Healthcare Isn't A Free Market, It's A Giant Economic Scam
from the destroying-us-all dept
Not long ago, someone I know who had no medical insurance, but who had some serious medical issues, ended up in the hospital for a few weeks. Some procedures needed to be done, but nothing that most people would consider too "drastic." Eventually, the bills showed up, and they were in the range of half a million dollars, for someone who did not have anything close to that. You hear stories about crazy medical bills, but what very few people realize is that the reality of hospital bills can often be orders of magnitude more crazy than what most people expect. Just last week, a friend of mine posted the following image to Facebook, noting that when his normal medical insurance billing statement has room for seven digits (i.e., millions of dollars) something is clearly screwed up.
Stephen Brill has a very long, but absolutely gripping, detailed analysis of the insanity of medical billing for Time Magazine. It's a truly astounding piece, that hopefully will open many people's eyes. It will take a while, but find some time to read it, just to get a sense of how totally screwed up the entire system is. I've been working on some other stories about some really sketchy activity on the pharmaceutical side of things, but this article really shines a light on the disgusting underbelly of the healthcare system. As Brill notes, so much of the debate about healthcare is really focused on "but who will pay for these things." But what it tends to ignore is why are the prices absolutely insane.
When medical care becomes a matter of life and death, the money demanded by the health care ecosystem reaches a wholly different order of magnitude, churning out reams of bills to people who can’t focus on them, let alone pay them. Soon after he was diagnosed with lung cancer in January 2011, a patient whom I will call Steven D. and his wife Alice knew that they were only buying time. The crushing question was, How much is time really worth? As Alice, who makes about $40,000 a year running a child-care center in her home, explained, “[Steven] kept saying he wanted every last minute he could get, no matter what. But I had to be thinking about the cost and how all this debt would leave me and my daughter.” By the time Steven D. died at his home in Northern California the following November, he had lived for an additional 11 months. And Alice had collected bills totaling $902,452. The family’s first bill — for $348,000 — which arrived when Steven got home from the Seton Medical Center in Daly City, Calif., was full of all the usual chargemaster profit grabs: $18 each for 88 diabetes-test strips that Amazon sells in boxes of 50 for $27.85; $24 each for 19 niacin pills that are sold in drugstores for about a nickel apiece. There were also four boxes of sterile gauze pads for $77 each. None of that was considered part of what was provided in return for Seton’s facility charge for the intensive-care unit for two days at $13,225 a day, 12 days in the critical unit at $7,315 a day and one day in a standard room (all of which totaled $120,116 over 15 days). There was also $20,886 for CT scans and $24,251 for lab work. Alice responded to my question about the obvious overcharges on the bill for items like the diabetes-test strips or the gauze pads much as Mrs. Lincoln, according to the famous joke, might have had she been asked what she thought of the play. “Are you kidding?” she said. “I’m dealing with a husband who had just been told he has Stage IV cancer. That’s all I can focus on … You think I looked at the items on the bills? I just looked at the total.”If we want a real fix to the mounting costs of healthcare (which are a massive drain on the economy), we need to start there. Unfortunately, those who are making out like bandits from this system have tremendous political clout, and they have no interest in letting the easy money go away.
Throughout the piece, Brill repeatedly discusses the "chargemaster," which is basically the internal price list at every hospital, which has no basis in reality whatsoever, but which the poorest patients, and those without insurance, or with limited insurance, are often hit over the head with. Throughout the article, Brill details over and over and over again how hospital administrators and spokespeople all refused to address the chargemaster at all, constantly blowing it off as no big deal, because so few people actually pay the list price. But they completely ignore a bunch of points, including that some patients are charged upfront for these things, and no one is ever told that the prices are negotiable, even though they all are.
What you see is a system where supposedly "non-profit" and "charitable" institutions are raking in massive profits -- while still begging the public for donations, and suggesting that any effort to reign in costs would put people at risk by cutting back on necessary hospital services. At times, these statements are so obviously bullshit, that it's really sickening.
In December, when the New York Times ran a story about how a deficit deal might threaten hospital payments, Steven Safyer, chief executive of Montefiore Medical Center, a large nonprofit hospital system in the Bronx, complained, “There is no such thing as a cut to a provider that isn’t a cut to a beneficiary … This is not crying wolf.”Sometimes these stories make you wonder if some of these "charitable" organizations deserve to be called charities at all:
Actually, Safyer seems to be crying wolf to the tune of about $196.8 million, according to the hospital’s latest publicly available tax return. That was his hospital’s operating profit, according to its 2010 return. With $2.586 billion in revenue — of which 99.4% came from patient bills and 0.6% from fundraising events and other charitable contributions — Safyer’s business is more than six times as large as that of the Bronx’s most famous enterprise, the New York Yankees. Surely, without cutting services to beneficiaries, Safyer could cut what have to be some of the Bronx’s better non-Yankee salaries: his own, which was $4,065,000, or those of his chief financial officer ($3,243,000), his executive vice president ($2,220,000) or the head of his dental department ($1,798,000).
Mercy Hospital is owned by an organization under the umbrella of the Catholic Church called Sisters of Mercy. Its mission, as described in its latest filing with the IRS as a tax-exempt charity, is “to carry out the healing ministry of Jesus by promoting health and wellness.”.... The overall chain had $4.28 billion in revenue that year. Its hospital in Springfield, Mo. (pop. 160,660), had $880.7 million in revenue and an operating profit of $319 million, according to its federal filing. The incomes of the parent company’s executives appear on other IRS filings covering various interlocking Mercy nonprofit corporate entities. Mercy president and CEO Lynn Britton made $1,930,000, and an executive vice president, Myra Aubuchon, was paid $3.7 million, according to the Mercy filing. In all, seven Mercy Health executives were paid more than $1 million each. A note at the end of an Ernst & Young audit that is attached to Mercy’s IRS filing reported that the chain provided charity care worth 3.2% of its revenue in the previous year. However, the auditors state that the value of that care is based on the charges on all the bills, not the actual cost to Mercy of providing those services — in other words, the chargemaster value. Assuming that Mercy’s actual costs are a tenth of these chargemaster values — they’re probably less — all of this charity care actually cost Mercy about three-tenths of 1% of its revenue, or about $13 million out of $4.28 billion.While I actually think it's a bit of a cheap shot to repeatedly show CEO salaries, the real issue is how these hospitals can ratchet up the prices with no basis in reality, simply because they know they can do so. Even if they recognize most people don't pay those fees, they still send such bills out there, which creates a tremendous amount of stress.
The stories of obvious overcharging fill the piece and demonstrate a key point in all of this. For all the talk about "free market" healthcare, nothing in our healthcare system is anything resembling a free market. You have truly "captive" customers with almost no price elasticity, combined with a system whereby it's rare for the buyers to actually be the ones "paying." If you were to design the most fucked up economic experiment ever, this might be it. And you can see the results.
Steve H.’s bill for his day at Mercy contained all the usual and customary overcharges. One item was “MARKER SKIN REG TIP RULER” for $3. That’s the marking pen, presumably reusable, that marked the place on Steve H.’s back where the incision was to go. Six lines down, there was “STRAP OR TABLE 8X27 IN” for $31. That’s the strap used to hold Steve H. onto the operating table. Just below that was “BLNKT WARM UPPER BDY 42268” for $32. That’s a blanket used to keep surgery patients warm. It is, of course, reusable, and it’s available new on eBay for $13. Four lines down there’s “GOWN SURG ULTRA XLG 95121” for $39, which is the gown the surgeon wore. Thirty of them can be bought online for $180. Neither Medicare nor any large insurance company would pay a hospital separately for those straps or the surgeon’s gown; that’s all supposed to come with the facility fee paid to the hospital, which in this case was $6,289.Or how about this one:
His bill — which included not only the aggressively marked-up charge of $13,702 for the Rituxan cancer drug but also the usual array of chargemaster fees for basics like generic Tylenol, blood tests and simple supplies — had one item not found on any other bill I examined: MD Anderson’s charge of $7 each for “ALCOHOL PREP PAD.” This is a little square of cotton used to apply alcohol to an injection. A box of 200 can be bought online for $1.91.The article is chock full of these kinds of stories. They're not anomalies, nor are they extreme outlier cases. They happen quite frequently. It's standard operating procedure. And, contrary to what most people think, these things don't just apply to those who are without insurance. While insurance may protect against some of these situations, often people discover that their insurance doesn't cover nearly as much as they expected (in part because they never think that bills could possibly be so high. And, while some hospitals are more open to forgiving massive debt for those who are poor, when those who thought they were comfortably in the middle class suddenly realize they may owe hundreds of thousands of dollars unexpectedly, the hospitals are a lot less sympathetic.
Not surprisingly, nearly every hospital that Brill tried to speak to about all this refused to talk about it. Sometimes they gave completely bogus excuses, such as claiming that it's "against the law" to discuss why they charge massive markups on basic items:
Wright said the hospital’s lawyers had decided that discussing Steve H.’s bill would violate the federal HIPAA law protecting the privacy of patient medical records. I pointed out that I wanted to ask questions only about the hospital’s charges for standard items — such as surgical gowns, basic blood tests, blanket warmers and even medical devices — that had nothing to do with individual patients. “Everything is particular to an individual patient’s needs,” she replied. Even a surgical gown? “Yes, even a surgical gown. We cannot discuss this with you. It’s against the law.” She declined to put me in touch with the hospital’s lawyers to discuss their legal analysis.In one case where he finally got an administrator to speak about the chargemaster rates, the answers were astounding, and either completely mendacious or disconnected from reality (I'm not sure which one is scarier).
“We think the chargemaster is totally fair,” says William Gedge, senior vice president of payer relations at Yale New Haven Health System. “It’s fair because everyone gets the same bill. Even Medicare gets exactly the same charges that this patient got. Of course, we will have different arrangements for how Medicare or an insurance company will not pay some of the charges or discount the charges, but everyone starts from the same place.” Asked how the chargemaster charge for an item like the troponin test was calculated, Gedge said he “didn’t know exactly” but would try to find out. He subsequently reported back that “it’s an historical charge, which takes into account all of our costs for running the hospital.”It's fair because we charge absolutely everyone insane amounts that have no basis in reality, and which we mark up ridiculously -- and then we offer discounts to many, but certainly not all patients. This answer is bullshit. Not everyone starts from the same place, but even if we grant that ridiculous claim, having everyone start at insane prices doesn't make it fair. It still makes it a giant scam.
And, of course, the hospitals know they're getting away with all sorts of crap here. Even when they're talking about things like Medicare, where the government is the "buyer," the situation is crazy. While the hospitals, pharma companies and others complain that government supported healthcare artificially deflates revenue and limits their ability to provide patient care, the article goes into a fair bit of detail about how that's hogwash, and the hospitals (and doctors) are massively profiting off of the taxpayer -- sometimes in completely cynical ways.
“One of the benefits attending physicians get from many hospitals is the opportunity to cruise the halls and go into a Medicare patient’s room and rack up a few dollars,” says a doctor who has worked at several hospitals across the country. “In some places it’s a Monday-morning tradition. You go see the people who came in over the weekend. There’s always an ostensible reason, but there’s also a lot of abuse.”If you know even the slightest bit about basic economics, the deeper you look at this system, the more and more you realize how insane it is. Nearly every single incentive is skewed, often dangerously so. The system is more or less designed to be abused, while making it increasingly difficult for people to get reasonable care. I'd argue that it may be worse than if you asked a bunch of economists to design the worst possible system of incentives.
