Sure. Until you give somebody a couple of aspirin unaccounted for and off the chart and they die by some odd happenstance.
These things seem relatively simple to you and me, but once you introduce the reasons for why a patient may be receiving medical treatment and the procedures involved in that treatment, it makes more sense.
Uncontrolled and unaccounted for variables are a nightmare in those types of circumstance.
So, it just is what it is?
$11.50 to dispense 10 acetaminophen tablets, and the only question we’re gonna ask is who is gonna pay for it?
There’s a bunch of reasons, but at least one is because antitrust has been a dead letter since the early 1980s.
Not sure I follow. Don’t hospitals compete and go out of business all the time? Is there some giant monopoly controlling this? If all the seperate hospitals have these ridiculous charges and fees wouldn’t that mean it’s a problem with the system/regulations/lawsuits? Honestly curious about your answer.
I don’t think that’s “the only question we’re gonna ask” - I think Skyz is merely pointing out the reason for the insanity, not saying we should just throw up our hands and accept it.
I have a whiny anecdote: my wife recently went to establish care with an OB/GYN (we’re planning to start a family in the next year or two). When she mentioned this, the physician suggested she get a genetic test for the cystic fibrosis gene, even though neither of us has a family history of CF, and it’s extremely unlikely that we’re both carriers of the gene (both parents have to be carriers for the child to have CF).
My wife, not yet wise to the racket, assumed that since her husband worked for the health system, we must have great insurance that would cover basically anything that the doctor had suggested was necessary (to the physician’s credit, she did suggest that my wife check to see if our insurance would cover it; however, she also had probably talked up the need for this test much more than was justified).
A few weeks later, we got a bill indicating that the cost of the test was $3,500, from which we would pay $1,200. Furious, I went and Google-searched and found that I could have ordered this test myself from a private diagnostic lab for about $400. After a bunch of (polite but firm) phone calls to different places - the billing office, the physician’s office, and our insurance - I grudgingly accepted that the ongoing headache of fighting the bill for another six months wasn’t worth it, and decided to chalk this up as an expensive lesson (my wife and I now know that before accepting any “elective” test or procedure, we have to call insurance and ask a) if it will be covered and b) how much it will cost).
This is a classic “why people hate our healthcare system” anecdote. There’s no reason the test should cost anything near that. But, as Skyz mentioned, things cost that much because we have to absorb the costs of so many other things along the way - you’re never just paying for that particular item or test. It’s insane.
Zep assumes that I’m just blindly supporting the current model. I’m not. I have a lot of problems with the current model. He’s just targeting the wrong parts of it (namely, suggesting that we need to switch to a single payer system, but also dismantle the FDA, and let people advertise basically any snake-oil that they want as medical treatment, so then the government will be on the hook to pay for “healthcare” procedures without a rigorous process to ensure that the procedures they’re paying for actually work).
This is how I see him responding haha also love The Dude
Depends on the location (obviously less of an issue in hospital-starved rural areas) - but yes, when hospital merge, prices go up:
http://www.rwjf.org/en/library/research/2012/06/the-impact-of-hospital-consolidation.html
Great, and telling, anecdote. That inspires me to share one.
One of my good friends is a physician, and he is the genuine article - wants to save the world, heal people, a true soul. That was always my archetype of a physician.
Then I started working with physicians on a variety of business deals. The vast majority of them aren’t selfless healers by nature who happen to make a lot of money because their service is highly valuable - they’re revenue maximizers looking to get rich. And they consistently exploit opportunities to goose their top line with extra procedures (in fairness, some was defensive medicine, but mostly not), elective stuff (like the kind you experienced), and slow-walking treatments (“how about six weeks of worthless physical therapy at my office before we do the inevitable surgery?”).
I’m not here to bash doctors or say they are duping us for extra bucks at the expense of providing needed care. But my own experience with them is that while they will get around to treating you (and do it well), they’ll make sure and exploit every loophole they can to milk extra revenue out of it. And it’s feasible precisely because patients aren’t educated consumers and have to rely on the physician to guide choices. In other words, it works because health care is not an adequately functioning market.
Again, anecdotally, but this type of experience is why there’s a bunch of regulations on physicians practice and engage in business. I’ve seen it with my own eyes, as I am sure you and others have.
This is extremely interesting to me, BG.
A catastrophic umbrella ALONG with an understanding from all members to neither “abuse” care or to have unreasonable expectations.
I like that.
Then there is another HUGE bug-a-boo…extremely expensive, end-of-Life (some say “delaying-death”) care…(…“We demand that EVERYTHING be done for Granddad…!”)
That is interesting, though unsurprising. Thought the below quote is odd. Maybe the private insurance keeps hospitals honest to a degree.
Hospital competition improves quality of care. This is true under both administered price systems, such as Medicare and the English National Health Service, and market determined pricing such as the private health insurance market. The evidence is more mixed from studies of market determined systems, however.
My experience is somewhat less cynical than this. I think more doctors meet the former description - truly motivated to help people - than the latter description - revenue maximizers looking to get rich. There’s an important distinction to make here, too, between private-practice docs vs. hospital-based physicians vs. a mixture of the two (would like @EyeDentist to chime in here) and people that work under different models of salary and reimbursement. Some health systems have moved away from payment-for-production because that model encouraged things like overly aggressive treatment (ordering surgery when it’s doubtful that it will actually help), ordering extra tests and/or procedures (i.e. the elective you-probably-don’t-need-this-but-our-lab-can-get-reimbursed-a-lot-of-money-for-it) and the like. I should ask - in working with physicians on your business deals, were you working with private practice docs? Or perhaps with docs who had left the practice of medicine to become Chief Medical Officer (or something similar) for businesses? That probably influences what kind of doc you’re dealing with.
