Skip to comments.Why No One Wants to Crack the Health Care Walnut
Posted on 03/29/2007 4:58:45 PM PDT by neverdem
A few days ago I had dinner with friends from a boutique actuarial services firm. After some chit chat, we soon turned to health care costs, health insurance and, as one would expect in the small talk lexicon of actuaries, mortality tables.
If you think health care is expensive now, wait until it's free."
I never did get the reason why we should all get the finest health care free. After all, I can't have the finest housing (just what I can afford) or the most expensive food (just what I can afford).
Why should I expect better medical care than I can afford? (Except for life-saving emergency care; I think all of us want to give that to those who need it)
He left out the real tiebreaker and ultimate fix to the medical cost burden... euthanasia.
But that will come later, after socialized medicine is completely entrenched, we all are trapped in the web, and costs must be kept down or the system goes completely bankrupt!
The cost of the insurance is high because health care, especially hospital care, charges are high.
Doctor visits are usually not so bad, unless lab tests are ordered. It is the lab tests that are high.
Doctor visits are usually not so bad, unless he must do a procedure or make a decision that can land him in court. It is the cost of the malpractice insurance that is high.
Hospital, labs and other businesses that process medical data and tissue in some way, and even the medical insurance industry itself, are the reason health care is so expensive.
The question seems to be, just what are a hospital's cost of labor and materials that justify charging $4.00 for something you can buy at the PDQ for two and a half cents?
Or, if the raw materials used by these businesses are costly, exactly what costs the manufacturer or jobber so much? How much could it cost to make a 5-0 suture?
I have lived in Britain with the NHS. People who think that socialized medicine is a good idea should have to live under it for a year. I made a very low wage (due to my qualifications not transferring there) and was taxed at 50%. People who can afford private insurance carry it. There are loads of private doctors that actually take appointments. You can see them when you need to, no waiting all day for whichever doctor happens to be in your local clinic any given day. When people tell me they'd love to see nationalized health care I always ask them 'how would you feel about the Gov't setting your income?'. They never want that! But they always think it is perfectally acceptable to want the Gov't to set medical incomes.
The NHS killer??? No one can sue the Gov't. Do you honestly think the people ( and the lawyers!!) in this country would stand for no lawsuits against the medical industry??
One more thing. Most people don't realize that THEY are the ones whose taxes will skyrocket for socialized medicine. They look it as if someone else is paying. Very naive.
Or just look at the room rate.
Should it cost $680 a night to spend time in a room that resembles a Motel 6, shared with one other customer with only the feeblest attempts at providing privacy?
And a shared phone and cable TV that cost amounts that would make your larcenous cable operator blush in admiration?
Seems to me that hospitals should be cleaning up, and yet everyone says they're losing money like crazy.
And this is true even in areas with few to no illegal aliens, so I don't think this is the problem here.
Anyone know what is?
It isn't that the suture or the box of tissues really costs the hospital so much; they're just charging you, and/or your insurance carrier, if you have one, a lot because in that way they recoup the cost of treating all those indigent cases. If you don't have insurance (and Medicaid counts as insurance) you will be charged even more, since the insurance company has negotiated a lower rate.
The high charges also cover the cost of building that new wing and buying the fantastic new equipment in the radiology suite, which is the biggest expense in any hospital. And the new imaging equipment is costly because hundreds of millions of bucks in corporate research funding went into developing it. Those aren't Brownie cameras they're taking pictures of your brain with.
Start saving up when yoiu're young is the only answer. We really need Health Savings Accounts.
You're leaving out several factors. First, the "what if?" factor. Hospitals have sicker and sicker patients now as the ones who used to stay longer are sent home earlier. They have to be prepared for someone to go south at any minute, have the staff to handle it (even if over half the time there are too many), AND pay for the insurance to cover a lawsuit in case someone sues them because they were a nurse short on the day their dad died.
Then there's the employee unions. Nurses have the hospital over a barrel. Pay and benefits have gone way up.
Then there's all those transcription costs, new software to keep up with all the new code costs, and so forth.
