Ways to decrease healthcare costs...

[Parkbandit]

Kid went in for a simple blood test... ended up getting a full physical, urine test, etc....

The kicker was when we were leaving, the nurse wanted to know what day was best for us to come back so we could get the blood test results.

I bet he billed out $500+ for something that should have cost the insurance company $50.

[Kembal]

Ask them to fax the blood test results to you first. I always do that and then see the doctor if there's anything to be concerned about.

[Parkbandit]

Ask them to fax the blood test results to you first. I always do that and then see the doctor if there's anything to be concerned about.

Yea.. my wife said she will call for the results.

Here's a way to lower healthcare costs: Provide each patient with an itemized bill at the end of your visit like any other service provider does. Show what part was covered by your co-pay and what was covered by your health insurance.

[Meos]

Doctors office should have a menu..

I heard a good one the other day... Co-worker of mine had a kid couple weeks ago. While his wife was going into labor, the doctors asked if they minded if med students observed the birth. They didn't mind at all.

They get the bill from the hospital a week or so later.. It cost them 250 dollars to let the med students watch the delivery.

I would have gone absolutely bananas. My point being.. If you know how much things will cost before you buy them.. We'd probably spend about a 1/3 as much at the doctor (made up statistic, but you get my point).

Fuckin med students should have paid them to watch his child be born. That's a hot ticket if it was my kid.

[diethx]

I hope your co-worker fought that charge. What garbage.

[Back]

Ways to decrease healthcare costs...

Don’t get sick. Don’t get hurt. Don’t claim anyone as a responsibility who could get sick or hurt.

[Alrisaren]

They get the bill from the hospital a week or so later.. It cost them 250 dollars to let the med students watch the delivery.

I find that hard to believe. Med students pay to be there and really offer nothing in terms of care. If I were your friend, I'd fight the charge.

[Tgo01]

Ways to decrease healthcare costs...

Don’t get sick. Don’t get hurt. Don’t claim anyone as a responsibility who could get sick or hurt.

You're doing it wrong. It's don't get sick and if you do get sick die quickly.

[Kembal]

Yea.. my wife said she will call for the results.

Here's a way to lower healthcare costs: Provide each patient with an itemized bill at the end of your visit like any other service provider does. Show what part was covered by your co-pay and what was covered by your health insurance.

Heh, healthcare billing is ridiculously inefficient. It usually takes a couple of weeks to file the claim, and then the insurance company takes a week or two to process it, and the healthcare provider takes another couple of weeks to mail the final statement. And, of course, you want to match that up with the insurance company's explanation of benefits, so gotta wait for that too.

I'm just starting to get final bills this month for my son's birth back at the beginning of May. It's even worse in Texas, since doctors are generally barred by law from being employees of a hospital...so all their charges come separately from the hospital charges. I have at least 10 different bills to pay due to this, if not more.

If they'd straighten out these procedures and make the whole thing electronic, I'd imagine everyone could reduce their costs quite a bit and make what you're asking for possible. (and I agree, it'd be much simpler!)

[Warriorbird]

The free market helps our healthcare system be inexpensive, efficient, and help everybody!

[AnticorRifling]

Lower the rates for the insurance the Dr has to carry so they don't have to raise costs to cover it. Clearly define what can and can't be sued over. Find a way to get every health care facility to accept all valid insurances so people have a choice where they can go instead of being pigeon holed into care they don't like but must use because their policy clearly knows who gives the most applicable care...

[Gan]

ZOMG Tort Reform!

[Parkbandit]

Lower the rates for the insurance the Dr has to carry so they don't have to raise costs to cover it. Clearly define what can and can't be sued over. Find a way to get every health care facility to accept all valid insurances so people have a choice where they can go instead of being pigeon holed into care they don't like but must use because their policy clearly knows who gives the most applicable care...

Tort Reform?

You must be a racist.

[AnticorRifling]

I don't know what dessert has to do with this....oh that's torte.

[Warriorbird]

Except the states with the strongest degree of medical tort reform have experienced no rate reductions. Voluntarily looking for cost reductions is the sort of altruistic expectation you'd laugh at liberals for having.

[Parkbandit]

Except the states with the strongest degree of medical tort reform have experienced no rate reductions. Voluntarily looking for cost reductions is the sort of altruistic expectation you'd laugh at liberals for having.

Who is asking for voluntary cost reductions? I laugh at liberals like you for creating positions for other people where they do not exist.

[Warriorbird]

Who is asking for voluntary cost reductions? I laugh at liberals like you for creating positions for other people where they do not exist.