And we're more or less stuck with it. For all the debate and the fight over reform, the reform package we got really did next to nothing to address any of these kinds of underlying issues. And this has nothing to do with silly claims of whether or not it's "socialist". The entire healthcare system, before and after the recent health reform, does not resemble anything even remotely close to a free market system. And, while there are some who argue that healthcare itself shouldn't be subjected to free market forces, but rather towards what provides the best care, it's not like the system is designed to match up with that belief either.
The system is completely broken. In researching other aspects of the system, I'd already come to the conclusion that it should be scrapped entirely, with something completely different put in its place, but this article just helps take that belief to another level. And, the scary thing is that the chances of that happening are basically zero. We're stuck with this system, in part because the economic incentives are screwed up so much that it's ripe for widespread abuse. And when you have so many billions of dollars flowing, with a small group of folks profiting massively from that, there's simply no chance they'll allow for any real changes.
And, the really scary thing is that the bits I've talked about here really only scratch the surface of Brill's overall article. And, his article really only touches on one part of the problem. It is a key part of the problem, but it's still just one part. And each of the other parts tend to look equally insane when you start digging deeper. We are in the middle of the most horrifying economic experiment ever constructed with our healthcare system, and it's only impacting almost everyone's lives. Oh yeah, and there's no real interest in taking on the actual problems.
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Filed Under: billing, charities, economics, free market, healthcare, hospitals, non-profits
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Someone?
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There are doctors fighting back.
http://reason.com/reasontv/2012/11/15/the-obamacare-revolt-oklahoma-doctors-fi
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It's what you get when capitalists control a market...
Basically, you've mistaken notions of what "capitalism" is -- just a term for economic tyranny by plutocrats. They'd happily grind you into hamburger to feed their dogs if could be made "legal", meaning most people would meekly obey.
All the good things in your own life that you associate with the term "capitalism" have been hard won by fighting back plutocrats and their inherited privileges.
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Repay in small amounts
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why are the prices absolutely insane.
A long time ago my wife had abdominal pains so we went to the emergency room. Well 7 hours and a few tests later they didn't find anything and the cost was 18,000 dollars. 18 grand for some tests.
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Re: It's what you get when capitalists control a market...
There's an important question here...is this how things should be?
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Re: It's what you get when capitalists control a market...
I can't argue why and can only make assumption but with that type of revenue, it would seem like there would be more competition. Any new hospital could open up their doors and charge half those costs and still make a killing. I am thinking that capitalism isn't what is causing the outrageous pricing. It would seem like a combination of government laws and regulations that prevent new competition in the market. Once government gets involved and sets up artificial barriers, it skews the market.
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So WHO do you finger as the criminal, Mike?
So after actually reading ALL your wall of text, I can't find any substance. You're variously ranting like a "conservative" over insane gov't rules and payouts, and mildly scandalized like a "liberal" over arbitrary pricing, puzzled as "libertarians" always are when "markets" aren't actually "free", but you don't actually even try to fix blame: your last three paragraphs are generic ranting about problems without any actual actors responsible for them.
The criminals are THE RICH, Mike, as always. They control the gov't and the hospitals AND the insurance companies, practically own the doctors through monopoly on schooling and licensing, and through another monopoly with lawyers, control every aspect of legalities.
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Second, third parties are paying for it, so there's little oversight in keeping prices in check. If we had to pay for each item on a medical bill, we'd complain. There would be rioting. But because someone else is paying, we just shrug and pass it on.
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It's not just the hospitals and med providers
Some years ago the founder of one of the big health insurance companies retired with a $350,000,000 going away present. I assume he also got away with a lot stock that had appreciated in value during his tenure there. None of that money paid for any health care - not a single physical exam, not a single minor surgery, not a single life saving procedure needed due to an accident, it paid for nothing except for a nice retirement lifestyle. Who paid for that bonus? Likely the insurance company's clients who had money deducted from pay checks and the employers of those clients who paid it as an employment benefit. You might think the salaries paid the CEOs of big enterprises in the US are outrageous, the health care business is just the same.
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All those layers make it insanely easy for the providers to jack up the prices to whatever they think they can get away with. And patients take the attitude of "Who the fuck cares what it costs? I've got health insurance!"
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It all needs to go
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I'd like to hear your reasoning for this
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ObamaCare
When they were discussing the Affordable Care Act prior to it's passage many people I work with were appalled at the discussion. Insurance was made out to be a robber baron villain while nowhere did you see any discussion of where a dollar of health care costs went to. Truth is most medical insurance companies work on about 2% net profit margin and are required to pay out in claims $0.85 of every dollar collected in premiums. Contrast with the pharma companies who operate on 24% profit margins. As noted in the post large insurance companies don't pay these ridiculous chargemaster fees and as a result most peoples insurance premiums are much much lower than the would be otherwise. In this context insurance companies are more like Robin Hood than Robber Baron.
But, the heart of the problem is in fact caused by the insurance companies. They look at the rates they contract with health care providers as a competitive advantage between each other and try hard to keep this info private. In what other walk of life do you buy a good or service with no ability to find out the price ahead of time? Imagine if you couldn't know anything about prices before buying a car. Hell, I'd come home with a Ferrari every time.
A simple chart showing where each dollar of health care spending ends up along with requiring published price lists (by insurance carrier as well as without insurance) would go a long way to fixing all this. A little sunlight makes a good disinfectant.
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Re: It's what you get when *CRONY*-capitalists control a market...
Howver, this is most certainly not the result of "capitalism" (defined as an economic system based on the respect for self-ownership derived property rights and voluntary exchange, in a market free from government force/aggression).
In a voluntary market, prices are made up of hundreds of thousands (if not millions) of voluntary exchanges occuring constantly. Thus providing an immense amount of knowledge that no one person, or bureaucrat, could ever know. As soon as State force enters the equation (i.e.,"regulation"), said knowledge is corrupted and perverts natural market incentives.
The current healthcare prices are forced by government through Medicare, keeping said prices insulated from natural voluntary market forces. They have no incentive to lower prices and compete since the Medicare prices are back by State aggression/violence (or threat thereof).
I highly recommend the two following articles to gain further understanding into why the healthcare industry is the way it is (one article touches on the history, the other on why prices are so high).
"The Medical Marketplace, Free and Unfree" by Andrew Foy, MD
"100 Years of Medical Robbery" by Dale Steinreich
The core issue is State force/intervention. Complex social issues cannot be solved through aggression/violence (or threat thereof), it always only makes matters worse in the long run.
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Re: It's what you get when capitalists control a market...
LOL yeah. The peasants stormed Cupertino and forced Steve Jobs to release the iPhone.
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. . . while independent doctors are closing their shops
Nevertheless, in the last decade over half of our independent physicians (primarily GPs) have closed their practices to join larger medical groups, move from the area or just retire early. They've found it increasingly unprofitable to practice traditional medicine.
A predictable exception are surgical specialists, most of whom work as an attending physician at a local hospital.
Another relevant note is that medical service providers here are being reimbursed at increasingly lower amounts - from both government and private sector insurance.
I have two customers that are established local service providers. One believes it will - unavoidably - become unprofitable within the next 18 months.
The other is realistically unsure of it's future and hopes to survive through streamlining the organization.
These are community driven companies.
They provide services that are in demand and they are immensely responsible with their operations.
But with new cuts from Medicare, Medicaid and private insurance coming each quarter, they (like our local physicians) are finding it less and less profitable to continue.
It's a meaningful piece of the Med-Ec nightmare puzzle.
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Re:
For example, in the UK, where we have "socialized" healthcare (which, considering we have people coming over specifically to use our healthcare, can't be that ba you don't get many of the abuses in the article. There are other problems ( some drugs are too expensive for their benefit, for example, though the cost has to be pretty obscene (I think the rule is if it is an ongoing treatment, it cannot cost more than 20k per year.))
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and as usual, a very small number of elite, powerful people are creaming in a vast fortune off the backs of others!
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Re: ObamaCare
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The question is simple: should a person's vital health be discriminated against based on his or her wealth? The answer has to be "no", because the desire for profits - and the growth of unaccountable corporatism due to the "consumer" not having much of a say in the matter, causing corporations to run away with whatever amount of profits they like - is always trumped by the moral need to give people a fair fighting chance against preventable illnesses.
The free market cannot solve everything, despite what we are often told. If the fire-truck refuses to arrive due to a company's incompetence rather than the government's incompetence, nobody can really be held to account. If the fire "company" can say "no deal" because of their right to refuse to trade, they cannot be in a position of power as such. The same has to apply with police forces for parallel moral reasons, as well as education - and the more you examine it, the more that health has to fall into this category too.
Contrary to how it must be perceived, not ALL health matters are socialised here in the U.K. Certain prescriptions still have to be paid for (the non-vital ones such as mild skin treatment, etc). So we are fairer than most would believe.
And we also do not restrict the existence of private health care if people wish to seek it. If they do even after paying NHS tax, you cannot and should not stop them - but they must pay their fair share initially to the NHS as a matter of moral principle.
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Re:
I agree with your second point, and I'll add a third: regulation. There is a law against practicing medicine without a license, you can't get a license without a degree, and a degree costs six figures (and your youth, and the risk of failure).
Oh, and a fourth: litigation. Medical malpractice has more to do with lawyers' oratory and juries' emotion than any logic, so it's hugely expensive. Therefore so is malpractice insurance, therefore so is any inherently risky practice such as thoracic surgery or obstetrics.
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Re: Re:
Who's bottom line do they have to think about? The hospital's? I'm don't understand why a doctor or nurse needs to give a frak about making sure the hospital is charging enough. Do you think the cashier at the Tesco cares what they're getting for a Snickers bar?
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There is no incentive to lower prices
There are 2 reasons for this:
1) The hospital at the end of the year gets to write off the difference between what it charged originally and what it got paid as a loss. So in the example above, the hospital will write $6000 off on its taxes.
2) The insurance company (at least those used as manager for large companies who fund their own insurance plans) will go back to its client and say, "Look at all the money we saved you! Instead of having to pay $10k for this procedure, you only had to pay $4k!" The client company then happily gives the insurance company a percentage of the 'savings' as a bonus.
Because of these 2 reasons, there is no incentive for hospitals to charge less for procedures that that know don't cost anything close to what they're charging - both the hospital and the insurer end up making money on the overpricing.
The entire healthcare and health insurance industries need to be dismantled and rebuilt.
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Re:
In contrary to creating a state of accountability it's fostered an increasing complex system that favors large corporate medical interests over local community ones.
One natural and predictable result of that complexity is the medical-financial nightmare Mike wrote about.
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This
Their mind-boggling greed is not hurting their industry, they are destroying the economy of an entire nation.
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Re:
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We're not perfect, but whenever we're feeling down we can look to America for a pick-me-up.
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Re:
http://www.telegraph.co.uk/health/healthnews/6661925/Hundreds-of-patients-died-needlessly- at-NHS-hospital-due-to-appalling-care.html
http://www.telegraph.co.uk/health/healthnews/9600165/L ack-of-weekend-NHS-consultants-risking-patients-lives.html
http://www.telegraph.co.uk/health/heal thnews/9639090/Cystic-Fibrosis-sufferer-denied-chance-of-life-drug-by-NHS.html
http://www.dailyma il.co.uk/health/article-2126379/Sentenced-death-old-The-NHS-denies-life-saving-treatment-elderly-man s-chilling-story-reveals.html?ITO=1490
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Re: Re: ObamaCare
Next time do your homework first.
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Re: Re: It's what you get when *CRONY*-capitalists control a market...