Okay, now take your Medicare and Medicaid patients, and that the government doesn't even cover the costs in most cases. It then forces the hospital and doctors to accept what it says they deserve and no more.
My gross bill was over $8,000. The bill insurance paid was about $3,000.
The net total of care I got was a patch to decrease my blood pressure.
They ran a bunch of tests and I probably spent a total of half an hour with doctors.
I have never paid so much for so little in my life. I don't want to support the medical establishment because frankly, I just think it's an awful deal.
If I ever need a major operation, I'll have it in India, the Philippines or some other country that has lower medical costs.
In the Philippines, I could hire my own full-time doctors and nurses, a whole hospital's worth of medical staff, for a month, and it wouldn't cost what one night of stay costs in a US hospital.
Good article. I'm not worried. As health care costs gobble more of our income, we will make adjustments. There's plenty of room for cost saving adjustments. The motivation's not there yet.
The health care industry has structured itself to guarantee high salaries to its participants. Everybody, from the doctors to the management to the vendors they choose are making plenty of money. Since they don't face the competition a typical business faces they are free to set prices as high as they want, except with a few major "customers" like Medicare and Medicade. They get the discount price, so instead of cutting costs internally everybody else has to bear an inflated price.
If there was a true, open market for health care services the prices would fall quickly. But first you have to end the monopoly on providing services that the medical community has created for itself -- a near impossibility.
Their "bunch of tests" probably included use of machinery totally hundreds of thousands. They probably didn't have to run that many, but if you stroked out the next day and your lawyer came after them, they'd be the ones in deep water for not running anything. How many doctors spent how much time with you? What specialties? Don't forget there are doctors behind the scenes interpreting thoses tests (if the lowly GP misses something on an x-ray that a radiologist could have seen, the GP goes down).
You're not supporting the medical establishment so much as you are the trial lawyers.
The reason it's cheaper in India, the Phillippines, and the like is 1) fewer lawyers, 2) fewer lawsuits, 3) topnotch care in some centers... you're on your own in others, 4) the unions here, and 5) did I mention the lawyers... not to mention all the clerical folk that are required to be sure your healthcare folk have jumped through the right hoops for their paperwork, not just as lawyer repellant but also to maximize reimbursement.
There are a few, like Tony Snow, who through no fault of their own develop a serious disease. But so many serious illnesses AND accidents that are self inflicted or at least exacerbated by harmful lifestyle choices. And we all have to share the cost of treating those.
It takes a lot of discipline to commit time to exercising regularly and eating a healthy diet without foods full of fat and sugar. That doesn't guarantee you longevity free of health problems, but it certainly increases the odds.
Sometimes I wonder why I bother, except for my own self image because I just end up paying for someone else's health problems due to their being a couch potato and eating like a pig.
And thank you for backing up what I've been saying on FR for ages now: we already have universal free medical care in the United States. That decision was made long ago, and there is no further point in debating the merits of "socialized medicine". The people of the United States have decided that everyone in America is entitled to health care regardless of ability to pay, and that is that. The only question that remains is how exactly we as a nation are going to provide that care. Right now the health care provider of last resort in the local hospital ER. But is that the best way, the most cost-effective, fair way, to provide universal free health care? Or can we organize a system that works better?
Look, health care isn't free, but we have to act as though it is free if we are going to keep society together. It is not fair to require the haves to pay for the have-nots' health care, but the alternative is to allow the have-nots and their kids to die in the streets, and we have decided that isn't going to be allowed to happen here in the U.S. Therefore, we have to develop a system to spread the unfairness around as evenly as possible. Right now we do that by requiring hospital ERs to provide indigent care regardless of cost ; they in turn either eat the expense (and eventually shut down) or they pass the expense on to the customers who can pay (and/or their insurance providers).
There may be a better way to provide free universal health care services. The only way to find out is to have a rational discussion of the issue. But arguing over whether or not we are going to provide free health care to all Amercans is pointless. We have already decided that we are. Therefore, let's debate the merits and disadvantages of various socialized medicine options instead of bickering over whether or not it should exist.
