Why is health care so expensive?

[Duff Miver]

Our local non-profit hospital recently announced it's financial results. As appropriate they broke about even.

One interesting note: 1/3 of all their charges were noncollectable. Those patients had neither insurance nor personal assets to pay the bills. They do try aggressively to collect, but you can't get blood from a turnip.

So, how do they break even when 1/3 isn't paid?

Simple: They overcharge everyone else by 50%.

And, if and when we have universal insurance, then the hospital can lower their charges by 1/3 and come out just fine. And insurers can lower their premiums by 1/3.

It's simple, really.

 

[StevieD]

Our local non-profit hospital recently announced it's financial results. As appropriate they broke about even.

One interesting note: 1/3 of all their charges were noncollectable. Those patients had neither insurance nor personal assets to pay the bills. They do try aggressively to collect, but you can't get blood from a turnip.

So, how do they break even when 1/3 isn't paid?

Simple: They overcharge everyone else by 50%.

And, if and when we have universal insurance, then the hospital can lower their charges by 1/3 and come out just fine. And insurers can lower their premiums by 1/3.

It's simple, really.

I hope so. But here in Mass where we all are supposed to have Insurance the costs have gone out of control since. The few times I have gone too emergency they ask me if I have insurance. I say yes. They look it up and tell me I have $100 co-pay. The co-pay has doubled since the mandated Health Insurance has been in place. Not to mention everything to do with Health Insurance costs have gone through the roof. I have a feeling this is the crooked insurance companies sticking it to us but still. We need someone to look out for the working man.

 

[ssd]

Duff:
Just wondering - what is your preferred universal health option?

Without more explanation here, it seems to me you are just cost shifiting - from the hospitals unrecovered debt now gets shouldered by the taxpayer. How is your healthcare option funded?

I am not being argumentative here - I agree that healthcare is expensive.

 

[Duff Miver]

Duff:
Just wondering - what is your preferred universal health option?

Without more explanation here, it seems to me you are just cost shifiting - from the hospitals unrecovered debt now gets shouldered by the taxpayer. How is your healthcare option funded?

I am not being argumentative here - I agree that healthcare is expensive.

Not so. The hospital's unrecovered debt now gets included in the bills of those who can pay via insurance or personal funds.

My proposal is really, really simple. Expand Medicare to cover everyone, fund it through payroll taxes.

Employers and employees can use the money they now spend on insurance to pay Medicare tax. Insurance company expenses for dividends, multi-million salaries, advertising, lobbying are done and gone. doggie has to get a real job.

Medicare controls costs better than any for-profit insurance company, and they can do even more by negotiating with drug companies and those physicians and hospitals which now refuse Medicare. If you want to practice medicine, you get paid the Medicare rate for all medically necessary procedures.

Hospitals can cut expenses for billing staff.

Cosmetic surgery is paid for by the consumer at whatever rate the traffic will bear.

"Physicians will give up medicine if they have to accept Medicare rates."

Bullshit. What physician, even at the low end of $150K/year will give up? What's he going to do instead, flip burgers? The thoracic surgeon who gets cut from $800K to $500K is going to get a shoe-shine box?

Medicare rates do need to be fair considering the education and skill level required.

Medicare rates may need to be adjusted to pay family practitioners more, and high-end specialists less.*

I would have some minimal mandatory co-payments, probably income based.

Poor folks pay $10 for an office visit, $200 for major surgery.

The rich pay $50 and $1000.

Something like that.

And there are some limits at the extreme end. 85 year olds don't get liver transplants unless they can pay out-of-pocket.


*I had a conversation the other night with two physician friends who both practice as specialists, one a rheumatologist and the other a nephrologist. I postulated to them that a general practitioner can handle 99% of the illness he sees. They agreed that is about the right number.

GP's are overwhelmed with patients, and specialists are scratching to find patients. A third friend, a cancer surgeon, reminds me to send him customers every time I see him..We should correct that.

Look, this isn't rocket science. We all need medical care, it isn't an option like needing a private jet.

So what we do is ban together, pool our money through tax collections, and negotiate the best deal we can. We believe on public schools, public roads, public law and courts, so why the Hell don't we believe in public health care?

