If Obamacare Is Like Medicare We're In Trouble
Why become a doctor if years and years of medical school, huge student loans, high malpractice insurance costs and years of grueling training don't make you much money? Dr. Abraham Verghese writes in the WSJ about Obama's speech to the AMA:
President Obama pointed to the problem of "a system of incentives where the more tests and services are provided, the more money we pay." As if to rub it in, he added, "And a lot of people in this room know what I'm talking about."...Yes, Mr. President, a lot of people inside and outside that room know exactly what you are talking about. A skewed reimbursement scheme set up by Medicare, a system that pays generously when you do something to a patient, but is stingy when you do something for a patient, is largely to blame. Cut, poke, sew, burn, insert, inject, dilate, stent, remove and you get very well paid; if you learn how to do this efficiently, maybe set up your own outpatient center so you can do it to more people in a shorter time (which is what happened when this payment system was put in place in 1989) and you are paid even more. If, however, you are a primary care physician, and if, just like the young doctor who saw my parents yesterday, you spend time getting to know your patients, and are willing to play quarterback when your patient enters the hospital, so that you can herd the consultants and guide the family through a bewildering experience that gets surreal if you are in the intensive care unit, then you may have great personal satisfaction but you will make five to tenfold less than your colleagues in the doing-to disciplines.
He goes on to debunk Obama's fairytale that preventive care will save piles of money:
Prevention is a good thing to do, but why equate it with saving money when it won't? Think about this: discovering high cholesterol in a person who is feeling well, is really just discovering a risk factor and not a disease; it predicts that you have a greater chance of having a heart attack than someone with a normal cholesterol. Now you can reduce the probability of a heart attack by swallowing a statin, and it will make good sense for you personally, especially if you have other risk factors (male sex, smoking etc).. But if you are treating a population, keep in mind that you may have to treat several hundred people to prevent one heart attack. Using a statin costs about $150,000 for every year of life it saves in men, and even more in women (since their heart-attack risk is lower)--I don't see the savings there.
(At first, I thought he was talking about the annual cost of statins, but I don't think he is, as I looked it up, and found that the non-generic of Zocor cost $2.75 a pill -- just over $1,000 a year.)
Or take the coronary calcium scans or heart scan, which most authorities suggest is not a test to be done on people who have no symptoms, and which I think of as the equivalent of the miracle glow-in-the-dark minnow lure advertised on late night infommercials. It's a money maker, without any doubt, and some institutions actually advertise on billboards or in newspapers, luring you in for this 'cheap' and 'painless' way to get a look at your coronary arteries. If you take the test and find you have no calcium on your coronaries, you have learned that . . . you have no calcium on your coronaries. If they do find calcium on your coronaries, then my friend, you have just bought yourself some major worry. You will want to know, What does this mean? Are my coronary arteries narrowed to a trickle? Am I about to die? Is it nothing? Asking such questions almost inevitably leads to more tests: a stress test, an echocardiogram, a stress echo, a cardiac catheterization, stents and even cardiac bypass operations--all because you opted for a 'cheap' and 'painless' test--if only you'd never seen that billboard.
WSJ commenter Robert Mitchell has a wise take on the issue:
The fallacy today is that we don't have universal health care. We do have it. Anyone can get health care practically anywhere they want. The rub is that they have to pay for it.Health care isn't free. Someone has to pay for technology and labor costs. I feel much more comfortable with people making their own cost decisions than politicians making those calls. The notion that government can be a more effective negotiator if it were a single payor is another fallacy. The problem is that the government is not negotiating for an individual's benefit. The government negotiates for its own benefit, which in our government equates to enhancing re-election probabilities for incumbents, and therefore the catering to of special interests. Those incentives are way out-of-whack to deliver effective medical treatment.
I have far greater faith in people's individual abilities to save and make their own medical choices. I would favor reforms in insurance to make catastrophic policies more readily available directly to individuals. However, inserting employers and governments in between physicians and patients only serves to skew incentives and increase costs of middle men. As the preventative medicine practitioners like to pronounce, people have to take responsibility for their own health. Those who don't will have higher bills to pay. Why is this a problem?
It's not about costs or health, it's about control.
Remember, these are nanny-staters, they think they know better than we how to live our lives.
And they're going to use universal health-care as the mallet with which they will whack us until we behave.
It's for our own good, really.
NOT!
brian at June 22, 2009 4:55 AM
I wish they'd come up with something that works, though I'm not hopeful.