"Tort reform will reduce costs!" "It doesn't." "Nobody's asking for reduced costs!"

Or were you seriously happy to be charged that much? Because it looked like you were blaming the doctor and then people started going "TORT REFORM!" which is silly.

Two instances of bemoaning the free market in one thread. It's like its not good at solving the problem or something.

[Parkbandit]

"Tort reform will reduce costs!" "It doesn't." "Nobody's asking for reduced costs!"

Ah, it's a reading comprehension problem.

Clue #1: Any tort reform would not be voluntary. It would take government regulation.

Also, do you have any unbiased case studies that conclude that tort reform on a federal scale will not reduce the cost of healthcare?

[RichardCranium]

Tort Reform?

You must be a racist.

If the PC has taught me anything, it's that everyone in Indiana is racist.

[Warriorbird]

Ah, it's a reading comprehension problem.

Clue #1: Any tort reform would not be voluntary. It would take government regulation.

Also, do you have any unbiased case studies that conclude that tort reform on a federal scale will not reduce the cost of healthcare?

Here's some Google work for you. Torts make up about 1.5% of total healthcare costs. Tort claim totals have not increased or decreased since the 1980s.

Why exactly would "tort reform" be an issue?

Lousiana, Republican as the day is long, has not experienced any reduction in insurance costs due to extremely extensive tort reform. They've experienced just the opposite.

Wacky footnote:

http://en.wikipedia.org/wiki/BMW_v._Gore

[Gan]

If the PC has taught me anything, it's that everyone in Indiana is racist.
And Texas

[Cephalopod]

And Texas

But there are no cock and ball ponds in Texas.

[Gan]

Staying away from that one.

[Warriorbird]

And Texas

Texas has some of the most restrictive tort reform laws in the entire country. You also have some of the highest healthcare costs, primarily due to physician self-referral.

[AnticorRifling]

You're factoring out the CYA cost of AVOIDING having to go down a legal path. I don't think you can clearly quantify tort as it applies to a medical environment unless you factor in some of the costs associated with the myriad of checks and balances in place to avoid such avenues. Do they provide benefit to the patient? Yes. Do they come at a huge, huge cost because of fear of reprocussion should there be an error? Yes.

[Warriorbird]

You're factoring out the CYA cost of AVOIDING having to go down a legal path. I don't think you can clearly quantify tort as it applies to a medical environment unless you factor in some of the costs associated with the myriad of checks and balances in place to avoid such avenues. Do they provide benefit to the patient? Yes. Do they come at a huge, huge cost because of fear of reprocussion should there be an error? Yes.

http://www.pbs.org/wgbh/pages/frontline/shows/architect/texas/tort.html

The actual upshot is Republicans get elected. Costs in Texas haven't dropped at all. With the deregulation of physician self referral they actually skyrocketed.

[Parkbandit]

Here's some Google work for you. Torts make up about 1.5% of total healthcare costs. Tort claim totals have not increased or decreased since the 1980s.

Why exactly would "tort reform" be an issue?

Lousiana, Republican as the day is long, has not experienced any reduction in insurance costs due to extremely extensive tort reform. They've experienced just the opposite.

Wacky footnote:

http://en.wikipedia.org/wiki/BMW_v._Gore

Good to see you decided not to pursue the "voluntary cost reduction" silliness you initially attempted.

Tort claims is very small percentage of the actual cost that could be reduced with meaningful tort reform. You lower the insurance every doctor has to carry and all the defensive medicine they are now forced to do.. and you will see that number run upwards of 10-12%.

[Kembal]

Good to see you decided not to pursue the "voluntary cost reduction" silliness you initially attempted.

Tort claims is very small percentage of the actual cost that could be reduced with meaningful tort reform. You lower the insurance every doctor has to carry and all the defensive medicine they are now forced to do.. and you will see that number run upwards of 10-12%.

I doubt that. Texas has pretty strict tort reform and healthcare costs haven't reduced at all.

[Latrinsorm]

It seems like the theory is that doctors practice defensive medicine to keep from being sued. That makes sense. It also seems like the theory is that if doctors are less likely to be sued (aka tort reform), they will no longer practice defensive medicine. Why? What do they stand to gain?

[crb]

Here's some Google work for you. Torts make up about 1.5% of total healthcare costs. Tort claim totals have not increased or decreased since the 1980s.

Why exactly would "tort reform" be an issue?

