providers) in the Kaiser system don't have complaints and Kaiser seems to do ok financially, yet in my area the plans they offer are about 20% less than a comparable plan from a private insurance company.  Each city could have a few hospital systems from which patients can pay into and receive all their care from.  They compete on price, quality and services.  Coordination would likely improve, physician autonomy may decrease, but they'd likely be better supported.  Maybe can even throw in a universal healthcare component where government finances (but doesn't run) these hospitals.  Of course this is on top of reducing drug prices, tort reform, end of life care, etc.

scottish

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Re: The problem with our healthcare
« Reply #67 on: March 13, 2017, 03:30:39 PM »
Quote
i'd also pair this with death panels so that we aren't incentivized to pump money into the last 6 months of a persons life.

Hey this is interesting.   The idea of death panels is controversial at best, and viewed as repugnant by many.  I'm surprised to see it here.

Does anyone else like the idea of death panels?     I don't think that I do, although they may come to pass over the next 20 to 30 years.   

Personally,  there's absolutely no way I want to spend my last years in a nursing home or a palliative care ward.   

ncornilsen

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Re: The problem with our healthcare
« Reply #68 on: March 13, 2017, 05:26:48 PM »
Quote
i'd also pair this with death panels so that we aren't incentivized to pump money into the last 6 months of a persons life.

Hey this is interesting.   The idea of death panels is controversial at best, and viewed as repugnant by many.  I'm surprised to see it here.

Does anyone else like the idea of death panels?     I don't think that I do, although they may come to pass over the next 20 to 30 years.   

Personally,  there's absolutely no way I want to spend my last years in a nursing home or a palliative care ward.   

I believe that it is a completely rational thing to do, when an individual is in their 80s, to determine a limit on what lengths we will go to prolong one's existence. It's going to be icky work, and I'll probably feel differently about it when it's my parents. And that's not to say a family can't pay with their own money, the exorbitant costs of those last few days, if it's worth it to them. (Of course, when a republican suggests this, I'll be because they want to kill the poor or something.)

Quote
Out of curiosity, what happens to a family of 4 who only makes $40k per year?


since a supplemental policy to bridge the gap between 0 and 10,000 ought to be fairly cheap, they'd... get one of those.

Quote
I like parts of this, but the last caveat is troublesome, mostly because I have kids who have pre-existing conditions, and for them to be penalized through no fault of their own seems like they will be put at a disadvantage. 

Also, I have a feeling that the effect of this is that many procedures will suddenly rise in price to $10,001 in order to soak the cap.  Not sure what can be done about this though. 

i'd also pair this with death panels so that we aren't incentivized to pump money into the last 6 months of a persons life. 

The catastrophic policy wouldn't have that caveat. And decoupling insurance from employment ought to mean less of those changes. But it would create an incentive with teeth to keep people from joining the plans that bridge the 0 to 10K gap after a diagnosis and causing the adverse selection death spiral.

And, as I said, I'm in support of some control on end-of-life spending.



kite

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Re: The problem with our healthcare
« Reply #69 on: March 13, 2017, 06:50:38 PM »
Giving free, accessible, and private birth control to all women and girls would placate both sides of the abortion debate.

I agree with everything you said...but this one is a real sticking point. We can't even agree on how to educate on sex education let alone giving free birth control to females. Conservatives will always be against this. If it's not because of religion, then because they don't want anybody to get anything "free" even if it saves money down the road. They're big on principles even if it means shooting themselves in the foot.

Good lord!  In a thread on what's wrong with the cost of health care comes this, which could be exhibit A for how to reduce costs.  Please, don't let yourself be brainwashed by the lefty echo chamber who've had this stunningly, ridiculously wrong.  Making it "free" costs many multiples more than it would if it were simply OTC as it is for millions of women around the world in China, India & Mexico. 
"Free" is not at all without cost.  It's a very high cost because of insurance overhead, not just for the drugs themselves, but for the entirely unrelated exam that comes with a prescription renewal.   It is also not "free" to the woman if it involves time off of work, getting a babysitter for other kids and transportation to submit to a pelvic exam lest her prescription for something unrelated is held hostage by a system of spiralling out of control costs.  You want birth control to be cheapest and most accessible, you make it OTC and let Wall Mart stick it on their shelves next to Ibuprofen and Claritin.  The market will cause the price to drop to around $9/month. 
The unintended benefits include undocumented, uninsured or traveling women can purchase without missing a beat.  A woman who doesn't want her employer or partner to know what she takes by having it appear on an EOB statement can do so privately by paying cash. 
The other unintended benefit for the rest of Americans waiting for doctors appointments is that your doctor isn't busy giving an unrelated exam in exchange for a prescription.  That is where patients save time and insurers and taxpayers would save money.  Because the real waste in health care resources is when well people are taking up time in doctor's offices. 