My son just had to go to the emergency room over a minor thing. He sat there for 6 hrs, in the hallway - not even a room. The nurses and doctors didn't seem busy. They never do. We're a small town, and every time I've been there, they're ordering lunch or dinner and casually chatting with each other. It's not like an episode of ER. Yet, I've never gotten out of there with a sick child in under 5 hrs.
All they did was check his vitals and take a blood test. There were no x-rays or other expensive procedures.
The cost? 9,000. My deductible is $5,000 because I only have a catastrophic plan. Then, there's some 80/20 co-pay. I'll probably end up paying around $7500 or so for a 6 hr (unnecessary) ER visit.
That's just ridiculous! I'm all for doctors making money, but the system has to be changed.
The interesting thing is that in areas that insurance doesn't usually cover, such as plastic surgery, prices are kept competitive. Doctors have the incentive to attract more customers, so the rate on an average breast augmentation or tummy tuck stays pretty stable or goes down, not up. Yet, the docs still make a great living. I don't see why that can't be the case in other areas.
lovelysoul at June 22, 2009 6:36 AM
lovelysoul - you should probably get the itemized bill and start going over it - you may find several charges on there worth disputing, and reduce your cost.
As far as the $150,000 per year of life saved in men, of course it's the cost of the drugs - remember the line above that: "But if you are treating a population, keep in mind that you may have to treat several hundred people to prevent one heart attack." All he did was average out the drug cost over the number of men taking them versus the probable number of heart attacks prevented and an estimate of how many years that saved for those men.
Written in words, that sounds confusing. But if 30,000 men take the Statins at $1000 per year, and it only saves one heart attack per 600 men using them, that's 50 attacks. If those men saved live an average of 4 years longer, that's 30,000 X $1000 / 50 / 4 = $150,000 per saved man per year. Each person, of course, only pays $1000 per year, but according to Dr. Verghese, less than 1% of them actually need the drugs.
WayneB at June 22, 2009 8:07 AM
Dr. Verghese wrote: "Using a statin costs about $150,000 for every year of life it saves in men, and even more in women (since their heart-attack risk is lower)--I don't see the savings there."
Using a statin doesn't prevent a heart attack in every patient. It reduces the incidence somewhat. Some people will have heart attacks while on statins, and some would not have a heart attack anyway.
Say the treatment population is 65 years old, with an expected life of 15 more years.
As an example just for the numbers, say you must treat 2250 of these men at $1000/year to prevent one heart attack that statistically would have happened. That saves 15 years of life in that one man. The cost of $2,250,000 saved 15 years of life, $150,000 per year of life saved.
Let anyone take statins as a matter of personal choice and expense. It is impossible to give this preventive treatment to everyone who would like it for free. It is easy to go bankrupt as a society if everyone must pay such costs in "prevention" to save years of life for other people.
Together, We All Pay More For Healthcare
Russell Roberts asks, if you go to dinner with a large group of strangers, and you know that the bill will be split evenly, will you order pricier dishes and drinks than if you were paying only for yourself? What about healthcare?
Andrew_M_Garland at June 22, 2009 8:08 AM
What if you went to dinner and were ordering for someone else and knew you would be sued if you ordered the wrong thing or failed to order the right thing? You'd order a lot of unnecessary items.
Conan the Grammarian at June 22, 2009 8:36 AM
I see he didn't bring up medical malpractice costs, but he's a lawyer. Lawyers do well looking out for lawyers. Doctors do well looking out for doctors. I do well looking out for myself.
MarkD at June 22, 2009 8:41 AM
That's exactly the problem, Andrew. People don't act as responsibily when they view the costs being spread out like that.
I think I read about a company - I believe "Whole Foods" - that has a kind of medical savings account program, which rewards employees with more money and bonuses at the end of the year the less they use it. The incentive is for them to choose wisely regarding their health, and when non-emergency treatment is needed, shop around and get the best price.
People don't generally worry about that with company insurance plans, but when it was in their best interest - putting extra money in their pockets - these employees discovered there was a vast difference in the cost of non-emergency care.
Although it may seem unfair to obese employees, or those with unfortunate medical conditions through no fault of their own, any health plan needs to reward individuals for maintaining good health. That way there is more money left to treat really necessary, catastrophic illnesses, which should be the goal, not providing people free statins (which likely cause liver damage anyway).
lovelysoul at June 22, 2009 8:42 AM
>>lovelysoul - you should probably get the itemized bill and start going over it - you may find several charges on there worth disputing, and reduce your cost.
