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[NZNova]

Surely at some point the american public at large has to realise just how badly they are being fucked, right?

 

[demon]

Surely at some point the american public at large has to realise just how badly they are being fucked, right?

You can always count on the stupidity of the American people.

 

[RDreamer]

Surely at some point the american public at large has to realise just how badly they are being fucked, right?

Until someone figures out some better marketing and buzzwords that can catch the masses... no.

 

[dojokun]

Depends on who the facility is contracted with. They aren't just making up charges. These places have set fee schedules depending on which payers they're contracted with. High charges like that are there for out of network payers processing through payer networks that reimburse really well... They never anticipate collecting those amounts. Really it comes down to your insurance plan, but it's always a good idea to see which facilities are in network with your insurance before deciding on where to have the procedure performed.

Often times the OON facilities will do exactly what you said, offer discounts to keep you at their facility. Gotta shop around for he best deal like you would do for anything else you're paying for.

surrogate specified that he didn't have insurance.

 

[Piecake]

I knew our healthcare system was a complete fuck up, but I didnt realize it was this bad. What a fucking racket

 

[Ekdrm2d1]

Thread makes me sad.

The U.S. Healthcare system is awful. Then again, I've never been to another country and needed medical help. 3rd world medical could be much worse than here.
Edit: The actual treatment is good. The billing/costs/insurance is awful.

Due to my recent medical bills, I would say screw gun policies and focus on healthcare. Stubborn of me, I know. Healthcare has been a political debate for the past 30 years or something. Nothing new. Seems like the same political debates go on for ever. Gay, Guns, Healthcare, Retirement, etc. etc.

lol :/

 

[scurker]

It took a while to get through the article, but it was a good read. I'm unfortunately too keenly aware of the cost of the medical system.

I used to ride my bike to and from work. About 5 months after I graduated from college, a guy ran a light and hit me, shattering my shoulder and knocking it out of socket among other things. That night in the emergency room, I had several CT scans, MRIs, X-rays and other things I don't really remember. $12,000. They couldn't perform surgery at the time, because there was nothing to attach anything to so I had to wait a month to get a titanium plate and about 14 screws put into my shoulder, and having to stay overnight. $20,000. About a year later due to nagging pain I ended up getting the plate and screws removed in outpatient surgery at the cost of $18,000. All said and done, the invoices from the hospital ended up being over $50,000.

But hospitals are only a part of the problem. My health insurance, United Health Care had the balls to tell me they weren't going to pay and was expecting me to foot the bill because the other guy didn't have enough coverage. What kind of screwed up world is that?

I eventually only had to end up paying $3,000 out of pocket. I was out of work for almost 4 months and was not eligible for short term disability, so I also lost out on the money I would have made during that time not to mention nearly having a mental breakdown having to fight insurance. Needless to say, there's still an ongoing lawsuit that I don't think I'm ever going to see the end of.

 

[ElRenoRaven]

Great read. I've seen it first hand. It's bullshit. It's nothing but pure greed. Take me. I went in to the ER one day. My visit resulted in the use of a reusable scalpel and some gauze bandages and a local to numb the pain. There were no tests nothing done other then those things used. 10 minutes of time to make the cut and do what they had to do. Keep in mind the wait was 30 plus minutes.

So what did this cost me you might ask. After then knocking a grand off since I was poor and had no health insurance it only cost me 1400 dollars. I'm not kidding either. 1400 dollars for that. Keep in mind had I had a ton of disposable income it would have been 2400 dollars. You know damn well they sanitized that scalpel and reused it again and again. The gauze I had to buy more of at the store. Cost me 3 bucks for enough to last 2 weeks. So you better believe our system is beyond fucked up.

 

[The Interrobanger]

I tore my ACL and Meniscus in November, had MRIs/ultrasounds/xrays done pretty much right away, surgery #1 in January and surgery #2 two weeks ago. Had to go to the ER twice in the last few weeks due to surgery side effects and such. Also had a follow up and got my stitches out on Tuesday. Did I mention my surgeon is the official orthopedic surgeon for the Toronto Maple Leafs?

My bill: $

Spoiler

00000

Thanks Canada!

 

[CharlieDigital]

I think by "UHC" he meant specifically single payor. His point is that a single payor system in America would either force American health insurance companies out of business, or reduce them to a small niche market.

My point is that it would not.

That is the meaning of "false dichotomy".

You can have UHC -- single payer -- and still have private health insurance as well.

 

[Evlar]

Finally finished it. Good research that hopefully wakes people up. Neatly addresses a number of the bullshit excuses for the extortion prices.

He loses his nerve at the end, though. Here's an article filled with details of how the powerful, armed with the power of giving life and ending pain, fitted with vast institutional resources and the favor of their communities, of politicians, of the courts, use this power to drive the sick and families of the dead into poverty. It's a tale of injustice on a Biblical scale. And, after successfully following the plot and confronting the practical solutions to these terrors, the author shrugs and says that we shouldn't really change things, change is hard, and you know, some people would lose (the people doing the exploiting). He advocates a few little reforms to slow the jackals down a step or two.

Bullshit. The beast cannot be reformed. It feeds on human blood (quite literally). It must be killed.

 

[Ezduo]

The author of this is on The Daily Show right now.

 

[empty vessel]

Finally finished it. Good research that hopefully wakes people up. Neatly addresses a number of the bullshit excuses for the extortion prices.

