Healthcare Costs Bullshit

[crb]

So I was up in my attic doing some work and I stood up too much and cut my head on a nail. Decided to go get a tetanus shot.

I have insurance of course, I'm not stupid, I buy it myself for $50 a month (technically $92 bi-monthly).

But I got my bill, check this shit out.

1. Office visit: $225
2. Tetanus & Diphtheria: $30
3. Immunization Administration: $28
4. Services provided in the room (kinky): $30

grand total for my 15 minute visit (most of which was waiting): $313

I was taken to the room by an MA. The MA took my bloodpressure and why I was there. Eventually a doctor came in for 30 seconds and checked my head, said I should put antibiotics on it (told her I already did) and insisted on doing a quick neuro check since I hit my head(whatever, my wife practices those on me all the time). MA came back in, did the shot. I left.

Take in the participating provider savings, then apply my copay, and I owe $25. If I had had no insurance I'd be on the hook for $313, most of which is because I'd be without the participating provider savings which was over $200.

The cost of Lasik surgery, which has providers compete on price and which patients by themselvs, has been cut in half or more in the last 10 years. The cost of other non-elective medical procedures has only risen, probably doubled or more, in the same time.

When healthcare consumers are not healthcare purchasers there is no incentive for providers to compete on price, or even advertise prices. Prices become irrelevant to the consumer, and if the consumer does not care about price, why should a business do anything other than raise prices?

I didn't need the neurocheck which I bet is the $30 in room fee. I sure as shit didn't even need the doctor to come into the room for all the good she did. I needed the shot, that is it. But the doctor comes into the room and does the check because I have insurance and they know they can bill for it, and they don't even ask me if I want it or not. (there is also an aspect of defensive medicine there, they have to cover their ass in case of a lawsuit and so they needed the doctor to review the MA's history.)

Our healthcare system will never be cost efficient until people have control of their own healthcare spending, until you walk into a doctor's office and see a price list. Until a doctor is required to ask your permission before performing any service they can bill for (and tell you how much it'll be).

Until then, we'll continue spending more per capita than anyone else for what is great (but inefficient) service where people with insurance are over provided for and people without insurance have higher than necessary bills and are under provided for (because the people with insurance have taken too large a share of the resources.)

ps... I actually pay squat. Because I have a brilliant HSA that $25 is deductable against my taxes, so in the end, I pay squat. I just wish I could deduct my insurance premiums.

[radamanthys]

Insurance is a form ofvoluntary socialized healthcare, in essence.

This whole medical expense fiasco can be boiled down to one clear fact: the industry is not within the confines of the free market, and is thus more expensive than it needs to be.

Regardless if the government subsidizes it, we still end up paying for it. Governmental subsidies <> free money.

[Tsa`ah]

But I got my bill, check this shit out.

1. Office visit: $225
2. Tetanus & Diphtheria: $30
3. Immunization Administration: $28
4. Services provided in the room (kinky): $30

grand total for my 15 minute visit (most of which was waiting): $313

I was taken to the room by an MA. The MA took my bloodpressure and why I was there. Eventually a doctor came in for 30 seconds and checked my head, said I should put antibiotics on it (told her I already did) and insisted on doing a quick neuro check since I hit my head(whatever, my wife practices those on me all the time). MA came back in, did the shot. I left.

Take in the participating provider savings, then apply my copay, and I owe $25. If I had had no insurance I'd be on the hook for $313, most of which is because I'd be without the participating provider savings which was over $200.

Chances are pretty good that those are the negotiated fees.


The cost of Lasik surgery, which has providers compete on price and which patients by themselvs, has been cut in half or more in the last 10 years. The cost of other non-elective medical procedures has only risen, probably doubled or more, in the same time.

No, the cost of lasiks has dropped because the technology has become cheaper. It really has nothing to do with competition.

I don't care to quote and respond to the rest of your post simply because notion of a la carte system of medicine is ridiculous. You're advocating consumer controlled treatment ... taking the method of care out of the doctor's hands and placing it into the patient's hands ... patients that have no clue what systolic/diastolic means.

You also assert that competition between practitioners would drive down costs. Possibly, but not likely ... hell, not even a chance. Aside from that, such a system would create huge disparities in care. The poor are limited to bargain basement healthcare while those that can afford insurance, or any medical bill thrown their way, get access to the best .... and the best don't have to deal with the poor.

Rising healthcare costs are driven a few factors. Mortality, technology, increased cost of training/education, malpractice claims.