Good and sensible advice, WayneB - especially as it directly affects the costs to ls.
But you know, and I know, and lovelysoul knows - she'll have a helluva fight on her hands.
You get into "Alice in Wonderland" territory the moment you battle to reduce costs to your insurance provider as well (and these battles over charges are often tangled).
It took me six months once to void a charge of $1,000 for an "unauthorized" ER visit for my son. The doctor he needed to see was doing an unexpected ER shift, so we met at his hospital office. There was no ER visit, as such. Yet it took hours and hours of calls and letters to untangle.
Jody Tresidder at June 22, 2009 8:45 AM
It's so frustrating, and I am shocked that an emergency room visit has gone up so much in the past few years. There's no realson for that.
My daughter had her tonsils out last year, and that was $14,000. Now, that is major surgery, but it lasts only about 20 mins, and we were shuffled into recovery and expected to leave within an hour. They were actually pushing her to get up and leave, while she was still too groggy, and I had to make them back off (the extra 30 mins probably cost $5,000...who knows?).
I suspect a tonsillectomy really doesn't cost $14,000. Obviously, the doctor and hospital need to make money, but what is the actual markup? It's like trying to sell a carton of milk for $3,000. We'd never stand for that, so why do we allow it in health care?
lovelysoul at June 22, 2009 9:04 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/06/22/if_obamacare_is.html#comment-1655105">comment from lovelysoulI have Kaiser because of this. An emergency room visit for me is $100. I pay $339 a month to have the Cadillac of care. I could pay $145, but I have THE most protective plan. I have to say that Kaiser's been pretty great so far. As a middle-class newspaper columnist, I can't afford Blue Cross, so I have an HMO. Are HMOs not available or good where you are?
Amy Alkon at June 22, 2009 9:10 AM
First, Anesthesiologists charge ridiculous amounts, and they NEVER cut anyone a break.
Second, the hospital is required to offer emergency care to anyone who shows up, whether they need critical care or not, whether they can pay or not. They have to make those costs up somewhere. They ought to be able to take the non-critical cases and send them to the local walk-in clinic. Cab fare is much cheaper than an ambulance in those cases too.
Third, we allow it because we let schmucks like Ted Kennedy write the laws creating things like HMOs, and we allow the states to put all kinds of ridiculous restrictions and requirements on insurers.
brian at June 22, 2009 9:36 AM
Many doctors love to set their patients up with statins (and the drug companies love them for it) but there is no solid evidence that taking them will descrease your mortality at all if you're female and precious little good epidemiological evidence for that even in men. It lowers your cholesterol but it doesn't mean you'll live any longer. Even a lot of doctors don't get that (and my experience working on a clinical practice guideline project convinced me that part of it is that they just don't understand the statistics).
Catherine at June 22, 2009 9:52 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/06/22/if_obamacare_is.html#comment-1655115">comment from CatherineThanks for mentioning that, Catherine. I had actually read that -- maybe in Taubes' work -- and also that the cholesterol/heart disease connection is not evidence-based.
PS I've been e-tormenting a prof who presented at HBES for his slide that said fatty foods cause heart disease. The evidence is not there, but he refused to look at it, and told me Ancel Keys (who I now refer to as Ancel "Mr. Selection Bias" Keys) did very solid work (not his exact words, but the gist of it). I've been sending him these e-mail with the debunking by Taubes, and goading him that if he's really a scientist, he'll look at the evidence. No response!
Depressingly, as I've learned from an epidemiologist friend and Gary Taubes, many who present themselves as scientists are merely careerists, and have little interest in the truth, especially if they've been getting grants to present what's actually the untruth for decades.
Amy Alkon at June 22, 2009 10:02 AM
I'll be 52 this November and I am not on any medication of any kind. My mom is 72, and she is not on any medication of any kind. We both have kinda low BP (is 106/64 low?). We've both been told that our bad cholesterol is low, which is good, but also that our GOOD cholesterol is low, and that's not so good, but it doesn't indicate a dire circumstance. We were told to eat less and move more. Which we've both been doing. But as long as we don't absolutely need any medication, we're not taking any. Besides, my dad takes enough for the 3 of us.
