that is all...


Peace

more public system, whether single payer or another structure.

but it's clear that free markets are not working in the case of health care. I agree with you.

around for the best place to have the stroke treated at the lowest price. That's unrealistic.

But I disagree with you about the vast majority of care: diabetes or impetigo or gout or... can and should be shopped around for, but that will take forcing providers to give up their current cash cow of simply deciding what a procedure costs.

There's a lot of ways we're unique in health care, but this is the biggest one: we're literally the only industrialized country that doesn't have a panel somewhere that sits around and says "this treatment can cost that much". We're also the only industrialized country where doctors make nearly as much as ours do (except for the Netherlands, which not coincidentally has one of the most expensive healthcare system in Europe; they also mandate private insurance).

Also, how are they to be shopped for, specialists are scarce, sometimes you body only responds to one formulation of a medication or another that's only manufactured by one or two drug manufacturers. And its not like you can choose to not have your diabetes treated anymore, that would mean your death. Its inelastic in that regard.

Basically the government says "you serve however many thousand people, so your hospital will get so many million dollars this year. Here are the price schedules our actuaries tell us will get you there; that is what you're allowed to charge."

The government sets prices all the time; I don't see why this should be different.

people get sticker shock, a person making 15-20 bucks an hour cannot easily afford a 250 dollar copay for insulin a month, and that's the lowest price for their plan, and in many cases only reflects a fraction of the actual cost.

I don't know how many times I have people, with insurance, call me and tell me they can't afford the copays on their medications, its heartbreaking. Sometimes the manufacturers come out with coupons, but those run out, eventually.

So say Amalgamated MedWidgetCo comes up with Lizinopril, which is like Lisinopril but different by one atom, and trials show it causes slightly less of a cough in some patients.

In theory, this is great, right? Now doctors have two drugs, not just one, for hypertension, and they can choose based on their patients' needs (maybe a patient who also has emphysema would go on Lizinopril or whatever).

In practice, they charge more because it's new, and bombard both physicians and patients (thankfully that may be changing soon) with ads about how much better it is (I don't know of another country with direct-to-patient advertisements for prescription drugs, either). Patients demand it ("you don't shop around for health care!&quot and insurance companies have to cover it when doctors prescribe it. But, since the original drug still works, they wish people would use it unless they needed the newer one. So they charge a copay (note that this already is screwing the guy with emphysema). And the drug companies find out about this, and offer "out of the goodness of their hearts" to send coupons to the patients to cover their copays. And to recover the coupon costs, jack up the price again the next year. Lather, rinse, repeat.

That said, our per capita spending on pharmaceuticals isn't particularly higher than Canada's; as irritating as the drug situation is it's not really the driver of costs:



(Canada is on the left, the US is on the right.)

With capitation, the health care provider (hospital or doctor) has no incentive to work very hard and long waits for treatment will become the norm. With fee for service, the provider can maximize their income by working harder (and hopefully smarter).

Military health care and two years with Kaiser, showed me the pitfalls of capitation where they are paid ahead of time.

If you sign up for an HMO, no. I can go to any hospital or doctor that takes Medicare. I will be seen quickly. I don't have to see my primary doctor before seeing my dermatologist, podiatrist, or rheumatologist. If I hurt my knee, i can go straight to an orthopedic surgeon without telling my GP. That is the kind of Medicare for all that I want.

clinics and private practices are being bought out by corporations.
Where I live, the hospital is doing just that and raising prices and coming up with new fees such as "use of the exam room." The tribe is holding out with their clinic but that is about it. Not many choices or opportunity to shop around left when this happens to a community.

Are you going to shop for a hospital with a good reputation and good rates while you are having a Heart Attack?

tired of our country being the only one out of all of the industrialized, developed world that does NOT recognize that when it comes to health care. The rest of that world doesn't even know what "medical bankruptcy" means or what it is like to worry about losing your house and most of your savings and security because of a serious or chronic illness, and they shake their head in disgust at us over that.

a broken proximal humerous/hospital stay from over a year ago because of the deductible and follow ups, etc. (FWIW, I couldn't pay much monthly because I have a massive student loan and a lot of other high expenses, but still, it's ridiculous).

commodity on an auction block? Health care is vital necessity.

do have a point and I did not mean that it should not be paid for. What I meant is that it should not be to the highest bidder like that young guy a few months ago or like the part of the TPP that wants to do the same thing.

accept multiple forms of payment.

Contrast that with medical care where you have to worry about in-network versus out-network hospitals, doctors, pharmacies, etc. You only have a few providers and choices, at least in larger metro areas, that are also within reasonable distance from home, in smaller towns and cities, choices are far fewer if not outright monopolistic.

The comparison you made is invalid.

And physicians and hospitals will go to great lengths to protect it.

Contrast that with medical care where you have to worry about in-network versus out-network hospitals, doctors, pharmacies, etc.