Point is, I don’t think most doctors view patients as cash machines, although some definitely do. Some are overly aggressive for a less nefarious reason - they always believe that more intervention is better, they went to medical school to learn to treat people, and thus always assume that more treatment is better care.
EDIT: also wanted to highlight this quote…
“And it’s feasible precisely because patients aren’t educated consumers and have to rely on the physician to guide choices.”
This is why healthcare cannot just work like a regular free market. Consumers have no hope of being properly educated on the decisions they’re asked to make; it’s not like deciding whether to buy the $1.50 jar of pasta sauce or the $2 jar of pasta sauce at the store, or even whether to buy a $14,000 Hyundai versus a $17,000 Toyota. The decisions are not something that can be easily shopped around for or understood; you have fairly little chance to learn from a prior experience (i.e. buying the $1.50 jar of pasta sauce, deciding that it sucks, and buying the $2 jar next time…or buying the Hyundai, getting a lemon, and buying the Toyota next time) because sometimes that one “experience” is the life-or-death decision.
Yes, great point to clarify, and my post overstated my own cynicism - in my anecdote, the physicians I worked with were not representative of the whole (though probably more so than I would prefer). The kinds of deals we were doing attracted the revenue maximizing segment of the larger physician community, so I naturally had to deal with this group more than the other, and my sample size was skewed. Without a doubt, the kind of doc influenced my experience.
But, my point, which I didn’t explain well, is that I was surprised and disappointend at just how many physicians fell into this “revenue maximizer” cast, even as there are plenty of others out there. And of course, the passage of Stark laws and the like are also a reflection that the “revenue maximizing” crowd is concerningly large in our health care world.[quote=“ActivitiesGuy, post:91, topic:230931”]
This is why healthcare cannot just work like a regular free market.
[/quote]
Agreed.
You can defend a system that costs much more, sends people to BK and often has poorer outcomes if you wish. But you only embarrass yourself.
The government is bought off to keep the bottom line as fat as possible. If people get sick it is just an externality. The evidence shows that a universal healthcare is superior. Even Trump has admitted this on several occasions, most recently in a televised conversation with the Australian Prime Minister, where he said they have a better healthcare system than we do.
O care is not universal. Will they continue to loose members if universal healthcare is on the table?
The U.S. healthcare is rationed by the fact that a lot of people can’t afford it, so they have to make choices to go without.
How about a universal healthcare system which the overwhelming majority of other industrialized countries have if not all of them. But spending less money with better overall outcomes is not desirable because it will effect the bottom line of the industry and that is what is most important.
In addition to traveling in order to save money, some medical tourists plan trips because they want to have a treatment that’s not approved in the United States or because they’ll have a shorter wait by going abroad. Gasp! They may have shorter wait times. But this can’t be possible because the current propaganda says it isn’t so.
No, I won’t because I’m not defending the system (which doesn’t cost much more (I’ve explained this to you several times), only sends less than 1% of the population to BK (which is legal protection from creditors and was also explained), and may or may not have worse outcomes (you’ve never actually supported this claim).
What it boils down to is medical ethics. That is, no matter what remuneration system is employed, an ethical physician is going to endeavor to maximize the well-being of the pt, whereas an unethical one is going to seek to maximize his/her income.
In a fee-for-service system, the medical decision-making of an ethical physician is dictated solely by what s/he perceives to be in the best interest of the pt. In contrast, the decision-making of an unethical physician will be influenced by the fact that intervening provides an opportunity to earn more. Because of this, the unethical physician will seek to maximize income by performing interventions of questionable (or worse) utility.
OK then, let’s switch over to a system of universal healthcare wherein all physicians are paid a straight salary. Problem solved, right? I’m afraid not. Again, the ethical physician’s decision-making will be influenced by nothing other than what is in the pt’s best interest. In contrast (and once again), the unethical physician’s primary concern will be to maximize his/her income. In a salaried system, this is accomplished not by doing as much as possible, but rather by doing as little as possible. So in a salaried system, the unethical doctor will decide not to intervene in cases where intervention is actually needed, in order to do as little work as possible (and thereby maximize his salary in terms of income/unit of care provided).
tl; dr One cannot solve the problem of faulty medical ethics via manipulating the payment system.
I can’t answer too broadly, as circumstances vary, but I go out of pocket a’la carte as the need arises similar to what you did.
There’s a Med-Express right up the road, and I don’t require ongoing medical treatment for any chronic or terminal conditions. I also don’t see any value (at this point, for current circumstance) in dumping money into a giant risk pool, i.e.-insurance. Based on the idea that the price will rise to meet what the market will bear- why have a giant pool of money in flux with thousands of doctors trying to figure out how to get their piece of it?
That is just begging for skyrocketing prices. That might be a mangled and oversimplified way of looking at it, but that’s just my view.
When the entire industrialized world runs their healthcare for a fraction of what the U.S. does often with better outcomes, is it any wonder people clamor for a better system? The evidence is all around us. But you can’t admit to it as it will begin to crumble your economic ideology.
It is too bad for you and your ilk that the evidence is all around about the superior results gotten from a universal system. Even Trump has admitted as much.