Regarding ER situations, I was just at our local one last night. Daughter #1 slammed her foot into a chair, and caused a hairline fracture to one of her toes. She's on crutches and seems to be coping fairly well. She had 2 finals today, and just called me from a friend's house. I have to pick her up in a little while to go see the orthopedic surgeon, not that he's going to be able to do anything. At the ER, they taped 2 of her toes together and sent her on her way. Told her to rest, ice it if it started to swell and take motrin for any pain. We were there a little less than 2 hours. They were having a busy night too. I haven't seen a bill yet, but the HUSKY plan she's on doesn't require a co-pay. With the insurance I used to have, it would have been a $50 co-pay for the ER visit. No ambulance, I drove her there. Not sure if the crutches would have cost anything.
Flynne at June 22, 2009 10:41 AM
I don't think I can get Kaiser here. We're very limited. My Humana PPO was reasonable at first, but they always start raising the rates from year to year. Now it's $446 per month for me and my two kids, which I guess isn't too bad, except that it's only catastrophic coverage and I rarely use it. An HMO would force me to go to doctors and hospitals about an hour away from where I live, so I'd rather have a PPO.
I used to be with a company that had emergency room coverage. I think I had a $75 deductible for emergency care, which was great, as that's about all we ever use. I dropped it because the rates got too high, but considering how the emergency costs have risen, I probably should've kept it.
lovelysoul at June 22, 2009 10:46 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/06/22/if_obamacare_is.html#comment-1655128">comment from lovelysoulPeople who live in NYC can't get Kaiser, either. It's in White Plains, though. It's not perfect, and there are plenty of people who surely have major gripes with them, but I realize I have affordable access to pretty good care (although what I pay monthly is a lot for me, I value health care and see it as one area where I won't cheap out...while I wouldn't even think of buying an organic egg these days...get the very cheapest jumbo ones at Trader Joe...$1.79 for really big'uns).
Amy Alkon at June 22, 2009 10:58 AM
Regarding the original article:
The unmentioned player here is the tort lawyer. I am surprised a doctor didn't mention this major factor in the cost of health care.
Regarding comments so far:
Lovelysoul - why did you go to the ER for a "minor" issue? Couldn't it wait till office hours?
Here in Israel several of the HMOs have walk-in clinics for after-hours "minor" issues.
Ben-David at June 22, 2009 11:39 AM
"Second, the hospital is required to offer emergency care to anyone who shows up, whether they need critical care or not, whether they can pay or not. They have to make those costs up somewhere. They ought to be able to take the non-critical cases and send them to the local walk-in clinic. Cab fare is much cheaper than an ambulance in those cases too."
That's a major reason why your insurance premiums are so high. That, and the drug companies charging $500 for a pill that cost them 1 cent to make. FYI: Drug companies spend more on advertising than R&D.
Hospital's shouldn't be allowed to soak the insurance companies to make up losses.
JoJo at June 22, 2009 11:45 AM
Ben-David, it seemed like an emergency. My son was "experimenting" brewing this exotic Amazonian tea he bought online, and after drinking it, he started feeling funny - tingling in his arms and legs, and he freaked out and thought maybe he was having a stroke or some sort of allergic reaction to it, and it was late at night, so he went to the ER. He could've waited, and I'm sort of annoyed that he didn't because he was fine (and it cost $9,000). Then again, I don't want him not to go if there is a genuine problem.
It's so fun raising teenagers! :)
lovelysoul at June 22, 2009 12:01 PM
JoJo:
Take Manufacturing 101 and get back to me. Should Microsoft sell Windows Vista for the $4.00 or so that it costs to "make" the retail disc and package? Of course not. R&D costs have to be put in there somewhere.
Same with drug companies. Should they not advertise? If it weren't for all the dick pill ads that piss me off so much, Pfizer and whomever else would have to charge a lot more for other medications because they aren't getting the windfall from V and C.
You really have no clue how commerce and industry work, do you?
Aside from the incorrect use of an apostrophe, how else should they recover those costs? Should they eat it? Or should they soak the taxpayer?
Again, the complete lack of cluefulness about how the real world works. Things cost money. If you aren't willing to pay for things, you aren't going to get them.
And that money has to come from somewhere.
brian at June 22, 2009 1:11 PM
I am always amazed at the stories I hear of bad medical care. My DS got her tonsils out, it was no where near $14k, and we were allowed to stay as long as we want, and they told us if we felt better with her staying overnight she could. All my deliveries, they asked me when I wanted to go home. When newborn was in the hospital 2 weeks ago for fever, they kept him 4 days no complaint, and would have kept him longer if I hadn't been comfortable taking him home.