 

[Trench]

*I had a conversation the other night with two physician friends who both practice as specialists, one a rheumatologist and the other a nephrologist. I postulated to them that a general practitioner can handle 99% of the illness he sees. They agreed that is about the right number.

GP's are overwhelmed with patients, and specialists are scratching to find patients. A third friend, a cancer surgeon, reminds me to send him customers every time I see him..We should correct that.

Look, this isn't rocket science. We all need medical care, it isn't an option like needing a private jet.

So what we do is ban together, pool our money through tax collections, and negotiate the best deal we can. We believe on public schools, public roads, public law and courts, so why the Hell don't we believe in public health care?

Good stuff, Duff. Some people are incapable of thinking outside the box. They're called Republicans.

 

[ssd]

You bring up good points, Muff. I do not think it will ever gain traction because as soon as you mention capping salaries, people will scream, "socialism".

You might be interested in reading this:

In The Healthcare Fix, economist Laurence Kotlikoff proposes a simple, straightforward approach to the problem that would create one system that works for everyone?and secure America's fiscal and economic future. Kotlikoff's proposed Medical Security System is not the "socialized medicine" so feared by Republicans and libertarians; it's a plan for universal health insurance. Because everyone would be insured, it's also a plan for universal healthcare.

I also think we (nation) need to understand the costs of our treatment - StevieD was alarmed at a $100 copay yet once past that, he probably could have cared less as to the costs of the other treatments that he received.

When I take my dog to the vet, the vet says we need 4 x-rays, 5 lab tests and yadda-yadda -yadda and the bill will be this. I say, let's start with this blood work and see what we find there. I'm happy to schedule the additional tests if it is determined that they are needed.

We pay our monthly premium and then a co-pay and don't worry about the rest. It's kinda like walking into a restaurant and telling the owner you want a great meal. Then, when the waiter presents you a $1000 bill, you flip your lid.

We have no 'menu' as to what the stuff costs -and out of sight, out of mind yet we wonder why premiums are going up? The insurance companies are getting the bills for umpteen xrays and blood analysis et al and at some point, you wonder if all this stuff is really needed or are bills being padded?

If you get a chance, take a look at his idea.

 

[Duff Miver]

You bring up good points, Muff. I do not think it will ever gain traction because as soon as you mention capping salaries, people will scream, "socialism".

You might be interested in reading this:

In The Healthcare Fix, economist Laurence Kotlikoff proposes a simple, straightforward approach to the problem that would create one system that works for everyone?and secure America's fiscal and economic future. Kotlikoff's proposed Medical Security System is not the "socialized medicine" so feared by Republicans and libertarians; it's a plan for universal health insurance. Because everyone would be insured, it's also a plan for universal healthcare.

I also think we (nation) need to understand the costs of our treatment - StevieD was alarmed at a $100 copay yet once past that, he probably could have cared less as to the costs of the other treatments that he received.

When I take my dog to the vet, the vet says we need 4 x-rays, 5 lab tests and yadda-yadda -yadda and the bill will be this. I say, let's start with this blood work and see what we find there. I'm happy to schedule the additional tests if it is determined that they are needed.

We pay our monthly premium and then a co-pay and don't worry about the rest. It's kinda like walking into a restaurant and telling the owner you want a great meal. Then, when the waiter presents you a $1000 bill, you flip your lid.

We have no 'menu' as to what the stuff costs -and out of sight, out of mind yet we wonder why premiums are going up? The insurance companies are getting the bills for umpteen xrays and blood analysis et al and at some point, you wonder if all this stuff is really needed or are bills being padded?

If you get a chance, take a look at his idea.

I'll look at that.

I agree that we consumers need motivation to spend wisely on health are, and that's the reason I think there should be some sort of co-pay for everyone. Some folks can't pay much, but they should have some "skin in the game". Right now there are too many who have no financial interest in the cost of their care.

I'm not proposing a "socialist" system where providers are paid a fixed salary. They should be able to earn more if they produce more. And, they can go out of the system to serve patients who pay cash, like your rich Saudis, and for non-medically necessary work like cosmetic surgery. In fact I understand that several local dermatologists have made substantial fortunes from Botox injections @ $600/pop, cash only.