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A few years ago, I spent a few hours in the hospital while they ran tests on me and the total bills for that were about $5,000.
If I didn't know any better, I'd think they actually want the poor to die off, leaving just the rich.
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Medical "Vacations"
I've also been hospitalized in Thailand, where I received first-class medical care for even less than Costa Rica. Ten days in the hospital, a truly gorgeous room with a bed for my husband, excellent food, two surgeries, four specialists...and the total bill was less than $5000. BC/BS picked up most of the tab, including translating the medical files. The doctors, by the way, mostly trained at Stamford Medical School.
When we need emergency care here, we have a family care doctor who takes no insurance and charges $50 a visit.
Many places--India and Singapore, for example--will arrange the entire process for you on-line, including speaking with a specialist who will route you to the best hospital for your needs and arrange for transportation. Google Medical Vacation and prepare to be stunned.
Americans should get over their fear of foreign doctors and seek extensive care elsewhere.
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Re:
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Re: ObamaCare
I think that Health Insurance increases costs by increasing most peoples 'ability to pay'.
Obamacare will also create a shortage of doctors (especially general practitioners, of which there is already a shortage), because it will dump millions more into a system, that they otherwise would not utilize.
In addition to this we have a lot of boomers coming to the point in their life when they will need increased healthcare.
So we are entering a time of increased demand, decreased supply and a greater ability to pay. This is a recipe for record high prices.
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Re: Re: It's what you get when capitalists control a market...
the law stepped in because he was charging too little, and they forced him to change things.
he used to work at a hospital but saw the craziness and just wanted to help people.
bureaucracy and legislation get pretty crazy.
further, there are many govt hurdles to overcome to set up a hospital, both state and federal wise.
with the corruption in place, your 'reasonable' hospital might not even get approved by the powers that be.
or delayed with so many costs that it's easier to shut down.
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The article doesn't take it far enough.
Why? EMTALA for one. This law forces all hospitals to treat any person regardless of means to pay. And lets face it, no one is going to work as a doctor for no pay because becoming a doctor is an extremely expensive proposition. More on that below. By forcing the hospitals to take all patients, you set up a system where the demand is ever increasing and then the hospital is forced to recoup the expense of non-payers somewhere. They are legally allowed to shift that cost onto other patients and their insurance. They do this by jacking up the costs of the simplest items. $77 for gauze pads, for example. In any other industry this is illegal but hospitals are given an exemption for this (i can't recall the law that provides this exemption. It might be EMTALA and it might not be.) Since these costs can be shifted elsewhere, the hospitals make free with it and the insurance companies pay for it. That's why you have an 8.9% annual increase in healthcare while inflation is at less that 5%. Thats also why your insurance rates for medical coverage are going through the roof, in spite of the Affordable Heath Care Act.
Add to this our education system following the same practice. Anyone can get a loan regardless of the means to pay it back. And they can't escape the loan even with bankruptcy. So, as a university with ever increasing demand, how do you cope? You raise your tuition. But the government will allow any student loan regardless of means to pay it back - so demand keeps increasing. Since demand keeps increasing so do the prices. Its a vicious circle that has no end.
So then you take the doctor who just graduated med school and has 500k of debt. How does one pay back that much money? Well, charge a lot for your time. Push to make more per hour every single year. And this is allowed by the insurance companies. Medicare obviously limits this earning ability but it also makes the doctors increase their prices for non-medicare patients even more. Yet another vicious circle that has no end.
Except the end is coming for both. With education, the next bubble is approaching. We have far far too many new graduates not able to find work. Too many lenders not getting a return on their investment. Eventually those lenders are going to go bankrupt because the revenue stream they need to survive, founded on those loans being paid back, is no longer a stream, but a trickle. And once again, the tax payer will have to bail out a financial institution that is following rules setup by the government. This is the same situation as the housing bubble all over again. With healthcare, the system can only support such geometric increases for so long before it collapses. People are deluding themselves in thinking it won't. Geometric functions in the real world are not supportable and 100% of the time reach a point where they collapse.
Can anyone tell me what the result of an industry collapsing the accounts for 25% of our GDP?
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Re: ObamaCare
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Mike, I would tend to agree with you on this when the shots are being taken at for-profit businesses, but when the institution is claiming to be a tax-exempt charity I think we actually need a lot more of this type of transparency. It is absolutely disgusting that the CEO of a non-profit is making a multi-million dollar salary! How many people could have been provided with medical care if that CEO took a salary draw that was reasonable? Now based on those chargemaster numbers that salary would have only covered a few paper cuts and maybe a splinter or two, but the principle remains the same. It's clear that the government will do nothing to remedy this situation, so maybe a little more disclosure of hospital admins pulling in several millions while people's children are dying because they can't afford treatment might spark enough public outcry to force some true reform.
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Re: Re: Re: It's what you get when *CRONY*-capitalists control a market...
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Re: It's what you get when capitalists control a market...
Only a Commie loving, Mao praising, Stalin worshiping, N. Korean cheerleader would have such a low option of REAL Capitalism. After all, it was Mao and Stalin that DID grind 100M+ people into hamburger to feed their dogs.
Let’s open it up to Real Competition, Transparency and reduce the Legal Barriers to Entry. The Govt Monopoly is fucking it all up. Central planning never works because No One can anticipate what will really happen.
Cronies & Monopolies are the problem, not the Capitalists who fight against the prior mentioned all day long.
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Re: So WHO do you finger as the criminal, Mike?
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As the TIME article says, over here they've spent billions lobbying to keep the government seeing things their way. Which is a ridiculous thing for supposedly non-profit organizations to do, but as long as the general public isn't aware they're doing, they can get away with it. (Hopefully these articles will raise awareness a bit.)
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Re: Re: ObamaCare
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Obamacare will help a few of the problems (like costs of providing healthcare to people without insurance being shifted to everyone else with insurance to make up for the unpaid bills for them), but it largely keeps the system the same.
The problem is the US's healthcare system costs way too much (other 1st world nations don't spend anywhere near as much money on healthcare as us) and STILL delivers worse results then other 1st world nations (The US ranks near the bottom in most ways of defining who's healthier, such as longer lives, fewer hospital stays).
Health care is one area that the free market just doesn't work for, because of the reasons outlined in the article.
Health insurance is the same thing, in order to get good enough discounts from hospitals you have to have more people covered under your health insurance to give you more bargaining power. In order to get more customers you need a reasonable/low healthcare premium. Such a system favors there being just a few big players and little competition (and indeed, most states have 1 to 3 health insurers who cover a combined 90%+ of the people with health insurance in the state).
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Also, the American healthcare system puts pressure on our system. Doctors will often move to the U.S. to make more money, we have difficulty getting affordable drugs and medical equipment when the American system pays so much, etc.
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Re: Re: It's what you get when capitalists control a market...
Plainly not true - since most european countries have FAR more government involvement than the US and most of these countries are able to provide free treatment with similar outcomes to the US and spens a smaller proportion of their GDP doing it.
The problem is not the fact that the government is involved with healthcare - it is the fact that the healthcare companies are involved with the government.
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It's a complex problem
But most people want to use health services at some point. They think they should be able to pay into the system low rates, but then have access to health care as they need it. If it works the way insurance should work, lots of people will pay in order to fund the health needs for a very few. One way to do that is to have high deductibles so that for routine treatment everyone pays out of pocket and then insurance only covers the big expenses. But you still need lots of people paying into the system to generate the money to pay out for the few. That has been the principle of requiring people to have insurance. To create that pool of money to draw upon.
That still doesn't get around the idea that the poor don't have enough money to pay those basic out-of-pocket fees. So you either don't treat them or you find ways to cover them using government funds, charity, or some other system based on a sliding scale.
What health care needs to address are several issues:
1. Bringing down the overall cost of services.
2. Getting people to skip health care services they don't really need (unless they want to pay for it themselves).
3. Getting people to pool funds (e.g., insurance, co-ops, government-supported services) so that there is money in the system to cover the expenses that are beyond most people's ability to cover themselves (e.g., cancer, organ transplants, accidents).
4. Improved lifestyles to make us healthier (e.g., should the system have to pay for the poor health of smokers?, of those who refuse to wear motorcycle helmets?).
5. Better environmental protections (so we aren't exposed to chemical/physical hazards which make us sicker).
6. Safer food systems (e.g., removing antibiotics from agriculture so that we aren't creating superbugs).
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Re: Re: It's what you get when capitalists control a market...
The market doesn't work for healthcare because:
1 Most people who need it are effectively under duress and unable to make reasonable consumer choices at the point of need.
2. Only a tiny minority can afford to pay the real costs of major lifesaving treatment at the time of need. The costs need to be spread across lifetime and across the population.
You can have insurance like the US and end up with all the overcharging and bankruptcy that goes with it or you can be rational like the UK and have a national health service that costs less than half as much and delivers the same or better outcomes for almost everyone.
Those who believe that the free market can provide healthcare in the modern world are fantasists.
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Textbook example of illogical thinking. You have provided no basis to blame the government here. I'm not saying there isn't one, I'm just saying your conclusion is completely unsupported by your premise, especially given that you are replying to someone saying that a complete government-run system in the UK is excellent.
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I have even read somewhere that the healthcare system in Cuba is better than the US.
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I have even read somewhere that the healthcare system in Cuba is better than the US.
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Re: It's a complex problem
What we've had in the past is what is called a death spiral. You provide everyone with low rates to get them to sign up for your health insurance rates. Then after a year you significantly jack up the rates and everyone bitches. The healthy people leave and the same company approaches them again with low rates. The sick people are stuck with the expensive insurance or no insurance because now that they have pre-existing conditions, no one else wants to cover them.
That's the problem with our system: no profitable way to provide care for sick people, especially those without money. It is a societal question that hasn't been fully addressed in the US. When publicly funded health systems try to develop priorities which don't pay for expensive treatments which will not prolong life, people scream death panels. But private insurance companies do it all the time. They deny services, they don't sign up sick people, and so on.
Another problem is that as private health insurance gets more expensive (and it was doing this long before Obamacare), fewer people can afford it. So fewer people pay into insurance pools and it gets that much more expensive. Our country was heading for an unsustainable health care system without Obamacare anyway.
Now, we could go back to a system where everything is paid on a cash basis or credit, which is what we did before health insurance. But most people would not be able to afford most of the modern medical procedures, like cancer treatment, organ transplants, dialysis, etc. While costs would come down if there was no health insurance or government systems, they probably would not come down sufficiently to become affordable for people living paycheck to paycheck. And people probably wouldn't be putting money aside for the day when they needed to cover unexpected health expenses.
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Re: Re: Re: It's what you get when *CRONY*-capitalists control a market...
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Re: So WHO do you finger as the criminal, Mike?
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Bet that crap would end real quick.
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Re: Re: It's what you get when *CRONY*-capitalists control a market...
Also, health care is not something I want subject to pure market forces. It is an inelastic good and therefore it's very easy for health care providers to gouge their customers. That's how you end up paying $1.50 for a tablet that costs $0.015 at a drug store.
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Re: Re: Re: It's what you get when capitalists control a market...
the law stepped in because he was charging too little, and they forced him to change things."
Specifics, please?
At least the town or city and date (within a year)?
Othewise this is like Michelle Bachmann's "A woman (who I never saw before) came up to me and told me a vaccination gave her daughter autism" story
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A highly skilled, experienced worker, working full-time, can expect to make a little under $100,000 with the right skillset, and that's pretty high-end. When you have people in charge who are making 1 to 2 orders of magnitude beyond what they're paying the most skilled of their employees--the ones who are actually generating the revenue--is it not fair to ask what they're doing to deserve such compensation?