He loses his nerve at the end, though. Here's an article filled with details of how the powerful, armed with the power of giving life and ending pain, fitted with vast institutional resources and the favor of their communities, of politicians, of the courts, use this power to drive the sick and families of the dead into poverty. It's a tale of injustice on a Biblical scale. And, after successfully following the plot and confronting the practical solutions to these terrors, the author shrugs and says that we shouldn't really change things, change is hard, and you know, some people would lose (the people doing the exploiting). He advocates a few little reforms to slow the jackals down a step or two.

Bullshit. The beast cannot be reformed. It feeds on human blood (quite literally). It must be killed.

Hear, hear.

 

[lmpaler]

It took a while to get through the article, but it was a good read. I'm unfortunately too keenly aware of the cost of the medical system.

I used to ride my bike to and from work. About 5 months after I graduated from college, a guy ran a light and hit me, shattering my shoulder and knocking it out of socket among other things. That night in the emergency room, I had several CT scans, MRIs, X-rays and other things I don't really remember. $12,000. They couldn't perform surgery at the time, because there was nothing to attach anything to so I had to wait a month to get a titanium plate and about 14 screws put into my shoulder, and having to stay overnight. $20,000. About a year later due to nagging pain I ended up getting the plate and screws removed in outpatient surgery at the cost of $18,000. All said and done, the invoices from the hospital ended up being over $50,000.

But hospitals are only a part of the problem. My health insurance, United Health Care had the balls to tell me they weren't going to pay and was expecting me to foot the bill because the other guy didn't have enough coverage. What kind of screwed up world is that?

I eventually only had to end up paying $3,000 out of pocket. I was out of work for almost 4 months and was not eligible for short term disability, so I also lost out on the money I would have made during that time not to mention nearly having a mental breakdown having to fight insurance. Needless to say, there's still an ongoing lawsuit that I don't think I'm ever going to see the end of.

Jesus man, that is ridiculous.

My experience with our glorious healthcare system was when my daughter was thought to have Hand,Foot, And Mouth disease that was spreading around the school system. Nothing fatal, just bumps on the skin and HIGHLY contagious. I took her into the ER because the Children's ER wasn't open for another 45 minutes. Waited 10 minutes, went to the back, a nurse came in and asked questions. She was really nice, checked out my kid and left. Doctor comes in, waves his flashlight in her ears, hands, and mouth and was out in literally less than 60 seconds. Nurse came back in, walked us out, took me to billing. Few weeks later I get a bill of $500 from the hospital and $200 for the doctor....for 60 fucking seconds.

 

[phosphor112]

I work in healthcare, I teach healthcare classes in college. I've shown many stats to my students about the disparity of our healthcare system in contrast to other first world countries in that we are the only first world country that does not have universal healthcare.

But but but waiting in line. =[.

It's funny... some people wait all life to go to a hospital because they don't want to be broke for the rest of their life, and by the time they do, the end up being super fucked up and those costs hit everyone.

Like waiting a little longer to be treated is such a bad thing in comparison...

 

[phosphor112]

I work in radiology. Even being exposed to this one slice of the medical world, I can tell you they ARE making up shit.

Here in California, insurance companies pay anywhere from roughly $400 to $550 for an MRI without contrast. Add another $100 or so for "with contrast." The type type of MRI is actually the first two done one after the other, "without and then with contrast." But it's considered a third type because MRI providers provide this option as a cheap package to get people to order it. It has its own CPT code. The price of this is about another $100 on top of the MRI with contrast.

So in CA expect insurance companies to pay like 500/600/700 (price of without/with/without and then with contrast) on average.

Over in Oregon, insurance companies are paying something like 800/900/1000 on average.

Why the discrepancy? MRI machines cost more in Oregon? MRI techs, radiologists, and other medical staff paid way more in Oregon? Medical companies taxed way more?

No. It's supply and demand.

On top of that, search the internet for stories about people getting charged thousands of dollars for an MRI. Even on NeoGAF I remember someone saying something like they were charged $8000 for one. At a bar here in LA a guy I met told me he was charged $5k for a CT scan. (CT scans are actually CHEAPER than MRI scans. Here in CA on average the insurance companies are paying like, 275/325/375 or so for a CT scan for without/with/without and then with contrast). My barber told me an MRI costs $15000, based on the fact that he was charged that much for one. I didn't have the heart to inform him of what insurance companies are paying.

You will also notice that the high prices people are paying are not consistent. My barber was charged $15k while other people are charged $8k or sometimes $1k. When charging the patient, the medical providers make that number up based on their individual thinking. When charging insurance companies, they have to deal with a market value, because insurance companies have the luxury of having some leverage in negotiating. Insurance companies negotiate rates from the comfort of their desk, before they send any patients over to the medical providers. Patients standing at the receptionist counter of an MRI provider are not in the same position.

If that was too long to read, just read this: Medical providers charge you thousands of dollars for radiology scans that insurance companies pay hundreds of dollars for.

If you want some proof that MRIs and CTs don't cost as much as people are getting charged, go to look up Medicare rates. It shows you how much the government pays for an MRI, a CT, or any other operation covered in Medicare. I just happen to work in radiology and can tell you that insurance companies pay a couple hundred more for an MRI than what the government pays. Individual people often pay thousands more.