EnjoyIt

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Re: The problem with our healthcare
« Reply #70 on: March 13, 2017, 10:45:16 PM »

My thoughts:

-everyone is required to have a catastrophic plan. Yearly stop-loss of $10,000. Maybe even nationalize this part. 1 preventative checkup per year, zero help with costs until the $10,000 mark. Maybe make costs the same, per person, no matter what, perhaps?
-Requirements for insurance policies are standardized across all 50 states.  These policies ought to be cheap, I mean they only have to cover up to $10,000 per year.
-It will become illegal for employers to do anything but provide a voucher that the employee can use to secure their own coverage.
-You can deny coverage for pre-existing conditions again, and the ratio of cost to young/old can increase a bit so we aren't forcing the young to subsidize the old. (fuck you baby boomers, you've looted this country enough.)

I'm not sure how to do it exactly, but I'd like to see more transparency in pricing for care. Emergency procedure's are a whole 'nother kettle of fish, but for non-emergency stuff certain should be do-able. Ideally people would be given enough information to make healthcare consumption decisions, while also feeling the economic impact of those decisions, to make this market work a bit more efficiently.

Now we are finally talking...a conversation on actually decreasing the cost of care.

1) I fully agree with insurance being completely removed from most of our healthcare expenditures.  Also have individuals buy catastrophic plans as you described above.  yes there will be a very sticky transition point regarding what is covered by the catastrophic plan and what the limit is.  These plans should be priced fairly. it should be less expensive for the healthier population but still have their premiums slightly higher to help offset the cost for the sicker and older population. 

2) I also fully agree with cutting off futile care to the brain dead or those that will receive no improvement in quality of life.  Families have the right to spend their own money if they desire.

3) Remove the massive bureaucracy out of health care.   Stop forcing physicians to document useless nonsense for coding purposes as well as stop forcing us to use ICD-10 coding system for billing purposes.

4) Minimize lawsuits by placing caps as well as stopping lawsuits from poor outcomes.   If we can't sue doctors and hospitals we must have the ability to remove poor performers from providing medical services to protect people.

5) Decrease some of the hoops the FDA forces drug companies to go through.  The process to approve a new medication is much more onerous in the US as compared to many other countries.  For example there is a new drug developed that can stop the bleeding for patients on a particular class of blood thinners.  This has never existed and can really save lives.  Plenty of trials have proven its efficacy but the FDA has delayed this drug going to market because they wanted more documentation despite the positive trials.  This company was forced to take out a loan to continue operations until this drug is approved.  Needles waste that not only costs money, but costs lives.

6) All medications and procedures need to have their costs easily listed and accessible.  I should know exactly how much it will cost to remove my gallbladder or to have my cholesterol checked. There will never be cost reduction if there is no price transparency and competition.

7) We will also need to provide a way for the poor to be able to access healthcare.  The best way for this is though community clinics and community hospitals.  They will get free healthcare, but they will also have to wait.  Lines will be longer unless you have an emergency.  No private rooms in the hospital.  But the medical care will be exactly the same if they paid for it.  Good free care that is appropriately rationed just like in other countries with socialized healthcare. 

I truly believe implementing all those changes above should cut the cost of healthcare by more than half.  While still provide plenty of incentive for innovation. These steps need to be implemented over 10 years as making all those changes at once would put 100,000s of people out of work as they are all part of the middle man process.  I would start with the most important which is mandatory price transparency.

Hey this is interesting.   The idea of death panels is controversial at best, and viewed as repugnant by many.  I'm surprised to see it here.

Does anyone else like the idea of death panels?     I don't think that I do, although they may come to pass over the next 20 to 30 years.   

Personally,  there's absolutely no way I want to spend my last years in a nursing home or a palliative care ward.   

Unfortunately there is a limit on how much we can spend on healthcare.  Spending money on keeping the braindead alive is a waste of a very limited resource.  I think if we chose a different name other than death panels it would not sound so evil.  How about we call it "compassionate care."  Allowing the very sick to die with dignity and comfort instead of continued pocking, probing and painful procedures that add nothing but suffering to our loved ones.  Believe me, I truly believe what some people are forcing unto their very sick loved ones is awful and cruel.

MoonLiteNite

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Re: The problem with our healthcare
« Reply #71 on: March 14, 2017, 05:22:07 AM »
Soo solution?
Don't get healthcare :)

I have had jaw sugar (major), wisdom teeth removed, and my nuts slightly snipped. All without insurance and all of it being a fair price.
Many doctors are willing to work with you if you say you don't have insurance but can pay all cash up front.