Are they working harder? I'd expect to pay someone 10x as much if they're working 10x as hard... but I don't see any CEOs working 400--4000 hours a week, seeing as how there are only 168 hours available to choose from.
So then, why should it be considered "a cheap shot" to call attention to such absurdities?
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For your 3rd, are you really suggesting we do away with regulations like the one which needs license to practice? Don't you think for that particular problem, the problem lies on why the degree cost six figures (educational cost problems) instead?
For your 4th point, are you suggesting that we do away with liability litigation, cos that's what those insurance supposed to protect the practitioners from? Are market forces enough to deter practitioner from malpractice, given most people I think agree with Ima's 1st point.
Back on Ima's post, I do think the 1st step on "fixing" the system is addressing the 2nd point, creating awareness about the prices. Not just for the patients, but the doctors as well.
For example, my mom got heart problems, and for prescriptions, her doctor always ask do we want patented or generics and explain the price differences. We use generics, and as far as I can tell, they're working fine.
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Re: So WHO do you finger as the criminal, Mike?
They control the gov't and the hospitals AND the insurance companies, practically own the doctors through monopoly on schooling and licensing, and through another monopoly with lawyers, control every aspect of legalities."
The first intelligent thing out_of_the_blue has ever said!
But it beggars the question as to why the boy normally shills for them...
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Re: Re: Re: ObamaCare
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forgot why I never get a hospital bill
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As you said, CEOs aren't the ones actually generating any wealth. Their employees are generating it.
The ratio of CEO to median worker pay used to be reasonable in this country. Now it's totally out of hand. But heaven forbid we talk about this because it's "class warfare" or "what the market will bear". If we had reasonable tax incentives then I don't think I'd have as much of a problem with high CEO pay, but instead we have upside-down tax incentives where highly-paid officers pay lower tax rates than the median worker.
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Re: Re: It's a complex problem
1. Under ObamaCare pre-existing conditions are gone. So you can throw that one out the window.
2. Low rates jacked up after a year are a myth. Most people insured in the USA today are insured through their place of employment with uniform rates no matter how long they've been employed or how old they are. Now this method of insuring through work is a nasty mess in and of itself. Everyone should self insure just like car insurance. The current group system allows big companies like Walmart to get a great deal while Joe the CPA and his 2 man office get the shaft. But the problem you are implying just doesn't exist.
3. What you kind of slide around but don't really touch is that 80% of health care dollars are spent on end of life care. (I'm using that term loosely here.) It's been shown that there are better outcomes with hospice care at end of life at much less cost when compared with hospital care. But discussing this always brings on the screams of "death panels". Given that in my 20s I don't really need insurance why should I pay for it? In my 80s however I'm going to cost far more than my premiums will cover. This is the one thing ObamaCare will help with.
4. One thing I always note is that my dog doesn't have health care insurance and he gets better care than I do at a price that doesn't bankrupt me. That includes one very sick dog with cancer that was stabilized for almost a year and that I had to put down a little over a year ago. If the vet can manage it why can't the doctor? The only two reasons I can think of are greed. Greed on the part of the medical community and greed on the part of the malpractice system.
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This is exactly why, I believe everyone should start doing their on healthcare, not with the idea to replace the actual system today in a short term but to prepare the road ahead for real change.
If the government won't do it or is incapable of doing it, people should take care of their own health by any means they can.
Learn how exams are done try to replicate the processes, find new suppliers, experiment with community funded clinics, make medicine and instruments, anything you can take away from the hospital to charge you is something you are regaining control over it.
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Re: Re: Re: Re: ObamaCare
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Re: It's what you get when capitalists control a market...
Make up your damn mind asshole.
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Re: Re: Re: Re: ObamaCare
Our system is based on people doing things because they make a profit and there's nothing wrong with that. Where it becomes a problem is when the system is rigged to allow the kind of abuses that Mike detailed in his post.
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Re: Re: Re: Re: ObamaCare
To be fair Insurance companies don't profit off sick people. They are basically profiting by putting people together in pools and then setting rates so that that particular group makes them money. They try to have more healthy than sick people in a group. The more sick people in the group the higher the rates.
All doctors 'profit' off of sick people. Doctor's need to make a living too, just like nurses and other healthcare professionals. I don't think making a profit off of sick people is wrong. Making an obscene profit certainly is though and many drug companies, health networks... have turned healthcare into a money machine.
My problem with insurance is once the majority of people carry insurance, it artificially raises the ability of the consumer to pay. It also means that the true cost is hidden from the consumer. This is a recipe for spiraling costs because the consumer doesn't really bear the cost. It gets hidden by the insurance, the cost of which is hidden because much of it is normally paid by the employer and never shown to the employee, many are on on government subsidized health care...
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Great Article, Mike
Here's the link to the story-
http://denver.cbslocal.com/2013/02/17/insider-reveals-secrets-of-hospital-billing/
And the Court Documents/Disposition, which the Plantiff desired sealed. From the story- "During the deposition, Sammons said his hospital charged patients $69 per minute of emergency room time and marked up prices for some medical supplies at a rate of 3 1/2 times what they cost the hospital. He was asked how the hospital decided on its pricing."
The attorney wanted the Disposition from the CFO sealed, but the prevailing party thought it was more important to be made public.
http://cbsdenver.files.wordpress.com/2013/02/sammons-skyridge-depo-redacted-for-privacy.p df
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Re: Re: Re: It's a complex problem
That's been one of the big selling points for it. But I am talking about how for-profit health insurance has been done up until this point.
2. Low rates jacked up after a year are a myth. Most people insured in the USA today are insured through their place of employment with uniform rates no matter how long they've been employed or how old they are. Now this method of insuring through work is a nasty mess in and of itself. Everyone should self insure just like car insurance. The current group system allows big companies like Walmart to get a great deal while Joe the CPA and his 2 man office get the shaft. But the problem you are implying just doesn't exist.
Actually it did exist. I saw it in action and then researched it and that's where I read about "death spirals." I have been buying my own health insurance for 20 years. I was using a plan that did exactly what I described. It was low and then increased 25% after one year. I could absorb that once, but got worried about that being the annual norm. I switched insurance companies and then was quoted an even lower price from the first one that jacked up the rates.
I decided I had better find a company I was happy with in case I got sick and was stuck with it, so I switched to Blue Cross. It too has gone up every year over the past 20 years, so I know health insurance was increasing considerably pre-Obama care.
Part of the problem with our health care system is tying it to employers. That ties people into jobs for health insurance reasons. Plus as more people freelance, it doesn't work anyway.
3. What you kind of slide around but don't really touch is that 80% of health care dollars are spent on end of life care. (I'm using that term loosely here.) It's been shown that there are better outcomes with hospice care at end of life at much less cost when compared with hospital care. But discussing this always brings on the screams of "death panels". Given that in my 20s I don't really need insurance why should I pay for it? In my 80s however I'm going to cost far more than my premiums will cover. This is the one thing ObamaCare will help with.
That is part of the issue and end of life care should be discussed. However, you're right, the Republicans started screaming "death panels" and killed the discussion.
4. One thing I always note is that my dog doesn't have health care insurance and he gets better care than I do at a price that doesn't bankrupt me. That includes one very sick dog with cancer that was stabilized for almost a year and that I had to put down a little over a year ago. If the vet can manage it why can't the doctor? The only two reasons I can think of are greed. Greed on the part of the medical community and greed on the part of the malpractice system.
The dog owners I know have been paying outrageous prices for vet care. $200 for a visit. Thousands for bone repairs or cancer treatments. It's not cheap at all around here.
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This is what happens
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Re: Re: Re: Re: It's a complex problem
Death spiral (insurance) - Wikipedia, the free encyclopedia
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Re: Re: Re: It's what you get when capitalists control a market...
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Re: Re: Re: It's what you get when capitalists control a market...
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Re: Re: Re: It's what you get when capitalists control a market...
So you think that Competition, Transparency and removing Monopoly barriers are “fantasy”? Sad world view…
I had a good laugh at your defense of the UK DeathCare system.
May 11, 2012 - Patients With Multiple Health Problems Overwhelm UK Health System
Feb 6, 2013 - Health Service, Pride of Britain, Ravaged by Hospital Scandal
”(Reuters) - The deaths of hundreds of hospital patients, left without food or water in filthy conditions, exposed an urgent need to change the culture of Britain's National Health Service (NHS)…”
Your 1st point - What? You buy insurance before the time of distress. There are millions of people that buy all types of insurance every day.
Your 2nd point - The point of insurance is to pool to payout on catastrophic events, thus you confirmed my point. The premiums paid by all end up helping payees in the time of need. You can’t prove ”costs need to be spread across lifetime”.
Again, the US system is fixed Against freedom. The McCarran–Ferguson Act exempting Insurance from Anti-competitive practices is, what I think, can be agreed to as “A Bad Idea”. The current system is a mess. As with Govt policies, the unintended consequences of people wanting to do the right thing has doctors quitting in droves and the rest creating a whirlwind of tests and costs.
The best part - if I don’t want to pay the ObamaCare Ins premium, I can pay a tax much lower than the premium and still be fully covered. From the Washington Post - “Roberts (Chief of SCOTUS) noted that a person earning $35,000 a year would pay a $60 monthly tax and someone earning $100,000 would pay $200. But the cost of a qualifying insurance policy is projected to be $400 a month. Clearly, it would be sensible to pay $60 or $200 rather than $400, because if one becomes ill, “guaranteed issue” assures coverage and “community rating” means that one’s illness will not result in higher insurance rates.”
“…Roberts’s decision limits Congress’s latitude by holding that the small size of the penalty is part of the reason it is, for constitutional purposes, a tax. It is not a “financial punishment” because it is not so steep that it effectively prohibits the choice of paying it. And, Roberts noted, “by statute, it can never be more.” …the penalty for refusing to purchase insurance counts as a tax only if it remains so small as to be largely ineffective.”
http://articles.washingtonpost.com/2013-01-18/opinions/36475082_1_health-insurance-ac a-premiums
Paying the tax instead of the premium means I’m still covered and can receive treatment because of “guaranteed issue” and “community rating.”
Sorry Govt, you Fucked it up again…
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Re: Re: Re: It's what you get when capitalists control a market...
May 11, 2012 - Patients With Multiple Health Problems Overwhelm UK Health System
Feb 6, 2013 - Health Service, Pride of Britain, Ravaged by Hospital Scandal
”(Reuters) - The deaths of hundreds of hospital patients, left without food or water in filthy conditions, exposed an urgent need to change the culture of Britain's National Health Service (NHS)…”
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Re: Re: So WHO do you finger as the criminal, Mike?
No way Nancy Pelosi was worth $35M when she entered office...
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Re: Repay in small amounts
Brilliant.
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Anyone with a serious health problem will die or go bankrupt.
Now - please return to the real world.
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Together with the patent system it incentivises the creation of unaffordable drugs and treatments.
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Re: Re: Re: It's a complex problem
This came out today.
Fewer Americans Getting Health Insurance From Employer
According to this, only 44.5% of adults 18+ get employer based insurance. 25.6% are on a government-based plan. 16.9% are uninsured. And 11.1% use something else (e.g., buy their own).
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The problem isn't "Obamacare." The problem is greed.
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Re: There are doctors fighting back.
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Re: . . . while independent doctors are closing their shops
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Re: Re: It's what you get when capitalists control a market...