Of all those listed, mortality is the biggest. The older you are, the more expensive and numerous your healthcare needs. People are living longer .... through medicine.

Competition has nothing to do with it, nor will it improve anything.

[crb]

Spoken like a true communist.

"Competition does not bring around lower prices and higher quality. Only government monopolies can do that."

Why don't you just up and move to Cuba or something?

[ElanthianSiren]

Spoken like a true communist.

"Competition does not bring around lower prices and higher quality. Only government monopolies can do that."

Why don't you just up and move to Cuba or something?

Competition would bring about lower prices and better care for those who need it least, I believe was the point. When you weigh that against however million americans are without insurance and/or are underinsured, the "communists" are generally going to side with making certain that individuals who need the care most, (and who drive up medical costs in this country by seeking emergency care rather than preventative care), get necessary coverage.

You are actually talking about two care models in any health care debate: accute versus chronic. Hitting your head on a nail is "oops I screwed up" accute care. Making sure somebody can get the kidney tests they need to make sure they're not burdening the state with dialysis costs because they had no access to kidney tests and have presented with kidney failure is chronic care. Such issues, if caught early, can often be allieviated by preventative measures in the initial disease states, such as taking ace inhibitors to help kidney function along.

The current system and the system you propose heavily favor those who need accute care while conveniently forgetting those who need chronic care.

[Stanley Burrell]

I have insurance of course, I'm not stupid

No, of course not. You simply "stand up too much" and become the Phineas Gage of errant nails in your attic's iron maiden.

[Warriorbird]

If you don't believe that it is possible for an industry as a whole to artificially drive prices up then you are VERY naive and likely should not be allowed out onto the Internet.

[grenthor]

As someone who has worked in the healthcare field for many years - I firmly believe there are 2 specific problems that are driving up the costs of Healthcare.

First and foremost is Insurance is messed up. Look at the costs and this statement in particular:
"If I had had no insurance I'd be on the hook for $313, most of which is because I'd be without the participating provider savings which was over $200."

That total dollar amount comes around due to the way the system works. Insurance company B comes in and negotiates a contract. Since they have so many patients they negotiate a volume discount of maybe 40% of whatever your normal charge is. Well, the provider knows they can't really get by on just 40% of thier normal charge, so they raise thier price to offset that cost. So now thier normal $100 charge is raised to $200 so that they can at least get $80.00 from that 40% contract.

Where this screws everyone over though is the Uninsured patient. If a provider charges a patient the old $100.00, that becomes thier Usual & Customary. Not to mention that most insurance companies have a "Best Price" clause stating that you can't charge anyone less than them.

This doesn't even go into how much it actually costs to bill an insurance company, go through all the hoops, carry the cost for sometimes 6 months or more before they even pay the claim, etc etc etc.
Or the record keeping that's required - keeping hard copies of all files for up to 10 years or more. All indexed, accessible and cross-referenced.

The second big problem is lawsuits and the cost they bring. People are less and less willing to accept the fact that sometimes medicine isn't perfect. And they get vindictive and start viewing any slight as a Lotto style payout. That's not to say that there aren't genuine fuckups, but the overwhelming majority are greedy people who aren't willing to take responsibility for themselves or accept that some accident doesn't actually warrant a 10 million dollar settlement.

This is so pervasive an issue, I don't think any of us realize just how much it's screwed up our system.

The scenario outlined in the first post is riddled with it. The neuro check, the PA check, the doctors check. Don't forget that all those records have to be checked over and saved "just in case". The costs certainly include the overhead for the doctors insurance, the offices insurance and so on. The cost of the shot include the serum makers insurance costs, the needle makers insurance costs and everyone else who touched it. Because remember, if something goes wrong ALL of them are potentially on the line for millions if not tens of millions of dollars no matter how miniscule the problem turns out to be.

If someone can get a handle on those two issues the system can work. As it stands now though and with the culture of litigation in our society I seriously doubt they ever can be fixed.

[Sean of the Thread]

I gave up on my credit after the 80,000 or so I got billed for having meningitis and a two week stay in ICU. Best part was my insurance had just been canceled like a few weeks or week prior by my employer.

They were nice however and passed around a collection hat and garned about $113 bucks for me.

Cock suckers.

[Ravenstorm]

The current system and the system you propose heavily favor those who need accute care while conveniently forgetting those who need chronic care.

Not forgetting. Dismissing. There's a huge difference.

[Tsa`ah]

Spoken like a true communist.