We have to worry about in-network because our providers make so incredibly much more than providers in other countries that we literally have to have insurance to pay for most things. The European countries that do this through private insurance have deductibles that are like our bronze plans; it's literally just for an emergency. They don't need insurance to pay for their medical care because the government mandates lower costs. And doctors make about $75K or so, rather than $200K.

controls and other methods of reducing costs. These won't need to be mandated if we don't let hospitals and doctors charge an arm and a leg for every procedure.

Also, substitution is easy - eating whatever is on sale this week will still keep you alive.

A colonoscopy isn't going to treat a gunshot wound, even if it's on sale this week.

Nobody's saying you should price trauma medicine, which is a miniscule fraction of healthcare spending anyways.

That's part of the problem.

In my city, urgent care is not available after 8pm.

Yes, I'm aware of that. I really, really wish DU could get over assuming that every difference of opinion is based on ignorance.

We were out of town and I thought my appendix had ruptured. The closest hospital didn't take my insurance. Luckily the next closest one did, and it wasn't something that required surgery.

be a part of the "free market", it is not a widget that can be bought and sold purely at will, predictably, and without necessity. A "for profit" motive should not even exist in health care, just like it shouldn't exist in public education.

A whole whole lot. The actual cases where you need a specific treatment right now or you'll die are tiny, and not what are driving healthcare costs anyways. Like I said upthread, nobody complains about food providers being for profit.

Most medical spending is on low intensity chronic care for conditions that respond to multiple types of treatments. Why shouldn't price be a factor in a patient's decisionmaking for that?

Hospitals and physicians like the idea of the US going single payer now because it legally locks in their cash cow and lets them attack any attempt to cut their payments as "cutting Medicare".

Remember, if we want a system like Canada has, we're going to ask physicians to take a 50% paycut and hospitals a 66% paycut while delivering care to 80 million more people than they are now.

and even at that, seniors without $$ for premium supplemental insurance struggle to find providers.

Where are you getting those pay cut estimates BTW?

the co-pay, and I would have been really pissed that the insurance company paid that ridiculous charge.

You know what happens if you need stitches in the UK? You go to the emergency room, nobody asks you about insurance, nobody asks you to stop by at the office, nobody takes your credit card information. They just stitch you up and send you on your way, end of story.

What a weird idea.

Seriously, it must be so nice to not have to weigh the likelihood of chest pain's being a heart attack vs. the unnecessary expense of the hospital bills in case it turns out to be indigestion.

in-network hospital. Costs need to be strictly controlled, but patients/insured need to participate in holding costs down too. I bet that's a less than $1000 service at in-network hospitals. This doesn't sound like an emergency to me, although I'm sure patient didn't think so at the time.

Some state legislatures have enacted laws that cap what out-of-network providers can go after patients for. More need to do so because single payer doesn't seem likely any time soon.

I mean this is bullshit.

Prior to my surgery, I had a number of office visits, one for an ultrasound, one for a pre-op workup that included an EKG.

Now, I had no way of knowing this, but the person who read the EKG (or the office they sent it to) was out-of-network. It was only $33, but still. How they hell was I supposed to know? And had I known, would I have been able to do anything about it?

And then, after the surgery was all done and the bills started to roll in, there was some random charge for an out-of-network thing. I can't actually remember what it was. So, again, how in the hell am I going to have any control over the fact that some people working on me are non-network?

pathologists, etc.

As to this event, the guy cut his finger. I'd have found an in-net hospital to go to. Bet he will next time too. In this case it was no secret. Now a heart attack or stroke, etc., is different. People should identify in-network hospitals so they will know where to go if they can make a decision. Just in case you will not when an emergency strikes, call your legislators and tell them to pass laws that prevent this.

We are open for business with rates guaranteed to be lower than you can find at any hospital.
Of course, you may die, but look at the DEAL we will give you.

Does this mean the free market actually works?

Did not top 50 bucks. And I am sure I am way, and I mean this, way over estimating it. With staff, perhaps 200... And again over estimating this.

We call this price gouging. Time for single payer

in America, but care is ordinary for residents of a blue-collar area. They just know how to gouge.

Continue doesn't mean they will always continue. Closing up Bayonne's techniques is being worked on right now.

This is billed on cost of care; even if Medicare negotiated its rate down 20% like it normally does, this still would cost the trust fund over $12,000. So, I mean, that's "better", sure....

because you have to take into account a few other things for the bean counters.

Truly, three suture points, and a little anesthesia is not that expensive.

Compare and contrast the cost of things like MRIs around the world to those in the United States. Heck, this... could have been done at an urgent care center as well... which are staffed, and running around the world, and replace the ER for very simple procedures like this. In fact, in some places of the world, MERE PARAMEDICS and nurse practitioners do this.

Here some numbers for you

http://healthpopuli.com/2013/04/02/u-s-health-costs-vs-the-world-is-it-still-the-prices-and-are-we-still-stupid/

This isn't a financing problem but a provider problem, and financing doesn't solve it. Medicare itself overpays significantly compared to every other country.

and that includes medicare.