The prices will not go down if the industry remains for-profit. That's why the only type of UHC that will work is the single payor. UHC in the form of making everyone buy insurance from for-profit companies (like the ACA does) will do nothing to lower costs.

Great post. I'm in radiology as well. Not IN MRI, but literally a stones throw away. We had a meeting the other week and they wanted us to streamline our scan-checks so we can get kids (in a children's hospital) in and out of the MRI faster so we can get more people in, and thus, more people charged. They said that MRI is the "money maker" compared to the rest of radiology. I honestly don't even think IR is as expensive even though it's a more involved processes... it's likely because of what you said... demand. Taking a kid to the IR suite happens once in a while. Patients getting scanned on the MRI's? 40+ during the 8-5 hours.

Oh, and I don't even know how much the 3T scans cost, but I know it's stupidly more expensive.

EDIT: You mentioned Pre and post costs along with pre/post... It's funny how much adding a perfusion costs to the thing. If you're doing a pre/post anyway, perfusion is basically a timed sequence... there is no addition materials as the gadolinium is already given, but you know what? Dump on an extra several thousand dollars to the cost...

 

[Schattenjäger]

Amazing article and perfectly articulates my problem with Obamacare

 

[CyclopsRock]

Can you give me an example of such?
I know the medical world imposes ridiculous rules on themselves (crazy work hours, huge residency requirements, ridiculous requirements for out of country doctors to certify to work in the US). But the government doesn't have much say in that. They just say "The docs must be certified" rules for certification are (probably fortunately) out of congress's hands.

I'm totally for that being streamlined however, I don't believe that'll lead to big savings. I have several friends that are doctors. And all of them, except one, has given up having their own practice to practice under a large conglomerate. The reason being that sure they'll make less money but they get vacation and don't have to worry about logistics. So it doesn't really matter if someone is willing to come and work for half the price. The cost/stress of running that will eventually drive them out of the market or to the conglomerates and they aren't lowering their rates.

I'll be honest, I'm not entirely sure what any of this has to do with what I said. I'm certainly not saying you're wrong, I just don't understand why you're saying it to me. I'm not saying the costs will come down if we bonfire the red tape and let any old Dr Jekyl perform open heart surgery.

In the UK, there has been a recent example of a hospital (Hinchingbrooke if you're interested in reading up on it) with an awful, terrible record. It was, as most hospitals in the UK are, run by the NHS and came bottom of a lot of patient surveys regarding satisfaction whilst running up a debt of £39m. As such, it was faced with closure and its patients subsumed into surrounding hospitals, but instead they ended up giving it to a private sector company to run. They got the same money and budgets to run it as the old administration had. Within 6 months, it had climbed to the top of its local patient satisfaction surveys. It had drastically cut the rate of 'superbugs' on its wards. It has also reduced the hospitals debt to just under £5m. It's not all perfect, of course - they had planned to have reduced the debt further by now. Their surveys are also on the way back down, albeit still far higher than they were before the private management took hold. I say this not to suggest "Hey, it we privatised all our hospitals, everything would be amazing!" Aside from anything, this experiment - and it was an experiment - is happening in isolation.

A system I'd want to see is one like the one at Hinchingbrooke but with further privatisations in the same area, so that you can actually leverage competition, as Hinchingbrooke had no competition, it just had better management. What I envisage is a system whereby patients can choose which hospital they go to based upon specialisms they might have, or survey results or personal recommendations, not being forced to go to their local one as now, a system which allows hospitals like Hinchingbrooke to slide so far down in the first place because, well, what are people going to do? The crucial thing here is that it's still free at the point of use. The patient wouldn't know any different, other than (in the example of Hinchingbrooke), the quality of their care has improved. It's still under the NHS banner, it's just run by a different set of people. If they can provide a better service and still make a profit, that's no skin off my nose. This way, if a hospital can "attract" more patients because of its reputation for quality, and that makes it more money, then it'll encourage competition. None of this happens in the US.

 

[Dead Man]

England. I realize individual care doesn't tend to be as good as in the US, but its not going to destroy me financially.

Nah, it's just as good. You may not have access to shit you couldn't afford anyway if you were inthe US, but that is not really much of a dealbreaker for most.

 

[kmag]

I'll be honest, I'm not entirely sure what any of this has to do with what I said. I'm certainly not saying you're wrong, I just don't understand why you're saying it to me. I'm not saying the costs will come down if we bonfire the red tape and let any old Dr Jekyl perform open heart surgery.

In the UK, there has been a recent example of a hospital (Hinchingbrooke if you're interested in reading up on it) with an awful, terrible record. It was, as most hospitals in the UK are, run by the NHS and came bottom of a lot of patient surveys regarding satisfaction whilst running up a debt of £39m. As such, it was faced with closure and its patients subsumed into surrounding hospitals, but instead they ended up giving it to a private sector company to run. They got the same money and budgets to run it as the old administration had. Within 6 months, it had climbed to the top of its local patient satisfaction surveys. It had drastically cut the rate of 'superbugs' on its wards. It has also reduced the hospitals debt to just under £5m. It's not all perfect, of course - they had planned to have reduced the debt further by now. Their surveys are also on the way back down, albeit still far higher than they were before the private management took hold. I say this not to suggest "Hey, it we privatised all our hospitals, everything would be amazing!" Aside from anything, this experiment - and it was an experiment - is happening in isolation.