"Competition does not bring around lower prices and higher quality. Only government monopolies can do that."

Why don't you just up and move to Cuba or something?

Nice.

Not only are you incapable of defending your premise, you show a complete lack of ability to debate the issue.

When in doubt, call someone a communist (even though I never suggested that all possessions be considered property of the state), make up a quote ... and suggest they move out of the country.

How very patriotic of you.

While it has been a close race for the "biggest dumbass on the PC" ... keep it up and you'll be the shoe-in candidate for 09'.

[Parkbandit]

make up a quote ...



:rofl: @ you. Look at your signature dumbfuck and tell me how you could EVER complain about anyone "making up a quote"



While it has been a close race for the "biggest dumbass on the PC" ... keep it up and you'll be the shoe-in candidate for 09'.

crb is very unlikely to take your title. He would be the Ralph Nader in that election next to you. The space you reserve on your mantle every year is well deserved.

http://i102.photobucket.com/albums/m85/snowkats/dumbass_award.jpg

[crb]

Nice.

Not only are you incapable of defending your premise, you show a complete lack of ability to debate the issue.

When in doubt, call someone a communist (even though I never suggested that all possessions be considered property of the state), make up a quote ... and suggest they move out of the country.

How very patriotic of you.

While it has been a close race for the "biggest dumbass on the PC" ... keep it up and you'll be the shoe-in candidate for 09'.
Hey Comrade, when some douche (thats you) comes in and says competition between providers will not lower prices, there isn't really much of a response I can make, it is like someone saying the sky is green, you just gotta write them off as mentally deficient..

Competition lowers prices in every field in which it is introduced.

Now you, like the idiot douche you are, claim that LASIK costs went down because the technology got better and cheaper. Well genius, why did the technology get better and cheaper? Competition! Procedures not typically covered by insurance (Lasik sometimes is if you can believe that, public school teachers in Michigan have it covered) are paid for out of pocket by the patient, so the patient will shop around just like if they were buying a car. Providers, to attract patients, recognize this and advertise their prices, then they get into pricing wars. To get an edge in pricing wars, providers will shop around for the technology that allows them to get a pricing edge against their competitors, knowing that the providers care about technology price (both initial costs, and cost to run/ownership/maintenance), medical equipment manufacturers then will start trying to get their prices lower as well.

On the flip side, providers can also advertise quality differences, the competition on quality results in them also looking for machines that produce better results, and so the equipment manufacturers have incentives to produce them.

Compare that to a situation where a provider knows what they charge has nothing to do with how many patients they have. So they charge however much they want, and since they charge however much they want, they don't really care that much about shopping around for good deals on equipment, because in the end all those costs just get passed along so they don't put any major effort into it. So the equipment manufacturers have less of an incentive to offer lower prices, etc.

And competition helps everyone in all circumstances, you think that people would only shop around for acute care? Actually, when you have an emergency you really don't have time to shop around. It is for the very chronic care you worry about that people would shop around the most for.

Furthermore, why do you think some people are uninsured? Choice? Roll of the dice? Or because insurance can be expensive for employers to provide? You don't think that lowering healthcare costs would result in more employers providing health insurance, or more people buying their own? You don't think making something cheaper will let more people afford to buy it? Hrmm... Really?

Your whole socialist attitude is summed up by this point:



Aside from that, such a system would create huge disparities in care. The poor are limited to bargain basement healthcare while those that can afford insurance, or any medical bill thrown their way, get access to the best .... and the best don't have to deal with the poor.

You don't have a problem with people not getting medical care, what your problem is that you can't stand that some people may get better care than others. You would still be as raving a crazy mouth foaming socialist if everyone in the country, including illegal immigrants, got free adequate care, so long as rich people out there got paid-for superior care. It seems to me you'd rather everyone be equally miserable than to have there be differences. So yes, move to Cuba, or hey North Korea, if you want equal misery you can't do much worse than North Korea.

Competition, in any industry, results in better and cheaper products and services. Medicine is no different.

[Tsa`ah]

Hey Comrade, when some douche (thats you) comes in and says competition between providers will not lower prices, there isn't really much of a response I can make, it is like someone saying the sky is green, you just gotta write them off as mentally deficient..

Oye ... you could point out instances in medicine where a free market has resulted in lower costs. Except, none exist.

The cost of chiropractics hasn't gone down. Cosmetic surgery in all the various fields, optometry ... you name it, the free market hasn't reduced costs.