However Medicare for all can, as Medicare now does, set reasonable rates, adjusted for low-high cost areas.

As I said, it would be nice if consumers shopped around, but right now that's impossible.

Dentists and vets have about the same investment in education and facilities, but have to work harder to get rich because many folks do shop dental and vet prices.

My friend the rheumatologist always has two or three residents under his wing. Part of his mentoring to them is supposed to include cost awareness, so he has asked for a price list of hospital services. His request has been turned down flat. He doesn't even know what patients are charged for his work because the hospital has many different rates, depending on who is actually paying the bill. They charge Medicaid the least, then Medicare, then multiple different insurers, and finally the highest rate to those who are paying out-of-pocket.

Single payer can stop that nonsense.

I'm no expert on exactly how all this should be done, however the good and sensible folks in Vermont are working on it right now. They are absolutely committed to single payer universal coverage which the people of Vermont can afford. Vermont is not a wealthy state, so if those tough Yankees can figure it out, it can work everywhere.

I have great respect for Vermonters. They're the only state with no gun laws at all. Don't need 'em; they are responsible folk who can be trusted with guns.

They have a budget problem like most states, so what's the first thing their legislators did? They cut their own pay.

I'd move to Vermont tomorrow if it weren't so damned cold.

 

[bleedingpurple]

I can give you some reasons that I have thought of in no particular order.

1. Excess Hospital Staff for Utilization Review / Cover Your Ass and Billing..

There have been so many lawsuits that there are tons and tons of staff reviewing charts for proper documentation and proper treatment practices. Yes they are needed but I know some who make 80 Grand per year to do this. Really. They can find iit done cheaper.

2. Hospital Equipment pays for itself over and over and over again. The amount they charge is astronomical. They have to make it up somewhere but holy shit an EKG and MRI are way overpriced and that is just the start.

3. Pharmacy - Drug costs are crazy and when hospitalized the meds are marked up as high as 1000 %. Yep I had two shots of Maalox mixed with lidocaine called the cocktail and it was $19 a piece. Just wonder what other meds cost?

4. We as a society keep health care prices up. We overeat, we drink too much, and smoke too much. We are a society of gluttany and bad habits.

5. We again are at fault for refusing to be checked even when insured because of fear or just not liking doctors or hospitals. The preventative is much more cheaper than the treatment or the cure and that is where universal health care comes in. If you have universal health care more people are going to get treated instead of waiting til the last second when prices get way overboard. Why not have universal coverage? We are paying for the costs anyway, maybe this way the people will get the care when needed.

Non compliance - It is amazing how many patients do not follow their protocol, they do not follow up with care, or do not take their meds do follow up treatment.


6. Insurance Companies - They have to make money but they piss me off. I like how they tell doctors what treatments or medications will and won't be covered. Hospitals are pressured to discharge patients faster than ever due to insurance coverage. These early discharges have lead to an increase in re - hospitalizations over the past 10 years.

Well I did this in a hurry.. I know I will have more but this was off the top of my head

 

[Duff Miver]

You might be interested in reading this:

In The Healthcare Fix, economist Laurence Kotlikoff

Okay, here it is in a nutshell -Participants?including all who are currently uninsured, all Medicaid and Medicare recipients, and all with private or employer-supplied insurance?would receive annual vouchers for health insurance, the amount of which would be based on their current medical condition. Insurance companies would willingly accept people with health problems because their vouchers would be higher. And the government could control costs by establishing the values of the vouchers so that benefit growth no longer outstrips growth of the nation's per capita income. It's a "single-payer" plan?but a single payer for insurance. The American healthcare industry would remain competitive, innovative, strong, and private.


I can't understand how it would be practical.

If present Ins premiums being paid aren't enough to insure everyone, where would he get the money to provide adequate vouchers for all?

He says govt would control costs by limiting the value of vouchers. How would that force insurers to insure all? They could simply say "no thanks" to pts they didn't want.

He says nothing at all about controlling costs, and one of the most effective ways to do that is to get rid of for-profit insurers along with their costs of dividends, million-dollar salaries and hundreds of millions of lobbying expenses.

I think it's pie-in-the-sky, similar to Ryan's voucher plan.