A system I'd want to see is one like the one at Hinchingbrooke but with further privatisations in the same area, so that you can actually leverage competition, as Hinchingbrooke had no competition, it just had better management. What I envisage is a system whereby patients can choose which hospital they go to based upon specialisms they might have, or survey results or personal recommendations, not being forced to go to their local one as now, a system which allows hospitals like Hinchingbrooke to slide so far down in the first place because, well, what are people going to do? The crucial thing here is that it's still free at the point of use. The patient wouldn't know any different, other than (in the example of Hinchingbrooke), the quality of their care has improved. It's still under the NHS banner, it's just run by a different set of people. If they can provide a better service and still make a profit, that's no skin off my nose. This way, if a hospital can "attract" more patients because of its reputation for quality, and that makes it more money, then it'll encourage competition. None of this happens in the US.

The company running Hinchingbrooke haven't started extracting profit yet. The contract terms means they needed to resolve the initial problems first then they can take £2 million in profit from any surplus generated. The hospitals operating deficit has increased to £4.1 million, the debt decrease was essentially a paper exercise. At an operating deficit of £5 million, Circle (the company running the hospital) can walk away from the contract without penalty.

Circle's initial approach was 'interesting' they bumped up spending on the highlight targets (A&E and cancer treatment timetables) but gutted the cleaning contract (removing almost all nighttime cleaning).

 

[CyclopsRock]

The company running Hinchingbrooke haven't started extracting profit yet. The contract terms means they needed to resolve the initial problems first then they can take £2 million in profit from any surplus generated. The hospitals operating deficit has increased to £4.1 million, the debt decrease was essentially a paper exercise. At an operating deficit of £5 million, Circle (the company running the hospital) can walk away from the contract without penalty.

Circle's initial approach was 'interesting' they bumped up spending on the highlight targets (A&E and cancer treatment timetables) but gutted the cleaning contract (removing almost all nighttime cleaning).

Sure, but they only took over a year ago (almost to the day). I think the signs are very promising, and at the very least they open up the possibility of private involvement in an area that's incredibly resistant to change. People seem to conflate the idea of "good quality, free at the point of use, universal healthcare system" with "enormous government monopoly". But they don't have to be conflated. It's the former that people love and go on marches for and who create #saveourNHS hashtags for, not the latter.

 

[jerry113]

I just got my teeth cleaned at a good dentist for $30 USD in Korea with no insurance. Yay Korea.

 

[scurker]

Jesus man, that is ridiculous.

And a lot of my charges were ridiculous too. One of the ones that comes to mind is the physical therapist fee. Basically she came in for 60 seconds, told me to swing my arm back and forth and gave me a sheet of paper with exercises. That apparently was worth $500.

And that's part of my issue with Obamacare. Sure, removing prior conditions and fixed caps helps but it doesn't really solve the root of the problem.

 

[mackattk]

I knew our healthcare system was a complete fuck up, but I didnt realize it was this bad. What a fucking racket

I figured this out when about two years ago after looking at threads such as these. If it wasn't for the personal accounts here, I would probably be one of the mindless drones that believe socialized healthcare is bad, and why should I pay for someone elses poor lifestyles choices?
I try not to think about it because it pisses me off so much.

 

[GaimeGuy]

I figured this out when about two years ago after looking at threads such as these. If it wasn't for the personal accounts here, I would probably be one of the mindless drones that believe socialized healthcare is bad, and why should I pay for someone elses poor lifestyles choices?
I try not to think about it because it pisses me off so much.

Why do you need anectodes when all the statistics point to the exact same conclusion?

 

[Hari Seldon]

Why do you need anectodes when all the statistics point to the exact same conclusion?

Well the anecdotes show how the statistics impact individuals, which may be hard to see since I'd say a lot of voters have decent enough health insurance and never had a serious illness. That is why this article is such a brilliant piece of old school journalism. He mixed in anecdotes, statistics, and simple old school reporting in order to make a clear case that can satisfy any doubter.

 

[JimmyRustler]

Thank god I live in Austria. Income taxes are huge but I don't really care. At least I don't have to fear of going bankrupt if I ever end up in a hospital.

 

[Dyno]

Read the article last night. Astounding. So now it seems like while banks and oil and all of the other evil corporate industries were sapping America's strength, it was the medical industry that was taking over biggest of all, creating businesses bigger than the towns they set up in.

Medicare for everyone is the answer. They seem to have created the culture that cuts through the medical chargemaster bullshit and will pay only what the service is truly worth. Run by congress too, which gives hope, it shows that America's political system can fix this problem with the tools already in place.

 

[AbsolutBro]

*hugs his nonprofit G.E.H.A. health insurance*

It cost me a bit more in terms of premiums than some of the other options, but the idea that there isn't something judging my life vs profit on the other end of the bill makes it worth it. I believe someone here posted an article about GEHA being tapped to run the public option, and if so I think that's a good start. GEHA isn't strangled by congress the way Medicare is.

 

[soul creator]

Read the article last night. Astounding. So now it seems like while banks and oil and all of the other evil corporate industries were sapping America's strength, it was the medical industry that was taking over biggest of all, creating businesses bigger than the towns they set up in.