Well to be fair, there has been a price reduction, but in the same breath there's a floor. Services priced at floor level are generally services you wouldn't want but exist because there's a demand from the lower middle class and working poor.


Competition lowers prices in every field in which it is introduced.

You do realize Nixon deregulated medicine to the extent that for-profit entities could compete. Yes ... your free market. Guess what didn't happen?


Now you, like the idiot douche you are, claim that LASIK costs went down because the technology got better and cheaper. Well genius, why did the technology get better and cheaper? Competition! Procedures not typically covered by insurance (Lasik sometimes is if you can believe that, public school teachers in Michigan have it covered) are paid for out of pocket by the patient, so the patient will shop around just like if they were buying a car. Providers, to attract patients, recognize this and advertise their prices, then they get into pricing wars. To get an edge in pricing wars, providers will shop around for the technology that allows them to get a pricing edge against their competitors, knowing that the providers care about technology price (both initial costs, and cost to run/ownership/maintenance), medical equipment manufacturers then will start trying to get their prices lower as well.

The reality is that lasik procedures never got cheaper. Sure, you can find some place with a newspaper coupon that offers 200 bucks an eye. Unfortunately the coupon neglects to inform the consumer about all of the costs and fees added on to the end bill. One can also find a bargain basement operation with old equipment, poorly trained personnel, and out of date procedures for a pretty low price ... for a reason.

You're not walking into a clinic where the staff and physician (if one exists) have the latest technology, training in the latest techniques, with the latest follow up program for cheap.

Just like you're not walking into a box brand optometrists clinic and getting two pair of eye glasses for a hundred bucks.


On the flip side, providers can also advertise quality differences, the competition on quality results in them also looking for machines that produce better results, and so the equipment manufacturers have incentives to produce them.

The problem with this is simply that you're under the assumption that lasiks became cheaper through competition and as such, so can everything else. You can advertise quality ... you can advertise results.

Both can be manipulated, both are subjective, and neither are definable in medicine.


Compare that to a situation where a provider knows what they charge has nothing to do with how many patients they have. So they charge however much they want, and since they charge however much they want, they don't really care that much about shopping around for good deals on equipment, because in the end all those costs just get passed along so they don't put any major effort into it. So the equipment manufacturers have less of an incentive to offer lower prices, etc.

I don't know about you, but I don't want my physician using Wal-Mart equipment. When I have to go to the ER, I expect (and know) that they're using the best equipment (because the field is so highly competitive). I know that the CT isn't some piece of shit made in China to save cost. I know that the MRI isn't some refurb purchased on e-bay. I know the X-Ray isn't some relic from the Korean War.

You suggest that competition brings out better quality, both in the practitioners and the manufacturers ... yet look at GM, Ford, Chrysler. None have produced a single vehicle (with a few minor exceptions) that can compete with non-domestic offerings.


And competition helps everyone in all circumstances, you think that people would only shop around for acute care? Actually, when you have an emergency you really don't have time to shop around. It is for the very chronic care you worry about that people would shop around the most for.

Not the Denny's there, let's go to the good Denny's on the other side of town.

Competition in medicine, as stated, will only benefit those that can already afford it.

Care on one end of the spectrum because a revolving door of "get em in, get em out" as cheaply as possible of Wal-Care. The other end of the spectrum just expands the Mayo Clinic.


Furthermore, why do you think some people are uninsured? Choice? Roll of the dice? Or because insurance can be expensive for employers to provide? You don't think that lowering healthcare costs would result in more employers providing health insurance, or more people buying their own? You don't think making something cheaper will let more people afford to buy it? Hrmm... Really?

Insurance is part of the problem. See Nixon.


Your whole socialist attitude is summed up by this point:

It's my socialist attitude?

Let's have it your way then. Do away with public transportation ... put it on the free market ... it'll get cheaper.

Do away with the current road system ... after all, free market and competition makes everything cheaper ... right?

No longer will we use tax dollars for the police or fire departments. It's privatized now.

911? Only if you subscribe bitch.

Let's not stop there. Our military? It's now a mercenary army.

Oh, the Canadians have invaded MI? Sure, we can help ... got 40 billion in small bills?


You don't have a problem with people not getting medical care, what your problem is that you can't stand that some people may get better care than others.

No, I've got a problem with both ... and it already happens.

I'm not even going to respond to the rest of your bullshit, it's not worth my effort.

In closing though, you have to make up your mind. Am I a communist or am I a socialist?