How we're getting robbed by health care providers

[Arlos]

Read this article: http://healthland.time.com/2013/02/20/b ... illing-us/

Just look at some of the first few paragraphs. Hospital charging some guy $15,000 for blood tests, where their real costs to perform those tests was a few HUNDRED dollars. See, Medicare payments to hospitals are based on what tests and such ACTUALLY cost the hospital to perform, including overhead, equipment, and salaries of all the nurses, doctors and techs involved. Why in hell are non-profit hospitals (like the one mentioned) marking services up 1000% per cent? How about the anti-cancer drug marked up 400%? It's insane.

It looks like all the arguments about Obamacare missed one very important question: *WHY* are the costs so high, often more than double the costs in every other westernized nation, when we, on average, get WORSE results?

Seriously, this article will piss you off. I just hope SOMETHING comes out of it, other than raising my blood pressure... (for which I would, no doubt, be charged $23,759 to cover their costs to put that cuff on my bicep and watch the automatic box until it spits out a result...)

What do YOU guys think we can do, other than complain a lot?

-Arlos

[Tikker]

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[brinstar]

didn't read the article

but recently saw a different article where a 20 cent blood sugar test cost $18

[Lyion]

It's funny but I had just read that when you posted it. The problem is the entire insurance/government payback system.

[Zanchief]

Let me guess, it's because of government pensions somehow.

[Spazz]

That or unions.

[brinstar]

"for-profit" health care system needs to be burned to the ground

[Tikker]

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[Spazz]

Thats bull. People will do things for the benefit of humanity and always have. The no one will do some thing unless it makes them rich is a new phenomenon.

[Drem]

research universities probably contribute more innovation to modern medicine than the hospital down the street, anyways

[Zanchief]

Yea tik, way out to lunch on that one. True, money does move innovation, but only if there's profit. There's plenty that needs to be researched that doesn't have a pot of gold at the end.

[Ganzo]

"for-profit" health care system needs to be burned to the ground

you can't though


you don't get innovation from working for what's good/right

simple as that

While it is somewhat true, money tends to drive the wrong kind of innovation in the medical field. Simple economics will tell you that there is more money in prolonging treatments and treating symptoms is more profitable than curing ailments. Don't tell me that the industry is not that sinister, my wife works in the EP Lab (pacemaker implants mostly) and deals with it every day. Prime example - the cheapest pacemaker has a battery life of 8 years, the most expensive one has a battery life of 4 years and cost almost double of the 8 year one. Feature wise there is almost no other differences, they do the same job of maintaining the correct heart beat for the patient and have the same level of reliability. The choice of a device implanted is up to the doctor’s discretion. I'm sure you've guessed by now that doctors select the expensive device for implanting, in fact they are audited by hospitals to see how many times they have chosen to go with the cheap ones and have to explain why they did so. This is simply done because of the battery lifetime, as hospitals and doctors have a vested interest in having procedure of re-implanting repeated at shorter intervals for higher profits. In fact the only times they use the cheap model is for the Medicare/Medicaid patients as they are forced to do so by the government. Another example - in her hospital a heart surgeon perfected a heart bypass technique which allows him to go between the ribs instead of opening up a ribcage and then stapling ribs back together as it is done everywhere else. His innovation turned a six hour procedure into a two hour one, and replaced a one week hospital recovery and three week rehab recovery into an overnight stay with a short outpatient rehab. In a very short time he had a six months wait list from patients; and soon after the hospital forbade him from performing this procedure and he was forced to do the surgery the old way that everyone else does. I’m sure you guessed the reason – his improvements robbed the hospitals of extended hospital and rehab stay income. This is what happens when for-profit medical industry is left unregulated; profits drive only one type of innovation – the kind that increases profits, stifling everything else.

[Lyion]

Non profits and for profits both have the same problems and deal with the same insurance and regulation red tape. Here's a great quote of what I think is completely wrong. It's actually not too different from our tax code.

http://www.thedailybeast.com/articles/2 ... rella.html

The web of cross-subsidies, underpayments, overpayments, and upcoding is opaque to everyone except the adminstrators. And they are not eager to make any of it clearer. In part because they genuinely feel, as does the middle manager in our story, that they are forced into these little subterfuges to recover legitimate costs that short-sighted bean-counters are refusing to cover.

I guess the answer is more taxes, government, control, and regulations, eh Zan and Spazz? It worked in Cuba, your guys model society, right? On that note, I was chatting with a buddy of mine who is Canadian, and he was planning a vacation to Cuba. I guess it's not frowned upon there like here.

[Tikker]

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[brinstar]

I guess the answer is more taxes, government, control, and regulations, eh Zan and Spazz?

as if that's never the solution?