Medicare for everyone is the answer. They seem to have created the culture that cuts through the medical chargemaster bullshit and will pay only what the service is truly worth. Run by congress too, which gives hope, it shows that America's political system can fix this problem with the tools already in place.

http://www.pnhp.org/publications/united-states-national-health-care-act-hr-676

 

[mackattk]

Why do you need anectodes when all the statistics point to the exact same conclusion?

These anecdotes more or less opened my eyes. Here in east tennessee, all I hear is that our health care system has its problems, but it is a hell of a lot better than the socialized mess that is going on in other countries.

 

[Hari Seldon]

Read the article last night. Astounding. So now it seems like while banks and oil and all of the other evil corporate industries were sapping America's strength, it was the medical industry that was taking over biggest of all, creating businesses bigger than the towns they set up in.

Medicare for everyone is the answer. They seem to have created the culture that cuts through the medical chargemaster bullshit and will pay only what the service is truly worth. Run by congress too, which gives hope, it shows that America's political system can fix this problem with the tools already in place.

You know, a good first step would be Medicare *prices* for everyone. That way the government incurs no debt, but the government negotiates healthcare prices for everyone.

 

[GaimeGuy]

These anecdotes more or less opened my eyes. Here in east tennessee, all I hear is that our health care system has its problems, but it is a hell of a lot better than the socialized mess that is going on in other countries.

In other words, you ignored the hard studies based on your "gut" instinct.

This is a prime example of how the crusade against critical thinking over the last 30 years by modern conservatives is causing problems.

You're embarassed about the fact that you would have been one of the "mindless drones" if it weren't for the accounts of people here, as you said.

You should be far, far more embarassed about the fact that you ignored statistical evidence simply because people said America is awesome.

I'm not trying to belittle you. I'm just trying to get you to realize there's a bigger issue with your previous viewpoint than its "correctness," or the anectodes (or lack thereof)

 

[Azih]

What I envisage is a system whereby patients can choose which hospital they go to based upon specialisms they might have, or survey results or personal recommendations, not being forced to go to their local one as now

I can't speak for the UK NHS, but in the Canadian system a patients is free to go to any hospital they wish.

One example of red tape that you raise, the one about insurance companies not being able to work across state lines, concerns me though. From my understanding when that was allowed in other fields of insurance all the insurance companies just 'moved' their headquarters to the states with the most insurer friendly, consumer unfriendly laws allowing an ugly race to the bottom. That's not good for anybody except the insurance companies.

 

[GaimeGuy]

I can't speak for the UK NHS, but in the Canadian system a patients is free to go to any hospital they wish.

One example of red tape that you raise, the one about insurance companies not being able to work across state lines, concerns me though. From my understanding when that was allowed in other fields of insurance all the insurance companies just 'moved' their headquarters to the states with the most insurer friendly, consumer unfriendly laws allowing an ugly race to the bottom. That's not good for anybody except the insurance companies.

You are exactly correct.

Try finding a credit card from a state other than South Dakota or Delaware, for instance.

 

[CyclopsRock]

I can't speak for the UK NHS, but in the Canadian system a patients is free to go to any hospital they wish.

Alas, they aren't here. A few reforms have been done recently (in the last 10 or so years) to try and instigate it, but generally speaking you go where you're told.

One example of red tape that you raise, the one about insurance companies not being able to work across state lines, concerns me though. From my understanding when that was allowed in other fields of insurance all the insurance companies just 'moved' their headquarters to the states with the most insurer friendly, consumer unfriendly laws. That's not good for anybody except the insurance companies.

Well a) that's the case with all the other businesses too, and states are free to legislate specific demands on activities within their state if they want and b) the problem with limiting companies to a single state is that the smaller the areas in which companies can compete, the less competition there will be. This is especially true when insurance companies have agreements with certain hospitals that give them a degree of exclusivity.

 

[mackattk]

In other words, you ignored the hard studies based on your "gut" instinct.

This is a prime example of how the crusade against critical thinking over the last 30 years by modern conservatives is causing problems.

You're embarassed about the fact that you would have been one of the "mindless drones" if it weren't for the accounts of people here, as you said.

You should be far, far more embarassed about the fact that you ignored statistical evidence simply because people said America is awesome.

I'm not trying to belittle you. I'm just trying to get you to realize there's a bigger issue with your previous viewpoint than its "correctness," or the anectodes (or lack thereof)

I do realize that there is a bigger issue, and indeed it is a problem. My parents are big fox news supporters, and by growing up in that environment skewed my views toward their beliefs. Any statistical evidence I saw that was on tv and local news backed up my parents beliefs.

I will say that I am not ashamed or embarassed by what I thought or believed before I saw how things really were. Its a life lesson, something that few people get to experience, based on the public opinion in my local area. You can't really fault people if they are a product of their environment. The blame is solely based on the top that dictate what information is going out to the public.

 

[Azih]

Alas, they aren't here. A few reforms have been done recently (in the last 10 or so years) to try and instigate it, but generally speaking you go where you're told.

I'm a bit confused. Are you in the UK or the US?

Well a) that's the case with all the other businesses too,

Sure, and it's not a good thing. Races to the bottom never are. And healthcare is a market which inherently has very inflexibly supply and very harsh demand for people in need.

b) the problem with limiting companies to a single state is that the smaller the areas in which companies can compete, the less competition there will be.

Maybe but I don't think the corollary, that the greater the area the more competition there will be, is true.

