I don't think any industry is going to fully eat the cost of people who don't pay. Those costs get spread around. Same thing that will be happening in 2014.
Yes you are correct. The funny thing is my local hospital is a not for profit. Despite this year after year they show millions of dollars in profits. I know this is not true though across the US though. I am not against doctors making a very good living, they earned it.
I am not against doctors making a very good living, they earned it.
That's a concern of mine. I want to make sure that the best and the brightest continue to be the one's going to med school.
I was a little bit surprised at how easy it was for my Ex to get into nursing school. But the work she had to do in order to actually graduate weeded out anyone who shouldn't be doing the job.
How is it BS? In a round about way that is what happens. When the hospitals eat the costs of the uninsured, they in turn gouge the insured people because they know they will get some of that lost cost back from us. Therefore the insurance companies gouge us back. It's a vicious cycle and it's all related.
Did you miss the part that Dean stated that insurance companies pay basically half the bill of a service? Or that I got good results from paying cash. I just posted how my local not for profit hospital made millions. Really, there is a lot of hype and bs over the cost of healthcare and the scope of the problem. Yes there is a problem but it is not the way it is presented to the public. Just because somebody is uninsured does not mean that they are not paying there own healthcare bills. Costs should be transparent and not made up figures.
About 75% - 80% of American's LIFETIME consumption of ALL healthcare is used in the last 12-16 months of life. I'm sorry but that's stupid and vain. I wouldn't subject an animal to that. Guess what, when you have end stage cancer and half your organs don't work you're going to die. It's simply a matter of where and in how much pain and suffering. But the idea that we as a society have to move mountains and pay any price to prolong that is insane.
That's a concern of mine. I want to make sure that the best and the brightest continue to be the one's going to med school.
The alternative is medical tourism. I have worked with people to have kidney transplants in Peru and heart surgery in India. The doctors are trained here anyway and the cost there is 1/10th what it is here. Long run M&M studies aren't in yet but I don't see them dramatically different from outcomes in the States. You're going to live on average about a decade with a donor kidney and you're to live about 7-9 years on average after open heart surgery w/o requiring another process to redo the same work. Post op survival is largely a matter of infection, lifestyle changes and dumb luck.
About 75% - 80% of American's LIFETIME consumption of ALL healthcare is used in the last 12-16 months of life. I'm sorry but that's stupid and vain. I wouldn't subject an animal to that. Guess what, when you have end stage cancer and half your organs don't work you're going to die. It's simply a matter of where and in how much pain and suffering. But the idea that we as a society have to move mountains and pay any price to prolong that is insane.
Sitting here thinking about all of the Baby Boomers who'll be on life support in about 25 years...
Because the AMA, the Pharma Companies and the Health Insurance industry are all gouging the US consumer as much as they can, so the people in their industries can get rich.
And Americans can't have an honest, intelligent national discussion about any of it, because of partisian politics.
Did you miss the part that Dean stated that insurance companies pay basically half the bill of a service? Or that I got good results from paying cash. I just posted how my local not for profit hospital made millions. Really, there is a lot of hype and bs over the cost of healthcare and the scope of the problem. Yes there is a problem but it is not the way it is presented to the public. Just because somebody is uninsured does not mean that they are not paying there own healthcare bills. Costs should be transparent and not made up figures.
Insurance companies pay a negotiated rate with the provider... They do not pay what would be typically billed.. and as you've pointed out as a self payor you can also pay a negotiated rate. What group of patients pay full price? I'm really curious. Everything is so intertwined.
And I do get what you're saying. Posted via Mobile Device
Let me say that while I worked in both the oilfield and the Federal Government, my medical insurance was exemplary. Low co-pays, if any, and very affordable. When I underwent bypass surgery in 1998, my Fed rates rose but nothing extraordinary. When I took early retirement, however, the COBRA was totally unaffordable. Now I'm without because the pre-existing condition clause pretty much nails my toes to the floor until 2014. The majors carriers that I have gotton quotes from won't insure me until then because they are riding the limits of the law for as long as they can. I cannot make money for them because at my age, I'm a cost center. Where they make their money is from the younger workers who are far better health risks.
The sad thing is that health care costs go incrementally through the roof because of the massive amounts of money that the doctors, hospitals, and pharmaceutical companies make, and the massive salaries of all of these health care provider companies mid-level to upper-level CEO's and their associated cronnies.