Hospital costs were high before the illegals started to access it wholesale, and the vast majority access emergency services.
Equipment may cost a bunch but the depreciation is also a bunch. It pays for itself quickly, after which the cost remains the same.
I talk to nurses and staff. Of course hospitals and other medical service sources are businesses, not eleemosynary organizations. But, regardless, they are the root of fantastically expensive health care insurance, and they don't have to be.
Social Security and The Department of Education out spend the Department of Defense. Guess where free health care will be on that list and which of those will get hacked to death. Do you need help guessing, hmmmm? Follow this clue to any European country or our neighbor to the north.
Health care isn't free, agreed. But many people abuse that notion. There is no real reason why healthy people should go to the ER (esp. in ambulances) for minor illnesses. But they do, and we all pay.
We all should have to take some responsibility for our use of the health care system. Saying that poor people have no responsibility is making our problem worse, and it really isn't helping them.
You think not all that much was done. You have no idea what was done, and neither does your friend. Behind the scenes, tests are being run, consults are taking place, and if you saw an itemized billing statement from the hospital and were qualified to interpret the procedure codes on it, it would reveal that a lot was done. If your friend was in the hospital for six days, something pretty significant was wrong with him because nowadays you don't get admitted as an inpatient unless they're going to give you a brain transplant.
My ONE HOUR visit (my husband timed it) to the emergency room last summer for a slash (3 stitches) between my thumb and forefinger (durned avocado seed!)....cost $1300 - my husband's company got it negotiated down to about $1100, and then the insurance paid about $900. When I got the bill I had a question about some of the items (I had requested an ITEMIZED bill).....they ended up telling me they would forgive the $240 I was supposed to pay (they had ignored my letter for a long time and I sent THEM a BILL for my time in responding to their stupid bills and trying to send me to Collection.) Anyhow....ONE HOUR at the rack rate was $1300. But, they must have a lot of profit margin built it, because ultimately they got paid about $900 - plus a fee for the Physicians Assistant.
Oh, and I saved myself about $75.....I took the stitches out myself a couple of weeks later, using the kit(scissors, tweezers, etc) we TOOK home with us from the Physician's Assistant who had put the stitches in. (He said we were paying for it, and my husband asked if we could have it - he thought the scissors would be great for fly fishing). NO, I never saw a REAL Doctor.
Everything is negotiable
Always ask for itemized bills - even if you have insurance
Take everything in the room that a nurse/doctor opens with you - it's yours.
And, of course, have insurance.
Demand will be near infinite, supply will be finite. Health care will have to be rationed by availability of services. We have all heard the stories of year long waits for otherwise routine dental care in Britain, or Cat scans in Canada.
Health care is too complex to be solved by government. Only the free market can possibly provide something remotely close to reasonable care for a reasonable price.
I have lots of stories. My sister-in-law spent her first night, after giving birth to her first child, in the hallway of the hospital. This was in the 70's. My husband's cousin waited 2 years to have her gallbladder out.....elective surgery. I could go on and on. That will be for the next thread here on a possible NHS.
I think the problem with this theory is that if you're going to give everyone life-saving emergency care, you might as well give everyone ALL care, because it's a heck of a lot cheaper.
For instance, someone who is poor has strep throat. Strep throat, if left untreated, can develop into rheumatic fever, which can cause heart failure and death. For the price of four dollars in penicillin, the strep throat could have been treated, but now we--as taxpayers--are stuck treating a patient who could have heart failure, which is a much more costly scenario.
I'm not saying that we should treat everyone. In fact, I don't think health care is a right at all; if you can't pay, you shouldn't get treatment. That said, if you're going to treat emergency cases, seems to me like it's a lot cheaper in the long run to treat everyone universally.
I think a cost accounting of any hospital would be interesting.
So what exactly was on the itemized billing statement she received? Billing statements are quite exact and show every last pill, injection, and gauze pad. What added up to $11000?
As I said, the debate over whether or not we are going to have a system of free, universal health care is over. The only thing left to argue is how best to implement the system.