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Re: Re: Re: Re: It's a complex problem
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Re: So WHO do you finger as the criminal, Mike?
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While I agree that such salaries may be unjustified and completely excessive, it's not the same thing as claiming to run a charity non-profit while receiving a multimillion dollar salary. When a non-profit finds ways to produce additional income they are completely hypocritical in not taking that additional income and putting to work for their stated mission, whatever that purpose may be. Making the CEO wealthy is a complete contradiction to the purpose of setting up the non-profit in the first place, and it is hypocritical, shameful, and downright wrong.
Again, don't think I support such ridiculous compensation packages, but it just isn't the same thing. Telling someone that they got rich off of successfully running a business is not an insult, it's a success story. Ethical issues and scaling aside, this is the American dream. Getting rich off the back of a charity organization is disgusting and is something you should be punished for, not rewarded.
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http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-fathe r/307617/
The discussion seems to confuse "health care" and "health insurance", and leads to optimize for the wrong result: total individuals covered, not low cost and high quality. Even when regulation permits anything like a free-ish market in insurance policies, that has almost no bearing on cost of care. The typical consumer has health insurance, and the first question asked about a procedure is not "How much does it cost?" but "Is it covered?" The market is distorted.
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Why would a doctors lifestyle be pertinent. Give them a good wage, $250,000-$350,000 or whatever, and limit what they can be paid to do, necessary not elective care. Those that choose to, can take a chance and specialize in elective care, which would be paid for by the elector. Maybe there could be a way where one could do some of both, but I doubt it.
Another issue is to take the burden off of hospitals by opening a whole lot more government run clinics. I have observed some of these in operation, and paid for by the county, and are quite effective. I bet the county doesn't allow for much float in prices, or more directly, the clinics chief who has to maintain the tight budget the county provides. This model is cost effective. Eliminates many emergency room visits. Provides long term treatment for a variety of conditions. We need enough clinics to cover all residents regardless of status, a large portion of them 24/7/366 (don't want them closing on Feb 29. when it shows up.:))
OK, so if you missed it, I am thinking that the Government pays for all necessary health care, but pays the price a single payer can negotiate (say 70% of lowest found retail price) for all goods. Salaries controlled, and supplies controlled. Systems for quality control and expense auditing need to be developed, on the quality side I think there is a lot of history to know what is best, and economically clinic by clinic comparison for cost vs patient (average use of supplies divided by number of patients served compared across all jurisdictions can point out errors early if watched in near real time). Incentives for better medical protocols or cost efficiency would add some color to the process.
Hospitals would then be paid by necessity, and surgeons and specialists might have a different pay scale, rather than annual, hourly. Care must be taken here so that surgeons billing rates don't follow the way of legal billing rates. (I talked for 30 seconds and bill 1 hour).
A mostly single payer system (remember those elective procedures) would take care of the drug price issue to a large extent. Give us our price or we go with alternatives, nationwide.
Speaking of drug companies, just how is it justified that advertising for prescription drugs is allowed to be directed at the end user, when the doctor is the one to make any initial decisions? Do you need the drug? Which one would be better given YOUR history? Any kind of influence at the doctor level should be disallowed as well. The decision should be made upon existing information on the drug. ALL existing information, failed studies included, and of course the patients history.
Next is insurance companies. Insurance is a way of financing some future disaster. You pay the premium, and theoretically you are taken care of at the time of your disaster. Unfortunately there are at least two things that get in the way of this being efficient. Profit, taken every year, even if there is no disaster (and at some point may say 'Hey, we don't have anymore money, too bad), and discount, your property isn't worth what it was when we insured it, and we will only pay X now. The whole point of health care insurance is to pay for the health care, and in doing it this way we add 3 layers of bureaucracy that are entirely unnecessary. The client insurance company relationship. The insurance company provider relationship. And, the insurance company government relationship (medi-anything). What a cost. And it's legislated. The profit of these companies is legislated. Boggles the boggling going on in my mind.
Speaking of insurance, what about malpractice insurance? It seems to me that there is a way of dealing with inept doctors other than insurance. Peer review, patient review, improved negligence legislation in the area, with jail time and loss of license more readily available seem better. Otherwise, we, the end user, keep paying the...Insurance Companies.
I am looking forward to Mike releasing his other articles in this area. What did I miss?
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So many discussions we're not having
Now, insurance companies and the government could refuse to pay for the fertility treatments, so that only wealthy parents can afford those. (Or, even more dicey, these entities might refuse to pay the costs if the parents and doctor decide to let all four babies go to term rather than only allowing one or two babies to go to term.)
But who pays for the childbirth and lifetime health care issues for the children? Can society refuse to pay? Is that fair to the kids?
We've got people not wanting to deny care, but not wanting to pick up the bill either. Some people think charities and non-profits will step in, but will they? And if they won't, are we okay not paying for people who can't afford it? Or will we just pretend that we don't see health care issues for those who can't get it?
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Re: Re: Re: Re: It's what you get when capitalists control a market...
It was right next door to my oncologist's office - part of the same health care system - which takes my insurance no problem.
Insurance, Obamacare, whatever you call it, doesn't fucking matter. Part of the overall problem. Politicizing it is diversionary bullshit.
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Dr. Frankenstein and His Collection of Assorted Body Parts.
Vide Dr. Frankenstein, you can keep a dead body going more or less indefinitely, and run up the bills accordingly. In the case of at least two of my relatives, there were elaborate procedures at a time when there was no possibility of anything that anyone would recognize as a recovery (End-stage Parkinson's disease in one case, climaxing in a broken hip; a mixture of strokes, emphysema, and arthritis in the other). In one case, the attending doctor actual told my father that if he had been present, he would have stopped the revival process. Another relative's demise was remarkable for the number of times he kept pulling his tubes out. I think I'd take that as a fairly clear statement of his wishes. One way or another, you have to set limits on this kind of thing.
Here's an interesting book:
William A. Knaus, _Inside Russian Medicine_, Grosset & Dunlap, March 1980, # ISBN-10: 0448149583, ISBN-13: 978-0448149585, Amazon Best Sellers Rank: #10,260,143.
The bad news is that it isn't easily available, though your librarian ought to be able to get it for you via inter-library loan, and if you find it at all interesting, you would be well advised to make your own set of copies with a digital camera (*). Knaus went to Russia in the early 1970's, as a "house doctor" for a touring State Department exhibition. One of his people started doing gastro-intestinal bleeding in Irkutsk, Siberia, and Knaus was immediately thrust into the deep end of the Russian medical system. One thing sort of led to another, and he wound up becoming extremely knowledgeable about the Russian medical system, a kind of ad hoc envoy to the Russian medical establishment. So he wrote a book to explain the differences.
One thing you might find interesting is that, in Russia, there is a long-standing tradition of having a lot of women doctors. This produces all kinds of different expectations.
(*) An illustration of what is wrong with the copyright system.
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Re: So many discussions we're not having
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Pfft, doctors
What would someone not pay?
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Re:
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Re: It's what you get when capitalists control a market...
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Re: Ambulance cost
Victoria, Australia
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wow, you know some very, very stupid people Masnick !!!!
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No transparency
Don't even think about any "rights" in the VA, and heaven help everyone when the Patient Protection and Affordable Health Care Act fully takes hold.
It's utter nonsense.
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We all know advertisers are a creepy corrupt bunch of liars
After some 12 to 18 months, he left this and went back to his old post in the advertising company.
When he got back, he was asked whey he came back when the advertising business is so corrupt? His response was that those in advertising knew nothing about corruption or lying, they were likened to innocent babes in mothers arms.
Having heard some of his stories, I don't wonder at any of the charges and prices I hear about for any hospital services etc.
Years ago, my wife had to have a special scan. I went with and saw the equipment being used. Just out of interest, I asked how old the machine was and how much was the price of the computer hardware being used.
I was told the machine was less than 6 months old. The computer being used to control the system had cost on the order of $50-$60 thousand dollars. I was shocked. I hadn't seen a computer of its ilk for at least 10 years. We had used those same machines at least that long ago. It was brand new but ancient in technology (as tech goes).
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Re: Re: It's what you get when capitalists control a market...
I agree and I think this is the core of the issue here. What we're seeing here is not capitalism, what we are seeing here is the result of anti-competitive laws. Just like with all other markets in the U.S.
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Re: Re: It's what you get when capitalists control a market...
Capitalism and Socialism are the same thing, basically. The real problem right now is largely "centralism", but ultimately things break down into good, old fashioned greed on the one hand and apathy on the other.
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Re: why are the prices absolutely insane.
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Medical practitioners are the biggest professional liars I have ever, ever met. Not having insurance there have been several times of when the medical firms people (nurses, doctors, receptionists) have told me that there would be no or a low charge (because I was going to walk out) for an emergency service. The bill was in the mail every time. Same for nursing homes and have similar experience from them lying to me about room charges (to get us to stay for a while longer) and worse because they are almost like prisons where getting out is just like an thrilling escape. The bill was in the mail almost before we got back home. They are outright liars of the worst professional kind and the sales speech the spout before you enter is almost a meaningless thing. To hear this story about chargemaster fees is no surprise.
Medical tourism is becoming extremely popular in the US and getting sick in the US is starting to become a nightmare. Taking a trip to Mexico or some small Caribbean or South America country for a large dental, or medical surgery is now a normal thing. Getting prescriptions from Canada is a classic way to save huge money.
I do think that a (truly) free market is still the best way and that the real problem (for the most part) is that legislation has been abused to un-free the market. Basically, corruption. Only some tweaking on the free market model is needed. The real problem is runaway government.
I would support legislation that forced (I'm not asking) that the chargemaster fees to be the actual price for individuals, insurance companies and Medicare, etc. alike. Since the large firms and government agencies would quickly force the chargemaster fees to be as low as possible it would then repreesent the cost of hospitals real ROI and margin of profit. This is the only legislation I think is needed. (in combination with removing other legislation)
While I'm at it... beyond having a degree a specific area of medical practice you are practicing I would also like to see the current licensing scheme thrown out. (throw out the BARR association admittance requirement too while we are at it) There will be no limits on malpractice lawsuits whatsoever of course.
“Any business, firm or organization may open and do business without forced to join any organization, club or party.” or something like that.
To keep drug prices low we will be eliminating all laws about drugs both prescriptions and illegal ones and closing the DEA completely. This will allow the purchase of medicine from any country or lowest price vendor. The FDA would still be required to sample and close down providers of low or no quality drug-makers. Closing the DEA will profit in many way including not destroying peoples lives and making them economic drains on the economy.
To solve some of the privacy issues with current health-care providers it will be allowed to sign in with the name “John Doe” if you are paying cash. You keep your own medical records.
On a different track: As for the chargemaster fees being discounted to some wouldn't the IRS consider the discount as income and be taxed accordingly?
I seem to be last to post (and wonder if anyone will read this) but I really think the comments everyone made were constructive and made this post much better. Thanks.
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It's mostly a non-free market
Over half of the healthcare industry is government funded and this gives an incentive for higher prices. The government has lots of money, people want healthcare, and politicians want to be the ones to give it to them at any cost. Notice how the exact same thing is happening with college prices as government pays more of the bills and gets more involved, this is no coincidence.
This doesn't happen with a reputable Vet or Dentist. I had a full jaw x-ray and was put under for oral surgery to have a deep wisdom tooth cut out and then needed stitches. I paid just over $1000 and this included many check-ups afterward, a plastic squirt tube and keep it clean, and a zip-lock bag full of gauze pads. This is still not a fully free market but it's much better because it doesn't have many of the same market manipulations.