I agree that insurance companies would benefit by having a larger pool of customers in order to spread out the risk but I don't know why that benefit would be passed down to the consumers. And heck the spreading of riskl is why universal systems are even better that some large powerful multi state insurance conglomerate.

 

[Azih]

In other words, you ignored the hard studies based on your "gut" instinct.

I don't think that's fair at all.

It's more like the very environment a lot of people grow up and live in doesn't even mention said hard studies and people form their convictions and opinions based on that.

Edit: Basically I think you're not addressing the real issue. It's not that people are anti-intellectual as such, it's that people tend to believe people who they think are authorities on a subject and who is portrayed as authoritative is heavily influenced by the media.

For example I know nothing about cars. If I see some guy on TV who looks like a gear head and is using car lingo that I'm not familiar with then I'm going to assume he knows what he's talking about and accept it even though it may be complete bullshit or incredibly inaccurate. I don't care enough about the subject to delve deep enough to judge its accuracy but I've accepted it.

 

[demon]

I don't think that's fair at all.

It's more like the very environment a lot of people grow up and live in doesn't even mention said hard studies and people form their convictions and opinions based on that.

This.

Give the guy a break. He's from a region of the country that is hostile to the notion that American healthcare isn't best healthcare. At least he was able to open his eyes.

 

[CyclopsRock]

I'm a bit confused. Are you in the UK or the US?

The UK.

Sure, and it's not a good thing. Races to the bottom never are. And healthcare is a market which inherently has very inflexibly supply and very harsh demand for people in need.

Well, firstly I'd argue that it's not at all the case that 'races to the bottom' are never a good thing. The same race to the bottom that lowers the level of regulation and decreases wages also decreases the prices of things. "Race to the bottom" is just another way of saying "competition", and the forces that inspire us to be able to buy a PC for $25 or a tablet for $70 are the same ones as those which force employees to take lower wages through threat of outsourcing, or cause countries to lower tax rates to encourage companies to headquarter there. To say it's unequivocally "good" or "bad" is silly.

I'd also argue against the idea that healthcare has an "inflexible" supply. This whole article and thread has demonstrate how huge the markups are in the healthcare industry - a lot of profit is being made at the expensive of insurance payers (and, often, insurance companies). Supply inflexibility only really occurs in markets where the margins are either very low (and so a new company could not afford to survive unless they steal a huge chunk of the market share) or where regulation is otherwise "artificially" limiting ones ability to grow. I don't think that either of these are "inherent" to healthcare, that's just how it is in the US right now.

Maybe but I don't think the corollary, that the greater the area the more competition there will be, is true.

I agree that insurance companies would benefit by having a larger pool of customers in order to spread out the risk but I don't know why that benefit would be passed down to the consumers. And heck the spreading of riskl is why universal systems are even better that some large powerful multi state insurance conglomerate.

Well I'd say that they're more likely to pass it on to the customers because they'd need to compete with so many other companies. The fact that insurance companies are also exempt from anti-competition laws is another stroke against competition in the market. But again, I don't think it's inherent to healthcare, that's just how it is in the US right now.

And you're right in your last sentence, but if you read my posts in this thread back you won't find me supporting the US system. The US system is awful. If I were tasked with designing the worst healthcare system I could, it wouldn't be dissimilar to the US system. What I have been arguing against in this thread is the idea that for-profit companies have no place in the healthcare industry. I think they absolutely do, and that there is a huge gulf of options between the US system and the entirely (or almost entirely) nationalised system in the UK.

 

[Azih]

Well, firstly I'd argue that it's not at all the case that 'races to the bottom' are never a good thing. The same race to the bottom that lowers the level of regulation and decreases wages also decreases the prices of things. "Race to the bottom" is just another way of saying "competition", and the forces that inspire us to be able to buy a PC for $25 or a tablet for $70 are the same ones as those which force employees to take lower wages through threat of outsourcing, or cause countries to lower tax rates to encourage companies to headquarter there. To say it's unequivocally "good" or "bad" is silly.

It's called the 'bottom' for a reason. Reduced worker safety standards, reduced wages leading to the rise of the working poor, lax environmental protections, 'headquarters' in the lowest tax jurisdictions possible etc are what I am referring to. Buying a tablet for 70 bucks is poor compensation.

I'd also argue against the idea that healthcare has an "inflexible" supply. This whole article and thread has demonstrate how huge the markups are in the healthcare industry - a lot of profit is being made at the expensive of insurance payers (and, often, insurance companies). Supply inflexibility only really occurs in markets where the margins are either very low (and so a new company could not afford to survive unless they steal a huge chunk of the market share) or where regulation is otherwise "artificially" limiting ones ability to grow.

Disagreed. It takes a lot of time to train nurses let alone doctors and specialists. No matter how much money you spend you can't pull a neurosurgeon out of a hat.

I agree with you that there is a place for private companies in healthcare. In Ontario, Canada for example things like X rays,ultrasounds, etc.are carried out by private companies. They're still regulated though and the government is still the single payer. Patients still just show their healthcard. It works well in my experience. There are a lot of benefits to single payer.

Market discipline in my view goes flying out the window when barriers to entry are high (and they are high in a lot of industries, including healthcare) and the existing players realize it's better for them to collude rather than engage in price wars. Consumers aren't who private companies work for after all, they work for the shareholders.

Edit: Especially when big players start gobbling up small operators as inevitably happens.