Lousiana, Republican as the day is long, has not experienced any reduction in insurance costs due to extremely extensive tort reform. They've experienced just the opposite.

Wacky footnote:

http://en.wikipedia.org/wiki/BMW_v._Gore


Healthcare is approaching 20% of GDP, which is about 3 trillion dollars. It isn't there yet, it'll be there soon.

1.5% of that is 45 billion dollars a year.

Removing the bush tax cuts on the "wealthy", WHICH IS A VERY BIG DEAL TO LIBERALS, which they expend more oxygen yelling about than any other issue, would be 70 billion a year, and that is static accounting. Dynamic accounting would put the gain at less.

So, even if we assume that your number on what tort costs actually are is correct (and of course, it doesn't factor in the practice of defense medicine, which is significant, and so the number is actually incorrect), it is still 45 billion a year, which is kinda a big deal. I wouldn't piss on that. How many poor orphans could be given oatmeal for 45 billion dollars?

[crb]

Here is why healthcare is expensive:

The purchaser of services is not the consumer of services. And when the consumption of services takes place there is no price disclosure.

I was working in the attic and stood up and bumped my head on a nail, it barely punctured the skin, only it was a rusty nail, it was a Sunday evening so I went to a local urgent care just to get a tetanus shot. I drove there, waited, read, was obviously okay. They gave my shot but the doctor did a 30 second neuromotor check. Maybe it is protocol for anything involving the head, maybe she was worried for that one in a million chance where I had a brain injury, she didn't check, and she would be sued (defensive medicine), or maybe she just wanted to do something quick and easy to pad the bill.

In anycase, that was another $75 bucks or whatever, not bad for 30 seconds of work. If a doctor was forced to get my okay prior to doing a procedure like that (she just walked in and went right into it), and disclose the cost, I would have said no (as would most people). But they don't do that.

For the birth of our first child my wife got some ibuprofen from the hospital afterwards, I asked for an itemized bill. It was $20 a pill. For the birth of our second child, we brought our own. If they had had to disclose that they charge $20 a pill for ibuprofen, we could have said no.

Mini clinics, in riteaids or whatever, are trying to change things. But they're disrupters, and they face regulatory and legal obstacles mostly put up by liberals defending the status quo and the various special interest stake holders who donate to campaigns. Some conservatives too, but mostly from "progressives" who like to prevent progress because they have a "I know best" attitude. But these are places where they have a menu, they have prices, and you can get quick and easy routine or preventative services.

The fact is, the only field of medicine without runaway inflation, where there has in fact been decreases in the costs of services, is cosmetic surgery, laser eye surgery, cosmetic dentistry, etc.

Why? Because people pay for it out of pocket, so they shop around on price. Providers compete on price, and every stake holder in the industry has the incentive to provide value.

If you want to control or reduce healthcare costs we need the purchaser of healthcare to be the consumer of it. That means destroying the employer provided healthcare system (which is merely a substitute for wages), and encouraging the adoption of HSA type health spending accounts (through tax incentives). That, and for all the regulations in the healthcare industry, a price disclosure regulation is sorely missing.

When people start shopping around on price for MRIs, hip surgery, and all other non-emergent care, the rate of medical inflation will slow.

[TheEschaton]

The idea that doctors would "voluntarily lower their prices" just because they would have less insurance to purchase is the faulty premise. CRB lauds the idea of shopping around, like they do in cosmetic, dental and, most importantly, non-essential medicine, and says it could help the medical costs of the industry as a whole.

The problem is, 1) the price isn't gonna come down because the insurance rates go down. If the doctors are good capitalists, they'll keep their price the same as long as demand is similar. This came when the medical field became less about caregiving and more about turning a buck. 2) Demand will always be there, because medical care is ALWAYS required in situations. 3) Unlike cosmetic surgery, for illness, people aren't going to shop around much. They'll follow the regular cachement of neighborhood clinics and so on, and so forth.

[~Rocktar~]

The idea that doctors would "voluntarily lower their prices" just because they would have less insurance to purchase is the faulty premise.

At what point did anyone mention the price would go down voluntarily? You make a flawed assumption here, market pricing deflation is not voluntary, it is driven by economic forces out side of the seller's control in most cases. Price competition is driven by one provider's desire or ability to increase market share at the expense of profit per transaction or buyer value perception. Only the value perception is somewhat in the seller's control and that is the basis of all consumer advertizing. The moment that one provider of what is generally considered equitably similar products lowers the price and can maintain the lower price at an acceptable profit, then that becomes the new price for the product. The only way price stability is maintained is due to consumer ignorance of price, no substantial return to the consumer for spending the time to price shop and outside price support. All of these are direct symptoms of the current system.