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Re: Re: Re: Re: It's what you get when capitalists control a market...
Actually, they are, boy, unless you're adding elective procedures like plastic surgery into the mix.
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Re: Re: Re: Re: Re: It's what you get when capitalists control a market...
Insurance and Obamacare are two different things.
Obamacare is when you don't have insurance.
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Re: Re: Re: Re: It's what you get when capitalists control a market...
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Re: Re: Re: Re: Re: Re: ObamaCare
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Re: Re: So many discussions we're not having
Actually a lot of them didn't. Women died in childbirth. People died from infectious diseases. Families had lots of kids because a good percentage of those kids didn't survive into adulthood.
The diseases that kill people in the US now (e.g., cancer, heart disease) are diseases that people get if they live long enough. We've eliminated lots of stuff, but now we are dealing with diseases/illnesses that kill people when they are older.
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Re: Re: It's what you get when capitalists control a market...
Can you cite a medical system anywhere in the world that operates on a purely capitalistic system where everyone in that society gets affordable health care?
I'm open to anything that brings down the cost of medical care, but I don't think the system you describe exists. There are societies where there is no government health care and no regulation, but treatment is not available to everyone, either.
I'm not sure you can have a truly unregulated health care system where there is no drug testing and no training requirements for health care professionals and expect people to be cared for safely.
Here's one example. What about blood testing for HIV and hepatitis C? Let's say you've had an accident and need a transfusion. How do you know that the blood you have been given is safe? Sure, you can sue if you have been given unsafe blood, but by then you have the disease.
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WRONG!
None of the debates ignore this question. The question is simply not relevant. If you are trying to prevent reformation of a corrupt system, then you have to IGNORE as many facts and as much evidence as possible and stick to rhetoric that will inflame the masses against their own betterment.
Keywords:
Economic disaster
For the Children
Socialist
Communist
Job creation
Wealth redistribution
Job losses
inferior medical care
Death camps
the terrorist will win
national debt (NEVER include debt of the ill person)
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Re: Re:
If you think that a few cherry picked headlines from the anti-NHS Torygraph is proof of anything, you're a blithering idiot.
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Re: Re: It's what you get when capitalists control a market...
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Re: Re: It's what you get when capitalists control a market...
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Re: why are the prices absolutely insane.
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I didn't cherry-pick those C+E to force an inaccurate conclusion either. If I had, it could be easily disproved by adding whatever info I omitted.
Here's a restatement of my point.
1) The US Gov is by far the single biggest financial player in the US healthcare system.
2) Stipulations for reimbursement by the US Gov are onerously complex. This problem is at least a generation old and it continues to worsen.
3a) Complex regulations almost always favor larger players who can more easily dedicate resources needed to cope with them.
3b)US medical corporations have every motivation to lobby US legislators to structure Gov regulations to favor their industry. US legislators will continue to to respond favorably to industry lobbying.
If you put on me to draw a conclusion, it would be this.
Neither the US Gov nor US corporations posses sufficient ethical responsibility to be entrusted with our healthcare.
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Re: Re: Re: It's what you get when capitalists control a market...
Which is why for-profit healthcare without a real public alternative is a very dangerous thing...
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Re: Re: Re: Re: It's what you get when *CRONY*-capitalists control a market...
Also, who's preventing companies from competing in healthcare? That particular strawman is the fantasy of morons. Most people in countries with socialised healthcare can choose private care if they wish and can afford it. They just can't avoid paying their fair share of the basics (which are still there for them if the private solutions fail.
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Not a free market? No, Duh!
Even where hospitals in theory should compete, they do not, because third-party payment for most medical services prevents an effective market from developing (and the services are being provided as a front for the guild-monopoly of physicians and the monopolies of medical and pharmaceutical manufacturers).
And all of these monopolies, unlike utility monopolies, have their rates unregulated.
Don't look for anything to fix this. Just as in copyright and general patent matters all of us who read TechDirt are familiar with, the incumbents in the market like things just the way they are, have a lot of political clout, and now, rhetorical cover from the phrase "health care" having been turned into a Newspeak phrase that means any of "health care", "health insurance", "government-run/regulated health insurance", or probably one or two other things according to what the Party needs it to mean at any given moment.
Whatever you think of the Obama/Pelosi reform of health insurance, it didn't do anything to reform health care. What's needed is the recognition that health care is provided by state-granted monopolies and the will to regulate those monopolies as to rates charged.
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Re: Not a free market? No, Duh!
Actually, in many areas there are more hospitals than are needed. Same goes with equipment like scanners. Lots of hospitals get them and then prescribe unnecessary tests in order to pay for the equipment. One problem is that consumers aren't able to tell when they need tests or have been sold on the idea that they need them.
Now I suppose if hospitals will only treat people who can pay, that would discourage unnecessary treatment of the poor, and that is one way for the market to work. But then we have to face up to the idea that health care varies according to income and savings.
Study: Too many Michigan hospital beds driving up consumer costs | Michigan Radio: "I found that the availability of beds themselves actually caused utilization to rise," Delamater says. "If a new hospital is built, there's pressure to get people into those beds regardless of the medical-based need for putting them in that hospital bed."
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Re: Repay in small amounts
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Re: Re:
I rather start small and work up.
- I learn how to do checkups and make them myself, only going to the hospital to do the exams necessary to confirm something.
- I rather start learning how to do the exams at home so, whatever exam I can do it myself is less $50 dollars off my back for gaze.
- I rather volunteer at a local clinic and donate resources to it.
- I rather start learning how to build medical equipment so local community clinics can be better equipped.
- I rather start learning how to manufacture drugs like blood thinners(i.e. aspirin).
- I rather build a microscope at home.
http://www.microscopy-uk.org.uk/mag/artjan06/aalens2.html
- I rather build a centrifuge at home.
http://www.thingiverse.com/thing:1483
- I rather build a PCR at home
http://openpcr.org/2011/07/dna-is-now-diy-openpcr-ships-worldwide/
- I rather build an ECG that hooks up to a smartphone.
http://blog.makezine.com/2009/08/24/diy-ecg-machine-using-sound-card/
http://www.swhar den.com/blog/2009-08-14-diy-ecg-machine-on-the-cheap/
- I rather plan and design container hospital modules, for surgery, CT-Scans and MRI's, that can fit in a truck bed or be pulled by car.
I rather start doing something, at the very least you create the capabilities to not only confirm diagnosis, you also learn why it is being done the way it is done and can spot true bad practices.
It starts small like everything in life. First we don't know much about it, we learn and we improve, rinse and repeat until we reach the point where we can actually do something useful.
Or you rather give up and let everything in the hands of people who don't care and don't give a fuck?
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Address this: Heaviest users usually least able to pay
Driving down the price for them helps, but they still don't have any money and probably aren't earning any if they are very ill, disabled, very young, very old, etc.
How should society address the healthcare needs of those who have the highest needs and the fewest resources? It's not a group a for-profit company is likely to serve unless someone is picking up the tab. There's no money to be made to provide services for free.
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Re: So WHO do you finger as the criminal, Mike?
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Re: Re: So WHO do you finger as the criminal, Mike?
I'm curious. Do you pay for this out of your own pocket or is someone else (e.g., government, insurance) covering it?
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Re: Re: Re: Re: Re: It's what you get when capitalists control a market...
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Re: Re: Re: Re: Re: Re: It's what you get when capitalists control a market...
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My experience with Mercy Hospital in Springfield
I get there and they rush me straight back to do a ct scan, and an xray. I tell them I am okay and don't want all of these tests, but they tell me they need to do them anyway.
I was in the hospital about an hour and a half
Well as I knew, I was just fine, until two weeks later when the bills started arriving. I was expecting a couple thousand dollars, but my bill was 11,300 for the hospital and 1800 for the ambulance. My car insurance covered $1000.00
I am paying about 300 a month and will be for a very long time.
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Re: The article doesn't take it far enough.
A collapse of the economy, followed by civil war and tyranny, followed by the rise of a new system and possibly a new political order which will hopefully be more sane and just that the current one. It might not be, thought. When economies fail, empires die and dark ages begin.
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Re: Re: Re: Re: Re: Re: It's what you get when capitalists control a market...
The odds are quite high that somewhere between the ages of 50 and 80 you will encounter a life threatening condition that is beyond your ability to pay at the time (unless you are in the 0.1%). That is what we are discussing here.
The fact that you also have a lot of minor ailments through your life and buy some vitamins and painkillers is totally irrelevant.
Under your proposed system I am already dead (twice). Fortunately I live in the UK and remain healthy both physically and financially.
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Re: Re: So many discussions we're not having
Mostly they didn't - odds are you wouldn't have survived long enough to ask the question.
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Re: Re: ObamaCare
MLR says an insurance company has to spend 85% on claims or refund the difference.
Hospitals cost shift because of non payers, which drives costs higher for payers. The amazon examples are moot...if amazon could only collect from 7 of 12 buyers, the prices quoted would increase substantially.
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Re: Re: It's what you get when capitalists control a market...
I'm from England, but lived in the US for 5+ years. I have experienced of healthcare on both sides of the Atlantic, and found the quality of hospital care to be similar in both countries. The major difference was the cost.
Our healthcare system is open to everyone, and is free at the point of use. To fund this system, we pay 9% of our income in National Insurance (on top of 22% income tax). This covers our healthcare and state pension.
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Re: Re: It's what you get when capitalists control a market...
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Re: Re: Re: ObamaCare
Yes, that is a big issue that needs to be discussed. Rates were going up for those with money in order to subsidize those without. But then, as insurance rates go up, more people and employers drop out, which reduces the pool even more, thus driving the rates up even more.
The way health care has been working pre-Obamacare was going to go under anyway.
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Re: Re: Re: It's what you get when capitalists control a market...
Canadians have also said that given a choice between their system and the US, they will stick with theirs.
And I have an American friend who lived in New Zealand for seven years and even though she is now back in the US, she still flies to New Zealand for medical checkups/treatment because it's covered there for her, and not here. (And her ex-husband was a US doctor.)
I grew up in a US military family and our health care was covered. It was great. That was one less worry. And I liked the fact that you didn't get unnecessary treatment. I avoided treatments that were in vogue when I was a kid that now have been proven to have been harmful. I got what I needed, but nothing more, which is how I prefer my health care.
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Re: Re: Re: So many discussions we're not having
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Re: Re: Re: Re: So many discussions we're not having
And we can certainly go back to the days of no health insurance and more limited medical care if that is what you are suggesting.
We're all going to die, too, and no one has yet figured out how to stop that. But most people opt for techniques that prolong their lives and give them improved quality of life. But for the survival of the human race, I suppose that isn't necessary. Have your kids, live long enough to raise them, and then you can die having accomplished one of your main purposes in life.
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Re: Re:
When you have the knowledge you don't need to follow those rules, just be aware of them.
What can't go on is people leaving their health in the hands of people who don't care.
Start small, learn how to do check ups by your own self, learn to build some simple instruments(i.e. microscope, centrifuge, ECG) start learning about medicines, you can manufacture blood thiners(aka Aspirin), start forming groups, start accumulating the knowledge, every little bit you learn is a bit you don't leave at the hands of uncaring people.
Build the fucking foundations of a system that your sons and daughters will be able to use and expand, DO NOT FUCKING LEAVE THIS TO GOVERNMENTS OR COMPANIES.
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Re: Re: Re: Re: So many discussions we're not having
and to learn how to alleviate suffering and prolong life.
What is more in most developed countries we also managed to work out a way of paying for it that didn't bankrupt the sick or leave a large proportion of the population without adequate cover.