 

[CyclopsRock]

It's called the 'bottom' for a reason. Reduced worker safety standards, reduced wages leading to the rise of the working poor, lax environmental protections, 'headquarters' in the lowest tax jurisdictions possible etc are what I am referring to. Buying a tablet for 70 bucks is poor compensation.

I don't really understand what you're arguing in favour of. I assume it's not high prices, so what? Is there a specific price point which is deemed "good" - anything lower than that is poor compensation and anything higher is putting too large-a pressure on people's finances? In the last few decades, the percentage of ones income that has been spent on things like food and clothing has gone down, and the amount spent on entertainment and luxury goods has gone up - and that's not because they're earning so much more.

Disagreed. It takes a lot of time to train nurses let alone doctors and specialists. No matter how much money you spend you can't pull a neurosurgeon out of a hat.

Well I'm not talking about changing the system for the better over night. Any reform to healthcare has to be done with a long term view. You can't pull a neurosurgeon out of a hat, but that's not a good reason not to do something that will otherwise be beneficial. If you don't think it will, that's fine, but people train in response to market trends - you can't wait for the training before enacting the change that incentivises people to do said training.

I agree with you that there is a place for private companies in healthcare. In Ontario, Canada for example things like X rays,ultrasounds, etc.are carried out by private companies. They're still regulated though and the government is still the single payer. Patients still just show their healthcard. It works well in my experience. There are a lot of benefits to single payer.

Market discipline in my view goes flying out the window when barriers to entry are high (and they are high in a lot of industries, including healthcare) and the existing players realize it's better for them to collude rather than engage in price wars. Consumers aren't who private companies work for after all, they work for the shareholders.

Edit: Especially when big players start gobbling up small operators as inevitably happens.

There's always a risk of that, but the US has that now already - it's not really a "risk" of opening the market. Besides, a lot of people said the same thing about the airline industry - it's hugely expensive to get into, and the players there were established over decades of nationalised functioning (in Europe, at least). In not too long-a time, however, a few small companies absolutely bust the industry open - Ryanair, Easyjet etc. Now, you won't find many people who find flying on them akin to the romantic 50's of transcontinental jet travel! But their desire to please their shareholders has lead them to offering a product that simply didn't exist before - a no frills flight which was cheap. And their numbers of customers and their profits suggest that pleasing ones customers and pleasing ones shareholders are not mutually exclusive. Do you want "no frills" healthcare? Probably not. But this article has shown how much fat there is to be trimmed in the cost of healthcare. There's plenty of space for a hospital to attract customers with lower prices without having to compromise on quality - if only they had an effective way of competing.

Edit: Incidentally, what you describe - private companies providing XRays etc - is exactly the sort of system I'd suggest, and one that we desperately need more of in the UK. But I don't see why that can't be extended to hospitals, too, especially if they are smaller and/or have a specialism. I support a healthcare system that's free at the point of use and nationally funded.

 

[kmag]

Alas, they aren't here. A few reforms have been done recently (in the last 10 or so years) to try and instigate it, but generally speaking you go where you're told.



Well a) that's the case with all the other businesses too, and states are free to legislate specific demands on activities within their state if they want and b) the problem with limiting companies to a single state is that the smaller the areas in which companies can compete, the less competition there will be. This is especially true when insurance companies have agreements with certain hospitals that give them a degree of exclusivity.

You're able to go where you want upon being referred to a consultant.

http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Pages/Yourrightstochoice.aspx

It's a relatively recent development but it does work. You simply tell the GP your choice when he refers you.

 

[Azih]

I don't really understand what you're arguing in favour of. I assume it's not high prices, so what?

I'm highlighting issues that result from lax legislation and regulation and pointing out an issue with allowing insurance to be sold across state lines. As Gaime pointed out, allowing credit card companies to operate across state lines resulted in all credit companies 'headquartered' in jurisdictions with anti-consumer, pro credit-card corp legal environments.

Simply, I don't think allowing health insurance to be sold across state lines is a good idea, UNLESS there are strict federal regulations in place that protect consumers. I don't think that's the major issue with American healthcare though.

Well I'm not talking about changing the system for the better over night. Any reform to healthcare has to be done with a long term view. You can't pull a neurosurgeon out of a hat, but that's not a good reason not to do something that will otherwise be beneficial. If you don't think it will, that's fine, but people train in response to market trends - you can't wait for the training before enacting the change that incentivises people to do said training.

I'm merely defending my point that the supply of healthcare is very inelastic because it takes a hell of a lot of time and expense to get more healthcare professionals. Note that I didn't say 'completely inelastic'. The market conditions of every commodity is distinct from each other and you have to treat them separately. The supply/demand dynamic of healthcare makes for an incredibly distorted market, sick people are desperate for care on the demand side (it's literally a matter of life and death in many cases), and you can't just turn on a tap to make more doctors (supply takes a long time ramp up and, also, you *want* qualification requirements for healthcare professionals to be high meaning not everyone no matter how incentivised will get through the process).

There's always a risk of that, but the US has that now already - it's not really a "risk" of opening the market.

Sure but it does speak against the idea that more competition is some sort of necessary result of what you're proposing.

In not too long-a time, however, a few small companies absolutely bust the industry open - Ryanair, Easyjet etc.