CRB lauds the idea of shopping around, like they do in cosmetic, dental and, most importantly, non-essential medicine, and says it could help the medical costs of the industry as a whole.

The problem is, 1) the price isn't gonna come down because the insurance rates go down. If the doctors are good capitalists, they'll keep their price the same as long as demand is similar. This came when the medical field became less about caregiving and more about turning a buck.

Addressed above though your root cause analysis is deeply flawed and greatly skewed by your completely unrealistic perception of the issue.


2) Demand will always be there, because medical care is ALWAYS required in situations. 3) Unlike cosmetic surgery, for illness, people aren't going to shop around much. They'll follow the regular cachement of neighborhood clinics and so on, and so forth.

History has shown this assumption to be as deeply flawed as the rest of your statements. Yes, emergency medical care will always be needed and very few people will shop around for who can set a broken leg or stitch a cut cheaper unless they do it ahead of time, that is true. However, traditionally, people have indeed shopped for medical care when they must pay for the cost of it out of pocket and they will indeed shop around for cost and value. Just look at the advertizing that goes into selling basic eye care and corrective vision implements or in basic dentistry to confirm that people will indeed price shop. Both industries are very necessary but non-emergency medical care and both are much lower in cost that other services that require the same level of education, investment in practice and in delivery of service. Why you may ask? Because of competition and the fact that most consumers are used to paying a much much larger percentage of out of pocket expense for glasses, eye exams, contacts, cleanings and so on than other insured care.

This same trend is seen in personal physicians, children's clinic services and chiropractic care, nutrition, podiatry and all manner of non-emergency health care. The fact is, unless bleeding or dying, when the consumer must pay a significant out of pocket expense and there by has a significant stake in the cost and value of the care, they shop for the best price/value proposition. Market forces at work drive higher quality, lower price and better value and have always been the only thing that will.

[TheEschaton]

I specifically mentioned illness, not corrective eye care, which is, believe it or not, under the category of cosmetic unless you're talking cataracts and astigmatisms. And even then, you usually stick with the specialist your GP recommended. Do you have any sort of proof of your statement that people'll shop for procedures like that (non-emergency, cosmetic-yet-quality-of-life-improving)?

[~Rocktar~]

I specifically mentioned illness, not corrective eye care, which is, believe it or not, under the category of cosmetic unless you're talking cataracts and astigmatisms. And even then, you usually stick with the specialist your GP recommended. Do you have any sort of proof of your statement that people'll shop for procedures like that (non-emergency, cosmetic-yet-quality-of-life-improving)?

And I called your distraction by specifically addressing non-emergency medical care of all types and illness may or may not be an emergency. Prove that my assertions are false. Advertising exists because there is little difference in product in an attempt to build a value proposition and draw a sale. Advertising in all forms of health care for basic medical needs has appeared in areas where people have a substantial personal stake in the cost. By the way, non-emergency does not necessarily mean cosmetic in nature.

[TheEschaton]

And that's why I asked for proof of that, because it's an interesting statement which, on its face, is not obviously true. You made the statement - you prove it true. That's how a debate works:

1) I make a statement that seems logical.
2) You provide a statement which contradicts mine, and, on its face, isn't apparent (IE, might be illogical or, in this case, an expenditure of more time and money, which, psycho-socially, is less likely).
3) You provide proof for your statement, which shows my statement to be false.
4) I alter my position.

However, until you provide proof, you're just saying shit, and my statement is the one which makes sense from a sociological position.

For example, if I said "all bananas are yellow," based on the fact that I've only ever seen yellow bananas, that would be a logical (if not necessarily true) conclusion. You could then say "Not all bananas are yellow" and then show me a purple banana. But until you provide the different colored banana, your statement is the illogical one in the debate, because every banana previously seen is yellow.

Now, let's try an actual debate. I made that statement that when seeking medical treatment, people will go to the most convenient location to get that service (convenience being based on proximity and availability of the service). This is a logical statement based on free clinics, emergency care, basic human behavior, etc, which you've already conceded are situations where people don't shop around.

Second, you made the statement that people will shop around for certain medical procedures, which are not cosmetic.

Third...you have to provide proof of that, because it is, on its face, not readily able to be seen as true.

Fourth....well, we'll get there.