The first step is profit gets out of the system. This is the huge factor that does this in the United States.

This hospital is a for profit hospital and does not accept many insurance already.

ours is well, changed, by a few that make millions.

I know the costs, and profit needs to get out. Of course, medical school cannot allow for the level of debt doctors get into. One reason they cannot afford to go into GP, because they have to pay three mortgages... right out the bat.

So some go into things like plastic surgery, when they wanted to go into GP, becuase they need to pay their debts.

Reforms are at structural levels, starting with well... yes pre med school.

I think the median Canadian GP salary is about $140K, which isn't very far below our level (though Canada has higher physician costs than most of Europe; German and French doctors pretty much never break six figures). If we brought down median physician compensation by about 10% we'd be where Canada is; we just would then have to tackle the small but expensive fraction who make ten or a hundred times the median. And Canada has more total physicians per capita than the US, though the US has more specialists per capita (and the gap between GP and specialist pay in Canada is much less than in the US, which may help explain that). But also Canadian GPs run private practices so it can be hard to get solid numbers on how much is their "salary" vs. the operating costs of that practice.

That's unlike hospitals, where really we're just paying more at every stage (in addition to having some real jerkoffs like the hospital in this OP). That may have to do with how many inputs a hospital has, which inflates the cost at each point.

than some may think

But the story with the OP is not that unusual unfortunately.

The AMA is starting to consider a single payer system, kind off sort off. but they will only do it if we also tackle student debt, and a few other other issues. And we are talking of an organization that has resisted structural reform for decades here. (I think the ACA is starting to show that it might work and the ACA was truly just futzing on the edges)

Which is why we need a system like Britain's. The insurance game isn't health care.

But the cruises for managers at luxury cabins are grand

They are a for profit hospital that doesn't accept most insurance. They bought my town's hospital and then stopped accepting Aetna, United Healthcare and some other carriers. I had to go to a neighboring town to get my annual tests.

Why are hospitals allowed to gouge consumers??? Disgraceful.....

for an insurance company not to kickback a high charge.

that once I could do... agreed

Looks like railroad tracks.

Of course I paid the bare minimum each month of my choice, they charged me 11 times what an insurance company would have paid. Legal extortion.

Stephen Thomas, director of the Maryland Center for Health Equity at the University of Maryland, praised O’Malley’s plan.

“What I see in this plan reflects some of the best of the Maryland model, and that includes addressing racial and ethnic minority populations who around the country suffer a disparity in health coverage,” Thomas said.

“We are a model to other states to show that if we want to move the needle in health coverage we must address health disparities of racial minorities,” he said.

Thomas called O’Malley’s goal of reaching a 95 percent health coverage rate “achievable.”

“Not only do I think it’s achievable, it is a goal worthy of our time and effort,” Thomas said. “Anything less is not worthy of our time.”

O’Malley’s plan also promotes universal access to reproductive health care for women, and addresses mental illness and addiction.

http://www.myeasternshoremd.com/news/state_regional/article_0c12c07f-82f8-5473-8a93-405610312eed.html

We are having another debate, right?

this coming Saturday, when MANY will be at parties, movies, etc.

Not sure what the subject of the debate will be, MAY be 'war' and such.

oh wait.

Of course, that usually means the NFL plays Saturday games.

A hospital in Phoenix charged a lady $83k for 3hrs in the ER where she received two doses of anti venom to treat a scorpion sting. The hospital paid ~$3800 for each dose from the maker of the anti venom...she was "out of network" as well.

Another hospital in San Diego (I believe) charged a man $150k to treat him for a rattlesnake bite...$83k of that was the pharmacy cost...the CNBC article does not say if he was "in" or "out" of "network".

Healthcare for profit is one thing but this is just insane.

Just don't let them use it at the ER on you or it's the same $17,000. Proof positive we need price controls for medical care in this country.

But it sounds like an error that UHC just paid without questioning it.

... shortfalls that result from other payers negotiating below-cost rates.

Why would a hospital agree to take below-cost rates? Because without the volumes from the payer in question, the economies of scale are lost and the problem would snowball.



This is why I advocate for Medicare for All, including dental, optical, hearing aids and mental health services. And yes, we can afford it.

Because the doctor over-scheduled, her time in outpatient surgery went fro 2.5 hours to 9 hours. The crooks at the hospital billed for $35,000 with a long laundry list of supplies and medication. The OB/Gyn billed $6,000. Medicare told the hospital that they were getting $1,200 and the doc that she was getting $750. They both shut up and accepted it.

Sanders for president.

Four stitches, $20K.

Our healthcare is great!!!

I know many get endless pleasure teasing me about it, would you like to know what the bill was for that to undergo rabies treatment?

Just fucking guess. Ignore that it was painful, guess how much the bill was.

And for everyone's information, it was fucking painful, and I've done my best to be a good sport about it.