I have annoyingly long waits at the pedi's office, but we get great care, so waits are expected.
Yes, insurance needs to go back to being insurance and not the current "full coverage" nonsense. And yes, government needs to get out of it. And insurance companies need to be able to sell to anyone in any state they like.
momof4 at June 22, 2009 1:43 PM
"Aside from the incorrect use of an apostrophe, how else should they recover those costs? Should they eat it? Or should they soak the taxpayer?
Again, the complete lack of cluefulness about how the real world works. Things cost money. If you aren't willing to pay for things, you aren't going to get them.
And that money has to come from somewhere.
"
Hey Brian, please explain to me why Kaiser Permanente should pay for the care of people who aren't subscribers? Yes, the money has to come from somewhere, but why should companies who aren't responsible eat the cost?
What other insurance industry can you name where companies are routinely expected to pay for the claims of uninsured people?
JoJo at June 22, 2009 2:19 PM
Well, first of all, the "insurance industry" doesn't pay dick. They're merely a clearinghouse for OPM (Other People's Money). So it isn't Kaiser that's paying, it's their customers.
As to why should Kaiser's customers pay for it? Well, who else is Kaiser going to bill for the services that they provide in their clinics? Aetna?
I suppose you believe that corporations pay taxes too.
brian at June 22, 2009 2:27 PM
"He goes on to debunk Obama's fairytale that preventive care will save piles of money"
Obama met with Kaiser's CEO a few weeks ago when he was hosting a Healthcare summit (for lack of a better phrase) along with the AMA, AHA, etc. http://xnet.kp.org/newscenter/clinicalexcellence/2009/051109halvorsonreform.html
He seems to have been impressed by Kaiser's business model. (Reminds me of the Mafia Boss that goes and checks out a family store front and decides he wants it...then pushes them to the brink of bankruptcy and then comes in to save the day --taking over the store and profits).
Obama's fairytale sounds strikingly familiar to Kaiser's preventative medicine approach to Healthcare (what they claim keeps their costs under control to provide affordable healthcare). http://news.yahoo.com/s/time/20090604/us_time/08599190270800 Check out #5
Whether Kaiser's preventative medicine approach to healthcare is where they receive the bulk in savings, which is then passed on to their members is anyone's guess. But that is the story brought to Obama.
Obama, the parrot in chief.
Feebie at June 22, 2009 3:04 PM
Then there is this nasty little bit about Pharma Companies agreement with Obama...
http://www.google.com/hostednews/ap/article/ALeqM5grrt7jGxXNvHzBA8yEmobX40UZLwD98VQP000
Feebie at June 22, 2009 3:37 PM
"What other insurance industry can you name where companies are routinely expected to pay for the claims of uninsured people?"
Plenty.
Ever heard of Uninsured Motorist coverage? Check out your Auto policy premium. More than likely you pay for another asshole who hits you and didn't bother purchasing insurance.
Anyone who writes Workers' Compensation Insurance. Insurance Fraud. Can't pay healthcare bills. Say your injury was during the course of your employment. This happens a lot.
(side bar, somewhat related)
The construction industry in California was in the practice of hiring illegals during the last housing boom. Since they couldn’t discriminate (their excuse), they did not follow up on validity of certain ethnicities' SSN's presented.
So. In one case I know of, you have claims coming in for ONE employee who has taken over five different identities, four of which have claims open on them (checks all being sent to Mexico) and one identity where the illegal immigrant is working and collecting benefits and healthcare.
Worker's compensation rates will be increasing across the board in California by 25% starting 7/1/09 - thanks in part to unsavory hiring practices of some of the housing contractors (some of which are no longer in business to pay premiums into the same pot where their crappy hiring policies resulted claim payments going out).
So, all employers (including small business owners) will suffer on account of poor hiring practices of other industries....leaving them less money to pay for benefit plans and/or hire more workers, or pay them more.
So essentially, every insurance industry transfers money around and ultimately, people who pay insurance will always be paying a portion of their premiums for others...one way or another.
Feebie at June 22, 2009 4:46 PM
>>My DS got her tonsils out, it was no where near $14k, and we were allowed to stay as long as we want, and they told us if we felt better with her staying overnight she could.