I'd much rather have something like Canada offers, or even if we would adopt the "public option," paying premiums commensurate with what the federal government workers pay. But healthcare doesn't want that, because that would rampantly destroy their profit incentive.
So who should we be more concerned with? The health care companies, to insure that they keep turning monstrous profits year after year to facilitate their unheard-of salaries, or the common American, who can ill-afford to buy health insurance, and even if he could, he'd find it most difficult even to pay the premiums and/or the copay. It's a no-brainer! The little man is literally getting shafted at the expense of this health care industry ogre!
Insurance companies pay a negotiated rate with the provider... They do not pay what would be typically billed.. and as you've pointed out as a self payor you can also pay a negotiated rate. What group of patients pay full price? I'm really curious. Everything is so intertwined.
And I do get what you're saying. Posted via Mobile Device
I had to get an endoscopy done. They wanted a bit over 2k to do it. Basically I told them "hey you are killing me, really 2k. I do not have insurance but I plan on paying you guys cash, I will bring it in with me. Is that the best you can do? I got a family to think about too." The receptionist went into the back came out and then told me something around $900.00. It was years ago so I do not remember the exact figures. So the only people that pay full price is people that do not have insurance and do not question the cost.
Most of the time if you ask them how much something will cost they give you a strange face. They do not want to tell you ahead of time. They just assume "you need this" and they are not used to people working with them like that. Of course some procedures have big unknowns too. I went into the Er one time thinking I was having a heart attack. They did a bunch of tests. Asked them "how much do I owe you" at the end of it all. They said we can not tell you. You will get a bill in the mail. I got the bill and called them up. Just said "hey I want to come down there and pay this thing but crap, can you help me out." Ended up knocking off a huge part of the bill off and even told me that if I want they can take my credit card over the phone. No need to come in.
I think they just want proof that you are willing to pay them in a timely manner.
During that time I signed up for a discount program that cost me like $150 a month. What I found out is that the discount was on the full price. If I DID NOT show them my card I could get a lot better price because of there pricing arrangements. With the discount card nothing was negotiable. So I was paying $150 for a plan and getting charged more!
Eventually I got my own health insurance plan, high deductible. I automatically get the no haggle low rate because they think the insurance is paying the bill. The only problem is that it can take a long time to get the bill. My statements show me "there charge" and "my acceptable responsibility." Despite not being close to my limit, I only have to pay the low "acceptable charges." That and I am covered if something real happens so I will not go broke.
Under the new law I have no idea if my plan is "acceptable." It does everything I need it to do. But they are making new requirements and not making things known until it kicks in. It is all a mystery. "Pass this bill and you will see" LOL. But worst case is that if I get cancer the max that will come out of my pocket is 8K a year. That is the cost of my insurance plan and my deductible maxed out. It covers me, my wife and one kid.
The funny thing is one time I was on vacation there were some billboards in the area. Vasectomies for $300.00. They even had stupid logos on them like "cheaper then child support. Call 1 800......" Not really related to anything hear though. Just something stupid I remember from a few years back.
I'm a Libertarian-leaning independent and also a nurse. I have mixed views on the solutions to this issue that aren't really clear enough to verbalize, but I did wanna comment on the following snippets...
Quote:
Originally Posted by *Dean*
I play golf and have some friends who are Surgeons.
They will tell you that Medicare (US Gov) really is what keeps the costs in line. That the insurance providers follow Medicare's lead on setting pricing. Do you ever here from anyone that Medicare has a higher price?
This is true. Insurance companies do follow Medicare's lead, and not just when it comes to the price they're willing to pay for a covered service.
Quote:
Originally Posted by Runs like Dog
In the UK, the NHS routinely disallows older patients or patients with a poor health history from qualifying for kidney transplants for example. It is in your face rationing. This worries many people.
We already have a type of rationing here, albeit in a roundabout way. I work in utilization management and see this every day, many times a day.
It goes like this: Some agency somewhere does a lot of "evidence-based research" and decides, for instance, that if your prostate cancer is above a certain stage and has metastasized to bone, certain types of radiation treatment or a certain chemo drug will do "more harm than good" because, well, they aren't likely to work that well anyway considering how far your cancer's already gone. They put out guidelines saying this. Medicare adopts said guidelines and since insurance companies follow Medicare, they adopt said guidelines within a year or two, as well.