My vasectomy was 750$ with ins, without, 125$
My wisdom teeth removal? They said it would be 250$ each tooth, so 1000$. Only charged me 250$ for all 4, that was including the pain meds.
Jaw surgery was est to be around 50k, in the end, i paid 10k....


I actually now carry HDHP, but even then i really don't even mention that i have it.  I only have it due to major health issues that will get me sooner or later

BeanCounter

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Re: The problem with our healthcare
« Reply #72 on: March 14, 2017, 07:04:03 AM »
Giving free, accessible, and private birth control to all women and girls would placate both sides of the abortion debate.

I agree with everything you said...but this one is a real sticking point. We can't even agree on how to educate on sex education let alone giving free birth control to females. Conservatives will always be against this. If it's not because of religion, then because they don't want anybody to get anything "free" even if it saves money down the road. They're big on principles even if it means shooting themselves in the foot.

Good lord!  In a thread on what's wrong with the cost of health care comes this, which could be exhibit A for how to reduce costs.  Please, don't let yourself be brainwashed by the lefty echo chamber who've had this stunningly, ridiculously wrong.  Making it "free" costs many multiples more than it would if it were simply OTC as it is for millions of women around the world in China, India & Mexico. 
"Free" is not at all without cost.  It's a very high cost because of insurance overhead, not just for the drugs themselves, but for the entirely unrelated exam that comes with a prescription renewal.   It is also not "free" to the woman if it involves time off of work, getting a babysitter for other kids and transportation to submit to a pelvic exam lest her prescription for something unrelated is held hostage by a system of spiralling out of control costs.  You want birth control to be cheapest and most accessible, you make it OTC and let Wall Mart stick it on their shelves next to Ibuprofen and Claritin.  The market will cause the price to drop to around $9/month. 
The unintended benefits include undocumented, uninsured or traveling women can purchase without missing a beat.  A woman who doesn't want her employer or partner to know what she takes by having it appear on an EOB statement can do so privately by paying cash. 
The other unintended benefit for the rest of Americans waiting for doctors appointments is that your doctor isn't busy giving an unrelated exam in exchange for a prescription.  That is where patients save time and insurers and taxpayers would save money.  Because the real waste in health care resources is when well people are taking up time in doctor's offices.
+1
This is a great example of one of the many things that's wrong with our health system.

ncornilsen

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Re: The problem with our healthcare
« Reply #73 on: March 14, 2017, 07:54:19 AM »
Insurance does not seem the best conveyance method for recurring commodities that are super cheap anyway. I get that we don't want cost to be a barrier to people controlling their reproduction, but there has to be a way to directly subsidize those costs without an insurance company skimming off the top or a gov't bureaucracy regulating it.

SimpleCycle

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Re: The problem with our healthcare
« Reply #74 on: March 14, 2017, 08:08:41 AM »
Just to get some real numbers in here, my insurance pays $131.70 for a 99215 (high complexity return patient office visit).  Medicare pays $111.78 for the same code.  Medicaid in my state pays $46.70 for that code, which shows how much cross subsidization already exists in our system.

Our health care system is wildly expensive, and why that is the case is a very complex issue.  I have a Masters degree in health policy and work in the field, which is enough to know that there are no easy answers and anyone who claims there are probably shouldn't be believed.

MrsPete

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Re: The problem with our healthcare
« Reply #75 on: March 14, 2017, 12:12:59 PM »
Because realistically, a doctor visit is not worth $100 that is charged
I disagree.  You're paying to see an expert who has invested many years/much money preparing to diagnose your ear infection.  Why shouldn't that expert be paid well? 

and asked him if he knows how to read food labels. 
Most people don't understand how to read food labels. 

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.
Good point -- all those things cost money.

Problem: How does one shop around when in an emergency medical situation?
Actually, I heard something on that subject years ago -- it may be a bit off topic:  I attended a grand opening of a new hospital -- they opened the doors and let the general public come in and have a look at their new facilities.  I found it interesting. 

Anyway, when we toured the maternity ward, the host told us that they'd splurged on private rooms, fancy this and that -- not medically necessary things, mind you, but things to make new moms choose their hospital instead of another.  They explained that this wasn't entirely altruistic; rather, they said that new mothers tend to take lots of time choosing where they'll give birth ... but then when a crisis comes along, the new mother automatically comes to "her hospital". 

kite

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Re: The problem with our healthcare
« Reply #76 on: March 14, 2017, 01:46:19 PM »
Insurance does not seem the best conveyance method for recurring commodities that are super cheap anyway. I get that we don't want cost to be a barrier to people controlling their reproduction, but there has to be a way to directly subsidize those costs without an insurance company skimming off the top or a gov't bureaucracy regulating it.