Then there is America - which has been moving steadily backwards on that front for the last 50 years because of its irrational phobia of anything that can be labelled socialism. Your solution of going all the way back to the dark ages is, I suppose, consistent!
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Re: My experience with Mercy Hospital in Springfield
They were all smiling.
After half an hour I just asked the guy if he could just get me something for the pain and let me go die somewhere else.
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Re: Re: Re: Re: It's what you get when capitalists control a market...
Local problems in one particular area probably caused by political meddling driven in part by US health companies trying to muscle in - and NO ONE in the UK is calling for a radical change to the system - we will fix the problems in our own way.
Most of the people mentioned in this report would not even get to a hospital in the US - they would have run out of money and or insurability long before and would be dying at home.
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Re: Re: Re: Re: Re: So many discussions we're not having
Why do you need others to administer money for you?
Why do people keep handing control over their finances and health to people who don't care?
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Re: Re: It's what you get when capitalists control a market...
Actually central planning works fine when the planners get good information fed back from the grassroots and badly when they believe they are the fount of all wisdom.
If central planning doesn't work how come the US has successful mega corporations like Google, Apple, Microsoft etc. These organisations all run central planning internally. By your thesis they can't exist - but they do!
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Re: Someone?
So, if the profit is only 7.6%, what's really going on? If you reduced the prices of EVERYTHING (all products and services) at the hospital by 7.7%, the hospital would be losing money, and all those things would still be outrageously priced. The answer is...it's broken somewhere else.
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Another scenario
Should the hospital take him in and treat him? Should the government have a pool of funds to cover that?
If there are no government or charitable funds, should the hospital charge higher rates for everyone else to generate a pool of money to pay the uninsured? Or if it doesn't do that, should the hospital workers work for free to treat everyone who needs emergency health care but can't pay for it?
People aren't talking about stuff like this. Do we let die people who can't pay for health care? And if not, who pays for it? Even if we drive down health care costs, how do we pay for those who can't pay?
This is a societal question. How do we deal with those who have needs but no money and no ability to earn enough to repay the debt? Those questions must factor into health care discussions. We can refuse to treat people without funds, but that will be a reflection upon our collective values. If this is what we choose to do, then we might as well be upfront about it.
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Re: Re: It's what you get when capitalists control a market...
In healthcare, neither are true in the extreme. Just as the article says, the patient has basically no ability to make a rational decision (pay a reasonable amount for a reasonable return), and the outcomes of particular paths of care are highly unpredictable. There's nothing about healthcare that leads me to believe that a completely free market would work out better than the current system.
Better regulation is really the only feasible way to I see to solve this problem. Its not like regulation is inherently bad. (Adam Smith assumed at least a minimum level of regulation was in place: laws protecting property-> no serious economist would argue to deregulate the "theft" market). The question is degree. Here, we obviously have not regulated the healthcare industry nearly well enough.
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Then I went into the hospital a few years later for something I can't go into, but I was unemployed at the time and the bill was around $80,000 and a hospital charity covered my entire bill. kookie. I know this is not the norm and the system is fucked and I consider myself lucky. just wanted to share my experience.
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My dad got 27 injections of a drug he didn't even need (and had now left him with massive pain issues)- $5000 a pop x 27.
Just read article where docs were charging $6000 for something that cost $10.
Please tell me we don't have a problem
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Re: Re: Re: It's what you get when capitalists control a market...
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Re: Re: Re: Re: It's what you get when capitalists control a market...
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Re: There are doctors fighting back.
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Re: Re: It's what you get when *CRONY*-capitalists control a market...
We shouldn't be paying for people to prolong their lives once they've reached old age, which is where the vast majority of the money goes.
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Re: Re: Re: Re: Re: So many discussions we're not having
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Re: Re: Re: Re: Re: Re: So many discussions we're not having
People would be looking at an entirely different set of priorities. And if we want to talk about that now, there is a whole lot of other stuff to put into the discussion in addition to health care as we know it today. Much of modern life is pretty expendable when we are talking about basic survival. Get rid of the multiple cars, the McMansions, the stock portfolios, the energy intensive tech devices, shipping food across the world, and so on.
If you want to ponder doomsday scenarios, we can always start with climate change.
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Re: Repay in small amounts
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Re: Repay in small amounts
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Re: There are doctors fighting back.
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Re: Re: Re: Re: ObamaCare
The subsidy is a scam. You pay income tax on the premiums paid, and the govt gives some back and calls it a subsidy. You need to earn 23000 to have enough left over to pay a 15000 premium(25fed,7.65fica,5state). How does an 8000 subsidy sound now? It's your damn money they are giving you.
Health care and health insurance are 2 different things. People are in for a big surprise when they figure out how much 'free' insurance really costs.
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Re: Re: profit of 7%
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Re: Re: Re: Re: Re: ObamaCare
Individual health care insurance mandate has roots two decades long | Fox News: "The mandate, requiring every American to purchase health insurance, appeared in a 1989 published proposal by Stuart M. Butler of the conservative Heritage Foundation called 'Assuring Affordable Health Care for All Americans,' which included a provision to 'mandate all households to obtain adequate insurance.'"
I would have tackled health care cost first, and then worried about extending coverage to everyone. So rather than the insurance mandate, I would have looked for some smaller scale experiments within states or organizations that have been successful at lowering costs and then would have pushed to expand those.
And those to the left of Obama fault Obamacare for not being a single-payer/universal healthcare system. That would have been my preference. As I said, that's what I grew up with and I like it.
I think it is a given that health care costs are too high and unaffordable for many. I think the government is going to have to use its clout to get lower prices and when that doesn't happen, I think restrictions on what services are covered will likely have to happen (that doesn't mean people with money can't buy more coverage, but the basic coverage will likely be more bare bones). Doctors, hospitals, and drug companies may have to accept that they will be getting less money. And I certainly hope insurance companies get less.
As I said in a previous comment, the healthcare situation is complex and requires changes up and down the system, including how people take care of themselves. As a country I hope we start living healthier lives and need less care.
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Re: Re: Re: Re: It's what you get when capitalists control a market...
The companies I mentioned are larger than many countries and have more complex structure than many countries.
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Re: Re: Re: Re: It's what you get when capitalists control a market...
The fact is that the US has been trying to have a private "capitalist" system for years and it has worked worse and worse over time. As a consequence there have been numerous attempts to fix the system whilst not really changing it (as you list them yourself) and every time it has failed and made things worse.
No country in the world successfully implements the system you propose whereas there are many reasonably successful variants of the system in the UK.
The system in the UK is also extremely popular with the public. That is not an accident it is because by and large the system works and we don't have to worry about health costs at a personal level.
If the isolated events you quote were widespread then the public would not be so supportive of the system.
The real problem in the US is that most people's healthcare used to be handled through their employer and most people expected to work in the same job throughout their lives. That has gone and will not come back - hence your present predicament.
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Re:
That's a big problem. Even if you want to price shop, you can't because it's hard to find out the actual price. You get a bill from your insurance company and it quotes a price that that isn't the price the insurance company actually pays. And a lot of medical places can't give you a price if you pay cash at that moment because they don't have it.
For medical services that insurance companies don't cover (e.g., cosmetic surgery) there is competitive pricing, but quality can vary greatly among providers. And among those there are providers who don't use anything close to safe procedures and people have died in backroom offices as a result. Unsanitary conditions, contaminated drugs, lack of emergency equipment.
The reason we have as many regulations as we have is that in the past we had a lot of unregulated health care that killed people. Unsafe, unmonitored medicine. Untrained practitioners. Quacks. I'm not defending over-regulation, but generally there is a reason we've ended up with each regulation.
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The article above pertains to the processes of Obamacare....which forces US tax payers to pay for the revenue stream supposedly gained by this. The GOP of the US Senate actually filibustered to NOT raise the debt ceiling, which is by all means a historical event in the entirety of the US Politics.
Congress created the debt ceiling as a means of control to make a president look bad if they do not agree. The practice has been around since the days of Herbert Hoover. The president of the United States has no control over the Debt Ceiling and can only propose budgets and raises of that nature.
Historically speaking, President Barrack Obama is the first president to push for spending by actually demand increasing the Debt Ceiling in the US.
Obamacare was originally only going to add prescription benefits/coverage and disabilities care, and to prevent Medicare and Medicaid fraud in hospital bills. That was tax affordable, but now you pay the tax if you cannot afford health insurance. The US government becomes an insurance broker in 2014....and it is not economically sound.
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Re: why are the prices absolutely insane.
My mother works in Medicare and Medicaid fraud recovery. saves the US GVT about $3.4 Billion a year. It is an auditing system.
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Re: Re:
So I go through the ratings and friend recommendations and "best dentist" lists to find someone who is (1) reasonably priced, (2) competent, and (3) honest (won't try to sell me services I don't need). It's been hard to identify dentists who are all three. And if you do go to a dentist and he tells you that you need a lot of services, how do you know? Do you trust him or seek a second opinion? It's like shopping for an auto mechanic. Once you've found someone who is reasonable, competent, and trustworthy, you stick with him, but you are likely to have had some bad experiences before you find the right one. It's bad enough paying for mistakes with a car. It's worse when it is your own body and the bills are likely to be higher.
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Re: Re: why are the prices absolutely insane.
Could you be more specific? Most people will not see $18,000 increases in their tax bills.
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Amen
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Re: Re: So many discussions we're not having
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Re: Re: Re:
No, I wasn't suggesting we do away with regulations like the one that requires medical licenses. And yes, as I said, the high cost of education is part of the problem. (And note that when you start a question with "don't you think...", it suggests to me that you're not really interested in the answer.)
2) No, I wasn't suggesting that we do away with liability litigation. Any maybe market forces can do a better job, we should certainly consider it.
Also, it would be great if juries were more aware of the consequences of huge awards. And before you ask, no, I'm not suggesting that we do away with juries.
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Re: It's what you get when capitalists control a market...
The real advantage of such corporations is that they are better able to deal with other similarly large entities. Although a lot of this is more corruption than efficiency.
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Re: Re: Repay in small amounts
Unfortunately bankruptcy law was meddled with as a gift to banks. Otherwise the financial end would be completely transparent to the "poor consumer".
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Re: ObamaCare
THAT is the basic conflict with "for profit" insurance. Your bottom line is in conflict with the interests of your customers and your contractual duty to pay claims.
It's a pretty fundemental conflict of interest.
Robber Baron insurance companies earn every bit of grief they manage to get.
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Two discussion-worthy reactions to Brill's article
Brill on health care: Steven Brill's opus on hospital prices.: "I can see two reasonable policy conclusions to draw from this, neither of which Brill embraces. One is that Medicare should cover everyone, just as Canadian Medicare does. Taxes would be higher, but overall health care spending would be much lower since universal Medicare could push the unit cost of services way down. The other would be to adopt all-payer rate setting rules—aka price controls—keeping the insurance market largely private, but simply pushing the prices down. Most European countries aren't single-payer, but do use price controls. Even Singapore, which is often touted by U.S. conservatives as a market-oriented forced-savings alternative to a universal health insurance system, relies heavily on price controls to keep costs down."
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Re: ObamaCare
Whether or not this is good public policy is another thing.
Regardless, as soon as this went it effect individuals immediately started to game the system. Mass corruption on an individual scale began. As soon as people realized that there was a big give away, people started acting like it was a cheap Vegas buffet. People ordered pumps they didn't need and the most expensive ones they could find.