Your oncologist's office tries to get precertification for your radiation treatment or chemo and is told they will either have to amend your treatment plan or Medicare/other insurance company won't pay for it.
It happens all the time, and the doctors themselves are sick of it because it's interfering with how they would normally treat their patient. Some agency that does not know their patient's case the same way they do has effectively blocked them from doing what they know needs to be done.
Quote:
Originally Posted by *Dean*
I agree.....everyone should get the benefits. I don't like the UK system if that is how it works.
From what I understand, it works that way in Canada, too. They have private insurance riders up there.
Let me say that while I worked in both the oilfield and the Federal Government, my medical insurance was exemplary. Low co-pays, if any, and very affordable. When I underwent bypass surgery in 1998, my Fed rates rose but nothing extraordinary. When I took early retirement, however, the COBRA was totally unaffordable. Now I'm without because the pre-existing condition clause pretty much nails my toes to the floor until 2014. The majors carriers that I have gotton quotes from won't insure me until then because they are riding the limits of the law for as long as they can. I cannot make money for them because at my age, I'm a cost center. Where they make their money is from the younger workers who are far better health risks.
The sad thing is that health care costs go incrementally through the roof because of the massive amounts of money that the doctors, hospitals, and pharmaceutical companies make, and the massive salaries of all of these health care provider companies mid-level to upper-level CEO's and their associated cronnies.
I'd much rather have something like Canada offers, or even if we would adopt the "public option," paying premiums commensurate with what the federal government workers pay. But healthcare doesn't want that, because that would rampantly destroy their profit incentive.
So who should we be more concerned with? The health care companies, to insure that they keep turning monstrous profits year after year to facilitate their unheard-of salaries, or the common American, who can ill-afford to buy health insurance, and even if he could, he'd find it most difficult even to pay the premiums and/or the copay. It's a no-brainer! The little man is literally getting shafted at the expense of this health care industry ogre!
I think you put it very well. And I wanted to add I used to work for a healthcare company, we were the "business managers" of the facilities. Our executives made ridiculous amounts of money, the company itself had ridiculous amounts of money - bonuses annually that doubled the already huge salaries of the executives... That company still exists and models like that do appear to be a part of the overall problem.
12,000,000 illegal immigrants, most of them uninsured, make up 1/3 of the total uninsured in the country. A conservative estimate for their use of ERs and other unpaid healthcare is $10 billion. Obamacare, AFAIK, doesn't address the issue of requiring illegals to obtain healthcare, so it will keep costing taxpayers.
I'm actually quite sympathetic to the plight of illegal immigrants and would like to see them naturalized and taxed, thus making them subject to the mandate for coverage as everyone else... but I'm probably in the minority in that regard as most people I talk to simply want them deported. Deporting 12 million people many of whom have birthright citizen children simply isn't going to happen so we might as well play with the cards we're holding.
The problem is that under Federal law (ironically signed by Reagan) hospitals are required to treat people at emergency rooms regardless of insurance coverage. In that sense, we have all had at least some form of universal health care since the 80s.
I will also note that shopping for doctors and healthcare is very different than shopping for other items. My brother, who is a doctor, noted that in his area (a major metropolis area with around 5 million people), doctors who advertised lower prices actually got less business. Though not entirely clear why, one theory was that people don't want to pay cheap for healthcare versus other items. This was even the case when much or most of the cost came either out of pocket or through a health savings account.
How does your brother think we should fix our system?
There is not short answer, as I understand what he is saying. Insurance reform is key (both for patients and for malpractice), as is getting doctors and hospitals to adopt technology. His practice (a large one with about 50 doctors) is advanced, and only just started using email and computers for note keeping about 3 years ago. Prior to that, it was all handwritten notes and dictaphones because the older doctors did nto want to change (he has noted that doctors appear to be the most stubborn group of people in the world).
Getting as many people insured is the key, as it spread costs (and insurance is a large numbers game) but he recognizes that some people just won't want that. He also notes that at times he feels constrained to use certain tests even when he does not think they are necessary. Raises costs and is bad for the patient - the problem is that patients want something done, even if it means writing a script for anit-biotics for a viral cold. We as Americans are not patient and think that advances in technology can and should be able to fix everything.
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Re: Any thoughts on the health care crisis? 