We already have the perfect mechanism to subsidize that gives maximum autonomy to individuals:  the tax code. If you are fortunate enough to be in a higher tax bracket -- should your birth-control be subsidized at all?  I don't think so.   If you are middle-class, it can be deductible or a tax credit.  If you are poor, it can be a line-item credit added to the EITC.  Alternatively, it can be an allowable purchase on EBT cards.  In fact, there is no reason that an EBT card can't have a non-food balance for a number of things that are tax-deductible to the middle-class. The same logic that sorts purchases into payable by FSA/HSA debit cards for the middle-class ought to do it.  It's already sorting your grocery bill (if you pay with EBT) into allowed & disallowed items. 
« Last Edit: March 14, 2017, 02:45:40 PM by kite »

EnjoyIt

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Re: The problem with our healthcare
« Reply #77 on: March 14, 2017, 02:10:33 PM »
Just to get some real numbers in here, my insurance pays $131.70 for a 99215 (high complexity return patient office visit).  Medicare pays $111.78 for the same code.  Medicaid in my state pays $46.70 for that code, which shows how much cross subsidization already exists in our system.

Our health care system is wildly expensive, and why that is the case is a very complex issue.  I have a Masters degree in health policy and work in the field, which is enough to know that there are no easy answers and anyone who claims there are probably shouldn't be believed.

You are right.  There is no easy fix.  My biggest gripe about the whole thing is that our politicians have us arguing about who will pay as opposed to actually trying to do something about cost.  Is it really worth your time to see medicaid patients?  I dunno maybe it is and maybe it isn't.  What do you think the percentage of your reimbursement is overhead? How much time do you spend with a level 5 Medicaid patient?

But wouldn't you rather just charge much less, get cash and fire your coder/biller, fire your collections agency, fire your IT guy and just have you and a nurse manage all your patients?  Don't you wish you did not have to try and get every chart up to a level 5 to squeeze every penny out of the insurance company or CMS? Don't you wish you did not have to waste valuable time documenting useless nonsense just so you can get paid.  Basic medical care should be a cash business that would instantly decrease the cost for everyone.

Emergency care is a whole other story. As well as medical care for those who can not afford to pay cash as described in my example a few posts up.

Cpa Cat

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Re: The problem with our healthcare
« Reply #78 on: March 14, 2017, 02:47:56 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.

On a similar vein - I went to the ER because I almost cut off the tips of two of my fingers. It wasn't a big deal in the end and the nurse bandaged it up and as I was walking out, he handed me two metal finger protectors and said something to the effect of "Here, these might be useful." They didn't actually fit over the bandages though, and I never used them.

When the bill came, those two metal thingies had a price tag of $20 each. $40 as an afterthought that was 100% not requested, required, or useful.

But I don't think the nurse was being malicious or anything. He probably had no idea I was going to get changed $40 for that. I doubt he would have offered them to me if he'd known. And I doubt he'll ever find out. He's completely disconnected from the billing process, which is completely disconnected from my actual visit.

There are two easy ways to have lowered by bill by $40: If the nurse knew what those things cost, he may not have even offered them. If the bill was presented me before I exited the building, I could have declined them. But neither the supplier of that item nor the purchaser of that item knows the price of that item is so we never get the opportunity to address the price.

EnjoyIt

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Re: The problem with our healthcare
« Reply #79 on: March 14, 2017, 03:08:33 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.

On a similar vein - I went to the ER because I almost cut off the tips of two of my fingers. It wasn't a big deal in the end and the nurse bandaged it up and as I was walking out, he handed me two metal finger protectors and said something to the effect of "Here, these might be useful." They didn't actually fit over the bandages though, and I never used them.

When the bill came, those two metal thingies had a price tag of $20 each. $40 as an afterthought that was 100% not requested, required, or useful.

But I don't think the nurse was being malicious or anything. He probably had no idea I was going to get changed $40 for that. I doubt he would have offered them to me if he'd known. And I doubt he'll ever find out. He's completely disconnected from the billing process, which is completely disconnected from my actual visit.

There are two easy ways to have lowered by bill by $40: If the nurse knew what those things cost, he may not have even offered them. If the bill was presented me before I exited the building, I could have declined them. But neither the supplier of that item nor the purchaser of that item knows the price of that item is so we never get the opportunity to address the price.