One little part of Obamacare was abused the moment it went into effect. People even got extra pumps even if they didn't need one because they already had one.
They just got them because they could like some sort of scavenger on one of those Hoarding reality shows.
THAT is the problem with offering something for free. The American consumer just can't handle it. They will abuse it. They will game the rules for no clear personal advantage. Then genuine thieves will start.
Tell Americans something is free and you will gaurantee that it it costs at least twice as much as it needs to.
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Shame implies guilt.
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Re: Another scenario
Then they are very stupid.
Medical riders on car insurance are dirt cheap and allow you to have full control of your treatment. Insurance agents don't like to talk about them because they aren't a money maker. However, they are very effective.
They also tend to be state mandated as they aren't a cash cow.
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Re: Re: ObamaCare
I fully support putting limits on how much is covered by health care. When people have unlimited coverage and no deductibles or co-pays they might get more health care coverage than they actually need, simply because it is free to them. "Massages are covered? Sure, I'll have one every week."
I support breast feeding, but I agree that there's no reason insurance should cover expensive models. In fact, I'd order a bulk of the basic model and tell mothers they can have that for free (with a deposit that can be refunded when they return the pump) or they can pay the extra themselves for something more expensive.
Free Breast Pumps And The Cost Of Health Care : Planet Money : NPR: "Insurers are still trying to figure out whether to pay for extra-fancy breast pumps, or just basic models."
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Re: Re: Another scenario
Medical riders on car insurance are dirt cheap and allow you to have full control of your treatment. Insurance agents don't like to talk about them because they aren't a money maker. However, they are very effective.
I was thinking about a pedestrian. Now I suppose that person could sue the driver, but perhaps the driver is driving without insurance, too. It's been known to happen. Some people drive with suspended licenses, so they probably aren't bothering have mandated car insurance.
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Re: Re: Re: why are the prices absolutely insane.
*grabs Calculator* Divide that $18,000 by about 370,000,000 then divide the result by 30% (0.00004865 divided by .30)and multiply that number (0.00016216) by 370.000,000 *puts calculator*
...the US Federal Government would have spent roughly $60,000 dollars on that procedure under Obamacre if your medical issues had occurred when it was active. That funding could go elsewhere like employment funding. So while the procedure cost you co-pay under normal health insurance policies and laws here before Obamacare set in...If it were set in after Obamacare and you didn't have to pay....that is how much Uncle Sam spends on each person.
*grabs calculator again* 370,000,000 tax payers (estimated by the time Obamacare rolls around in 2014, everyone will be paying the same amount at 30%, business ownerships or not) times $60,000 dollars per person Obamacare pays for....
that is $22,200,000,000.......which happens to be the current Debt Ceiling. At any time we spend more that that value based on the current economic stream....will cause the value of the US Dollar to default and become negative. We would go into bankrupt as Greece and Iceland had done.
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Re:
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http://www.techdirt.com/articles/20130218/21462222020/yet-another-court-says-ip-addresses-a re-not-enough-to-positively-identify-infringers.shtml#c838
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Re: Re: Re: Re: why are the prices absolutely insane.
Most people won't have enough taxable income to see that kind of tax increase so it won't impact everyone the same way. That's an important point.
The health care system was taking an increasing part of our economy pre-Obama care, so doing nothing probably wasn't an option either. He basically took a Republican idea and got it passed.
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Re: It's not just the hospitals and med providers
It isn't a 'capitalism' thing, it's fascism.
The 'American dream' never existed... just ask any Native.
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Re: Re: Re: It's what you get when capitalists control a market...
Without government exerting any control, corporates don't need to go through the step of exercising power over government and skew the market directly. Monopolies and Cartels
Only with government exerting control and skewing the market in favour of the citizenry does an outcome beneficial to the majority occur.
Amazing that laissez faire is so in vogue, laissez faire happened, it was horrible for the vast majority and we changed it because of that.
It was marked by squalor,poverty, disease and a low value on life.
What is truly bizarre is that the same people who want totally free markets where the conditions cannot possibly exist for them to work properly (the real world) because distance is real, access is uneven, choice is limited and people are not wholly rational creatures
go completely against free markets in the one place that comes closest to meeting the criteria for a free market to function - online, where distance is irrelevant, information is available to everyone equally but the people there are of course no more and quite possible less, rational.
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Re: Re: Re: Re: Re: why are the prices absolutely insane.
The is fact that your procedure under normal US health insurance (non-Obamacare)would have cost you roughly $18,000....under Obamacare, the federal government pays $60,000 for that same procedure.
Individuals will not see an increase personally on tehir own until they hear more about how it has an effect on the economy in 2016...by then it would be too late for the US to get out of debt. I cannot predict that but I can tell you one thing...It will cost the US GOVERNMENT 30% more to pay for what you would normally have to if you were insured outside of Obmamcare.
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Re: Re: Re: Re: Re: Re: why are the prices absolutely insane.
Health insurance BEFORE Obamacare wasn't working either. People were dropping out because they couldn't afford the insurance.
My preference would be what other countries are doing that works for them.
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Re: Re: Re: Re: Re: Re: Re: why are the prices absolutely insane.
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US vs The World.
Most of you have universal healthcare. That's fine and dandy :-) I commend you for it. The problem here in the states is that unlike other nations with universal health care, ours under Obamacare is Universal Health Insurance.
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Re: Re: Re: Re: Re: Re: So many discussions we're not having
Die of starvation long before healthcare even becomes an issue.
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Re: Re: Repay in small amounts
"Hello, this is 911, please give medical insurance number or credit card number before we can proceed."
that way we don't have any costs that can't be paid.
just don't be unconscious.
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Re: Re: Re: It's what you get when capitalists control a market...
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Re: Re: It's what you get when *CRONY*-capitalists control a market...
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Re: Re: It's what you get when capitalists control a market...
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Re: Re: It's what you get when *CRONY*-capitalists control a market...
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Re:
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Re:
The problem is that Obama basically said that his new system was universal health care...along the lines of the UK...and that we shouldn't worry about it. It turns out that when you look at it, Obamacare is a Universal Health Insurance Plan...
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Re: ObamaCare
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I believe it
Also, compare that to the lythotripsy I had 10 years earlier at the same hospital with the same doctor for a mere $11,000.
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Another reason why we haven't been able to get cheaper health care
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Re:
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Re: Medical "Vacations"
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Re: Re: Re:
The detail and (technical) knowledge of (the above makes) this comment is exceptional.
Health diagnistics and monitoring is becoming increasingly easily done with everyday devices like your cellphone and the only issues are ones of privacy (stand up for this) its best that we use a home computer rather than a smart(stupid)phone.
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Re: So many discussions we're not having
Your local community property association possibly (likely?) (can I make a more disgusting example of a legal organization? -puke-) prohibits hanging your clothes out, (a wonderful way to save energy costs, prohibits putting up a TV antenna(I mean... really!) because its an eyesore, or painting a cool picture on your garage door (what is free expression anyway?),
We all want to live as long as we can providing functionable feedback to our kids (or (generally) generation). This is a “why we live, kind of, argument”. Do our individual actions mater? (Yeeeessssss!)
I have said this before: “what is the difference between THINKING and THOUGHT? (argue with me.)
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Re: Not a free market? No, Duh!
And. What did the elected officials do? (after they were successfully prosecuted?) Thats right they RE-appointed the same president as before... (I mean REALLY... whats the use when voters are not paying attention.)
my comment on Illinois elected officials and the stupid voters who put them there: http://www.techdirt.com/articles/20130219/10065822029/illinois-politician-seeks-to-outlaw-anonymous- comments-allow-anonymous-gun-ownership.shtml#c631
and http://www.techdirt.com/articles/20130222/18003222079/illinois-bill-to-outlaw-online-anonymity-dropp ed-because-people-got-pissed-off-not-because-its-unconstitutional.shtml#c92
As such the residents of the city in question have to rely on emergency services from neighboring city (who paid up) hospitals with (as long as) 40 minuet travel times.
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Health care
Best Regards,
Stephanie Recchi
DNA.capsule@yahoo.com
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Billing Statement
It's likely the invoice allows for "millions" to accommodate payments from large employers. For example, Boeing employs about 1,700 in Tacoma. If their monthly employee plan premiums range from $600 - $1,000, a realistic range for individual and family plans, their bill would exceed $1.0 million. I'm not saying that's a reasonable amount to pay - but it's realistic and Boeing isn't even Tacoma's largest employer.
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Simple enough - bad goals, bad result.
It's a complete fail in the basic philosophy of it. How badly it fails and in what way isn't even all that relevant unless you discuss how to fix the whole thing - sure you can try to treat the symptom like high bills (lord knows US healthcare is good at going for the symptom over the root illness, too) but if you do that instead of treating the illness you'll kill the patient.
Simply put: universal/single payer can be encapsulated with "High quality care for everyone as affordably as possible, but without penny-pinching it to death."
For-profit care? "Maximum money for every greedy hand in the chain, while producing some sort of care at the lowest attainable cost and quality possible in order to maximize the profit margin."
It's hardly surprising care in America is an ultra-expensive nightmare for a huge percentage of the population. As with everything else in a capitalistic state, a great many need to suffer so that a few can reap sickening profit.
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Re: There are doctors fighting back.
It posits the monstrously false choice between "efficiency" and the modern health care system. Fact: the single most efficient payer in health care is Medicare, running at 4% overhead. Fact: ACA imposes medical loss ratios onto insurance companies and caps them at 20% - a level that is five times higher than 4%, meaning private insurers previously couldn't even hope for anything resembling efficiency and had to be legislated to take efficiency seriously vs. shareholder profit. This fact means that this is not "doctors vs, Obamacare", it's Obamacare vs. making quite as much cash off sick people.
The article also posits the inhumane notion that sick people should be negotiating anything. This is a common position of people for whom no expense is to be spared and no financial distractions appear when they become sick. We call these people billionaires. We call the myopic who echo their worldview libertarians.
It falsely claims ACA drives people outside the regular market to find alternatives when what ACA does is create health insurance exchanges in the regular market that did not exist outside or inside it.
It goes on like that. Like Reason tends to do. Libertarian economics is nothing more than anarchy for rich people.
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I have an idea
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Re: Re: It's what you get when capitalists control a market...
See http://en.wikipedia.org/wiki/Certificate_of_need
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Re: The article doesn't take it far enough.
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Re:
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clear picture health care or any service
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Scam is right!
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Scam scam all world scammer
DR now , their all evil , they wish you died health for your
fresh organs to other need & DR money make more big money ........
take care eat health you don't need DR
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Re:
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High Medical costs
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Re: Re: It's what you get when *CRONY*-capitalists control a market...
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Re: Re: It's what you get when *CRONY*-capitalists control a market...
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Re: Re: Re: It's what you get when *CRONY*-capitalists control a market...
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Duplicate comment
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Re: Re: Re: Re: Re: Re: It's what you get when capitalists control a market...
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It’s still bad
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Medical tyranny
Cost is most certainly a huge issue with "healthcare". The cost is seen in other ways as well. If pharma cannot patent a treatment it is NOT likely to get done. Look how they've lobbied against medicinal cannabis. They try and limit the public's choice of treatment so they can make more money. So people are made to suffer for profit. Think stem cell therapy. They know they can't compete and seek to deny the public the choice. Those people and the ones who've aided and abetted them ought to be brought up for prosecution and put in a cage. Absolutely disgusting!
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Just wondering here, if it would help to build an app where people could compare base prices between hospitals, in order to make a informed choice on which hospitals provides good care for a reasonable price. Would you use such an app?
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