Well no frills airlines are a new market, do you think a bunch of small companies will still be around as the market matures? There were dozens and dozens of car manufacturers in the States before they all eventuallly mooshed into Ford, GM, and Chrysler. Same for telecoms.

And their numbers of customers and their profits suggest that pleasing ones customers and pleasing ones shareholders are not mutually exclusive.

Never said they were mutually exclusive. I do make the point that there is no mutual interest between shareholders and consumers. The two groups have incentives and interests that are diametrically opposed.

Do you want "no frills" healthcare? Probably not. But this article has shown how much fat there is to be trimmed in the cost of healthcare. There's plenty of space for a hospital to attract customers with lower prices without having to compromise on quality - if only they had an effective way of competing.

Here's the odd thing about this conversation Cyclops. The article shows how horrible and wasteful the American system is. We agree on that. But you are proposing solutions that don't take into account everything that makes the other systems more efficient.

The low administrative overhead of single payer, the purchasing power of a single buyer, these I submit would make far more of a difference to the cost of American health care then what you seem to be proposing.

I support a healthcare system that's free at the point of use and nationally funded.

That's fair enough. We're not that far apart (I think this being an American healthcare thread is confusing the issue though). I will say though that I just don't see how private hospitals will make any difference in a nationally funded, single payer system where the government is deciding what treatments to fund and how much it will pay for them.

I do agree with you that British patients should be able to go to any hospital or general practitioner they wish like in Canada. I'm not sure why your NHS doesn't allow that. That brings the element of competition that you're getting at without the need for private hospitals.

Edit: Ah you guys do have more say now as kmag points out and it sounds similar to what we have here. That's a good development for British healthcare I think.

 

[LegendofJoe]

Until someone figures out some better marketing and buzzwords that can catch the masses... no.

Here's one: 8 cents of every dollar you make is being stolen from you by the healthcare industry.

 

[Angry Fork]

Surely at some point the american public at large has to realise just how badly they are being fucked, right?

I wish at some point liberals would learn to stop accepting half measures, maybe we wouldn't have to deal with Obamacare being the 'solution' for the next 30 years.

 

[CSX]

I remember asking one of my cousins who is a nurse why hosptial bills tend to be so large.

Her answer was that your bill not only covers you but also the empty rooms next to you.

Didn't really understand that answer till I took a PS class where a lecture covered this. The professor gave the same answer but expands it with other reasons such as having a too huge infrastructure of hospitals which leads to many unused equipment/rooms. The cost to maintain this all goes towards the patients.

So I guess all this ridiculous pricing is their way of getting that money or the health industry is full of greedy crooks :\

 

[LegendofJoe]

PPACA should not be the best we can do for 30 years. Id be interested in forming a gaf protest group if that's something people are interested in.

 

[jmdajr]

I work in radiology. Even being exposed to this one slice of the medical world, I can tell you they ARE making up shit.

Here in California, insurance companies pay anywhere from roughly $400 to $550 for an MRI without contrast. Add another $100 or so for "with contrast." The type type of MRI is actually the first two done one after the other, "without and then with contrast." But it's considered a third type because MRI providers provide this option as a cheap package to get people to order it. It has its own CPT code. The price of this is about another $100 on top of the MRI with contrast.

So in CA expect insurance companies to pay like 500/600/700 (price of without/with/without and then with contrast) on average.

Over in Oregon, insurance companies are paying something like 800/900/1000 on average.

Why the discrepancy? MRI machines cost more in Oregon? MRI techs, radiologists, and other medical staff paid way more in Oregon? Medical companies taxed way more?

No. It's supply and demand.

On top of that, search the internet for stories about people getting charged thousands of dollars for an MRI. Even on NeoGAF I remember someone saying something like they were charged $8000 for one. At a bar here in LA a guy I met told me he was charged $5k for a CT scan. (CT scans are actually CHEAPER than MRI scans. Here in CA on average the insurance companies are paying like, 275/325/375 or so for a CT scan for without/with/without and then with contrast). My barber told me an MRI costs $15000, based on the fact that he was charged that much for one. I didn't have the heart to inform him of what insurance companies are paying.

You will also notice that the high prices people are paying are not consistent. My barber was charged $15k while other people are charged $8k or sometimes $1k. When charging the patient, the medical providers make that number up based on their individual thinking. When charging insurance companies, they have to deal with a market value, because insurance companies have the luxury of having some leverage in negotiating. Insurance companies negotiate rates from the comfort of their desk, before they send any patients over to the medical providers. Patients standing at the receptionist counter of an MRI provider are not in the same position.

If that was too long to read, just read this: Medical providers charge you thousands of dollars for radiology scans that insurance companies pay hundreds of dollars for.

If you want some proof that MRIs and CTs don't cost as much as people are getting charged, go to look up Medicare rates. It shows you how much the government pays for an MRI, a CT, or any other operation covered in Medicare. I just happen to work in radiology and can tell you that insurance companies pay a couple hundred more for an MRI than what the government pays. Individual people often pay thousands more.


The prices will not go down if the industry remains for-profit. That's why the only type of UHC that will work is the single payor. UHC in the form of making everyone buy insurance from for-profit companies (like the ACA does) will do nothing to lower costs.

Checked my Bill from my recent CT scans and my insurance company only paid like less than 500 bucks or so (actually 75 bucks!). Me? I paid nothing.Who knows what it would be without insurance.