I'm sure the machinery totalled in the millions, but I only spent about an hour all total in the rooms where it lived.
So if you have a $1,000,000 machine and the things last well over ten years, that machine is worth only about $273 a day. They appear to run them 24/7, but for the sake of simplicity let us say the machine is used ten times a day. This means it should cost me about $ 27 to use it. If the person who ran the machine for me is worth $50 an hour, and she does two tests in an hour, then that should cost me $25. Mark that up by 100% for overhead and the test could be reasonably worth $100.
Of course if utilization is higher than I say - and I'm sure it is, since there were patients stacked up like cordwood waiting for it, as I was - this figure would be way, way, too high.
The actual bill for the test was $1,200!
Do you see now why I am so puzzled, and outraged, by this?
So some poor homeless guy with no money comes in and would be charged that. Because I have insurance, they fought down the bill so the test probably cost me only about $400. That still seems like at least four times more than the fair value of the service.
I don't understand why a cost structure like this is tolerable. Do you know of any cost breakdowns that show where the money goes?
Oh, it's cheaper in the Philippines because people are cheaper. Doctors make about $300 a month. I could afford to run my own hospital over there, with one patient -- me -- if it proved necessary.
I guess I can do that because I know in advance that I won't sue myself ...
You said more in that sentence than you realize. Think about it.
Question - was your own doc or whoever covers after hours unavailable? Do you have a Doc-In-the-Box nearby?
The ER is meant to handle whatever comes in - they have to be prepared to run a gazillion tests should you pass out while you look at them stitching you up. If they don't and you do have a heart irregularity, you can sue them.
You got out in an hour? Wow! They must not have been that busy that day. Nonetheless, they had to have sufficient staff available to cover an onslaught of 5 or 10 patients at the same time (or more, depending on the ER).
Yes and no. One of the big problems with a lot of the uninsured and Medicaid-type patients is noncompliance. Some is understandable (lack of reliable transportation to whatever facilities), some ignorance/inability to understand complex directions, and some just downright laziness.
I'm sure there are statistics somewhere, but the failure rate (patients who don't show for appointments) is huge for those getting the care for "free."
It was a Sunday morning......and NO they weren't busy....and I asked if I should go to an immediate care facility....they said "No" - we have two tracks....you're going into the immediate care track.....plus, I would NEVER call the "doc in a box" for getting stitches....they'd just charge me at least $75 to refer me to someone else.....We consider ourselves in charge of our own healthcare, and make our own choices....this was the choice we made that morning.
I don't understand - that's exactly what every urgent care facility I've seen is set up to handle. Something that needs attention fairly quickly but isn't a life-saving emergency.
I don't think so; it was not meant to be a value judgement, simply a statement of fact about the cost of hiring people.
In no way does that mean that the people there are less intelligent or capable. Their dysfunctional economy is what makes them cheaper to hire, not anything intrinsically bad about them.
I met a very nice doctor over there and felt she was as capable as anyone I met in the US.
Thing is, I'd rather die than pay $100,000 for a lifesaving operation. It just feels like giving in to an extortion plot, not buying a service.
I realized your intent, but the words mean a lot more. I'm not disparaging Filippinos in any way. Check out my profile - I live in a primarily Filippino neighborhood, and they're the most wonderful patriotic people that Hawaii has been blessed with.
I had a Filippino boss in one job. She was awesome, though I never could understand how folk could send their kids back to grandma and grandpa half a world away and not see them for a year or two or 3 at a time. My boss confided in me that she was torn between two completely different cultures. In America she had any appliance she wanted, accessibility to art, theater, etc., but the stress level of her job was huge. In the Philippines she could stay home a day or two if she felt like it, more of a mañana philosophy. She wouldn't have the lifestyle though. Overall she decided the stress was worth it. I would imagine that's the impetus behind many of our neighbors. It's a cinch they work twice as hard as most others here.
No, by "cheaper people" I meant that they don't have our conveniences, our demands. My question - do you expect to live your lifestyle as is while expecting your doctor to live as a Filippino in his own country? Want him to be working mowing lawns on the side to make ends meet?