I'll make you even more angry they cost only $2 each and probably much less in bulk. I'll make you even angrier.  If a provider applied the splint they can bill your insurance for the application of it.  How much they bill is a complete mystery of course but I am guessing Medicaid would pay about $30 for the application of each splint.

http://www.shoplet.com/Djo-Global-Finger-Splint-PROCARE-Frog-Style-Aluminum-Foam-Left-or-Right-Hand-Silver-Blue-Large/MCK19673000/spdv?gclid=CjwKEAjwqZ7GBRC1srKSv9TV_iwSJADKTjaDDRGtb_KBbn_SElt9rycCSoCYVY-JEr2BO_nH2qiKBBoCodjw_wcB

Proud Foot

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Re: The problem with our healthcare
« Reply #80 on: March 14, 2017, 03:37:58 PM »
I saw this article yesterday and found rather interesting. What Hospitals Waste

EnjoyIt

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Re: The problem with our healthcare
« Reply #81 on: March 14, 2017, 04:10:27 PM »
I saw this article yesterday and found rather interesting. What Hospitals Waste

Great article and an awesome woman.  Thanks for the link/read.

Ichabod

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Re: The problem with our healthcare
« Reply #82 on: March 15, 2017, 12:31:12 PM »
If you were to redesign the health care system from scratch, how would you design it? 

I really feel like much of the medical system is just run plain inefficiently.  I hate going to the doctor where they make me fill out the same form every time.  I also hate that half the time I go to the doctor, I end up getting sick afterwards from something I picked up while there.  I hate talking to my doctor, because he or she seems really overwhelmed and unempathetic most of the time.  I don't blame them, I just think they are overloaded. 

If I have something minor, like bronchitis or a UTI, what I realized is that the worst part of it is that I have to haul my uncomfortable ass to the doctor, talk to them for 15 minutes, maybe do a test, and then get a prescription or a note to give my employer.  I am sure I probably have made other people sick doing this.  (As an aside, I always wonder how doctors and nurses avoid just being sick all the time) I end up having to be annoyed for 3-4 hours instead of being home resting.  Maybe there is no way around this, but it sure is annoying.  They just opened up one of those urgent care clinics across town - maybe that is a better option now.

A national health insurance policy that covers expenses over 10% of your income. In 2013, 10% was roughly the income the average person was spending on premiums and deductibles. This means everyone can afford healthcare for those of us who believe it should be part of the social compact, and there is still incentive to shop around for those of us who believe in the free market. If you want some kind of gap insurance for below that, it's fine, but it's not tax-deductible.

A lot of people trod out the unconscious man rushed in the ambulance as why the free market won't work for health care. Most of health care isn't like that. Providers just compete on things other than price, because most don't self-pay. ERs compete on wait-times (many hospitals have billboards with their current wait-times). Websites exist that have grades and reviews of doctors. Word-of-mouth of who's good. People don't normally end up consuming healthcare with no choice.

People will demand lower-cost solutions to common health issues. Physician assistants and nurse practitioners for colds and flus. Midwives for births. Maybe people will become more involved with their own care of "Do I really need that test/treatment/drug?" And you don't need everybody to participate in aggressive price shopping. As long as some critical mass does providers will start competing on costs.

Expensive treatments like cancer and end-of-life care will still probably expensive. We can't afford the best for everyone. We can either ration it by cost or by some government committee ("Death panels"). Government can't cover everything. Kidney transplant for a 68-year-old? Better be able to pay out of pocket or have private insurance. But I'd hope this plan will bend the cost curve for a lot of medical care and provide some modicum of affordable care for the poor.

Also, insurance is for unexpected costs. Car insurance covers accidents, not oil changes. Home insurance covers tornadoes, not replacing your 30-year-old roof because it's time. Health insurance shouldn't cover well-patient exams, colds, flu, labor and delivery, contraception. Those are all normal things. We're not insuring against them, we're just financing it differently. (This is what vision and dental "insurance" is, and if you look at the full cost of the policies, you're normally not saving much, if any, money.)

Preventive care is not the panacea people thought it would be. If it was, insurance companies would have to be told to cover it. People don't neglect contraception, because of the cost. Condoms are cheap/free. People don't accept some probability of an abortion/unwanted pregnancy because of the minimal cost of contraception. Making the pill OTC is a better idea and would be more effective.

Edit: Re: your last paragraph. My company offers Tel-A-Doc as benefit. You can phone the doctor, and the doctor will even phone in a prescription for you. There are other similar services and apps. Now, we just need an UberPrescriptions.
« Last Edit: March 15, 2017, 12:43:35 PM by Ichabod »

Cwadda

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Re: The problem with our healthcare
« Reply #83 on: March 15, 2017, 12:57:54 PM »
If you were to redesign the health care system from scratch, how would you design it? 