Momof4,
Can you remember what the total cost was (roughly)?
Jody Tresidder at June 22, 2009 5:53 PM
Kaiser is not available in this state except as a small part of very large multi-state contract. I talked to the HR rep and she said Kaiser says it is too expensive doing business in this state for them.
I dated a lady who worked for another HMO and she told me that most HMOs (her employer included) treated long time, no/low claim individuals very well even if they had a large claim later on. New customers and/or ones that have some claims all along get screwed. She recommended not going with an HMO but if you have been with one for 5+ years and the cost is still reasonable to not even dare thinking about leaving.
The Former Banker at June 22, 2009 6:23 PM
"As to why should Kaiser's customers pay for it? Well, who else is Kaiser going to bill for the services that they provide in their clinics? Aetna?"
Talk about missing the point. That's exactly what happens right now.
Hospitals routinely overcharge insurance companies to cover the uninsured. Check out an itemized bill sometime and note the $50 ACE bandage and the $100 bottle of aspirin. And people wonder why their insurance premiums keep going up.
Does it ever occur to anyone that maybe your premiums would be lower or your plan would cover more if the insurance company wasn't being milked dry to pay for all the uninsured?
JoJo at June 22, 2009 6:23 PM
"Hospitals routinely overcharge insurance companies to cover the uninsured."
Yes, but in Kaiser's case they ARE the hospital as well as the health plan (insurance).
They aren't likely to overcharge themselves.
Feebie at June 22, 2009 6:59 PM
So what do you propose? Not treat the uninsured? Or do you prefer to milk the taxpayers instead of the insureds?
WHO JUST HAPPEN TO BE THE SAME MOTHERFUCKING PEOPLE.
No matter how you slice it, the taxpayers are getting horked to pay for the healthcare of the non tax-payers.
Thanks, 52%!
brian at June 22, 2009 7:23 PM
If government-run healthcare is expanded, then we are all going to be spending a lot more time on the important questions of life. Here is an example of one of those important questions:
This is not a joke. This is a real "frequently-asked" (!) question posted on the Medicare/Medicaid website.
DavidJ at June 22, 2009 7:29 PM
LS, I wanna say $7k. $1500ish for anesthesia, plus surgeon, facility, etc etc. It was at Strictly Pediatrics here in Austin. The nurse assigned us just happened to be the nurse who cared for me at my maternal/fetal health specialists during my pregnancy with her, so she knew me well. I think they give great treatment to everyone though. DS actually says she wants her tonsils out again. Apparently they are REALLY nice there!
momof4 at June 22, 2009 7:44 PM
Does it ever occur to anyone that maybe your premiums would be lower or your plan would cover more if the insurance company wasn't being milked dry to pay for all the uninsured?
Also at issue is the under/uninsured being soaked for being uninsured. If you walk into an ER with an injury, insured, crappy but insured, the group negotiation may get a final bill to the insurance company of $500 with $100 coming out of the injured persons pocket.
But if I walked into the ER with the same injury, but was uninsured, the same bill would be $1500-$4500 that I would have to pay. And when it is Mr. Joe Blow -- barely keeping his head above water at a min wage job -- where is he going to come up with money for insurance.
So when the uninsured are being claimed to cost $X number of billions, trim that number by a third. Because the hospital is charging $450 for an uninsured x-ray vs $150 if you are insured.
Jim P. at June 22, 2009 8:48 PM
> So what do you propose? Not treat
> the uninsured?
Let me parenthetically note my amazement and naked, shameless audacity of this commenter.
Inexplicable....
Crid [CommentCrid@gmail.com] at June 22, 2009 9:37 PM
This New Yorker piece is a few weeks old now, but still a good read if you have not yet done so. Medical expenses don't correlate well with outcomes, and in many cases more is worse. Plus lots of other interesting nuggets less easily summarized. I think it's worth your time regardless of where you fall on the current healthcare debates. http://bit.ly/ZlmYz
Cheezburg at June 22, 2009 10:11 PM
What an enlightening article, Cheezburg. Everyone should read it. I guess what we really need is doctor reform.
lovelysoul at June 23, 2009 6:39 AM
I was just in the hospital for "day surgery".
The hospital bill just arrived: $12,476.86.
This is just the hospital portion— not the anesthesiologist or my brilliant doctor, or whatever else will show up.