I don't think any doctors mow lawns on the side, not because they are not poor but because mowing lawns pays even worse than medicine. Baseline labor is about 200 pesos (US$ 4) a day plus 50 pesos ($1) for lunch.
My doctor or any other professional lives his own life and has his own income and expenses. As his patient I would pay whatever his fees were. If I hired him fully time, hypothetically, then I would pay him the going wage, whatever it is.
A single female friend of mine over there lives a lifestyle that compares to a US middle class lifestyle with the exception of not owning a car. Her expenses are about $1,000 a month. She makes her money halfway through her job and half from a side business she runs. She has a beautiful house on which she was her own contractor. She has a $300 cellphone that contracted an annoying cellphone virus I had to fix for her. I'm just glad I was there to help.
So you can see doctors are not paid well at all. They are paid better than laborers and that's about all you can say.
I really loved the hospitality and warmth of the Filipino people, which is why I mention that country as an interesting benchmark. It also seemed to be easy for me to meet and get along with people there, while that has not proven nearly as true in the US.
I meant if you paid them here on the scale of what Filippino doctors earn in their country, they'd be mowing lawns on the side (or they wouldn't have gone into medicine in the first place). Check out their overhead costs, their malpractice insurance costs, not to mention their student loans. Your average GP here isn't rolling in dough. Some of the specialists perhaps, but the doctors I know live in the same quarters on base as others of their rank. A doctor lives on our street, a geriatric specialist. We share the street with a gardener, a lawyer, a flight attendant, a caterer, and a cop (among many others - i.e., it's hardly beachfront property, very middle class). Most homes are in the 1800- 2000 sq. ft. range on 5000 sq ft lots.
So is the doc on our street living high on the hog? How far down in the ghetto do you want him to live?
I'm not asking anyone to live in the ghetto.
I am simply saying that I'd rather not pay $100,000 for an operation, and wondering why on earth I should be asked to.
It actually irks me that, despite these outrageous fees, nobody appears to be getting rich off them. Doctors probably got very little of the outrageous fees I paid, nurses don't make that much, and hospitals are going bust. So where is the money going? Who IS getting rich off of these fees?
If the money all goes to lawyers and insurance companies, I'd rather have my care done in another country, where a higher percentage goes to those who actually do the work. In extremis, I could buy my own equipment and set up my own hospital for less than what it takes to do one operation here!
That was my point.
Does that make more sense?
Sorry, I misunderstood what you meant by "doc in the box" - I consider my "doc in the box" the doctor I go to, if I absolutely HAVE to go for a referral, or generic medication, or something to get non-specialist advice on, i.e. ear infection.....I do NOT go to her for other major issues....she's useless.
OK, now I'm really confused. I never heard of anyone not on Medicaid, or a member of an HMO, who went to the hospital and didn't get an itemized billing statement. Are you saying that a representative of the hospital's business office just said to her at discharge, "You owe us $11000," without specifying in writing what she owes it for? She needs to get a properly itemized statement (which will run to many pages) before she writes any checks. And believe me, her insurance carrier will have an itemized statement before it processes any claims.
Hospitals have to charge ins. cos. and those who can pay enough so they can cover expenses for the ones who can't pay. Those and malpractice ins. costs are most of what you paid for.
Why didn't you go to a walk-in clinic? I know those aren't available everywhere, but they are a good deal where they are. I wouldn't use one for a serious illness, but I do use them for routine problems. They're cheap, for sure.
Emergency rooms and hospitals are an expensive way to treat people. Many areas of the country have low cost clinics. I'd prefer to subsidize the low cost clinics than to treat people in expensive facilities. The co-pays in the clinics are usually low so that people who need treatment for minor illnesses can get it, but it's not free, so people who have flu aren't tempted to seek medical care.
Anything short of making people responsible for their own health is going to be too expensive.
Because it was Sunday and it was closed.....and my husband was driving, I was hurting and trying to keep from gushing blood.....minor little details.