[~Rocktar~]

And that's why I asked for proof of that, because it's an interesting statement which, on its face, is not obviously true. You made the statement - you prove it true. That's how a debate works:

Has never worked that way for you before, why should I be held to a higher standard than you hold yourself?


1) I make a statement that seems logical.

The Earth "seems" flat. What's your point?


2) You provide a statement which contradicts mine, and, on its face, isn't apparent (IE, might be illogical or, in this case, an expenditure of more time and money, which, psycho-socially, is less likely).
3) You provide proof for your statement, which shows my statement to be false.

There is no such proof for you since you are, in your own mind, infallible and cannot therefore be wrong.


4) I alter my position.

Never happens, see above.


However, until you provide proof, you're just saying shit, and my statement is the one which makes sense from a sociological position.

You always "just saying shit" and provide no basis in reality for it. I want you to back your statement with facts and obviously you can't because it is your opinion no matter how much you wish it were otherwise. I provide several known examples supporting my assertion and you have already discarded them thereby debate cannot take place as you fail to acknowledge any possible position other than your own.

In addition, my statement makes perfect and rational sense based on the perspective of sales, marketing and the real world of business, all areas you either have little or no foundation in. It is easily understandable why you cannot fathom the rationality of my statement because it is based in reality and not some ideological fantasy land of your own creation.



Now, let's try an actual debate.

You can't because you cannot comprehend any point of view or assertion that might differ from yours.


I made that statement that when seeking medical treatment, people will go to the most convenient location to get that service (convenience being based on proximity and availability of the service). This is a logical statement based on free clinics, emergency care, basic human behavior, etc, which you've already conceded are situations where people don't shop around.

Second, you made the statement that people will shop around for certain medical procedures, which are not cosmetic.

Third...you have to provide proof of that, because it is, on its face, not readily able to be seen as true.

Fourth....well, we'll get there.

Again, the only reason you do not readily see it as true is because of your skewed sensibilities and lack of foundation in reality. Using the legal measure of rationality, the so called "normal man" hypothesis, it is perfectly rational to assert that a normal person, when confronted with a substantial expense based on his/her decision that does not require urgent or critical care, to shop around for the best price/value between equal levels of care. How again is this not rational or logical?

[Warriorbird]

Healthcare is approaching 20% of GDP, which is about 3 trillion dollars. It isn't there yet, it'll be there soon.

1.5% of that is 45 billion dollars a year.

Removing the bush tax cuts on the "wealthy", WHICH IS A VERY BIG DEAL TO LIBERALS, which they expend more oxygen yelling about than any other issue, would be 70 billion a year, and that is static accounting. Dynamic accounting would put the gain at less.

So, even if we assume that your number on what tort costs actually are is correct (and of course, it doesn't factor in the practice of defense medicine, which is significant, and so the number is actually incorrect), it is still 45 billion a year, which is kinda a big deal. I wouldn't piss on that. How many poor orphans could be given oatmeal for 45 billion dollars?

It's sort of endearing that you think they'd get the money.

[Gan]

Texas has some of the most restrictive tort reform laws in the entire country. You also have some of the highest healthcare costs, primarily due to physician self-referral.

Care to throw up some actual comaprisons? Or are you just going to ride on the blog post you linked?

[Kembal]

Healthcare is approaching 20% of GDP, which is about 3 trillion dollars. It isn't there yet, it'll be there soon.

1.5% of that is 45 billion dollars a year.

Removing the bush tax cuts on the "wealthy", WHICH IS A VERY BIG DEAL TO LIBERALS, which they expend more oxygen yelling about than any other issue, would be 70 billion a year, and that is static accounting. Dynamic accounting would put the gain at less.

So, even if we assume that your number on what tort costs actually are is correct (and of course, it doesn't factor in the practice of defense medicine, which is significant, and so the number is actually incorrect), it is still 45 billion a year, which is kinda a big deal. I wouldn't piss on that. How many poor orphans could be given oatmeal for 45 billion dollars?

I think the point is that even doing tort reform wouldn't be enough. I pulled up three links that compare our healthcare spending to other countries:

http://krugman.blogs.nytimes.com/2008/03/28/runaway-health-care-costs-were-1/
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/
http://economix.blogs.nytimes.com/2009/07/08/us-health-spending-breaks-from-the-pack/

You're going to need a lot more reform than just tort reform to achieve the savings we need.

[Warriorbird]

Care to throw up some actual comaprisons? Or are you just going to ride on the blog post you linked?

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

[Gan]

Care to throw up some actual comaprisons? Or are you just going to ride on the blog post you linked?


http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

How about some actual data?