The bill is itemized thus:
OR Services $11699.00
Pharmacy/IV $155.86
M&S Supplies $622.00
I am one of the lucky, o-so-lucky ones to have nice, comprehensive insurance. I don't know how much of the whole nut I'll end up paying, but one of the things I do is call the provider right away, let them know I got the bill, and begin to work out how to pay what I owe. It's a technique I learned from the days of having no insurance. The effort you make to let them know you're not a deadbeat goes a long way.
Here's what I wonder— I've heard folks say out-of-control medical costs began with the inception of Medicare. Once you can bill the government, the sky's the limit.
Here's what else I wonder— what is the impact of physicians' offices billing the insurance company directly? It didn't used to be that way. You got the bill and submitted a claim to the insurance company and YOU had to fight it out. Nowadays, most people have no idea what it costs to visit a doctor. Doctors and staff have no idea what procedures cost, either— when I had no insurance, I would have to question the necessity and cost of every request for diagnostic work. The question "How much with that blood test cost me?" was met with deer-in-the-headlights stares most of the time.
Also— are you able to get a clear picture of costs and payment with your doctors' bills? Some of the bills we get are completely incomprehensible. There's not a clear accounting of service and payments, it's a colossal jumble.
I don't even bother trying to decipher it these days because Medicare pays for my husband's stuff and I've got Cigna. But when we had no insurance, it wasn't unusual to be on the phone severl hours a week. As Willem de Kooning said, "The trouble with being poor is that it takes up all of your time."
Deirdre B. at June 23, 2009 7:34 AM
I thought the analogy in that article that Cheezburg posted was great. Something to the effect of: suppose you're building a house, but rather than pay a contractor to oversee the entire project, you pay separately the electrician for every socket he installs, the plumber for each pipe he puts in, the carpenter for every screw he drills. Is it any wonder then that you end up with a house full of sockets, pipes, and screws, and the whole thing is a mess?
The point is that no one is overseeing the doctors or the quality of medical care, and they aren't policing themselves in most areas. They're independent agents, and the incentive for many doctors is to view medicine as a revenue stream, rather than take the most effective approach for patient care.
That article really explains why a tonsilectomy here in FL is $14,000 but $7,000 in TX. Until we get a handle on that, it doesn't make a difference who writes the check - the government or insurance companies.
lovelysoul at June 23, 2009 7:51 AM
Or you.
Deirdre B. at June 23, 2009 7:57 AM
"So what do you propose? Not treat the uninsured? Or do you prefer to milk the taxpayers instead of the insureds?"
Booting out the illegals would probably reduce the uninsured load by at least 50%.
How about treating it like car insurance by mandating that people buy a basic, stripped-down policy to cover catastrophes?
JoJo at June 23, 2009 8:55 AM
I got a quote on just such a policy - $200 a month with an over $10,000 deductible.
I suspect that if I put $200 a month into lottery tickets or blackjack I'd do better.
brian at June 23, 2009 5:38 PM
Look, put aside all the stuff your parents told you, everything you want to believe and any irrelevancies about your health plan, or lack thereof, or how good or bad it is. None of this matters.
Children, everywhere, deserve decent medical care. That's it. You can make any argument you like for adults being lazy, or stupid, or undeserving - BUT Children, Everywhere, Deserve Decent Health Care. Children have no choice in their parents, their circumstances and they do not understand that because they are poor many people believe that their suffering does not matter.
I grew up ridiculously poor. Now, I am not. I grew up in a Scottish slum, I have lived in CA, USA for over four years and am now an Australian. Without state based health care, just like state based education, I would have been utterly uneducated and probably died very young. Actually, I wouldn't have been born because my mother would have died in childbirth before I even got here.
I don't see many people who attack universal health care also saying that nobody should go to school unless their parents can afford to pay for private schooling. Both are basic needs, in fact medical care is more pressing than education. You can live without an education. Try living with Cystic Fibrosis.
If you really feel that the adult poor have no right to universal health care, maybe you can make an argument, and maybe I would even agree with you - but Children, Everywhere, Deserve Decent Medical Care. Regardless of financial circumstances, regardless of race, colour, creed or arsehole parents. Regardless of their luck in the draw in the great lottery of life.
State Based Health Care is not Socialism, anybody who cares to look up the meaning of Socialism will quickly realise that.
Ensuring that all children have access to decent medical care means you are being a decent human being. That's all.
Alison Dennehy at September 20, 2009 11:40 PM
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