I really feel like much of the medical system is just run plain inefficiently.  I hate going to the doctor where they make me fill out the same form every time.  I also hate that half the time I go to the doctor, I end up getting sick afterwards from something I picked up while there.  I hate talking to my doctor, because he or she seems really overwhelmed and unempathetic most of the time.  I don't blame them, I just think they are overloaded. 

If I have something minor, like bronchitis or a UTI, what I realized is that the worst part of it is that I have to haul my uncomfortable ass to the doctor, talk to them for 15 minutes, maybe do a test, and then get a prescription or a note to give my employer.  I am sure I probably have made other people sick doing this.  (As an aside, I always wonder how doctors and nurses avoid just being sick all the time) I end up having to be annoyed for 3-4 hours instead of being home resting.  Maybe there is no way around this, but it sure is annoying.  They just opened up one of those urgent care clinics across town - maybe that is a better option now.

A national health insurance policy that covers expenses over 10% of your income. In 2013, 10% was roughly the income the average person was spending on premiums and deductibles. This means everyone can afford healthcare for those of us who believe it should be part of the social compact, and there is still incentive to shop around for those of us who believe in the free market. If you want some kind of gap insurance for below that, it's fine, but it's not tax-deductible.

A lot of people trod out the unconscious man rushed in the ambulance as why the free market won't work for health care. Most of health care isn't like that. Providers just compete on things other than price, because most don't self-pay. ERs compete on wait-times (many hospitals have billboards with their current wait-times). Websites exist that have grades and reviews of doctors. Word-of-mouth of who's good. People don't normally end up consuming healthcare with no choice.

People will demand lower-cost solutions to common health issues. Physician assistants and nurse practitioners for colds and flus. Midwives for births. Maybe people will become more involved with their own care of "Do I really need that test/treatment/drug?" And you don't need everybody to participate in aggressive price shopping. As long as some critical mass does providers will start competing on costs.

Expensive treatments like cancer and end-of-life care will still probably expensive. We can't afford the best for everyone. We can either ration it by cost or by some government committee ("Death panels"). Government can't cover everything. Kidney transplant for a 68-year-old? Better be able to pay out of pocket or have private insurance. But I'd hope this plan will bend the cost curve for a lot of medical care and provide some modicum of affordable care for the poor.

Also, insurance is for unexpected costs. Car insurance covers accidents, not oil changes. Home insurance covers tornadoes, not replacing your 30-year-old roof because it's time. Health insurance shouldn't cover well-patient exams, colds, flu, labor and delivery, contraception. Those are all normal things. We're not insuring against them, we're just financing it differently. (This is what vision and dental "insurance" is, and if you look at the full cost of the policies, you're normally not saving much, if any, money.)

Preventive care is not the panacea people thought it would be. If it was, insurance companies would have to be told to cover it. People don't neglect contraception, because of the cost. Condoms are cheap/free. People don't accept some probability of an abortion/unwanted pregnancy because of the minimal cost of contraception. Making the pill OTC is a better idea and would be more effective.

Edit: Re: your last paragraph. My company offers Tel-A-Doc as benefit. You can phone the doctor, and the doctor will even phone in a prescription for you. There are other similar services and apps. Now, we just need an UberPrescriptions.

Very interesting take on this. I've been trying to become more knowledgeable about health care to form a solid opinion. Thank you for posting.

Bobberth

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Re: The problem with our healthcare
« Reply #84 on: March 15, 2017, 01:33:58 PM »
The reason costs are so high in this country is that we are paying for socialized health care AND our own health care system. Bayer, Merck, Medtronic et al are global companies. Their goal is to make more money each year. It doesn't matter where that money comes from. So every time Germany decides they are only going to pay 20% of the asking price for drug X, Pfizer says, "OK. We will accept that." The companies roll over pretty much any time a country demands a lower price. Why would they do that? They run the numbers and see the price break will cost them $10mm so they look elsewhere to make up that revenue. Can they make that up in France? Nope, they limit costs. UK? Canada? Japan? Australia? No to all of those. Costs are limited there. The US? Winner winner chicken dinner! The government is specifically required NOT to negotiate lower prices. It's so easy to jack prices up in the US that it's not worth fighting for higher prices elsewhere. Insurance companies just want to take their cut of the pie so higher prices don't bother them as long as there is enough reserves coming in each year. It's playing a game of whack-a-mole except all but one mole is permanently forced down so only one can go up. That is us. Every time a country around the world limits their expenses, the US makes up for the lost revenue.

SimpleCycle

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Re: The problem with our healthcare
« Reply #85 on: March 15, 2017, 07:44:18 PM »
Just to get some real numbers in here, my insurance pays $131.70 for a 99215 (high complexity return patient office visit).  Medicare pays $111.78 for the same code.  Medicaid in my state pays $46.70 for that code, which shows how much cross subsidization already exists in our system.