[Spazz]

A lot of problems seem like they could be solved that way. When it comes to personal freedom I think the govt should totally be hands off but when it comes to making programs in our society to tackle big problems... Yea I want them to do that. Healthcare and prison both have a lot in common, they are both necessary but when you turn them into big business you get a nightmare. I believe in private business lyion just not on life and death matters like health and prison cuz in those cases what is good for shareholders and owners isnt whats good for the rest of society.

[Reynaldo]

Would be nice to have a more transparent connect between insurance and the providers.

I have a pretty good insurance plan and pay like 5 bucks for drugs, 20 dollar copay for visits. So you're kind of brainwashed into thinking you're getting a deal, nevermind the 350 I'm paying each and every month to the premium to have the "luxury" of the lower copays / deducbible.

I wish they had something like the Allstate thing, where if you don't have any surgeries or catastrophic events for a year, your premium goes down 50 bucks a month or something. Or tie in an incentive to have yearly physicals / checkups that can also lower the payments if you stay on top of your preventative maintenance.

When i was working for Disney they had incentives like that to get health checkups and goals to meet for certain measurables, where they would pay you up to 300 bucks a year for meeting them. Not a huge amount but anything helps.

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As far as on-topic, one of my uncles is an oncologist and he was bemoaning the margins they actually take home is miniscule. Basically after all the overhead Arlos mentions and material / procedure cost, figured in with the patients that fail to pay at all, they're running on like a 1-3% profit.

[Arlos]

Like the article notes, the one medical group that ISN'T making a huge profit are frequently the doctors. It's the bigger medical institutions that are.

See, the fallacy that everyone ignores is the claim that health care is a standard capitalist "free market" like any other product. The problem is, it isn't. Not in any way, shape or form.

If you feel like getting a new pair of shoes, you can eventually decide not to get them, or you can shop around to several stores, do research, etc. You can choose to participate or not participate in the market at your discretion. You get cancer, though, and you are a completely involuntary participant. If you want to live, you *HAVE* to buy the products and services, you can't shop around because of constraints on you from your insurance (if you have any), nor can you effectively research prices of products to get a good deal, because with that Chargemaster system, list prices are drawn up with absolutely no relationship to reality or how much that product or service actually costs.

How, in any way, is that a free market system? Also, consider that health insurance is fundamentally different from any other kind of "insurance." Other insurance you buy, car, homeowners, renters, etc. are all bought with the hope that you never actually need to use them. However, we ALL need medical care of some kind or other, so health "insurance" is bought with the express intent of USING it, often frequently. As a result, treating it like other insurance products will get you nowhere.

What we really need to do is to is, I think, the following, assuming we keep something like our current system. (Obviously, I am hugely in favor of just expanding Medicare to cover the entire population, and going with a single-payer system):

1) Put in absolute hard caps on the profits that hospitals, etc. are allowed to take in. They go over that, that money gets refunded to patients.

2) Tie the salary of the administrative staff to the salaries of the doctors, with a hard cap (3x? 5x?) in how far above the lowest paid doctor the highest paid management person can be paid.

3) Allow Medicare to negotiate drug prices, use comparative analysis, and let it pay market rates for durable medical equipment. (see the story for things like crutches and wheelchairs having to be bought at 3-5x actual normal prices)

4) Force all hospitals to abolish the existing chargemaster system, and tie charges for medical procedures to what they actually COST.

5) Enact tort reform to cut down the amount of frivolous malpractice suits, so that doctors don't feel compelled to order multiple unnecessary tests, just because they're panicked about liability. (CT scans, just because someone says the word "head" in the emergency room, etc.)

6) Do SOMETHING about the sky-high prices of so many drugs out there. Either cut how long companies can maintain exclusive manufacture rights, limit profit margins on each unit of drug sold, etc.

I know that there would be outraged screams about the government interfering in business, and let the market decide, etc, but like we already saw, this ISN'T a free market. As such, it absolutely needs different regulations. There is no reason the US should be paying 2x the costs that other western nations are paying for health care, yet getting worse results and having a much larger segment of our population be uninsured.

-Arlos

[Ganzo]

The first step should be to deny doctors the right to refuse Medicare/Medicaid as many of them do now

[Tikker]

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[Spazz]

If you could cure aids in your garage would you ? It takes funding like say a university but people try to do good shit all the time.

[Zanchief]

I guess the answer is more taxes, government, control, and regulations, eh Zan and Spazz? It worked in Cuba, your guys model society, right? On that note, I was chatting with a buddy of mine who is Canadian, and he was planning a vacation to Cuba. I guess it's not frowned upon there like here.

No people do it all the time. Why don't you bring up all the Liberal european countries that have weathered the economic crisis so well, while still providing great services to their country like Sweden and Finland. Oh right...they make you look bad.

[Tikker]

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[Zanchief]

If you could cure aids in your garage would you ? It takes funding like say a university but people try to do good shit all the time.

but really tho, $5000 bucks is enough to cure Aids



right Gaazy?

hahahaha

[Arlos]

Heh, somehow I knew that was coming....

-Arlos