Our health care system is wildly expensive, and why that is the case is a very complex issue.  I have a Masters degree in health policy and work in the field, which is enough to know that there are no easy answers and anyone who claims there are probably shouldn't be believed.

You are right.  There is no easy fix.  My biggest gripe about the whole thing is that our politicians have us arguing about who will pay as opposed to actually trying to do something about cost.  Is it really worth your time to see medicaid patients?  I dunno maybe it is and maybe it isn't.  What do you think the percentage of your reimbursement is overhead? How much time do you spend with a level 5 Medicaid patient?

But wouldn't you rather just charge much less, get cash and fire your coder/biller, fire your collections agency, fire your IT guy and just have you and a nurse manage all your patients?  Don't you wish you did not have to try and get every chart up to a level 5 to squeeze every penny out of the insurance company or CMS? Don't you wish you did not have to waste valuable time documenting useless nonsense just so you can get paid.  Basic medical care should be a cash business that would instantly decrease the cost for everyone.

Emergency care is a whole other story. As well as medical care for those who can not afford to pay cash as described in my example a few posts up.

I'm not a provider, but I love hearing your thoughts on this.  I work at a large academic medical center that tends to want to be a leader and therefore signs up for every new CMS program.  And I totally agree that the level of overhead and bureaucracy are insane.  We are accredited by a national accreditation body for our specialty, plus certified as part of a specialty-specific quality program, and participate in a CMS demonstration project for our specialty.  That's three sets of reporting requirements just for specialty specific programs.  And none of this reporting is automatically supported by our EMR, even though the alleged point of meaningful use is to enable data-driven decision making.  And ultimately we participate in these programs for some combination of marketing and "it's the right thing to do".

I absolutely agree that we're way past the point of needing to talk about how to contain cost.  And the answers are uncomfortable for a lot of patients and providers.  People think in absolutes so often (this treatment is better!) instead of relatively (this treatment is slightly better for 10x the cost) and it makes rational decision making hard.  To some extent who is paying has an influence on the tools available to address costs, but no matter how we pay, cost must be addressed.

Unfortunately I think people raise a great point about how we've chosen to make the healthcare industry 17% of our economy and it's hard to undo that.  Healthcare supplies a ton of jobs, and we may not have the political will to rock the boat.

Cwadda

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Re: The problem with our healthcare
« Reply #86 on: March 16, 2017, 08:16:26 AM »
The reason costs are so high in this country is that we are paying for socialized health care AND our own health care system. Bayer, Merck, Medtronic et al are global companies. Their goal is to make more money each year. It doesn't matter where that money comes from. So every time Germany decides they are only going to pay 20% of the asking price for drug X, Pfizer says, "OK. We will accept that." The companies roll over pretty much any time a country demands a lower price. Why would they do that? They run the numbers and see the price break will cost them $10mm so they look elsewhere to make up that revenue. Can they make that up in France? Nope, they limit costs. UK? Canada? Japan? Australia? No to all of those. Costs are limited there. The US? Winner winner chicken dinner! The government is specifically required NOT to negotiate lower prices. It's so easy to jack prices up in the US that it's not worth fighting for higher prices elsewhere. Insurance companies just want to take their cut of the pie so higher prices don't bother them as long as there is enough reserves coming in each year. It's playing a game of whack-a-mole except all but one mole is permanently forced down so only one can go up. That is us. Every time a country around the world limits their expenses, the US makes up for the lost revenue.

Very solid point. The thing is, Trump said he would negotiate with the companies. He never did, lol, he only made it better for them.

GetItRight

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Re: The problem with our healthcare
« Reply #87 on: March 16, 2017, 01:09:13 PM »
The Market for Medical Care Should Work Like Cosmetic Surgery: http://www.ncpa.org/pdfs/st349.pdf

vivian

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Re: The problem with our healthcare
« Reply #88 on: March 18, 2017, 06:23:15 AM »

Anyway, when we toured the maternity ward, the host told us that they'd splurged on private rooms, fancy this and that -- not medically necessary things, mind you, but things to make new moms choose their hospital instead of another.  They explained that this wasn't entirely altruistic; rather, they said that new mothers tend to take lots of time choosing where they'll give birth ... but then when a crisis comes along, the new mother automatically comes to "her hospital".

There are some good points in this thread, but there is a fundamental assumption about how people buy medical care that is wrong. The whole idea that we would rationally choose cheaper care if only the costs and options were more open is transparent is crazy. When you are sick, you are also stressed, also emotional, not in a frame of mind to rationally compare options.

Maybe the mustashians here, but isn't the whole idea behind this forum that most people don't act in this way? I quoted the above bc the one medical area I know many do shop around for in advance is maternity care. And what do new moms want? Fancy services.

In other areas, we can't think rationally bc we are too stressed. My newborn daughter was born premature and spent two weeks in NICU. Do you think I was in a state of mind to calmly review our options? Even if I was by the second week, do you think I had the medical knowledge to question the doctor about necessity of treatment? If the doctor said XYZ is needed, I went along. Or the emotional state to do something like: the hospital down the street charges less for NICU, so I'm going to move her there.

As for end of life care, it is one thing to say, without the stress of the situation, that it does not make sense. It is another to have yourself, your spouse, your parent facing a situation. How do you know that THIS hospital visit is it for them, and they won't get better and have many years to come?  I've had relatives with severe illnesses, spend a long time in hospitals, put DNR orders on them, but they recovered and now have a happy life.

We are not rational actors that a market based approach assumes. Not for many issues, but especially not medical care when we may literally be talking life and death. Trying to use market mechanisms to lower cost of health care is not going to solve the problem.


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Ichabod

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Re: The problem with our healthcare
« Reply #89 on: March 18, 2017, 12:56:46 PM »

Anyway, when we toured the maternity ward, the host told us that they'd splurged on private rooms, fancy this and that -- not medically necessary things, mind you, but things to make new moms choose their hospital instead of another.  They explained that this wasn't entirely altruistic; rather, they said that new mothers tend to take lots of time choosing where they'll give birth ... but then when a crisis comes along, the new mother automatically comes to "her hospital".

There are some good points in this thread, but there is a fundamental assumption about how people buy medical care that is wrong. The whole idea that we would rationally choose cheaper care if only the costs and options were more open is transparent is crazy. When you are sick, you are also stressed, also emotional, not in a frame of mind to rationally compare options.

Maybe the mustashians here, but isn't the whole idea behind this forum that most people don't act in this way? I quoted the above bc the one medical area I know many do shop around for in advance is maternity care. And what do new moms want? Fancy services.

In other areas, we can't think rationally bc we are too stressed. My newborn daughter was born premature and spent two weeks in NICU. Do you think I was in a state of mind to calmly review our options? Even if I was by the second week, do you think I had the medical knowledge to question the doctor about necessity of treatment? If the doctor said XYZ is needed, I went along. Or the emotional state to do something like: the hospital down the street charges less for NICU, so I'm going to move her there.

As for end of life care, it is one thing to say, without the stress of the situation, that it does not make sense. It is another to have yourself, your spouse, your parent facing a situation. How do you know that THIS hospital visit is it for them, and they won't get better and have many years to come?  I've had relatives with severe illnesses, spend a long time in hospitals, put DNR orders on them, but they recovered and now have a happy life.

We are not rational actors that a market based approach assumes. Not for many issues, but especially not medical care when we may literally be talking life and death. Trying to use market mechanisms to lower cost of health care is not going to solve the problem.


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Your NICU example is a great one. I doubt anyone would seriously contemplate a NICU transfer after a traumatic birth. I know time in the NICU is really expensive, and I don't have any ideas on how to solve it.

I also think we overestimate how much healthcare is like the NICU where we wouldn't be capable of shopping around, and we also estimate how many people need to shop around for there to be a benefit. Would some cancer patients hear that their oncologist is only the second-best in the state and demand the top oncologist even if she costs $75,000 more over the  course of their treatment? Yes, but as long as some cancer patients think "I'm going to go with cheaper, average oncologist and buy an Escalade with the leftover money), you're going to have some oncologists competing on price. Those price-competitive oncologists find cheaper ways to do things, and everyone benefits as their practices spread.

I hate that poor people can't get the healthcare they need. It's not that I love the idea of the "undeserving poor" suffering and support free-market healthcare for that reason. It's because I believe prices send important information about what people want and value. So I think it would be a great idea if the government funded HSAs and acted as a catastrophic insurer, but if people want a solution where they can waltz in and out of the hospital without seeing a bill... I think we're losing really important information.

Sofa King

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Re: The problem with our healthcare
« Reply #90 on: March 18, 2017, 02:06:11 PM »
Sorry to say I think the real mistake we are all making is thinking things will ever actually get any better. There may be some small things here and there that may make it seem like it's getting better but nothing will ever change in any meaningful way. I know that sounds very negative but it's how I feel.

47%MMM

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Re: The problem with our healthcare
« Reply #91 on: March 23, 2017, 06:57:33 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.

Well we're obviously slotting you for coach class care...

:)